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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 33

Introduction Patients and methods

Overweight and obesity are increasingly common among Study design

children and adolescents all over the world1 and in fact Egypt
is encountering the double burden of malnutrition.2,3 The A cross-sectional study was conducted at the general pediatric
growing prevalence of childhood obesity has also led to out-patient clinic of Bab-El-Shaeria Hospital, Al-Azhar
appearance of obesity-related comorbid conditions at an early University-Cairo, Egypt, over a period of 5 months from
age.4 May to September 2013. The study was approved by the local
Obesity is a complex, multifactorial condition in which Ethics Committee. Informed parental consent was obtained
excess body fat may put a child or adolescent at risk of serious prior to enrollment in the study.
health problems such as dyslipidemia, hypertension, diabetes
mellitus, and cardiovascular diseases.4–6 Study population
These complications of obesity are attributed to various
inflammatory sialoproteins secreted from the adipocytes A sample of 100 candidates were consecutively enrolled: 50
mass.7 The newly identified function of the adipocytes has pro- obese subjects with BMI P95th centile for-age and gender as
gressed from a simple energy storage tissue to a major endo- per Egyptian Growth Charts 2002,21 aged between 2–16 years;
crine system. The hormones secreted from adipose tissue and 50 healthy non-obese subjects with BMI 5th -< 85th centile
influence energy homeostasis, glucose and lipid metabolism, of matched age and sex as controls. Cases with genetic disease
vascular homeostasis, immune response, and reproductive or medical syndromes; diabetes mellitus; other endocrinal dis-
functions.8 Moreover, obesity is associated with oxidative turbances; and/or medical conditions or on medications pre-
stress 9, which in association with systemic inflammation disposing hypomagnesemia (e.g. gastroenteritis, chronic
affects both insulin secretion and its action, thus resulting in kidney disease, chronic liver disease, diuretics and ampho-
poor glycemic control.10 In addition, there exist an influence tericin) were excluded. Overweight subjects with BMI 85th -
of various inflammatory sialoproteins secreted from the adipo- < 95th centile were not included.
cyte mass on insulin resistance (IR), serum lipids and glycemic
control.11,12 Methods
Magnesium (Mg) deficiency is a frequent association in
patients with the main risk factors, hyperlipidemia, hyperten-
History
sion, diabetes, and obesity.8,13
Magnesium is a vital divalent metal ion and a cofactor for All candidates were subjected to comprehensive history-taking
several enzymes involved in the metabolism of fats, proteins including detailed dietary history using a validated food
and carbohydrates, and also assists the action of insulin.14 frequency questionnaire (based on 24-h recall); family history
Mg is necessary for the activity of lecithin cholesterol acyl- of obesity or metabolic disorders; and full medical and medic-
transferase and lipoprotein lipase, which lowers triglyceride inal history. Enrollment of cases and controls was done simul-
levels and raises HDL-cholesterol levels. Mg (2+)-ATP is also taneously to avoid seasonal bias in dietary characteristics.
the controlling factor for the rate-limiting enzyme in the
cholesterol biosynthesis.13 It plays a significant role in glucose Clinical examination
and insulin metabolism, mainly through its impact on tyrosine A detailed clinical examination was performed including
kinase activity, by transferring the phosphate from ATP to anthropometric measurements and blood pressure (BP) using
protein. It may also affect phosphorylase b kinase activity by calibrated measuring equipment. In addition, weight for height
releasing glucose-1-phosphate from glycogen. In addition, indices were calculated to assess weight status and the degree
Mg may directly affect glucose transporter protein activity 4, of obesity.
and help to regulate glucose translocation into the cell.15 Anthropometric measurements: Height, weight, and waist
Moreover, studies have shown the association of hypomagne- circumference were measured while the subjects were lightly
semia with oxidative stress.16. However, supportive evidences clothed and without shoes. Measurements were conducted
whether hypomagnesemia is a cause or an effect, are not yet using a digital weighing scale, wall-mounted stadiometer,
available. and non-elastic tape measure. The results were recorded to
Several studies linked obesity with a low serum Mg and it the nearest 0.1 kg, 0.1 cm, and 0.5 cm, respectively, and com-
has been speculated that Mg deficiency is one of the causes pared with appropriate Egyptian growth charts 2002.21
for the above-mentioned disorders,7,13,17 yet the relationship Weight for height indices: Weight-height indices including
between Mg and obesity is still unclear.18 body mass index (BMI) and percent ideal body weight
Serum Mg exhibits a good correlation with intracellular (%IBW) to assess weight status and the degree of obesity,
free Mg measured by nuclear magnetic resonance spec- being the most commonly used both clinically and in popula-
troscopy,19 and total serum Mg concentration is an established tion studies.22–24 BMI-for-age is the appropriate method for
biomarker of Mg status.15,20 IBW calculation that can be applied consistently to all subjects
The aim of the present study was to evaluate serum of ages between 2 and 20 years.24
magnesium status in obese children and adolescents and to BMI was calculated for each subject as weight (in kilo-
study its relationship with the degree of obesity and serum grams) divided by height (in meters) squared (kg/m2). The
lipid profile. 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 35

r = - 0.8
P < 0.001

Serum Mg (mg/dL)

