Relationships of Chronotype and Daily Intake of Magnesium, Sodium
and Potassium with Nutritional Status among Adolescents in
Kerinci Regency
M. Berri Ridhoka
1
, Dono Indarto
1,2
and Muthmainah
1,3
1
Postgraduate Program of Nutrition Sciences, Universitas Sebelas Maret, Surakarta, Indonesia
2
Department of Physiology and Biomedical Laboratory, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
3
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.
1
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
Copyright
c
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.
2
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.
3
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
̅
SD
Gende
r
- -
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
g
(
score >50
)
90 62.9
Evening (score ≤50) 53 37.1
Magnesium intake habit
- -
Inade
q
uate
(
M <250 m
g
/ FM <220 m
g)
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
g)
38 26.6
Potassium intake habit
- -
Inadequate (<4700 mg) 122 85.3
Ade
q
uate
(
≥4700 m
g)
21 14.7
Dichotom
y
nutritional status
- -
Normal 82 57.3
Malnutrition
(
under and overwei
g
ht
)
61 42.7
Table 2: Bivariate; Relationships of Chronotype and Daily Intake of Magnesium, Sodium and Potassium with Nutritional
Status.
Independent Variable
Nutritional Status
OR
CI 95%
P value
Normal Malnutrition
(
Over/Under Wei
g
ht
)
Lower Upper
Dichotomy Chronotype
2.4 1.238 4.978 0.016
Morning (score >50) 59 31
Evening (score ≤50) 23 30
Ma
g
nesium intake habit
2.6 1.310 5.317 0.01
Ade
q
uate
(
M <250 m
g
/ FM < 220 m
g)
60 31
Inadequate (M ≥250mg/ FM ≥ 220
m
g)
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
r
Uppe
r
Chronot
yp
e 0.019 2.404 1.154 5.009
0.134
Ma
g
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).
4
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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Relationships of Chronotype and Daily Intake of Magnesium, Sodium and Potassium with Nutritional Status among Adolescents in Kerinci
Regency
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