Magnesium and C-reactive protein in heart failure: an anti-inflammatory effect of magnesium administration?

Prognostic Value of the Magnesium Depletion Score for Mortality Outcomes Among NAFLD Patients

BACKGROUND

The magnesium depletion score (MDS), a novel clinical score, incorporates alcohol consumption, kidney disease, use of diuretics and proton pump inhibitors (PPIs) to assess magnesium levels. However, the prognostic significance of the MDS individuals with nonalcoholic fatty liver disease (NAFLD) remains uncertain. This research aimed to explore the relationship between the MDS and mortality outcomes in NAFLD patients, including all-cause mortality, cancer mortality, and cardiovascular disease (CVD) mortality.

METHOD

Data acquired on 16,394 NAFLD patients from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018 were analyzed in this cohort study. Mortality outcomes were assessed using the linked National Death Index, which included all-cause mortality, cancer mortality, and CVD mortality. Cox proportional hazards models were used to determine the hazard ratios (HRs) for mortality outcomes related to the MDS. Subgroup analyses were also performed to explore the potential modifying influences of different demographic and clinical characteristics.

RESULT

An elevated MDS was associated with significantly higher risks of all-cause mortality (HR 1.22; 95% CI, 1.15-1.30), cancer mortality (HR 1.15; 95% CI, 1.03-1.28), and CVD mortality (HR 1.33; 95% CI, 1.18-1.51). While these associations remained consistent in many subgroups, factors such as gender, education level, and alcohol consumption influenced the link between the MDS and mortality.

CONCLUSION

The MDS is as an innovative and feasible prognostic indicator for mortality among NAFLD patients. Incorporating the MDS into clinical practice could improve risk stratification and inform targeted interventions aimed at diminishing the risk of mortality linked to magnesium deficiency within this group.

Dietary Magnesium Intake in Relation to Depression in Adults: A GRADE-Assessed Systematic Review and Dose-Response Meta-analysis of Epidemiologic Studies

CONTEXT

The relation of magnesium (Mg) intake with depression was previously investigated by meta-analyses. However, due to limited data, a dose-response analysis was not performed.

OBJECTIVE

Considering the recently published articles, a systematic review and dose-response meta-analysis was conducted to summarize the relation of dietary Mg intake with depression in adults.

DATA SOURCES

Medline (PubMed), ISI Web of Science, Scopus, and Google Scholar were comprehensively searched up to August 2023.

DATA EXTRACTION

Observational studies that reported the relation of dietary Mg intake and depression in adults were included and their data were extracted.

DATA ANALYSIS

A total of 63 214 participants from 10 cross-sectional and 3 cohort studies were included in the current study. Pooling 15 effect sizes from 12 studies (including 50 275 participants) revealed that individuals with the highest Mg intake had a 34% lower risk of depression, compared with those with the lowest Mg intake (RR: 0.66; 95% CI: 0.57, 0.78). Moreover, the linear dose-response analysis revealed that each 100-mg/d increment in Mg intake was associated with a 7% reduced risk of depression (RR: 0.93; 95% CI: 0.90, 0.96). Additionally, based on nonlinear dose-response analysis, increasing Mg intake from 170 to 370 mg/d was associated with a reduced risk of depression. Analyses were also conducted on 9 studies (49 558 participants) with representative populations, and similar results were found in the meta-analysis (RR: 0.71; 95% CI: 0.61, 0.83) and linear (RR: 0.93; 95% CI: 0.90, 0.96) and nonlinear dose-response analysis.

CONCLUSION

The current study shows an inverse dose-dependent association between dietary Mg intakes and risk of depression in both a general and representative population of adults in a dose-response manner.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42024506570.

Propensity score matched cohort study on magnesium supplementation and mortality in critically ill patients with HFpEF

Heart failure with preserved ejection fraction (HFpEF) emerges as a singular subclass of heart failure, bereft of specific therapeutic options. Magnesium, an indispensable trace element, is essential to the preservation of cardiac integrity. However, the association between magnesium supplementation and mortality in HFpEF patients remains unclear. This study extracted HFpEF patient data from the MIMIC-IV database between 2008 and 2019. Propensity score matching was conducted to ensure that patients receiving magnesium supplementation (including magnesium sulfate and magnesium oxide) were balanced with those not receiving it in terms of baseline characteristics. The primary analysis focused on the 28-day all-cause mortality rate, with secondary endpoints encompassing ICU and one-year mortality rates, along with the duration of hospitalization. After matching, the study's final cohort balanced at 1970 patients, with 985 patients per group. The results showed that magnesium intake significantly contributed to a decrease in the 28-day all-cause mortality rate (hazard ratio [HR], 0.682; 95% confidence interval [CI], 0.539-0.863), particularly in subgroups such as older patients (HR, 0.65; 95% CI 0.52-0.81), females (HR, 0.55; 95% CI 0.41-0.73), and those with hypertension (HR, 0.62; 95% CI 0.48-0.79) or without diabetes (HR, 0.54; 95% CI 0.41-0.71). Although magnesium treatment improved both ICU and one-year mortality rates, it concurrently resulted in extended ICU and hospital stays. Mediation analysis indicated that blood urea nitrogen partially mediated the association between magnesium intake and mortality, accounting for approximately 22.73% of the observed effect. Magnesium supplementation has illustrated a significant potential for mitigating the mortality rate in the HFpEF patient, particularly among the elderly, female, and individuals with hypertension. Therefore, magnesium supplementation stands as a potentially valuable supplementary treatment modality for patients with HFpEF. Further comprehensive research is warranted to explore its effects more deeply.

Association between magnesium depletion score and the risk of metabolic dysfunction associated steatotic liver disease: a cross sectional study

The relationship between magnesium deficiency and metabolic dysfunction associated steatotic liver disease (MASLD) remains unclear. This study aimed to examine the association between the magnesium depletion score (MDS) and the risk of MASLD, as well as explore potential underlying mechanisms. Data from 12,024 participants from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were analyzed. MDS was calculated based on the use of diuretics and proton pump inhibitors, kidney function, and alcohol consumption. MASLD was defined using the fatty liver index. Logistic regression, restricted cubic spline analysis, and mediation analyses were conducted to evaluate the association between MDS and MASLD and to identify potential mediators. A higher MDS was significantly associated with an increased risk of MASLD (OR = 2.00, 95% CI [1.47, 2.74] for MDS 3 vs. 0). A dose-response relationship between MDS and MASLD risk was observed. Neutrophils, albumin, and white blood cells partially were identified as partial mediators of the association, with albumin exhibiting the highest mediating effect (14.05%). Elevated MDS is significantly associated with an increased risk of MASLD in U.S. adults. Inflammation and albumin may serve as potential mediators of this relationship. These findings underscore the importance of addressing magnesium deficiency in the prevention and management of MASLD.

The Integral Role of Magnesium in Muscle Integrity and Aging: A Comprehensive Review

Aging is characterized by significant physiological changes, with the degree of decline varying significantly among individuals. The preservation of intrinsic capacity over the course of an individual's lifespan is fundamental for healthy aging. Locomotion, which entails the capacity for independent movement, is intricately connected with various dimensions of human life, including cognition, vitality, sensory perception, and psychological well-being. Notably, skeletal muscle functions as a pivotal nexus within this intricate framework. Any perturbation in its functionality can manifest as compromised physical performance and an elevated susceptibility to frailty. Magnesium is an essential mineral that plays a central role in approximately 800 biochemical reactions within the human body. Its distinctive physical and chemical attributes render it an indispensable stabilizing factor in the orchestration of diverse cellular reactions and organelle functions, thereby rendering it irreplaceable in processes directly impacting muscle health. This narrative review offers a comprehensive exploration of the pivotal role played by magnesium in maintaining skeletal muscle integrity, emphasizing the critical importance of maintaining optimal magnesium levels for promoting healthy aging.

Effects of lacto-ovo-vegetarian diet vs. standard-weight-loss diet on obese and overweight adults with non-alcoholic fatty liver disease: a randomised clinical trial

The aim of the study was to compare the effects of a lacto-ovo-vegetarian diet (LOV-D) vs. a standard weight-loss diet (SWL-D) on obese/overweight adults with NAFLD. Present randomised clinical trial recruited 75 overweight/obese adults with NAFLD, who were randomly assigned into LOV-D and SWL-D groups for 3 months. The LOV-D was designed based on eliminating meat, poultry, and fish; while including dairy products and eggs. The SWL-D was planned according to the standard food pyramid, which was free in all sources of food. Adherence to LOV-D significantly outperformed SWL-D in reducing levels of alanine aminotransferase (ALT), body weight, waist circumference, BMI, fasting blood sugar, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), triacylglycerol (TG), cholesterol, low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP). Furthermore, ultrasonography revealed a higher alleviation in NAFLD grade among LOV-D, compared with SWL-D. This study suggests that adherence to LOV-D for 3 months has beneficial effects on NAFLD improvement, anthropometric measures, glycaemic-related markers, and lipid profiles.

