Anemia and Cognitive Performance in University Students: The Role of Moderating Factors beyond Hemoglobin

Anemia persists as a significant public health challenge among university students, particularly females, with prevalence rates in Indonesia ranging from 21.7% to 39.9%. While theoretical models posit that reduced hemoglobin levels should impair attention, memory, and executive function due to cerebral hypoxia and neurotransmitter dysregulation, empirical data reveal an “Anemia Paradox” where affected students often maintain average or superior academic performance. This literature review synthesizes findings from over 20 national and international journals published between 2015 and 2025 to investigate this discrepancy and deconstruct the complex, often contentious relationship between hemoglobin concentration and cognitive output in high-functioning young adults. The review indicates that the correlation between anemia and cognitive performance is non-linear and heavily obscured by moderating variables. Specifically, biological resilience mechanisms such as cerebral autoregulation and the presence of Cognitive Reserve (CR) effectively compensate for physiological deficits, masking immediate cognitive decline. Furthermore, external confounders like academic stress and sleep quality frequently exert a more significant impact on cognition than mild physiological variances. Consequently, the report concludes that intervention strategies must shift from simple iron supplementation to holistic lifestyle and stress management, acknowledging that biological and motivational compensation often buffer the immediate impact of anemia on academic achievement.