Effects of magnesium supplements on blood pressure, endothelial function and metabolic parameters in healthy young men with a family history of metabolic syndrome

The effect of magnesium supplementation on serum concentration of lipid profile: an updated systematic review and dose-response meta-analysis on randomized controlled trials

BACKGROUND

Some evidence suggests magnesium might reduce serum levels of lipid profile. Due to the significance of this matter on hand, we centralized our aim to conduct a systematic review and meta-analysis to interrogate the effect of magnesium supplementation on serum levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C) in the general population aged ≥ 18 years.

METHODS

In line with conducting this study first, relevant articles were found through searching databases, including five databases: Cochrane Library, ClinicalTrials.gov, ISI Web of Science, Scopus, and PubMed until January 2024. Following fulfilling the first aim, their mean differences and standard deviations were calculated to conduct the meta-analysis. Ultimately, an assessment of the statistical heterogeneity of intervention effects was performed using I-squared statistics and Cochran's Q test.

RESULTS

Regarding serum levels of TC, TG, LDL-C, and HDL-C, twenty-one, twenty-three, twenty, and twenty-five studies were included in the meta-analysis. The pooled estimates showed no significant differences in serum levels of TC, TG, and LDL-C between the magnesium group and comparison group (weighted mean difference (WMD) = 0.34 mg/dl, 95% confidence interval (CI): -1.75 to 2.43, P = 0.749, I2 = 99.1%; WMD=-2.06 mg/dl, 95% CI: -6.35 to 2.23, P = 0.346, I2 = 99.1; WMD = 1.71 mg/dl, 95% CI: -0.81 to 4.24, P = 0.183, I2 = 99.4, respectively). However, magnesium significantly increased HDL-C (WMD = 1.21 mg/dl, 95% CI: 0.58 to 1.85, P < 0.001, I2 = 99.5).

CONCLUSION

In conclusion, our study showed that magnesium significantly increased HDL-C levels. However, due to high heterogeneity, we must note that more research is needed to make robust recommendations regarding magnesium supplementation in clinical practice.

REGISTRY NUMBER

This study was registered in PROSPERO under the protocol number CRD42024505142.

Phytochemical-mediated efferocytosis and autophagy in inflammation control

Efferocytosis, the clearance of apoptotic cells, is a critical process that maintains tissue homeostasis and immune regulation. Defective efferocytosis is linked to the development of chronic inflammatory conditions, including atherosclerosis, neurological disorders, and autoimmune diseases. Moreover, the interplay between autophagy and efferocytosis is crucial for inflammation control, as autophagy enhances the ability of phagocytic cells. Efficient efferocytosis, in turn, regulates autophagic pathways, fostering a balanced cellular environment. Dysregulation of this balance can contribute to the pathogenesis of various disorders. Phytochemicals, bioactive compounds found in plants, have emerged as promising therapeutic agents owing to their diverse pharmacological properties, including antioxidant, anti-inflammatory, and immunomodulatory effects. This review aims to highlight the pivotal role of phytochemicals in enhancing efferocytosis and autophagy and explore their potential in the prevention and treatment of related disorders. This study examines how phytochemicals influence key aspects of efferocytosis, including phagocytic cell activation, macrophage polarization, and autophagy induction. The therapeutic potential of phytochemicals in atherosclerosis and neurological diseases is highlighted, emphasizing their ability to enhance efferocytosis and autophagy and reduce inflammation. This review also discusses innovative approaches, such as nanoformulations and combination therapies to improve the targeting and bioavailability of phytochemicals. Ultimately, this study inspires further research and clinical applications in phytochemical-mediated efferocytosis enhancement for managing chronic inflammatory and autoimmune conditions.

Magnesium and Potassium Supplementation for Systolic Blood Pressure Reduction in the General Normotensive Population: A Systematic Review and Subgroup Meta-Analysis for Optimal Dosage and Treatment Length

BACKGROUND/OBJECTIVES

Studies have shown that consistent reductions of 2 mm Hg in systolic blood pressure (SBP) for the general normotensive population can result in significant decreases in mortality from heart disease and stroke. The purpose of this meta-analysis was to determine the optimal dose and duration of treatment for magnesium and potassium supplementation, having previously discovered that both reduce SBP by -2.79 and -2.10 mm Hg, respectively.

METHODS

Placebo-controlled, randomized clinical trials examining the effects of magnesium and potassium supplementation on SBP were identified. Pairwise meta-analyses with subgroups for dosage and treatment duration were run.

RESULTS

Magnesium at dosages of ≤360 mg/day and durations greater than 3 months reduced SBP by -3.03 and -4.31 mm Hg, respectively. Potassium at dosages of ≤60 mmol/day and durations greater than 1 month reduced SBP by -2.34 and -2.80 mm Hg, respectively.

CONCLUSIONS

Both supplements demonstrated greater reductions in SBP for the general population at lower dosages and longer treatment durations. Future studies are needed to validate these findings and provide tailored recommendations. These studies could investigate varying dosages over long-term follow-up to provide robust data on optimal dosages and treatment durations, as our findings were limited due to reliance on previously published trials.

Potassium Magnesium Citrate Is Superior to Potassium Chloride in Reversing Metabolic Side Effects of Chlorthalidone

BACKGROUND

Thiazide diuretics (TD) are the first-line treatment of hypertension because of its consistent benefit in lowering blood pressure and cardiovascular risk. TD is also known to cause an excess risk of diabetes, which may limit long-term use. Although potassium (K) depletion was thought to be the main mechanism of TD-induced hyperglycemia, TD also triggers magnesium (Mg) depletion. However, the role of Mg supplementation in modulating metabolic side effects of TD has not been investigated. Therefore, we aim to determine the effect of potassium magnesium citrate (KMgCit) on fasting plasma glucose and liver fat by magnetic resonance imaging during TD therapy.

METHODS

Accordingly, we conducted a double-blinded RCT in 60 nondiabetic hypertension patients to compare the effects of KCl versus KMgCit during chlorthalidone treatment. Each patient received chlorthalidone alone for 3 weeks before randomization. Primary end point was the change in fasting plasma glucose after 16 weeks of KCl or KMgCit supplementation from chlorthalidone alone.

RESULTS

The mean age of subjects was 59±11 years (30% Black participants). Chlorthalidone alone induced a significant rise in fasting plasma glucose, and a significant fall in serum K, serum Mg, and 24-hour urinary citrate excretion (all P<0.05). KMgCit attenuated the rise in fasting plasma glucose by 7.9 mg/dL versus KCl (P<0.05), which was not observed with KCl. There were no significant differences in liver fat between the 2 groups.

CONCLUSIONS

KMgCit is superior to KCl, the common form of K supplement used in clinical practice, in preventing TD-induced hyperglycemia. This action may improve tolerability and cardiovascular safety in patients with hypertension treated with this drug class.

Vitamins and Minerals for Blood Pressure Reduction in the General, Normotensive Population: A Systematic Review and Meta-Analysis of Six Supplements

Hypertension is the leading preventable risk factor for cardiovascular disease and all-cause mortality worldwide. However, studies have shown increased risk of mortality from heart disease and stroke even within the normal blood pressure (BP) range, starting at BPs above 110-115/70-75 mm Hg. Nutraceuticals, such as vitamins and minerals, have been studied extensively for their efficacy in lowering BP and may be of benefit to the general, normotensive population in achieving optimal BP. Our study investigated the effects of six nutraceuticals (Vitamins: C, D, E; Minerals: Calcium, Magnesium, Potassium) on both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in this population. We performed a systematic review and pairwise meta-analysis for all six supplements versus placebo. Calcium and magnesium achieved significant reductions in both SBP and DBP of -1.37/-1.63 mm Hg and -2.79/-1.56 mm Hg, respectively. Vitamin E and potassium only yielded significant reductions in SBP with values of -1.76 mm Hg and -2.10 mm Hg, respectively. Vitamins C and D were not found to significantly lower either SBP or DBP. Future studies should determine optimal dosage and treatment length for these supplements in the general, normotensive population.

