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Kocyigit SE, Katipoglu B. Hypomagnesemia may be related to frailty, gait and balance problems, and basic activities of daily living in older adults. Acta Clin Belg 2024:1-8. [PMID: 38849991 DOI: 10.1080/17843286.2024.2364143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/01/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVES The study aims to investigate the relationship between hypomagnesemia, preclinical hypomagnesemia, and normomagnesemia as along with geriatric syndrome and comprehensive geriatric parameters(CGA). METHODS 217 patients who applied to the geriatric clinic between November 2022 and December 2023 were included in the study. All patients underwent CGA. Patients were categorized into three groups: Magnesium (Mg) level ≤ 1.5 mg/dL, Mg level 1.5-1.8 mg/dL, and Mg level > 1.8 mg/dL. These three groups were compared in terms of demographic characteristics, comorbidities, CGA parameters, and geriatric syndromes. Regression analyses was conducted for significant parameters, adjusting for confounders. RESULTS 74.9% of all participants were female, with an average age of 76.5 ± 6.6 years. The frequency of hypomagnesemia was 14.2%. Demographic characteristics and medication use, including proton pump inhibitors and diuretics, were similar in these three groups. While the FRIED frailty scale and the duration of the timed-up-and-go test were higher in the hypomagnesemia group, the Basic Activities Daily of Living (ADLs) and the Tinetti-POMA(performance-oriented mobility assessment) scores were lower in the hypomagnesemia group. When normomagnesemia was accepted as the reference category, FRIED frailty scale, Basic ADLs, and POMA score were more significant in the hypomagnesemia group (p = 0.025, p = 0.013 and p = 0.011,respectively), but there was no significance in the preclinical hypomagnesemia group regardless of the covariates. CONCLUSION Hypomagnesemia, particularly serum Mg levels below 1.5 mg/dL, may be associated with frailty, basic ADLs, gait, and balance tests. In geriatric practice, patients with hypomagnesemia should be evaluated in terms of the risk of the mentioned disorders.
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Affiliation(s)
- Suleyman Emre Kocyigit
- Department of Geriatric Medicine, Balikesir University Medicine of Faculty, Balikesir, Turkey
| | - Bilal Katipoglu
- Department of Geriatric Medicine, Ataturk City Training and Research Hospital, Balikesir, Turkey
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Costello R, Rosanoff A, Nielsen F, West C. Perspective: Call for Re-evaluation of the Tolerable Upper Intake Level for Magnesium Supplementation in Adults. Adv Nutr 2023; 14:973-982. [PMID: 37487817 PMCID: PMC10509448 DOI: 10.1016/j.advnut.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
In 1997, the US Institute of Medicine (IOM) dietary reference intakes (DRI) Committee established a magnesium (Mg) tolerable upper intake level (UL) for adults of 350 mg/d from supplemental intake alone. Diarrhea was the limiting factor. The safety of oral Mg dietary supplements exceeding the UL is currently in debate. Increasing the UL may result in more Mg supplementation, decreasing the prevalence of undernutrition for this nutrient and thus providing additional protection against numerous chronic diseases. This perspective aims to show that more recent and comprehensive evidence-based data on the occurrence of diarrhea indicate that the Mg UL for adults should be re-evaluated. To update the literature base to re-evaluate setting the Mg UL, a PubMed search was conducted to identify intervention studies published between 1997 and 2022 that used single-ingredient Mg products reporting a priori diarrhea adverse events among adults. The Food and Drug Administration Center for Food Safety and Adverse Event Reporting System (CAERS) was also searched for adverse events caused by Mg supplementation. The PubMed search identified 10 studies, including 5 meta-analyses and 5 randomized controlled trials, that met the search criteria. Seven studies (Mg intakes of 128-1200 mg/d) found no significant differences in diarrhea occurrence between the intervention and control groups. One meta-analysis found only minor differences in gastrointestinal disturbances between groups given placebo versus 520 mg Mg/d, but withdrawals were not significantly different between groups. Another meta-analysis found that 3 of 13 studies (120-973 mg/d) reported diarrhea that led to study withdrawal, but the treatment arm was not specified in 2 studies. The CAERS search, when limited to single-ingredient suspect Mg products, found only 40 attributable cases of gastrointestinal adverse events. Only one-third of these 40 cases noted a complaint of diarrhea. These updated data indicate that doses above the current UL for Mg supplements can be consumed without adverse events.
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Affiliation(s)
- Rebecca Costello
- CMER, Center for Magnesium Education and Research, Pahoa, Hawaii, United States.
| | - Andrea Rosanoff
- CMER, Center for Magnesium Education and Research, Pahoa, Hawaii, United States
| | - Forrest Nielsen
- CMER, Center for Magnesium Education and Research, Pahoa, Hawaii, United States
| | - Christina West
- CMER, Center for Magnesium Education and Research, Pahoa, Hawaii, United States
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3
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Xing B, Xu X, Li C, Zhao Y, Wang Y, Zhao W. Reduced Serum Magnesium Levels Are Associated with the Occurrence of Retinopathy in Patients with Type 2 Diabetes Mellitus: a Retrospective Study. Biol Trace Elem Res 2022; 200:2025-2032. [PMID: 34275107 DOI: 10.1007/s12011-021-02824-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/07/2021] [Indexed: 01/01/2023]
Abstract
The aim of this study is to explore the relationship between serum magnesium (Mg2+) level and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). The clinical data of 2222 patients with T2DM, including 713 patients with DR and 1509 patients without DR, between September 2016 and August 2020 in our hospital, were analyzed retrospectively. Further, the role and predictive value of serum Mg2+ on the prevalence of DR were determined through logistic regression and the receiver operating characteristic (ROC) curve respectively. The level of serum Mg2+ was lower in DR group than that in non-DR group (0.92 vs 0.88 mmol/L, P < 0.001). Stratified serum Mg2+ levels into quartiles (Q1-Q4), the first (Q1, Mg2+ ≤ 0.85 mmol/L) and fourth quartile (Q4, ≥ 0.96 mmol/L) represented the lowest and highest quartile, respectively. And the incidence of DR was obviously higher in Q1 and Q2 than that in Q3 and Q4 (50.9% and 30.2% vs 23.5% and 21%, respectively). Logistic regression demonstrated that there remained an independent association between lower serum Mg2+ levels and the occurrence of DR (OR were 3.907 and 1.709 in Q1 and Q2, respectively) no matter whether the interference of confounding variables. ROC curve showed the best cut-off value of serum Mg2+ level in predicting the occurrence of DR was 0.875 mmol/L. Lower Mg2+ levels are related with an increased risk of developing DR. Serum Mg2+ level can be a potential clinical indicator to help identify DR in patients with T2DM.
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Affiliation(s)
- Baodi Xing
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Xiang Xu
- Department of International Medical Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chengqian Li
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Yuhang Zhao
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Yangang Wang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Wenjuan Zhao
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China.
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4
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Lee CC, Yang PK, Chen LC, Cheong ML, Tsai YL, Tsai MS. Associations between gene expression of magnesium transporters and glucose metabolism in pregnancy. J Formos Med Assoc 2021; 121:1231-1237. [PMID: 34865947 DOI: 10.1016/j.jfma.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/PURPOSE To assess the relationship between gene expressions of the magnesium transporters and glucose parameters in pregnant women. METHODS A cohort of women without ongoing or prior medical illnesses was recruited at the start of an early singleton pregnancy. Expression levels of the magnesium transporters-SLC41A1, CNNM2, MAGT1, TRPM6, and TRPM7-were assessed in the peripheral leukocytes, while total calcium and magnesium were assessed in the serum between 10 and 13 weeks gestation. Glucose parameters were assessed between 24 and 28 weeks gestation using the 75 g oral glucose tolerance test. RESULTS A total of 208 patients were included in the study. The expressions of the magnesium transports were generally unrelated to age, body mass index (BMI), or serum levels of calcium and magnesium. The magnesium transporters were correlated with each other at baseline (correlation coefficients: 0.31 to 0.51). BMI was a strong predictor of fasting glucose levels, while both BMI and age were strong predictors of post-load glucose levels. The expression of TRPM7 was found to be predictive of 1-h post-load blood glucose after accounting for the effects of age and BMI (β = -0.196, p = 0.020). CONCLUSION The increased maternal expression of the magnesium transporter TRPM7 may be associated with decreased glucose tolerance in pregnant women. In particular, the association between TRPM7 and 1-h post-load glucose levels was found to be independent of the effects of age and BMI. Future studies are needed to determine whether a mechanistic relationship can be demonstrated between TRPM7 and glucose metabolism.
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Affiliation(s)
- Chia-Chieh Lee
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
| | - Po-Kai Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Ching Chen
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
| | - Mei-Leng Cheong
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
| | - Ya-Lun Tsai
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
| | - Ming-Song Tsai
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan.
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Gómez-Seguí I, Fernández-Zarzoso M, de la Rubia J. A critical evaluation of caplacizumab for the treatment of acquired thrombotic thrombocytopenic purpura. Expert Rev Hematol 2020; 13:1153-1164. [PMID: 32876503 DOI: 10.1080/17474086.2020.1819230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Acquired thrombotic thrombocytopenic purpura (aTTP) is a thrombotic microangiopathy caused by inhibitory autoantibodies against ADAMTS13 protein. Until recently, the combination of plasma exchange (PEX) and immunosuppression has been the standard front-line treatment in this disorder. However, aTTP-related mortality, refractoriness, and relapse are still a matter of concern. Areas covered: The better understanding of the pathophysiological mechanisms of aTTP has allowed substantial improvements in the diagnosis and treatment of this disease. Recently, the novel anti-VWF nanobody caplacizumab has been approved for acute episodes of aTTP. Caplacizumab is capable to block the adhesion of platelets to VWF, therefore inhibiting microthrombi formation in the ADAMTS13-deficient circulation. In this review, the characteristics of caplacizumab together with the available data of its efficacy and safety in the clinical setting will be analyzed. Besides, the current scenario of aTTP treatment will be provided, including the role of other innovative drugs. Expert opinion: With no doubt, caplacizumab is going to change the way we treat aTTP. In combination with standard treatment, caplacizumab can help to significantly reduce aTTP-related mortality and morbidity and could spare potential long-term consequences by minimizing the risk of exacerbation.
