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Huang R, Kong X, Geng R, Wu J, Li J, Gu Y, Wu Y, You D, Zhao Y, Ni S, Zhong Z, Bai J. Associations of dietary magnesium intake with the risk of atherosclerotic cardiovascular disease and mortality in individuals with and without type 2 diabetes: A prospective study in the UK Biobank. DIABETES & METABOLISM 2024; 50:101554. [PMID: 38950854 DOI: 10.1016/j.diabet.2024.101554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND The association between dietary magnesium (Mg) intake and the risk of atherosclerotic cardiovascular disease (ASCVD) remains uncertain. We aimed to examine the associations of dietary Mg intake with the risk of ASCVD events and mortality in individuals with and without type 2 diabetes. METHODS A total of 149,929 participants (4603 with type 2 diabetes) from the UK Biobank were included in the analyses. The hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated using Cox proportional hazard models. Furthermore, interactions of dietary Mg intake with type 2 diabetes status were examined on multiplicative and additive scales. RESULTS During a median follow-up of 12.0 and 12.1 years, 7811 incident ASCVD events and 5000 deaths (including 599 ASCVD deaths) were documented, respectively. There were significantly negative associations between sufficient dietary Mg intake (equal to or greater than the recommended daily intake) and the risk of ASCVD incidence (HR 0.63 [95 % CI 0.49;0.82]), ASCVD mortality (0.45 [0.24;0.87]), and all-cause mortality (0.71 [0.52;0.97]) in participants with type 2 diabetes, whereas no significant association was observed in participants without type 2 diabetes (1.01 [0.94;1.09] for ASCVD incidence; 1.25 [0.93;1.66] for ASCVD mortality; 0.97 [0.88;1.07] for all-cause mortality). Multiplicative and additive interactions of dietary Mg intake with type 2 diabetes status were both observed. CONCLUSION Sufficient dietary Mg intake was significantly associated with lower risks of ASCVD events and mortality in individuals with type 2 diabetes but not in those without type 2 diabetes. Our findings provide insight into the importance of dietary Mg intake for reducing modifiable cardiovascular burden in individuals with type 2 diabetes, which may inform future personalized dietary guidelines.
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Affiliation(s)
- Ruyu Huang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Xinxin Kong
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Rui Geng
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jingwei Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA 19122, USA
| | - Jiong Li
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yong Gu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yaqian Wu
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Dongfang You
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Senmiao Ni
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Zihang Zhong
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jianling Bai
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China.
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Liu C, Qiu L, Zhang Y, Chen L, Wang H, Lin H, Tao Y, Ye H. The interaction between estimated glomerular filtration rate and dietary magnesium intake and its effect on stroke prevalence: a cross-sectional study spanning 2003-2018. Front Nutr 2024; 11:1395685. [PMID: 38919391 PMCID: PMC11196627 DOI: 10.3389/fnut.2024.1395685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/14/2024] [Indexed: 06/27/2024] Open
Abstract
Background Despite the known associations of dietary magnesium intake and estimated glomerular filtration rate (eGFR) with cardiovascular diseases, their combined effects on stroke risk remain unclear. Therefore, this study aims to explore the associations of dietary magnesium intake and eGFR with stroke risk. Methods The National Health and Nutrition Examination Survey (NHANES) data of 37,637 adult participants (≥18 years) from 2003 to 2018 was analyzed. Dietary magnesium intake was categorized as low (≤ 254 mg/day) and normal (> 254 mg/day) based on experimental data. Multiple logistic regression analyses and interaction tests were conducted to assess the associations of dietary magnesium intake and eGFR with stroke risk, with a focus on the interaction between different chronic kidney disease (CKD) stages based on eGFR levels and dietary magnesium intake. Additional analyses included multiplicative interaction analysis, restricted cubic spline analysis, and subgroup evaluations by age, sex, and ethnicity. Results Dietary magnesium intake and eGFR were inversely correlated with the risk of stroke. Participants with low dietary magnesium intake had a higher stroke risk than those with normal magnesium intake (odds ratio [OR] 1.09, 95% confidence interval [CI]: 1.03-1.42). Likewise, low eGFR was associated with an elevated stroke risk compared with normal eGFR (OR 1.56, 95% CI: 1.15-2.13). Furthermore, the two factors showed a multiplicative interaction effect on stroke risk (OR 1.05, 95% CI: 1.01-1.09). We observed a significant interaction between stage G3 CKD and low dietary magnesium intake (OR 1.05, 95% CI: 1.01-1.09), suggesting a potential association with stroke risk. However, similar associations were not observed for stages G4 and G5, possibly due to the smaller number of participants with G4 and G5 CKD. The restricted cubic spline analysis revealed a non-linear relationship between dietary magnesium intake, eGFR, and stroke risk. The interaction between magnesium deficiency and low eGFR persisted in participants aged >60 years, as well as in females, non-Hispanic Black people, and people of other races. Conclusion Dietary magnesium intake and eGFR correlate negatively with stroke prevalence. Moreover, there was an interaction between dietary magnesium intake and stroke prevalence across different CKD stages. Further large-scale prospective studies are needed to analyze the potential relationship between dietary magnesium intake, eGFR, and stroke.
