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Serum magnesium status among obese children and adolescents

Article in Egyptian Pediatric Association Gazette · March 2016

DOI: 10.1016/j.epag.2015.11.002

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Egyptian Pediatric Association Gazette (2016) 64, 32–37

H O S T E D BY Contents lists available at ScienceDirect

Egyptian Pediatric Association Gazette

journal homepage: http://www.elsevier.com/locate/epag

Serum magnesium status among obese children

and adolescents
Ali M. Zaakouk a, Mohammed A. Hassan a, Omar A. Tolba b,*

a
Department of Pediatrics, Al-Azhar University, Egypt
b
Cairo University Children’s Hospital, Department of Pediatrics, Cairo University, Egypt

Received 8 September 2015; revised 17 October 2015; accepted 17 November 2015

Available online 15 December 2015

KEYWORDS Abstract Background and objectives: Serum magnesium is involved in the pathogenesis of obesity
Magnesium; and its related diseases. The aim of the present study was to evaluate serum magnesium status in
Obesity; obese children and adolescents and to study its relationship with the degree of obesity and serum
Children; lipid profile.
Adolescents; Design and settings: A cross-sectional study was conducted at the general pediatric out-patient
Serum lipid profile clinic of a university hospital, over a period of 5 months from May to September 2013.
Methods: 50 obese subjects of ages 2–16 years and 50 healthy normal weight subjects of matched
age and sex as controls were consecutively enrolled. Comprehensive history, anthropometric mea-
surements and blood pressure were taken. BMI and degree of obesity were calculated. Fasting total
serum magnesium, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were mea-
sured.
Results: Obese cases compared to normal weight controls showed significantly lower serum mag-
nesium and HDL-cholesterol levels and significantly higher total cholesterol, LDL-cholesterol,
triglycerides, systolic and diastolic blood pressures. Serum magnesium showed a significant, strong
inverse correlation with the degree of obesity (r =
0.8, p < 0.001); significant, moderate inverse
correlation with total cholesterol and LDL-cholesterol; and non-significant correlation with triglyc-
erides and HDL-cholesterol. The degree of obesity showed a significant, moderate positive correla-
tion with total cholesterol and LDL-cholesterol and a non-significant correlation with triglycerides
and HDL-cholesterol.
Conclusion: Serum magnesium levels are inversely correlated with the degree of obesity, and is
related to an unfavorable serum lipid profile in obese children and adolescents, who also show a
trend to higher systemic blood pressure.
Ó 2015 The Authors. Production and hosting by Elsevier B.V. on behalf of The Egyptian Pediatric
Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).