Hypomagnesemia and Cardiovascular Risk in Type 2 Diabetes

Hypomagnesemia is tenfold more common in individuals with type 2 diabetes (T2D), compared to the healthy population. Factors that are involved in this high prevalence are low Mg2+ intake, gut microbiome composition, medication use and presumably genetics. Hypomagnesemia is associated with insulin resistance, which subsequently increases the risk to develop T2D or deteriorates glycaemic control in existing diabetes. Mg2+ supplementation decreases T2D associated features like dyslipidaemia and inflammation; which are important risk factors for cardiovascular disease (CVD). Epidemiological studies have shown an inverse association between serum Mg2+ and the risk to develop heart failure (HF), atrial fibrillation (AF) and microvascular disease in T2D. The potential protective effect of Mg2+ on HF and AF may be explained by reduced oxidative stress, fibrosis and electrical remodeling in the heart. In microvascular disease, Mg2+ reduces the detrimental effects of hyperglycemia and improves endothelial dysfunction. Though, clinical studies assessing the effect of long-term Mg2+ supplementation on CVD incidents are lacking and gaps remain on how Mg2+ may reduce CVD risk in T2D. Despite the high prevalence of hypomagnesemia in people with T2D, routine screening of Mg2+ deficiency to provide Mg2+ supplementation when needed is not implemented in clinical care as sufficient clinical evidence is lacking. In conclusion, hypomagnesemia is common in people with T2D and is both involved as cause, probably through molecular mechanisms leading to insulin resistance, and consequence and is prospectively associated with development of HF, AF and microvascular complications. Whether long-term supplementation of Mg2+ is beneficial, however, remains to be determined.

Effect of oral magnesium supplement on cardiometabolic markers in people with prediabetes: a double blind randomized controlled clinical trial

To evaluate the effect of magnesium supplementation on insulin resistance and cardiovascular markers in people with prediabetes. A 12 week double-blind placebo-controlled randomized clinical trial was conducted at Isfahan Endocrine and Metabolism Research Center, Iran, on people with prediabetes (n = 86) to compare the effects of magnesium oxide 250 mg/day versus a placebo on anthropometric indices, blood pressure, fasting glucose, insulin, HOMA-IR index, C-reactive protein, uric acid and lipid profile. Both groups had similar distributions of anthropometric and biochemical variables at baseline. Those who received magnesium supplementation had significantly higher levels of HDL-cholesterol compared to the placebo group at the end of the study (49.7 ± 10.9 vs 43.6 ± 7.2 mg/dL, P = 0.003). The mean changes of HOMA-IR index, total cholesterol, LDL-cholesterol, triglyceride, uric acid and C-reactive protein levels as well as anthropometric indices and blood pressure in supplemented and placebo groups did not differ significantly. Magnesium supplementation increased HDL-cholesterol levels in people with prediabetes. However, other cardiometabolic markers were not improved by magnesium supplementation at the above dosage and duration.

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

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

Effect of Magnesium Supplementation on Inflammatory Parameters: A Meta-Analysis of Randomized Controlled Trials

Magnesium (Mg) may have several beneficial effects on human health outcomes. One hypothesized mechanism eliciting such effects is the action of Mg on serum inflammatory parameters. However, studies on this topic to date have several important limitations. Therefore, the present systematic review and meta-analysis aimed to summarize the current state of the art of all randomized control trials (RCTs) investigating the effects of Mg supplementation versus placebo on serum parameters of inflammation. We searched several databases until 23 November 2021 for RCTs. Eligible studies were RCTs investigating the effect of oral Mg supplementation vs. placebo and having serum inflammatory markers as an outcome. Among 2484 papers initially screened, 17 randomized controlled trials (889 participants; mean age: 46 years; females: 62.5%) were included. Generally, a low risk of bias was present. In meta-analysis, Mg supplementation significantly decreased serum C reactive protein (CRP) and increased nitric oxide (NO) levels. In descriptive findings, Mg supplementation significantly reduced plasma fibrinogen, tartrate-resistant acid phosphatase type 5, tumor necrosis factor-ligand superfamily member 13B, ST2 protein, and IL-1. In conclusion, Mg supplementation may significantly reduce different human inflammatory markers, in particular serum CRP and NO levels.

Magnesium intake and vascular structure and function: the Hoorn Study

Purpose

Circulating and dietary magnesium have been shown to be inversely associated with the prevalence of cardiovascular disease (CVD) and mortality in both high and low-risk populations. We aimed to examine the association between dietary magnesium intake and several measures of vascular structure and function in a prospective cohort.

Methods

We included 789 participants who participated in the vascular screening sub-cohort of the Hoorn Study, a population-based, prospective cohort study. Baseline dietary magnesium intake was estimated with a validated food frequency questionnaire and categorised in energy-adjusted magnesium intake tertiles. Several measurements of vascular structure and function were performed at baseline and most measurements were repeated after 8 years of follow-up (n = 432). Multivariable linear and logistic regression was performed to study the cross-sectional and longitudinal associations of magnesium intake and intima-media thickness (IMT), augmentation index (Aix), pulse wave velocity (PWV), flow-mediated dilatation (FMD), and peripheral arterial disease (PAD).

Results

Mean absolute magnesium intake was 328 ± 83 mg/day and prior CVD and DM2 was present in 55 and 41% of the participants, respectively. Multivariable regression analyses did not demonstrate associations between magnesium intake and any of the vascular outcomes. Participants in the highest compared to the lowest magnesium intake tertile demonstrated in fully adjusted cross-sectional analyses a PWV of −0.21 m/s (95% confidence interval −1.95, 1.52), a FMD of −0.03% (−0.89, 0.83) and in longitudinal analyses an IMT of 0.01 mm (−0.03, 0.06), an Aix of 0.70% (−1.69, 3.07) and an odds ratio of 0.84 (0.23, 3.11) for PAD

Conclusion

We did not find associations between dietary magnesium intake and multiple markers of vascular structure and function, in either cross-sectional or longitudinal analyses.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-021-02667-0.

The Effect of Magnesium Supplementation on Endothelial Function: A Randomised Cross-Over Pilot Study

Evidence supports an association between low magnesium (Mg) intake and coronary heart disease and between Mg intake and endothelial function. The aim of this study was to assess the effect of one week of Mg supplementation on endothelial function, assessed by flow mediated dilatation (FMD). Nineteen healthy men and women completed this cross-over pilot study in which participants were randomised to take an over-the-counter magnesium supplement for one week or to follow their usual diet. Weight, FMD and blood pressure (BP) were taken on completion of each intervention and 24 h urine collections and blood samples were taken to assess compliance. Baseline serum Mg was within normal range for all participants. Urinary Mg and urinary magnesium-creatinine ratio (Mg/Cr) significantly increased between interventions, (p = 0.03, p = 0.005, respectively). No significant differences in FMD or BP were found between the interventions. A significant negative correlation was seen between age and FMD (r = -0.496, p = 0.031). When adjusted for age, saturated fat was negatively associated with FMD (p = 0.045). One week of Mg supplementation did not improve FMD in a healthy population.

The Acute Effect of Magnesium Supplementation on Endothelial Function: A Randomized Cross-Over Pilot Study

Magnesium (Mg) deficiency might be a catalyst in the process of endothelial dysfunction, an early event in the pathogenesis of atherosclerosis. The aim of this study was to determine the acute effect of an oral Mg supplement as compared to control on endothelial function assessed by flow-mediated dilatation (FMD). Nineteen participants (39 years, body mass index (BMI) 22.9 kg/m²) completed this randomized cross-over study. Blood pressure (BP) and FMD were measured and blood samples were taken before participants drank 200 mL water, with or without an over the counter Mg supplement (450 mg and 300 mg for men and women). Measurements were repeated at 60 and 120 min. There was a statistically significant two-way interaction between treatment and time on serum Mg (p = 0.037). A difference of −0.085 mm in FMD was observed 60-min post drink in the control group, as compared to baseline FMD, and no difference was observed in the supplement group as compared to baseline. Despite the non-significant interaction between treatment and time on FMD, once adjusted for baseline, the difference seen in the control group and the lack of change in the supplement group at 60 min post-drink suggests that Mg might attenuate the reduction in FMD post-prandially.

