الفهرس 
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Abstract
Childhood obesity is one of the most alarming challenges developing in today’s world. According to the Global Health Observatory Data 2017 by World Health Organization (WHO), there are over 340 million obese children and adolescents aged 5–19. Since 2000, the mean BMI has plateaued, usually at high levels, in many high-income countries, but has continued to rise in low- and middle-income countries. In 2019, the World Obesity Federation estimated there would be 206 million children and adolescents aged 5–19 years living with obesity in 2025, and 254 million in 2030, with the highest percentage in China, followed by India, the USA, Indonesia, and Brazil, and with only seven of the top 42 countries being high-income countries.
In Egypt, previous studies indicated that obesity is an important public health problem among school children. A cross sectional survey conducted in 2018 including 31270 children in school age period in Egypt aged 6-12 years old, found that 15.02% was overweight and 10.55% was obese, and prevalence among boys (14.2%) was more than girls (6.7%).
Consequences of obesity in childhood, include insulin resistance, type 2 diabetes mellitus and increased incidences of metabolic syndrome. Thus, the early detection and prevention of obesity in children is essential.
Magnesium is an important cofactor for enzymes involved in carbohydrate metabolism. obese subjects are often Mg deficient. A significantly strong inverse relationship was seen between serum magnesium levels and body mass index. Also, a strong relationship between magnesium and insulin action has been reported. Low serum and intracellular magnesium concentrations are associated with IR, impaired glucose tolerance, and decreased insulin secretion.
The aim of our study was to study the relation between insulin resistance and serum magnesium level in obese children and assess the effect of magnesium supplementation on insulin sensitivity in obese children.
This current study was a cross sectional interventional one which included 60 obese children in the age range of 6 - 18 years with BMI at 95th centile or more according to CDC growth charts. They were recruited from Pediatric Outpatient clinics in Tur Sinai district, South Sinai during the period between November 2022 till July 2023. All cases were subjected to 24 hours dietary recall, full anthropometric measurements including weight, height, WHR, WHtR and BMI, and Z scores, laboratory investigations including serum magnesium, fasting blood glucose, fasting insulin and HOMA IR was calculated. Additionally, a tailored nutritional program for diet adjustment and exercise program was done for all participants. Then, they were randomly divided into two groups. Only one group received oral daily supplemental magnesium at dose of 300 mg/day for three months in addition to the tailored nutritional rehabilitation program and exercise schedule that all patients followed. Follow up was done monthly for all patients by taking full anthropometric measurements and 24 hours dietary recall. At the end of the three months, laboratory investigations were repeated. Then the results of both groups were compared.
In the current study, obesity was more common in males, with 58.3 % were males and 41.6% were females. Regarding anthropometric measurements, WHR showed increased level ranging between 0.85 and 1.05 with 59 cases reaching the high-risk level. Also, WHtR showed increased level > 0.5 indicating central obesity in all cases and it ranged between 0.55 and 0.92.
Concerning laboratory investigations, serum magnesium level was low in 39 cases (65 %), fasting blood glucose was high reaching prediabetic level in 39 cases (65%), fasting insulin was high in 45 cases (75 %) and HOMA IR showed severe level in 33 cases (55%) and moderate level in 15 cases (25 %).
Upon applying the nutritional intervention program and exercise for three months, the nutritional analysis showed significant decrease in energy and carbohydrates and significant increase in proteins.
Regarding the effect of nutritional intervention and exercise programs on anthropometric measurements in obese children in group A, there was a significant increase in height and height z score between visits with P-value<0.001. On the other hand, there was significant decrease in weight and Waist/Hip ratio group with P-value 0.007. Additionally, there was significant decrease in BMI and BMI z-score between with P-value <0.001. And there was significant decrease in Waist/Hip ratio and Waist/Ht ratio with P-value 0.013 and 0.000 respectively.
The current study showed significant effect of magnesium supplementation with nutritional intervention and exercise programs on anthropometric measurements in obese children in group B. There was significant increase in height and, height z score between visits in group B with P-value <0.001. On the other hand, there was significant decrease in weight, BMI and BMI z-score between visits with P-value <0.001. In addition, there was significant decrease in Waist/Hip ratio and Waist/Ht ratio between visits with P-value 0.011 and 0.003 respectively. BMI z-score group showed significant decrease in number of obese cases between visits from 30 to 24 , and also showed increase in number of overweight between visits from 0 to 6 with P-value 0.043. Additionally, Waist/Hip group showed significant decrease in number of cases with high-risk waist/hip ratio from 29 to 20, and there was increase in number of cases with good waist/hip ratio from 0 to 6 with P-value 0.002.
In group A, after nutritional intervention and exercise programs there was significant decrease in FG, fasting insulin and HOMA IR with P-values 0.035, 0.008 and 0.006 respectively.
Adding magnesium supplements to nutritional intervention and exercise program in group B, there was significant reduction in FG level and significant improvement in FG group with P-value 0.004 and 0.038 respectively, Also, there was significant reduction in fasting insulin and HOMA IR with P-value 0.001 for each. Also, there was significant increase in magnesium level and significant improvement in Mg group with P-value <0.001.
In the current study, regarding percentage of change in the laboratory results between the first and third visits in the two groups, there was significant higher change in magnesium level between the first visit and the third visit in group B with P- value 0.000, and with median(IQR) 78.41 (27.27 – 128.57) compared to median(IQR) 0 (-5.88 – 25) in group A. Additionally, in our study, in group B there was more improvement with more reduction in FBG with median(IQR) -7.01 (-16.67 – 3.26) compared with -5 (-11.76 – 4.42) in group A. Also, there was more improvement with more reduction in fasting insulin in group B with median (IQR) -12.3 (-25.82 – 0) compared with -7.97 (-27.59 – 7.14) in group A. Moreover, there was more reduction in HOMA IR in group B indicating more improvement with mean (IQR) -21.75 (-36.67 – -1.96) compared with -16.71 (-36.84 – 8.75) in group A. However, these changes were statistically non-significant and that may be due to limited study time and limited number of cases in our study.
In conclusion, the current study concludes that serum magnesium level was low in obese children. Additionally, there was a significant negative correlation between serum magnesium level and fasting blood glucose, fasting insulin and HOMA IR. Supplementing Mg to obese children had the benefit of improving hypomagnesaemia and thus improving insulin resistance in obese children especially if combined with proper nutritional and exercise programs.