Diabetes is the main factor accounting for hypomagnesemia in obese subjects

Association Between Serum Magnesium Levels and Glycemic Control in Type 2 Diabetes

Introduction

Serum magnesium is a crucial mineral within the human body. It is imperative for diabetic patients to maintain optimal serum magnesium levels. We focus on the relationship between glycemic control and serum magnesium in type 2 diabetes mellitus (T2DM).

Methods

The retrospective, observational, cross-sectional study comprised 1694 patients recruited from the People's Hospital of Yuxi. Fasting blood samples were collected for analysis, accompanied by the recording of participants' demographic characteristics. Patients were categorized into two groups based on whether their glycosylated hemoglobin (HbA1c) levels < 7%. A t-test was employed to identify significant differences between the two groups. Correlation coefficients were calculated using Pearson's method. A Logistic regression analysis was conducted to assess the association between variables and glycemic control. A linear regression analysis was performed to assess the relationship between serum magnesium levels and HbA1c.

Results

Patients with poor glycemic control exhibited elevated age, low-density lipoprotein (LDL-C), fasting plasma glucose (FPG), and homeostasis model assessment (HOMA-IR) compared to those with good glycemic control (P < 0.001). Additionally, total cholesterol (TC) levels were significantly higher in patients with poor glycemic control. Conversely, high-density lipoprotein (HDL-C) and serum magnesium levels were lower in patients with poor glycemic control. Serum magnesium levels exhibited negative correlations with HOMA-IR (r = -0.05, P < 0.05), HbA1c (r = -0.29, P < 0.05), and FPG (r = -0.20, P < 0.05). Moreover, serum magnesium was significantly associated with reduced odds of glycemic control (OR = 0.0005, 95% CI 0.0001-0.0027, P < 0.001).

Conclusion

The serum magnesium level in patients with T2DM is closely associated with glycemic control.

Magnesium: A Defense Line to Mitigate Inflammation and Oxidative Stress in Adipose Tissue

Magnesium (Mg) is involved in essential cellular and physiological processes. Globally, inadequate consumption of Mg is widespread among populations, especially those who consume processed foods, and its homeostasis is impaired in obese individuals and type 2 diabetes patients. Since Mg deficiency triggers oxidative stress and chronic inflammation, common features of several frequent chronic non-communicable diseases, interest in this mineral is growing in clinical medicine as well as in biomedicine. To date, very little is known about the role of Mg deficiency in adipose tissue. In obesity, the increase in fat tissue leads to changes in the release of cytokines, causing low-grade inflammation and macrophage infiltration. Hypomagnesemia in obesity can potentiate the excessive production of reactive oxygen species, mitochondrial dysfunction, and decreased ATP production. Importantly, Mg plays a role in regulating intracellular calcium concentration and is involved in carbohydrate metabolism and insulin receptor activity. This narrative review aims to consolidate existing knowledge, identify research gaps, and raise awareness of the critical role of Mg in supporting adipose tissue metabolism and preventing oxidative stress.

Global prevalence of hypomagnesemia in type 2 diabetes mellitus - a comprehensive systematic review and meta-analysis of observational studies

PURPOSE

Hypomagnesemia, characterized by low magnesium levels, has been implicated in the pathophysiology of Type 2 Diabetes Mellitus (T2DM). This meta-analysis aims to provide a comprehensive assessment of hypomagnesemia prevalence in individuals with T2DM as well as its potential implications for diabetes management and complications.

METHODS

We conducted a comprehensive systematic review and meta-analysis using databases like PubMed, Google Scholar, Science Direct, and Research Gate to identify relevant studies between January 2008 and August 2023. We focused on observational studies related to serum magnesium levels and Type 2 Diabetes in individuals aged 19 and older. Newcastle Ottawa tool was used for quality assessment. A random effect meta-analysis was performed to calculate the prevalence of hypomagnesemia in T2DM.

RESULTS

We identified a total of 671 studies, and after screening 383 abstracts and full texts by two independent reviewers, we identified 19 eligible studies encompassing 4192 patients diagnosed with T2DM. The mean age was 55.4 (SD, 4.39) years with a mean HbA1C level of 8.01. The pooled prevalence of hypomagnesemia in T2DM was 32% (95% CI: 22-36%) out of 4192 cases. On subgroup analysis, the prevalence of hypomagnesemia in male and female were 19.8% and 20.1%, respectively. Geographically, Asia had the highest prevalence of hypomagnesemia with 31.9% (95% CI: 24-41.1%).

CONCLUSION

This meta-analysis highlights a significant prevalence of hypomagnesemia in individuals with T2DM, emphasizing the need for further investigation due to the intricate nature of the association between serum magnesium levels and T2DM.

Hypomagnesemia and Poor Glycemic Control among Type 2 Diabetic Patients: A Cross-Sectional Study

Background/Aim

Hypomagnesaemia has been shown to have a significant impact on both glycaemic control and diabetes complications in type 2 diabetes mellitus (T2DM) patients. This study aims to assess the prevalence of hypomagnesaemia in T2DM patients and find the association between serum magnesium levels and outcomes relevant to glycaemic control and diabetic complications in primary care unit.

Methods

A cross-sectional study was conducted and included 373 patients (222 males and 151 females) from primary care unit. Serum magnesium levels were measured by the colorimetric endpoint method using the Cobas C501 system. Hypomagnesaemia was determined to be a serum magnesium level <1.6 mg/dL. In addition, the following data was also obtained: patients' characteristics, anthropometric measurements, smoking status, HbA1c, comorbidities and therapeutic management.

Results

Patients' mean age was 56.2 ± 10.8 years, 24.6% were smokers, and most were overweight or obese. About 60% have a history of hypertension, and the majority have had diabetes for more than 10 years. Their mean HbA1c level was 8.5 ± 2%. The prevalence of hypomagnesaemia was 11% (95% CI: 8%-14.6%). It was found to be significantly higher among females (adjusted OR: 2.7, 95%CI: 1.2%-5.8%), patients with HbA1c ≥8% (adjusted OR: 2.4, 95%CI: 1.1%-5.5%) and patients with a history of diabetic retinopathy (adjusted OR: 2.7, 95%CI: 1.1%-7.1%).

Conclusion

The study showed that hypomagnesaemia is more prevalent in females and is associated with diabetic retinopathy and poor glycaemic control. Having a sufficient magnesium level may be associated with better glycaemic control and a reduced occurrence of complications.

Does Ionized Magnesium Offer a Different Perspective Exploring the Association between Magnesemia and Targeted Cardiovascular Risk Factors?

Evidence of the association of magnesium (Mg) with arterial stiffness has so far been conflicting. The interplay between hypertension and elevated body mass index (BMI), with hypomagnesemia, instead, has been described in the literature in a more consistent way. Our study aims at revisiting the correlations between blood Mg levels and hemodynamic and body composition parameters in the general population, exploring the sensitivity profile of ionized Mg (Ion-Mg) compared to total Mg (Tot-Mg). We collected data from 755 subjects randomly chosen from a Swiss population previously described and stratified our sample into four equivalent classes according to ionized (whole blood) and total (serum) magnesium. After correcting for age, statistically significant differences emerged between: (i) Tot-Mg ≤ 0.70 and 0.81 ≤ Tot-Mg ≤ 0.90 for cf-PWV (p = 0.039); (ii) Tot-Mg ≤ 0.70 and Tot-Mg ≥ 0.91 for o-PWV (p = 0.046). We also found a statistically significant difference among groups of Ion-Mg values for the 24 h extremes of systolic blood pressure (p = 0.048) and among groups of Tot-Mg for BMI (p = 0.050). Females showed significantly lower levels of total magnesium (p = 0.035) and ionized magnesium (p < 0.001) than males. The overall agreement between magnesium analysis methods was 64% (95%CI: 60.8−67.7%). Our results confirm that Ion-Mg compared with Tot-Mg offers a different profile in detecting both correlations with hemodynamic and body composition parameters and dysmagnesemias. Lower levels of magnesium were associated with worse arterial aging parameters, larger 24 h blood pressure excursions, and higher BMI. Ion-Mg was superior in detecting the correlation with blood pressure only. Considering Ion-Mg as a more specific marker of the magnesium status, and the partially contradictory results of our explorative cross-sectional study, to avoid confounding factors and misinterpretations, ionized magnesium should be used as reference in future studies.

Effect of combined calcium, magnesium, vitamin C and E supplementation on seminal parameters and serum oxidative stress markers in fructose-induced diabetic Wistar rats

CONTEXT

Deleterious effects of diabetes on seminal quality, serum metals and antioxidants have been confirmed.

OBJECTIVE

This study evaluated the effect of combined calcium, magnesium, vitamin C and E supplementation on seminal parameters, serum total antioxidant capacity (TAC), nitric oxide (NO), malonyldialdehyde (MDA), calcium and magnesium in fructose-induced diabetic rats.

