¹Master in Clinical Biochemistry, Master in Clinical Biology, PhD Candidate in Clinical Biology School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon;

²University Professor, Director of Doctoral Studies, Professor at the Catholic University and Vice-Dean of Academic Research at the Faculty of Medicine and Pharmacy, University of Douala;

³PhD in Biochemistry and Food Biotechnology from the University of Dschang;

⁴PhD candidate in Food Science and Nutrition at the Faculty of Science, University of Douala

Corresponding Author: NGNOTUE MBOBDA Claude Alain, E-mail: claudembobda10@gmail.com.

	ABSTRACT
	INTRODUCTION
	METHODS
	RESULTS
	DISCUSSION
	CONCLUSION
	RECOMMENDATIONS
	REFERENCES

	ABSTRACT

Background: Aging leads to alterations in electrolyte regulation mechanisms, increasing the risk of imbalances such as hyponatremia, hypochloremia, hypokalemia, and hypomagnesemia. These disturbances can cause severe complications, including renal dysfunction and increased morbidity. Objective: This study aims to analyze the prevalence of sodium, chloride, potassium, and magnesium imbalances based on age, gender, and geographic location in Western Cameroon. Methods: A cross-sectional study was conducted among 768 participants aged 50 years and above. Blood samples were analyzed to measure levels of sodium, chloride, potassium, and magnesium, classified into three categories: hypo-, normal, and hyper-. Results: The study revealed a high prevalence of electrolyte imbalances, especially among women and individuals over 60 years old, particularly in rural areas such as Baham and Bandjoun. Geographic differences, dietary habits, and age-related comorbidities appear to significantly influence these imbalances. Conclusion: Monitoring electrolytes in older adults is essential to prevent complications associated with aging.

	INTRODUCTION

   Aging is accompanied by profound physiological changes that significantly affect the regulation of essential electrolytes, including sodium, chloride, potassium, and magnesium. These ions play a pivotal role in maintaining vital physiological functions, such as water balance, nerve signal transmission, muscle contraction, and cardiac activity. Among older adults, electrolyte imbalances such as hyponatremia, hypochloremia, hypokalemia, and hypermagnesemia are commonly observed. These disturbances are often aggravated by the presence of comorbid conditions, including chronic kidney disease, hypertension, and nutritional deficiencies.

   In Western Cameroon, specific geographic characteristics, local dietary patterns, and cultural practices further contribute to the prevalence and severity of these imbalances. This study seeks to assess the impact of aging on sodium, chloride, potassium, and magnesium imbalances in five representative localities. The analysis integrates demographic factors such as age and gender, alongside environmental determinants, to provide a comprehensive understanding of the underlying mechanisms and contributing factors in this population.

	METHODS

   Study Population

   The study was conducted in five localities in Western Cameroon: Bafang, Bafoussam, Baham, Bandjoun, and Dschang. Participants were aged 50 years and older, stratified into the following age groups:

       50–59 years

       60–69 years

       70–79 years

       ≥80 years

   The study included a total of 768 participants, comprising 451 women and 317 men.

   Data Collection

   Blood samples were collected from participants to measure serum levels of key electrolytes, including sodium, chloride, potassium, and magnesium. Blood samples were drawn into lithium-heparin tubes to ensure accurate plasma analysis. Strict adherence to the manufacturer’s guidelines for reagent use was ensured, including compliance with specific temperature and pressure conditions, to preserve sample integrity and guarantee reliable measurements.

   The measured electrolyte levels were classified into the following categories:

   Sodium and Chloride:

      Hyponatremia/Hypochloremia: Levels below normal ranges.

      Normonatremia/Normochloremia: Levels within normal ranges.

      Hypernatremia/Hyperchloremia: Levels above normal ranges.

   Potassium and Magnesium:

      Hypokalemia/Hypomagnesemia: Levels below normal ranges.

      Normokalemia/Normomagnesemia: Levels within normal ranges.

      Hyperkalemia/Hypermagnesemia: Levels above normal ranges.

