Protein and Folic Acid Intake as Associated Factors of Serum Albumin Levels in Pregnant Women with Chronic Energy Deficiency
Abstract
Background: Chronic Energy Deficiency (CED) remains a major nutritional problem among pregnant women. Inadequate intake of protein and micronutrients can impair maternal metabolic adaptation during pregnancy, including the maintenance of serum albumin levels. However, evidence regarding the association of protein and folic acid intake with serum albumin levels among pregnant women with CED remains limited. Objective: This study aimed to evaluate the association between dietary intake and serum albumin levels in pregnant women with CED. Methods: A cross-sectional study was conducted at Parung Panjang Primary Health Center, Bogor Regency, West Java, Indonesia, from March to June 2026. A total of 38 pregnant women aged 20–35 years with CED, defined by mid-upper arm circumference (MUAC) <23.5 cm, were recruited using purposive sampling. Dietary intake was assessed using two non-consecutive 24-hour dietary recalls and analyzed based on the Indonesian Food Composition Table. Serum albumin levels were measured using the Bromocresol Green colorimetric method. Data were analyzed using descriptive statistics Spearman's rank correlation, with statistical significance set at p<0.05. Results: The mean serum albumin level was 3.68 ± 0.21 g/dL. Mean protein and folic acid intakes were 52.39 ± 13.70 g/day and 478.42 ± 227.43 mcg/day, respectively. Protein intake was significantly positively correlated with serum albumin levels (r=0.382; p=0.018). Folic acid intake also showed a significant positive correlation with serum albumin levels (r = 0.378; p = 0.019). Energy, fat, carbohydrate, vitamin A, vitamin C, iron, and zinc intakes were not significantly associated with serum albumin levels. Conclusion: Protein and folic acid intake were significantly associated with serum albumin levels among pregnant women with CED. As a potential clinical implication, supplementary feeding should prioritize these nutrients over mere caloric adequacy. Future large-scale trials must evaluate their impact on perinatal outcomes.