* Corresponding author at: Department of Pediatrics, Cairo University Children’s Hospital, Cairo University, 50 Lebanon Street, El
Mohandessin, 12411 Giza, Egypt. Tel.: +20 1222101717, +20 233025539.
E-mail addresses: alizaakook@hotmail.com (A.M. Zaakouk), mapissar@gmail.com (M.A. Hassan), omartolba80@yahoo.com (O.A. Tolba).
Peer review under responsibility of Egyptian Pediatric Association Gazette.
http://dx.doi.org/10.1016/j.epag.2015.11.002
1110-6638 Ó 2015 The Authors. Production and hosting by Elsevier B.V. on behalf of The Egyptian Pediatric Association.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Serum magnesium status and obesity
Introduction
Overweight and obesity are increasingly common among
children and adolescents all over the world1 and in fact Egypt
is encountering the double burden of malnutrition.2,3 The
growing prevalence of childhood obesity has also led to
appearance of obesity-related comorbid conditions at an early
age.4
Obesity is a complex, multifactorial condition in which
excess body fat may put a child or adolescent at risk of serious
health problems such as dyslipidemia, hypertension, diabetes
mellitus, and cardiovascular diseases.4–6
These complications of obesity are attributed to various
inflammatory sialoproteins secreted from the adipocytes
mass.7 The newly identified function of the adipocytes has pro-
gressed from a simple energy storage tissue to a major endo-
crine system. The hormones secreted from adipose tissue
influence energy homeostasis, glucose and lipid metabolism,
vascular homeostasis, immune response, and reproductive
functions.8 Moreover, obesity is associated with oxidative
stress 9, which in association with systemic inflammation
affects both insulin secretion and its action, thus resulting in
poor glycemic control.10 In addition, there exist an influence
of various inflammatory sialoproteins secreted from the adipo-
cyte mass on insulin resistance (IR), serum lipids and glycemic
control.11,12
Magnesium (Mg) deficiency is a frequent association in
patients with the main risk factors, hyperlipidemia, hyperten-
sion, diabetes, and obesity.8,13
Magnesium is a vital divalent metal ion and a cofactor for
several enzymes involved in the metabolism of fats, proteins
and carbohydrates, and also assists the action of insulin.14
Mg is necessary for the activity of lecithin cholesterol acyl-
transferase and lipoprotein lipase, which lowers triglyceride
levels and raises HDL-cholesterol levels. Mg (2+)-ATP is also
the controlling factor for the rate-limiting enzyme in the
cholesterol biosynthesis.13 It plays a significant role in glucose
and insulin metabolism, mainly through its impact on tyrosine
kinase activity, by transferring the phosphate from ATP to
protein. It may also affect phosphorylase b kinase activity by
releasing glucose-1-phosphate from glycogen. In addition,
Mg may directly affect glucose transporter protein activity 4,
and help to regulate glucose translocation into the cell.15
Moreover, studies have shown the association of hypomagne-
semia with oxidative stress.16. However, supportive evidences
whether hypomagnesemia is a cause or an effect, are not yet
available.
Several studies linked obesity with a low serum Mg and it
has been speculated that Mg deficiency is one of the causes
for the above-mentioned disorders,7,13,17 yet the relationship
between Mg and obesity is still unclear.18
Serum Mg exhibits a good correlation with intracellular
free Mg measured by nuclear magnetic resonance spec-
troscopy,19 and total serum Mg concentration is an established
biomarker of Mg status.15,20
The aim of the present study was to evaluate serum
magnesium status in obese children and adolescents and to
study its relationship with the degree of obesity and serum
lipid profile.
33
Patients and methods
Study design
A cross-sectional study was conducted at the general pediatric
out-patient clinic of Bab-El-Shaeria Hospital, Al-Azhar
University-Cairo, Egypt, over a period of 5 months from
May to September 2013. The study was approved by the local
Ethics Committee. Informed parental consent was obtained
prior to enrollment in the study.
Study population
A sample of 100 candidates were consecutively enrolled: 50
obese subjects with BMI P95th centile for-age and gender as
per Egyptian Growth Charts 2002,21 aged between 2–16 years;
and 50 healthy non-obese subjects with BMI 5th -< 85th centile
of matched age and sex as controls. Cases with genetic disease
or medical syndromes; diabetes mellitus; other endocrinal dis-
turbances; and/or medical conditions or on medications pre-
disposing hypomagnesemia (e.g. gastroenteritis, chronic
kidney disease, chronic liver disease, diuretics and ampho-
tericin) were excluded. Overweight subjects with BMI 85th -
< 95th centile were not included.
Methods
History
All candidates were subjected to comprehensive history-taking
including detailed dietary history using a validated food
frequency questionnaire (based on 24-h recall); family history
of obesity or metabolic disorders; and full medical and medic-
inal history. Enrollment of cases and controls was done simul-
taneously to avoid seasonal bias in dietary characteristics.
Clinical examination
A detailed clinical examination was performed including
anthropometric measurements and blood pressure (BP) using
calibrated measuring equipment. In addition, weight for height
indices were calculated to assess weight status and the degree
of obesity.
Anthropometric measurements: Height, weight, and waist
circumference were measured while the subjects were lightly
clothed and without shoes. Measurements were conducted
using a digital weighing scale, wall-mounted stadiometer,
and non-elastic tape measure. The results were recorded to
the nearest 0.1 kg, 0.1 cm, and 0.5 cm, respectively, and com-
pared with appropriate Egyptian growth charts 2002.21
Weight for height indices: Weight-height indices including
body mass index (BMI) and percent ideal body weight
(%IBW) to assess weight status and the degree of obesity,
being the most commonly used both clinically and in popula-
tion studies.22–24 BMI-for-age is the appropriate method for
IBW calculation that can be applied consistently to all subjects
of ages between 2 and 20 years.24
BMI was calculated for each subject as weight (in kilo-
grams) divided by height (in meters) squared (kg/m2). The
readings were plotted on age- and gender-specific percentiles
34 A.M. Zaakouk et al.