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Affiliation(s)
- Chunhua Liu
- Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, Lishui City, China
| | - Linan Qiu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuanyuan Zhang
- Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, Lishui City, China
| | - Liping Chen
- Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, Lishui City, China
| | - Huaqiang Wang
- Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, Lishui City, China
| | - Huajian Lin
- Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, Lishui City, China
| | - Yongjun Tao
- Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, Lishui City, China
| | - Haiqin Ye
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Han M, Zhang Y, Fang J, Sun M, Liu Q, Ma Z, Hu D, Gong X, Liu Y, Jin L, Liu Z, Ma Y. Associations between dietary magnesium intake and hypertension, diabetes, and hyperlipidemia. Hypertens Res 2024; 47:331-341. [PMID: 37821564 DOI: 10.1038/s41440-023-01439-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 10/13/2023]
Abstract
Hypertension, diabetes, and hyperlipidemia significantly impact chronic diseases and mortality. Magnesium is an essential nutrient for maintaining critical physiological functions, and magnesium deficiency is often associated with adverse health outcomes. In a cross-sectional study of US adults, we aimed to explore dietary magnesium intake and its association with the prevalence of hypertension, diabetes, and hyperlipidemia in US adults over 20 years of age in NHANES 2007-2018. We obtained data on 24,171 samples of hypertension, 9950 samples of diabetes, and 12,149 samples of hyperlipidemia. We used multivariable logistic regression models adjusted for multiple sociodemographic, anthropometric, and lifestyle factors, with participants subdivided into five groups based on quintiles of daily dietary magnesium. After adjusting for the major lifestyle and dietary variables, an independent and significant inverse relationship between dietary magnesium and hypertension, diabetes, and hyperlipidemia was observed. Compared with the lowest quintile of magnesium intake, the prevalence of hypertension, diabetes, and hyperlipidemia was significantly reduced in the highest magnesium quintile. The OR of hypertension in the highest quintile was 0.66 (95% CI: 0.51-0.87; P trend < 0.001), the OR of diabetes was 0.56 (95% CI: 0.39-0.81; P trend < 0.001), and the OR of hyperlipidemia was 0.68 (95% confidence interval: 0.53-0.86; P trend = 0.007). In the subgroup analysis, most of the inverse relationships persisted. Our findings highlight the potential of magnesium-rich foods to prevent hypertension, diabetes, and hyperlipidemia in US adults. This article summarizes and discuss recent findings on: 1) A high dietary magnesium intake was associated with a lower prevalence of hypertension; 2) An inverse relationship between dietary magnesium with diabetes hyperlipidemia; 3) Monitoring and management of magnesium was important.