Role of Magnesium in the Intensive Care Unit and Immunomodulation: A Literature Review

Both the role and the importance of magnesium in clinical practice have grown considerably in recent years. Emerging evidence suggests an association between loss of magnesium homeostasis and increased mortality in the critical care setting. The underlying mechanism is still unclear, but an increasing number of in vivo and in vitro studies on magnesium's immunomodulating capabilities may shed some light on the matter. This review aims to discuss the evidence behind magnesium homeostasis in critically ill patients, and its link with intensive care unit mortality via a likely magnesium-induced dysregulation of the immune response. The underlying pathogenetic mechanisms, and their implications for clinical outcomes, are discussed. The available evidence strongly supports the crucial role of magnesium in immune system regulation and inflammatory response. The loss of magnesium homeostasis has been associated with an elevated risk of bacterial infections, exacerbated sepsis progression, and detrimental effects on the cardiac, respiratory, neurological, and renal systems, ultimately leading to increased mortality. However, magnesium supplementation has been shown to be beneficial in these conditions, highlighting the importance of maintaining adequate magnesium levels in the intensive care setting.

Magnesium Improves Cardiac Function in Experimental Uremia by Altering Cardiac Elastin Protein Content

Cardiovascular complications are accompanied by life-threatening complications and represent the major cause of death in patients with chronic kidney disease (CKD). Magnesium is important for the physiology of cardiac function, and its deficiency is common in CKD. In the present study, we investigated the impact of oral magnesium carbonate supplementation on cardiac function in an experimental model of CKD induced in Wistar rats by an adenine diet. Echocardiographic analyses revealed restoration of impaired left ventricular cardiac function in animals with CKD. Cardiac histology and real-time PCR confirmed a high amount of elastin protein and increased collagen III expression in CKD rats supplemented with dietary magnesium as compared with CKD controls. Both structural proteins are crucial in maintaining cardiac health and physiology. Aortic calcium content increased in CKD as compared with tissue from control animals. Magnesium supplementation numerically lowered the increases in aortic calcium content as it remained statistically unchanged, compared with controls. In summary, the present study provides evidence for an improvement in cardiovascular function and aortic wall integrity in a rat model of CKD by magnesium, as evidenced by echocardiography and histology.

The effect of the Dietary Approaches to Stop Hypertension (DASH) diet on body composition, complete blood count, prothrombin time, inflammation and liver function in haemophilic adolescents

There is no dietary strategy that has yet been specifically advocated for haemophilia. Therefore, we sought to assess the effect of the Dietary Approaches to Stop Hypertension (DASH) diet in adolescents with haemophilia. In this parallel trial, forty male adolescents with haemophilia were dichotomised into the DASH group or control group for 10 weeks. The serum high sensitivity C-reactive protein, IL-6, complete blood count (CBC), serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, partial thromboplastin time (PTT), waist circumference (WC), percentage of body fat, fat-free mass and liver steatosis were measured at the beginning and end of the study. Serum vitamin C was measured as a biomarker of compliance with the DASH diet. The DASH diet was designed to include high amounts of whole grains, fruits, vegetables and low-fat dairy products, as well as low amounts of saturated fats, cholesterol, refined grains, sweets and red meat. Serum vitamin C in the DASH group was significantly increased compared with the control (P = 0·001). There was a significant reduction in WC (P = 0·005), fat mass (P = 0·006), hepatic fibrosis (P = 0·02) and PTT (P = 0·008) in the DASH group, compared with the control. However, there were no significant differences regarding other selected outcomes between groups. Patients in the DASH group had significantly greater increase in the levels of erythrocyte, Hb and haematocrit, as compared with the control. Adherence to the DASH diet in children with haemophilia yielded significant beneficial effects on body composition, CBC, inflammation and liver function.

Magnesium Disorders and Prognosis in Heart Failure: A Systematic Review

Magnesium is an essential mineral for the human body and plays an important role in cardiovascular health. Hypomagnesaemia has been linked with increased cardiovascular mortality in heart failure; however, previous studies have yielded conflicting results. Even fewer studies have addressed the association between hypermagnesemia and prognosis in heart failure. The aim of the present systematic review was to investigate the association of serum magnesium levels with cardiovascular and all-cause mortality in patients with heart failure and reduced ejection fraction (HFrEF). Cardiovascular morbidity, referring to heart failure rehospitalizations and ventricular arrhythmias, was also investigated. Eligible studies were identified by searching PubMed and Scopus. The Quality in Prognosis (QUIPS) tool was used to assess the quality of included studies. Eight studies (total of 13,539 patients with HFrEF) that assessed the effects of serum magnesium levels on cardiovascular mortality, all-cause mortality, and cardiovascular morbidity met inclusion criteria. In half of the studies, hypomagnesemia was found to be an independent risk factor for cardiovascular mortality, including sudden cardiac death. Only 1 study reported that hypermagnesemia (serum magnesium levels above 2.4 mg/dL) is a prognostic factor for noncardiac mortality suggesting that hypermagnesemia is more likely an indicator of comorbidities rather than a true independent prognostic marker. Finally, low serum magnesium levels were not associated with readmissions for heart failure or ventricular arrhythmias in patients with HFrEF.

The Role of Magnesium in the Pathogenesis of Metabolic Disorders

Magnesium (Mg) is an essential nutrient for maintaining vital physiological functions. It is involved in many fundamental processes, and Mg deficiency is often correlated with negative health outcomes. On the one hand, most western civilizations consume less than the recommended daily allowance of Mg. On the other hand, a growing body of evidence has indicated that chronic hypomagnesemia may be implicated in the pathogenesis of various metabolic disorders such as overweight and obesity, insulin resistance (IR) and type 2 diabetes mellitus (T2DM), hypertension (HTN), changes in lipid metabolism, and low-grade inflammation. High Mg intake with diet and/or supplementation seems to prevent chronic metabolic complications. The protective action of Mg may include limiting the adipose tissue accumulation, improving glucose and insulin metabolism, enhancing endothelium-dependent vasodilation, normalizing lipid profile, and attenuating inflammatory processes. Thus, it currently seems that Mg plays an important role in developing metabolic disorders associated with obesity, although more randomized controlled trials (RCTs) evaluating Mg supplementation strategies are needed. This work represents a review and synthesis of recent data on the role of Mg in the pathogenesis of metabolic disorders.

The Effect of Oral Magnesium Supplementation on Inflammatory Biomarkers in Adults: A Comprehensive Systematic Review and Dose-response Meta-analysis of Randomized Clinical Trials

This is a comprehensive systematic review and dose-response meta-analysis evaluating the effects of oral magnesium supplementation on inflammatory biomarkers including C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) among adults. The major databases including PubMed, Web of Science, Embase, and Google Scholar were searched for relevant publications until December 14, 2020, using appropriate keywords. The Cochrane Collaboration tool was used to assess the quality of each study. We also performed a subgroup analysis to identify probable sources of heterogeneity. A total of 18 studies with 927 participants fulfilled the eligibility criteria and included in this meta-analysis. Our results indicate that the supplementation with magnesium had no statistically significant effect on serum concentrations of CRP (WMD, - 0.49; 95% CI, - 1.72 to 0.75 mg/L; P = 0.44), IL-6 (WMD, - 0.03; 95% CI, - 0.40 to 0.33 pg/mL; P = 0.86), and TNF-α (WMD, 0.12; 95% CI, - 0.08 to 0.31 pg/mL; P = 0.24) compared with controls. In addition, based on dose-response assessment, no significant non-linear association was found between magnesium supplementation dosage or duration on serum CRP and IL-6 concentrations. The findings of the present systematic review and meta-analysis did not support the notion that oral magnesium supplementation could have favorable effects on CRP, IL-6, and TNF-α in the adult population.

Proton pump inhibitor therapy and risk of knee replacement surgery: a general population-based cohort study

OBJECTIVE

Proton pump inhibitors (PPIs) are among the most commonly used medications for patients with osteoarthritis (OA). Various types of PPIs have different impacts on lowering serum magnesium level that may affect knee OA progression. We aimed to compare the risk of clinically relevant endpoint of knee replacement (KR) among initiators of five different PPIs with that among histamine-2 receptor antagonist (H2RA) initiators.

DESIGN

Among patients with knee OA (≥50 years) in The Health Improvement Network database in the UK we conducted five sequential propensity-score matched cohort studies to compare the risk of KR over 5-year among patients who initiated omeprazole (n = 2,672), pantoprazole (n = 664), lansoprazole (n = 3,747), rabeprazole (n = 751), or esomeprazole (n = 827) with those who initiated H2RA.

RESULTS

The prevalence of PPI prescriptions among participants with knee OA increased from 12.7% in 2000-44.0% in 2017. Two-hundred-and-seventy-four KRs (30.8/1,000 person-years) occurred in omeprazole initiators and 230 KRs (25.4/1,000 person-years) in H2RA initiators. Compared with H2RA initiators, the risk of KR was 21% higher in omeprazole initiators (hazard ratio [HR] = 1.21,95% confidence interval [CI]:1.01-1.44). Similar results were observed when pantoprazole use was compared with H2RA use (HR = 1.38,95%CI:1.00-1.90). No such an increased risk of KR was observed among lansoprazole (HR = 1.06,95%CI:0.92-1.23), rabeprazole (HR = 0.97,95%CI:0.73-1.30), or esomeprazole (HR = 0.83,95%CI:0.60-1.15) initiators compared with that among H2RA initiators.

