Background: Calcium (Ca) and magnesium (Mg) are essential micronutrients integral to metabolic processes and cardiovascular health. Emerging evidence suggests that the dietary Ca:Mg ratio may influence chronic disease risk, yet variability in this ratio across diverse demographic groups and its relationship to body composition and vitamin D status remain unclear. Methods: Dietary intakes of Ca and Mg were assessed using validated Food Frequency Questionnaires (FFQs) and body composition was quantified via Dual-energy X-ray Absorptiometry (DXA) scans. Relationships between dietary Ca:Mg ratios and demographics, body composition parameters (lean and fat mass), and vitamin D and parathyroid hormone (PTH) levels were examined statistically using SPSS ver. 29.0 and R ver. 4.5.1 (2025) employing Kruskal–Wallis, regression, and moderated mediation analyses. Results: We examined 155 healthy adults with a mean age of 36.6 ± 12.5 years. Only 16.8% had adequate intakes of Mg compared with 45.8% who had adequate dietary Ca intakes. Significant differences in the Ca:Mg ratio were observed across racial groups (p = 0.023) and age groups (p = 0.017). South Asian Indians exhibited the highest median Ca:Mg ratio (4.83), whereas African Americans exhibited the lowest (2.67). Interestingly, our moderated mediation analysis indicated that African Americans were the most sensitive to the impact of PTH changes on the balance of Ca:Mg (indirect effect = −0.762, 95% CI [−1.298, −0.234]), indicating that even slight shifts in their Ca:Mg balances cause significant elevation in the PTH, which, in turn, leads to lowering of their vitamin D levels. Young adults (ages 18–29) had the highest median Ca:Mg ratio (4.73). No statistically significant differences were detected based on Gender (p = 0.425 and BMI (p = 0.744) on Ca:Mg ratios. Additionally, dietary Ca:Mg ratios were positively associated with sPTH in males (r = 0.203, p < 0.05), but not with body composition. Conclusion: Important variations in dietary Ca:Mg ratios exist across racial and age demographics, notably among young adults, and specific ethnic groups exhibited elevated ratios. Tailored nutritional interventions may be necessary for these populations to optimize Ca:Mg balance and support metabolic and cardiovascular health outcomes in these populations.

Individuals with overweight and obesity consistently demonstrate lower circulating concentrations of serum 25-hydroxyvitamin D (25OHD), the primary biomarker of vitamin D status. Additionally, they exhibit an attenuated response to conventional vitamin D supplementation and may require doses approximately 2–3 times higher than those recommended for individuals with normal body weight to achieve equivalent serum 25OHD concentrations. However, accumulating evidence from randomized controlled trials raises concerns regarding the safety of high-dose vitamin D supplementation, with some studies reporting increased risks of falls and fractures, as well as potential adverse effects on bone mineral density and cognitive outcomes. Magnesium is an essential cofactor in vitamin D metabolism, participating in enzymatic processes required for the hepatic and renal hydroxylation of vitamin D into its active forms. Inadequate Magnesium status may therefore influence vitamin D status and response to vitamin D treatment. Previous randomized clinical trials suggest that Magnesium supplementation, administered either alone or in combination with moderate doses of vitamin D, can effectively increase serum 25OHD concentrations, particularly among individuals with overweight or obesity. Collectively, these findings suggest that optimizing Magnesium status may improve the response to vitamin D supplementation and potentially reduce the need for high-dose vitamin D therapy in obese individuals. Physicians treating overweight or obese patients for vitamin D deficiency should consider co-supplementation with Magnesium and/or encourage intake of Magnesium-rich foods to improve vitamin D status and supplementation outcomes in this population.