   Data Analysis

   Data analysis was conducted using SPSS and XLSTAT software. The following analytical approaches were employed:

   1. Pearson Correlation Tests:

   Associations between electrolyte levels, age, gender, and localities were assessed using Pearson correlation coefficients. À significance threshold of p < 0.05 was applied.

   2. Cross-Tabulation Analysis:

   Dynamic cross-tabulation tables were used to explore associations between categorical variables, such as electrolyte status, age groups, gender, and geographical localities.

   These combined methods ensured a robust and comprehensive analysis of the relationships between the measured parameters and the demographic characteristics of the study population.

	RESULTS

   Population Distribution

   The majority of participants were aged between 50 and 69 years. Women accounted for 58.7% of the population, with a higher representation in older age groups (≥60 years).

   Sodium and Chloride Levels (Table 1)

   Analysis of sodium and chloride levels across localities, age groups, and gender revealed the following patterns:

   Sodium

   Hyponatremia:

      At Bafang, 7.4% of women and 20% of men aged 50–59 years had hyponatremia. In the 60–69 age group, rates were 16.7% for women and 20% for men.

      At Baham, 20.9% of women and 7.7% of men aged 50–59 years exhibited hyponatremia.

   Normonatremia:

      High levels of normonatremia were observed in Bafang (92.6% in women and 76% in men aged 50–59 years) and Bafoussam (80% in women and 93% in men of the same age group).

   Hypernatremia:

      Hypernatremia rates were generally low. For example, at Bafang, no women aged 50–59 years exhibited hypernatremia, while the rate among men was 4%.

   Chloride:

   Hypochloremia:

      At Baham, 4.7% of women and 3.8% of men aged 50–59 years displayed hypochloremia.

   Normochloremia:

      Elevated normochloremia rates were recorded in Dschang, with 75% of women aged 50–59 years exhibiting normal levels, compared to 36% of men.

   Hyperchloremia:

      Hyperchloremia rates varied across localities. At Bandjoun, 68% of women aged 50–59 years exhibited hyperchloremia, compared to 56% of men.

   Overall Observations:

      Hyponatremia and hypochloremia were relatively rare, but higher rates were observed in women aged 50–59 years, particularly in Baham.

      Normonatremia and normochloremia were predominant in most localities, with high rates among women in Bafang and Dschang.

      Hypernatremia and hyperchloremia were less common but more pronounced in localities such as Baham and Bandjoun, with higher rates among men in certain age groups.

      This suggests that although variations in natremia and chloremia exist according to age, sex, and locality, the majority of individuals fall within the normal ranges.

   Potassium and Magnesium Levels (Table 2)

   The rates of hypokalemia and hypomagnesemia were also significant, particularly in rural localities such as Bandjoun and Baham. Among men aged 70 years and older, cases of normokalemia associated with moderate hypomagnesemia were observed, indicating complex imbalances dependent on sex and age.

   Potassium levels are classified into three categories: hypokalemia (low potassium), normokalemia (normal potassium), and hyperkalemia (high potassium).

   Bafang:

   50-59 years old:

      Women: Hypokalemia: 10.3% (3/29), Normal: 44.8% (13/29), Hyperkalemia: 37.9% (11/29).

      Men: Hypokalemia: 7.4% (2/27), Normal: 40.7% (11/27), Hyperkalemia: 44.4% (12/27).

   60-69 years old:

      Women: Hypokalemia: 31.3%, Normal: 43.8%, Hyperkalemia: 18.8%.

      Men: Hypokalemia: 7.1%, Normal: 50%, Hyperkalemia: 32.1%.

   70-79 years old:

      Women: Hypokalemia: 16.7%, Normal: 33.3%, Hyperkalemia: 50%.

      Men: Hypokalemia: 33.3%, Normal: 41.7%, Hyperkalemia: 25%.

   ≥80 years old:

      Women: Hypokalemia: 0%, Normal: 33.3%, Hyperkalemia: 66.7%.

      Men: Hypokalemia: 28.6%, Normal: 57.1%, Hyperkalemia: 14.3%.