MATERIALS AND METHODS

Thirty rats were grouped into non-diabetic controls, diabetic controls, diabetic rats given vitamin E + C, calcium + magnesium and vitamin E + C + calcium + magnesium. The analytes were evaluated using standard methods. Statistical significance was set at p < .05.

RESULTS

The diabetic controls had significantly higher MDA (p = .036) but lower (p = .0001) TAC, calcium, magnesium, sperm count, and %motility than the non-diabetic controls. The Vitamin C + E group showed the greatest improvement as they had the highest values of seminal parameters compared to other supplemented groups.

CONCLUSION

Combined Vitamin C + E supplementation may provide better ameliorative benefits than a combination of Vitamin C, E, calcium and magnesium in diabetics.

Leptin and its relationship with magnesium biomarkers in women with obesity

Some studies have demonstrated the participation of leptin in magnesium metabolism. On the other hand, there is evidence of the role of magnesium in the leptin intracellular signaling pathway. Therefore, the aim of this study was to investigate the existence of a relationship between serum leptin concentrations and magnesium biomarkers in women with obesity. Case-control study involving 108 women aged between 20 and 50 years, divided into two groups: obese (n = 52) and control (n = 56). Body weight, height and waist circumference, body mass index, dietary magnesium intake, magnesium biomarkers and serum leptin concentrations were measured. Serum leptin concentrations showed a statistically significant difference between groups (p < 0.001). Mean values of magnesium intake were lower than intake recommended, and with no statistically significant difference between two groups (p > 0.05). Women with obesity had lower plasma and erythrocyte magnesium concentrations than control group did (p < 0.001). Magnesium concentrations found in the urine of women with obesity were higher than the control group was, with a statistically significant difference (p < 0.001). There was a correlation between serum leptin and magnesium biomarkers (p < 0.001). Women with obesity show an inadequate magnesium nutritional status characterized by low plasma and erythrocyte concentrations and high concentrations in urine, and they also have high serum leptin concentrations. Thus, it was possible to observe a correlation between hyperleptinemia and magnesium biomarkers, requiring further studies to determine whether the dysfunction of this hormone can influence the compartmentalization of the mineral in obese organisms.

Association of Serum Magnesium with Insulin Resistance and Type 2 Diabetes among Adults in China

Magnesium is an essential mineral for the human body and a cofactor or activator for more than 300 enzymatic reactions, including blood glucose control and insulin release. Diabetes is a well-known global burden of disease with increasing global prevalence. In China, the prevalence of diabetes in adults is higher than the global average. Evidence shows that magnesium is a predictor of insulin resistance and diabetes. However, the majority of studies focus on dietary magnesium instead of serum magnesium concentration. We study the correlation of serum magnesium levels with insulin resistance and Type 2 diabetes. In this prospective cohort study, we included 5044 participants aged 18 years and older without insulin resistance (IR) and diabetes at the baseline from China Health and Nutrition Survey (CHNS). A fasting blood sample was taken for the measurement of both types of magnesium, fasting blood glucose, hemoglobin A1c (HbA1c), and fasting insulin. The homeostatic model (HOMA-IR) was calculated. Demographic characteristics of participants, and risk factors such as intensity of physical activities, smoking status, drinking habit, and anthropometric information were recorded. IR was defined as HOMA-IR ≥ 2.5, and Type 2 diabetes mellitus was defined as fasting plasma glucose ≥ 7.0 mmol/L or HbA1c ≥ 6.5%, or a self-reported diagnosis or treatment of diabetes. A total of 1331 incident insulin resistance events and 429 incident diabetic events were recorded during an average follow-up of 5.8 years. The serum magnesium concentration was categorized into quintiles. After adjusting for relevant covariates, the third quintile of serum magnesium (0.89−0.93 mmol/L) was correlated with 29% lower risk of incident insulin resistance (hazard ratio = 0.71, 95% CI 0.58, 0.86) and with a lower risk of Type 2 diabetes. Multivariable-adjusted hazard ratios (95% confidence intervals) for insulin resistance were compared with the lowest quintile of serum magnesium (<0.85). We found similar results when evaluating serum magnesium as a continuous measure. Restricted cubic spline (RCS) curves showed a nonlinear dose−response correlation in both serum magnesium levels and insulin resistance, and in serum magnesium levels and Type 2 diabetes. Lower serum magnesium concentration was associated with a higher risk of insulin resistance and diabetes.

Adequate magnesium level as an associated factor of pre-diabetes and diabetes mellitus remission in patients with obesity submitted to bariatric surgery

Bariatric surgery (BS) can lead to remission of type 2 diabetes mellitus (T2DM), however, the evidence on the influence of preoperative serum magnesium levels on this reversal is scarce. To study the influence of preoperative serum magnesium levels on the pre-T2DM and T2DM remission one year after BS. Retrospective study carried out among 1656 patients with obesity who underwent BS in the Centro Hospitalar Universitário São João. T2DM and pre-T2DM remission were defined as being normal glycaemic measures of at least one year's after BS and without pharmacological therapy. To assess the association between preoperative serum magnesium levels and pre- and T2DM remission, logistic regression models, crude and adjusted for sex, age and body mass index were computed. Patients with normoglycaemia presented hypomagnesaemia less often than those patients with pre-T2DM and T2DM (17.0% vs. 21.3% vs. 39.9%) (p < 0.001). One year after BS, 62.9% of patients with pre-T2DM or T2DM before BS showed remission. Adequate magnesium levels were positively associated with T2DM and pre-T2DM remission, one year after BS (OR 1.79; 95% CI 1.34-2.38), independently of sex, age, and body mass index. Adequate preoperative serum magnesium levels showed to be an important clinical parameter for pre-T2DM and T2DM remission.

Evaluation of serum magnesium differences in hypertensive crises and control patients: A randomly matched case-control study

Although the role of magnesium in blood pressure has been well studied among hypertensive patients, no study has explored the role of magnesium in hypertensive crises. The primary objective of this study is to evaluate the differences in serum magnesium levels between hypertensive crises patients and matched controls (age‐, sex‐, race‐, and diabetes‐matched) in a 1:1 random match. This study is a single‐center, retrospective, chart review, case‐control study of patients with hypertensive crises (case group) and patients without hypertensive crises (control group). Patients were included in the case group if they were 18 years of age or older with hypertensive crises and have a documented magnesium level. The control group patients were required to be 18 years of age or older, have no diagnosis of hypertensive crises, and have a documented magnesium level. The primary outcome of the study was to compare the mean serum magnesium in patients with hypertensive crises versus patients without hypertensive crises. Three hundred and fifty‐eight patients were included in the study: 179 patients in both the case group and control group. The primary outcome results showed that serum magnesium concentration was not significantly different between the case group (1.89 ± 0.29 mg/dl) and control group (1.90 ± 0.31 mg/dl) (p = .787). This study found no significant difference in serum magnesium levels in patients with hypertensive crises compared to a random matched control group. Larger observational or experimental studies may be useful to evaluate the effect of magnesium on blood pressure in hypertensive crises.

Circulating magnesium status is associated with type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a long-term cohort study

BACKGROUND

Low serum magnesium levels predict cardiovascular and all-cause mortality in patients with typ 2 diabetes.

SETTING

Outpatient clinic of obesity and central hospital.

OBJECTIVES

To assess long-term alterations in circulating magnesium status after Roux-en-Y gastric bypass (RYGB) surgery and associations with remission of type 2 diabetes (T2D).

METHODS

Retrospective analysis of 5-year outcomes of plasma magnesium (p-Mg) and glucometabolic statuses in patients who underwent primary RYGB and who completed the annual follow-up program. Data were investigated from 84 patients without diabetes and 62 with T2D before RYGB, who showed either prolonged remission (n = 30), temporary remission (n = 16), or no remission (n = 16) after surgery.

RESULTS

Body mass indexes before RYGB were similar in patients with and without T2D, irrespective of remission. The patients not achieving remission showed longer diabetes durations; higher circulating glucose levels; more intensive antidiabetic drug treatment, including insulin; and significantly lower p-Mg concentrations (.73 [±.08] mmol/L compared with .80-.82 [±.07] mmol/L, respectively; P < .01) than the groups showing remission or without diabetes before surgery. After RYGB, the p-Mg increased similarly, by 10-12% in the groups with T2D before surgery, irrespective of remission; however, the nonremission group did not reach the p-Mg levels registered in the other groups after follow-up. The nonremission group reached .82 (.09) mmol/L, compared with .87 (.06) and .88 (.08) mmol/L (P < .05), respectively, in patients with remission or without a history of diabetes.

CONCLUSION

The p-Mg concentrations increased after RYGB, with similar increments irrespective of T2D remission; however, the nonremission group started from an inferior level and did not reach the p-Mg concentrations seen in the groups achieving remission or without a history of diabetes before surgery.