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Affiliation(s)
- Mengying Han
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education, China Medical University, Shenyang, China
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, 110122, Shenyang, China
| | - Yixin Zhang
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education, China Medical University, Shenyang, China
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, 110122, Shenyang, China
| | - Jiaxin Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, 130021, Changchun, Jilin, China
| | - Ming Sun
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education, China Medical University, Shenyang, China
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, 110122, Shenyang, China
| | - Qitong Liu
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education, China Medical University, Shenyang, China
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, 110122, Shenyang, China
| | - Zhaoyu Ma
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education, China Medical University, Shenyang, China
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, 110122, Shenyang, China
| | - Daibao Hu
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education, China Medical University, Shenyang, China
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, 110122, Shenyang, China
| | - Xiaoyu Gong
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education, China Medical University, Shenyang, China
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, 110122, Shenyang, China
| | - Yang Liu
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education, China Medical University, Shenyang, China
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, 110122, Shenyang, China
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, 130021, Changchun, Jilin, China.
| | - Zuyun Liu
- The Second Affiliated Hospital and School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 310058, Hangzhou, Zhejiang, China.
| | - Yanan Ma
- Key Laboratory of Environmental Stress and Chronic Disease Control & Prevention, Ministry of Education, China Medical University, Shenyang, China.
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, 110122, Shenyang, China.
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Khafri S, Ahmadi Ahangar A, Saadat P, Alijanpour S, Babaei M, Bayani M, firouzjahi A, Fadaee Jouybari F, Hosseini Shirvani S, Frajzadeh Z, Ezamie N. Mediatory role of the serum mineral level and discharge disability of stroke survivors. CASPIAN JOURNAL OF INTERNAL MEDICINE 2024; 15:124-131. [PMID: 38463915 PMCID: PMC10921102 DOI: 10.22088/cjim.15.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 08/12/2023] [Accepted: 10/02/2023] [Indexed: 03/12/2024]
Abstract
Background Possible association between minerals contributing and mortality related to stroke were seen, but prospective data on the relation of vitamin D, magnesium and calcium serum levels with stroke were inconsistent. Consideration about the potential health effects of minerals and nutrients, the current study was conducted. Methods This analytical cross-sectional study was conducted on 216 stroke survivors who were referred to the Ayatollah Rouhani Hospital of Babol, Iran. Demographic characteristics, clinical variables, and serum mineral levels were completed in the checklist. Admit score and discharge scale of these patients were determined according to the National Institute of Health Stroke Scale. A path model was constructed to explore the interrelationship between variables and to verify the relationship between variables and disability discharges. Results Of 216 stroke patients, 185 (85.6%) cases were ischemic. The discharge status of 29 (12.9%) cases were severe or expired. The patients with moderate and severe admit scores, hemorrhagic stroke type, diabetes mellitus, hypertension and live in the village significantly had a poor discharge disability scale (all of p<0.05). Of all direct paths, Mg (β=-2.85), and among indirect paths, calcium(β=-3.59) had the highest effect on the discharge scale. Only mg had affected the discharge scale through direct and indirect (β=-2.45) paths and had the greatest reverse effect on the discharge scale (β=-5.30; totally). Conclusion Hypomagnesemia and hypocalcemia play a mediatory role in poor outcomes. Especially, hypomagnesemia was the direct parameter for poor outcomes. The independent role of each mineral in this issue is difficult to define and suggested for future study.