   Link with Early Aging (Bafang):

   A higher proportion of hypokalemia and hyperkalemia is observed among older individuals (≥70 years). These electrolyte imbalances are potentially associated with early aging, driven by chronic conditions (hypertension, diabetes) and frequent nutritional deficiencies in rural areas.

   Global Analysis of Magnesium Levels

   Magnesium levels are classified into three categories: hypomagnesemia (low magnesium), normomagnesemia (normal magnesium), and hypermagnesemia (high magnesium).

   Bafoussam:

   50-59 years old:

      Women: Hypomagnesemia: 4.3% (1/23), Normal: 95.7% (22/23), Hypermagnesemia: 8.7% (2/23).

      Men: Hypomagnesemia: 0%, Normal: 78.6%, Hypermagnesemia: 21.4%.

   60-69 years old:

      Women: Hypomagnesemia: 0%, Normal: 92%, Hypermagnesemia: 12%.

      Men: Hypomagnesemia: 5%, Normal: 90%, Hypermagnesemia: 15%.

   70-79 years old:

      Women: Hypomagnesemia: 10%, Normal: 62.5%, Hypermagnesemia: 25%.

      Men: Hypomagnesemia: 5%, Normal: 70%, Hypermagnesemia: 35%.

   ≥80 years old:

      Women: Hypomagnesemia: 0%, Normal: 85.7%, Hypermagnesemia: 14.3%.

      Men: Hypomagnesemia: 0%, Normal: 83.3%, Hypermagnesemia: 16.7%.

   Link with Early Aging (Bafoussam):

   Among older individuals (≥70 years), hypermagnesemia becomes more frequent, which may be related to impaired renal function, a hallmark of aging. Additionally, the reduced prevalence of hypomagnesemia in older individuals might reflect dietary adjustments or medical interventions.

   Electrolyte imbalances increase with age, particularly cases of hypokalemia and hypermagnesemia. These anomalies are potentially linked to early aging, especially through their impact on cardiac, muscular, and renal dysfunctions.

	DISCUSSION

   Electrolytic Imbalances in Elderly Populations of West Cameroon: A Confirmatory Perspective

   Our study highlights the significant prevalence of electrolyte imbalances among the elderly in West Cameroon, with disparities influenced by sex, age, and geographic locality. Women, particularly those residing in rural areas, exhibit heightened vulnerability due to nutritional deficiencies, hormonal shifts, and sociocultural constraints.

   Stability of Natremia and Chloremia Levels

   The observed stability in natremia and chloremia levels among the majority of participants, particularly women aged 50–59 years in Dschang and Bandjoun, reflects a certain resilience in electrolyte homeostasis. This stability is likely attributable to local dietary habits characterized by moderate salt consumption and minimally processed foods, as well as relatively preserved renal function (2).

   However, outliers such as hypernatremia and hyperchloremia, more frequent among men in Baham and Bandjoun and women aged 50–59 years in Dschang, highlight the influence of chronic dehydration, excessive salt consumption, and age-related decline in glomerular filtration rate (GFR). These findings align with Palmer’s (3) research on the impact of renal aging on electrolyte balance.

   Hypothetical Explanations for Normal Electrolyte Levels

   1. Balanced Diets: Local dietary patterns characterized by moderate salt consumption, a primary source of sodium and chloride, appear instrumental in maintaining normal electrolyte levels.

   2. Preserved Renal Function: Despite advancing age, many participants demonstrate functional renal systems capable of efficient electrolyte regulation.

   These findings are consistent with Hannon et al. (2), who observed optimal electrolyte regulation among elderly rural African populations, often attributed to minimally processed diets rich in minerals and a lower prevalence of metabolic disorders compared to urban populations.

   Hypernatremia and Hyperchloremia: Local Variability and Insights

   Although relatively rare, hypernatremia and hyperchloremia exhibit marked variability across localities. In Baham and Bandjoun, these imbalances are more frequent among men, whereas in Dschang, hyperchloremia predominantly affects women aged 50–59 years, with a prevalence of 75%.

   Contributory Factors

   1. Chronic Dehydration: Hypernatremia often reflects dehydration, a common issue among the elderly due to reduced thirst sensation and insufficient fluid intake.