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Affiliation(s)
| | | | - Javier de la Rubia
- Hematology Service, University Hospital Doctor Peset , Valencia, Spain.,Internal Medicine, School of Medicine and Dentistry, Catholic University of Valencia , Valencia, Spain
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6
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A Review of the Action of Magnesium on Several Processes Involved in the Modulation of Hematopoiesis. Int J Mol Sci 2020; 21:ijms21197084. [PMID: 32992944 PMCID: PMC7582682 DOI: 10.3390/ijms21197084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 12/18/2022] Open
Abstract
Magnesium (Mg2+) is an essential mineral for the functioning and maintenance of the body. Disturbances in Mg2+ intracellular homeostasis result in cell-membrane modification, an increase in oxidative stress, alteration in the proliferation mechanism, differentiation, and apoptosis. Mg2+ deficiency often results in inflammation, with activation of inflammatory pathways and increased production of proinflammatory cytokines by immune cells. Immune cells and others that make up the blood system are from hematopoietic tissue in the bone marrow. The hematopoietic tissue is a tissue with high indices of renovation, and Mg2+ has a pivotal role in the cell replication process, as well as DNA and RNA synthesis. However, the impact of the intra- and extracellular disturbance of Mg2+ homeostasis on the hematopoietic tissue is little explored. This review deals specifically with the physiological requirements of Mg2+ on hematopoiesis, showing various studies related to the physiological requirements and the effects of deficiency or excess of this mineral on the hematopoiesis regulation, as well as on the specific process of erythropoiesis, granulopoiesis, lymphopoiesis, and thrombopoiesis. The literature selected includes studies in vitro, in animal models, and in humans, giving details about the impact that alterations of Mg2+ homeostasis can have on hematopoietic cells and hematopoietic tissue.
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7
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Feng J, Wang H, Jing Z, Wang Y, Cheng Y, Wang W, Sun W. Role of Magnesium in Type 2 Diabetes Mellitus. Biol Trace Elem Res 2020; 196:74-85. [PMID: 31713111 DOI: 10.1007/s12011-019-01922-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/26/2019] [Indexed: 12/11/2022]
Abstract
Magnesium (in its ionized and biologically active form, Mg2+) is an essential trace element that participates in numerous physiologic processes. Abnormal Mg2+ homeostasis can lead to many metabolic disorders, including diabetes mellitus (DM) and its complications. Mg2+ participates in energy generation and is required for DNA and RNA synthesis, reproduction, and protein synthesis. Additionally, Mg2+ acts as a calcium antagonist and protects vascular endothelial cells from oxidative stress. Imbalances in Mg2+ status, more frequently hypomagnesemia, inhibit glucose transporter type 4 translocation, increase insulin resistance, affect lipid metabolism, induce oxidative stress, and impair the antioxidant system of endothelial cells, In these ways, hypomagnesemia contributes to the initiation and progression of DM and its macrovascular and microvascular complications. In this review, we summarize recent advances in knowledge of the mechanisms whereby Mg2+ regulates insulin secretion and sensitivity. In addition, we discuss the future prospects for research regarding the mechanisms whereby Mg2+ status impacts DM and its complications.
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Affiliation(s)
- Jianan Feng
- Department of Nephrology, The First Hospital of Jilin University, 71 Xinmin Street, Jilin Province, Changchun, 130021, China
| | - Heyuan Wang
- Department of Endocrinology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Zhe Jing
- Department of Nephrology, The First Hospital of Jilin University, 71 Xinmin Street, Jilin Province, Changchun, 130021, China
- Department of Laboratory Medicine, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Yue Wang
- Department of Nephrology, The First Hospital of Jilin University, 71 Xinmin Street, Jilin Province, Changchun, 130021, China
| | - Yanli Cheng
- Department of Nephrology, The First Hospital of Jilin University, 71 Xinmin Street, Jilin Province, Changchun, 130021, China
| | - Wanning Wang
- Department of Nephrology, The First Hospital of Jilin University, 71 Xinmin Street, Jilin Province, Changchun, 130021, China
| | - Weixia Sun
- Department of Nephrology, The First Hospital of Jilin University, 71 Xinmin Street, Jilin Province, Changchun, 130021, China.
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8
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Gómez-De León A, Villela-Martínez LM, Yáñez-Reyes JM, Gómez-Almaguer D. Advances in the treatment of thrombotic thrombocytopenic purpura: repurposed drugs and novel agents. Expert Rev Hematol 2020; 13:461-470. [DOI: 10.1080/17474086.2020.1750361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Andrés Gómez-De León
- Hematology Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario ‘Dr. José Eleuterio González’, Monterrey, México
| | - Luis Mario Villela-Martínez
- Centro Médico “Dr. Ignacio Chavez”. ISSSTESON, Hermosillo, México
- Universidad del Valle de México. Campus Hermosillo, Hermosillo, México
| | - José Miguel Yáñez-Reyes
- Hematology Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario ‘Dr. José Eleuterio González’, Monterrey, México
| | - David Gómez-Almaguer
- Hematology Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario ‘Dr. José Eleuterio González’, Monterrey, México
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9
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Rashvand S, Mobasseri M, Tarighat-Esfanjani A. Effects of Choline and Magnesium Concurrent Supplementation on Coagulation and Lipid Profile in Patients with Type 2 Diabetes Mellitus: a Pilot Clinical Trial. Biol Trace Elem Res 2020; 194:328-335. [PMID: 31385202 DOI: 10.1007/s12011-019-01802-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/26/2019] [Indexed: 01/29/2023]
Abstract
Metabolic failure is associated with dyslipidemia and coagulation which can result in a higher risk of cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). The aim of this study was to assess the effects of choline and magnesium co-supplementation on lipid profile and coagulation parameters in patients with T2DM. In a randomized, double-blind, placebo-controlled trial, supplements of choline bitartrate (1000 mg), magnesium oxide (500 mg), choline plus magnesium, or placebo were administered for 2 months to 96 diabetic participants of both sexes aged 30-60 years. Anthropometric characteristics, dietary intake, physical activity, serum lipids, and coagulation markers were measured in all subjects. Significant differences were observed in plasminogen activator inhibitor-1 (PAI-1) levels in the magnesium and choline-magnesium groups (p < 0.05). Moreover, tissue plasminogen activator (tPA) levels increased in choline-magnesium groups (p < 0.001). When adjusted for potential confounders, a significant decrease in PAI-1 (p = 0.03) and a marginally significant increase in tPA (p = 0.054) were found in the choline-magnesium group compared with the other groups. Compared with baseline values, there were significant differences in serum magnesium, HDL, and triglycerides (TG) following choline-magnesium co-supplementation (p < 0.05); however, there were no significant differences in serum magnesium, HDL, and TG among the groups (p > 0.05). Overall, concurrent supplementation of magnesium and choline is more effective than either magnesium or choline alone to improve coagulation in subjects with T2DM.
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Affiliation(s)
- Samaneh Rashvand
- Nutrition Research Center, Student Research Committee, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Mobasseri
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Tarighat-Esfanjani
- Nutrition Research Center, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Attar Nishabouri St., PO Box 14711, Tabriz, 5166614711, Iran.
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10
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Greupner T, Schneider I, Gellert S, Hahn A. Magnesium Bioavailability and Tolerability Do Not Differ between Two Supplements with Different Release Properties. J Diet Suppl 2019; 17:454-466. [PMID: 31230494 DOI: 10.1080/19390211.2019.1629146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Magnesium (Mg2+) is one of the most frequently supplemented micronutrients. Due to possible gastrointestinal side effects, the European Food Safety Authority and the Institute of Medicine set the upper intake level for Mg2+ from supplements to 250 and 350 mg, respectively. Nevertheless, systematic data concerning the tolerability of Mg2+ supplements are scarce. The aim of the study was to directly compare the bioavailability and tolerability of two 500 mg Mg2+ supplements in a crossover study with duplicate determination. The different release properties were either a direct release (one phase) or a delayed release of the second half (two phases). An open-label, controlled trial with a crossover design, duplicate determination, and one-week washout phases was conducted. The participants ingested the test product after overnight fasting. Blood samples were taken at baseline and after 1, 2, 3, 4, 6, and 8 hours, and urine was collected over a period of 24 hours. The participants were on standardized nutrition during all examination days. There were no significant differences between the test products regarding 24-hour renal Mg2+ excretion and area under the curve of serum Mg2+ levels for 8 hours. Both test products were well tolerated with a very low frequency of gastrointestinal adverse effects and no significant differences between the test products. The Mg2+ bioavailability did not differ between the test products. The supplements examined had the same good tolerability. Both test products are therefore suited to enhance Mg2+ supply without relevant side effects.
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Affiliation(s)
- Theresa Greupner
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
| | - Inga Schneider
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
| | - Sandra Gellert
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
| | - Andreas Hahn
- Institute of Food Science and Human Nutrition, Leibniz University Hannover, Hannover, Germany
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11
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Sakaguchi Y, Hamano T, Obi Y, Monden C, Oka T, Yamaguchi S, Matsui I, Hashimoto N, Matsumoto A, Shimada K, Takabatake Y, Takahashi A, Kaimori JY, Moriyama T, Yamamoto R, Horio M, Yamamoto K, Sugimoto K, Rakugi H, Isaka Y. A Randomized Trial of Magnesium Oxide and Oral Carbon Adsorbent for Coronary Artery Calcification in Predialysis CKD. J Am Soc Nephrol 2019; 30:1073-1085. [PMID: 31036759 DOI: 10.1681/asn.2018111150] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Developing strategies for managing coronary artery calcification (CAC) in patients with CKD is an important clinical challenge. Experimental studies have demonstrated that magnesium inhibits vascular calcification, whereas the uremic toxin indoxyl sulfate aggravates it. METHODS To assess the efficacy of magnesium oxide (MgO) and/or the oral carbon adsorbent AST-120 for slowing CAC progression in CKD, we conducted a 2-year, open-label, randomized, controlled trial, enrolling patients with stage 3-4 CKD with risk factors for CAC (diabetes mellitus, history of cardiovascular disease, high LDL cholesterol, or smoking). Using a two-by-two factorial design, we randomly assigned patients to an MgO group or a control group, and to an AST-120 group or a control group. The primary outcome was percentage change in CAC score. RESULTS We terminated the study prematurely after an interim analysis with the first 125 enrolled patients (of whom 96 completed the study) showed that the median change in CAC score was significantly smaller for MgO versus control (11.3% versus 39.5%). The proportion of patients with an annualized percentage change in CAC score of ≥15% was also significantly lower for MgO compared with control (23.9% versus 62.0%). However, MgO did not suppress the progression of thoracic aorta calcification. The MgO group's dropout rate was higher than that of the control group (27% versus 17%), primarily due to diarrhea. The percentage change in CAC score did not differ significantly between the AST-120 and control groups. CONCLUSIONS MgO, but not AST-120, appears to be effective in slowing CAC progression. Larger-scale trials are warranted to confirm these findings.