and weight status was considered normal, overweight or obese Pearson product moment was used to estimate correlation
as mentioned above.21 between variables. p-value < 0.05 was considered statistically
IBW was calculated as IBW = [BMI at the 50th percentile significant.
for that subject’s age  (Height in m)2] based on BMI Method.
Percent IBW was calculated as [(actual body weight/IBW)  Results
100].23,24
Degree of obesity was assessed by %IBW. Subjects with Table 1 presents the demographic and clinical characteristics
weights > 120% IBW were considered to be obese.23,24 of the two groups. Both groups were comparable regarding
Blood pressure measurements: BP was measured in dupli- age (p = 0.416), sex (p = 0.548), family history of obesity
cates using a mercury sphygmomanometer with appropriate- (p = 0.117) and consumption of Mg-rich foods (p = 0.053).
sized cuffs from the right arm in the sitting position after the Obese cases had significantly higher weight, height, and BMI
subject had rested for five minutes. Hypertension is defined percentiles; and waist circumference measurement (p < 0.001
as a BP greater than the 95th percentile specific for age and for all). Also, they had significantly higher percentiles of sys-
gender.25 tolic and diastolic blood pressure compared to the non-obese
controls (p < 0.001 and p = 0.034, respectively).
Biochemical tests Compared to the non-obese control subjects, the obese
Venous blood samples were obtained after an overnight fast of cases had significantly lower serum Mg concentration and
12–14 h for estimation of serum magnesium (Mg), total choles- HDL-C (p < 0.001) and significantly higher fasting TC,
terol (TC), low-density lipoprotein-cholesterol (LDL-C), high- LDL-C, and TG (p < 0.001 for all except TG p = 0.002)
density lipoprotein-cholesterol (HDL-C), and triglycerides (Table 2).
(TG) in all subjects. A statistically significant, strong inverse correlation was
Serum Mg was measured spectrophotometrically using found between serum Mg concentration and the degree of obe-
ready for use kit (HumanÒ Company, Germany). Serum Mg sity (r =
0.8, p < 0.001) (Fig. 1).
levels (mg/dL) were calculated according to the formula: ion- As shown in Table 3, in the obese cases serum Mg had a sig-
ized Mg in mmol/L = [0.66  (total Mg in mmol/L)] nificant moderate inverse correlation with TC and LDL-C
+ 0.039.26 (r =
0.412, p = 0.003 and r =
0.311, p = 0.028;
TC, TG and HDL-C were measured using standard meth- respectively), non-significant inverse correlation with TG
ods. LDL-C was calculated using Friedewald’s formula.27 Cal-
culation was valid only when TG were <400 mg/dL.
Thresholds for normal biochemical values were as follows:
serum Mg concentration of 1.5–2.3 mg/dL 28,29; fasting TC of Table 2 Biochemical data of obese cases and non-obese
<170 mg/dL; HDL-C of >45 mg/dL; LDL-C of <110 mg/dL; controls.
and TG of <75 mg/dL for ages 0–9 years and <90 mg/dL
Variable (mg/dL) Obese Non-obese p value
for ages 10–19 years.30,31 (n = 50) (n = 50)
Serum 1.5 ± 0.5 2.4 ± 0.3 <0.001
Statistical analysis
magnesium
Data were analyzed using IBM SPSS Advanced Statistics ver- Total cholesterol 190.2 ± 25.6 130.0 ± 30.8 <0.001
sion 20.0 (IBMÓ Corp., Armonk, NY, USA). Numerical data LDL-cholesterol 142.6 ± 26.3 91.1 ± 17.5 <0.001
were expressed as mean, standard deviation, and range. Triglycerides 107.1 ± 17.0 94.4 ± 22.3 0.002
Qualitative data were expressed as frequency and percentage. HDL-cholesterol 51.3 ± 7.5 59.4 ± 11.4 <0.001
Chi-square test was used to examine the relation between the Data are expressed as mean ± standard deviation.
qualitative variables. For quantitative data, comparison Statistical analysis by: t-test for independent samples.
between 2 groups was done using independent sample t-test.