Background: The Healthy Eating Index (HEI) estimates the diet quality, and low HEI scores are associated with adverse bone outcomes. However, the relationship between HEI scores and bone health in individuals who are obese but otherwise healthy or obese with comorbidities remains unclear. Objective: We aimed to evaluate the association of HEI scores with bone mineral density (BMD), bone regulating hormones and bone turnover markers in individuals with metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) phenotypes. Methods: This was a cross-sectional analysis of 122 adults who were overweight or obese. A questionnaire was completed to obtain demographic data. Body composition and BMD were assessed by a Dual Energy X-Ray Absorptiometry (DXA) exam. The HEI scores and dietary components were calculated using a 24-h dietary recall. Blood samples were collected for the analysis of serum 25-hydroxyvitamin D (s25OHD), total osteocalcin (OC), parathyroid hormone (PTH), and C-terminal telopeptide (CTx) concentrations. The MHO and MUO phenotypes were classified according to the absence or presence of metabolic abnormalities. Results: The sample mean age was 37.91 & PLUSMN; 12.66 years, 50.8% were men, mean body mass index (BMI) was 30.01 & PLUSMN; 4.63 kg/m2, and 45.9% were classified as the MUO phenotype. The mean HEI scores were 54.42 & PLUSMN; 16.25 and 61.48% had low-diet quality. HEI scores were positively associated with s25OHD in the MUO phenotype group (& beta; = 0.194, 95%CI = 0.038-0.350, p = 0.016). Certain dietary score components, such as fruits, seafood and plant protein, added sugars, whole grains, and fatty acids were also associated with bone health markers. However, HEI scores were not associated with BMD measures, neither with other bone regulating hormones and turnover markers. Conclusion: There was a positive association between HEI scores and s25OHD in adults who were overweight or obese with MUO phenotype. Additionally, the adequate consumption of specific food groups may benefit bone mass and metabolism. These results emphasize the importance of lifestyle interventions encouraging healthy eating habits to prevent s25OHD deficiency, poor bone health, and cardiometabolic complications.

High-dose vitamin D supplementation can increase total osteocalcin concentrations that may reduce insulin resistance in individuals at risk for prediabetes or diabetes mellitus. Magnesium is a cofactor in vitamin D metabolism and activation. The purpose of this study was to determine the combined effect of vitamin D and magnesium supplementation on total osteocalcin concentrations, glycemic indices, and other bone turnover markers af-ter a 12-week intervention in individuals who were overweight and obese, but otherwise healthy. We hypothesized that combined supplementation would improve serum total os-teocalcin concentrations and glycemic indices more than vitamin D supplementation alone or a placebo. A total of 78 women and men completed this intervention in 3 groups: a vi-tamin D and magnesium group (1000 IU vitamin D 3 and 360 mg magnesium glycinate), a vitamin D group (1000 IU vitamin D 3 ), and a placebo group. Despite a significant increase in serum 25-hydroxyvitamin D concentrations in the vitamin D and magnesium group com-pared with the placebo group (difference = 5.63; CI, -10.0 to -1.21; P = .001) post-intervention, there were no differences in serum concentrations of total osteocalcin, glucose, insulin, and adiponectin or the homeostatic model assessment of insulin resistance (HOMA-IR) among groups ( P > .05 for all). Additionally, total osteocalcin (beta = -0.310, P = .081), bone-specific al-kaline phosphatase (beta = 0.004, P = .986), and C-terminal cross-linked telopeptide (beta = 0.426, P = .057), were not significant predictors of HOMA-IR after the intervention. Combined sup-plementation was not associated with short-term improvements in glycemic indices or bone turnover markers in participants who were overweight and obese in our study. This trial was registered at clinicaltrials.gov (NCT03134417).(c) 2022 Elsevier Inc. All rights reserved.

Postmenopausal women are at an increased risk for cardiovascular disease as well as a reduction in psychosocial well-being. The objective of this study was to create and implement an innovative intervention that would address the health needs of overweight postmenopausal women. In this virtual pilot project, named Integrative Intervention with Creative Arts Therapy and Nutrition, three postmenopausal women received 16 weeks of alternating creative arts therapies and nutrition education sessions. Survey scores and verbal responses showed that the participants improved in the areas of quality of life, affect, self-efficacy, stress, anxiety, and body image while also reporting physical gains. The findings suggest that a multimodal intervention with physical and creative aspects is beneficial for weight management in this population.