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Affiliation(s)
- Yusuke Sakaguchi
- Departments of Inter-Organ Communication Research in Kidney Disease
| | - Takayuki Hamano
- Departments of Inter-Organ Communication Research in Kidney Disease,
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California
| | - Chikako Monden
- Department of Internal Medicine, Kisei Hospital, Osaka, Japan; and
| | | | | | | | | | | | | | | | | | | | - Toshiki Moriyama
- Health Care Division, Health and Counseling Center, Osaka University, Toyonaka, Japan
| | - Ryohei Yamamoto
- Health Care Division, Health and Counseling Center, Osaka University, Toyonaka, Japan
| | | | - Koichi Yamamoto
- Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ken Sugimoto
- Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiromi Rakugi
- Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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12
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Association between serum magnesium and blood count: influence of type 2 diabetes and central obesity. Br J Nutr 2019; 121:1287-1293. [DOI: 10.1017/s0007114519000862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AbstractThe relationship between serum Mg and blood cell counts in Chinese adult diabetes or central obesity was assessed by investigating 8163 subjects with China Health and Nutrition Survey (mean age 59⋅6 years, 54⋅9 % men). Participants were classified according to blood Mg (below 0⋅65 mmol/l, or 0⋅66–0⋅94 mmol/l or above 0⋅95 mmol/l), type 2 diabetes (yes/no) and central obesity (yes/no). Leucocytes, erythrocytes, platelets (PLT), Hb and glycated Hb (HbA1c) were determined using standardised methods and conditions. HbAc1, leucocytes and PLT were significantly higher among subjects with central obesity than without central obesity (P < 0⋅05). A significant increase for Hb, erythrocytes, PLT, but not leucocytes, across progressive Mg groups was observed in subjects without diabetes (P < 0⋅05). Hb, erythrocytes and HbAc1 were significantly higher among subjects with higher Mg than in subjects with lower Mg with diabetes (P < 0⋅05). Central obesity disturbed the positive association between PLT count and serum Mg. Type 2 diabetes caused metabolism disorder in serum Mg, blood sugar and blood cell count. Hb, erythrocytes and PLT, but not leucocytes, are positively correlated with serum Mg, but this association is somehow disturbed by type 2 diabetes or central obesity.
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13
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Ephraim RK, Awuku YA, Adu P, Ampomah LT, Adoba P, Panford S, Ninnoni JP, Agbodzakey H. High risk of coagulopathy among Type-2 Diabetes Mellitus clients at a municipal hospital in Ghana. Ghana Med J 2018; 51:101-107. [PMID: 29622820 DOI: 10.4314/gmj.v51i3.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Persistent hyperglycaemia in diabetes mellitus causes coagulopathies due to glycation of haemoglobin, prothrombin, fibrinogen and other proteins involved in the clotting mechanism. Shortened activated partial thromboplastin time (APTT) and prothrombin time (PT) reflect hypercoagulable state, which is associated with an increased thrombotic risk and adverse cardiovascular effects. This study assessed the coagulation profile of type 2 diabetes mellitus (T2DM) clients at a municipal hospital in Ghana. Methods A hospital-based case-control study was conducted from January to April 2015 at the Agona Swedru Municipal Hospital. Sixty (60) persons with T2DM and 40 without were recruited and screened using appropriate protocols. Blood samples were collected for coagulation and biochemical tests. Demographic and clinical information were collected using pre-tested questionnaire. Data was analyzed with GraphPad Prism version 5. Results APTT and PT were significantly shorter among patients with T2DM compared to those without (20.88 ± 5.19 v 31.23 ± 5.41, P=0.0001; and 11.03 ± 2.06sec v 14.46 ± 1.86, P=0.0001 respectively). INR was decreased among patients with T2DM compared to those without (0.83 ± 0.18 v 1.13 ± 0.17, P=0.0001). No significant difference was found in platelet count between T2DM and non-diabetics (179.85 ± 66.15×103 /mm3 v 168.55 ± 35.77×103 /mm3, P=0.326). Serum magnesium was lower among the T2DM patients compared to the non-diabetics, while serum ionized calcium was significantly higher among the T2DM patients (P<0.05). Conclusion Clients with T2DM may have a high coagulation risk evidenced by shortened APTT, PT and a high ionized calcium compared with controls. Funding Study was funded by Lord Ampomah and Solomon Panford.
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Affiliation(s)
- Richard Kd Ephraim
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast
| | - Yaw A Awuku
- Department of Internal Medicine and Therapeutics, University of Cape Coast, Cape Coast
| | - Patrick Adu
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast
| | - Lord Tw Ampomah
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast
| | - Prince Adoba
- Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Solomon Panford
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast
| | - Jerry Pk Ninnoni
- Department of Mental Health, School of Nursing, University of Cape Coast, Cape Coast, Ghana
| | - Hope Agbodzakey
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast.,Department of Internal Medicine and Therapeutics, University of Cape Coast, Cape Coast.,Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Mental Health, School of Nursing, University of Cape Coast, Cape Coast, Ghana
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DiNicolantonio JJ, O'Keefe JH, Wilson W. Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis. Open Heart 2018; 5:e000668. [PMID: 29387426 PMCID: PMC5786912 DOI: 10.1136/openhrt-2017-000668] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/06/2017] [Accepted: 11/07/2017] [Indexed: 12/15/2022] Open
Abstract
Because serum magnesium does not reflect intracellular magnesium, the latter making up more than 99% of total body magnesium, most cases of magnesium deficiency are undiagnosed. Furthermore, because of chronic diseases, medications, decreases in food crop magnesium contents, and the availability of refined and processed foods, the vast majority of people in modern societies are at risk for magnesium deficiency. Certain individuals will need to supplement with magnesium in order to prevent suboptimal magnesium deficiency, especially if trying to obtain an optimal magnesium status to prevent chronic disease. Subclinical magnesium deficiency increases the risk of numerous types of cardiovascular disease, costs nations around the world an incalculable amount of healthcare costs and suffering, and should be considered a public health crisis. That an easy, cost-effective strategy exists to prevent and treat subclinical magnesium deficiency should provide an urgent call to action.
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Affiliation(s)
- James J DiNicolantonio
- Department of Preventive Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - James H O'Keefe
- Department of Preventive Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - William Wilson
- Hospital Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
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15
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Zghoul N, Alam-Eldin N, Mak IT, Silver B, Weglicki WB. Hypomagnesemia in diabetes patients: comparison of serum and intracellular measurement of responses to magnesium supplementation and its role in inflammation. Diabetes Metab Syndr Obes 2018; 11:389-400. [PMID: 30122966 PMCID: PMC6080849 DOI: 10.2147/dmso.s168398] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE In this clinical trial, we assessed the efficacy of magnesium (Mg) supplementation in hypomagnesemic type 2 diabetes patients in restoring serum and intracellular Mg levels. The study had two coprimary end points: the change in serum and intracellular Mg level between baseline and after 3 months of supplementation. We compared the efficacy with regard to lowering hemoglobin A1c (HbA1c), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and 8-isoprostane as secondary end points. PATIENTS AND METHODS In an open-label trial, 47 hypomagnesemic type 2 diabetes patients were administered 336 mg Mg daily. At baseline and after 3 months, serum, cellular Mg, and inflammation biomarkers were measured. For intracellular Mg levels, sublingual epithelial cells were analyzed by analytical scanning electron microscopy using computerized elemental X-ray analysis. Blood samples were analyzed for Mg, creatinine, HbA1c, and CRP. Systemic inflammatory markers including TNF-α and the oxidative stress marker 8-isoprostane were determined using enzyme-linked immunosorbent assay. RESULTS Mg supplementation significantly increased the intracellular and serum levels. Statistically clinical improvement in HbA1c and CRP levels was not observed, but significant decreases in TNF-α as well as in 8-isoprostane were found. CONCLUSION A feasible clinical method for the assessment of intracellular Mg was demonstrated in tissue samples obtained noninvasively, providing evidence for potential clinical translation of this method to routinely determine intracellular Mg concentration.
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Affiliation(s)
- Nadia Zghoul
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait, Kuwait,
| | - Nada Alam-Eldin
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait, Kuwait,
| | - Ivan Tong Mak
- Department of Biochemistry and Molecular Medicine, George Washington University, Washington, DC, USA
| | | | - William B Weglicki
- Department of Biochemistry and Molecular Medicine, George Washington University, Washington, DC, USA
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Serum magnesium concentrations and all-cause, cardiovascular, and cancer mortality among U.S. adults: Results from the NHANES I Epidemiologic Follow-up Study. Clin Nutr 2017; 37:1541-1549. [PMID: 28890274 DOI: 10.1016/j.clnu.2017.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/07/2017] [Accepted: 08/22/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few studies have examined the associations of serum magnesium (Mg) concentrations with total and cause-specific mortality in a nationally representative sample of US adults. We investigate the dose-response relationships of baseline serum Mg concentrations with risk of mortalities in a large, nationally representative sample of US adults. METHODS We analyzed prospective data of 14,353 participants aged 25-74 years with measures of serum Mg concentrations at baseline (1971-1975) from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study (NHEFS). Mortality data was linked through December 31, 2011. We estimated the mortality hazard ratios (HRs), for participants within serum Mg categories of <0.7, 0.7-0.74, 0.75-0.79, 0.8-0.89 (referent), 0.9-0.94, 0.95-0.99, and ≥1.0 mmol/L using weighted multivariate-adjusted Cox proportional hazards models. RESULTS During a median follow-up of 28.6 years, 9012 deaths occurred, including 3959 CVD deaths, 1923 cancer deaths, and 708 stroke deaths. The multivariate-adjusted HRs (95% CIs) of all-cause mortality across increasing categories of Mg were 1.34 (1.02, 1.77), 0.94 (0.75, 1.18), 1.08 (0.97, 1.19), 1.00 (referent), 1.05 (0.95, 1.16), 0.96 (0.79, 1.15), and 0.98 (0.76, 1.26). Similar trends were observed for cancer (HRs for serum Mg < 0.7: 1.39, 95% CI: 0.83, 2.32) and CVD mortality (HRs for serum Mg < 0.7: 1.28, 95% CI: 0.81, 2.02) but were not statistically significant. An elevated risk for stroke mortality was observed among participants with serum Mg < 0.70 mmol/L (HR: 2.55, 95% CI: 1.18, 5.48). CONCLUSIONS Very low serum Mg concentrations were significantly associated with an increased risk of all-cause mortality in US adults.
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Abstract
OBJECTIVE Type 1 diabetes mellitus (T1DM) may lead to deficiencies in trace elements that have substantial functions in the human organism. Changes in serum magnesium (Mg), copper (Cu), and zinc (Zn) levels are correlated with metabolic control and diabetes complications. The aim of this study was to evaluate the intra-erythrocyte levels of trace elements and urinary Mg excretion following intravenous (iv) Mg tolerance testing in children with T1DM. METHODS A total of 43 children aged 2-18 years with T1DM and age/gender-matched 25 healthy children were included in the study. The iv Mg tolerance test was performed following the measurement of intra-erythrocyte Mg (eMg1), Cu (eCu1), and Zn (eZn1) levels using the atomic absorption spectrophotometer method. The Mg retention ratio was estimated from measurements in 24 h urine samples. RESULTS No statistically significant difference was found for eMg1, eCu1, and eZn1 levels between the patient and control groups (p>0.05). In the patient group, the eMg1, eCu1, and eZn1 levels measured after the iv Mg tolerance test significantly increased compared with the baseline levels (p<0.05), and the Mg excretion ratio measured from the urine collected after the iv MgSO4 infusion was >50%. CONCLUSION The increased retention value following the iv Mg tolerance testing indicates intracellular Mg deficiency in children with T1DM.
