Biodegradable magnesium and zinc composite microspheres with synergistic osteogenic effect for enhanced bone regeneration

Biodegradable polymer microspheres in bone tissue engineering have become appealing as their non-invasive advantages in irregular damage bone repair. However, current microspheres used in BTE still lack sufficient osteogenic capacity to induce effective bone regeneration. In this study, we developed osteogenic composite microspheres concurrently loaded with magnesium oxide (MgO) and zinc oxide (ZnO), both of which are osteogenic active substances, using a facile and scalable emulsification method. The osteogenic composite microspheres exhibited a sequential yet complementary release profile characterized by a rapid release of Mg2+ and a gradual release of Zn2+ in a physiological environment, thereby maintaining the concentration of bioactive ions at a sustained high level. As a result, the combination of Mg2+ and Zn2+ in the composite microspheres led to a synergistic enhancement in biomimetic mineralization and the upregulation in the expression of osteogenic-related genes and proteins at the cellular level. Through a critical-sized calvarial rate defect model, the osteogenic composite microspheres were demonstrated to have strong osteogenic ability to promote new bone formation via ultrasonic imaging, histological and immunohistochemical evaluations. In sum, these osteogenic composite microspheres as microcarriers of Mg2+ and Zn2+ have great potential in the delivery of therapeutic ions for treating bone defects.

Effect of magnesium oxide or citrate supplements on metabolic risk factors in kidney stone formers with idiopathic hyperoxaluria: a randomized clinical trial

Magnesium is one of the recommended treatments for calcium stone formers (CSFs) with hyperoxaluria. In this study, we compared the effect of magnesium oxide (MgO) or magnesium citrate (MgCit) with placebo on 24-hour urine (24-U) metabolites and the calcium oxalate supersaturation index (CaOx SS). In a randomized, double-blind, placebo-controlled clinical trial, 90 CSFs with idiopathic hyperoxaluria were recruited from a tertiary stone prevention clinic. Patients were randomly assigned into three groups: 120 mg MgO, 120 mg MgCit or placebo (supplements were taken three times per day, with meals). Finally, 76 patients were included in the final analysis. Analyses of 24-U were performed at baseline and after eight weeks. Study outcomes included changes in 24-U oxalate, magnesium, citrate, and CaOx SS. Dietary factors were controlled by 24-hour food recalls. Repeated measure ANOVA was used to compare the results. After the intervention, both MgO and MgCit supplements decreased 24-U oxalate excretion (-8.13±16.45 in the MgO group and -16.99±18.02 in the MgCit group) and CaOx SS compared to the placebo, with the effects of MgCit reaching statistical significance (p=0.011 and p=0.010, respectively). An increasing trend was observed for 24-U magnesium and citrate excretion without significant differences among groups. Interestingly, MgCit exhibited a significantly greater inhibitory effect on 24-U oxalate in patients with normal urine magnesium levels (p=0.021). Clinically, both MgO and MgCit reduced 24-U oxalate and CaOx SS compared to placebo. However, MgCit demonstrated a greater effect, especially in patients with normal urine magnesium levels.

[Risk Factors Analysis for Hypermagnesemia with Magnesium Oxide]

While decreased renal function is a known risk factor for hypermagnesemia caused by magnesium oxide (MgO), few studies have comprehensively investigated other contributing factors. In this study, the researchers analyzed the risk factors for hypermagnesemia development in 256 inpatients receiving MgO treatment at the Matsuyama Shimin Hospital. Multivariate analysis identified blood urea nitrogen ≧22 mg/dL, estimated glomerular filtration rate ≦43.1 mL/min, and MgO ≧1000 mg/d as risk factors. Additionally, the researchers' findings suggest a correlation between the number of risk factors and the incidence of hypermagnesemia, including the prevalence of Grade 3 cases. Interestingly, low body mass index emerged as a potential risk factor even in patients without the three identified factors. These findings highlight the importance for pharmacists to advocate for routine serum Mg level monitoring in patients with the risk factors identified in this study.

