An inexpensive tropical fruit could help solve one of the world’s most common nutritional deficiencies, with researchers finding that guava juice can significantly improve hemoglobin levels in women and girls.
Study: Effect of guava juice intake on hemoglobin levels in Indonesian women: a systematic review and meta-analysis. Image credit: New Africa/Shutterstock.com
Indonesian systematic reviews published in journals BMJ nutrition, prevention and healthhave shown that adding guava juice to the diet can increase hemoglobin levels in adolescent girls and pregnant women. Given the high prevalence of iron deficiency anemia in women, especially in low- and middle-income countries (LMICs), this may provide a low-cost dietary therapy to supplement iron supplementation.
Iron deficiency anemia in young women
In 2021, it is estimated that approximately 45% of pregnant women and 39.5% of non-pregnant women worldwide will be affected by anemia. Similar numbers were found in Indonesia: 48.9% for pregnant women and 32% for adolescent girls. Women with severe anemia are twice as likely to die during pregnancy and postpartum than those with mild anemia.
Iron deficiency is a major cause of anemia, especially in LMICs. Reasons for this include inadequate dietary intake, high rates of infectious diseases, heavy bleeding during menstruation, frequent pregnancies, and poor access to healthcare.
Iron deficiency anemia has traditionally been treated with iron supplements, but oral iron can cause symptoms such as diarrhea, constipation, other intestinal symptoms, and an unpleasant taste, and some women may not be able to take iron supplements. Treatment can be further complicated during pregnancy because physiological changes can reduce iron absorption.
Therefore, even in national nutrition programs such as Gerakan Nasional Aksi Belgizi and iron supplementation programs targeted at pregnant women and adolescent girls, the use of iron supplements remains low.
Nutritional benefits of guava
Guava is an inexpensive fruit grown locally. Its juice is rich in vitamin C, folic acid, antioxidants, flavonoids, polyphenols, and other micronutrients. The current study aimed to investigate the potential of guava juice as a natural adjunct to iron therapy.
Guava juice and iron supplements
This systematic review and meta-analysis included 17 Indonesian studies published between 2019 and 2024, with a total of 726 participants. Most studies were quasi-experimental, but two were randomized controlled trials (RCTs). Participants were pregnant women or adolescent girls, and their numbers ranged from 15 to 230.
Although this finding was encouraging, most of the evidence came from relatively small quasi-experimental studies rather than randomized trials.
Most studies evaluated guava juice in parallel with iron supplementation, but a few studies used guava juice alone or in combination with carrot or red spinach juice. Intervention duration ranged from 5 days to 3 months.
Eight studies compared guava juice with iron supplementation and iron supplementation alone, but only five of these provided extractable data for a direct comparison meta-analysis. One study used papaya juice and another dragon fruit juice as a comparison. The remaining seven studies did not have a control group.
The meta-analysis was limited to 12 studies because no other studies had available data. The results were promising, consistently showing a significant increase in hemoglobin by an average of 1.7 g/dL among the group participants who consumed guava juice.
When stratified by participant type, the average improvement in hemoglobin levels for adolescents was 1.5 g/dL compared to 1.8 g/dL for pregnant women.
Across five studies that directly compared guava juice interventions to iron-only controls, hemoglobin levels in the guava juice group increased by an additional 1.3 g/dL on average. This was confirmed to be robust by sensitivity analysis, with little evidence of publication bias.
Possible physiological pathways
The degree of hemoglobin improvement observed by the researchers is large enough to potentially move some people with mild or moderate anemia into the non-anemic category. Other experimental studies in male athletes, anemic schoolchildren, and postpartum women have shown similar positive effects from both guava juice and guava fruit consumption.
This suggests that the rich content of vitamin C and polyphenols in guava has beneficial effects, regardless of the form of consumption. Vitamin C improves the absorption of iron from non-heme sources, such as iron supplements, by converting ferric iron to the more easily absorbed ferrous form.
Guava also contains folate, antioxidants, flavonoids, and polyphenols that support red blood cell survival by reducing oxidative stress. Researchers suggest that juice preparation may improve compliance and increase nutrient availability while promoting more consistent intake.
Research limitations
Despite the promising results, this review also points out limitations. All studies were conducted in Indonesia, limiting generalizability to other populations. Many studies had a moderate risk of bias, had relatively small sample sizes, and most had nonrandomized designs. Missing data also reduced the size of the meta-analysis. Studies showed high heterogeneity due to differences in guava dosage, preparation method, and duration.
Future follow-up studies should include large, well-designed RCTs across multiple countries with standardized reporting including regimen and results. These should include not only hemoglobin, but also parameters such as transferrin and ferritin, which reflect broader health effects and long-term effectiveness. This will help determine the optimal dosage, frequency of administration, and duration of use.
Implementation research is also needed to understand the extent to which such interventions can be integrated into existing programs and to support their real-world relevance.
conclusion
Overall, this study concludes that guava juice significantly improves hemoglobin levels in women and adolescent girls. The authors highlight the potential of guava juice as an affordable, culturally acceptable, and locally available dietary supplement for iron supplementation and anemia prevention programs in resource-limited settings.
This is particularly relevant for tropical countries with high guava production, such as India and Indonesia. The authors suggest incorporating guava juice into school nutrition programs, prenatal care packages, and community health initiatives.
This could be a sustainable and complementary strategy to prevent and treat mild to moderate anemia, in line with the United Nations Decade of Action on Nutrition (2016-2025) and a diet that emphasizes local foods.
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