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Affiliation(s)
- Vahap Uğurlu
- Osmangazi University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Eskişehir, Turkey
| | - Çiğdem Binay
- Osmangazi University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Eskişehir, Turkey Phone: +90 532 377 14 96 E-mail:
| | - Enver Şimşek
- Osmangazi University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Eskişehir, Turkey
| | - Cengiz Bal
- Osmangazi University Faculty of Medicine, Department of Medical Statistics, Eskişehir, Turkey
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18
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Na HS, Shin HJ, Kang SB, Hwang JW, Do SH. Effects of magnesium sulphate on coagulation after laparoscopic colorectal cancer surgery, measured by rotational thromboelastometry (ROTEM®). Anaesthesia 2014; 69:1314-21. [DOI: 10.1111/anae.12684] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 11/27/2022]
Affiliation(s)
- H. S. Na
- Department of Anaesthesiology and Pain Medicine; Seoul National University Bundang Hospital; Seongnam Gyeonggi South Korea
| | - H. J. Shin
- Department of Anaesthesiology and Pain Medicine; Seoul National University Bundang Hospital; Seongnam Gyeonggi South Korea
| | - S. B. Kang
- Department of Surgery; Seoul National University Bundang Hospital; Seongnam Gyeonggi South Korea
| | - J. W. Hwang
- Department of Anaesthesiology and Pain Medicine; Seoul National University Bundang Hospital; Seongnam Gyeonggi South Korea
| | - S. H. Do
- Department of Anaesthesiology and Pain Medicine; Seoul National University Bundang Hospital; Seongnam Gyeonggi South Korea
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19
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Galli-Tsinopoulou A, Maggana I, Kyrgios I, Mouzaki K, Grammatikopoulou MG, Stylianou C, Karavanaki K. Association between magnesium concentration and HbA1c in children and adolescents with type 1 diabetes mellitus. J Diabetes 2014; 6:369-77. [PMID: 24393429 DOI: 10.1111/1753-0407.12118] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 12/14/2013] [Accepted: 12/25/2013] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Assimina Galli-Tsinopoulou
- 4th Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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20
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Kaur B, Henry J. Micronutrient status in type 2 diabetes: a review. ADVANCES IN FOOD AND NUTRITION RESEARCH 2014; 71:55-100. [PMID: 24484939 DOI: 10.1016/b978-0-12-800270-4.00002-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Type 2 diabetes is characterized by significant losses of important micronutrients due to metabolic basis of the disease and its complications. Evidence of changes in trace mineral and vitamin metabolism as a consequence of type 2 diabetes is reviewed in this chapter. This review is not a meta-analysis but an overview of the micronutrient status, metabolic needs, and potential micronutrient requirements in type 2 diabetics. This chapter will not concentrate on vitamin D and type 2 diabetes as this is a topic that has been extensively reviewed before. The less well-known micronutrients notably zinc, magnesium, chromium, copper, manganese, iron, selenium, vanadium, B-group vitamins, and certain antioxidants are assessed. While some evidence is available to demonstrate the positive influence of micronutrient supplementation on glycemic control, much remains to be investigated. Additional research is necessary to characterize better biomarkers of micronutrient status and requirements in type 2 diabetics. The optimal level of micronutrient supplementation to achieve glucose homeostasis in type 2 diabetics remains a challenge.
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Affiliation(s)
- Bhupinder Kaur
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Singapore, Singapore.
| | - Jeyakumar Henry
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Singapore, Singapore
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Barbagallo M, Di Bella G, Brucato V, D'Angelo D, Damiani P, Monteverde A, Belvedere M, Dominguez LJ. Serum ionized magnesium in diabetic older persons. Metabolism 2014; 63:502-9. [PMID: 24462317 DOI: 10.1016/j.metabol.2013.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 12/05/2013] [Accepted: 12/09/2013] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Mario Barbagallo
- Geriatric Unit, Dept. of Internal Medicine and Specialties, University of Palermo, Italy.
| | - Giovanna Di Bella
- Geriatric Unit, Dept. of Internal Medicine and Specialties, University of Palermo, Italy
| | - Virna Brucato
- Geriatric Unit, Dept. of Internal Medicine and Specialties, University of Palermo, Italy
| | - Daniela D'Angelo
- Geriatric Unit, Dept. of Internal Medicine and Specialties, University of Palermo, Italy
| | - Provvidenza Damiani
- Geriatric Unit, Dept. of Internal Medicine and Specialties, University of Palermo, Italy
| | - Alfredo Monteverde
- Geriatric Unit, Dept. of Internal Medicine and Specialties, University of Palermo, Italy
| | - Mario Belvedere
- Geriatric Unit, Dept. of Internal Medicine and Specialties, University of Palermo, Italy
| | - Ligia J Dominguez
- Geriatric Unit, Dept. of Internal Medicine and Specialties, University of Palermo, Italy
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Overview of platelet physiology: its hemostatic and nonhemostatic role in disease pathogenesis. ScientificWorldJournal 2014; 2014:781857. [PMID: 24729754 PMCID: PMC3960550 DOI: 10.1155/2014/781857] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 11/10/2013] [Indexed: 12/23/2022] Open
Abstract
Platelets are small anucleate cell fragments that circulate in blood playing crucial role in managing vascular integrity and regulating hemostasis. Platelets are also involved in the fundamental biological process of chronic inflammation associated with disease pathology. Platelet indices like mean platelets volume (MPV), platelets distributed width (PDW), and platelet crit (PCT) are useful as cheap noninvasive biomarkers for assessing the diseased states. Dynamic platelets bear distinct morphology, where α and dense granule are actively involved in secretion of molecules like GPIIb , IIIa, fibrinogen, vWf, catecholamines, serotonin, calcium, ATP, ADP, and so forth, which are involved in aggregation. Differential expressions of surface receptors like CD36, CD41, CD61 and so forth have also been quantitated in several diseases. Platelet clinical research faces challenges due to the vulnerable nature of platelet structure functions and lack of accurate assay techniques. But recent advancement in flow cytometry inputs huge progress in the field of platelets study. Platelets activation and dysfunction have been implicated in diabetes, renal diseases, tumorigenesis, Alzheimer's, and CVD. In conclusion, this paper elucidates that platelets are not that innocent as they keep showing and thus numerous novel platelet biomarkers are upcoming very soon in the field of clinical research which can be important for predicting and diagnosing disease state.
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Borisevich N, Loznikova S, Sukhodola A, Halets I, Bryszewska M, Shcharbin D. Acidosis, magnesium and acetylsalicylic acid: effects on thrombin. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2013; 104:158-164. [PMID: 23266689 DOI: 10.1016/j.saa.2012.11.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/13/2012] [Accepted: 11/15/2012] [Indexed: 06/01/2023]
Abstract
Thrombin, an enzyme from the hydrolase family, is the main component of the blood coagulation system. In ischemic stroke it acts as a serine protease that converts soluble fibrinogen into insoluble strands of fibrin forming blood clots in the brain. It has been found to phosphoresce at room temperature in the millisecond and microsecond ranges. The phosphorescence of thrombin was studied under physiological conditions, in acidosis (decrease of pH from 8.0 to 5.0) and on the addition of salts (magnesium sulfate and sodium chloride) and of acetylsalicylic acid, and its connection with thrombin function is discussed. Acidosis significantly increased the internal dynamics of thrombin. We propose that lactate-acidosis plays a protective role in stroke, preventing the formation of clots. The addition of NaCl and MgSO(4) in different concentrations increased the internal dynamics of thrombin. Also, the addition of MgSO(4) decreased thrombin-induced platelet aggregation. However, magnesium sulfate and acetylsalicylic acid in the therapeutic concentrations used for treatment of ischemic stroke had no effect on thrombin internal dynamics. The data obtained will help to elucidate the conformational stability of thrombin under conditions modulating lactate-acidosis and in the presence of magnesium sulfate.
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Affiliation(s)
- Nikolaj Borisevich
- BI Stepanov Institute of Physics of NASB, Skoriny str. 68, 220072 Minsk, Belarus
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Hocaoglu C, Kural B, Aliyazıcıoglu R, Deger O, Cengiz S. IL-1β, IL-6, IL-8, IL-10, IFN-γ, TNF-α and its relationship with lipid parameters in patients with major depression. Metab Brain Dis 2012; 27:425-30. [PMID: 22707092 DOI: 10.1007/s11011-012-9323-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 06/07/2012] [Indexed: 01/22/2023]
Abstract
There is some evidence that an immune response with an increased production of proinflammatory cytokines frequently accompanies major depression. The aim of this study was to determine the serum levels of interleukines (IL-1β, IL-6, IL-8, IL-10), tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ) and immonuglobulines (IgG, IgA and IgM) levels and to examine the relationships between all above parameters and lipid parameters. The study group included 30 patients and 30 healthy volunteers. Although total cholesterol, HDL-cholesterol, and IgM levels were increased significantly (p < 0.05) in patients and compared to those of the controls, no statistically significant differences (p > 0.05) were observed with other parameters. IFN-γ were positively correlated with total cholesterol (r = 0.425; P = 0.019) and LDL-cholesterol (r = 0.391; P = 0.032) levels in patients. Other cytokines and immunoglobulins did not show any correlation with lipid parameters. It was concluded that although no differences was observed in cytokines and immunoglobulin levels in the present study, the dysregulation of the lipids and immune system including the cytokine network is associated with the etiology and pathophysiology of major depressive disorders.
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Affiliation(s)
- Cicek Hocaoglu
- Department of Psychiatry, Faculty of Medicine, Rize University, 53100, Rize, Turkey.
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Rosanoff A, Weaver CM, Rude RK. Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutr Rev 2012; 70:153-64. [PMID: 22364157 DOI: 10.1111/j.1753-4887.2011.00465.x] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In comparison with calcium, magnesium is an "orphan nutrient" that has been studied considerably less heavily. Low magnesium intakes and blood levels have been associated with type 2 diabetes, metabolic syndrome, elevated C-reactive protein, hypertension, atherosclerotic vascular disease, sudden cardiac death, osteoporosis, migraine headache, asthma, and colon cancer. Almost half (48%) of the US population consumed less than the required amount of magnesium from food in 2005-2006, and the figure was down from 56% in 2001-2002. Surveys conducted over 30 years indicate rising calcium-to-magnesium food-intake ratios among adults and the elderly in the United States, excluding intake from supplements, which favor calcium over magnesium. The prevalence and incidence of type 2 diabetes in the United States increased sharply between 1994 and 2001 as the ratio of calcium-to-magnesium intake from food rose from <3.0 to >3.0. Dietary Reference Intakes determined by balance studies may be misleading if subjects have chronic latent magnesium deficiency but are assumed to be healthy. Cellular magnesium deficit, perhaps involving TRPM6/7 channels, elicits calcium-activated inflammatory cascades independent of injury or pathogens. Refining the magnesium requirements and understanding how low magnesium status and rising calcium-to-magnesium ratios influence the incidence of type 2 diabetes, metabolic syndrome, osteoporosis, and other inflammation-related disorders are research priorities.