Magnesium Oxide in Constipation

Magnesium oxide has been widely used as a laxative for many years in East Asia, yet its prescription has largely been based on empirical knowledge. In recent years, several new laxatives have been developed, which has led to a resurgence in interest and increased scientific evidence surrounding the use of magnesium oxide, which is convenient to administer, of low cost, and safe. Despite these advantages, emerging clinical evidence indicates that the use of magnesium oxide should take account of the most appropriate dose, the serum concentration, drug-drug interactions, and the potential for side effects, especially in the elderly and in patients with renal impairment. The aim of this review is to evaluate the evidence base for the clinical use of magnesium oxide for treating constipation and provide a pragmatic guide to its advantages and disadvantages.

Nutritional interventions for treating foot ulcers in people with diabetes

BACKGROUND

Foot ulcers in people with diabetes are non-healing, or poorly healing, partial, or full-thickness wounds below the ankle. These ulcers are common, expensive to manage and cause significant morbidity and mortality. The presence of a wound has an impact on nutritional status because of the metabolic cost of repairing tissue damage, in addition to the nutrient losses via wound fluid. Nutritional interventions may improve wound healing of foot ulcers in people with diabetes.

OBJECTIVES

To evaluate the effects of nutritional interventions on the healing of foot ulcers in people with diabetes.

SEARCH METHODS

In March 2020 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that evaluated the effect of nutritional interventions on the healing of foot ulcers in people with diabetes.

DATA COLLECTION AND ANALYSIS

Two review authors, working independently, assessed included RCTs for their risk of bias and rated the certainty of evidence using GRADE methodology, using pre-determined inclusion and quality criteria.

MAIN RESULTS

We identified nine RCTs (629 participants). Studies explored oral nutritional interventions as follows: a protein (20 g protein per 200 mL bottle), 1 kcal/mL ready-to-drink, nutritional supplement with added vitamins, minerals and trace elements; arginine, glutamine and β-hydroxy-β-methylbutyrate supplement; 220 mg zinc sulphate supplements; 250 mg magnesium oxide supplements; 1000 mg/day omega-3 fatty acid from flaxseed oil; 150,000 IU of vitamin D, versus 300,000 IU of vitamin D; 250 mg magnesium oxide plus 400 IU vitamin E and 50,000 IU vitamin D supplements. The comparator in eight studies was placebo, and in one study a different dose of vitamin D. Eight studies reported the primary outcome measure of ulcer healing; only two studies reported a measure of complete healing. Six further studies reported measures of change in ulcer dimension, these studies reported only individual parameters of ulcer dimensions (i.e. length, width and depth) and not change in ulcer volume. All of the evidence identified was very low certainty. We downgraded it for risks of bias, indirectness and imprecision. It is uncertain whether oral nutritional supplement with 20 g protein per 200 mL bottle, 1 kcal/mL, nutritional supplement with added vitamins, minerals and trace elements, increases the proportion of ulcers healed at six months more than placebo (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.42 to 1.53). It is also uncertain whether arginine, glutamine and β-hydroxy-β-methylbutyrate supplement increases the proportion of ulcers healed at 16 weeks compared with placebo (RR 1.09, 95% CI 0.85 to 1.40). It is uncertain whether the following interventions change parameters of ulcer dimensions over time when compared with placebo; 220 mg zinc sulphate supplement containing 50 mg elemental zinc, 250 mg magnesium oxide supplement, 1000 mg/day omega-3 fatty acid from flaxseed oil supplement, magnesium and vitamin E co-supplementation and vitamin D supplementation. It is also uncertain whether 150,000 IU of vitamin D, impacts ulcer dimensions when compared with 300,000 IU of vitamin D. Two studies explored some of the secondary outcomes of interest for this review. It is uncertain whether oral nutritional supplement with 20 g protein per 200 mL bottle, 1 kcal/mL, nutritional supplement with added vitamins, minerals and trace elements, reduces the number of deaths (RR 0.96, 95% CI 0.06 to 14.60) or amputations (RR 4.82, 95% CI 0.24 to 95.88) more than placebo. It is uncertain whether arginine, glutamine and β-hydroxy-β-methylbutyrate supplement increases health-related quality of life at 16 weeks more than placebo (MD -0.03, 95% CI -0.09 to 0.03). It is also uncertain whether arginine, glutamine and β-hydroxy-β-methylbutyrate supplement reduces the numbers of new ulcers (RR 1.04, 95% CI 0.71 to 1.51), or amputations (RR 0.66, 95% CI 0.16 to 2.69) more than placebo. None of the included studies reported the secondary outcomes cost of intervention, acceptability of the intervention (or satisfaction) with respect to patient comfort, length of patient hospital stay, surgical interventions, or osteomyelitis incidence. One study exploring the impact of arginine, glutamine and β-hydroxy-β-methylbutyrate supplement versus placebo did not report on any relevant outcomes.