Context Poor diet quality and unhealthy dietary patterns have been linked to poor bone health, yet few studies have investigated the role of diet quality in bone health in pediatric populations. Objective This systematic review aims to assess the available evidence on the association between diet quality and bone health markers in children and adolescents. Data Sources The PubMed, Scopus, and Virtual Health Library databases were searched electronically from October to November 2022, without any restrictions on date or language. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist was used to assess the quality of the studies. Data Extraction Published observational studies in children and adolescents (ages 2 to 19 years) that investigated the association between diet quality and bone health were eligible for inclusion. Two researchers independently analyzed and selected all articles using the Rayyan app. Initially, 965 papers were identified. A total of 12 observational studies qualified, including 8 cross-sectional and 4 longitudinal studies. The sample comprised 7130 individuals aged 3 to 17.9 years, representing both sexes. Bone health was evaluated by measures of bone mineral density and bone mineral content. Data Analysis Seven studies (58.3%) showed significant associations between diet quality and bone health markers, all of which evaluated diet quality by identifying dietary patterns. Diet quality as evaluated by all dietary indexes was not associated with bone health markers. Conclusions Adherence to a healthy diet may benefit bone health in children and adolescents. These findings emphasize the importance of developing effective public health policies that encourage healthy eating habits from childhood to preserve bone health. Longitudinal research using a specific tool to assess diet quality in relation to bone health is warranted. Future studies should also measure bone-regulating hormones and markers of bone turnover. Systematic Review Registration PROSPERO registration no. CRD42022368610.

BACKGROUND:The long-term impact of vitamin D deficiency and metabolic syndrome (MetS) on cardiovascular disease (CVD) and all-cause mortality are still a matter of debate.AIM:To test the hypotheses that lower serum 25 hydroxyvitamin D [25(OH)D] concentrations (a marker of vitamin D level) and MetS have a long-term impact on the risk of CVD and all-cause mortality, and individuals with vitamin D deficiency can be identified by multiple factors.METHODS:A sample of 9094 adults, 20 to 90 years of age, who participated in the Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1994) were followed through December 2015 was analyzed. The associations of serum 25(OH)D concentrations and MetS with CVD and all-cause mortality were analyzed longitudinally using Cox regression models. Classification and regression tree (CART) for machine learning was applied to classify individuals with vitamin D deficiency.RESULTS:Of 9094 participants, 30% had serum 25(OH)D concentrations < 20 ng/mL (defined as vitamin D deficiency), 39% had serum 25(OH)D concentrations between 20 to 29 ng/mL (insufficiency), and 31% had serum 25(OH)D concentrations ≥30 ng/mL (sufficiency). Prevalence of MetS was 28.4%. During a mean of 18 years follow-up, vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality. Subjects with both vitamin D deficiency and MetS had the highest risk of CVD mortality (HR = 1.77, 95%CI: 1.22-2.58) and all-cause mortality (HR = 1.62, 95%CI: 1.26-2.09), followed by those with both vitamin D insufficiency and MetS for CVD mortality (HR = 1.59, 95%CI: 1.12-2.24), and all-cause mortality (HR = 1.41, 95%CI: 1.08-1.85). Meanwhile, vitamin D sufficiency significantly decreased the risk of CVD and all-cause mortality for those who even had MetS. Among the total study sample, CART analysis suggests that being non-Hispanic Black, having lower serum folate level, and being female were the first three predictors for those with serum 25(OH)D deficiency.CONCLUSION:Vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality. There was a significant joint effect of vitamin D deficiency and MetS on the risk of mortality. Findings of the CART analysis may be useful to identify individuals positioned to benefit from interventions to reduce the risk of CVD and all-cause mortality.