Crosstalk of Magnesium and Serum Lipids in Dyslipidemia and Associated Disorders: A Systematic Review

Dyslipidemia is a significant threat to public health worldwide and the identification of its pathogenic mechanisms, as well as novel lipid-lowering agents, are warranted. Magnesium (Mg) is a key element to human health and its deficiency has been linked to the development of lipid abnormalities and related disorders, such as the metabolic syndrome, type 2 diabetes mellitus, or cardiovascular disease. In this review, we explored the associations of Mg (dietary intake, Mg concentrations in the body) and the lipid profile, as well as the impact of Mg supplementation on serum lipids. A systematic search was computed in PubMed/MEDLINE and the Cochrane Library and 3649 potentially relevant papers were detected and screened (n = 3364 following the removal of duplicates). After the removal of irrelevant manuscripts based on the screening of their titles and abstracts (n = 3037), we examined the full-texts of 327 original papers. Finally, after we applied the exclusion and inclusion criteria, a number of 124 original articles were included in this review. Overall, the data analyzed in this review point out an association of Mg concentrations in the body with serum lipids in dyslipidemia and related disorders. However, further research is warranted to clarify whether a higher intake of Mg from the diet or via supplements can influence the lipid profile and exert lipid-lowering actions.

Statement on additional scientific evidence in relation to the essential composition of total diet replacement for weight control

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to revise the Opinion on the essential composition of total diet replacements for weight control (TDRs) regarding the minimum content of linoleic acid (LA) and alpha-linolenic acid (ALA) and the maximum content of magnesium (Mg). Through a comprehensive literature search, human studies were retrieved reporting on LA and ALA concentrations in adipose tissue (AT), on weight loss and gallstone formation following TDR consumption and on diarrhoea after supplemental Mg intake. The distribution of the amount of LA and ALA release from AT during weight loss when consuming TDRs was estimated using statistical simulations. Using the fifth percentile, the coverage of the adequate intake (AI) for both FA was estimated. For the risk of developing diarrhoea when consuming TDRs with an Mg content of 350 mg/day, four cross-over studies using 360-368 mg Mg/day were reviewed. The Panel concludes that (1) there is no need to add LA to TDRs, as the amount released from AT during weight loss when consuming TDRs is sufficient to cover the AI for LA; (2) a minimum of 0.8 g/day ALA is needed in TDRs in order to meet the AI for ALA; (3) the minimum fat content of TDRs of 20 g/day as derived in the Panel's previous opinion is proposed to be maintained until the availability of further evidence, given the considerable uncertainty as to the amount of fat required for reducing the risk of gallstone formation; and (4) the likelihood that Mg-induced diarrhoea occurs at a severity that may be considered of concern for overweight and obese individuals consuming TDRs is low when the total maximum Mg content in TDRs is 350 mg/day.

Magnesium: Biochemistry, Nutrition, Detection, and Social Impact of Diseases Linked to Its Deficiency

Magnesium plays an important role in many physiological functions. Habitually low intakes of magnesium and in general the deficiency of this micronutrient induce changes in biochemical pathways that can increase the risk of illness and, in particular, chronic degenerative diseases. The assessment of magnesium status is consequently of great importance, however, its evaluation is difficult. The measurement of serum magnesium concentration is the most commonly used and readily available method for assessing magnesium status, even if serum levels have no reliable correlation with total body magnesium levels or concentrations in specific tissues. Therefore, this review offers an overview of recent insights into magnesium from multiple perspectives. Starting from a biochemical point of view, it aims at highlighting the risk due to insufficient uptake (frequently due to the low content of magnesium in the modern western diet), at suggesting strategies to reach the recommended dietary reference values, and at focusing on the importance of detecting physiological or pathological levels of magnesium in various body districts, in order to counteract the social impact of diseases linked to magnesium deficiency.

The Effects of Magnesium Supplementation on Blood Pressure and Obesity Measure Among Type 2 Diabetes Patient: a Systematic Review and Meta-analysis of Randomized Controlled Trials

In this study, we aimed to systematically review the literature to evaluate the effects of magnesium (Mg) supplementation on blood pressure (BP) and obesity measure among patients with type 2 diabetes mellitus (T2DM). Major electronic databases of Web of Science, the Cochrane library, PubMed, and Scopus were searched completely from the inception until 15 October 2019 to identify randomized clinical trials (RCTs) pertaining to the topic of interest. All outcomes were pooled using a random-effects model and expressed as weighted mean differences (WMD) with 95% confidential intervals (CI). Heterogeneity, sensitivity analysis, and publication bias were also assessed using standard methods. The pooled analysis of five RCTs showed that Mg supplementation did not affect body weight (WMD: - 0.01 kg, 95% CI: - 0.36 to 0.33), BMI (WMD: - 0.07, 95% CI: - 0.18 to 0.04), and waist circumference (WMD: 0.12, 95% CI: - 1.24 to 1.48) in T2DM patients compared to the control groups of the patients who received placebo. However, pooling seven RCTs together showed significant reduction of systolic blood pressure (WMD: - 5.78 mmHg, 95% CI: - 11.37 to - 0.19) and diastolic blood pressure (WMD: - 2.50 mmHg, 95% CI: - 4.58 to - 0.41) in T2DM patients. Furthermore, subgroup analysis by dose of intervention, intervention duration, and type of intervention suggested that Mg supplementation for > 12 weeks, in doses higher than 300 mg/day or inorganic forms, could significantly decrease both systolic and diastolic BP in T2DM patients. Based on the findings, Mg supplementation has beneficial effects on BP in type 2 diabetes patients independent of body weight status. However, further investigations are needed to provide more reliable evidences.

Magnesium in Obesity, Metabolic Syndrome, and Type 2 Diabetes

Magnesium (Mg²⁺) deficiency is probably the most underestimated electrolyte imbalance in Western countries. It is frequent in obese patients, subjects with type-2 diabetes and metabolic syndrome, both in adulthood and in childhood. This narrative review aims to offer insights into the pathophysiological mechanisms linking Mg²⁺ deficiency with obesity and the risk of developing metabolic syndrome and type 2 diabetes. Literature highlights critical issues about the treatment of Mg²⁺ deficiency, such as the lack of a clear definition of Mg²⁺ nutritional status, the use of different Mg²⁺ salts and dosage and the different duration of the Mg²⁺ supplementation. Despite the lack of agreement, an appropriate dietary pattern, including the right intake of Mg²⁺, improves metabolic syndrome by reducing blood pressure, hyperglycemia, and hypertriglyceridemia. This occurs through the modulation of gene expression and proteomic profile as well as through a positive influence on the composition of the intestinal microbiota and the metabolism of vitamins B1 and D.