AUTHORS' CONCLUSIONS

Evidence for the impact of nutritional interventions on the healing of foot ulcers in people with diabetes compared with no nutritional supplementation, or compared with a different dose of nutritional supplementation, remains uncertain, with eight studies showing no clear benefit or harm. It is also uncertain whether there is a difference in rates of adverse events, amputation rate, development of new foot ulcers, or quality of life, between nutritional interventions and placebo. More research is needed to clarify the impact of nutritional interventions on the healing of foot ulcers in people with diabetes.

Effect of Magnesium Supplementation on Circulating Biomarkers of Cardiovascular Disease

(1) Background: Magnesium supplementation may be effective for the prevention of cardiometabolic diseases, but the mechanisms are unclear. Proteomic approaches can assist in identifying the underlying mechanisms. (2) Methods: We collected repeated blood samples from 52 individuals enrolled in a double-blind trial which randomized participants 1:1 to oral magnesium supplementation (400 mg magnesium/day in the form of magnesium oxide) or a matching placebo for 10 weeks. Plasma levels of 91 proteins were measured at baseline with follow-up samples using the Olink Cardiovascular Disease III proximity extension assay panel and were modeled as arbitrary units in a log₂ scale. We evaluated the effect of oral magnesium supplementation for changes in protein levels and the baseline association between serum magnesium and protein levels. The Holm procedure was used to adjust for multiple comparisons. (3) Results: Participants were 73% women, 94% white, and had a mean age of 62. Changes in proteins did not significantly differ between the two intervention groups after correction for multiple comparisons. The most statistically significant effects were on myoglobin [difference −0.319 log₂ units, 95% confidence interval (CI) (−0.550, −0.088), p = 0.008], tartrate-resistant acid phosphatase type 5 (−0.187, (−0.328, −0.045), p = 0.011), tumor necrosis factor ligand superfamily member 13B (−0.181, (−0.332, −0.031), p = 0.019), ST2 protein (−0.198, (−0.363, −0.032), p = 0.020), and interleukin-1 receptor type 1 (−0.144, (−0.273, −0.015), p = 0.029). Similarly, none of the associations of baseline serum magnesium with protein levels were significant after correction for multiple comparisons. (4) Conclusions: Although we did not identify statistically significant effects of oral magnesium supplementation in this relatively small study, this study demonstrates the value of proteomic approaches for the investigation of mechanisms underlying the beneficial effects of magnesium supplementation. Clinical Trials Registration: ClinicalTrials.gov NCT02837328.

Circulating Ionized Magnesium: Comparisons with Circulating Total Magnesium and the Response to Magnesium Supplementation in a Randomized Controlled Trial

Ionized Mg (iMg) is considered the biologically active fraction of circulating total Mg (tMg). It is possible that iMg may be a more physiologically relevant marker than tMg. Using data from a double-blind pilot randomized controlled trial, we tested (1) whether oral Mg supplementation will increase iMg concentrations compared with placebo and (2) the relationship between iMg and tMg at baseline. Additionally, we evaluated the agreement between iMg measured in fresh whole blood versus stored samples. A total of fifty-nine participants were randomized 1:1 to oral Mg supplementation (400 mg/day, Mg Oxide) or placebo for 10 weeks. Fasting blood samples were obtained at baseline and follow-up. The analysis used linear regression and an intent-to-treat approach. Participants were generally healthy, the mean age was 62, and 73% were female. The baseline iMg and tMg were modestly and positively associated (r = 0.50). The ratio of baseline iMg to tMg was 64%. The mean supplement effect on iMg was 0.03 mmol/L (95% CI:0.01, 0.05) for Mg supplementation versus placebo. The supplement effect on iMg was not statistically significantly different according to baseline iMg status (above/below median). Compared to fresh blood, iMg was consistently higher in refrigerated and frozen samples by 0.14 and 0.20 mmol/L, respectively. In this relatively healthy adult population, Mg supplementation over 10 weeks resulted in increased iMg concentrations. Whether iMg is a more appropriate measure of Mg status than tMg, and the public health or clinical utility of measuring iMg remains to be determined.

