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Assessing the Impact of Dietary Calcium–Magnesium Ratio on Calciotrophic Hormones and Body Composition Using Validated Food Frequency Questionnaires
Journal article   Open access   Peer reviewed

Assessing the Impact of Dietary Calcium–Magnesium Ratio on Calciotrophic Hormones and Body Composition Using Validated Food Frequency Questionnaires

Emad Aldeen Alsayed, Patricia A. Shewokis, Jennifer Nasser and Deeptha Sukumar
Dietetics, v 5(1), 7
23 Jan 2026
DOI: https://doi.org/10.3390/dietetics5010007
Featured in Collection :   Research Supported by Drexel Libraries' OA Programs
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https://doi.org/10.3390/dietetics5010007View
Published, Version of Record (VoR)Open Access Discount via Drexel Libraries Read and Publish Program 2026CC BY V4.0,  Open

Abstract

calcium-to-magnesium ratio (Ca:Mg) vitamin D parathyroid hormone food frequency questionnaire (FFQ) dietary assessment body composition ethnic differences age differences metabolic syndrome
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.

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