Effectively Prescribing Oral Magnesium Therapy for Hypertension: A Categorized Systematic Review of 49 Clinical Trials

Trials and meta-analyses of oral magnesium for hypertension show promising but conflicting results. An inclusive collection of 49 oral magnesium for blood pressure (BP) trials were categorized into four groups: (1) Untreated Hypertensives; (2) Uncontrolled Hypertensives; (3) Controlled Hypertensives; (4) Normotensive subjects. Each group was tabulated by ascending magnesium dose. Studies reporting statistically significant (p < 0.05) decreases in both systolic BP (SBP) and diastolic BP (DBP) from both baseline and placebo (if reported) were labeled "Decrease"; all others were deemed "No Change." Results: Studies of Untreated Hypertensives (20 studies) showed BP "Decrease" only when Mg dose was >600 mg/day; <50% of the studies at 120-486 mg Mg/day showed SBP or DBP decreases but not both while others at this Mg dosage showed no change in either BP measure. In contrast, all magnesium doses (240-607 mg/day) showed "Decrease" in 10 studies on Uncontrolled Hypertensives. Controlled Hypertensives, Normotensives and "magnesium-replete" studies showed "No Change" even at high magnesium doses (>600 mg/day). Where magnesium did not lower BP, other cardiovascular risk factors showed improvement. Conclusion: Controlled Hypertensives and Normotensives do not show a BP-lowering effect with oral Mg therapy, but oral magnesium (≥240 mg/day) safely lowers BP in Uncontrolled Hypertensive patients taking antihypertensive medications, while >600 mg/day magnesium is required to safely lower BP in Untreated Hypertensives; <600 mg/day for non-medicated hypertensives may not lower both SBP and DBP but may safely achieve other risk factor improvements without antihypertensive medication side effects.

Prevalence of nutritional deficiencies in bariatric surgery candidates and its effect on metabolic status

BACKGROUND

Nutritional deficiencies are common among obese individuals and constitute one of the main concerns in the bariatric field. The aim of this study was to investigate nutritional status in bariatric surgery candidates, comparing individuals with and without metabolic syndrome (MetS) and to explore possible associations between nutritional and metabolic status.

METHODS

Patients accepted for gastric sleeve surgery between 2010 and 2015 were included and anthropometric and metabolic parameters were recorded before surgery. Univariate and multivariate analyses were applied in order to find possible associations between MetS, nutritional, anthropometric, and metabolic parameters.

RESULTS

A total of 330 patients were evaluated (285 females, mean age of 41.88 ± 10.4 years old, mean body mass index 43.91 ± 6.2 kg/m²) and MetS was present in 47% of them. Patients without MetS presented a higher prevalence of folate deficiency (12 vs. 2%, p < 0.001). Male gender, older age, lower magnesium levels, and higher BMI and calcium levels were predictors of a greater number of MetS components. Male gender, a greater number of MetS components, and lower magnesium were predictors of higher homeostatic model assessment for insulin resistance (HOMA-IR).

CONCLUSIONS

The rising prevalence of obesity is causing a parallel increase in the use of bariatric surgery. The high occurrence of preoperative nutritional deficiencies can impair metabolic status and contribute to a worse outcome after surgery. Nutritional assessment and improvement before surgery may be crucial to optimize patient status, and future studies should explore the effect of the correction of these deficiencies in the metabolic status of these patients.

The effects of magnesium supplementation on obesity measures in adults: a systematic review and dose-response meta-analysis of randomized controlled trials

Previous studies reported inconsistent findings regarding the effects of magnesium supplementation on obesity measures. This study was done to quantify the effect of magnesium supplementation on body weight, Body Mass Index (BMI), Waist Circumference (WC), Body Fat (BF) percentage and Waist to Hip Ratio (WHR). Four online databases (Scopus, PubMed, Google Scholar and Cochrane library) were searched until March 2020 using relevant keywords. Random-effects model was used to pool effect sizes; Cochran's Q-test and I2 index assessed heterogeneity. Sensitivity analysis and Egger test were used to check the robustness of findings and the possibility of publication bias, respectively. Thirty-two RCTs including different dosage of magnesium (48-450 mg/d), and duration (6-24 weeks) were entered to this study. Magnesium supplementation resulted in a great reduction in BMI [Weighted Mean Difference (WMD): -0.21 kg/m², 95% CI: -0.41, -0.001, P = 0.048, I² = 89.5%, n = 22], which was mainly driven by the effect among those with magnesium deficiency, insulin resistance related disorders, and obesity at baseline. No significant change was observed in bodyweight, WC, BF percentage and WHR as compared to controls. However, the change in body weight, and WC was significant in subgroups of participants with insulin resistance related disorders, hypertension, obesity, magnesium deficiency at baseline, and females. We found a significant reduction in BMI following magnesium supplementation. The change in body weight and WC were evident in certain subgroups.

Association of magnesium consumption with type 2 diabetes and glucose metabolism: A systematic review and pooled study with trial sequential analysis

Prevention of type 2 diabetes (T2D) with diet or diet supplementation is challenging. This article aims to draw conclusive associations between magnesium intake and T2D incidence and evaluate the effect of magnesium supplementation on glucose metabolism. Databases were searched for related articles from inception to May 15, 2019. Prospective cohort studies investigating the relevant relationship as well as randomized controlled trials (RCTs) assessing the effect of magnesium supplementation were eligible. We conducted trial sequential analysis (TSA) to prove the sufficiency of the current evidence. Twenty-six publications involving 35 cohorts were included in the analysis. Compared to the lowest magnesium intake, the highest level was associated with a 22% lower risk for T2D; the risk was reduced by 6% for each 100 mg increment in daily magnesium intake. Additional analysis of 26 RCTs (1168 participants) was performed, revealing that magnesium supplementation significantly reduced the fasting plasma glucose (FPG) level (SMD, -0.32 [95% CI, -0.59 to -0.05], 2-hour oral glucose tolerance test (2-h OGTT) result (SMD, -0.30 [-0.58 to -0.02]), fasting insulin level (SMD, -0.17 [-0.30 to -0.04]), homeostatic model assessment-insulin resistance (HOMA-IR) score (SMD, -0.41 [-0.71 to -0.11]), triglyceride (TG) level, systolic blood pressure (SBP) and diastolic blood pressure (DBP). TSA showed an inverse association, with most benefits of magnesium supplementation on glucose metabolism being stable. In conclusion, magnesium intake has an inverse dose-response association with T2D incidence, and supplementation appears to be advisable in terms of glucose parameters in T2D/high-risk individuals.

Effects of Oral Magnesium Supplementation on Vascular Function: A Systematic Review and Meta-analysis of Randomized Controlled Trials

INTRODUCTION

The effects of magnesium (Mg) supplementation on vascular function have been evaluated in some randomized controlled trials (RCT) but their results are conflicting.

AIM

A systematic review and meta-analysis were conducted to summarize the effects of oral Mg supplementation on vascular function in RCT.

METHODS

The databases MEDLINE (PubMed), Embase, Web of Science and Cochrane Library were accessed from inception to May 27, 2019. Intergroup differences (treatment vs. control group) related to changes in flow-mediated dilation (FMD) and pulse wave velocity (PWV), expressed as mean and standard deviation, were used to evaluate the effect of Mg supplementation on these outcomes. The results of the meta-analysis were expressed using a random-effects model. The heterogeneity between studies was evaluated using the I² statistic.

RESULTS

The oral supplementation of Mg had no significant effect on FMD (mean difference 2.13; 95% CI - 0.56, 4.82; p = 0.12) and PWV (mean difference - 0.54, 95% CI - 1.45, 0.36, p = 0.24). Heterogeneity for both outcomes (FMD and PWV) was high (I² = 99%, p < 0.001). However, in subgroup analyses, oral Mg significantly improved FMD in studies longer than 6 months, in unhealthy subjects, in individuals older than 50 years, or in those with body mass index (BMI) ≥ 25 kg/m². The reduced number of RCT and the heterogeneity among them were the main limitations.

CONCLUSIONS

This meta-analysis suggest that oral Mg supplementation may improve endothelial function when conducted at least for 6 months and in unhealthy, overweight or older individuals. Registration number: PROSPERO CRD42019111462.

Effects of magnesium citrate, magnesium oxide and magnesium sulfate supplementation on arterial stiffness in healthy overweight individuals: a study protocol for a randomized controlled trial

Background

Arterial stiffness is closely related to the process of atherosclerosis, an independent cardiovascular risk factor, and predictive of future cardiovascular events and mortality. Recently, we showed that magnesium citrate supplementation results in a clinically relevant improvement of arterial stiffness. It remained unclear whether the observed effect was due to magnesium or citrate, and whether other magnesium compounds may have similar effects. Therefore, we aim to study the long-term effects of magnesium citrate, magnesium oxide and magnesium sulfate on arterial stiffness. In addition, we aim to investigate possible underlying mechanisms, including changes in blood pressure and changes in gut microbiota diversity.