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Affiliation(s)
- Andrea Rosanoff
- Center for Magnesium Education & Research, 13-1255 Malama Street, Pahoa, HI 96778, USA.
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27
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Van Laecke S, Nagler EVT, Vanholder R. Thrombotic microangiopathy: a role for magnesium? Thromb Haemost 2012; 107:399-408. [PMID: 22274299 DOI: 10.1160/th11-08-0593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 12/01/2011] [Indexed: 12/15/2022]
Abstract
Despite advances in more recent years, the pathophysiology and especially treatment modalities of thrombotic microangiopathy (TMA) largely remain enigmatic. Disruption of endothelial homeostasis plays an essential role in TMA. Considering the proven causal association between magnesium and both endothelial function and platelet aggregability, we speculate that a magnesium deficit could influence the course of TMA and the related haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura. A predisposition towards TMA is seen in many conditions with both extracellular and intracellular magnesium deficiency. We propose a rationale for magnesium supplementation in TMA, in analogy with its evidence-based therapeutic application in pre-eclampsia and suggest, based on theoretical grounds, that it might attenuate the development of TMA, minimise its severity and prevent its recurrence. This is based on several lines of evidence from both in vitro and in vivo data showing dose-dependent effects of magnesium supplementation on nitric oxide production, platelet aggregability and inflammation. Our hypothesis, which is further amenable to assessment in animal models before therapeutic applications in humans are implemented, could be explored both in vitro and in vivo to decipher the potential role of magnesium deficit in TMA and of the effects of its supplementation.
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Affiliation(s)
- Steven Van Laecke
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium.
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Prabodh S, Prakash DSRS, Sudhakar G, Chowdary NVS, Desai V, Shekhar R. Status of copper and magnesium levels in diabetic nephropathy cases: a case-control study from South India. Biol Trace Elem Res 2011; 142:29-35. [PMID: 20552294 DOI: 10.1007/s12011-010-8750-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 06/07/2010] [Indexed: 12/23/2022]
Abstract
Diabetic nephropathy is a complication of diabetes mellitus. This present study investigates the status of copper and magnesium in diabetic nephropathy cases to establish a possible relation. Forty patients of diabetic nephropathy participated in the study as cases. Forty age- and sex-matched healthy individuals served as controls. Blood samples were collected from both cases and controls for determination of FBS, PPBS, HbA1c, microalbumin, copper, and magnesium levels. The mean concentrations of FBS, PPBS, HbA1c, and microalbumin of cases were significantly higher than that of controls. The mean magnesium levels of cases (1.60 ± 0.32 meq/L) were significantly lower than controls 2.14 ± 0.16 meq/L (p < 0.05). But the mean copper levels of cases, 165.42 ± 5.71 μg/dl, shows no significant difference with controls, 166.6 ± 5.48 μg/dl, (p > 0.05).The findings in the present study suggest that hypomagnesemia may be linked with development of diabetic nephropathy.
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Affiliation(s)
- S Prabodh
- Department of Biochemistry, NRI Medical College, General Hospital, Chinakakani, Guntur district, Andhra Pradesh, India
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Takaya J, Yamato F, Kuroyanagi Y, Higashino H, Kaneko K. Intracellular magnesium of obese and type 2 diabetes mellitus children. Diabetes Ther 2010; 1:25-31. [PMID: 22127671 PMCID: PMC3118274 DOI: 10.1007/s13300-010-0003-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Magnesium is a critical cofactor in numerous enzymatic reactions. Diabetic patients and obese subjects are often reported to have intracellular magnesium ([Mg(2+)](i)) deficiency. We studied the change of [Mg(2+)](i) in obese children and children with type 2 diabetes mellitus (DM2) after educational intervention or treatment. METHODS A total of 25 subjects were included: 13 with simple obesity (10 male, 3 female; mean age 16±8 years, intervention period 1.0±0.6 years), 12 with DM2 (8 male, 4 female; mean age 15±3 years, medication period 1.1±0.7 years), and 16 controls (8 male, 8 female; mean age 17±7 years). By using a fluorescent probe, mag-fura-2, we examined the basal and insulin-stimulated [Mg(2+)](i) of platelets in the blood. Plasma leptin, ghrelin, adiponectin, and resistin levels were determined with the use of enzyme-linked immunosorbent assay (ELISA). RESULTS Mean basal [Mg(2+)](i) was lower in the obesity (160±65 μmol/L) and DM2 groups (140±30 μmol/L) compared with the control group (330±28 μmol/L). The elevated [Mg(2+)](i) after insulin stimulation was also lower in these two groups (420±140 μmol/L, and 330±70 μmol/L, respectively) compared with the control group (690±270 μmol/L). In the DM2 group, the basal [Mg(2+)](i) was significantly increased after treatment, while in the obesity group, stimulated [Mg(2+)](i) was increased after intervention. CONCLUSION Platelet [Mg(2+)](i) increased after intervention in children with obesity or DM2.
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Affiliation(s)
- Junji Takaya
- Department of Pediatrics, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka, 570-8506, Japan,
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Arinzon Z, Peisakh A, Schrire S, Berner YN. Prevalence of hypomagnesemia (HM) in a geriatric long-term care (LTC) setting. Arch Gerontol Geriatr 2009; 51:36-40. [PMID: 19665241 DOI: 10.1016/j.archger.2009.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 07/07/2009] [Accepted: 07/09/2009] [Indexed: 11/28/2022]
Abstract
Electrolyte abnormalities are frequently observed in elderly long-term care (LTC) patients. Magnesium is a trace mineral, but is the second most abundant intracellular cation and the fourth most abundant cation in the body. This was a cross-sectional study to assess the prevalence of hypomagnesemia (HM) in non-selected elderly LTC patients. A total of 159 patients aged 65 years and older were included in the study. The attributes and variables related to the patients' hospital course were used to compare the two groups. We used univariate and multivariate analyses to correlate magnesium levels with demographic, clinical factors and laboratory data. HM was found in 36% of the patients, of whom 35% presented with moderate HM (0.8-0.9 microequiv./l) and 18% with severe HM (<or=0.7 microequiv./l). Patients with HM had a higher number of comorbid diseases per patient (p=0.038), low body mass index (BMI) (p=0.044) and more of them presented with laboratory markers of malnutrition, such as low total cholesterol (TC) and serum albumin (SA) levels. Coexistence with other electrolyte abnormalities was higher among patients with HM than without (p=0.006), predominantly hypocalcemia and hypokalemia (p=0.023 and 0.032, respectively). Using regression analysis, independent variables significantly associated with serum magnesium levels were serum albumin, calcium, potassium, urea levels, chronic renal failure (CRF), chronic heart failure (CHF), diabetes mellitus (DM) and diuretic drugs (R(2)=0.877). Both early (up to 30 days) and late rate of death were higher in patients with HM. The incidence of HM in LTC elderly patients is high and multifactorial. Understanding the causes of HM, correction of magnesium level, and definitive and effective treatment of the cause leading to HM is important to improve patient prognosis.
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Affiliation(s)
- Zeev Arinzon
- The Department of Geriatric Medicine, Sapir Medical Center, Kfar Saba, Israel.
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Abstract
Magnesium (Mg) is the fourth most abundant mineral in the body and the most abundant intracellular divalent cation, with essential roles in many physiological functions. Consequently, the assessment of Mg status is important for the study of diseases associated with chronic deficiency. In spite of intense research activities there is still no simple, rapid, and accurate laboratory test to determine total body Mg status in humans. However, serum Mg < 0.75 mmol/l is a useful measurement for severe deficiency, and for values between 0.75 and 0.85 mmol/l a loading test can identify deficient subjects. The loading test seems to be the gold standard for Mg status, but is unsuitable in patients with disturbed kidney and intestinal functions when administered orally. There is also a need to reach a consensus on a standardized protocol in order to compare results obtained in different clinical units. Other cellular Mg measurements, such as total or ionized Mg, frequently disagree and more research and systematic evaluations are needed. Muscle Mg appears to be a good marker, but biopsies limit its usefulness, as is the case with bone Mg, the most important but heterogeneous Mg compartment. The development of new and non invasive techniques such as nuclear magnetic resonance (NMR) may provide valuable tools for routinely analysing ionized Mg in tissues. With the development of molecular genetics techniques, the recent discovery of Transient Receptor Potential Melastatin channels offers new possibilities for the sensitive and rapid evaluation of Mg status in humans.
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Abstract
PURPOSE OF REVIEW This review summarizes the evidence for benefits of magnesium on metabolic abnormalities, inflammatory parameters, and cardiovascular risk factors and related-potential mechanisms. Controversy due to contrasting results in the literature is also discussed. RECENT FINDINGS Increased dietary magnesium intake confers protection against the incidence of diabetes, metabolic syndrome, hypertension, and cardiovascular disease. It ameliorates insulin resistance, serum lipid profiles, and lowers inflammation, endothelial dysfunction, oxidative stress, and platelet aggregability. Magnesium acts as a mild calcium antagonist on vascular smooth muscle tone, and on postreceptor insulin signaling; it is critically involved in energy metabolism, fatty acid synthesis, glucose utilization, ATPase functions, release of neurotransmitters, and endothelial cell function and secretion. Prospective studies, however, have found only a modest effect for dietary magnesium on incident pathologies. Furthermore, magnesium supplementation on glucose metabolism, blood lipid levels, and ischemic heart disease has given inconsistent results. SUMMARY There is strong biological plausibility for the direct impact of magnesium intake on metabolic and cardiovascular risk factors, but in-vivo magnesium deficiency might play only a modest role. Reverse causality, the strong association between magnesium and other beneficial nutrients, or the possibility that people who choose magnesium-rich foods are more health-conscious may be confounding factors.
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Affiliation(s)
- Simona Bo
- Department of Internal Medicine, University of Turin, Italy.
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Abstract
AbstractDiet plays an important role in the primary and secondary prevention of cardiovascular disease. The growing perception that abnormal haemostatic processes of coagulation, platelet aggregation and fibrinolysis contribute to cardiovascular disease aetiology motivated this review on the relationships of diet, specific foods and nutrients with haemostatic function. Functional endpoints that reflect the function and status of some of these processes and which can be measured in dietary trials are identified. The effects of energy intake and expenditure, alcohol, total fat and specific fatty acids, non-starch polysaccharides (dietary fibre), antioxidant nutrients and some foods on a variety of haemostatic markers are reviewed. The results indicate that the prudent low-fat, high-fibre diet and maintenance of ideal body weight recommended to protect against and treat hyperlipidaemia and coronary heart disease will also benefit haemostatic profiles. It is concluded that more research on specific effects is needed for improved recommendations on a population level for prevention of cardiovascular disease.
