Relationships of Chronotype and Daily Intake of Magnesium, Sodium

and Potassium with Nutritional Status among Adolescents in

Kerinci Regency

M. Berri Ridhoka

, Dono Indarto

1,2

and Muthmainah

1,3

Postgraduate Program of Nutrition Sciences, Universitas Sebelas Maret, Surakarta, Indonesia

Department of Physiology and Biomedical Laboratory, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia

Department of Histology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia

Keywords: Chronotype, Magnesium, Sodium, Potassium, Adolescent.

Abstract: Circadian rhythm and daily intake of micronutrients have different correlations with nutritional status. This

study investigated the relationships of chronotype and daily intake of magnesium, sodium and potassium with

nutritional status among adolescents. One hundred and forty-three students at several senior high schools in

Kerinci Regency, Jambi Province were participated in this cross-sectional study. Data of chronotype and

micronutrient intake were collected using questionnaires and analyzed using the multiple logistic regression

test. More than half of adolescents have morning chronotype and 85.3% of adolescents have low potassium

intake. However, malnutrition (underweight and overweight) was found in 42.7% of adolescents. Chronotype

and Mg intake were significantly related to nutritional status (OR= 2.4 p= 0.019 and OR= 2.5 p= 0.018) but

sodium and potassium intake were not related to nutritional status. Night chronotype significantly increased

2.4 times risk of poor nutritional status (p= 0.019) but inadequate magnesium intake increased 2.5 times risk

of poor nutritional status (p= 0.018). In conclusion, chronotype and magnesium intake have relationships but

no relationship with nutritional status for sodium and potassium intake among adolescents in Kerinci regency,

Jambi province.

INTRODUCTION

The nutritional status problem in Indonesia is a

double burden of malnutrition. A double burden of

malnutrition means overweight and underweight

happen altogether within the country area. It does not

just happen in developed countries but also in

developing countries such as Indonesia (Lembong et

al., 2018

; Kumala and Bardosono, 2014). Nutritional

status can be affected by interaction between nutrition

intake, daily body needs, and environment.

Indonesia's adolescent malnutrition prevalence in

2018 for 16-18 years old is 13.5% for overweight and

8.1% for underweight (Harjatmo et al., 2017;

Kementerian Kesehatan Republik Indonesia, 2018a).

In Kerinci Regency, the prevalence of overweight in

2018 for 13-15 years old adolescent is 15.3% and

underweight is 5.5% (Kementerian Kesehatan

Republik Indonesia, 2018b).

Chronotype is a manifestation of the circadian

rhythm. In adolescents, there is a biological

mechanism that affects the circadian rhythm. When

they hit puberty, there exists a shift toward

eveningness and back to morningness at the end of

the adolescent period (Diaz-Morales & Escribano,

2014).

Evening chronotype can affect bad intake habits.

According to a study by Toktas et al., 2018, the

individual intake of food of an evening chronotype

person is higher in calories, fat, and carbohydrate than

a morning chronotype. The evening chronotype

prefers fast food (mean calory 727 kcal, fat 29.63 g,

and carbohydrate 103.58 g) to the morning

chronotype. This kind of intake habit can affect body

weight.

Nutritional status is usually connected with

macronutrients such as calories, fat, protein, or

carbohydrate. However, less consider the effect of

micronutrients on nutritional status. Micronutrient is

defined as minerals and or vitamins, which are needed

only small amount (< 100 mg/day). Micronutrient

such as magnesium, sodium, and potassium also have

a relation to body weight (Tal et al., 2019; Thaha,

Ridhoka, M., Indarto, D. and Muthmainah, .

Relationships of Chronotype and Daily Intake of Magnesium, Sodium and Potassium with Nutritional Status among Adolescents in Kerinci Regency.

DOI: 10.5220/0011663000003608

In Proceedings of the 4th International Conference on Social Determinants of Health (ICSDH 2022), pages 127-131

ISBN: 978-989-758-621-7; ISSN: 2975-8297

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

127

2010). Inside mitochondria, magnesium and

adenosine triphosphate (ATP) make the Mg-ATP

complex that produces energy for the metabolic

system. Therefore, low magnesium intake can also

cause bodyweight increase (Grimes et al., 2016).

A high sodium plasma concentration forces the

body to defend homeostasis by stimulating the

hypothalamus. This stimulation, therefore, might

cause thirst where the body will gain extracellular

water volume from drinking water, leading to a

bodyweight increase. Besides that, sodium can

increase lipogenic enzymatic activity and the capacity

to incorporate glucose into lipids, increasing fat mass

and adipose size (Elfassy et al., 2018; Larsen et al.,

2013; Song et al., 2013).

According to Tal et al., 2019, potassium has a

relation to decreasing BMI. However, the real

mechanism is still unknown. He estimates potassium

plays a role in producing energy by increasing Mg,

Iron, and calcium metabolism.