Methods

In this randomized, double-blind, placebo-controlled trial, a total of 162 healthy overweight and slightly obese men and women will be recruited. During a 24-week intervention, individuals will be randomized to receive: magnesium citrate; magnesium oxide; magnesium sulfate (total daily dose of magnesium for each active treatment 450 mg); or placebo. The primary outcome of the study is arterial stiffness measured by the carotid–femoral pulse wave velocity (PWV_c–f), which is the gold standard for quantifying arterial stiffness. Secondary outcomes are office blood pressure, measured by a continuous blood pressure monitoring device, and gut microbiota, measured in fecal samples. Measurements will be performed at baseline and at weeks 2, 12 and 24.

Discussion

The present study is expected to provide evidence for the effects of different available magnesium formulations (organic and inorganic) on well-established cardiovascular risk markers, including arterial stiffness and blood pressure, as well as on the human gut microbiota. As such, the study may contribute to the primary prevention of cardiovascular disease in slightly obese, but otherwise healthy, individuals.

Trial registration

ClinicalTrials.gov, NCT03632590. Retrospectively registered on 15 August 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3414-4) contains supplementary material, which is available to authorized users.

The Effects of Choline and Magnesium Co-Supplementation on Metabolic Parameters, Inflammation, and Endothelial Dysfunction in Patients With Type 2 Diabetes Mellitus: A Randomized, Double-Blind, Placebo-Controlled Trial

Objective: To our knowledge, no study has investigated the effects of choline and magnesium co-supplementation on metabolic parameters, inflammation, and endothelial dysfunction in patients with type 2 diabetes mellitus (T2DM). The aim of this study was investigation of the effects of the choline and magnesium co-supplementation on metabolic parameters, inflammation, and endothelial dysfunction in patients with T2DM.Methods: A randomized double-blind placebo-controlled parallel clinical trial was carried out among 96 diabetic patients. Ninety-six patients were randomly assigned to either choline, magnesium, choline-magnesium, or placebo for 2 months. Anthropometric measurement; metabolic, inflammatory, and endothelial markers; dietary intake; and physical activity were assessed at baseline and after treatment.Results: There was a significant change in serum magnesium in both magnesium and choline-magnesium groups (p < 0.05). Also, significant changes were observed in interleukin (IL)-6 levels in magnesium and choline-magnesium groups (p < 0.05). Moreover, vascular cell adhesion molecule-1 (VCAM-1) levels decreased in choline and choline-magnesium groups (p < 0.05). When adjusted for potential confounders, inflammation and endothelial factors (IL-6 and VCAM-1) decreased significantly in the choline-magnesium group as compared to other groups (p < 0.05). Compared to baseline values there were no significant differences in all anthropometric measurements and metabolic factors among four groups (p > 0.05).Conclusions: Choline and magnesium co-supplementation was more effective in improving inflammation and endothelial dysfunction than supplementation with choline or magnesium alone.

The effects of magnesium and vitamin E co-supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial

This study was carried out to determine the effects of magnesium and vitamin E co-supplementation on wound healing and metabolic status in patients with diabetic foot ulcer (DFU). The current randomized, double-blind, placebo-controlled trial was conducted among 57 patients with grade 3 DFU. Participants were randomly divided into two groups to take either 250 mg magnesium oxide plus 400 IU vitamin E (n = 29) or placebo per day (n = 28) for 12 weeks. Compared with the placebo, taking magnesium plus vitamin E supplements reduced ulcer length (β [difference in the mean of outcomes measures between treatment groups] -0.56 cm; 95% CI, -0.92, -0.20; p = 0.003), width (β -0.35 cm; 95% CI, -0.64, -0.05; p = 0.02) and depth (β -0.18 cm; 95% CI, -0.33, -0.02; p = 0.02). In addition, co-supplementation led to a significant reduction in fasting plasma glucose (β -13.41 mg/dL; 95% CI, -20.96, -5.86; p = 0.001), insulin (β -1.45 μIU/ml; 95% CI, -2.37, -0.52; p = 0.003), insulin resistance (β -0.60; 95% CI, -0.99, -0.20; p = 0.003) and HbA1c (β -0.32%; 95% CI, -0.48, -0.16; p < 0.003), and a significant elevation in insulin sensitivity (β 0.007; 95% CI, 0.003, 0.01; p < 0.001) compared with the placebo. Additionally, compared with the placebo, taking magnesium plus vitamin E supplements decreased triglycerides (β -10.08 mg/dL; 95% CI, -19.70, -0.46; p = 0.04), LDL-cholesterol (β -5.88 mg/dL; 95% CI, -11.42, -0.34; p = 0.03), high sensitivity C-reactive protein (hs-CRP) (β -3.42 mg/L; 95% CI, -4.44, -2.41; p < 0.001) and malondialdehyde (MDA) (β -0.30 μmol/L; 95% CI, -0.45, -0.15; p < 0.001), and increased HDL-cholesterol (β 2.62 mg/dL; 95% CI, 0.60, 4.63; p = 0.01) and total antioxidant capacity (TAC) levels (β 53.61 mmol/L; 95% CI, 4.65, 102.57; p = 0.03). Overall, magnesium and vitamin E co-supplementation for 12 weeks to patients with DFU had beneficial effects on ulcer size, glycemic control, triglycerides, LDL- and HDL-cholesterol, hs-CRP, TAC, and MDA levels.

Chronic magnesium deficiency and human disease; time for reappraisal?

Numerous epidemiological, experimental and clinical studies over the last 30 years have consistently shown that chronic magnesium deficiency is associated with and/or exacerbates a number of major disorders (Table 1). Yet chronic magnesium deficiency is not widely recognized and a major reason for this failure is that serum magnesium levels do not accurately reflect body magnesium stores. Specifically, in chronic magnesium deficiency, serum magnesium levels are often within the normal reference range (usually lowest quartile) and may not progress to overt hypomagnesaemia. This raises serious questions namely (i) should chronic magnesium deficiency be considered in high-risk patients irrespective of serum magnesium, even when 'normal'? and (ii) if recognized, should oral magnesium supplement be given to restore body stores? Appreciating the vital role of magnesium for normal cellular function and bone health may help in formulating a well-considered and justifiable approach to these questions. Pragmatic tests for assessing magnesium status in the adult are suggested and discussed.

Positive Effects of Tomato Paste on Vascular Function After a Fat Meal in Male Healthy Subjects

Tomato consumption has been recently associated with a reduced incidence of cardiovascular disease (CVD). The aim of this study was to test whether a seven-day period of tomato paste purèe (tomato paste, TP) supplementation could improve some haemodynamic parameters in healthy volunteers before and after a standardized fat meal (FM).

METHODS AND RESULTS

Nineteen healthy male volunteers participated in a randomized, single-blind (operator) crossover study. Participants maintained low fiber diets (LFD) during the study periods. They were randomized either to a LFD and TP arm (80 g of TP/day) for seven-days, or to a control arm (LFD-only) with a two-week washout period. Flow Mediated Dilatation and other morpho-functional vascular indices were measured by ultrasound. Stiffness Index and Reflection Index were estimated by digital photo-plethysmography. All these parameters were measured one h before and two and 3.5 h after the FM. The difference in Stiffness Index was increased in the LFD and TP + FM-arm, as compared to the LFD-only + FM arm at both two and 3.5 h points. After the FM, in both arms, at two h, we observed a reduction in the Reflection Index and an increase in heart rate. Interestingly, only in the LFD and TP + FM-arm, some haemodynamic changes were detectable at two h; notably, there was an increase in brachial artery diameter and a reduction in diastolic blood pressure (BP).

CONCLUSIONS

TP has no effect on Flow Mediated Dilatation but acutely modifies some haemodynamic parameters triggered by FM, suggesting possible haemodynamic beneficial effects in people consuming tomatoes.