Degree of obesity (%)

Figure 1 Correlation between serum magnesium and degree of obesity.

It has been observed that the low serum levels of Mg in the

Table 3 Correlations between serum magnesium, degree of obese group, despite a high dietary intake of Mg-rich food,
obesity and lipid profile in obese cases (n = 50). might be due to decreased Mg intestinal absorption or
increased excretion, both mechanisms are plausible. An
Lipid profile Serum Mg (mg/dL) Degree of obesity (%)
(mg/dL) increased fat or calcium intake in obese cases is known to
r p r p interfere with Mg absorption. The intake of dairy products
Total cholesterol
0.412 0.003 0.331 0.019 and carbonated soft drinks rich in phosphorus could interfere
LDL-cholesterol
0.311 0.028 0.327 0.021 with Mg absorption while caffeine can increase renal Mg
Triglycerides
0.067 0.644 0.122 0.399 excretion.36 Vegetarian and unprocessed food-based diet as
HDL-cholesterol 0.055 0.704
0.006 0.967 in whole grains, nuts, and green leafy vegetables are high in
Correlation coefficient (r) by Pearson product moment method. 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,
(r =
0.067, p = 0.644) and non-significant positive LDL-C, and TG and significantly lower HDL-C. This is in
correlation with HDL-C (r = 0.055, p = 0.704). The degree agreement with the result of Huerta et al.17 who found that
of obesity had a significant moderate positive correlation obese children with BMI P95% had higher TC, LDL-C,
with TC and LDL-C (r = 0.331, p = 0.019 and r = 0.327, and TG and lower HDL-C than lean children with BMI
p = 0.021; respectively), non-significant positive correlation <85%. It is also in line with that of Sothern et al.37 who
with TG (r = 0.122, p = 0.399) and non-significant inverse reported that childhood obesity has been associated with ele-
correlation with HDL-C (r =
0.006, p = 0.967). 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
Discussion LDL-C, non-significant inverse correlation with TG and
non-significant positive correlation with HDL-C.
This work targeted studying the relationship between serum On the other hand, the correlation between the degree of
Mg and obesity, and their correlation with serum lipid profile. obesity and serum lipid levels showed a significant positive cor-
The relationships between disorders of serum Mg and lipid relation with TC and LDL-C, and a non-significant correlation
serum levels have been observed.32,33 However, there is a lack with TG and HDL-C. These results are in agreement with
of data concerning the serum Mg status and its correlation those of Steinberger et al. 38 who concluded that there is some
with body composition in adolescent populations with relationship between adiposity and LDL-C, but it is substan-
obesity.18,34 tially weaker. Also, they agree in part with those of Bogalus
In the current study, obese cases had significantly lower Heart study that included 1560 young people aged 5–26 years,
serum Mg concentrations with a significant strong inverse cor- regarding LDL-C which correlated positively with weight, and
relation with the degree of obesity, in spite of the observed disagreed regarding triglycerides that correlated positively and
higher dietary intake of Mg-rich food that did not reach statis- HDL-C that correlated negatively.39
tical significance. These results are comparable with the previ- This associated unfavorable pattern of serum lipid profile is
ous reports of Huerta et al.17 and Jose et al.35 who found in consistency with the results of Bianco and colleagues40 who
significantly lower serum Mg concentrations and negative stated that in pediatric population, they mostly found an
correlation between serum Mg and BMI in obese/overweight increase in total and LDL cholesterol, combined hyperlipi-
children (ages: 8–17 years and 4–14 years, respectively). There demia usually develops in adolescents with an increasing TG
is a controversy regarding dietary intake of Mg in the few pub- concentration in preexisting hypercholesterolemia; and Singhal
lished reports, Huerta et al.17 found that it was significantly et al.41 who noted that fasting serum TG levels are often ele-
lower in obese children and Jose et al.35 reported that it was vated in obesity and are considered an early sign of metabolic
significantly higher in overweight Indian children. syndrome.
36 A.M. Zaakouk et al.

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