Oral Magnesium Supplementation Improved Lipid Profile but Increased Insulin Resistance in Patients with Diabetic Nephropathy: a Double-Blind Randomized Controlled Clinical Trial

Low serum magnesium concentrations were associated with development of renal failure. We aimed to determine whether magnesium supplementation improves renal function, insulin resistance, and metabolic profiles in patients with diabetic nephropathy. A total of 80 hypomagnesemic patients diagnosed with type 2 diabetes and early-stage nephropathy were recruited. Subjects received either daily magnesium oxide or placebo for 12 weeks. Biochemical and anthropometric variables were measured. Physical activity and dietary intakes were also recorded. This study was approved by the ethics committee of Isfahan University of Medical Sciences and was registered on the Iranian Registry of Clinical Trials website (IRCT registration no. IRCT201404271485N12). Serum magnesium levels were not changed significantly. Although the supplementation did not influence glycemic indices, patients in the magnesium group had greater insulin resistance compared with the placebo group after intervention (0.3 ± 2.3 μIU/mL vs. - 0.04 ± 2.05, P = 0.04). No significant changes were observed in serum total cholesterol, triglycerides, HDL, LDL, and total cholesterol/HDL cholesterol ratio. Furthermore, magnesium did not affect inflammation, serum levels of creatinine, and blood urine nitrogen. However, a marginal decrease in microalbuminuria (- 3.1 ± 2.2 mg/L vs. - 14 ± 9.9, P = 0.09) was observed. Oral magnesium supplementation slightly improved microalbuminuria but resulted in increased insulin resistance in patients with diabetic nephropathy.

A Pilot Randomized Trial of Oral Magnesium Supplementation on Supraventricular Arrhythmias

Low magnesium may increase the risk of atrial fibrillation. We conducted a double-blind pilot randomized trial to assess adherence to oral magnesium supplementation (400 mg of magnesium oxide daily) and a matching placebo, estimate the effect on circulating magnesium concentrations, and evaluate the feasibility of using an ambulatory heart rhythm monitoring device (ZioPatch) for assessing premature atrial contractions. A total of 59 participants were randomized; 73% were women, and the mean age was 62 years. A total of 98% of the participants completed the follow-up. In the magnesium supplement group, 75% of pills were taken, and in the placebo group, 83% were taken. The change in magnesium concentrations was significantly greater for those given the magnesium supplements than for those given the placebo (0.07; 95% confidence interval: 0.03, 0.12 mEq/L; p = 0.002). The ZioPatch wear time was approximately 13 of the requested 14 days at baseline and follow-up. There was no difference by intervention assignment in the change in log premature atrial contractions burden, glucose, or blood pressure. Gastrointestinal changes were more common among the participants assigned magnesium (50%) than among those assigned the placebo (7%), but only one person discontinued participation. In sum, compliance with the oral magnesium supplementation was very good, and acceptance of the ZioPatch monitoring was excellent. These findings support the feasibility of a larger trial for atrial fibrillation (AF) prevention with oral magnesium supplementation.

Unprecedented Synergistic Effects of Nanoscale Nutrients on Growth, Productivity of Sweet Sorghum [Sorghum bicolor (L.) Moench], and Nutrient Biofortification

Evidence-based synergistic effects of nanoscale materials (size of <100 nm in at least one dimension) were scantly documented in agriculture at field scale. Herein, we report for the first time on effects of nanoscale zinc oxide (n-ZnO), calcium oxide (n-CaO), and magnesium oxide (n-MgO) on growth and productivity of sweet sorghum [Sorghum bicolor (L.) Moench]. A modified sol-gel method was used to prepare nanoscale materials under study. Characterization was performed using transmission and scanning electron microscopies, X-ray diffraction, and dynamic light scattering. Average sizes (25, 53.7, and 53.5 nm) and ζ potentials (-10.9, -28.2, and -16.2 mV) of n-ZnO, n-CaO, and n-MgO were measured, respectively. The significant grain yield (17.8 and 14.2%), cane yield (7.2 and 8.0%), juice yield (10 and 12%), and higher sucrose yield (21.8 and 20.9%) were recorded with the application of nanoscale materials in the years 2014 and 2015, respectively. Nutrient uptake was significant with foliar application of nanoscale nutrients.