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Affiliation(s)
- Soraya Khafri
- Department of Biostatistics and Epidemiology, Babol University of Medical Sciences, Babol, Iran
| | - Alijan Ahmadi Ahangar
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Payam Saadat
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Shayan Alijanpour
- Students Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Research and Planning Unit, Pre-hospital Emergency Organization and Emergency Medical Service Center, Babol University of Medical Sciences, Babol, Iran
| | - Mansor Babaei
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohammadali Bayani
- Department of Internal Medicine, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Alireza firouzjahi
- Department of Pathology, School of Medicine, Babol University of Medical Sciences
| | | | | | - Zahra Frajzadeh
- Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Nafisseh Ezamie
- Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
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Rao ND, Lemaitre RN, Sitlani CM, Umans JG, Haack K, Handeland V, Navas-Acien A, Cole SA, Best LG, Fretts AM. Dietary magnesium, C-reactive protein and interleukin-6: The Strong Heart Family Study. PLoS One 2023; 18:e0296238. [PMID: 38128021 PMCID: PMC10734955 DOI: 10.1371/journal.pone.0296238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES To examine the associations of dietary Mg intake with inflammatory biomarkers (C-reactive protein (CRP) and interleukin 6 (IL-6)), and the interaction of dietary Mg intake with single nucleotide polymorphism (SNP) rs3740393, a SNP related to Mg metabolism and transport, on CRP and IL-6 among American Indians (AIs). METHODS This cross-sectional study included AI participants (n = 1,924) from the Strong Heart Family Study (SHFS). Mg intake from foods and dietary supplements was ascertained using a 119-item Block food frequency questionnaire, CRP and IL-6 were measured from blood, and SNP rs3740393 was genotyped using MetaboChip. Generalized estimating equations were used to examine associations of Mg intake, and the interaction between rs3740393 and dietary Mg, with CRP and IL-6. RESULTS Reported Mg intake was not associated with CRP or IL-6, irrespective of genotype. A significant interaction (p-interaction = 0.018) was observed between Mg intake and rs3740393 on IL-6. Among participants with the C/C genotype, for every 1 SD higher in log-Mg, log-IL-6 was 0.04 (95% CI: -0.10 to 0.17) pg/mL higher. Among participants with the C/G genotype, for every 1 SD higher in log-Mg, log-IL-6 was 0.08 (95% CI: -0.21 to 0.05) pg/mL lower, and among participants with the G/G genotype, for every 1 SD higher in log-Mg, log-IL-6 was 0.19 (95% CI: -0.38 to -0.01) pg/mL lower. CONCLUSIONS Mg intake may be associated with lower IL-6 with increasing dosage of the G allele at rs3740393. Future research is necessary to replicate this finding and examine other Mg-related genes that influence associations of Mg intake with inflammation.
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Affiliation(s)
- Nandana D. Rao
- Institute of Public Health Genetics, University of Washington, Seattle, Washington, United States of America
| | - Rozenn N. Lemaitre
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Cardiovascular Research Health Unit, University of Washington, Seattle, Washington, United States of America
| | - Colleen M. Sitlani
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Cardiovascular Research Health Unit, University of Washington, Seattle, Washington, United States of America
| | - Jason G. Umans
- MedStar Health Research Institute, Hyattsville, Maryland, United States of America
- Department of Medicine, Georgetown University, Washington, DC, United States of America
| | - Karin Haack
- Texas Biomedical Research Institute, San Antonio, Texas, United States of America
| | | | - Ana Navas-Acien
- Department of Environmental Health Science, Columbia University, New York, New York, United States of America
| | - Shelley A. Cole
- Texas Biomedical Research Institute, San Antonio, Texas, United States of America
| | - Lyle G. Best
- Missouri Breaks Industries Research Inc, Eagle Butte, South Dakota, United States of America
| | - Amanda M. Fretts
- Institute of Public Health Genetics, University of Washington, Seattle, Washington, United States of America
- Cardiovascular Research Health Unit, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
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Sun P, Wang Z, Li B, Chen S. Association of Dietary Magnesium Intake with the Risk of Stroke among Adults. Int Heart J 2023; 64:1002-1009. [PMID: 37967982 DOI: 10.1536/ihj.23-299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
The relationship between dietary magnesium intake and the risk of stroke is controversial. This study aimed to examine the association of dietary magnesium intake with the risk of stroke among American adults.The relationship between dietary magnesium intake and the risk of stroke was analyzed using the National Health and Nutrition Examination Survey (NHANES) 2007-2018 data with 29,653 adults. The amount of magnesium from the diet was assessed by two 24-hour dietary recalls. Stroke outcomes were defined using the results of the self-reported questionnaires. The association between dietary magnesium intake and the risk of stroke was evaluated using logistic regression models and restricted cubic spline.In our study, an inverse association between dietary magnesium intake and the risk of stroke was found. For the highest versus lowest quartile of dietary magnesium intake, the multivariate-adjusted odds ratio (95% confidence interval) of stroke was 0.56 (0.36-0.86). The magnesium intake of women was negatively associated with stroke risk, but this negative association was not found in men. Then, the inverse association was statistically significant among the 40-59 year-old group. The results from the dose-response analysis show a linear relationship between dietary magnesium intake and the risk of stroke.Dietary magnesium intake was inversely associated with the risk of stroke, especially in women. Therefore, our study emphasizes the importance of appropriately increasing dietary magnesium intake.