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Takaya J, Yamato F, Higashino H, Kaneko K. Intracellular magnesium and adipokines in umbilical cord plasma and infant birth size. Pediatr Res 2007; 62:700-3. [PMID: 17957162 DOI: 10.1203/pdr.0b013e318157d219] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Many epidemiologic studies have disclosed that restricted fetal growth has been associated with an increased risk of insulin resistance in adulthood. We studied the relationship of intracellular magnesium [Mg2+]i in cord blood platelets to adipocytokine and birth size. The subjects were 20 infants with small for gestational age (SGA) and 45 infants with appropriate for gestational age (AGA). By using a fluorescent probe, we examined [Mg2+]i of platelets in the cord blood. Cord plasma insulin, IGF-I, ghrelin, adiponectin, plasminogen activator inhibitor-1 (PAI-1), and leptin levels were determined with the use of ELISA. Mean [Mg2+]i was lower in the SGA than in the AGA groups (p < 0.001). Adiponectin and IGF-I were also lower in the SGA than in the AGA, whereas PAI-1 was higher in the SGA. [Mg2+]i was significantly correlated with birth weight, birth length, and adiponectin. Birth weight was also correlated with cord plasma IGF-I, adiponectin, and leptin. Quantitative insulin sensitivity check index (QUICKI) was lower in the SGA group than in the AGA group. [Mg]i and adiponectin were correlated with QUICKI in all subjects. [Mg]i, as well as leptin and IGF-I, reflect the extent of fetal growth. Decreased [Mg2+]i may be involved in the underlying processes to insulin resistance.
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Affiliation(s)
- Junji Takaya
- Department of Pediatrics, Kansai Medical University, Moriguchi, Osaka 570-8506, Japan
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He K, Song Y, Belin RJ, Chen Y. Magnesium intake and the metabolic syndrome: epidemiologic evidence to date. ACTA ACUST UNITED AC 2007; 1:351-5. [PMID: 17679786 DOI: 10.1111/j.1559-4564.2006.05702.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The importance of magnesium intake in relation to the metabolic syndrome has been increasingly recognized. Magnesium is an essential mineral, critical for a number of metabolic functions in the human body. The major dietary sources of magnesium intake include whole grains, legumes, nuts, and green leafy vegetables. Animal studies indicate a pivotal role of magnesium in glucose homeostasis and insulin secretion and action. Experimental and clinical studies suggest that magnesium intake may be inversely related to the risk of hypertension and type 2 diabetes mellitus, and may decrease blood triglyceride and increase high-density lipoprotein cholesterol levels. The purpose of this brief review is to summarize the epidemiologic data relating magnesium to the metabolic syndrome and to discuss the potential mechanisms.
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Affiliation(s)
- Ka He
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Duke AM, Hopkins PM, Halsall PJ, Steele DS. Mg2+ dependence of Ca2+ release from the sarcoplasmic reticulum induced by sevoflurane or halothane in skeletal muscle from humans susceptible to malignant hyperthermia. Br J Anaesth 2006; 97:320-8. [PMID: 16849381 DOI: 10.1093/bja/ael179] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In normal resting muscle, cytosolic Mg(2+) exerts a potent inhibitory influence on the sarcoplasmic reticulum (SR) Ca(2+) release channel (ryanodine receptor, RyR1). Impaired Mg(2+)-regulation of RyR1 has been proposed as a causal factor in malignant hyperthermia (MH). The aim of this study was to compare the effects of cytosolic Mg(2+) on SR Ca(2+) release induced by halothane or sevoflurane in normal (MHN) and MH susceptible (MHS) human skeletal muscle fibres. METHODS Samples of vastus medialis muscle were obtained from patients under investigation for MH susceptibility. Single fibres were mechanically skinned and perfused with solutions mimicking the intracellular milieu. Changes in [Ca(2+)](i) were detected using fura-2 fluorescence after application of equimolar halothane or sevoflurane. RESULTS In MHN fibres, concentrations of sevoflurane or halothane as high as 10 mM typically failed to induce SR Ca(2+) release at physiological free [Mg(2+)] (1 mM). However, when [Mg(2+)] was decreased to 0.4 mM, SR Ca(2+) release occurred in 51% (16/33) and 6% (2/33) of MHN fibres after the addition of 1 mM halothane or 1 mM sevoflurane, respectively. Further decreases in [Mg(2+)] increased the proportion of responsive fibres. In the presence of 0.1 mM [Mg(2+)], Ca(2+) release occurred in all fibres (33/33) after the introduction of 1 mM halothane or 1 mM sevoflurane. In MHS fibres, 1 mM halothane or 1 mM sevoflurane-induced Ca(2+) release in 54% (7/13) or 15% (2/13) of fibres, respectively, at 1 mM Mg(2+). A decrease in [Mg(2+)] to 0.2 mM Mg(2+) was sufficient to render 100% of MHS fibres (13/13) responsive to 1 mM halothane or 1 mM sevoflurane. CONCLUSIONS In both MHS and MHN fibres (i) halothane is a more potent activator of SR Ca(2+) release than sevoflurane and (ii) as with halothane, the efficacy of sevoflurane-induced SR Ca(2+) release exhibits a marked dependence on cytosolic [Mg(2+)]. The marked potentiation of SR Ca(2+) release after a moderate reduction in cytosolic [Mg(2+)] suggests that conditions which cause hypomagnesaemia will increase the probability and possibly severity of an MH event. Conversely, maintenance of a normal or slightly increased cytosolic [Mg(2+)] may reduce the probability of MH.
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Affiliation(s)
- A M Duke
- Institute of Membrane and Systems Biology, University of Leeds Woodhouse Lane, Leeds LS2 9JT, UK
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Atabek ME, Kurtoglu S, Pirgon O, Baykara M. Serum magnesium concentrations in type 1 diabetic patients: relation to early atherosclerosis. Diabetes Res Clin Pract 2006; 72:42-7. [PMID: 16214256 DOI: 10.1016/j.diabres.2005.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Revised: 05/13/2005] [Accepted: 09/06/2005] [Indexed: 11/19/2022]
Abstract
Hypomagnesemia and sub-clinical atherosclerosis are common in type 1 diabetic patients, and are especially common in poorly controlled and chronically treated diabetics. The aim of this study was to evaluate the relationships between serum magnesium (Mg) and intima-media thickness (IMT), and functions of common carotid artery (CCA), accepted as markers of early carotid atherosclerosis in type 1 diabetic patients. Serum magnesium levels were measured in 51 diabetic patients (26 girls and 25 boys). Age, duration of diabetes as well as major cardiovascular risk factors, including anthropometric and metabolic parameters were matched between girls and boys. CCA structure and functions were measured by ultrasonography as IMT, cross-sectional compliance (CSC), cross-sectional distensibility (CSD), diastolic wall stress (DWS), and incremental elastic modulus (IEM). The difference for serum Mg was significant between diabetic girls and boys (0.75+/-0.09 mmol/l versus 0.86+/-0.14 mmol/l; p=0.02). Mg levels were correlated with IMT (r=-0.58, p=0.004) and DWS (r=-0.49, p=0.01) in girls and with IMT (r=-0.55, p=0.007) and DWS (r=-0.46, p=0.03) in boys. In a multivariate regression model, Mg, systolic blood pressure and waist-hip ratio emerged as independent correlates for mean IMT in girls with the total variance explained being 63%, and Mg and triglycerides emerged as independent correlates for mean IMT in boys with the total variance explained being 68%. Mg did not emerge as independent correlates for mean DWS in both girls and boys. Serum magnesium levels in children and adolescent patients with type 1 diabetes are associated with early atherosclerosis.
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Affiliation(s)
- Mehmet Emre Atabek
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Selcuk University, Faculty of Medicine, Cocuk Sagligi ve Hastaliklari, 42080 Konya, Turkey.
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Steele DS, Duke AM. Defective Mg2+ regulation of RyR1 as a causal factor in malignant hyperthermia. Arch Biochem Biophys 2006; 458:57-64. [PMID: 16620769 DOI: 10.1016/j.abb.2006.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 03/01/2006] [Accepted: 03/02/2006] [Indexed: 11/27/2022]
Abstract
In skeletal muscle, Mg(2+) exerts a dual inhibitory effect on RyR1, by competing with Ca(2+) at the activation site and binding to a low affinity Ca(2+)/Mg(2+) inhibitory site. Pharmacological activators of RyR1 must overcome the inhibitory action of Mg(2+) before Ca(2+) efflux can occur. In normal muscle, where the free [Mg(2+)](i) is approximately 1mM, even prolonged exposure to millimolar levels of volatile anesthetics does not initiate SR Ca(2+) release. However, when the cytosolic [Mg(2+)] is reduced below the physiological range, low levels of volatile anesthetic within the clinically relevant range (1mM) can initiate SR Ca(2+) release, in the form of a propagating Ca(2+) wave. In human muscle fibers from malignant hyperthermia susceptible patients, such Ca(2+) waves occur when 1mM halothane is applied at physiological [Mg(2+)](i). There is increasing evidence to suggest that defective Mg(2+) regulation of RyR1 confers susceptibility to malignant hyperthermia. At the molecular level, interactions between critical RyR1 subdomains may explain the clustering of RyR1 mutations and associated effects on Mg(2+) regulation.
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Affiliation(s)
- Derek S Steele
- Institute of Membrane and Systems Biology, University of Leeds, Leeds LS29JT, UK.
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McCarty MF. Magnesium may mediate the favorable impact of whole grains on insulin sensitivity by acting as a mild calcium antagonist. Med Hypotheses 2005; 64:619-27. [PMID: 15617878 DOI: 10.1016/j.mehy.2003.10.034] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2003] [Accepted: 10/17/2003] [Indexed: 12/15/2022]
Abstract
Recent epidemiology has linked high consumption of whole grains with reduced risk for diabetes, coronary disease, stroke, and various types of cancer; there is reason to suspect that improved insulin sensitivity is largely responsible for this protection. This phenomenon may be partially explained by the lower glycemic indices of some whole grain food products in comparison to their fiber-depleted analogs. Nonetheless, the fact that whole wheat flour promotes insulin sensitivity relative to white flour--and yet has a near-identical glycemic index--suggests that certain nutrients or phytochemicals in whole wheat, depleted by the refining process, promote preservation of insulin sensitivity. Magnesium is a likely candidate in this regard; magnesium deficiency promotes insulin resistance in rodents and in humans, whereas supplemental magnesium has been found to prevent type 2 diabetes in rodent models of this syndrome, and to improve the insulin sensitivity of elderly or diabetic humans. Magnesium-rich diets as well as above-average serum magnesium are associated with reduced diabetes risk in prospective epidemiology, and with greater insulin sensitivity in cross-sectional studies; moreover, other types of magnesium-rich foods--dairy products, legumes, and nuts--have been linked to decreased diabetes risk in prospective studies. The biochemical role of magnesium in support of insulin function is still poorly understood. In light of evidence that magnesium can function as a mild natural calcium antagonist, it is interesting to note suggestive evidence that increases in intracellular free calcium may compromise the insulin responsiveness of adipocytes and skeletal muscle, and may indeed play a pathogenic role in the insulin resistance syndrome. Thus, it is proposed that some or all of the favorable impact of good magnesium status on insulin function may reflect antagonism of the induction or effects of increased intracellular free calcium. Further research concerning the potential health benefits of long-term magnesium supplementation is clearly warranted. These considerations, however, should not detract from efforts to better inform the public regarding the strong desirability of choosing whole grain products in preference to refined grains.