MATERIALS AND METHOD

This research was an analytical observational study

with a cross-sectional design and was conducted

from November to December 2021. The population

of this study was adolescents, who studied in the

senior high schools in Kerinci Regency, Jambi

Province (5039 adolescents). the sample size was

calculated using the estimated proportion formula and

got a minimum of 105 subjects (Masturoh & Anggita,

2018), subjects were determined using cluster

random sampling from senior high school and got 7

schools out of 14 schools in Kerinci. The selection of

the research subjects used inclusion criteria: aged ≤18

years old and studied in X-XII grades while the

exclusion criteria were smoking, drinking alcohol,

drinking coffee more than 1 glass/day, and having a

stress score (≥20). The author got 143 research

subjects after inclusion and exclusion criteria

selection. The protocol of this study has been

approved by the Research Ethics Committee, Faculty

of Medicine of Universitas Sebelas Maret Surakarta

with protocol ID 01/02/10/108.

Data on basic characteristics among selected

adolescents were collected using an open questionary

and Morningness Eveningness Questionnaire Self-

Assessment (MEQ-SA) (Yula, 2021) was used to

collect the chronotype data. The chronotype data

were classified as morning and evening chronotypes.

Daily intake of magnesium, sodium, and potassium

was taken using the Semi-Quantitative Food

Frequency Questionnaire (SQ-FFQ) (the standard

form of SQ-FFQ), which was then classified as

inadequate (magnesium:

male <250 mg/ female <220 mg

and potassium: <4700 mg

) and adequate (magnesium:

male ≥250 mg/ female ≥ 220 mg and potassium: ≥4700 mg)

while sodium intake was adequate (

≤1500 mg) and

excessive (

>1500 mg). The Perceived Stress Scale

(PSS-10) (Indira, 2016) was used to determine stress

scores among selected adolescents with a score above

19 excluded from this study.

Anthropometry data, such as height and body

weight, were measured using a microtoice and a body

weight scale respectively. The age was measured

using an open questionnaire. Body mass index (BMI)

for age is classified as severely thinnes (<-3SD),

thinnes (-3SD till <-2SD), normal (-2SD till +1SD),

overweight (+1SD till +2SD) and obese (>+2SD)

(Kementerian Kesehatan Republik Indonesia, 2020),

but the result in this research classified as

malnutrition (underweight and obese) and normal

nutrition status for statistic need. Before the research

begins, the subject will be asked to fill out informed

consent as approval to be included in the research.

All collected data with 143 research subjects were

analyzed using the IBM Statistic 24. Categorical and

numerical data were presented as frequency,

percentage, mean and ± standard deviation

respectively. The chi square test was used to figure

out the relationship between independent and

dependent variables. The significant relationships of

individual variables were then further analyzed using

the Multiple Logistic Regression test whether or not

all variable influenced nutritional status. Data of all

statistic test were considered a significant value with

p-value <0.05.

RESULTS AND DISCUSSION

3.1 Results

3.1.1 Characteristics of Subject

Table 1 shows the characteristic of the subjects. The

result showed that the majority of the subject is

female with 83 subjects (58%), the majority of

students are in age 16 with 72 subjects (50,3%), the

majority of the subject are morning type (90

subjects/62,9%), the majority of the subjects are

adequate magnesium (91 subjects/63,6%), the

majority of the subjects are also adequate sodium

(105 subjects/73,4%), the majority of the subjects are

inadequate potassium (122 subjects/85,3%), and

more than half of them are normal in nutritional status

(82 subjects/57,3%).

ICSDH 2022 - The International Conference on Social Determinants of Health

128

Table 1: Characteristics of Subject.

Variable N % X

Gende

- -

Male 60 42.0

Female 83 58.0

Age (years old)

16.06 0.882

14 5 3.5

15 27 18.9

16 72 50.3

17 31 21.7

18 8 5.6

Dichotomy Chronotype

- -

Mornin

(

score >50

)

90 62.9

Evening (score ≤50) 53 37.1

Magnesium intake habit

- -

Inade

uate

(

M <250 m

/ FM <220 m

52 36.4

Adequate (M ≥250 mg/ FM ≥ 220 mg) 91 63.6

Sodium intake habit

- -

Adequate (≤1500 mg) 105 73.4

excessive

(

>1500 m

38 26.6

Potassium intake habit

- -

Inadequate (<4700 mg) 122 85.3

Ade

uate

(

≥4700 m

21 14.7

Dichotom

nutritional status

- -

Normal 82 57.3

Malnutrition

(

under and overwei

)

61 42.7

Table 2: Bivariate; Relationships of Chronotype and Daily Intake of Magnesium, Sodium and Potassium with Nutritional

Status.

Independent Variable

Nutritional Status

CI 95%

P value

Normal Malnutrition

(

Over/Under Wei

)

Lower Upper

Dichotomy Chronotype

2.4 1.238 4.978 0.016

Morning (score >50) 59 31

Evening (score ≤50) 23 30

nesium intake habit

2.6 1.310 5.317 0.01

Ade

uate

(

M <250 m

/ FM < 220 m

60 31

Inadequate (M ≥250mg/ FM ≥ 220

22 30

Sodium intake habit

0.97 0.458 2.055 1

Adequate (≤1500 mg) 60 45

excessive (>1500 mg) 22 16

Potassium intake habit

2.7 0.936 7.880 0.09

Adequate (≥4700 mg) 16 5

Inadequate (<4700 mg) 66 56

Table 3: Multivariate; Relationships of Chronotype and Daily Intake of Magnesium, Sodium and Potassium with Nutritional

Status.