Variations in Magnesium Concentration Are Associated with Increased Mortality: Study in an Unselected Population of Hospitalized Patients

Dysmagnesemia is a serious disturbance of microelement homeostasis. The aim of this study was to analyze the distribution of serum magnesium concentrations in hospitalized patients according to gender, age, and result of hospitalization. The study was conducted from February 2018 to January 2019 at the Central Clinical Hospital in Warsaw. Laboratory test results from 20,438 patients were included in this retrospective analysis. When a lower reference value 0.65 mmol/L was applied, hypermagnesemia occurred in 196 patients (1%), hypomagnesemia in 1505 patients (7%), and normomagnesemia in 18,711 patients (92%). At a lower reference value of 0.75 mmol/L, hypomagnesemia was found in 25% and normomagnesemia in 74% of patients. At a lower reference value of 0.85 mmol/L, hypomagnesemia was found in 60% and normomagnesemia in 39% of patients. Either hypo- or hyper-magnesemia was associated with increased risk of in-hospital mortality. This risk is the highest in patients with hypermagnesemia (40.1% of deaths), but also increases inversely with magnesium concentration below 0.85 mmol/L. Serum magnesium concentration was not gender-dependent, and there was a slight positive correlation with age (p < 0.0001, r = 0.07). Large fluctuations in serum magnesium level were associated with increased mortality (p = 0.0017). The results indicate that dysmagnesemia is associated with severe diseases and generally severe conditions. To avoid misdiagnosis, an increase of a lower cut-off for serum magnesium concentration to at least 0.75 mmol/L is suggested.

Influence of Demographic and Lifestyle Variables on Plasma Magnesium Concentrations and Their Associations with Cardiovascular Risk Factors in a Mediterranean Population

Several studies have shown that a low magnesium (Mg) intake in the diet is associated with greater cardiovascular risk and greater risk of diabetes. However, the results are not consistent in all populations. To minimize the biases derived from diet measurement, more objective biomarkers of magnesium status have been proposed. Although there is still no ideal biomarker for Mg, several studies have shown that plasma Mg concentrations could be a relatively acceptable biomarker for cardiovascular risk assessment. However, further studies are required to better characterize this marker in different populations. Our aim was to analyze the association between plasma Mg concentrations (measured through inductively coupled plasma mass spectrometry (ICP-MS)) methods, and cardiovascular risk factors in individuals from a general Mediterranean population (aged 18–80 years). The influence of demographic and lifestyle variables, including adherence to the Mediterranean diet, on plasma Mg concentrations was analyzed. The mean Mg level of the population studied was 0.77 ± 0.08 mmol/L, the prevalence of hypomagnesemia (<0.70 mmol/L) being 18.6%. We did not find any statistically significant differences between plasma Mg concentrations and sex, age, tobacco smoking and total adherence to the Mediterranean diet (p > 0.05). We found a statistically significant association between plasma Mg concentrations and the prevalence of type-2 diabetes (0.77 ± 0.08 mmol/L in non-diabetics versus 0.73 ± 0.13 mmol/L in diabetics; p = 0.009). Despite the low prevalence of type-2 diabetes in this population (11.24% in subjects with hypomagnesemia versus 3.91%, in normomagnesemia; p = 0.005), hypomagnesemia was associated with greater odds of being diabetic in comparison with normomagnesemia (OR = 3.36; p = 0.016, even after adjustment for sex, age, obesity, and medications). On the other hand, no statistically significant association of plasma Mg concentrations with obesity, hypertension, fasting triglycerides, HDL-cholesterol or uric acid was found. However, in contrast to what was initially expected, a statistically significant association was found between plasma Mg concentrations (basically in the highest quartile) and greater total cholesterol (p < 0.05) and LDL-cholesterol concentrations (p < 0.05). In conclusion, our results contribute to increasing the evidence gathered by numerous studies on the inverse association between hypomagnesemia and type-2 diabetes, as well as to the observation, previously reported in some studies, of a direct association with hypercholesterolemia. This paradoxical link should be deeply investigated in further studies.

Are Circulating Mg2+ Levels Associated with Glucose Tolerance Profiles and Incident Type 2 Diabetes?

Magnesium (Mg²⁺) is an enzyme co-factor that plays a key role in many biochemical reactions, as well as in glucose metabolism. Clinical evidences have demonstrated that depletion of serum Mg²⁺ increases exponentially with the duration of type 2 diabetes mellitus (T2DM). Diabetes is associated with low Mg²⁺, and hypomagnesemia is associated with insulin resistance, inflammation, and increased risk for cardiovascular disease. In subjects at high risk of inflammation and insulin resistance, supplementation of Mg²⁺ alone ameliorates both phenotypes, slowing the development and progression of hepatic steatosis. We analyze the relationship between serum Mg²⁺ levels and the onset of T2DM in a large cohort of well-characterized adult white individuals participating in the CATAMERI study, who were reexamined after a mean follow-up of 5.6 ± 0.9 years. In our analysis we acquired a significant negative correlation between Mg²⁺ levels, fasting glucose, and 2h-post load glucose in subjects who underwent an OGTT. Moreover, Mg²⁺ levels correlated negatively with fasting insulin levels, and positively with the lipid profile. As for the detrimental effect of lower circulating Mg²⁺ levels, our data revealed a significant reduction of T2DM risk of about 20% for each 1 mg/dL increase of circulating Mg²⁺. The present results are consistent with the theory that Mg²⁺ supplementation could ameliorate insulin sensitivity reducing the risk to develop T2DM.

Differences in Serum Magnesium Levels in Diabetic and Non-Diabetic Patients Following One-Anastomosis Gastric Bypass

Patients with obesity and type 2 diabetes mellitus (T2DM) are regarded to have reduced serum magnesium (Mg) concentrations. We aimed to assess the changes in serum Mg concentrations at 12-month follow-up in patients, with and without T2DM, who underwent one anastomosis gastric bypass surgery. Overall, 50 patients (80% female, age 42.2 (12.5) years) with morbid obesity (mean baseline BMI 43.8 (4.3) kg/m2) were included in the analysis. Half of the included patients had T2DM diagnosed at baseline, and these patients showed lower serum Mg concentration (0.78 (0.07)) vs. 0.83 (0.05) mmol/L; p = 0.006), higher blood glucose levels (129.9 (41.3) vs. 87.6 (8.1) mg/dL; p < 0.001) as well as HbA1c concentrations (6.7 (1.4) vs. 5.3 (0.5)%; p < 0.001). During follow-up, BMI and glucose levels showed a decrease; however, serum Mg levels remained stable. At baseline 42% of patients were found to be Mg deficient, which was reduced to 33% at six months and to 30% at 12 months follow-up. Moreover, patients with T2DM had an odds ratio of 9.5 (95% CI = 3.0-29.7; p < 0.001) for magnesium deficiency when compared to patients without T2DM. Further research into the role of Mg and its role in T2DM and other obesity-related comorbidities are needed.

Concentration of Selected Elements in the Infrapatellar Fat Pad of Patients with a History of Total Knee Arthroplasty

In the period of long development, the human body adapted to specific concentrations of trace elements. Any changes in the trace element content manifesting in a deficiency or excess of metals in the human body may impair the functioning of the skeletal and articular system and of the organs, and may also predispose the body to the development of diseases, i.e., osteoporosis. Our study aimed to analyze the concentrations of calcium (Ca), magnesium (Mg), fluorides (F-), and lead (Pb) in the infrapatellar fat pad (Hoffa's fat pad) of subjects who had undergone a total knee replacement (TKR) surgery. We also endeavored to establish how concentration levels of those elements are affected by selected biological and environmental factors. The studied group comprised 48 residents of Western Pomerania Province: 34 women (n = 34) aged 56-87 and 12 men (n = 12) aged 59-85. Concentration levels of Ca, Mg, and Pb were established using inductively coupled plasma-atomic emission spectrometry (ICP-AES). A Thermo Orion ion-selective electrode was applied for measuring F- concentration. Subjects aged 75-87 showed higher Mg concentration values than those aged 56-74. Big city residents and smokers were found to have higher infrapatellar fat pad Mg concentration than their non-smoking counterparts and small town dwellers. Of all the elements whose concentrations we analyzed in our studies, only magnesium was found to correlate with smoking, place of residence, and age. Our findings regarding the quantities of selected elements in the infrapatellar fat pad may be used for the interpretation and analysis of biological, morphological, and mechanical changes in the human body.

Association of serum magnesium with type 2 diabetes mellitus and diabetic retinopathy

INTRODUCTION AND OBJECTIVE

The rising burden of type 2 diabetes mellitus (T2DM) globally has led to huge morbidity and socioeconomic impact in developing countries. In India, too, it has become a silent epidemic and it is estimated that there are over 60 million diabetics. Although in recent years, a lot of research papers have come up on the management of diabetes, latest treatment modalities may not be affordable to all. So, it becomes imperative to prioritize research on prevention and primary care. Magnesium is an intracellular cation and coenzyme for various reactions of the glycolytic pathway. Hypomagnesemia has been shown to precipitate hyperglycemia and has, therefore, been implicated in insulin resistance and its microvascular complications. Poor glycemic control has been associated with retinopathy. Hence, we evaluated association of serum magnesium with T2DM and diabetic retinopathy.