CONCLUSIONS

In this population-based cohort study, initiation of omeprazole or pantoprazole use was associated with a higher risk of KR than initiation of H2RA use. This study raises concern regarding an unexpected risk of omeprazole and pantoprazole on accelerating OA progression.

Integrating supplementation in the management of patients with heart failure: an evidence-based review

INTRODUCTION

Complementary, alternative and integrative medicine includes a myriad of therapies including herbal medicines, vitamins, dietary interventions and more, that are taken alone or in adjunct to standard conventional treatment. Often the main goals are to slow progression of disease, increase effectiveness of a drug, reduce side effects and improve quality of life. The study of these therapies and their influence in heart failure is not new. However, even for an experienced clinician, a gap exists between the literature and the application of knowledge to make a confident recommendation.

AREAS COVERED

This review has a focus on specific supplements that are commonly used for individuals with HF. It discusses the mechanism of action, expected benefits, potential adverse effects, suggested doses, forms and drug interactions of these therapies. The literature search methodology included using medical subject headings terms to search in PubMed. Articles used were screened and critically appraised by the authors of this review.

EXPERT OPINION

There are promising outcomes pertaining to the use of CAM in patients with HF. Advances in large scale, randomized, placebo-controlled trials are necessary to support evidence-based decision making regarding the use of supplements in conjunction, and in comparison, to conventional therapies for heart failure.

Intravenous magnesium sulfate for prevention of vancomycin plus piperacillin-tazobactam induced acute kidney injury in critically ill patients: An open-label, placebo-controlled, randomized clinical trial

BACKGROUND

Recent studies have shown an increased risk of acute kidney injury (AKI) induced by vancomycin + piperacillin-tazobactam (VPT) combination. In this study, the efficacy of intravenous magnesium sulfate in prevention of VPT induced AKI in critically ill patients admitted to the ICU has been evaluated.

METHODS

In an open-label, placebo-controlled, randomized clinical trial, 72 adults (≥ 18 years old) who had indications to receive VPT as empiric therapy were assigned to the magnesium or control group in 1:1 ratio. Concomitant with VPT, intravenous infusion of magnesium sulfate was started for patients in the magnesium group. The target serum level of magnesium was defined 3 mg/dl. Patients in the control group received normal saline as placebo. The target serum level of magnesium was defined 1.9 mg/dl in this group. The study's primary outcome was incidence of AKI during and up to 48 h after the treatment course. Escalation and de-escalation of VPT regimen, duration of hospitalization, length of ICU stay and 28-day mortality were secondary outcomes.

RESULTS

Thirty patients in each group completed the examination. Five patients in the magnesium group and 11 patients in the control group experienced AKI (p = 0.072). De-escalation of VPT regimen was done approximately in 60% of patients. Duration of hospitalization and length of ICU stay were not statistically different between the groups. Finally, 28-day mortality was 23.33% in each group. Although the incidence of AKI was not statistically different between the groups in unadjusted logistic regression model, it became significant after adjusting for confounding factors [unadjusted model (OR = 0.34; 95% CI: 0.10-1.16, p = 0.084), adjusted model: (OR = 0.26; 95% CI: 0.07-0.96, p = 0.04)].

CONCLUSIONS

Administration of magnesium sulfate with the target serum levels around 3 mg/dL reduced the incidence of AKI in critically ill patients who were receiving VPT as empric therapy.

Randomized Study of the Effects of Vitamin D and Magnesium Co-Supplementation on Muscle Strength and Function, Body Composition, and Inflammation in Vitamin D-Deficient Middle-Aged Women

This study aimed to investigate the effects of vitamin D and magnesium co-supplementation on muscle strength and function, body composition, and inflammation in vitamin D-deficient middle-aged women. In this study, 83 healthy middle-aged women (40-55 years) with vitamin D deficiency were randomly assigned into two groups: (1) intervention: receiving a 50,000-IU vitamin D soft gel (weekly) plus a 250-mg magnesium tablet (daily); (2) control: receiving a vitamin D placebo (weekly) plus a magnesium placebo (daily), for 8 weeks. Before and after the intervention, anthropometric indices, muscle strength, muscle function, and some inflammatory markers were measured. After 8 weeks of supplementation, significant difference was observed in handgrip strength and time for Time Get Up and Go (TGUG) test between the intervention and placebo groups (P < 0.05). Regarding percentage of fat mass (FM%) and fat free mass (FFM%), and knee extension strength, there was no significant difference between the two groups at the end of intervention (P > .05). Serum 25(OH)-D levels increased significantly (P < 0.001) and its change was significantly different between the two groups, at the end of the intervention (P < 0.001). Serum level of hs-CRP decreased significantly in the intervention group compared to baseline (P < 0.001), and the change in hs-CRP was significant between the two groups at the end of the intervention (P < 0.01). Furthermore, serum level of TNF-α declined significantly in the intervention group compared to baseline (P < 0.001) but, no significant differences were seen between the two groups in regard of serum levels of TNF-α and IL-6 after the intervention (P > 0.05). Our findings show that vitamin D and magnesium co-supplementation, for 8 weeks, in healthy middle-aged women with vitamin D deficiency have beneficial impacts on muscle strength, muscle function, and probably inflammation.

Prevention of vancomycin-induced nephrotoxicity; an update review of clinical and preclinical studies

PURPOSE

Clinical and preclinical evidences regarding new strategies for prevention of vancomycin-induced nephrotoxicity are reviewed.

METHODS

Evidence from 2014 to end of 2019 was included. Finally, twelve animal studies and one clinical trial were evaluated.

RESULTS

Although incidence of vancomycin-induced nephrotoxicity was not reduced significantly in the clinical trial, antioxidants reduced incidence of vancomycin-induced nephrotoxicity in preclinical studies.

CONCLUSIONS

Antioxidants including vitamin C, vitamin E, cilastatin, melatonin, zingerone, rutin, naringenin, saffron, silymarin and dexmedetomidine were nephroprotective against vancomycin-induced nephrotoxicity in preclinical studies. The nephroprotective effects of these antioxidants must be confirmed before routine use in the clinical practice.

'Magnesium'-the master cation-as a drug-possibilities and evidences

Magnesium (Mg²⁺) is the 2nd most abundant intracellular cation, which participates in various enzymatic reactions; there by regulating vital biological functions. Magnesium (Mg²⁺) can regulate several cations, including sodium, potassium, and calcium; it consequently maintains physiological functions like impulse conduction, blood pressure, heart rhythm, and muscle contraction. But, it doesn't get much attention in account with its functions, making it a "Forgotten cation". Like other cations, maintenance of the normal physiological level of Mg²⁺ is important. Its deficiency is associated with various diseases, which point out to the importance of Mg²⁺ as a drug. The roles of Mg²⁺ such as natural calcium antagonist, glutamate NMDA receptor blocker, vasodilator, antioxidant and anti-inflammatory agent are responsible for its therapeutic benefits. Various salts of Mg²⁺ are currently in clinical use, but their application is limited. This review collates all the possible mechanisms behind the behavior of magnesium as a drug at different disease conditions with clinical shreds of evidence.

Magnesium and inflammation: Advances and perspectives

Magnesium is an essential element of life, involved in the regulation of metabolism and homeostasis of all the tissues. It also regulates immunological functions, acting on the cells of innate and adaptive immune systems. Magnesium deficiency primes phagocytes, enhances granulocyte oxidative burst, activates endothelial cells and increases the levels of cytokines, thus promoting inflammation. Consequently, a low magnesium status, which is often underdiagnosed, potentiates the reactivity to various immune challenges and is implicated in the pathophysiology of many common chronic diseases. Here we summarize recent advances supporting the link between magnesium deficiency, inflammatory responses and diseases, and offer new hints towards a better understanding of the underlying mechanisms.

Relationship between dietary magnesium intake and rheumatoid arthritis in US women: a cross-sectional study

OBJECTIVES

Diet has been shown to be associated with rheumatoid arthritis (RA), and magnesium has been shown to inhibit inflammatory responses, but research on the relationship between dietary magnesium and RA is limited and controversial. In this study, we aimed to explore the non-linear relationship between dietary magnesium intake and RA in US women.

DESIGN

Cross-sectional survey.

SETTING

National Health and Nutrition Examination Survey (NHANES).

PRIMARY AND SECONDARY OUTCOME MEASURES

Non-linear relationship between dietary magnesium intake and prevalence of RA.

PARTICIPANTS

A total of 13 324 women aged 18-80 years (RA n=12 306, non-RA n=1018) were included in this study.

RESULTS

Overall, the absolute risk (AR) of RA was 7.24% in all participants. In the multivariable logistic regression analysis, we found a negative correlation between dietary magnesium intake and RA (OR=0.84, 95% CI 0.75 to 0.95, p=0.006). When we converted dietary magnesium intake into a categorical variable (tertiles), the ARs of the low group, the middle group and the high group were 9%, 7.1% and 4.9%, respectively. We noticed that the ORs between the three groups were not equidistant; then, we detected a U-shaped linking by smooth curve fitting and obtained inflection points at 181 and 446 mg/day. The prevalence of RA decreased when dietary magnesium intake was <181 mg/day (OR=0.7, 95% CI 0.5 to 0.8, p<0.001) and increased when it was >446 mg/day (OR=2.8, 95% CI 1.2 to 6.6, p=0.020), remaining at a minimum when it was between 181 and 446 mg/day (OR=1.0, 95% CI 0.7 to 1.2, p=0.700).