Magnesium oxide use and reduced risk of dementia: a retrospective, nationwide cohort study in Taiwan

OBJECTIVE

Dietary magnesium may be associated with a lower risk of dementia; however, the impact of magnesium oxide (MgO), a common laxative, on dementia has yet to be elucidated. This study aimed to investigate the association between the usage of MgO and the risk of developing dementia.

METHODS

We used a dataset from the National Health Research Institute Database (NHRID) of Taiwan containing one million randomly sampled subjects to identify patients aged ≥50 years with no history of MgO usage. A total of 1547 patients who had used MgO were enrolled, along with 4641 controls who had not used the MgO propensity score matched by age, gender and comorbidity, at a ratio of 1:3. After adjusting for confounding risk factors, a Cox proportional hazards model was used to compare the risk of developing dementia during a 10 year follow-up period.

RESULTS

Of the enrolled patients, 44 (2.84%) developed dementia, when compared to 199 (4.28%) in the control group. The Cox proportional hazards regression analysis revealed that the patients who had used MgO were less likely to develop dementia with a crude hazard ratio of 0.617 (95% CI, 0.445-0.856, p = .004). After adjusting for age, gender, comorbidity, geographical area and urbanization level of residence, and monthly income, the adjusted hazard ratio was 0.517 (95% CI, 0.412-0.793, p = .001).

CONCLUSIONS

The patients who used MgO had a decreased risk of developing dementia. Further studies on the effects of MgO in reducing the risk of dementia are therefore warranted.

Modulating effect of MgO-SiO2 nanoparticles on immunological and histopathological alterations induced by aflatoxicosis in rats

INTRODUCTION

AflatoxinB1 (AFB1) is well-known as a feed borne-hepatotoxic and immunosuppressive mycotoxin. This study was conducted to evaluate the efficacy of nanocomposite magnesium oxide and silicon oxide (MgO-SiO₂) in reducing the toxic effects of AFB1on the immunity and histological alterations in liver, spleen and intestine of adult male rats.

EXPERIMENTAL DESIGN

Animals were divided into a control (Gp1) and three experimental groups (Gps); Gp2 received feed contained 200 ppb AFB1, Gp3 received feed contained 200 ppb AFB1 and 0.5 g/kg MgO-SiO₂ nanocomposite. While, rats of Gp4 received feed contained 0.5 g/kg MgO-SiO₂ nano-composite.

METHODS

Cellular and humoral immune responses, as well as histopathological examination and caspase-3 expression in liver, spleen, and intestine, were all evaluated. Residual concentration of AFB1was determined in serum, liver and fecal samples. The obtained data were statistically analyzed.

RESULTS

AFB1markedly reduced body weight gain and food and water consumption. Cellular immune response (total and differential leukocytes count, neutrophils' phagocytic activity, lymphocyte transformation, macrophage activity and serum lysozyme activity), serum total protein, and humoral immune response (fractions of protein as estimated by SDS- PAGE electrophoresis) were all severely reduced by AFB1. Moreover, AFB1induced marked histological alterations and apoptosis in liver, spleen, and intestine.

CONCLUSION

These findings suggested that the nanocomposite MgO-SiO₂ has high affinity to adsorb AFB1 and can effectively modulate its toxicity in rats.

IMPACT STATEMENT

Nanocomposite MgO-SiO₂ may offer a novel effective and cheap approach for the preventive management of aflatoxicosis in animals.

Dietary Supplementation of Magnesium Oxide (MgO) Nanoparticles for Better Survival and Growth of the Freshwater Prawn Macrobrachium rosenbergii Post-larvae