MATERIALS AND METHODS

In a cross-sectional study in North India, 250 consenting adult patients from outpatient department of family medicine of our hospital were recruited. Critically ill patients and those on magnesium supplements were excluded. Clinicolaboratory profile was evaluated. Patients were divided based on serum magnesium level ≤ 1.7 mg/dL (group 1) and > 1.7 mg/dL (group 2). Glycemic control and proportion of diabetic retinopathy were compared between these two groups by using univariate regression analysis.

RESULTS

Out of 250 patients, 110 patients (44%) were found to have hypomagnesemia. Glycemia by fasting blood sugar (P = 0.02), post-Prandial blood sugar (P = 0.04), and HbA1C(P = 0.01) was poorly controlled in hypomagnesemia group. In group 1, 62.7% had non proliferative diabetic retinopathy and 21.8% had proliferative diabetic retinopathy, whereas in group 2, 14.3% had nonproliferative diabetic retinopathy and 8.6% had proliferative diabetic retinopathy (P < 0.001).

CONCLUSIONS

Magnesium deficiency is associated with increased risk of diabetic retinopathy and poor glycemic control. Dietary supplementation may be advised to prevent such complications and improve glycemic control.

Effect of micronutrient malnutrition on periodontal disease and periodontal therapy

Periodontitis is a complex chronic inflammatory noncommunicable disease, initiated by the development of a dysbiotic microbial plaque biofilm below the gingival margin. Whilst the pathogenic biofilm is a "necessary cause" of periodontitis, it is insufficient on its own to cause the disease, and a destructive immune-inflammatory response is a key to the translation of risk to destructive events. Other exposures or "component causes" include individual genetic predisposition, lifestyle (including smoking and nutrition), and environmental factors. Dietary nutrients are essential for life as they provide crucial energy sources in the form of macronutrients, as well as important cofactors in the form of micronutrients, which regulate the functionality of enzymes during the regulation of anabolic and catabolic processes in human cells. Moreover, micronutrients can regulate gene transcription factors, such as the proinflammatory nuclear factor kappa B and the anti-inflammatory nuclear factor (erythroid-derived 2)-like 2. This review focuses on the role of vitamins (vitamin A, carotenoids, the vitamin B complex, vitamins C, D, and E, and coenzyme Q10) and minerals (calcium, magnesium, iron, zinc, potassium, copper, manganese, and selenium) in human physiology and the impact of their deficiencies upon periodontal health and disease.

Hypomagnesemia and hypermagnesemia

Introduction:Magnesium is an essential element which also has pleiotropic effects in humans. Recent studies have altered our interpretation of a disturbed magnesium balance both leading to hypomagnesemia and hypermagnesemia. Methods: a narrative review of their clinical relevance is presented. Results: Although magnesium balance is strictly controlled by the kidneys, hypomagnesemia is fairly common, especially in people with comorbid conditions. Increased renal magnesium wasting, often aggravated by drugs, is commonly found in conditions associated with unfavorable outcomes such as diabetes mellitus and sepsis. Depending on its severity hypomagnesemia may reveal itself by potentially hazardous neurological and cardiovascular symptoms. Intravenous magnesium is an evidence-based treatment of torsades de pointes and preeclampsia irrespective of the presence of preexisting hypomagnesemia. Magnesium deficiency and/or hypomagnesemia has been linked to cardiovascular disease, vascular calcification and endothelial function both in vitro and in vivo. (Severe) hypermagnesemia can be life-threatening but is almost exclusively observed in patients with substantially decreased kidney function associated with high magnesium intake through supplements or magnesium containing cathartics or antacids. Conclusion:It remains unclear whether mild hypermagnesemia confers survival benefit especially in subjects with decreased kidney function. The role of oral magnesium supplementation of chronic mild asymptomatic hypomagnesemia also merits further exploration through interventional studies in various study populations.

Association between serum magnesium concentration and metabolic syndrome, diabetes, hypertension and hyperuricaemia in knee osteoarthritis: a cross-sectional study in Hunan Province, China

OBJECTIVES

To examine the associations between serum magnesium (Mg) concentration with the prevalence of metabolic syndrome (MetS), diabetes mellitus (DM), hypertension (HP) and hyperuricaemia (HU) in patients with radiographic knee osteoarthritis (OA).

METHODS

The present study was conducted at the Health Management Center of Xiangya Hospital. Radiographic OA was evaluated for patients aged over 40 years with basic characteristics and blood biochemical assessment. Serum Mg concentration was measured using the chemiluminescence method. MetS, DM, HP and HU were diagnosed based on standard protocols. The associations between serum Mg concentration with MetS, DM, HP and HU were evaluated by conducting multivariable adjusted logistic regression.

RESULTS

A total of 962 patients with radiographic knee OA were included. Compared with the lowest quintile, the multivariable adjusted ORs and related 95% CIs of DM were 0.40 (95% CI 0.23 to 0.70, p=0.001), 0.33 (95% CI 0.18 to 0.60, p<0.001), 0.27 (95% CI 0.14 to 0.52, p<0.001) and 0.22 (95% CI 0.11 to 0.44, p<0.001) in the second, third, fourth and highest quintiles of serum Mg, respectively (p for trend <0.001); the multivariable adjusted ORs of HU were 0.33 (95% CI 0.19 to 0.59, p<0.001), 0.52 (95% CI 0.30 to 0.91, p=0.022) and 0.39 (95% CI 0.22 to 0.70, p=0.001) in the third, fourth and highest quintiles of serum Mg, respectively (p for trend <0.001); and the multivariable adjusted ORs of MetS were 0.59 (95% CI 0.36 to 0.94, p=0.027) in the second and 0.56 (95% CI 0.34 to 0.93, p=0.024) in the highest quintiles of serum Mg. However, the inverse association between serum Mg and the prevalence of MetS was non-linear (p for trend=0.067). There was no significant association between serum Mg and HP in patients with OA.

CONCLUSIONS

The serum Mg concentration was inversely associated with the prevalence of MetS, DM and HU in patients with radiographic knee OA.

LEVEL OF EVIDENCE

Level III, cross-sectional study.

Association Between Magnesium Status, Dietary Magnesium Intake, and Metabolic Control in Patients with Type 2 Diabetes Mellitus

BACKGROUND

Hypomagnesemia could worsen glycemic control by impairing insulin release and promoting insulin resistance. On the contrary, type 2 diabetes mellitus (T2DM) may induce and/or exacerbate low serum magnesium levels, and this could, in turn, worsen glycemic control of diabetes.

OBJECTIVE

The aim of this study was to investigate the relationship between serum magnesium level, dietary magnesium intake, and metabolic control parameters in patients with T2DM.

METHODS

The study included 119 patients with T2DM (26 male, 93 female; mean age 54.7 ± 8.4 years). Serum magnesium level was measured by spectrophotometric method. Magnesium intake was assessed by food frequency questionnaire. Anthropometric measurements were taken. The General Linear Model procedure was applied to determine the relationship of serum magnesium with quantitative variables.

RESULTS

Of the 119 patients, 23.5% of the patients had inadequate magnesium intake (lower than 67% of the recommended daily allowance), and 18.5% had hypomagnesemia. In patients with hypomagnesemia (< 0.75 mmol/l), serum levels of fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and serum glycosylated hemoglobin (HbA1c) were higher compared to patients with normomagnesemia. FPG levels were significantly higher in patients with hypomagnesemia in Model 1 (179.0 ± 64.9 vs. 148.7 ± 52.0 mg/dl, p = 0.009) but the significance disappeared in other models. PPG levels were significantly higher in patients with hypomagnesemia in all models (287.9 ± 108.4 vs. 226.8 ± 89.4 mg/dl, p = 0.006 for Model 1, p = 0.027 for Model 2, p = 0.016 for Model 3). Serum HbA1c levels were significantly higher in patients with hypomagnesemia, and this significance proceeded (8.0 ± 1.9% vs. 6.5 ± 1.2%, p = 0.000 for all models). Body fat mass was significantly higher in patients with hypomagnesemia as compared to patients with normomagnesemia in model 3 (35.4 ± 9.4 kg, 34.6 ± 10.2 kg; p = 0.034). Dietary magnesium intake was not significantly associated with either metabolic parameters or anthropometric measurements.

CONCLUSION

Hypomagnesemia in T2DM is directly associated with poor metabolic control. Clinical assessment should, therefore, focus on augmentation of magnesium status and adequate magnesium intake in patients with T2DM.