CONCLUSION

There was a U-shaped relationship between dietary magnesium and RA in women, and our study highlights the importance of moderate dietary magnesium intake in possibly exerting a protective role in women with RA.

Effect of DASH diet on oxidative stress parameters: A systematic review and meta-analysis of randomized clinical trials

BACKGROUND AND AIMS

Oxidative stress (OS) is one of the main risk factors for several chronic diseases. The Dietary Approaches to Stop Hypertension (DASH) contain many antioxidants and may contribute to managing OS.

OBJECTIVE

To perform a systematic review and meta-analysis to examine the impacts of the DASH diet on OS parameters.

METHODS

A comprehensive electronic search in MEDLINE, Scopus, EMBASE, and the Cochrane Central Register of Controlled Trials was performed through September 2020 to find related studies evaluating the impact of the DASH diet on OS parameters. Standardized mean differences were pooled using random-effects meta-analysis.

RESULTS

Eight studies with a total of 317 subjects met our inclusion criteria. Four studies included in meta-analysis model with 200 participants (100 in treatment and 100 in control group). The DASH diet was associated with a statistically significant decrease in malondialdehyde (MDA) (SMD: -0.53; 95% CI: -0.89, -0.16; I² = 42.1%), and a significant increase in glutathione (GSH) (SMD: 0.83; 95% CI: 0.36, 1.03; I² = 42.1%). Meta-analysis found no statistically significant effect of DASH diet on nitric oxide (NO) (SMD: -1.40; 95% CI: -0.12, 1.93; I² = 92.6%) or total antioxidant capacity (TAC) levels (SMD: 0.95; 95% CI: -0.10, 1.99; I² = 87.6%).

CONCLUSION

Our results demonstrated that a DASH diet could significantly increase GSH and decrease MDA levels. Furthermore, there is a trend to improve TAC, NO, and f2-isoprostanes by the adherence to the DASH diet. However, long-term, large sample size and well-designed randomized clinical trials are still needed to draw concrete conclusions about DASH diet's effects on OS parameters.

Magnesium, Oxidative Stress, Inflammation, and Cardiovascular Disease

Hypomagnesemia is commonly observed in heart failure, diabetes mellitus, hypertension, and cardiovascular diseases. Low serum magnesium (Mg) is a predictor for cardiovascular and all-cause mortality and treating Mg deficiency may help prevent cardiovascular disease. In this review, we discuss the possible mechanisms by which Mg deficiency plays detrimental roles in cardiovascular diseases and review the results of clinical trials of Mg supplementation for heart failure, arrhythmias and other cardiovascular diseases.

Associations of different types of dairy intakes with depressive symptoms in adults

BACKGROUND

Current evidence on the associations between different types of milk products and depressive symptoms is few and controversial, and there has been no study focusing on different types of milk (whole-fat, low-fat, and skim). This study aimed to appraise their associations.

METHODS

This cross-sectional study included adults (N=21,924) from the National Health and Nutrition Examination Survey 2007-2016. Patient Health Questionnaire was used to evaluate depressive symptoms. Logistic regression model was implemented to assess the association of dairy consumption with depressive symptoms.

RESULTS

After multivariate adjustment, compared to non-consumers, the odds ratios (95% confidence intervals) of depressive symptoms for intake < 175.38 g/d and 175.38 to < 321.56 g/d of skim milk were 0.48 (0.27-0.85) and 0.46 (0.29-0.75), and 0.70 (0.55-0.88) for intake < 81.00 g/d of milk desserts, while 1.61 (1.05-2.46), 1.70 (1.15-2.50) and 1.55 (1.11-2.16) for intake < 129.63 g/d, 129.63 to < 289.75 g/d and ≥ 289.75 g/d of whole milk, respectively. These associations remained significant in stratified analyses by gender and age. Additionally, yogurt was negatively associated with depressive symptoms in both females and the age group (≥ 60 years). Low-fat milk was inversely associated with depressive symptoms for both males and the age group (≥ 60 years). Moderate creams intake was negatively associated with depressive symptoms in males.

LIMITATIONS

It was difficult to infer causality for a cross-sectional study.

CONCLUSIONS

Intakes of skim milk and moderate milk desserts were negatively associated with depressive symptoms, while whole milk was positively associated with depressive symptoms among adults.

Clinical and Metabolic Responses to Magnesium Supplementation in Women with Polycystic Ovary Syndrome

We hypothesized that magnesium supplementation might help improve metabolic profiles and clinical symptoms of polycystic ovary syndrome (PCOS) through its role in insulin action. The present study aimed to investigate the effect of magnesium supplementation on metabolic profiles and levels of sex hormones in women with PCOS. In this parallel randomized, double-blind, placebo-controlled clinical trial, 60 women with PCOS aged 20-45 years were recruited. After stratification for body mass index (BMI), age, and types of medications, participants were randomly assigned to consume magnesium supplements (containing 250 mg magnesium oxide) or placebo for 8 weeks. To assess biochemical indicators, a venous blood sample was taken after an overnight fasting. The mean age of study participants was 26.4 years. We found that magnesium supplementation for 8 weeks among women with PCOS had favorable effects on BMI compared with the placebo group (changes from baseline in intervention group: - 0.31 ± 0.07 vs. 0.07 ± 0.09 kg/m² in control group). In addition, the supplementation lead to preventing the increase in waist circumference in intervention group compared with the control group (0.02 vs. 1.15 cm). No significant effects on glycemic variables and lipid profile were seen following the magnesium supplementation. A significant increase in serum LH levels in intervention group and a decrease in placebo group were observed (P = 0.01). Although we found a significant decrease in serum testosterone levels in intervention and placebo groups, comparing the changes between the two groups, a marginally significant difference in serum testosterone levels was found (51.65 vs. 47.80 in intervention, 43.41 vs. 39.46 in placebo, P = 0.08). A significant increase in serum dehydroepiandrogens (DHEA) (136.32 vs. 172.37 intervention, 102.74 vs. 120.15 placebo, P = 0.01) was seen in two groups. Magnesium supplementation had no significant effects on FSH, 17OH-progesteron, sex hormone-binding globulin (SHBG), and free androgen index (FAI) levels. We found evidence indicating that magnesium supplementation did not influence serum lipid profiles and glycemic indicators among women with PCOS. Magnesium supplementation resulted in reduced BMI and testosterone levels as well as increased DHEA concentrations in women with PCOS. Also, magnesium supplementation may increase serum LH levels. ClinicalTrials.gov IRCT registration no. NCT02178150.

The effects of combined magnesium and zinc supplementation on metabolic status in patients with type 2 diabetes mellitus and coronary heart disease

Background

The present research aimed to analyze the impacts of magnesium and zinc supplements on glycemic control, serum lipids, and biomarkers of oxidative stress and inflammation in patients suffering from coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM).

Methods

According to the research design, a randomized, double-blind, placebo-controlled trial has been implemented on 60 subjects suffering from CHD and T2DM. Therefore, participants have been randomly divided into 2 groups for taking placebo (n = 30) or 250 mg magnesium oxide plus 150 mg zinc sulfate (n = 30) for 12 weeks.

Results

Magnesium and zinc significantly decreased fasting plasma glucose (FPG) (β − 9.44 mg/dL, 95% CI, − 18.30, − 0.57; P = 0.03) and insulin levels (β − 1.37 μIU/mL, 95% CI, − 2.57, − 0.18; P = 0.02). Moreover, HDL-cholesterol levels significantly enhanced (β 2.09 mg/dL, 95% CI, 0.05, 4.13; P = 0.04) in comparison to the placebo. There was an association between magnesium and zinc intake, and a significant decrease of C-reactive protein (CRP) (β − 0.85 mg/L, 95% CI, − 1.26, − 0.45; P < 0.001), a significant increase in total nitrite (β 5.13 μmol/L, 95% CI, 1.85, 8.41; P = 0.003) and total antioxidant capacity (TAC) (β 43.44 mmol/L, 95% CI, 3.39, 83.50; P = 0.03) when compared with placebo. Furthermore, magnesium and zinc significantly reduced the Beck Depression Inventory index (BDI) (β − 1.66; 95% CI, − 3.32, − 0.009; P = 0.04) and Beck Anxiety Inventory (BAI) (β − 1.30; 95% CI, − 2.43, − 0.16; P = 0.02) when compared with the placebo.

Conclusions

In patients with T2DM and CHD, the 12-week intake of magnesium plus zinc had beneficial effects on FPG, HDL-cholesterol, CRP, insulin, total nitrite, TAC levels, and BDI and BAI score. This suggests that magnesium and zinc co-supplementation may be beneficial for patients with T2DM and CHD. Further studies on more patients and lasting longer are needed to determine the safety of magnesium and zinc co-supplementation.

Trial registration

Current Controlled Trials http://www.irct.ir: IRCT20130211012438N31 at 11 May 2019 of registration. This study retrospectively registered.

Serum magnesium and high-sensitivity C-reactive protein as a predictor for gestational diabetes mellitus in Sudanese pregnant women

Background

Gestational diabetes mellitus (GDM) is a big health problem that adversely affects both the maternal and perinatal outcomes. We aimed to predict the development of GDM in the first trimester using high sensitivity C-reactive protein (hs-CRP) and serum magnesium.