Objective Higher protein intake during weight loss is associated with better health outcomes, but whether this is because of improved diet quality is not known. The purpose of this study was to examine how the change in self-selected protein intake during caloric restriction (CR) alters diet quality and lean body mass (LBM). Methods In this analysis of pooled data from multiple weight loss trials, 207 adults with overweight or obesity were examined before and during 6 months of CR (approximately 10 food records/person). Body composition was measured by dual-energy x-ray absorptiometry. Diet quality was assessed using the Healthy Eating Index in 2 groups: lower (LP) and higher (HP) protein intake. Results Participants (mean [SD], 54 [11] years; 29 [4] kg/m(2)) lost 5.0% (5.4%) of weight. Protein intake was 79 (9) g/d (1.0 [0.2] g/kg/d) and 58 (6) g/d (0.8 [0.1] g/kg/d) in the HP and LP groups, respectively (p < 0.05), and there was an attenuated LBM (kilograms) loss in the HP (-0.6% [1.5%]) compared with the LP (-1.2% [1.4%]) group (p < 0.01). The increased Healthy Eating Index score in the HP compared with the LP group was attributed to greater total protein and green vegetable intake and reduced refined grain and added-sugar intake (p < 0.05). Conclusions Increasing dietary protein during CR improves diet quality and may be another reason for reduced LBM, but it requires further study.

Osteocalcin (OC) is a non-collagenous protein expressed by osteoblasts and has gained immense attention due to its endocrine role in modulating glucose homeostasis and fat mass. However, the relationship of this bone turnover marker with adipose tissue distribution and alternative methods of insulin resistance (IR) risk evaluation have not been fully explored. Considering that a better understanding of OC hormone role may be a possible pathway to improve cardiometabolic health, the objective of this study was to investigate the association of OC with central and total adiposity and IR risk. This is a cross-sectional study with 154 non-osteoporotic men (57.1%) and women (42.9%), mean age and BMI were 37.3 ± 13.1 years and 29.1 ± 5.5 kg/m², respectively. Weight, height and waist circumference (WC) were measured to calculate BMI and waist-height ratio (WhR). Body composition was assessed by dual energy x-ray absorptiometry (DXA). Blood samples were obtained to analyze serum OC, fasting glucose, insulin, adiponectin, and triglycerides. IR was evaluated using traditional (Homeostatic Model Assessment for Insulin Resistance, HOMA-IR) and alternatives methods (HOMA-adiponectin, HOMA-AD; triglyceride-glucose (TyG) index; quantitative insulin-sensitivity check index, QUICKI). Multivariable linear regression models were performed to determine the association between OC and outcomes. The sample mean OC concentration was 20.7 ± 17.1 ng/mL. After adjustments of potential covariates, OC was positively associated with free fat mass (β = 5.54, p = 0.013) and lean mass (β = 5.41, p = 0.012), and inversely associated with WC (β = −11.39, p = 0.004), WhR (β = −0.06, p = 0.004), visceral abdominal tissue (−1.16, p = 0.015), android fat (β = −3.01, p = 0.001), trunk fat (β = −0.08, p = 0.001), total region fat (β = −53.57, p = 0.015), and total fat mass (β = −5.32, p = 0.016). Moreover, OC was inversely associated to HOMA-AD (β = −0.43, p = 0.026) and QUICKI (β = −0.38, p = 0.020). These results suggests that OC is an important predictor of central and total adiposity, as well as IR. Whether or not improvements in OC will be associated with improvements in body composition and glucose metabolism should be examined in future interventional studies. American Heart Association, Drexel University College of Nursing and Health Professions

Objective: Poor vitamin D and magnesium status is observed in individuals who are overweight and obese (Owt/Ob) and is often associated with a heightened risk of cardiovascular disease. Magnesium is a cofactor that assists vitamin D metabolism. We aimed to determine the efficacy of a combined magnesium and vitamin D regimen compared with vitamin D only on increasing serum 25-hydroxyvitamin D (25OHD) concentrations and the effects of these supplements on cardiometabolic outcomes. Methods: This 12-week double-blinded randomized controlled trial had three treatment arms: magnesium + vitamin D (MagD; 360 mg magnesium glycinate + 1000 IU vitamin D 3 x daily), vitamin D only (VitD; 1000 IU vitamin D 3 x daily), and placebo. A total of 95 Owt/Ob participants were randomized into one of these three study arms. Anthropometry, dietary intake, concentrations of serum 25OHD, serum parathyroid hormone (PTH), serum inflammatory markers, and blood pressure were obtained at baseline and week 12. Results: The MagD group experienced the greatest increase in serum 25OHD concentrations (6.3 +/- 8.36 ng/ mL; P < 0.05). There was a decrease in systolic blood pressure (7.5 +/- 8.26 mmHg; P < 0.05) for individuals who had a baseline systolic blood pressure of > mmHg in the MagD group. There were no statistically significant treatment effects on serum PTH concentrations and markers of inflammation. Conclusions: A combined MagD treatment may be more effective in increasing serum 25OHD concentrations compared with VitD supplementation alone in Owt/Ob individuals. (c) 2022 Elsevier Inc. All rights reserved.