Table 1 Demographic and clinical characteristics of obese cases and non-obese controls.
Variable Obese (n = 50) Non-obese (n = 50) p value
Age (years) 9.3 ± 2.4 9.7 ± 2.5 0.416
Sex (male/female) 23/27 26/24 0.548y
Family history of obesity 6 (12%) 1 (2%) 0.117y
Eating food rich in magnesium 15 (30%) 7 (14%) 0.053y
Weight for age percentiles–sex specific 95.8 ± 6.2 41.0 ± 10.2 <0.001
Height for age percentiles–sex specific 42.4 ± 9.1 22.0 ± 6.1 <0.001
BMI for age percentiles–sex specific 98.7 ± 1.2 49.5 ± 8.7 <0.001
Waist circumference (cm) 90.9 ± 13.0 69.0 ± 9.7 <0.001
Systolic BP percentiles (mm Hg) 58.4 ± 11.6 45.0 ± 9.8 <0.001
Diastolic BP percentiles (mm Hg) 62.2 ± 9.9 57.4 ± 12.3 0.034
BMI: body mass index, BP: blood pressure.
Data are expressed as mean ± standard deviation or frequency and (percentage).
Statistical analysis by: t-test for independent samples or yChi-square test.
Serum magnesium status and obesity
Serum Mg (mg/dL)
Degree of obesity (%)
Figure 1 Correlation between serum magnesium and degree of obesity.
Table 3 Correlations between serum magnesium, degree of
obesity and lipid profile in obese cases (n = 50).
Lipid profile Serum Mg (mg/dL) Degree of obesity (%)
(mg/dL)
r p r p
Total cholesterol
0.412 0.003 0.331
LDL-cholesterol
0.311 0.028 0.327
Triglycerides
0.067 0.644 0.122
HDL-cholesterol 0.055 0.704
0.006
Correlation coefficient (r) by Pearson product moment method.
(r =
0.067, p = 0.644) and non-significant positive
correlation with HDL-C (r = 0.055, p = 0.704). The degree
of obesity had a significant moderate positive correlation
with TC and LDL-C (r = 0.331, p = 0.019 and r = 0.327,
p = 0.021; respectively), non-significant positive correlation
with TG (r = 0.122, p = 0.399) and non-significant inverse
correlation with HDL-C (r =
0.006, p = 0.967).
Discussion
This work targeted studying the relationship between serum
Mg and obesity, and their correlation with serum lipid profile.
The relationships between disorders of serum Mg and lipid
serum levels have been observed.32,33 However, there is a lack
of data concerning the serum Mg status and its correlation
with body composition in adolescent populations with
obesity.18,34
In the current study, obese cases had significantly lower
serum Mg concentrations with a significant strong inverse cor-
relation with the degree of obesity, in spite of the observed
higher dietary intake of Mg-rich food that did not reach statis-
tical significance. These results are comparable with the previ-
ous reports of Huerta et al.17 and Jose et al.35 who found
significantly lower serum Mg concentrations and negative
correlation between serum Mg and BMI in obese/overweight
children (ages: 8–17 years and 4–14 years, respectively). There
is a controversy regarding dietary intake of Mg in the few pub-
lished reports, Huerta et al.17 found that it was significantly
lower in obese children and Jose et al.35 reported that it was
significantly higher in overweight Indian children.
35
r = - 0.8
P < 0.001
It has been observed that the low serum levels of Mg in the
obese group, despite a high dietary intake of Mg-rich food,
might be due to decreased Mg intestinal absorption or
increased excretion, both mechanisms are plausible. An
increased fat or calcium intake in obese cases is known to
interfere with Mg absorption. The intake of dairy products
0.019 and carbonated soft drinks rich in phosphorus could interfere