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Affiliation(s)
- Peng Sun
- Department of Cardiology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University
| | - Zhiqiang Wang
- Department of Outpatient, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University
| | - Bo Li
- Department of General Practice, Zhangcun Town Health Center in Huancui District
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Ibrahim A, Legha R, Ravi R, Raj JP, Pushparajan L. Association of serum magnesium levels with acute ischaemic stroke in patients with type 2 diabetes mellitus: a propensity score-matched case-control study. BMJ Open 2023; 13:e073997. [PMID: 37880171 PMCID: PMC10603440 DOI: 10.1136/bmjopen-2023-073997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Magnesium (Mg) deficiency has been found to be associated with many clinical conditions, such as type 2 diabetes mellitus (T2DM), cardiovascular diseases and likewise. Studies evaluating the association between serum Mg levels and ischaemic stroke in T2DM from India are limited, and this formed the aim of this study. METHODS We conducted a case-control study among patients with T2DM where cases had a history of acute ischaemic stroke in the preceding 2 years and controls with no such history. Data regarding sociodemographic and clinical details and laboratory parameters, including serum Mg concentration, were collected using a semistructured questionnaire. Furthermore, propensity score matching (PSM) was done to match the controls with the cases. RESULTS We enrolled a total of 200 participants (cases: 75 and controls: 125), but after PSM, 149 participants (cases: 75 and control:74) were analysed. The serum Mg concentrations were significantly low (p<0.001) among the cases (mean (SD)=1.74 (0.22)) when compared with the controls (mean (SD)=1.95 (0.13)). For every 0.1 mg/dL decrease in serum Mg concentration, the odds of ischaemic stroke increase by approximately 1.918 times (95% CI 1.272 to 2.890; p=0.002). CONCLUSIONS The mean Mg level in the ischaemic stroke group was significantly low compared with the no stroke group in patients with T2DM. We recommend further controlled studies to evaluate the role of Mg supplementation in the management of acute ischaemic stroke.
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Affiliation(s)
- Anisha Ibrahim
- Department of Medicine, Travancore Medical College, Kollam, Kerala, India
| | - R Legha
- Department of Medicine, Travancore Medical College, Kollam, Kerala, India
| | - Renju Ravi
- Department of Pharmacology, Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
| | - Jeffrey Pradeep Raj
- Division of Clinical Pharmacology, Department of Pharmacology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Libby Pushparajan
- Department of Neurology, St Gregorios Medical Mission Hospital, Parumala, Kerala, India
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Ferrè S, Liu YL, Lambert JW, Katz R, Gianella FG, Drew DA, Shlipak MG, Moe OW, Ix JH, Toto RD, Neyra JA. Serum Magnesium Levels and Cardiovascular Outcomes in Systolic Blood Pressure Intervention Trial Participants. Kidney Med 2023; 5:100634. [PMID: 37235044 PMCID: PMC10206180 DOI: 10.1016/j.xkme.2023.100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Rationale and Objective Serum magnesium levels have been inversely yet inconsistently associated with cardiovascular (CV) outcomes. In this study, we examined the association of serum magnesium levels with CV outcomes in the Systolic Blood Pressure Intervention Trial (SPRINT) participants. Study Design Case-control post hoc analysis of SPRINT. Setting & Participants A total of 2,040 SPRINT participants with available serum samples at baseline level were included in this study. Case participants (n = 510) who experienced a CV event during the SPRINT observation period (median follow-up of 3.2 years) and control participants (n = 1,530) without CV events were sampled in a 1:3 ratio for measurements of serum magnesium level at baseline and 2-year follow-up. Predictors Baseline serum magnesium levels and 2-year percentage change in serum magnesium levels (ΔSMg). Outcome SPRINT primary composite CV outcome. Analytical Approach Multivariable conditional logistic regression analysis, accounting for matching factors, was used to evaluate the association of baseline