Effect of magnesium sulfate administration to improve insulin resistance in type 2 diabetes animal model: using the hyperinsulinemic-euglycemic clamp technique

This study attempted to elucidate the possible mechanism of magnesium sulfate (MgSO₄ ) administration on reducing insulin resistance in type 2 diabetic rats. Fifty Wistar rats were divided into five groups: NDC was fed the normal diet, CD received high-fat diet with 35 mg/kg of streptozotocin, CD-Mg animals received MgSO₄ via drinking water, CD-Ins1, and CD-Ins2 animals treated with low or high dose of insulin. Body weight and blood glucose levels were measured weekly. Intraperitoneal glucose tolerance test (IPGTT), insulin tolerance test, and metabolic cage assessment were performed monthly. After 12 weeks, the hyperinsulinemic-euglycemic clamp was performed for all animals and blood sample was taken to measure glycated hemoglobin (HbA1c), plasma insulin, glucagon, calcium, and magnesium levels. Liver and gastrocnemius muscle were isolated to measure glucagon receptor (GR), Glucose 6 phosphatase (G6Pase), Phosphoenolpyruvate carboxykinase (Pepck) and Glucose transporter 4 (Glut4) genes expression and GLUT4 protein translocation into the cell membrane. Consuming of high-fat diet generated insulin-resistant rats. Magnesium or insulin therapy altered insulin resistance, blood glucose, IPGTT, gluconeogenesis pathway, GR, body weight, the percentage of body fat, and HbA1C in diabetic rats. Administrations of MgSO₄ or insulin in Type 2 diabetes mellitus animals increase GLUT4 gene and protein expression. Mg could improve glucose tolerance via stimulation of Glut4 gene expression and translocation and also suppression of the gluconeogenesis pathway and GR gene expression. Mg also increased glucose infusion rate and displayed beneficial effects in the treatment of glucose metabolism and improved insulin resistance.

Increased circulating magnesium concentrations after Roux-en-Y gastric bypass surgery in patients with type 2 diabetes

BACKGROUND

Low circulating magnesium concentrations predict cardiovascular and all-cause mortality in patients with type 2 diabetes (T2D). Epidemiologic and clinical studies have indicated lower extra- and intracellular magnesium concentrations in patients with diabetes.

OBJECTIVE

We aimed to describe alterations, if any, in circulating magnesium concentrations after laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) in patients with obesity and T2D.

SETTING

Outpatient clinic of obesity and central hospital.

METHODS

Retrospective analysis of 1-year outcome of plasma magnesium (p-Mg) and glucometabolic status in all consecutive patients who underwent primary LRYGBP and who completed the follow-up visits, including biochemical test panels 6 and 12 months after surgery.

RESULTS

LRYGBP and complete follow-up visits were performed in 51 patients with T2D and 86 patients without T2D. All patients were given similar dietary advice and multivitamin and mineral supplementation after surgery. Before RYGB, the patients with T2D showed lower p-Mg compared with patients without T2D (.79 ± .06 mM and .82 ± .05 mM, respectively, P<.01). P-Mg was inversely correlated to fasting blood glucose and glycosylated hemoglobin levels. After surgery, mean p-Mg increased by 5.2% in the group with T2D compared with 1.4% in the patients without T2D (P<.01), ending at an equal level of .83 mM. The alterations in p-Mg were inversely related to the changes in fasting glucose and glycosylated hemoglobin concentrations.

CONCLUSION

The lowered p-Mg associated with impaired glucometabolic status in patients with T2D was increased after LRYGBP, reaching similar concentrations as in patients without T2D.

Hypomagnesemia Is Prevalent in Patients Undergoing Gynecologic Surgery by a Gynecologic Oncologist

OBJECTIVE

The aim of this study was to assess the incidence of and risk factors for hypomagnesemia in patients undergoing gynecologic surgery by a gynecologic oncologist.

METHODS

A retrospective chart review was performed on all patients undergoing surgery for gynecologic pathology from July 2011 to July 2015 by a single surgeon. Demographic data, surgical indication, surgery performed, preoperative laboratory values, postoperative laboratory values, and medical history were examined. Hypomagnesemia was defined as less than 1.8 mg/dL. Hypermagnesemia was defined as greater than 2.5 mg/dL.

RESULTS

Six hundred sixty-nine patients were identified for analysis. One hundred ninety-seven patients had hypomagnesemia (29.4%). Four hundred sixty-six patients had normal magnesium levels (69.5%), and 6 patients had hypermagnesemia (1%). Among patients with benign disease, 24.9% had preoperative hypomagnesemia compared with 32.7% of patients with a gynecologic malignancy. African American race (P = 0.041), diabetes mellitus (P < 0.001), and malignancy (P = 0.029) were all associated with preoperative hypomagnesemia. Diabetes and major surgery were associated with postoperative hypomagnesemia (P = 0.012 and P = 0.048, respectively). Hypomagnesemia was associated with increased preoperative and postoperative pain (P = 0.049 and P < 0.001, respectively) as well as postoperative hypokalemia (P = 0.001). Age, body mass index, hypertension, cancer type, hematocrit, surgical indication, and length of hospital stay were not associated with hypomagnesemia.

CONCLUSIONS

Perioperative hypomagnesemia is prevalent in patients undergoing gynecologic surgery by a gynecologic oncology, especially in patients who have a gynecologic malignancy. We recommend routine preoperative and postoperative evaluation of serum magnesium in all patients undergoing gynecologic surgery by a gynecologic oncologist.

Hypomagnesemia and its relation with chronic low-grade inflammation in obesity

Introduction:

The accumulation of visceral fat in obesity is associated with excessive production of proinflammatory adipokines, which contributes to low-grade chronic inflammation state. Moreover, the literature has shown that mineral deficiency, in particular of magnesium, has important role in the pathogenesis of this metabolic disorder with relevant clinical repercussions.

Objective:

To bring updated information about the participation of hypomagnesemia in the manifestation of low-grade chronic inflammation in obese individuals.

Method:

Articles published in PubMed, SciELO, LILACS and ScienceDirect, using the following keywords: "obesity," "magnesium" and "low grade inflammation."

Results:

Scientific evidence suggests that magnesium deficiency favors the manifestation of low-grade chronic inflammation in obese subjects.

Conclusion:

From literature data, it is evident the participation of magnesium through biochemical and metabolic reactions in protecting against this metabolic disorder present in obesity.

Prevention and Therapy of Type 2 Diabetes-What Is the Potential of Daily Water Intake and Its Mineral Nutrients?

We aim to present an overview of the possible influence of drinking water in general and mineral water in particular in improving glycemic parameters in persons with or without type 2 diabetes. We performed a literature search that produced 15 randomized controlled trials (RCTs) on this topic with mainly small sample sizes. We also discuss relevant observational and animal studies as well as the effects of important supplements in mineral water such as hydrogencarbonate and magnesium. There is low evidence for the positive effects of water or mineral water in improving glycemic parameters in diabetic and non-diabetic persons, and the results are heterogenous, making it difficult to reach an unequivocal conclusion. Meta-analyses of prospective cohort studies and other observational studies, studies with animal models and interventional studies using hydrogencarbonate and magnesium supplements suggest a probable positive effect of drinking water and mineral water in particular on glycemic parameters, supporting the positive results found in some of the RCTs, especially those substituting diet beverages or caloric beverages with water, or those using bicarbonate and magnesium-rich water. Regarding the high prevalence, the associated suffering and the resulting health expenditures of type 2 diabetes, it is imperative to conduct larger and more rigorous trials to answer the question whether drinking water or mineral water can improve glycemic parameters in diabetic and non-diabetic persons.

The Central Role of Biometals Maintains Oxidative Balance in the Context of Metabolic and Neurodegenerative Disorders

Traditionally, oxidative stress as a biological aspect is defined as an imbalance between the free radical generation and antioxidant capacity of living systems. The intracellular imbalance of ions, disturbance in membrane dynamics, hypoxic conditions, and dysregulation of gene expression are all molecular pathogenic mechanisms closely associated with oxidative stress and underpin systemic changes in the body. These also include aspects such as chronic immune system activation, the impairment of cellular structure renewal, and alterations in the character of the endocrine secretion of diverse tissues. All of these mentioned features are crucial for the correct function of the various tissue types in the body. In the present review, we summarize current knowledge about the common roots of metabolic and neurodegenerative disorders induced by oxidative stress. We discuss these common roots with regard to the way that (1) the respective metal ions are involved in the maintenance of oxidative balance and (2) the metabolic and signaling disturbances of the most important biometals, such as Mg²⁺, Zn²⁺, Se²⁺, Fe²⁺, or Cu²⁺, can be considered as the central connection point between the pathogenesis of both types of disorders and oxidative stress.