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Affiliation(s)
- Mark F McCarty
- Pantox Laboratories, 4622 Santa Fe Street, San Diego, CA 92109, USA.
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Takaya J, Yamato F, Higashino H, Kobayashi Y. Relationship of intracellular magnesium of cord blood platelets to birth weight. Metabolism 2004; 53:1544-7. [PMID: 15562397 DOI: 10.1016/j.metabol.2004.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Magnesium (Mg(2+)) has an important role in insulin action, and insulin stimulates Mg(2+) uptake in insulin-sensitive tissues. Impaired biologic responses to insulin are referred to as insulin resistance. Diabetic patients and obese subjects are reported to have intracellular magnesium ([Mg(2+)](i)) deficiency. Many epidemiologic studies have disclosed that restricted fetal growth has been associated with increased risk of insulin resistance in adult life. We studied the relationship of [Mg(2+)](i) in cord blood platelets to birth weight. The subjects were 19 infants who were small for gestational age (SGA) and 45 who were appropriate for gestational age (AGA). By using a fluorescent probe, mag-fura-2, we examined the basal and insulin-stimulated [Mg(2+)](i) of platelets in the cord blood. Cord plasma insulin-like growth factor-1 (IGF-1)and leptin levels were determined with the use of enzyme-linked immunosorbent assay (ELISA). Birth weight was correlated with cord plasma IGF-1 (P < .001) and leptin (P < .005). Mean basal [Mg(2+)](i), but not plasma Mg(2+), was lower in the SGA than in the AGA group (291 +/- 149 micromol/L v 468 +/- 132 micromol/L, P < .001). The basal [Mg(2+)](i) was significantly correlated with the birth weight (P < .001) as well as birth length (P < .001). At 60 seconds after stimulation with insulin, there was no significant difference in stimulated [Mg(2+)](i) between the SGA and AGA groups. Although the SGA group had low [Mg(2+)](i), the platelets had good potentiality to compensate for low [Mg(2+)](i). [Mg(2+)](i) reflects the extent of fetal growth. Decreased [Mg(2+)](i) in SGA might underlie the initial pathophysiologic events leading to insulin resistance.
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Affiliation(s)
- Junji Takaya
- Department of Pediatrics, Kansai Medical University, Osaka 570-8506, Japan
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Kempfert J, Behrends S. Analysis of nitric oxide-sensitive guanylyl cyclase in human platelets before and after aggregation. Platelets 2004; 14:429-35. [PMID: 14713512 DOI: 10.1080/0953710032000141752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Nitric oxide (NO) inhibits cell adhesion to vascular endothelium and platelet aggregation through activation of soluble guanylyl cyclase (sGC) and a consequent increase in cGMP. The aim of the present study was to analyze NO-sensitive sGC in human platelets before and after aggregation. NO-sensitive sGC activity was tested in the cytosol and membrane fractions of native human platelets and ADP-induced platelet aggregates in the presence of 3 mM Mn2+ as cofactor. After ADP-induced platelet aggregation there was a significant increase of sGC activity in membranes. Western blot analysis showed a partial translocation of the enzyme to the plasma membrane. These findings support recent data that sGC is associated with cellular membranes in various tissues and cell types and that this membrane association is influenced by the activation state in human platelets (Nat Cell Biol 2002; 4: 307-11). Using 3 mM Mg2+ instead of Mn2+ as cofactor, a sharp decrease of sGC activity was apparent in the cytosol of aggregated platelets. Kinetic analysis of the cytosolic enzyme and concentration-response curves for free Mg2+ showed that platelet aggregation changes binding of free Mg2+ but not binding of the substrate complex Mg.GTP. This effect was specific for free Mg2+ and was not seen for Mn2+. In addition, changes in free Mg2+ concentration in a physiological range markedly influenced NO-stimulated sGC activity. This provides a possible explanation for the increased platelet aggregability in patients with low intraplatelet Mg2+ levels.
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Affiliation(s)
- Jörg Kempfert
- Institute of Experimental and Clinical Pharmacology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
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Farvid MS, Siassi F, Jalali M, Hosseini M, Saadat N. The impact of vitamin and/or mineral supplementation on lipid profiles in type 2 diabetes. Diabetes Res Clin Pract 2004; 65:21-8. [PMID: 15163474 DOI: 10.1016/j.diabres.2003.11.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/13/2003] [Accepted: 11/21/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of the present study was to assess the impact of Mg + Zn, Vitamins C + E, and combination of these micronutrients on serum lipid and lipoprotein profiles in type 2 diabetic patients. MATERIALS AND METHODS In a randomized, double-blind, placebo controlled clinical trial, 69 type 2 diabetic patients were randomly divided into four groups, each group receiving one of the following daily supplement for 3 months; group M: 200 mg Mg and 30 mg Zn (n = 16), group V: 200mg Vitamin C and 150 mg Vitamin E (n = 18), group MV: minerals plus vitamins (n = 17), group P: placebo (n = 18). Fasting blood and urine samples were collected at the beginning and at the end of the trial. Serum triglyceride, total cholesterol, high density lipoprotein cholesterol (HDL-c) and low density lipoprotein cholesterol (LDL-c) were measured enzymatically. Apolipoproteins (apo) A1 and B were measured by immunoturbidimetric method. Adjustment for differences in baselines covariates and changes in variables during study were performed by analysis of covariance using general linear models. RESULTS Results indicate that after 3 months of supplementation mean serum levels of HDL-c and apo A1 increased significantly in the MV group by 24% (50.4 +/-19.3 mg/dl versus 40.6 +/- 10.8 mg/dl) and 8.8% (169.8 +/- 33.8 mg/dl versus 156.1+ /- 23.9 mg/dl), respectively (P < 0.01). There were no significant changes in the levels of these parameters in the other three groups. Serum levels of total cholesterol, LDL-c, triglyceride, and apo B were not altered after supplementation in all four groups. CONCLUSION It is concluded that since co-supplementation of Mg, Zn, Vitamins C and E significantly increases HDL-c and apo A1, supplementation of these micronutrients could be recommended for the type 2 diabetic patients based on their daily requirements.
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Affiliation(s)
- Maryam Sadat Farvid
- Department of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Hsiao G, Shen MY, Chou DS, Lin CH, Chen TF, Sheu JR. Involvement of the antiplatelet activity of magnesium sulfate in suppression of protein kinase C and the Na+/H+ exchanger. J Biomed Sci 2004; 11:19-26. [PMID: 14730206 DOI: 10.1007/bf02256545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2003] [Accepted: 08/12/2003] [Indexed: 12/01/2022] Open
Abstract
Magnesium sulfate is widely used to prevent seizures in pregnant women with hypertension. The aim of this study was to examine the inhibitory mechanisms of magnesium sulfate in platelet aggregation in vitro. In this study, magnesium sulfate concentration-dependently (0.6-3.0 mM) inhibited platelet aggregation in human platelets stimulated by agonists. Magnesium sulfate (1.5 and 3.0 mM) also concentration-dependently inhibited phosphoinositide breakdown and intracellular Ca+2 mobilization in human platelets stimulated by thrombin. Rapid phosphorylation of a platelet protein of M(r) 47,000 (P47), a marker of protein kinase C activation, was triggered by phorbol-12-13-dibutyrate (PDBu, 50 nM). This phosphorylation was markedly inhibited by magnesium sulfate (3.0 mM). Magnesium sulfate (1.5 and 3.0 mM) further inhibited PDBu-stimulated platelet aggregation in human platelets. The thrombin-evoked increase in pHi was markedly inhibited in the presence of magnesium sulfate (3.0 mM). In conclusion, these results indicate that the antiplatelet activity of magnesium sulfate may be involved in the following two pathways: (1) Magnesium sulfate may inhibit the activation of protein kinase C, followed by inhibition of phosphoinositide breakdown and intracellular Ca+2 mobilization, thereby leading to inhibition of the phosphorylation of P47. (2) On the other hand, magnesium sulfate inhibits the Na+/H+ exchanger, leading to reduced intracellular Ca+2 mobilization, and ultimately to inhibition of platelet aggregation and the ATP-release reaction.
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Affiliation(s)
- George Hsiao
- Graduate Institute of Pharmacology, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei 110, Taiwan
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44
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Erkens JA, Klungel OH, Stolk RP, Spoelstra JA, Grobbee DE, Leufkens HGM. Antihypertensive drug therapy and the risk of lower extremity amputations in pharmacologically treated type 2 diabetes patients. Pharmacoepidemiol Drug Saf 2004; 13:139-46. [PMID: 15072112 DOI: 10.1002/pds.932] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE The objective of this study was to determine the association between different antihypertensive drug therapies and lower extremity amputations (LEAs) in type 2 diabetes patients. METHODS Data were obtained from the PHARMO Record Linkage System comprising pharmacy records and data on hospitalisations for all 450,000 residents of eight Dutch cities. In a nested case-control study among 12,140 type 2 diabetes patients who used antihypertensive drugs, 26 cases with a first LEA and 94 controls without a LEA matched on age, sex and calendar time were identified. Logistic regression was used to estimate the relative risk of LEA and to adjust for potential confounding factors. RESULTS Among type 2 diabetes patients who used antihypertensive drugs, subjects who used thiazide diuretics, alone or in combination, had a higher risk of LEA compared to subjects who used Angiotensin Converting Enzyme (ACE) inhibitor monotherapy (crude odds ratio (OR): 6.11 [95% confidence interval (CI): 1.32-28.27]). The use of thiazide diuretics was also associated with an increased risk of LEA when compared to the use of any non-thiazide antihypertensive drug (adjusted OR: 7.04 [1.10-45.30]). The increased risk of LEA associated with the use of thiazides compared to the use of non-thiazides depended on the duration of use (adjusted OR(< or = 365 days), 4.82 [0.61-38.34] and adjusted OR(>365 days), 26.16 [1.02-674.02], p-trend = 0.01). CONCLUSIONS Treatment with thiazide diuretics compared to treatment with other antihypertensive drugs was associated with excess amputations in type 2 diabetes patients. Due to several limitations of this study, our findings do not preclude the use of thiazides in type 2 diabetes mellitus patients as yet.
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Affiliation(s)
- Joëlle A Erkens
- Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
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45
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Plante DK, Nadler JL. Diabetes and Vascular Disease. Semin Cardiothorac Vasc Anesth 2003. [DOI: 10.1177/108925320300700306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The incidence of diabetes is on the rise; most of this increase is accounted for by type 2 diabetes and is secondary to the growing prevalence of obesity. Most of the late complications of both type 1 and type 2 diabetes are secondary to microvascular and macrovascular complications. Microvascular complications include retinopathy, neuropathy, and nephropathy. Nephropathy is strongly linked to the complications of macrovascular disease, which include cardiovascular, cerebrovascular, and peripheral vascular disease. Hence, once microalbuminuria (an early marker of nephropathy) is present, the patient is at a greater risk of cardiovascular disease and other microvascular complications, including retinopathy. A number of cellular mechanisms are altered secondary to hyperglycemia, and recently, a common pathway linking these mechanisms has been proposed, ultimately leading to oxidative damage and thus end-organ or tissue damage. Due to the increased risk of vascular complications, many diabetic patients undergo surgical procedures, including revascularization and bypass. Recent studies have highlighted the importance of strict glycemic control during the perioperative and postoperative period, even in the nondiabetic patient. The results of these studies have shown a decrease in morbidity, mortality, and hospital stay with strict glycemic control. Glycemic control has been directly linked to decreased microvascular complications. Macrovascular disease, however, has not been clearly linked to glucose levels alone, and although it certainly plays a role, other components of the metabolic syndrome, including blood pressure and lipid status, are equally important.