This study was performed to assess the growth-promoting potential of dietary magnesium oxide nanoparticles (MgO NPs) in Macrobrachium rosenbergii post-larvae (PL). MgO NPs were supplemented at 0, 100, 200, 300, 400 and 500 mg kg^-1 with the basal diet (containing 0.95 g Mg kg^-1); the concentrations of Mg in MgO NP-supplemented diets were increased correspondingly (1.07, 1.15, 1.24, 1.37 and 1.46 g Mg kg^-1 respectively). MgO NP-supplemented diets were fed to M. rosenbergii PL (initial weight 0.11 ± 0.04 g) for a period of 90 days. In the carcasses of experimental prawns, the content of Mg was found to be elevated significantly with respect to the individual diet (102.14, 183.29, 205.46, 221.03, 237.10 and 254.36 μg Mg g^-1 respectively) when compared with that of the control. The contents of Cu, Zn, Fe, Ca, Na and K levels were also found to be elevated in the carcasses of experimental prawns. Significant (P < 0.05) improvements were observed in nutritional indices [survival rate (SR), weight gain (WG), specific growth rate (SGR), feed conversion ratio (FCR) and protein efficiency ratio (PER)], activities of digestive enzymes (protease, amylase and lipase), concentrations of basic biochemical constituents (total protein, amino acid, carbohydrate, lipid, profiles of amino acids and fatty acids) and population of haemocytes [total and differential (hyalinocytes, semigranulocytes and granulocytes)] in all the test PL. Maximum performance was recorded in 500 mg kg^-1 MgO NP-supplemented-feed-fed PL. There were no significant elevations recorded in activities of antioxidant enzymes [superoxide dismutase (SOD) and catalase (CAT)], lipid peroxidation (LPO) and metabolic enzymes [glutamic oxaloacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT)] recorded in any of the MgO NP-supplemented-feed-fed PL when compared with the control. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) showed increases in the staining intensity of polypeptide bands resolved in 500 mg kg^-1 MgO NP-supplemented-feed-fed PL when compared with the control. Based on the gradual improvement in attaining survival, growth, FCR, biochemical constituents and haemocyte population, this study recommends MgO NP supplementation of 500 mg kg^-1 for sustainable maintenance of M. rosenbergii PL. As the studied highest concentration of MgO NPs showed the best performance, it is necessary to study with beyond 500 mg kg^-1 of MgO NPs to optimize the actual concentration.

Antacid attenuates the laxative action of magnesia in cancer patients receiving opioid analgesic

OBJECTIVE

This study was designed to investigate pharmacological interaction between magnesium laxative and antacid in patients receiving opioid analgesic.

METHODS

Data obtained from a total of 441 eligible patients receiving opioid analgesic for the first time were retrospectively analysed. The incidence of constipation, defined as stool-free interval of 3 days and more within the first week of opioid intake, was compared between patients who took laxative alone and those who received laxative in combination with antacid.

KEY FINDINGS

Laxatives were prescribed in 74% of patients, among them 61% received antacids such as proton pump inhibitor and H2 receptor blocker. Magnesia was the most commonly used laxative (89%). Constipation occurred in 21% and 55% of patients with and without laxatives, respectively. Antacids reversed the laxative action of lower doses (<2000 mg/day) but not higher doses (>2000 mg/day) of magnesia without affecting the effects of other laxatives. Therefore, it is suggested that both acid-dependent and acid-independent mechanisms may operate in the laxative action of magnesia, in which the former may be involved in the action of lower doses of magnesia.

CONCLUSION

Care should be taken to avoid the unfavourable pharmacological interaction between low doses of magnesia and antacid.

The effects of magnesium, L-carnitine, and concurrent magnesium-L-carnitine supplementation in migraine prophylaxis

Given the conflicting results about the positive effects of magnesium and L-carnitine and as there is no report concerning concurrent supplementation of magnesium and L-carnitine on migraine prophylaxis, the effects of magnesium, L-carnitine, and concurrent magnesium-L-carnitine supplementation on migraine indicators were assessed. In this clinical trial, 133 migrainous patients were randomly assigned into three intervention groups: magnesium oxide (500 mg/day), L-carnitine (500 mg/day), and Mg-L-carnitine (500 mg/day magnesium and 500 mg/day L-carnitine), and a control group. After 12 weeks of supplementation, the checklist of migraine indicators including migraine attacks/month, migraine days/month, and headache severity was completed, and serum concentrations of magnesium and L-carnitine were measured by atomic absorption spectrophotometry and enzymatic UV test, respectively. The results showed a significant reduction in all migraine indicators in all studied groups (p < 0.05). The ANOVA results showed a significant reduction in migraine frequency across various supplemented and control groups (p = 0.008). By separating the effects of magnesium supplementation from other confounding factors such as routine treatments using the repeated measures and nested model, it was clarified that magnesium supplementation had a significant effect on all migraine indicators. Oral supplementation with magnesium oxide and L-carnitine and concurrent supplementation of Mg-L-carnitine besides routine treatments could be effective in migraine prophylaxis; however, larger trials are needed to confirm these preliminary findings.