   2. High Salt Consumption: Dietary habits specific to certain localities may contribute to excessive salt intake, exacerbating these imbalances.

   3. Declining Renal Function: Age-related reductions in glomerular filtration rate (GFR) further amplify electrolyte disturbances.

   Palmer (3) emphasized that hypernatremia and hyperchloremia in the elderly are frequently associated with dehydration and chronic illnesses. Similarly, Tapsoba et al. (4) linked high-salt diets to increased electrolyte imbalances in rural Sub-Saharan African populations.

   Age and Gender Influences on Electrolyte Imbalances

   Age Effects. Older age groups (≥60 years) tend to exhibit fewer electrolyte imbalances. This paradox may be attributed to a mortality selection effect, wherein individuals with severe health conditions are underrepresented in the oldest cohorts.

   Gender Differences. Women appear more susceptible to hyponatremia and hypochloremia, likely due to postmenopausal hormonal changes and unmet nutritional needs.

   Potassium Imbalances: Hypokalemia and Hyperkalemia

   The prevalence of both hypokalemia and hyperkalemia increases with age, particularly in individuals aged ≥70 years. Hypokalemia is often linked to nutritional deficiencies and prolonged diuretic use, as noted by Palmer (3). Conversely, hyperkalemia frequently results from impaired renal function, a hallmark of aging.

   Hamer et al. (5) also associated potassium imbalances with heightened cardiovascular risks. Hyperkalemia, notably prevalent in localities such as Bafang, may explain the increased cardiovascular vulnerability observed among the elderly in these regions.

   Magnesium Imbalances: Hypomagnesemia and Hypermagnesemia

   The elevated prevalence of hypermagnesemia among individuals aged ≥70 years aligns with findings by Elin (8), who associated high magnesium levels with chronic kidney disease. Tapsoba et al. (6) further suggested that excessive magnesium absorption from medications could contribute to this imbalance.

   Although less common, hypomagnesemia remains clinically significant due to its association with neuromuscular and cardiovascular disorders (9). Its occurrence among younger cohorts (50–69 years) may be linked to dietary deficiencies specific to rural settings.

   Early Aging and Clinical Implications

   Our study underscores the strong association between chronic electrolyte imbalances and early aging. Nutritional deficiencies, particularly prevalent in rural areas, play a pivotal role in exacerbating these imbalances. For instance, insufficient intake of potassium and magnesium, often due to limited dietary diversity, disrupts cellular metabolism and neuromuscular function key features of accelerated aging.

   In women, postmenopausal hormonal changes exacerbate vulnerability by impairing sodium and water homeostasis, predisposing them to conditions like hyponatremia and hypochloremia.

   Furthermore, chronic conditions such as hypertension and diabetes are key contributors to this process. These diseases impair renal function and vascular integrity, reducing the efficiency of electrolyte regulation (7). Hyperkalemia, particularly prevalent in Bafang, exemplifies this dynamic, being strongly associated with cardiovascular risks (5) and renal dysfunction (10). These imbalances create a vicious cycle where accelerated aging worsens electrolyte disturbances, increasing health risks.

   Study Limitations

   Despite the valuable insights provided by this research, certain limitations should be acknowledged:

   Selection Bias: The study primarily focused on rural populations, which may limit the generalizability of findings to urban or peri-urban settings where dietary habits and access to healthcare differ.

   Measurement Errors: The use of cross-sectional data restricts the ability to establish causal links between electrolyte imbalances and early aging. Additionally, inaccuracies in self-reported medical histories or dietary habits could introduce bias.

   Generalizability: The study’s findings may not fully apply to populations with different sociodemographic profiles or healthcare systems.

	CONCLUSION

   This study underscores the significant prevalence of electrolyte imbalances among the elderly populations in the West Region of Cameroon, revealing substantial disparities shaped by gender, age, and geographic location. Women, particularly those residing in rural areas, are disproportionately affected due to a combination of nutritional deficiencies, hormonal changes, and sociocultural constraints. The observed electrolyte disturbances including chronic dehydration, elevated sodium and chloride levels, as well as imbalances in potassium and magnesium are closely linked to dietary practices, deteriorating renal function, and chronic conditions such as hypertension and diabetes. These imbalances contribute to the acceleration of the aging process, further exacerbating the vulnerability of this population.