Methods

The study conducted in the antenatal care clinic of Saad Abualila Hospital (Khartoum, Sudan). Pregnant women were enrolled in this longitudinal cohort study during first trimester ≤14 weeks of gestation. Serum hs-CRP and magnesium concentrations were measured between weeks 11 and 14 of gestation. Glucose tolerance test and fasting plasma insulin (FPI) measurement were performed between 24 and 28 weeks gestational age. To assess insulin sensitivity and β-cell function, Homeostatic Model Assessment Insulin Resistance (HOMA-IR), HOMA-β indices and Quantitative Insulin Sensitivity Check Index (QUICKI) were calculated and used.

Results

Out of the 126 who completed the study 19 (15%) were diagnosed as GDM. The median (interquartile) of FBG was significantly higher in women with GDM [81 (70–95) vs. 67(60–75) mg/dl; P = < 0.001] compared to women without GDM. There was no significant difference in hs-CRP, serum magnesium, HOMA-IR, QUICKI and HOMA- β between women with GDM and women without GDM. No correlation was observed between body mass index (BMI), serum magnesium, hs-CRP, FBG and insulin levels.

Conclusions

First trimester hs-CRP and serum magnesium levels were not correlated with the later development of gestational diabetes in this setting.

The role of magnesium in different inflammatory diseases

Magnesium deficiency (MgD) can cause inflammation in human body. The known mechanisms of inflammation caused by MgD include activation of phagocytic cells, opening of calcium channels, activation of the N-methyl-D-aspartate (NMDA) receptor, and activation of nuclear factor (NF)-κB. In addition, MgD causes systemic stress response through neuroendocrinological pathways. The inflammation caused by MgD can result in pro-atherogenic changes in the metabolism of lipoproteins, endothelial dysfunction, and high blood pressure. Studies suggest that magnesium may play an important role in the pathophysiology of some inflammatory diseases. Several clinical trials and laboratory studies have been done on the functional role of magnesium. In this study, we review some inflammatory diseases, in which the magnesium has a role in their pathophysiology. Among these diseases, diabetes, asthma, preeclampsia, atherosclerosis, heart damage, and rheumatoid arthritis have been highlighted.

DASH Dietary Pattern and Cardiometabolic Outcomes: An Umbrella Review of Systematic Reviews and Meta-Analyses

BACKGROUND

The Dietary Approaches to Stop Hypertension (DASH) dietary pattern, which emphasizes fruit, vegetables, fat-free/low-fat dairy, whole grains, nuts and legumes, and limits saturated fat, cholesterol, red and processed meats, sweets, added sugars, salt and sugar-sweetened beverages, is widely recommended by international diabetes and heart association guidelines.

OBJECTIVE

To summarize the available evidence for the update of the European Association of the Study of Diabetes (EASD) guidelines, we conducted an umbrella review of existing systematic reviews and meta-analyses using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach of the relation of the DASH dietary pattern with cardiovascular disease and other cardiometabolic outcomes in prospective cohort studies and its effect on blood pressure and other cardiometabolic risk factors in controlled trials in individuals with and without diabetes.

METHODS

MEDLINE and EMBASE were searched through 3 January 2019. We included systematic reviews and meta-analyses assessing the relation of the DASH dietary pattern with cardiometabolic disease outcomes in prospective cohort studies and the effect on cardiometabolic risk factors in randomized and non-randomized controlled trials. Two independent reviewers extracted relevant data and assessed the risk of bias of individual studies. The primary outcome was incident cardiovascular disease (CVD) in the prospective cohort studies and systolic blood pressure in the controlled trials. Secondary outcomes included incident coronary heart disease, stroke, and diabetes in prospective cohort studies and other established cardiometabolic risk factors in controlled trials. If the search did not identify an existing systematic review and meta-analysis on a pre-specified outcome, then we conducted our own systematic review and meta-analysis. The evidence was summarized as risk ratios (RR) for disease incidence outcomes and mean differences (MDs) for risk factor outcomes with 95% confidence intervals (95% CIs). The certainty of the evidence was assessed using GRADE.

RESULTS

We identified three systematic reviews and meta-analyses of 15 unique prospective cohort studies (n = 942,140) and four systematic reviews and meta-analyses of 31 unique controlled trials (n = 4,414) across outcomes. We conducted our own systematic review and meta-analysis of 2 controlled trials (n = 65) for HbA1c. The DASH dietary pattern was associated with decreased incident cardiovascular disease (RR, 0.80 (0.76⁻0.85)), coronary heart disease (0.79 (0.71⁻0.88)), stroke (0.81 (0.72⁻0.92)), and diabetes (0.82 (0.74⁻0.92)) in prospective cohort studies and decreased systolic (MD, -5.2 mmHg (95% CI, -7.0 to -3.4)) and diastolic (-2.60 mmHg (-3.50 to -1.70)) blood pressure, Total-C (-0.20 mmol/L (-0.31 to -0.10)), LDL-C (-0.10 mmol/L (-0.20 to -0.01)), HbA1c (-0.53% (-0.62, -0.43)), fasting blood insulin (-0.15 μU/mL (-0.22 to -0.08)), and body weight (-1.42 kg (-2.03 to -0.82)) in controlled trials. There was no effect on HDL-C, triglycerides, fasting blood glucose, HOMA-IR, or CRP. The certainty of the evidence was moderate for SBP and low for CVD incidence and ranged from very low to moderate for the secondary outcomes.

CONCLUSIONS

Current evidence allows for the conclusion that the DASH dietary pattern is associated with decreased incidence of cardiovascular disease and improves blood pressure with evidence of other cardiometabolic advantages in people with and without diabetes. More research is needed to improve the certainty of the estimates.

The Effects of Magnesium and Zinc Co-Supplementation on Biomarkers of Inflammation and Oxidative Stress, and Gene Expression Related to Inflammation in Polycystic Ovary Syndrome: a Randomized Controlled Clinical Trial

Magnesium and zinc are known to exert multiple beneficial effects including anti-inflammatory and antioxidant actions. To our knowledge, data on the effects of magnesium and zinc co-supplementation on biomarkers of inflammation and oxidative stress and gene expression related to inflammation in subjects of polycystic ovary syndrome (PCOS) are scarce. This study was conducted to evaluate the effects of magnesium and zinc co-supplementation on biomarkers of inflammation and oxidative stress and gene expression related to inflammation in subjects with PCOS. This randomized double-blind, placebo-controlled trial was conducted among 60 subjects with PCOS diagnosed according to the Rotterdam criteria, aged 18-40 years old. Participants were randomly assigned into two groups to take either 250 mg of magnesium oxide plus 220 mg of zinc sulfate (containing 50 mg zinc) supplements (n = 30) or placebo (n = 30) twice a day for 12 weeks. Biomarkers of inflammation and oxidative stress were assessed at baseline and at end of treatment. Gene expression related to inflammatory cytokines was assessed in peripheral blood mononuclear cells (PBMCs) of PCOS women with RT-PCR method. After the 12-week intervention, compared with the placebo, magnesium and zinc co-supplementation significantly decreased serum high-sensitivity C-reactive protein (hs-CRP) (- 1.6 ± 2.4 vs. + 0.1 ± 0.7 mg/L, P = 0.001) and protein carbonyl (PCO) (- 0.14 ± 0.28 vs. + 0.02 ± 0.07 mmol/mg protein, P = 0.002) and significantly increased plasma total antioxidant capacity (TAC) levels (+ 60.7 ± 69.4 vs. - 1.5 ± 141.5 mmol/L, P = 0.03). Results of RT-PCR demonstrated that compared with the placebo, magnesium and zinc co-supplementation downregulated gene expression of interleukin-1 (IL-1) (P = 0.007) and tumor necrosis factor alpha (TNF-α) (P = 0.03) in PBMCs of subjects with PCOS. Overall, magnesium and zinc co-supplementation, compared with the placebo, for 12 weeks among PCOS women had beneficial effects on serum hs-CRP, plasma PCO, TAC, and gene expression of IL-1 and TNF-α.

CLINICAL TRIAL REGISTRATION NUMBER

http://www.irct.ir : IRCT201706075623N121.

Effect of magnesium supplements on serum C-reactive protein: a systematic review and meta-analysis

INTRODUCTION

The aim of the study was to undertake a systematic review and meta-analysis of prospective studies to determine the effect of magnesium (Mg) supplementation on C-reactive protein (CRP). Design: Systematic review and meta-analysis of randomised controlled trials (RCTs).

MATERIAL AND METHODS

Data sources: PubMed-Medline, Web of Science, Cochrane Database, and Google Scholar databases were searched (up until December 2016). Eligibility criteria: Randomized controlled trials evaluating the impact of Mg supplementation on CRP. We used random effects models meta-analysis for quantitative data synthesis. For sensitivity analysis was used the leave-one-out method. Heterogeneity was quantitatively assessed using the I² index. Main outcome: Level of CRP after Mg supplementation.