Challenges in the Diagnosis of Magnesium Status

Magnesium is a critical mineral in the human body and is involved in ~80% of known metabolic functions. It is currently estimated that 60% of adults do not achieve the average dietary intake (ADI) and 45% of Americans are magnesium deficient, a condition associated with disease states like hypertension, diabetes, and neurological disorders, to name a few. Magnesium deficiency can be attributed to common dietary practices, medications, and farming techniques, along with estimates that the mineral content of vegetables has declined by as much as 80⁻90% in the last 100 years. However, despite this mineral's importance, it is poorly understood from several standpoints, not the least of which is its unique mechanism of absorption and sensitive compartmental handling in the body, making the determination of magnesium status difficult. The reliance on several popular sample assays has contributed to a great deal of confusion in the literature. This review will discuss causes of magnesium deficiency, absorption, handling, and compartmentalization in the body, highlighting the challenges this creates in determining magnesium status in both clinical and research settings.

Serum magnesium levels and risk of coronary artery disease: Mendelian randomisation study

BACKGROUND

Observational studies have shown that serum magnesium levels are inversely associated with risk of cardiovascular disease, but whether this association is causal is unknown. We conducted a Mendelian randomisation study to investigate whether serum magnesium levels may be causally associated with coronary artery disease (CAD).

METHODS

This Mendelian randomisation analysis is based on summary-level data from the CARDIoGRAMplusC4D consortium's 1000 Genomes-based genome-wide association meta-analysis of 48 studies with a total of 60,801 CAD cases and 123,504 non-cases. Six single-nucleotide polymorphisms associated with serum magnesium levels at genome-wide significance were used as instrumental variables.

RESULTS

A genetic predisposition to higher serum magnesium levels was inversely associated with CAD. In conventional Mendelian randomisation analysis, the odds ratio of CAD was 0.88 (95% confidence interval [CI] 0.78 to 0.99; P = 0.03) per 0.1-mmol/L (about 1 standard deviation) increase in genetically predicted serum magnesium levels. Results were consistent in sensitivity analyses using the weighted median and heterogeneity-penalised model averaging methods, with odds ratios of 0.84 (95% CI 0.72 to 0.98; P = 0.03) and 0.83 (95% CI 0.71 to 0.96; P = 0.02), respectively.

CONCLUSIONS

This study based on genetics provides evidence that serum magnesium levels are inversely associated with risk of CAD. Randomised controlled trials elucidating whether magnesium supplementation lowers the risk of CAD, preferably in a setting at higher risk of hypomagnesaemia, are warranted.

Oral Magnesium Supplementation and Metabolic Syndrome: A Randomized Double-Blind Placebo-Controlled Clinical Trial

The objective of the study was to evaluate the efficacy of oral magnesium supplementation in the improvement of metabolic syndrome (MetS) and its components. This is a randomized double-blind, placebo-controlled clinical trial that enrolled 198 individuals with MetS and hypomagnesemia who were randomly allocated to receive either 30 mL of magnesium chloride 5% solution, equivalent to 382 mg of elemental magnesium (n = 100), or placebo solution (n = 98), daily for 16 weeks. Serum magnesium levels <1.8 mg/dL defined hypomagnesemia. At final conditions, a total of 48 (48%) and 76 (77.5%) individuals had MetS in the magnesium and placebo groups (P = 0.01), respectively. At baseline, percent of individuals with 3, 4, and 5 criteria of MetS in the magnesium group were 60.0%, 37.0%, and 3.0%, respectively, and in the control group 55.1%, 35.7%, and 9.2%, respectively. Between basal and final conditions, changes in the components of MetS were significantly higher in the magnesium than placebo groups: -3.6 ± 3.3 mmHg, P = 0.001 for systolic blood pressure; -5.5 ± 1.7 mmHg, P = 0.005 for diastolic blood pressure; -12.4 ± 3.6 mg/dL, P < 0.005 for fasting glucose; -61.2 ± 24 mg/dL, P = 0.003 for triglycerides; and 0.9 ± 0.4 mg/dL, P = 0.06 for high-density lipoprotein cholesterol. Magnesium supplementation improves MetS by reducing blood pressure, hyperglycemia, and hypertriglyceridemia.

Effect of magnesium supplementation on endothelial function: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND AIMS

Findings of past studies are inconsistent regarding the effects of magnesium (Mg) supplementation on endothelial function (EF). We performed this meta-analysis to examine the effects of magnesium supplementation on flow-mediated dilation (FMD) and carotid intima media thickness (CIMT) as markers of EF.

METHODS

Literature searches of English publications in MEDLINE and EMBASE databases were conducted up to November 2017. Results are reported as weighted mean difference (MD) with 95% confidence intervals (CI) using random effects model (DerSimonian-Laird method). Cochrane's Q test and I-squared (I²) were used to determine heterogeneity among included studies. To determine potential sources of heterogeneity, subgroup analysis was conducted for pre-defined criteria. Funnel plot and Egger's regression test were used to assess publication bias.

RESULTS

Seven RCTs with 306 participants were included. Mg supplementation significantly increased FMD (MD: 2.97; 95% CI: 0.23 to 5.70%, p = 0.033). Between studies heterogeneity was high and subgroup analysis could not identify the sources of heterogeneity. Magnesium supplementation had no significant effect on CIMT (MD: -0.13 mm; 95% CI: 0.27, 0.01; p = 0.077) with high heterogeneity. Mg dose, duration of treatment, healthy status, baseline CIMT and sample size were the potential sources of heterogeneity. Mg supplementation could decrease CIMT to a greater extent in hemodialysis (HD) patients; lower doses of Mg, higher sample size and follow up duration and subjects with higher baseline CIMT also reduced the heterogeneity to some degree (p < 0.001).

CONCLUSIONS

Magnesium supplementation may improve endothelial function without affecting carotid intima media thickness.

The Efficacy of a Pre-Workout Vegan Supplement on High-Intensity Cycling Performance in Healthy College-Aged Males

There is a limited supply of sport nutrition supplements currently available for vegan or vegetarian athletes. In addition, the efficacy of a vegan or vegetarian pre-workout supplement that does not contain any processed ingredients or stimulants is currently unknown. The purpose of the current study was to examine the effects of an unprocessed vegan pre-workout supplement on high-intensity cycling performance. Participants completed three separate cycling trials following the consumption of a vegan pre-workout supplement, an isocaloric processed supplement, or a zero-calorie placebo supplement. Each supplement was consumed 30 minutes prior to each trial, and each cycling trial was separated by a minimum of 72 hours. Supplements were administered using a randomized, double-blind cross-over design. Each cycling trial was performed at a workload equal to 80% VO_2peak until exhaustion. The average time in seconds (s) until exhaustion values for the vegan, isocaloric, and zero-calorie supplements were 482 ± 163, 480 ± 157, and 496 ± 238, respectively. Consumption of the vegan supplement did not significantly improve performance compared to an isocaloric and zero-calorie supplement (F = 0.12, p =.89). The results of this study indicate that individuals who choose a vegan pre-workout supplement (over an isocaloric or zero-calorie product) will not experience any acute decrements or ergogenic benefits in cycling performance. Although the present study does not support performance benefits of the tested vegan pre-workout supplement before cycling, additional research examining various exercise intensities and modalities is warranted.

Dapagliflozin acutely improves endothelial dysfunction, reduces aortic stiffness and renal resistive index in type 2 diabetic patients: a pilot study

Background

Sodium-glucose cotransporter-2 inhibitors reduce blood pressure (BP) and renal and cardiovascular events in patients with type 2 diabetes through not fully elucidated mechanisms. Aim of this study was to investigate whether dapagliflozin is able to acutely modify systemic and renal vascular function, as well as putative mechanisms.