Parameter p-value OR

CI 95%

Nagelkerke R

Square

Lowe

Uppe

Chronot

e 0.019 2.404 1.154 5.009

0.134

nesium intake habit 0.018 2.506 1.170 5.367

Sodium intake habit 0.757 1.141 0.494 2.634

Potassium intake habit 0.418 1.615 0.501 5.269

Relationships of Chronotype and Daily Intake of Magnesium, Sodium and Potassium with Nutritional Status among Adolescents in Kerinci

Regency

129

3.1.2 The Analysis of Chronotype, Daily

Intake of Magnesium, Sodium and

Potassium with Nutritional Status

Based on table 2 chronotype, magnesium intake habit

and potassium have a relation to nutritional status

(p<0,05), but sodium has no relation to nutritional

status. Evening chronotype significantly increased

2.4 times the risk of malnutrition, inadequate

magnesium significantly increased 2.6 times the risk

of malnutrition and inadequate potassium increased

2.7 times the risk of malnutrition while excessive

sodium has no risk of malnutrition (OR 0.97).

Based on table 3, only chronotype and magnesium

intake habits have a relation to nutritional status

(p<0,05), but sodium and potassium intake have no

relation to nutritional status. Evening chronotype

significantly increased 2.4 times the risk of

malnutrition and inadequate magnesium significantly

increased 2.6 times the risk of malnutrition while

excessive sodium (OR 1,14) and inadequate

potassium (OR 1,61) have no risk of malnutrition.

These independent variables together have 13,4% in

total effect on nutritional status. another 86,6% come

from outside of these independent variables.

3.2 Discussion

Chronotype has relation with nutritional status with p

value 0.019 (p<0.05), Evening chronotype

significantly increased 2.4 times the risk of

malnutrition. This research is linear with the research

conducted by Rafkhani et al., (2021) stated that there

is an indirect relation chronotype to nutritional status

with a p-value of 0.037 with mediator dietary habit.

Evening chronotype has unhealthy intake behavior

compared to morning chronotype, their eating time

and lifestyle change, they prefer to eat high

macronutrient like energy after eight pm (Toktas et al,

2018). According to research from Agagunduz et al

(2020), Resting Energy Expenditure (REE) in

adolescents with obesity changed based on gender

and chronotype. Night chronotype change REE that

caused the risk of obesity in adolescents. This may

happen based on the changing circulation level of

some nutrition such as glucose, fatty acid, and

triglyceride, alongside some hormones such as

insulin, glucocorticoid, and adipokines.

Magnesium has relation with nutritional status

with p value 0,018 (p<0,05), Inadequate magnesium

increased 2,5 times risk of malnutrition. This research

is in line with the research conducted by Patimah et

al., (2021), which stated that magnesium intake in

female students has a relation to nutritional status

with a p-value of 0,001. Magnesium plays a role in

insulin and epinephrine secretion. Insulin can

transport glucose into cells. Inside mitochondria,

magnesium, and adenosine triphosphate (ATP) make

the Mg-ATP complex that produces energy for the

metabolic system. Therefore, low magnesium intake

can also cause body weight increase (Shamnani et al.,

2018; Grimes et al., 2016).

Sodium has no relation to nutritional status with a

p-value of 0.757 (p>0.05). This research is in line

with the research conducted by Sari et al., (2017),

which stated that there is no relation between sodium

with nutritional status with a p-value of 0.678.

Although, theoretically, excessive sodium makes a

high concentration of plasma sodium leads to body

homeostasis unstable. The human body needs to

maintain its homeostasis, which might lead to thirst

stimulation. Therefore, sodium increases

extracellular water volume, leading to body weight

gain (Lee et al., 2018; Elfassy et al., 2018).

Potassium has no relation with nutritional status

with a p-value of 0,418 (p>0,05). This research is in

line with the research conducted by Maigoda et al.,

(2020), which stated that there is no relation to

potassium intake with SGA (Subjective Global

Assessment), SGA is used to estimate malnutrition in

hemodialysis patients. Theoretically, high potassium

can decrease BMI levels. Although it is still unclear

how potassium has a relation to nutritional status, it is

estimated this relation is how potassium can reduce

inflammation and increase insulin sensitivity.

Potassium can also modulate energy balance through

the deposition/ mobilization of fat or energy balance

(Tal et al., 2019).

CONCLUSION

Chronotype and magnesium intake have relationships

with nutritional status but sodium and potassium have

no relationship with nutritional status among

adolescents in Kerinci regency, Jambi province.

ACKNOWLEDGMENT

The authors would like to thank the schools,

students and parents for their willingness to be

involved in this research

ICSDH 2022 - The International Conference on Social Determinants of Health

130

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