Role of Magnesium in Oxidative Stress in Individuals with Obesity

Adipose tissue is considered an endocrine organ that promotes excessive production of reactive oxygen species when in excess, thus contributing to lipid peroxidation. Magnesium deficiency contributes to the development of oxidative stress in obese individuals, as this mineral plays a role as an antioxidant, participates as a cofactor of several enzymes, maintains cell membrane stability and mitigates the effects of oxidative stress. The objective of this review is to bring together updated information on the participation of magnesium in the oxidative stress present in obesity. We conducted a search of articles published in the PubMed, SciELO and LILACS databases, using the keywords 'magnesium', 'oxidative stress', 'malondialdehyde', 'superoxide dismutase', 'glutathione peroxidase', 'reactive oxygen species', 'inflammation' and 'obesity'. The studies show that obese subjects have low serum concentrations of magnesium, as well as high concentrations of oxidative stress marker in these individuals. Furthermore, it is evident that the adequate intake of magnesium contributes to its appropriate homeostasis in the body. Thus, this review of current research can help define the need for intervention with supplementation of this mineral for the prevention and treatment of disorders associated with this chronic disease.

Endothelial dysfunction biomarker, endothelial cell-specific molecule-1, and pediatric metabolic syndrome

BACKGROUND

The aim of this study was to compare serum endothelial cell-specific molecule-1 (endocan) in pediatric patients with metabolic syndrome (MetS) and in healthy children, and to determine whether it can be used as an indicator of endothelium damage-induced complications in pediatric MetS patients.

METHODS

The study included 30 patients, aged 6-16 years, who were diagnosed with MetS. Another 30 children with no diseases were recruited as healthy controls. Endocan concentration was measured using enzyme-linked immunosorbent assay.

RESULTS

Endocan was increased almost threefold in the MetS group compared with the healthy group. Systolic arterial tension and diastolic arterial tension, serum triglyceride, total cholesterol, and low-density lipoprotein cholesterol were higher, and high-density lipoprotein cholesterol was lower, in the MetS children than in the healthy group. Fasting blood glucose (FBG), hemoglobin A1c (HBA1C), and homeostasis model assessment insulin resistance (HOMA-IR) were also significantly increased in the children with MetS compared with the healthy group.

CONCLUSIONS

Serum endocan level in pediatric MetS patients could be an important indicator of cardiovascular risk in adulthood.

Association among dietary magnesium, serum magnesium, and diabetes: a cross-sectional study in middle-aged and older adults

BACKGROUND

A number of studies have reported the association between magnesium (Mg) and diabetes. However, the various conclusions were inconsistent and the data on the Chinese population was limited. The objective of this study was to evaluate the association among dietary Mg, serum Mg, and diabetes in Chinese adults.

METHODS

A cross-sectional study that contained 2904 subjects was conducted. Biochemical test results and dietary intakes of subjects were collected for analysis. The adjusted odds ratios (ORs) and the corresponding 95 % confidence intervals (95 % CIs) were used to determine the relationship between Mg status and diabetes by logistic regression.

RESULTS

The prevalence of diabetes of the investigated population was 10.1 %. Dietary Mg intake was not significantly correlated with diabetes (P > 0.05). The significant negative association between serum Mg and diabetes existed, and the multivariate adjusted OR was 0.34 (95 % CI 0.24, 0.49) in model 3 for the highest quartile of serum Mg compared with the lowest. The P values for trend were all less than 0.001 for the relationship between serum Mg and diabetes. Dietary Mg intake and serum Mg were not significantly correlated in the diabetes population (P = 0.936).

CONCLUSIONS

Dietary Mg was not significantly correlated with diabetes, while serum Mg was inversely correlated with diabetes in the Chinese population. Meanwhile, dietary Mg intake and serum Mg were not significantly correlated in the diabetes population.

Obesity and hypomagnesemia

BACKGROUND

Whether low serum magnesium is an epiphenomenon related with obesity or, whether obesity per se is cause of hypomagnesemia, remains to be clarified.

OBJECTIVE

To examine the relationship between body weight status and hypomagnesemia in apparently healthy subjects.

METHODS

A total of 681 healthy individuals aged 30 to 65years were enrolled in A cross-sectional study. Extreme exercise, chronic diarrhea, alcohol intake, use of diuretics, smoking, oral magnesium supplementation, diabetes, malnutrition, hypertension, liver disease, thyroid disorders, and renal damage were exclusion criteria. Based in the Body Mass Index (BMI), body weight status was defined as follows: normal weight (BMI <25kg/m²); overweight (BMI ≥25<30 BMIkg/m²); and obesity (BMI ≥30kg/m²). Hypomagnesemia was defined by serum magnesium concentration ≤0.74mmol/L. A multiple logistic regression analysis was used to compute the odds ratio (OR) between body weight status (independent variables) and hypomagnesemia (dependent variable).

RESULTS

The multivariate logistic regression analysis showed that dietary magnesium intake (OR 2.11; 95%CI 1.4-5.7) but no obesity (OR 1.53; 95%CI 0.9-2.5), overweight (OR 1.40; 95%CI 0.8-2.4), and normal weight (OR 0.78; 95%CI 0.6-2.09) were associated with hypomagnesemia. A subsequent logistic regression analysis adjusted by body mass index, waist circumference, total body fat, systolic and diastolic blood pressure, and triglycerides levels showed that hyperglycemia (2.19; 95%CI 1.1-7.0) and dietary magnesium intake (2.21; 95%CI 1.1-8.9) remained associated with hypomagnesemia.

CONCLUSIONS

Our results show that body weight status is not associated with hypomagnesemia and that, irrespective of obesity, hyperglycemia is cause of hypomagnesemia in non-diabetic individuals.

Association of Serum Magnesium Level with Odds of Prediabetes and Diabetes in a Southern Chinese Population: a Prospective Nested Case-Control Study

Although emerging clinical evidence supports that magnesium deficiency is a risk factor for the development of type 2 diabetes, there are sparse studies concerning the dynamic change of serum magnesium with the risk of diabetes and its early stages. In this nested case-control study, we performed a 75-g oral glucose tolerance test or a standardized steamed bread meal test in 178 subjects with incident glucose metabolism impairment (33 with type 2 diabetes and 145 with prediabetes) and 178 matched controls at baseline and at 3-year follow-up and determined the associations between baseline serum magnesium levels as well as changes in serum magnesium levels at follow-up and odds of prediabetes and diabetes. After adjusting for potential confounders, the odds ratios of risk for prediabetes and type 2 diabetes in the highest quartile of serum magnesium levels were 0.22 (95 % confidence intervals [CI] 0.10-0.49; p for trend <0.001) and 0.02 (95 % CI 0.00-0.29; p for trend = 0.009), respectively, as compared with the lowest quartile. In addition, a significant decline in the serum magnesium level was detected in type 2 diabetes cases (p = 0.015) at 3 years as compared with at baseline. These results suggest that a low magnesium level is an independent risk factor for prediabetes and type 2 diabetes, and that the reduction of serum magnesium is associated with type 2 diabetes in a southern Chinese population.

Low Magnesium Levels in Adults with Metabolic Syndrome: a Meta-Analysis

There is conflicting evidence regarding the relationship between magnesium deficiency and metabolic syndrome, and a systematic assessment of the literature has not been performed. Our objective was to clarify the association between magnesium levels and metabolic syndrome by performing a meta-analysis. Based on 13 eligible studies involving 14 analyses and 5496 enrolled participants, magnesium levels were significantly lower in adults with metabolic syndrome than in controls (standardized mean difference [SMD] = -0.98, 95 % confidence interval [CI] = -1.44 to -0.52). There was marked heterogeneity when all comparisons were considered (I (2) = 98 %, p < 0.001). In the subgroup meta-analysis and meta-regression model, a significant difference in magnesium levels was noted by geographic location and study quality. Magnesium levels were lower in the experimental cases than in the controls in West Asia (SMD = -3.80, 95 % CI = -5.36, -2.23) and Latin America (SMD = -1.38, 95 % CI = -1.88, -0.87), but not in East Asia (SMD = -0.01, 95 % CI = -0.30, 0.29) or Europe/Oceania (SMD = -0.25, 95 % CI = -0.53, 0.03). Moreover, the inverse association was greater in high-quality studies (SMD = -2.52, 95 % CI = -3.72, -1.32) than in low-quality studies (SMD = -0.33, 95 % CI = -0.57, -0.08). In conclusion, although there was a high level of heterogeneity, this meta-analysis provided convincing evidence of reduced magnesium levels in adults with metabolic syndrome based on the findings of observational studies. However, the present findings should be validated by additional prospective studies or trans-regional multicenter randomized controlled trials, which generally yield higher-level evidence than case-control studies and cross-sectional studies.

CLINICAL TRIAL REGISTRATION NUMBER

NCT02151227 ( ClinicalTrials.gov Protocol Registration System); CRD42015017946 ( www.crd.york.ac.uk/PROSPERO ).

Insulin Modulates the Na+/Mg2+ Exchanger SLC41A1 and Influences Mg2+ Efflux from Intracellular Stores in Transgenic HEK293 Cells

BACKGROUND

Magnesium deficiency is a common complication of diabetes with an unclear molecular background.

OBJECTIVE

We investigated the effect of the insulin (INS)-signaling pathway (ISP) on the regulation of Mg(2+) efflux (Mg(2+)E) conducted by solute carrier family 41, member A1 (SLC41A1; activated by protein kinase A) in transgenic human embryonic kidney (HEK) 293 cells.