RESULTS

From a total of 96 entries identified via searches, eight studies were included in the final selection. The meta-analysis indicated a significant reduction in serum CRP concentrations following Mg supplementation (weighted mean difference (WMD) -1.33 mg/l; 95% CI: -2.63 to -0.02, heterogeneity p < 0.123; I² = 29.1%). The WMD for interleukin 6 was -0.16 pg/dl (95% CI: -3.52 to 3.26, heterogeneity p = 0.802; I² = 2.3%), and 0.61 mg/dl (95% CI: -2.72 to 1.48, p = 0.182, heterogeneity p = 0.742; I² = 6.1%) for fasting blood glucose. These findings were robust in sensitivity analyses. Random-effects meta-regression revealed that changes in serum CRP levels were independent of the dosage of Mg supplementation (slope: -0.004; 95% CI: -0.03, 0.02; p = 0.720) or duration of follow-up (slope: -0.06; 95% CI: -0.37, 0.24; p = 0.681).

CONCLUSIONS

This meta-analysis suggests that Mg supplementation significantly reduces serum CRP level. RCTs with a larger sample size and a longer follow-up period should be considered for future investigations to give an unequivocal answer.

Dietary Magnesium and Chronic Disease

Although official magnesium (Mg) dietary reference intakes are open to question, a significant number of adults likely have intakes that are in the range of 50%-99% of the requirement. This moderate or marginal (subclinical) deficient Mg intake generally is asymptomatic. Animal studies, however, indicate that moderate or subclinical Mg deficiency primes phagocytic cells for the release of proinflammatory cytokines leading to chronic inflammatory and oxidative stress. Human studies have found that dietary Mg is inversely related to serum or plasma C-reactive protein (CRP). Individuals with apparently deficient Mg intakes have an increased likelihood of serum or plasma CRP ≥3.0 mg/L, considered an indicator of chronic inflammatory stress that increases the risk for chronic disease. In addition, elevated serum or plasma CRP in individuals with chronic disease is decreased by Mg supplementation, which suggests that Mg decreases the risk for chronic disease. The importance of dietary Mg intake on the risk for chronic disease through affecting inflammatory and oxidative stress is supported by numerous meta-analyses and systematic reviews that have found dietary Mg is inversely associated with chronic diseases such hypertension, ischemic heart disease, stroke, metabolic syndrome, diabetes, and colorectal cancer.

Magnesium-Zinc-Calcium-Vitamin D Co-supplementation Improves Hormonal Profiles, Biomarkers of Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial

Data on the effects of magnesium-zinc-calcium-vitamin D co-supplementation on hormonal profiles, biomarkers of inflammation, and oxidative stress among women with polycystic ovary syndrome (PCOS) are scarce. The objective of this study was to assess the effects of magnesium-zinc-calcium-vitamin D co-supplementation on hormonal profiles, biomarkers of inflammation, and oxidative stress in women with PCOS. Sixty PCOS women were randomized into two groups and treated with 100 mg magnesium, 4 mg zinc, 400 mg calcium plus 200 IU vitamin D supplements (n = 30), or placebo (n = 30) twice a day for 12 weeks. Hormonal profiles, biomarkers of inflammation, and oxidative stress were assessed at baseline and at end-of-treatment. After the 12-week intervention, compared with the placebo, magnesium-zinc-calcium-vitamin D co-supplementation resulted in significant reductions in hirsutism (-2.4 ± 1.2 vs. -0.1 ± 0.4, P < 0.001), serum high sensitivity C-reactive protein (-0.7 ± 0.8 vs. +0.2 ± 1.8 mg/L, P < 0.001), and plasma malondialdehyde (-0.4 ± 0.3 vs. +0.2 ± 1.0 μmol/L, P = 0.01), and a significant increase in plasma total antioxidant capacity concentrations (+46.6 ± 66.5 vs. -7.7 ± 130.1 mmol/L, P = 0.04). We failed to find any significant effect of magnesium-zinc-calcium-vitamin D co-supplementation on free androgen index, and other biomarkers of inflammation and oxidative stress. Overall, magnesium-zinc-calcium-vitamin D co-supplementation for 12 weeks among PCOS women had beneficial effects on hormonal profiles, biomarkers of inflammation, and oxidative stress.

Magnesium deficiency and increased inflammation: current perspectives

Animal studies have shown that magnesium deficiency induces an inflammatory response that results in leukocyte and macrophage activation, release of inflammatory cytokines and acute-phase proteins, and excessive production of free radicals. Animal and in vitro studies indicate that the primary mechanism through which magnesium deficiency has this effect is through increasing cellular Ca²⁺, which is the signal that results in the priming of cells to give the inflammatory response. Primary pro-inflammatory cytokines such as tumor necrosis factor-α and interleukin (IL)-1; the messenger cytokine IL-6; cytokine responders E-selectin, intracellular adhesion molecule-1 and vascular cell adhesion molecule-1; and acute-phase reactants C-reactive protein and fibrinogen have been determined to associate magnesium deficiency with chronic low-grade inflammation (inflammatory stress). When magnesium dietary intake, supplementation, and/or serum concentration suggest/s the presence of magnesium deficiency, it often is associated with low-grade inflammation and/or with pathological conditions for which inflammatory stress is considered a risk factor. When magnesium intake, supplementation, and/or serum concentration suggest/s an adequate status, magnesium generally has not been found to significantly affect markers of chronic low-grade inflammation or chronic disease. The consistency of these findings can be modified by other nutritional and metabolic factors that affect inflammatory and oxidative stress. In spite of this, findings to date provide convincing evidence that magnesium deficiency is a significant contributor to chronic low-grade inflammation that is a risk factor for a variety of pathological conditions such as cardiovascular disease, hypertension, and diabetes. Because magnesium deficiency commonly occurs in countries where foods rich in magnesium are not consumed in recommended amounts, magnesium should be considered an element of significant nutritional concern for health and well-being in these countries.

Magnesium intake and mortality due to liver diseases: Results from the Third National Health and Nutrition Examination Survey Cohort

People with fatty liver disease are at high risk of magnesium deficiency. Meanwhile, low magnesium status is linked to both chronic inflammation and insulin resistance. However, no study has investigated the association between intake of magnesium and risk of mortality due to liver diseases. We evaluated the association between total magnesium intake and mortality due to liver diseases in the Third National Health and Nutrition Examination Study (NHANES III) cohort, which included 13,504 participants who completed liver ultrasound examination for hepatic steatosis. Overall magnesium intake was associated with a reduced risk of mortality due to liver disease at borderline significance (P = 0.05). In fully-adjusted analyses, every 100 mg increase in intake of magnesium was associated with a 49% reduction in the risk for mortality due to liver diseases. Although interactions between magnesium intake and alcohol use and hepatic steatosis at baseline were not significant (P > 0.05), inverse associations between magnesium intake and liver disease mortality were stronger among alcohol drinkers and those with hepatic steatosis. Our findings suggest higher intakes of magnesium may be associated with a reduced risk of mortality due to liver disease particularly among alcohol drinkers and those with hepatic steatosis. Further studies are warranted to confirm the findings.

Dietary Composition Independent of Weight Loss in the Management of Non-Alcoholic Fatty Liver Disease

Poor dietary composition is an important factor in the progression of non-alcoholic fatty liver disease (NAFLD). The majority of NAFLD patients follow diets with overconsumption of simple carbohydrates, total and saturated fat, with reduced intake of dietary fiber and omega-3 rich foods. Although lifestyle modifications including weight loss and exercise remain the keystone of NAFLD management, modifying dietary composition with or without a calorie-restricted diet may also be a feasible and sustainable strategy for NAFLD treatment. In the present review article, we highlight the potential therapeutic role of a “high quality healthy diet” to improve hepatic steatosis and metabolic dysfunction in patients with NAFLD, independent of caloric restriction and weight loss. We provide a literature review evaluating the evidence behind dietary components including fiber-, meat- and omega-3-rich diets and, pending further evidence, we concur with the EASL-EASD-EASO Clinical Guidelines recommendation of the Mediterranean diet as the diet of choice in these patients.

Data from Controlled Metabolic Ward Studies Provide Guidance for the Determination of Status Indicators and Dietary Requirements for Magnesium

Determination of whether magnesium (Mg) is a nutrient of public health concern has been hindered by questionable Dietary Recommended Intakes (DRIs) and problematic status indicators that make Mg deficiency assessment formidable. Balance data obtained since 1997 indicate that the EAR and RDA for 70-kg healthy individuals are about 175 and 250 mg/day, respectively, and these DRIs decrease or increase based on body weight. These DRIs are less than those established for the USA and Canada. Urinary excretion data from tightly controlled metabolic unit balance studies indicate that urinary Mg excretion is 40 to 80 mg (1.65 to 3.29 mmol)/day when Mg intakes are <250 mg (10.28 mmol)/day, and 80 to 160 mg (3.29 to 6.58 mmol)/day when intakes are >250 mg (10.28 mmol)/day. However, changing from low to high urinary excretion with an increase in dietary intake occurs within a few days and vice versa. Thus, urinary Mg as a stand-alone status indicator would be most useful for population studies and not useful for individual status assessment. Tightly controlled metabolic unit depletion/repletion experiments indicate that serum Mg concentrations decrease only after a prolonged depletion if an individual has good Mg reserves. These experiments also found that, although individuals had serum Mg concentrations approaching 0.85 mmol/L (2.06 mg/dL), they had physiological changes that respond to Mg supplementation. Thus, metabolic unit findings suggest that individuals with serum Mg concentrations >0.75 mmol/L (1.82 mg/L), or as high as 0.85 mmol/L (2.06 mg/dL), could have a deficit in Mg such that they respond to Mg supplementation, especially if they have a dietary intake history showing <250 mg (10.28 mmol)/day and a urinary excretion of <80 mg (3.29 mmol)/day.