0.021 with Mg absorption while caffeine can increase renal Mg
0.399 excretion.36 Vegetarian and unprocessed food-based diet as
0.967 in whole grains, nuts, and green leafy vegetables are high in
Mg which is lost during processing. Therefore, the low serum
Mg levels are likely to be an ‘effect’ rather than a cause.35
Meanwhile, obese cases had significantly higher fasting TC,
LDL-C, and TG and significantly lower HDL-C. This is in
agreement with the result of Huerta et al.17 who found that
obese children with BMI P95% had higher TC, LDL-C,
and TG and lower HDL-C than lean children with BMI
<85%. It is also in line with that of Sothern et al.37 who
reported that childhood obesity has been associated with ele-
vated serum levels of TC, TG, and LDL-C.
The correlation between serum Mg and serum lipid levels
revealed a significant inverse correlation with serum TC and
LDL-C, non-significant inverse correlation with TG and
non-significant positive correlation with HDL-C.
On the other hand, the correlation between the degree of
obesity and serum lipid levels showed a significant positive cor-
relation with TC and LDL-C, and a non-significant correlation
with TG and HDL-C. These results are in agreement with
those of Steinberger et al. 38 who concluded that there is some
relationship between adiposity and LDL-C, but it is substan-
tially weaker. Also, they agree in part with those of Bogalus
Heart study that included 1560 young people aged 5–26 years,
regarding LDL-C which correlated positively with weight, and
disagreed regarding triglycerides that correlated positively and
HDL-C that correlated negatively.39
This associated unfavorable pattern of serum lipid profile is
in consistency with the results of Bianco and colleagues40 who
stated that in pediatric population, they mostly found an
increase in total and LDL cholesterol, combined hyperlipi-
demia usually develops in adolescents with an increasing TG
concentration in preexisting hypercholesterolemia; and Singhal
et al.41 who noted that fasting serum TG levels are often ele-
vated in obesity and are considered an early sign of metabolic
syndrome.
36
Also this is coupled with a propensity of obese cases to have
significantly higher mean systolic and diastolic blood pressure
centiles than non-obese controls. According to epidemiologic
surveys of children and adolescents over the past 20 years,
BP levels have been increasing, and the prevalence of hyperten-
sion and prehypertension are also increasing, explained par-
tially by the rise in obesity rates.30
Conclusion
This study observes lower serum Mg with an inverse correla-
tion with the degree of obesity, serum total cholesterol and
LDL-cholesterol, along with a trend to higher systemic blood
pressure among obese children and adolescents. Therefore,
serum Mg can be used as an early biomarker for obesity-
related morbidities. Further investigations are recommended
to identify the possible etiology of such derangement, as Mg
dietary intake was noted to be higher in Mg-deficient subjects,
which points to a metabolic error being either a cofactor in the
pathogenesis of obesity or a consequence. Such findings might
be of significance in fighting the obesity epidemic and its mul-
tisystem complications.
Conflict of interest
The authors declare no conflict of interest.
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