	RECOMMENDATIONS

   1. Promotion of Nutritional Improvement: It is imperative to promote a balanced diet and moderate salt intake, particularly in rural areas. Targeted nutritional education programs for elderly populations could significantly reduce the prevalence of electrolyte imbalances while fostering healthier dietary habits.

   2. Strengthening Healthcare Services: In light of the high prevalence of chronic diseases like hypertension and diabetes, it is crucial to improve healthcare infrastructure in rural regions. This would include the establishment of specialized health centers focused on managing age-related conditions and electrolyte imbalances, ensuring that the elderly receive appropriate care.

   3. Enhancement of Medical Monitoring for the Elderly: Regular monitoring of biochemical parameters, particularly electrolytes and renal function, for individuals aged 60 and above should be systematically integrated into national healthcare protocols. Special attention should be devoted to women, who are particularly susceptible to postmenopausal electrolyte disturbances.

   4. Training Healthcare Professionals: Healthcare providers, especially those working in rural areas, must be trained in the early detection and management of electrolyte imbalances. This should encompass the identification of dehydration signs and abnormalities in potassium, magnesium, sodium, and chloride levels.

   5. Improvement of Healthcare Access: Enhancing access to healthcare in rural areas is essential to ensure that elderly individuals benefit from consistent and comprehensive medical attention, mitigating the adverse effects of geographic isolation and limited healthcare access.

   By implementing these recommendations, policymakers can significantly enhance the quality of life for elderly populations in the West Region of Cameroon and alleviate the detrimental effects of electrolyte imbalances, thus mitigating accelerated aging and its associated complications.

	REFERENCES

1. Hoorn EJ & Zietse R. Disorders of sodium balance. New England Journal of Medicine. 2017;376(6):547-557. https://doi.org/10.1056/NEJMra1603466.
2. Hannon M, et al. Dietary sodium and potassium intake in rural populations. Journal of Global Health. 2022;12(1):132-145. https://doi.org/10.7189/jogh.12.010421.
3. Palmer BF. Pathophysiology of hypernatremia in the aging kidney. Clinical Journal of the American Society of Nephrology. 2015;10(4):724-732. https://doi.org/10.2215/CJN.09260914.
4. Tapsoba C, et al. Electrolyte imbalances in rural African elderly. BMC Geriatrics. 2021;21(1):1-9. https://doi.org/10.1186/s12877-021-02037-6.
5. Hamer M, Kivimaki M & Batty GD. Hypertension, potassium, and cardiovascular risk: A review. Hypertension, 2017;69(5):846-852. https://doi.org/10.1161/HYPERTENSIONAHA.117.08946.
6. Tapsoba H, Melse-Boonstra A & Brouwer ID. Magnesium status and its dietary determinants in different population groups. Nutrition Reviews. 2021;79(3):315-329. https://doi.org/10.1093/nutrit/nuaa068.
7. Foley RN & Collins AJ. Chronic kidney disease in aging populations: Implications for healthcare. Nature Reviews Nephrology. 2018;14(10):601-612. https://doi.org/10.1038/s41581-018-0042-4.
8. Elin RJ. ssessment of magnesium status. Clinical Chemistry. 2010;56(9):1411-1421. https://doi.org/10.1373/clinchem.2010.14
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9. Rosique RG, Rosique MJ & Fadel MG. Hypomagnesemia and its implications in chronic diseases. American Journal of Medicine. 2015;128(8):830-836. https://doi.org/10.1016/j.amjmed. 2015.04.022
10. Malouf R, Grimley Evans J & Areosa Sastre A. Magnesium for the treatment of chronic conditions in older populations. Cochrane Database of Systematic Reviews. 2012;3:CD009359. https://doi.org/10.1002/14651858.CD009359.pub2.

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