Magnesium supplementation through seaweed calcium extract rather than synthetic magnesium oxide improves femur bone mineral density and strength in ovariectomized rats

Commercially available seaweed calcium extract can supply high amounts of calcium as well as significant amounts of magnesium and other microminerals. The purpose of this study was to investigate the degree to which the high levels of magnesium in seaweed calcium extract affects the calcium balance and the bone status in ovariectomized rats in comparison to rats supplemented with calcium carbonate and magnesium oxide. A total of 40 Sprague-Dawley female rats (7 weeks) were divided into four groups and bred for 12 weeks: sham-operated group (Sham), ovariectomized group (OVX), ovariectomized with inorganic calcium and magnesium supplementation group (OVX-Mg), and ovariectomized with seaweed calcium and magnesium supplementation group (OVX-SCa). All experimental diets contained 0.5% calcium. The magnesium content in the experimental diet was 0.05% of the diet in the Sham and OVX groups and 0.1% of the diet in the OVX-Mg and OVX-SCa groups. In the calcium balance study, the OVX-Mg and OVX-SCa groups were not significantly different in calcium absorption compared to the OVX group. However, the femoral bone mineral density and strength of the OVX-SCa group were higher than those of the OVX-Mg and OVX groups. Seaweed calcium with magnesium supplementation or magnesium supplementation alone did not affect the serum ALP and CTx levels in ovariectomized rats. In summary, consumption of seaweed calcium extract or inorganic calcium carbonate with magnesium oxide demonstrated the same degree of intestinal calcium absorption, but only the consumption of seaweed calcium extract resulted in increased femoral bone mineral density and strength in ovariectomized rats. Our results suggest that seaweed calcium extract is an effective calcium and magnesium source for improving bone health compared to synthetic calcium and magnesium supplementation.

Calcium and Magnesium Supplementation Improves Serum OPG/RANKL in Calcium-Deficient Ovariectomized Rats

Magnesium (Mg) deficiency has been reported to result in increases in bone resorption through changes in the cytokine system, such as decreases in serum osteoprotegerin (OPG) concentrations and increases in receptor activator of NF-κB ligand (RANKL) concentrations. However, there are few data about the effects of Mg supplementation on OPG and RANKL. This study was carried out to investigate the effects of Mg supplementation on bone mineral density (BMD), bone mineral content (BMC), serum OPG, and RANKL in ovariectomized (OVX) rats relative to calcium (Ca) intake levels. Fifty-five Sprague-Dawley female rats were divided into the following five groups and fed for 12 weeks as indicated: sham-operated control group (sham), OVX Ca-deficient group (OLCa, 0.1% Ca and 0.05% Mg), OVX Ca-deficient and Mg-supplemented group (OLCaMg, 0.1% Ca and 0.1% Mg), OVX Ca-adequate group (OACa, 0.5% Ca and 0.05% Mg), and OVX Ca-adequate and Mg-supplemented group (OACaMg, 0.5% Ca and 0.1% Mg). The BMD of the lumbar spine, femur, and tibia in the OVX groups was significantly lower than that in the sham group. The OVX group with an adequate-Ca diet showed significantly higher BMC of the lumbar spine compared to the low Ca-diet group regardless of Mg supplementation. The OACaMg group had significantly higher levels of OPG and OPG/RANKL ratio than did the OLCa group. From the above results, it is still unclear whether Mg supplementation can improve bone mineral status, while Mg supplementation with an adequate-Ca diet resulted in a change in cytokines that may promote bone formation.

Effects of oral magnesium supplementation on insulin sensitivity and blood pressure in normo-magnesemic nondiabetic overweight Korean adults

BACKGROUND AND AIM

Little is known about the effect of magnesium on insulin sensitivity and BP in healthy individuals. Therefore, we investigated whether magnesium could improve insulin sensitivity and blood pressure (BP) in normo-magnesemic nondiabetic overweight adults.