Methods

Neuro-hormonal and vascular variables, together with 24 h diuresis, urinary sodium, glucose, isoprostanes and free-water clearance were assessed before and after a 2-day treatment with dapagliflozin 10 mg QD in sixteen type 2 diabetic patients; data were compared with those obtained in ten patients treated with hydrochlorothiazide 12.5 mg QD. Brachial artery endothelium-dependent and independent vasodilation (by flow-mediated dilation) and pulse wave velocity were assessed. Renal resistive index was obtained at rest and after glyceryl trinitrate administration. Differences were analysed by repeated measures ANOVA, considering treatment as between factor and time as within factor; Bonferroni post hoc comparison test was also used.

Results

Dapagliflozin decreased systolic BP and induced an increase in 24 h diuresis to a similar extent of hydrochlorothiazide; 24 h urinary glucose and serum magnesium were also increased. 24 h urinary sodium and fasting blood glucose were unchanged. Oxidative stress was reduced, as by a decline in urinary isoprostanes. Flow-mediated dilation was significantly increased (2.8 ± 2.2 to 4.0 ± 2.1%, p < 0.05), and pulse-wave-velocity was reduced (10.1 ± 1.6 to 8.9 ± 1.6 m/s, p < 0.05), even after correction for mean BP. Renal resistive index was reduced (0.62 ± 0.04 to 0.59 ± 0.05, p < 0.05). These vascular modifications were not observed in hydrochlorothiazide-treated individuals.

Conclusions

An acute treatment with dapagliflozin significantly improves systemic endothelial function, arterial stiffness and renal resistive index; this effect is independent of changes in BP and occurs in the presence of stable natriuresis, suggesting a fast, direct beneficial effect on the vasculature, possibly mediated by oxidative stress reduction.

Effect of magnesium supplementation on type 2 diabetes associated cardiovascular risk factors: a systematic review and meta-analysis

BACKGROUND

Cardiovascular disorders remain the leading cause of death in type 2 diabetic patients. In the present study, a systematic review and a meta-analysis of randomised controlled trials (RCTs) were conducted aiming to evaluate the effect of magnesium supplementation on type 2 diabetes (T2D) associated cardiovascular risk factors in both diabetic and nondiabetic individuals.

METHODS

PubMed, Scopus, Cochrane, Web of Science and Google Scholar databases were searched from inception to 30 June 2016 aiming to identify RCTs evaluating the effect of magnesium supplementation on T2D associated cardiovascular risk factors. The data were analysed using a random effect model with inverse variance methodology. Sensitivity analysis, risk of bias analysis, subgroup analysis, meta-regression and publication bias analysis were also conducted for the included studies using standard methods.

RESULTS

Following magnesium supplementation, a significant improvement was observed in fasting plasma glucose (FPG) [weighted mean difference (WMD) = -4.641 mg dL-1 , 95% confidence interval (CI) = -7.602, -1.680, P = 0.002], high-density lipoprotein (HDL) (WMD = 3.197 mg dL-1 , 95% CI = 1.455, 4.938, P < 0.001), low-density lipoprotein (LDL) (WMD = -10.668 mg dL-1 , 95% CI = -19.108, -2.228, P = 0.013), plasma triglycerides (TG) (WMD = -15.323 mg dL-1 , 95% CI = -28.821, -1.826, P = 0.026) and systolic blood pressure (SBP) (WMD = -3.056 mmHg, 95% CI = -5.509, -0.603, P = 0.015). During subgroup analysis, a more beneficial effect of magnesium supplementation was observed in diabetic subjects with hypomagnesaemia.

CONCLUSIONS

Magnesium supplementation can produce a favourable effect on FPG, HDL, LDL, TG and SBP. Therefore, magnesium supplementation may decrease the risk T2D associated cardiovascular diseases, although future large RCTs are needed for making robust guidelines for clinical practice.

Sleep-disordered breathing is associated with blood pressure and carotid arterial stiffness in obese children

INTRODUCTION

Both sleep-disordered breathing (SDB) and high blood pressure (BP) occur more frequently among obese children than among normal weight children, and this may be due to endothelial dysfunction and worsened arterial stiffness. The aim of this study was to evaluate the possible association between SDB and BP, and the possible role of endothelial function and local and systemic arterial stiffness in a sample of obese children asymptomatic for sleep disturbances.

MATERIALS AND METHODS

Thirty-nine obese children were included in the study. Children underwent overnight limited channel polysomnography, and the vascular measurements included the following: office and 24-h ambulatory BP; brachial flow-mediated dilatation, carotid intima-media thickness and carotid distensibility measured using ultrasound; and systemic arterial stiffness index measured using digital volume pulse analysis.

RESULTS

Significant correlations between different BP measurements (both office and ambulatory BP monitoring and estimated by Z score) and SDB were found, including correlations involving the respiratory disturbance index, the apnea-hypopnea index (AHI), the number of desaturations per hour and the mean peripheral saturation (r ranging between 0.330 and 0.474). Carotid distensibility was correlated with the AHI (r = -0.367; P = 0.030) and with the mean oxygen saturation (r = 0.401; P = 0.017). In contrast, there was no relationship among flow-mediated dilatation, stiffness index, carotid intima-media thickness and all the tested respiratory markers. In the multivariate analysis, the supine Z SBP remained independently associated with the number of desaturations per hour and the AHI, even after correction for carotid distensibility and BMI.

CONCLUSION

Our data suggest that in obese children asymptomatic for sleep respiratory problems, SDB might worsen BP, in part, through an increase in arterial stiffness.

Effects of long-term magnesium supplementation on endothelial function and cardiometabolic risk markers: A randomized controlled trial in overweight/obese adults

Long-term magnesium supplementation improves arterial stiffness, a cardiovascular disease risk marker. Effects on endothelial function may be another mechanism whereby increased magnesium intakes affect cardiovascular risk. Therefore, a 24-week, randomized, double-blind, placebo-controlled trial was performed to examine effects of magnesium supplementation on endothelial function and cardiometabolic risk markers. Fifty-two overweight and obese subjects (30 men and 22 women, age 62 ± 6 years) were randomized to receive either three times daily magnesium (total dose: 350 mg) or placebo capsules. Endothelial function was assessed at the start and at the end of the study. Cardiometabolic risk markers were measured at baseline, after 12 weeks, and at week 24. Brachial artery flow-mediated vasodilation did not change following long-term magnesium supplementation (0.49 pp; 95% CI: −0.38 to 1.36 pp; P = 0.26). Changes in reactive hyperemia index, retinal microvascular caliber and plasma markers for microvascular endothelial function (sVCAM-1, sICAM-1 and sE-selectin) were also not different. In addition, no effects on serum lipids, plasma glucose, insulin sensitivity, and low-grade systemic inflammation were observed. In conclusion, a daily magnesium supplement of 350 mg for 24 weeks does not improve endothelial function and cardiometabolic risk markers in overweight and obese middle-aged and elderly adults.

Effect of magnesium supplementation on lipid profile: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

We performed a meta-analysis of randomized controlled trials (RCTs) in order to evaluate the effect of oral magnesium supplementation on lipid profile of both diabetic and non-diabetic individuals.

METHODS

PubMed-Medline, SCOPUS, Web of Science, and Google Scholar databases were searched (from inception to February 23, 2016) to identify RCTs evaluating the effect of magnesium on lipid concentrations. A random-effects model and generic inverse variance method were used for quantitative data synthesis. Sensitivity analysis was conducted using the leave-one-out method. A weighted random-effects meta-regression was performed to evaluate the impact of potential confounders on lipid concentrations.

RESULTS

Magnesium treatment was not found to significantly affect plasma concentrations of any of the lipid indices including total cholesterol (WMD 0.03 mmol/L, 95% CI -0.11, 0.16, p = 0.671), LDL-C (WMD -0.01 mmol/L, 95% CI -0.13, 0.11, p = 0.903), HDL-C (WMD 0.03 mmol/L, 95% CI -0.003, 0.06, p = 0.076), and triglycerides concentrations (WMD -0.10 mmol/L, 95% CI -0.25, 0.04, p = 0.149). In a subgroup analysis comparing studies with and without diabetes, no difference was observed between subgroups in terms of changes in plasma total cholesterol (p = 0.924), LDL-C (p = 0.161), HDL-C (p = 0.822), and triglyceride (p = 0.162) concentrations.