METHODS

HEK293 cells overexpressing SLC41A1 were loaded with the Mg(2+) fluorescent indicator mag-fura-2 and Mg(2+). Measurements of Mg(2+)E were conducted in Mg(2+)-free buffer by using fast-filter fluorescence spectrometry. We examined the effects of INS, inhibitors of ISP or p38 mitogen-activated protein kinase (p38 MAPK), an activator of adenylate cyclase (ADC), and their combinations on SLC41A1-attributed Mg(2+)E.

RESULTS

The application of 400 μU/mL INS inhibited SLC41A1-mediated Mg(2+)E by up to 50.6% compared with INS-untreated cells (P < 0.001). Moreover, INS evoked the early onset of Mg(2+) release from intracellular stores. The application of 0.1 μM wortmannin or 10 μM zardaverine (both ISP inhibitors) restored SLC41A1 Mg(2+)E capacity in the presence of INS to the same levels in INS-untreated cells. The simultaneous application of 10 μM forskolin, an ADC activator, and INS resulted in a reduction of Mg(2+)E of up to 59% compared with untreated cells (P < 0.001), which was comparable to that in cells treated with INS alone. Inhibition of p38 MAPK with 10 μM SB 202190 (SB) in the absence of INS resulted in a decrease (P < 0.001) of SLC41A1-dependent Mg(2+)E (by up to 49%) compared with Mg(2+)E measured in untreated cells. Simultaneous exposure of cells to SB and INS had a stronger inhibitory effect on SLC41A1 activity than INS alone (P < 0.05).

CONCLUSIONS

INS affects intracellular Mg(2+) concentration in transgenic HEK293 cells by regulating SLC41A1 activity (via ISP) and by influencing the compartmentalization and cellular distribution of Mg(2+). In addition, p38 MAPK activates SLC41A1 independently of INS action.

Hypomagnesemia and the Risk of New-Onset Diabetes Mellitus after Kidney Transplantation

Several studies suggest a link between post-transplant hypomagnesemia and new-onset diabetes after transplantation (NODAT), but this relationship remains controversial. We conducted a retrospective cohort study of 948 nondiabetic kidney transplant recipients from January 1, 2000, to December 31, 2011, to examine the association between serum magnesium level and NODAT. Multivariable Cox proportional hazards models were fitted to evaluate the risk of NODAT as a function of baseline (at 1 month), time-varying (every 3 months), and rolling-average (i.e., mean for 3 months moving at 3-month intervals) serum magnesium levels while adjusting for potential confounders. A total of 182 NODAT events were observed over 2951.2 person-years of follow-up. Multivariable models showed an inverse relationship between baseline serum magnesium level and NODAT (hazard ratio [HR], 1.24 per 0.1 mmol/L decrease; 95% confidence interval [95% CI], 1.05 to 1.46; P=0.01). The association with the risk of NODAT persisted in conventional time-varying (HR, 1.32; 95% CI, 1.14 to 1.52; P<0.001) and rolling-average models (HR, 1.34; 95% CI, 1.13 to 1.57; P=0.001). Hypomagnesemia (serum magnesium <0.74 mmol/L) also significantly associated with increased risk of NODAT in baseline (HR, 1.58; 95% CI, 1.07 to 2.34; P=0.02), time-varying (HR, 1.78; 95% CI, 1.29 to 2.45; P<0.001), and rolling-average models (HR, 1.83; 95% CI, 1.30 to 2.57; P=0.001). Our results suggest that lower post-transplant serum magnesium level is an independent risk factor for NODAT in kidney transplant recipients. Interventions targeting serum magnesium to reduce the risk of NODAT should be evaluated.

Magnesium and disturbances in carbohydrate metabolism

Magnesium is actively involved in a number of metabolic reactions as an important co-factor, with special emphasis on carbohydrate metabolism. After a brief overview of the regulation of intra- and extracellular magnesium, the present review first describes the regulatory role of magnesium in important metabolic pathways involved in energy metabolism and glycaemic control. Next the clinical significance of hypomagnesaemic conditions with regard to the management of glucose in prediabetic stages, such as insulin resistance/impaired glucose tolerance and in type 2 diabetes mellitus are characterized. Cross-sectional as well as longitudinal studies suggest that a reduced dietary magnesium intake serves as a risk factor for the incidence of both impaired glucose regulation and type 2 diabetes. Mechanisms that might be responsible for diabetes-associated hypomagnesaemia are discussed. Furthermore, the role of hypomagnesaemia in the development and progression of chronic diabetic complications are addressed. Finally, the available literature on the effects of magnesium supplementation on glycaemic control parameters during prediabetic conditions (preventive approach) as well as type 2 diabetes mellitus (therapeutic approach) are reviewed systematically. There is considerable evidence that chronic magnesium supplementation may delay the progression from impaired glucose regulation to type 2 diabetes; however, the effects of oral magnesium supplementation as an adjunct therapy for type 2 diabetes are quite heterogeneous with respect to the various measures of glycaemic control. The results of this review suggest a requirement for critical consideration of the pros and cons of magnesium replacement therapy, based on variables such as magnesium status, stage of disease and glycaemic control.

Association of serum concentrations of magnesium and some trace elements with cardiometabolic risk factors and liver enzymes in adolescents: the CASPIAN-III Study

This study aims to investigate the association of serum concentrations of magnesium (Mg), selenium (Se), chromium (Cr), and copper (Cu) with cardiometabolic risk factors and liver functions in Iranian children and adolescents. This case-control study was conducted under a national surveillance program. It comprised 320 students, aged 10-18 years, in two groups of equal number with or without metabolic syndrome (MetS). Serum concentrations of Mg and abovementioned trace elements were measured by atomic absorption spectrophotometry. Median regression analysis and different models of logistic regression were used to determine the associations of these elements with cardiometabolic risk factors. In the MetS group, the median of Mg, Se, Cr, and Cu was lower or equal to controls. Mg had significant inverse association with some MetS components; however, the corresponding figure was stronger for the simultaneous association of Mg, Se, Cr, and Cu with MetS components. The binary logistic regression revealed that Mg was a significant protective factor against MetS (P = 0.0001). Likewise, by considering the simultaneous association of Mg, Se, Cr, and Cu with MetS, Se was a significant protective factor against MetS. The corresponding figures were not significant for Cr and Cu. Se and Cu had significant inverse association with liver enzymes. The protective role of Mg and Se against MetS and liver enzymes, as well as the associations of these elements with some cardiometabolic risk factors and liver enzymes in the pediatric age group should be considered in future preventive and interventional studies.

New insight into improvement of cardiovascular outcomes with intensive glycemic control in patients with metabolic syndrome and type 2 diabetes mellitus included

The epidemiology of metabolic syndrome (MetS) is very concerning since this is a widespread chronic disease in adult and elderly population. Different epidemiological studies confirmed strong relationship between type 2 diabetes mellitus (DM2) inclusive MetS and the occurrence of microvascular and macrovascular complications in these patients. Therefore, we are discussing molecular mechanisms and pathways recently introduced and intensively researched. These molecules have been held responsible for direct and indirect correlative trends important in the assessment of potential benefit of intensive glycemic control. Novel substances may improve patient's outcome in recent future regarding cardiovascular complications though their acting mechanisms have not been completely elucidated. We are reviewing whether it would intensive glycemic control be a reasonable approach in patients with MetS when DM2 is included and which recommendations are currently widely applied. The aim was therefore to emphasize current need for further investigations in the field since the utility of intensive glycemic control in all DM/MetS patients as mean for reduction of cardiovascular complications still remains controversial.

Association between magnesium concentration and HbA1c in children and adolescents with type 1 diabetes mellitus

BACKGROUND

Magnesium levels may be decreased in patients with type 1 diabetes mellitus (T1DM), influencing disease control. Relevant studies concern mainly adults and there are few data from the pediatric population. The aim of the present study was to evaluate magnesium levels and examine their possible association with glycemic control in youths with T1DM.

METHODS

In all, 138 children and adolescents with T1DM aged between 1.9 and 20.3 years were recruited to the study. Using a cross-sectional design, we measured anthropometric parameters, HbA1c, serum magnesium, ionized and total calcium, phosphorus, potassium, sodium, and urinary albumin (UA). Estimated glomerular filtration rate (eGFR), based on serum creatinine concentrations, was also calculated.

RESULTS

Lower levels of magnesium were found in subjects with poor versus good glycemic control (0.79 ± 0.09 vs 0.82 ± 0.09 mmol/L, respectively; P = 0.002). Serum magnesium levels were negatively correlated with HbA1c (P < 0.001) and positively correlated with UA, calcium, phosphorus, and potassium levels (P < 0.05). After adjustment for confounding factors, only magnesium levels remained significantly associated with HbA1c (adjusted r(2)  = 0.172; P = 0.004). The odds ratio for poor glycemic control, indicated by HbA1c >7.5%, between the highest and lowest magnesium concentration quartiles was 0.190 and amounted to a decrease of 1.7% in the HbA1c level.