Background: South Asian Indians (SAI) have a higher prevalence of both chronic diseases and vitamin D deficiency compared to Caucasians. Previous research shows that vitamin D status is a determinant of metabolic health. SAIs have higher total fat, lower lean mass, and higher visceral or truncal fat compared to Caucasians. These factors are all associated with chronic health conditions at a younger age than their Caucasian counterparts. The study aimed to determine the association between body composition parameters and the biomarkers of vitamin D status and whether these relationships differed between Caucasian and SAI cohorts. Healthy SAIs and Caucasian men, who were 22 to 60 years of age, were enrolled. Anthropometric and body composition measurements, serum levels of 25 Hydroxy-vitamin D (25OHD), Parathyroid Hormone, and Vitamin D Binding-Protein were obtained. Independent t-test and Mann-Whitney u test were used to report the differences between groups. Spearman correlation was used to identify the possible association. A P value of less than 0.05 was considered significant. 30 SAIs and 30 Caucasians completed the study. Both groups did not significantly differ in their age and BMI. The 25OHD levels were statistically different between Caucasians (31.24 ± 9.14 ng/mL) and SAIs (22.94 ± 7.19 ng/mL), (P < 0.01). The correlation analysis found that among Caucasians, percent of Fat Free Mass (FFM), android fat, gynoid fat, visceral adipose tissue (VAT) correlated negatively with 25OHD levels (P < 0.05). Among SAIs, % of FFM, Fat Mass, Lean mass correlated negatively with 25OHD levels (P < 0.05). VAT showed a negative association with vitamin D status in Caucasians only. These findings may have important implications for development of metabolic diseases in young Caucasian vs a SAI population. Drexel CNHP Seed Grant to Dr. Sukumar

Dietary protein alters circulating amino acid (AAs) levels and higher protein intake (HP) is one means of losing weight. We examined 34 overweight and obese women (57 ± 4 years) during 6 months of energy restriction (7.3 ± 3.8% weight loss) divided into groups consuming either normal protein (NP; 18.6 energy% protein) or HP (24.3 energy% protein). There was a reduction in fasting serum glucogenic AAs (p = 0.015) that also associated with greater weight loss (p < 0.05) in the HP group, but not in the NP group. These findings have implications for nutrient prioritization during energy restriction.

Background: Data on dietary magnesium intake on the risk of type 2 diabetes mellitus (T2DM) among children and adolescents is limited. Aim: We examined whether dietary magnesium intake was related to body mass index (BMI) percentile, and glycemic indices at baseline and at end of the HEALTHY Study for both intervention and control schools. The HEALTHY Study was a multi-component, school-based intervention, to prevent T2DM in children and adolescents from 6th to 8th grades. Methods: A secondary data analyses of 2181 ethnically diverse students with completed dietary records, BMI percentile, and plasma insulin and glucose concentrations at baseline (6th grade) and end of study (8th grade) were included from the HEALTHY Study. Dietary magnesium intake was self-reported using the Block Kids Food Frequency Questionnaire. A hierarchical multiple regression model was used to determine the relationships between dietary magnesium intake, BMI percentile, and glycemic indices at baseline and end of the HEALTHY Study, adjusting for magnesium intake from supplements, total energy intake, and fitness level. Results: Dietary magnesium intake was related to BMI percentile at baseline and at end of the HEATHY Study (β = −0.05, 95% CI = −0.02 to 0, p = 0.04; β = −0.06, 95% CI = −0.02 to −0.003, p = 0.004); R 2 [regression coefficient effect size] = 0.03; R 2 = 0.06). Dietary magnesium intake was not related to plasma insulin and glucose concentrations at baseline and end of the HEALTHY Study. Conclusion: Dietary magnesium intake was inversely related to BMI percentile among middle school students from the HEALTHY Study. Research is required to evaluate the dose-response relationship between fruit and vegetable consumption (good sources of magnesium) and risk of T2DM in children and adolescents. This relationship also needs to be explored among different BMI categories.