Dietary magnesium and calcium intake and risk of depression in the general population: A meta-analysis

OBJECTIVE

Several epidemiological studies have evaluated the associations between dietary magnesium (Mg) and calcium (Ca) intake and the risk of depression. However, the results of these studies remain controversial. Thus, we performed a meta-analysis to explore these associations and to investigate the possible dose-response relationship between dietary Mg intake and risk of depression.

METHODS

MEDLINE, Web of Science, Embase, Cochrane CENTRAL, CINAHL database, Chinese National Knowledge Infrastructure, Wan fang databases and Databases of Chinese Scientific and Technical Periodicals were searched for eligible publications up to September 2016. Pooled relative risks with 95% confidence intervals were calculated using random-effects model. Publication bias was estimated using Egger's test and the funnel plot. Dose-response relationship was assessed by restricted cubic spline functions.

RESULTS

A total of 17 epidemiological studies from 12 articles were included in the present meta-analysis. Among these studies, 11 studies evaluated the association between dietary Mg intake and risk of depression and 6 studies evaluated the association between dietary Ca intake and risk of depression. When comparing the highest with the lowest intake, the pooled relative risks of depression were 0.81 (95% confidence interval = [0.70, 0.92]) for Mg and 0.66 (95% confidence interval = [0.42, 1.02]) for Ca. Dietary Mg intake was significantly associated with a reduced risk of depression among studies conducted in Asia (relative risk  = 0.57; 95% confidence interval = [0.44, 0.74]) and in studies adjusting for energy intake (relative risk  = 0.73; 95% confidence interval = [0.58, 0.92]). For dose-response analysis, evidence of a nonlinear relationship was found between dietary Mg intake and risk of depression, and the largest risk reductions were observed for 320 mg/day.

CONCLUSION

This meta-analysis indicated that moderate Mg intake may be inversely associated with the risk of depression, which still needs to be confirmed by larger prospective cohort studies.

Serum levels of magnesium and their relationship with CRP in patients with OSA

BACKGROUND

Low levels of magnesium (Mg) are associated with chronic inflammatory stress. Some animal studies have reported that a moderate deficiency of Mg, similar to that which occurs in humans, may increase inflammatory or oxidative stress stimulated by other factors, such as disrupted sleep or sleep deficiency.

PURPOSE

This cross-sectional study evaluated the relationship between serum levels of Mg and the inflammatory response in patients with a new diagnosis of obstructive sleep apnea (OSA).

METHODS

This clinical, retrospective study registered 68 patients with newly diagnosed mild to severe OSA and 30 without OSA. The Apnea-Hypopnea Index (AHI), oxygen desaturation index (ODI), time until blood hemoglobin oxygen saturation <90 % (SpO₂ <90 %), and mean blood hemoglobin SpO₂ were measured. Serum levels of Mg, plasma C-reactive protein (CRP), and total sleep time (TST) by polysomnography were also measured.

RESULTS

Mg levels were lower in patients with OSA than those in controls matched for age, sex, and body mass index (BMI). Patients with OSA had substantially higher plasma CRP concentrations than controls. A negative correlation was observed between the AHI and ODI and Mg levels. Significant differences in Mg and CRP levels were observed between patients with AHI scores of 5-15 and scores ≥30 based on OSA severity but independent of BMI. Furthermore, the AHI, ODI, TST <90 %, and mean SpO₂ significantly correlated with CRP. A significant negative correlation was observed between Mg and CRP levels (p < 0.0001).

CONCLUSION

Our results show that Mg levels changed depending on the presence and severity of OSA. Low levels were associated with a higher CRP concentration in patients with OSA.

The effects of DASH diet on weight loss and metabolic status in adults with non-alcoholic fatty liver disease: a randomized clinical trial

BACKGROUND & AIMS

This study was designed to determine the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on weight loss and metabolic status in overweight patients with non-alcoholic fatty liver disease (NAFLD).

METHODS

This randomized controlled clinical trial was done among 60 overweight and obese patients with NAFLD. Patients were randomly allocated to consume either the control (n = 30) or the DASH eating pattern (n = 30) for 8 weeks. Both diets were designed to be calorie-restricted. Both diets were consisted of 52-55% carbohydrates, 16-18% proteins and 30% total fats; however, the DASH diet was designed to be rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fats, cholesterol and refined grains.

RESULTS

Adherence to the DASH eating pattern, compared to the control diet, weight (P = 0.006), BMI (P = 0.01), alanine aminotransferase (ALT) (P = 0.02), alkalin phosphatase (ALP) (P = 0.001), insulin levels (P = 0.01), homoeostasis model of assessment-estimated insulin resistance (HOMA-IR) (P = 0.01) significantly decreased and quantitative insulin sensitivity check index (QUICKI) (P = 0.004) significantly increased. Compared with the control diet, the DASH diet has resulted in significant reductions in serum triglycerides (P = 0.04) and total-/HDL-cholesterol ratio (P = 0.01). Finally, decreased concentrations of serum high-sensitivity C-reactive protein (hs-CRP) (P = 0.03), malondialdehyde (MDA) (P = 0.04), increased levels of nitric oxide (NO) (P = 0.01) and glutathione (GSH) (P = 0.009) were found in the DASH group compared with the control group.

CONCLUSIONS

Consumption of DASH diet for 8 weeks among patients with NAFLD had beneficial effects on weight, BMI, ALT, ALP, triglycerides, markers of insulin metabolism, inflammatory markers, GSH and MDA.

Retracted: Magnesium supplementation affects metabolic status and pregnancy outcomes in gestational diabetes: a randomized, double-blind, placebo-controlled trial

BACKGROUND

To our knowledge, prior research has not examined the effects of magnesium supplementation on metabolic status and pregnancy outcomes in maternal-child dyads affected by gestational diabetes (GDM).

OBJECTIVE

This study was designed to assess the effects of magnesium supplementation on metabolic status and pregnancy outcomes in magnesium-deficient pregnant women with GDM.

DESIGN

A randomized, double-blind, placebo-controlled clinical trial was performed in 70 women with GDM. Patients were randomly assigned to receive either 250 mg magnesium oxide (n = 35) or a placebo (n = 35) for 6 wk. Fasting blood samples were taken at baseline and after a 6-wk intervention.

RESULTS

The change in serum magnesium concentration was greater in women consuming magnesium than in the placebo group (+0.06 ± 0.3 vs. -0.1 ± 0.3 mg/dL, P = 0.02). However, after controlling for baseline magnesium concentrations, the changes in serum magnesium concentrations were not significantly different between the groups. Changes in fasting plasma glucose (-9.7 ± 10.1 vs. +1.8 ± 8.1 mg/dL, P < 0.001), serum insulin concentration (-2.1 ± 6.5 vs. +5.7 ± 10.7 μIU/mL, P = 0.001), homeostasis model of assessment-estimated insulin resistance (-0.5 ± 1.3 vs. +1.4 ± 2.3, P < 0.001), homeostasis model of assessment-estimated β-cell function (-4.0 ± 28.7 vs. +22.0 ± 43.8, P = 0.006), and the quantitative insulin sensitivity check index (+0.004 ± 0.021 vs. -0.012 ± 0.015, P = 0.005) in supplemented women were significantly different from those in women in the placebo group. Changes in serum triglycerides (+2.1 ± 63.0 vs. +38.9 ± 37.5 mg/dL, P = 0.005), high sensitivity C-reactive protein (-432.8 ± 2521.0 vs. +783.2 ± 2470.1 ng/mL, P = 0.03), and plasma malondialdehyde concentrations (-0.5 ± 1.6 vs. +0.3 ± 1.2 μmol/L, P = 0.01) were significantly different between the supplemented women and placebo group. Magnesium supplementation resulted in a lower incidence of newborn hyperbilirubinemia (8.8% vs. 29.4%, P = 0.03) and newborn hospitalization (5.9% vs. 26.5%, P = 0.02).

CONCLUSION

Magnesium supplementation among women with GDM had beneficial effects on metabolic status and pregnancy outcomes. This trial was registered at www.irct.ir as IRCT201503055623N39.

Relationship between Serum Magnesium Concentration and Radiographic Knee Osteoarthritis

OBJECTIVE

To establish whether there is a relationship between serum magnesium (Mg) concentration and radiographic knee osteoarthritis (OA).

METHODS

There were 2855 subjects in this cross-sectional study. Serum Mg concentration was measured using the chemiluminescence method. Radiographic OA of the knee was defined as changes consistent with Kellgren-Lawrence (K-L) grade 2 on at least 1 side. Mg concentration was classified into 1 of 4 quartiles: ≤ 0.87, 0.88-0.91, 0.92-0.96, or ≥ 0.97 mmol/l. Multivariable logistic analysis was used to test the association between serum Mg and radiographic knee OA after adjustment for potentially confounding factors. The OR with 95% CI for the association between radiographic knee OA and serum Mg concentration were calculated for each quartile. The quartile with the lowest value was regarded as the reference category.