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Affiliation(s)
| | - Jerry L. Nadler
- University of Virginia Health System; Chief, Division of Endocrinology and Metabolism, Charlottsville, Virginia
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46
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Sheu JR, Hsiao G, Shen MY, Lee YM, Yen MH. Antithrombotic effects of magnesium sulfate in in vivo experiments. Int J Hematol 2003; 77:414-9. [PMID: 12774935 DOI: 10.1007/bf02982655] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this study, magnesium sulfate was effective in reducing the mortality of adenosine diphosphate-induced acute pulmonary thromboembolism in mice, when it was administered intravenously at doses of 100 and 200 microg/g body weight. In addition, intravenous injections of magnesium sulfate (100 and 200 microg/g) significantly prolonged bleeding time in the severed mesenteric arteries of rats by approximately 1.7- and 1.9-fold, respectively, compared with normal saline. Continuous infusion of magnesium sulfate (20 microg/g per minute) for 10 minutes also significantly increased the bleeding time by approximately 1.7-fold, and the bleeding time returned to baseline within 60 minutes of cessation of magnesium sulfate infusion. On the other hand, platelet thrombi formation was induced by irradiating mesenteric venules with filtered light in mice pretreated with intravenous fluorescein sodium. When magnesium sulfate was administered at 300 microg/g during induction of platelet plug formation with 10 microg/kg fluorescein sodium, occlusion time was not significantly prolonged, but a dose of 600 microg/g did significantly prolong the occlusion time. Furthermore, aspirin (250 microg/g) also showed a similar activity in this experiment in prolonging the occlusion time. In conclusion, these results suggest that magnesium sulfate has an effective antithrombotic activity in vivo, and treatment with magnesium sulfate may lower the risk of thromboembolic-related disorders.
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Affiliation(s)
- Joen R Sheu
- Graduate Institute of Medical Sciences, Taipei Medical University, Taipei, Taiwan.
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47
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Takaya J, Higashino H, Kotera F, Kobayashi Y. Intracellular magnesium of platelets in children with diabetes and obesity. Metabolism 2003; 52:468-71. [PMID: 12701060 DOI: 10.1053/meta.2003.50076] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Magnesium (Mg(2+)), the second most abundant intracellular cation, is a critical cofactor in numerous enzymatic reactions. By using a fluorescent probe, mag-fura-2, we examined the basal levels and changes in intracellular Mg(2+)([Mg(2+)](i)) of platelets in diabetic and obese children. Under the basal condition, the platelet [Mg(2+)](i) of both type 1 and type 2 diabetes mellitus (DM) and the obesity groups was significantly lower than the values in the nondiabetic control group (377 +/- 62 micromol/L, 312 +/- 72 micromol/L, 373 +/- 35 micromol/L v 594 +/- 62 micromol/L, respectively, P <.05). [Mg(2+)](i) was increased after the stimulation with 100 microU/mL of insulin. After 60 seconds of insulin stimulation, the value of [Mg(2+)](i) was lower in the type 1 DM group compared with the control group (729 +/- 85 micromol/L v 1,078 +/- 67 micromol/L, P <.005). The increase in percentage over the resting [Mg(2+)](i) was higher in the type 2 DM group than in the stimulated control group (222% +/- 51% v 98% +/- 18 %, P <.05), although the stimulated [Mg(2+)](i) did not reach the level of the control group. The diabetic patients and obese subjects have [Mg(2+)](i) deficiency. In the type 2 DM and obese groups, platelets responded well to insulin. In children under insulin-resistant states, [Mg(2+)](i) decreases before the poor reactivity to insulin occurs in platelets. Decreased [Mg(2+)](i) might underlie the initial pathophysiologic events leading to insulin resistance and abnormality of platelet coagulation.
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Affiliation(s)
- Junji Takaya
- Department of Pediatrics, Kansai Medical University, Moriguchi, Osaka, Japan
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48
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Sheu JR, Hsiao G, Shen MY, Fong TH, Chen YW, Lin CH, Chou DS. Mechanisms involved in the antiplatelet activity of magnesium in human platelets. Br J Haematol 2002; 119:1033-41. [PMID: 12472585 DOI: 10.1046/j.1365-2141.2002.03967.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this study, magnesium sulphate dose-dependently (0.6-3.0 mmol/l) inhibited platelet aggregation in human platelets stimulated by agonists. Furthermore, magnesium sulphate (3.0 mmol/l) markedly interfered with the binding of fluorescein isothiocanate-triflavin to the glycoprotein (GP)IIb/IIIa complex in platelets stimulated by collagen. Magnesium sulphate (1.5 and 3.0 mmol/l) also inhibited phosphoinositide breakdown and intracellular Ca+2 mobilization in human platelets stimulated by collagen. Magnesium sulphate (3.0 mmol/l) significantly inhibited thromboxane A2 formation stimulated by collagen in platelets. Moreover, magnesium sulphate (1.5 and 3.0 mmol/l) obviously increased the fluorescence of platelet membranes tagged with diphenylhexatriene. In addition, magnesium sulphate (1.5 and 3.0 mmol/l) increased the formation of cyclic adenosine monophosphate (AMP) in platelets. Phosphorylation of a protein of Mr 47 000 (P47) was markedly inhibited by magnesium sulphate (1.5 mmol/l). In conclusion, the antiplatelet activity of magnesium sulphate may involve the following two pathways. (1) Magnesium sulphate may initially induce membrane fluidity changes with resulting interference of fibrinogen binding to the GPIIb/IIIa complex, followed by inhibition of phosphoinositide breakdown and thromboxane A2 formation, thereby leading to inhibition of both intracellular Ca2+ mobilization and phosphorylation of P47. (2) Magnesium sulphate might also trigger the formation of cyclic AM, ultimately resulting in inhibition of the phosphorylation of P47 and intracellular Ca+2 mobilization.
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Affiliation(s)
- Joen-Rong Sheu
- Graduate Institute of Medical Sciences and Department of Pharmacology, Taipei Medical University, Taipei, Taiwan.
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49
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Guerrero-Romero F, Rodríguez-Morán M. Hypomagnesemia is linked to low serum HDL-cholesterol irrespective of serum glucose values. J Diabetes Complications 2000; 14:272-6. [PMID: 11113690 DOI: 10.1016/s1056-8727(00)00127-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Hypomagnesemia is common in diabetic subjects, and is especially common in poorly controlled diabetes, suggesting that diabetes low serum magnesium status is osmotic diuresis-dependent. To assess the relationship between serum magnesium and HDL-cholesterol concentration adjusted by serum glucose values. We assessed the serum magnesium levels of 50 controlled (HbA(1c)</=7.5% and FPG<126 mg/dl), 110 non-controlled (HbA(1c)>7.5% and FPG>/=126 mg/dl) type II diabetic patients, 40 subjects with impaired fasting glucose (IFG) (FPG>/=110 mg/dl and <126 mg/dl) and 190 healthy volunteers (FPG<110 mg/dl). Healthy volunteers were required to have normal blood pressure and normal laboratory tests. Subjects in the groups included were matched by age and body mass index (BMI). The average of diabetes duration was of 11.4+/-6.6, and 10.9+/-6.2 years, P=NS, for the controlled and non-controlled diabetic patients, respectively. Thirty (60.0%) controlled diabetic subjects, 58 (52. 7%) non-controlled diabetic patients, 21 (52.5%) subjects with IFG, and 39 (20.5%) healthy volunteers had serum magnesium levels </=1.7 mg/l. Serum HDL-cholesterol value showed significant graded increase with serum magnesium levels irrespective of glucose values. Results of this study suggest that hypomagnesemia by an etiopathogenic pathway glycemia independent seems to be involved to decrease HDL-cholesterol.
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50
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Barbagallo M, Gupta RK, Dominguez LJ, Resnick LM. Cellular ionic alterations with age: relation to hypertension and diabetes. J Am Geriatr Soc 2000; 48:1111-6. [PMID: 10983912 DOI: 10.1111/j.1532-5415.2000.tb04788.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cytosolic free calcium (Cai) and magnesium (Mgi) are vital to cellular homeostasis and function. OBJECTIVE To evaluate cellular divalent cations in normal subjects at different ages and their relationship to ion levels in essential hypertension and diabetes. DESIGN A cross-sectional study. SETTING A university hospital in New York. PARTICIPANTS A total of 103 subjects (32 older, 71.1 +/- 1.2 y/o, and 71 young/middle aged subjects, 51.1 +/- 2.3 y/o). INTERVENTION Oral glucose tolerance test. MEASUREMENTS 19F and 31P NMR spectroscopy were used to measure Cai and Mgi levels in erythrocytes from normal (>65 y/o, n = 11; <65 y/o, n = 26), hypertensive (EH) (>65 y/o, n = 9; <65 y/o, n = 30), and type 2 diabetic (DM) (>65 y/o, n = 12; <65 y/o, n = 15) subjects; these levels were also compared with glucose and insulin levels before and after oral glucose loading. RESULTS Fasting Mgi levels were lower (207 +/- 7.8 vs 236 +/- 7.5 microM; P < .05) and Cai higher (32.2 +/- 3.0 vs 20.3 +/- 1.8 nM; P < .05) in older than in younger normal subjects. For all normal subjects, the greater the age, the higher the Cai (r = 0.622, P = .004) and the lower the Mgi (r = -0.423; P = .011). However, no significant (P = NS) differences in Mgi or Cai levels were observed between older normal and young/middle-aged subjects with EH (Mgi = 189.7 +/- 5.9 vs 182.6 +/- 9.8 microM; Cai = 33.8 +/- 4.9 vs 35.6 +/- 4.0 nM) or DM (Mgi = 182.8 +/- 10.9 vs 180.8 +/- 8.1 microM; Cai = 33.6 +/- 4.3 vs 39.7 +/- 5.9 nM). Significant relationships were also found between cellular ion content, blood pressure, and glycemic indices. CONCLUSIONS Aging is associated with the onset of altered Cai and Mgi levels, indistinguishable from those observed in hypertension and diabetes, independent of age. We suggest that these ionic changes may be clinically significant, underlying the predisposition of older subjects to cardiovascular and metabolic diseases.
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Affiliation(s)
- M Barbagallo
- Institute of Internal Medicine and Geriatrics, University of Palermo, Italy
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