CONCLUSIONS

The present study shows that low serum magnesium levels in children and adolescents with T1DM are associated with an increased risk of poor glycemic control, potentially contributing to the early development of cardiovascular complications.

Serum ionized magnesium in diabetic older persons

OBJECTIVE

Several alterations of magnesium metabolism have been associated with type 2 diabetes pathophysiology, a condition particularly frequent in older persons. We aimed to evaluate serum total (Mg-tot) and serum ionized magnesium (Mg-ion) in older persons with type 2 diabetes in order to explore clinically applicable methods for the detection of magnesium deficit.

MATERIAL/METHODS

Mg-tot and Mg-ion were measured in 105 fasting subjects with type 2 diabetes (mean age: 71.1±0.8 years; M/F: 45/60) and in 100 age-matched non-diabetic control persons (mean age: 72.2±0.8 years; M/F: 42/58).

RESULTS

Mg-ion concentrations were significantly lower in diabetic persons compared with controls (0.49±0.05 mmol/L vs. 0.55±0.05 mmol/L; p<0.001). Mg-tot was also slightly but significantly lower in diabetic patients (0.82±0.007 mmol/L vs. 0.84±0.006 mmol/L; p<0.05). There was an almost complete overlap in the values of Mg-tot in older diabetic patients and controls; conversely, 44.8% of diabetic patients had Mg-ion values below 0.47 mmol/L, while none of the controls did. After adjustment for age, sex, BMI, and triglycerides, Mg-tot was significantly associated with FBG in all the participants (p<0.05) and Mg-ion was significantly associated with FBG in all the participants (p<0.01) and with HbA1c in diabetic participants (p<0.001).

CONCLUSIONS

Alterations of magnesium serum concentrations are common in type 2 diabetic older adults; Mg-ion evaluation may help to identify subclinical magnesium depletion (i.e. in patients with normal Mg-tot); the close independent associations of Mg-tot and Mg-ion with FBG and with HbA1c reinforce the possible link between magnesium homeostasis and altered glucose metabolism.

Low serum magnesium levels and diabetic foot ulcers

Objective: Magnesium plays an important role in glucose homeostasis and insulin sensitivity. The aim of this study was to investigate the association between serum magnesium levels and diabetic foot ulcers.

Methods: A total of 147 subjects were included in this study. The participants were divided into three groups, including a study group of 49 patients with diabetes and foot ulcers, a control group of patients with diabetes without foot ulcers and a control group of 49 healthy subjects. Measurements and comparisons were made of the participants’ magnesium levels, HBA1C percentages, serum fasting glucose levels, creatinine levels and serum lipid levels for all groups. MedCalc version 12.0 (MedCalc, Turkey) was used for the statistical analysis.

Results: The groups were similar in terms of age and sex (p=0.116 and 0.897, respectively). The magnesium levels of the patients with diabetes and foot ulcers were lower than those in the patients with diabetes without foot ulcers and the healthy subjects (p<0.001). There was a strong relationship between the serum magnesium levels and the incidence of diabetic foot ulcers (OR 5.9, Cl 95% 2.7-12.6, p<0.001).

Conclusions: A low serum magnesium level is associated with diabetic foot ulcers. Therefore, the magnesium levels should be controlled in patients with diabetes (with or without foot ulcers) and magnesium supplementation can be a complimentary treatment in such cases.

Relevance of a Hypersaline Sodium-Rich Naturally Sparkling Mineral Water to the Protection against Metabolic Syndrome Induction in Fructose-Fed Sprague-Dawley Rats: A Biochemical, Metabolic, and Redox Approach

The Metabolic Syndrome increases the risk for atherosclerotic cardiovascular disease and type 2 Diabetes Mellitus. Increased fructose consumption and/or mineral deficiency have been associated with Metabolic Syndrome development. This study aimed to investigate the effects of 8 weeks consumption of a hypersaline sodium-rich naturally sparkling mineral water on 10% fructose-fed Sprague-Dawley rats (Metabolic Syndrome animal model). The ingestion of the mineral water (rich in sodium bicarbonate and with higher potassium, calcium, and magnesium content than the tap water used as control) reduced/prevented not only the fructose-induced increase of heart rate, plasma triacylglycerols, insulin and leptin levels, hepatic catalase activity, and organ weight to body weight ratios (for liver and both kidneys) but also the decrease of hepatic glutathione peroxidase activity and oxidized glutathione content. This mineral-rich water seems to have potential to prevent Metabolic Syndrome induction by fructose. We hypothesize that its regular intake in the context of modern diets, which have a general acidic character interfering with mineral homeostasis and are poor in micronutrients, namely potassium, calcium, and magnesium, could add surplus value and attenuate imbalances, thus contributing to metabolic and redox health and, consequently, decreasing the risk for atherosclerotic cardiovascular disease.

Serum magnesium level is associated with type 2 diabetes in women with a history of gestational diabetes mellitus: the Korea National Diabetes Program study

Gestational diabetes mellitus (GDM) is a strong predictor of postpartum prediabetes and transition to overt type 2 diabetes (T2DM). Although many reports indicate that low magnesium is correlated with deteriorated glucose tolerance, the association between postpartum serum magnesium level and the risk for T2DM in women with a history of GDM has not been evaluated. We analyzed postpartum serum magnesium levels and development of prediabetes and T2DM in women with prior GDM according to American Diabetes Association (ADA) criteria using the Korean National Diabetes Program (KNDP) GDM cohort. During a mean follow-up of 15.6 ± 2.0 months after screening, 116 women were divided into three groups according to glucose tolerance status. Ultimately, eight patients (6.9%) were diagnosed with T2DM, 59 patients (50.9%) with prediabetes, and 49 patients (42.2%) with normal glucose tolerance (NGT) after follow-up. The T2DM group had the lowest serum magnesium level (0.65 [0.63-0.68] mM/L) in the postpartum period, but there was no significant difference between the prediabetes group (0.70 [0.65-0.70] mM/L) and the NGT group (0.70 [0.65-0.70] mM/L) (P=0.073) Multiple logistic regression analysis showed that postpartum HOMA-IR was a significant predictor of both prediabetes and T2DM. Moreover, we found that postpartum serum magnesium level was also a possible predictor for T2DM development. Serum magnesium level in the postpartum period may be a possible predictor for T2DM development in women with a history of GDM.

Dietary magnesium and genetic interactions in diabetes and related risk factors: a brief overview of current knowledge

Nutritional genomics has exploded in the last decade, yielding insights—both nutrigenomic and nutrigenetic—into the physiology of dietary interactions and our genes. Among these are insights into the regulation of magnesium transport and homeostasis and mechanisms underlying magnesium’s role in insulin and glucose handling. Recent observational evidence has attempted to examine some promising research avenues on interaction between genetics and dietary magnesium in relation to diabetes and diabetes risk factors. This brief review summarizes the recent evidence on dietary magnesium’s role in diabetes and related traits in the presence of underlying genetic risk, and discusses future potential research directions.

Increased plasma magnesium concentrations 3 years after biliopancreatic diversion with duodenal switch

BACKGROUND

Biliopancreatic diversion with duodenal switch, BPD-DS, is a surgical procedure for treatment of super obese patients. It renders very good weight results and it strongly reduces the incidence of type 2 diabetes. One important mechanism of weight reduction after BPD-DS is malabsorption. Hypomagnesemia is an established cardiovascular risk factor. While it is well-known that magnesium levels decline after jejuno-ileal bypass and increase after gastric bypass surgery, information on how magnesium status is affected by BPD-DS is scant. The aim of the present study was to evaluate plasma magnesium concentrations (P-Mg) after BPD-DS.

METHODS

Thirty-one patients, all Caucasians (9 diabetics, 12 men, age 38 ± 8 years, weight 159 ± 22 kg, body mass index (BMI) 53.9 ± 5.2 kg/m(2)) underwent BPD-DS. We evaluated weight, glycated hemoglobin levels (HbA1c) and P-Mg preoperatively as well as at 1 and 3 years after surgery. All subjects were treated with vitamin and mineral substitution after surgery, including 100 mg of magnesium salt. P-Mg was analyzed with respect to changes over time, correlation to BMI and HbA1c levels before and 3 years after surgery.

RESULTS

The plasma magnesium concentrations increased by 15 % from 0.77 ± 0.07 to 0.88 ± 0.09 mmol/l over 3 years (p < 0.001). The weight loss was 71 ± 25 kg. No patient had diabetes at follow-up. No correlations between P-Mg and BMI or HbA1c were seen.

CONCLUSIONS

Although exerting much of its weight-reducing effect by a malabsorptive mechanism, BPD-DS yields a rise in P-Mg 3 years postoperatively, possibly contributing to the improved metabolic state after this operation.