RESULTS

Significant association between serum Mg concentration and radiographic knee OA was observed in the model after adjustment for age, sex, and body mass index, as well as in the multivariable model. The multivariable-adjusted OR (95% CI) for radiographic knee OA in the second, third, and fourth serum Mg concentration quartiles were 0.90 (95% CI 0.71-1.13), 0.92 (95% CI 0.73-1.16), and 0.72 (95% CI 0.57-0.92), respectively, compared with the lowest (first) quartile. A clear trend (p for trend was 0.01) was observed. The relative odds of radiographic knee OA was decreased by 0.72 times in the fourth serum Mg quartile compared with the lowest quartile.

CONCLUSION

Serum Mg concentration may have an inverse relationship with radiographic OA of the knee.

Vitamin E supplementation is associated with lower levels of C-reactive protein only in higher dosages and combined with other antioxidants: The Cooperative Health Research in the Region of Augsburg (KORA) F4 study

The aim of the present study was to examine the association between intake of five common antioxidative nutrients from supplements and medications (vitamin E, vitamin C, carotenoids, Se, and Zn) and levels of high-sensitivity C-reactive protein (hs-CRP) in the general population. For this purpose, a total of 2924 participants of the population-based Cooperative Health Research in the Region of Augsburg (KORA) F4 study (2006-8) were investigated cross-sectionally. Intake of dietary supplements and medication during the last 7 d was recorded in a personal interview, when participants were asked to show product packages of ingested preparations. Linear regression models were calculated; first, the exposure to regular nutrient intake was treated with a binary response (yes/no); then regularly ingested amounts were divided into quartiles to examine dose-response relationships. Effect of single v. combined supplementation of antioxidants was assessed through the inclusion of interaction terms into the models. Regular intake of any of the five investigated antioxidants per se was not associated with hs-CRP levels. However, dose-response analyses revealed that participants who regularly ingested more than 78 mg vitamin E/d, which corresponds to the upper quartile, had 22% lower hs-CRP levels (95% CI 0·63, 0·97) compared to those of persons who were not exposed to any vitamin E supplementation. Stratified analyses showed that this association was found only in persons who took vitamin E in combination with other antioxidants. The combined supplementation of vitamin E with other antioxidants could thus be a promising strategy for the prevention of inflammation-related diseases in the general population, if further studies could confirm that the proposed association is causal.

Correlation of magnesium deficiency with C-reactive protein in elective cardiac surgery with cardiopulmonary bypass for ischemic heart disease

BACKGROUND AND OBJECTIVE

Cardiac surgery is associated with systemic inflammatory response, which is triggered by cardiopulmonary bypass (CPB) and possibly with underlying magnesium deficiency. Animal studies have shown that magnesium deficiency intensifies oxidative stress and inflammatory processes. We aimed to find a link between serum, erythrocyte, cardiac tissue magnesium concentration and C-reactive protein (CRP) as an inflammatory marker in patients undergoing elective cardiac surgery with CPB.

MATERIALS AND METHODS

The data of 27 patients undergoing elective cardiac surgery with CPB for ischemic heart disease were analyzed. Measurements were taken at the baseline, i.e., 24 h before surgery (serum magnesium, CRP); time point 1, before CPB (serum, erythrocyte and cardiac tissue magnesium); time point 2, after CPB (serum, erythrocyte and cardiac tissue magnesium), and time point 3, 15-17 h after surgery (serum, erythrocyte magnesium, CRP).

RESULTS

There was a negative correlation between baseline serum magnesium and baseline CRP (P=0.009; r=-0.492), negative correlation between cardiac tissue magnesium at the time point 1 and baseline CRP (P=0.021; r=-0.443), and positive correlation between CRP at time point 3 and erythrocyte magnesium at time point 2 (P<0.001; r=0.637).

CONCLUSIONS

The data of our study verify that inflammatory marker CRP and magnesium concentration in serum and cardiac tissue before the surgery are inversely related in patients undergoing elective cardiac surgery with CPB. Well-planned further studies are needed to evaluate the importance of underlying magnesium deficiency on the severity of systemic inflammatory response and postoperative complications after surgery with CPB.

DASH diet, insulin resistance, and serum hs-CRP in polycystic ovary syndrome: a randomized controlled clinical trial

This study was designed to assess the effects of Dietary Approaches to Stop Hypertension (DASH) eating plan on insulin resistance and serum hs-CRP in overweight and obese women with PCOS. This randomized controlled clinical trial was done on 48 women diagnosed with PCOS. Subjects were randomly assigned to consume either the control (n=24) or the DASH eating pattern (n=24) for 8 weeks. The DASH diet consisted of 52% carbohydrates, 18% proteins, and 30% total fats. It was designed to be rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fats, cholesterol, refined grains, and sweets. Sodium content of the DASH diet was designed to be less than 2 400 mg/day. The control diet was also designed to contain 52% carbohydrates, 18% protein, and 30% total fat. Fasting blood samples were taken at baseline and after 8 weeks intervention to measure -insulin resistance and serum hs-CRP levels. -Adherence to the DASH eating pattern, compared to the -control diet, resulted in a significant reduction of serum insulin levels (-1.88 vs. 2.89 μIU/ml, p=0.03), HOMA-IR score (-0.45 vs. 0.80; p=0.01), and serum hs-CRP levels (-763.29 vs. 665.95 ng/ml, p=0.009). Additionally, a significant reduction in waist (-5.2 vs. -2.1 cm; p=0.003) and hip circumference (-5.9 vs. -1 cm; p<0.0001) was also seen in the DASH group compared with the control group. In conclusion, consumption of the DASH eating pattern for 8 weeks in overweight and obese women with PCOS resulted in the improvement of insulin resistance, serum hs-CRP levels, and abdominal fat accumulation.

CLINICAL TRIAL REGISTRATION NUMBER

www.irct.ir: IRCT201304235623N6.

Predicting therapeutic response in patients with heart failure: the story of C-reactive protein

Heart failure continues to be a major public health burden in the USA. With markedly high rates of morbidity and mortality upon diagnosis, effective treatment and prognosis are critical in the management of chronic heart failure. Growing evidence now supports the hypothesis that inflammation plays a key role in the progression and worsening of heart failure. Of the various inflammatory mediators identified, C-reactive protein, an acute phase inflammatory marker, has been associated with poor prognosis in patients with heart failure. Several interventional studies have been investigated to explore C-reactive protein modulation and potential treatment options and health outcomes; however, further studies are warranted before C-reactive protein-targeted therapy may be recommended in the management of heart failure.

The paradox of bardoxolone methyl: a call for every witness on the stand?

People with type 2 diabetes and chronic kidney disease (CKD) remain an extremely vulnerable population with increased cardiovascular morbidity, mortality and mounting societal costs. As such, any effort to improve their dismal outcome is heavily supported. Yet, most drugs fail to replicate the promising signals of early experiments in humans in large and methodologically sound trials. As a recent example, an independent data and safety committee advised the termination of a phase 3 trial due to excessive cardiovascular disease and especially heart failure in patients allocated to the antioxidant synthetic triterpenoid bardoxolone methyl versus placebo. We evaluate the reasons why this outcome in hindsight was possibly not totally unexpected and develop a mechanistic model that shows that the consistent drop in serum magnesium concentration in patients exposed to bardoxolone methyl might have contributed to the development of heart failure. As such, this trial, despite its negative outcome, might provide additional pieces of the puzzle enabling us to get a better grip on diseases that share increased inflammation and oxidative stress, such as type 2 diabetes, metabolic syndrome, heart failure and CKD.

Oral magnesium supplementation decreases C-reactive protein levels in subjects with prediabetes and hypomagnesemia: a clinical randomized double-blind placebo-controlled trial

BACKGROUND AND AIMS

It has been suggested that magnesium deficiency is associated with the triggering of acute phase response, which may contribute to type 2 diabetes and cardiovascular disease risk. We undertook this study to determine whether oral magnesium supplementation modifies serum levels of high-sensitivity C-reactive protein (hsCRP) in apparently healthy subjects with prediabetes and hypomagnesemia.

METHODS

A total of 62 men and non-pregnant women aged 18-65 year, with new diagnosis of prediabetes (glucose 5.6 <7.0 mmol/L and/or post-load glucose ≥7.7 <11.1 mmol/L) and hypomagnesemia (serum magnesium levels <0.74 mmol/L) were enrolled in a clinical double-blind placebo-controlled trial and randomly allocated to receive either magnesium chloride (30 mL of MgCl2 5% solution) or NaHCO3 0.1% solution, once daily for 3 months.

RESULTS

At basal conditions, anthropometric and biochemical variables were similarly distributed in both groups. At the end of follow-up, participants who received magnesium chloride showed higher serum magnesium levels (0.86 ± 0.08 vs. 0.69 ± 0.16 mmol/L, p = 0.002) and lower hsCRP levels (4.8 ± 15.2 vs. 17.1 ± 21.0 nmol/L, p = 0.01) compared with participants in the control group.

CONCLUSIONS

Oral magnesium supplementation decreases hsCRP levels in apparently healthy subjects with prediabetes and hypomagnesemia.