CONCLUSIONS

Results of the present meta-analysis indicated that magnesium supplementation showed no significant effects on the lipid profile of either diabetic or non-diabetic individuals.

Perspective: The Case for an Evidence-Based Reference Interval for Serum Magnesium: The Time Has Come

The 2015 Dietary Guidelines Advisory Committee indicated that magnesium was a shortfall nutrient that was underconsumed relative to the Estimated Average Requirement (EAR) for many Americans. Approximately 50% of Americans consume less than the EAR for magnesium, and some age groups consume substantially less. A growing body of literature from animal, epidemiologic, and clinical studies has demonstrated a varied pathologic role for magnesium deficiency that includes electrolyte, neurologic, musculoskeletal, and inflammatory disorders; osteoporosis; hypertension; cardiovascular diseases; metabolic syndrome; and diabetes. Studies have also demonstrated that magnesium deficiency is associated with several chronic diseases and that a reduced risk of these diseases is observed with higher magnesium intake or supplementation. Subclinical magnesium deficiency can exist despite the presentation of a normal status as defined within the current serum magnesium reference interval of 0.75-0.95 mmol/L. This reference interval was derived from data from NHANES I (1974), which was based on the distribution of serum magnesium in a normal population rather than clinical outcomes. What is needed is an evidenced-based serum magnesium reference interval that reflects optimal health and the current food environment and population. We present herein data from an array of scientific studies to support the perspective that subclinical deficiencies in magnesium exist, that they contribute to several chronic diseases, and that adopting a revised serum magnesium reference interval would improve clinical care and public health.

A systematic review and meta-analysis of randomized controlled trials on the effects of magnesium supplementation on insulin sensitivity and glucose control

A systematic review and meta-analysis was conducted to evaluate the effect of oral magnesium supplementation on insulin sensitivity and glucose control in both diabetic and non-diabetic individuals. PubMed-Medline, SCOPUS, Web of Science and Google Scholar databases were searched (from inception to November 25, 2015) to identify RCTs evaluating the effect of magnesium on insulin sensitivity and glucose control. A random-effects model and generic inverse variance method were used to compensate for the heterogeneity of studies. Publication bias, sensitivity analysis, and meta-regression assessments were conducted using standard methods. The impact of magnesium supplementation on plasma concentrations of glucose, glycated hemoglobin (HbA1c), insulin, and HOMA-IR index was assessed in 22, 14, 12 and 10 treatment arms, respectively. A significant effect of magnesium supplementation was observed on HOMA-IR index (WMD: -0.67, 95% CI: -1.20, -0.14, p=0.013) but not on plasma glucose (WMD: -0.20mmol/L, 95% CI: -0.45, 0.05, p=0.119), HbA1c (WMD: 0.018mmol/L, 95% CI: -0.10, 0.13, p=0.756), and insulin (WMD: -2.22mmol/L, 95% CI: -9.62, 5.17, p=0.556). A subgroup analysis comparing magnesium supplementation durations of <4 months versus ≥4 months, exhibited a significant difference for fasting glucose concentrations (p<0.001) and HOMA-IR (p=0.001) in favor of the latter subgroup. Magnesium supplementation for ≥4 months significantly improves the HOMA-IR index and fasting glucose, in both diabetic and non-diabetic subjects. The present findings suggest that magnesium may be a beneficial supplement in glucose metabolic disorders.

Long-term magnesium supplementation improves arterial stiffness in overweight and obese adults: results of a randomized, double-blind, placebo-controlled intervention trial

BACKGROUND

Epidemiologic studies have suggested a protective effect of magnesium intake on cardiovascular disease risk. However, intervention trials of magnesium supplementation on blood pressure and conventional cardiometabolic risk markers are inconsistent. Effects on vascular function markers related to cardiovascular disease risk have rarely been studied.

OBJECTIVE

The objective was to evaluate the effects of long-term magnesium supplementation on arterial stiffness.

DESIGN

We performed a 24-wk, randomized, double-blind, placebo-controlled intervention study. Fifty-two overweight and slightly obese individuals (30 men and 22 postmenopausal women, mean ± SD age: 62 ± 6 y) were randomly allocated to receive either 3 times daily magnesium (3 × 117 mg or 350 mg/d) or placebo capsules. Twenty-four-hour urine collections and 24-h ambulatory blood pressure assessments were performed at the start and end of the study. Carotid-to-femoral pulse wave velocity (PWVc-f) was assessed at baseline, after 12 wk, and at week 24.

RESULTS

Serum magnesium concentrations did not differ after 12 wk but tended to increase after 24-wk magnesium supplementation compared with placebo by 0.02 mmol/L (95% CI: 0.00, 0.04 mmol/L; P = 0.09). Twenty-four-hour urinary magnesium excretion increased by 2.01 mmol (95% CI: 1.22, 2.93 mmol; P < 0.001) at week 24. PWVc-f was not changed after 12 wk (0.0 m/s; 95% CI: -0.6, 0.5 m/s; P = 0.90) but was improved in the magnesium compared with the placebo group by 1.0 m/s (95% CI: 0.4, 1.6 m/s; P = 0.001) after 24 wk. Office and 24-h ambulatory blood pressure levels were not changed. No adverse events were observed.

CONCLUSION

Our data indicate that a daily magnesium supplement of 350 mg for 24 wk in overweight and obese adults reduces arterial stiffness, as estimated by a decrease in PWVc-f, suggesting a potential mechanism by which an increased dietary magnesium intake beneficially affects cardiovascular health. This trial was registered at clinicaltrials.gov as NCT02235805.

Relationship between the concentrations of heavy metals and bioelements in aging men with metabolic syndrome

Heavy metals may exacerbate metabolic syndrome (MS) but abnormal serum concentrations of bioelements may also co-exist with MS. The primary aim of the study was to assess the relationship of blood heavy metal and bioelement concentrations and MS, in men aged 50-75 years. Heavy metals-lead (Pb), cadmium (Cd), mercury (Hg), arsenic (As), tungsten (W), Macroelements-magnesium (Mg) and calcium (Ca), and microelements-iron (Fe), zinc (Zn) copper (Cu), chromium (Cr), molybdenum (Mo), selenium (Se) and manganese (Mn), body mass index (BMI), waist to hip ratio (WHR), abdominal circumference (AC) and blood pressure (BP), total cholesterol (TCh), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), fasting plasma glucose (FPG), insulin, and Homeostasis Model Assessment-Insulin resistance (HOMA-IR). The men with MS showed statistically significant higher Zn and lower Mg concentrations. Those with diabetes had higher Ca concentration and lower Mg concentration. Cr and Mn concentrations were significantly higher in obese men. The participants with hypertension had lower Mg concentration. We found statistically significant positive correlations (W-TCh, W-LDL, Mg-TCh, Mg-LDL, Ca-TCh, Ca-LDL, Ca-insulin, Ca-HOMAR-IR, Zn-TG, Zn-insulin, Zn-HOMA-IR, Cu-BP systolic, Mn-BMI, Mn-AC, Mn-WHR, Mn-insulin, Mn-HOMA-IR, Se-TCh, Se-LDL, Se-TG, Se-insulin, Se-HOMA-IR, Cr-TCh, Cr-HDL, Cr-LDL, Cr-TG) and negative correlations (Cd-insulin, Hg-WHR, W-insulin, W-HOMA-IR, Mg-BMI, Mg-AC, Mg-WHR, Mg-BP systolic, Mo-insulin, Mn-HDL). Tungsten may contribute to lipid disorders. Magnesium appears to play the protective role in the occurrence of metabolic disorders. Microelements Mn, Cr and Se may intensify MS.