ABSTRACT Magnesium and vitamin D are two micronutrients that contribute directly to the metabolism of macronutrients, maintenance of muscle function, and various metabolic processes (i.e., protein synthesis and bone metabolism). Dietary recommendations are established based on age and gender differences; however, energy expenditure is not accounted for in determining these values. It is believed that athletes may require greater nutrient quantities than less active populations because of their increased energy expenditure. Nutrient intake values have yet to be determined for athletes, leading to inadequate energy intake, deficiencies, and insufficiencies; thus, supplementation may be an effective way of achieving nutrient adequacy in athletes. The purpose of this narrative review was to present research pertaining to magnesium supplementation and vitamin D supplementation on exercise performance. A systematic keyword search for articles from PubMed was conducted from June to August 2020. The search terms included various words related to the topic. Inclusion criteria required articles to be available in English; to be a clinical trial, randomized controlled trial, or longitudinal study; and to involve magnesium supplementation, vitamin D supplementation, or supplementation of both micronutrients. In addition, the research conducted on magnesium or vitamin D were required to focus on athletes or those who exercised regularly. However, because of the paucity of published data regarding the combined effects of magnesium and vitamin D supplementation on exercise performance, those studies that could provide some information in nonathletic populations were included. The search did not limit the years in which studies were published because of the scarcity of articles related to the topic. After reviewing the articles for originality and applicability, 13 studies were included in our narrative review. Some researchers have reported that magnesium supplementation may provide ergogenic benefits via contributions to muscle function and recovery. In addition, some researchers have reported that vitamin D supplementation may positively affect physical endurance and muscle recovery in athletes. However, more research is required to provide more definitive conclusions. The interactions between magnesium and vitamin D during metabolism may potentiate the functions of each micronutrient, making the combined effects of magnesium and vitamin D greater than the effects of either one alone. However, research is required to elucidate their combined effects on exercise performance.

Background: The HEALTHY Study was a multicomponent school-based intervention, designed to prevent type 2 diabetes mellitus (T2DM) in middle-school students. Objectives: We examined whether the difference in dietary magnesium intake, BMI percentile, and plasma glucose and insulin concentrations from 6th to 8th grade were related in the intervention schools and in the control schools that participated in the HEALTHY Study. Methods: A total of 2181 ethnically diverse students, from 11.3 to 13.7 y of age, with completed dietary records, BMI percentile, and plasma glucose and insulin concentrations at 6th and 8th grades were included. Dietary magnesium intake was self-reported using the Block Kids FFQ. A hierarchical multiple regression model was used to determine whether the differences in dietary magnesium intake, BMI percentile, and plasma glucose and insulin concentrations from 6th to 8th grades were related, while adjusting for dietary calcium intake and total energy intake. Results: The difference in dietary magnesium intake was significantly related to changes in BMI percentile from 6th to 8th grade in intervention and in control schools [intervention: beta: -0.07; 95% CI: -0.58, -0.02; P = 0.03; R-2 (regression coefficient effect size): 0.14; 95% CI for R-2: 0.10, 0.17; control: beta: -0.08; 95% CI: -0.63, -0.09; P = 0.01; R-2: 0.12; 95% CI for R-2: 0.08, 0.15]. The difference in dietary magnesium intake was not related to plasma glucose and insulin concentrations in intervention and in control schools. Conclusions: We conclude that a multicomponent intervention was associated with reduced risk of T2DM, and that this association may be modulated, in part, by magnesium. The differences in dietary magnesium intake from 6th to 8th grade were negatively related to changes in BMI percentile among middle-school students.