METHODS AND RESULTS

In a double-blinded, placebo-controlled, randomized trial, a total of 155 participants (BMI > or = 23 kg/m(2)) received either 12.3 mmol (300 mg) of elemental magnesium in the form of magnesium oxide (n=75) or placebo (n=80) each day for 12 weeks, constituting the intent-to-treat population. A repeated-measures ANOVA was used to evaluate the between-group changes in variables during the study. The baseline characteristics between the intervention and control groups were similar. There were no significant differences between the groups in the pattern of change of the homeostasis model assessment insulin resistance index, BP over time during the 12-week study. In subgroup analysis, magnesium supplementation (n=8, 27, and 24, respectively) lowered BP much more than placebo (n=16, 29, and 25, respectively) in those subjects whose systolic BP > or = 140 mmHg, diastolic BP 80-90 mmHg, and diastolic BP > or = 90 mmHg at the start of the study (P=0.016, 0.043, and 0.023, respectively); in comparison, those subjects whose initial BP reading was low at baseline did not show a change in BP. No significant adverse events related to magnesium supplementation were recorded.

CONCLUSIONS

These results suggested that magnesium supplementation does not reduce BP and enhance insulin sensitivity in normo-magnesemic nondiabetic overweight people. However, it appears that magnesium supplementation may lower BP in healthy adults with higher BP.

Hypomagnesaemia due to use of proton pump inhibitors--a review

Magnesium homeostasis is essential for many intracellular processes and depends on the balance of intestinal absorption and renal excretion. Hypomagnesaemia may arise from various disorders. We review the literature on hypomagnesaemia due to the use of proton pump inhibitors, as illustrated by a case of a 76-year-old woman with muscle cramps and lethargy caused by hypomagnesaemia and hypocalcaemia with a low parathyroid hormone level while using esomeprazole, a proton pump inhibitor (PPI). After oral magnesium repletion both abnormalities resolved. Fractional magnesium excretion was low, excluding excessive renal loss. A causal relation with PPI use was supported by the recurrence of hypomagnesaemia after rechallenge. In the past decade our understanding of transcellular magnesium transport was enhanced by the discovery of several gene mutations i.e. transient receptor potential melastin (TR PM) 6 and 7. In this light we discuss the possible aetiology of proton pump inhibitor related hypomagnesaemia.

Effects of source and level of magnesium on catalase activity and its gene expression in livers of broiler chickens

The effects of dietary supplemental magnesium oxide (MgO), magnesium-L-aspartate (MgAsp) and monomagnesium-di-L-aspartate (MgdiAsp) on hepatic catalase (CAT) activity and its mRNA expression were investigated. A total of 360 one-day-old male Abor Acre broiler chickens were allocated to ten treatments, i.e. control plus 9 treatments from 3 x 3 factorial arrangement (Mg source, Mg level), each treatment with six replicates of 6 chickens. The birds were fed with the basal diet alone or supplemented with magnesium (Mg) at 0.9, 1.8, 2.7 g/kg of the diet from MgO, MgAsp or MgdiAsp. Results showed that hepatic Mg concentration increased quadratically as MgO or MgAsp supplementation increased (p < 0.01). Hepatic CAT activity increased linearly in birds fed with MgAsp or MgdiAsp (p < 0.01) and quadratically in birds fed with MgO (p < 0.05) as dietary Mg supplementation level increased. Hepatic CAT mRNA was linearly correlated with the dietary Mg supplementation level (p < 0.01). There were positive correlations among hepatic CAT activity, its mRNA expression level and hepatic Mg concentration (p < 0.01). No effect of Mg2+ on the purified CAT activity was detected in vitro enzymatic reaction system (p > 0.05). Supplemental MgAsp or MgdiAsp was more efficient to increase hepatic Mg concentrations, enhance hepatic CAT activity and its mRNA expression than MgO (p < 0.01). It can be concluded that dietary Mg supplementation could increase hepatic Mg concentration, enhance CAT mRNA expression and consequently enhance CAT activity, and the organic Mg (MgAsp or MgdiAsp) is much more efficient than the inorganic form (MgO).

[Causes and treatment of hypomagnesemia]

Plasma magnesium (Mg) is known to be maintained within a normal range through its gastrointestinal absorption as well as renal excretion, and disturbances at these sites might cause hypomagnesemia. Mg balance is most susceptible to the malfunction of the thick ascending limb of renal tubules, because 70% of urinary Mg excretion is reabsorbed from this site. Investigation of hypomagnesemia-exhibiting inherited diseases revealed molecular mechanisms of Mg transport pathways; paracellin-1 as a passive paracellular transport and TRPM6 as an active transcellular transport. Mild and severe hypomagnesemia are treated with oral replacement such as magnesium oxide, as well as intravenous administration of magnesium sulfate.