and ΔSMg with CV outcomes. Individual matching of cases and controls was based on the SPRINT treatment arm allocation (standard vs intensive) and prevalence of chronic kidney disease (CKD). Results The median serum magnesium level at baseline was similar among the case and control groups. In a fully adjusted model, each standard deviation (SD) (0.18 mg/dL) higher of the baseline serum magnesium level was independently associated with a lower risk for composite CV outcomes in all study participants (adjusted odds ratio 95% CI, 0.79 [0.70-0.89]). This association was similar when serum magnesium levels were analyzed in quartiles but dissipated in the standard (vs intensive) arm of SPRINT (0.88 [0.76-1.02] vs 0.65 [0.53-0.79], respectively; Pinteraction = 0.06). The presence or absence of CKD at baseline did not modify this association. ΔSMg was not independently associated with CV outcomes occurring after 2 years. Limitations ΔSMg was small in magnitude, limiting effect size. Conclusions Higher baseline serum magnesium levels were independently associated with reduced risk for CV outcomes in all study participants, but ΔSMg was not associated with CV outcomes.
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Affiliation(s)
- Silvia Ferrè
- Department of Scientific Activities, National Kidney Foundation, New York, NY
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Yu-Lun Liu
- Peter O’Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Fabiola G. Gianella
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX
| | - David A. Drew
- Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, San Francisco VA Health Care System, San Francisco, CA
| | - Orson W. Moe
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Physiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Joachim H. Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA
- Herbert Wertheim School of Public Health, University of California San Diego, San Diego, CA
| | - Robert D. Toto
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX
| | - Javier A. Neyra
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
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Xu Q, Hu L, Chen L, Li H, Tian X, Zuo Y, Zhang Y, Zhang X, Sun P, Wang Y, Meng X, Wang A. Low serum magnesium is associated with poor functional outcome in acute ischemic stroke or transient ischemic attack patients. CNS Neurosci Ther 2022; 29:842-854. [PMID: 36415111 PMCID: PMC9928556 DOI: 10.1111/cns.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/12/2022] [Accepted: 10/16/2022] [Indexed: 11/24/2022] Open
Abstract
AIM The association between magnesium and outcomes after stroke is uncertain. We aimed to investigate the association of serum magnesium with all-cause mortality and poor functional outcome. METHODS We included patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) from the China National Stroke Registry III. We used Cox proportional hazards model for all-cause mortality and logistic regression model for poor functional outcome (modified Rankin Scale [mRS] 2-6/3-6) to examine the relationships. RESULTS Among the 6483 patients, the median (interquartile range) magnesium was 0.87 (0.80-0.93) mmol/L. Patients in the first quartile had a higher risk of mRS score 3-6/2-6 at 3 months (adjusted odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.02, 1.64; adjusted OR: 1.29; 95% CI: 1.04-1.59) compared with those in the fourth quartile. Similar results were found for mRS score 26 at 1 year. The age- and sex-adjusted hazard ratio (HR) with 95% CI in first quartile magnesium was 1.40 (1.02-1.93) for all-cause mortality within 1 year, but became insignificant (HR: 1.03; 95% CI: 0.71-1.50) after adjusting for potential variables. CONCLUSIONS Low serum magnesium was associated with a high risk of poor functional outcome in patients with AIS or TIA.
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Affiliation(s)
- Qin Xu
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Lele Hu
- The Second People's Hospital of GuiyangGuizhouChina
| | - Lu Chen
- Department of NeurologyZiBo Central HospitalZiboChina
| | - Hao Li
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xue Tian
- Department of Epidemiology and Health StatisticsSchool of Public Health, Capital Medical UniversityBeijingChina,Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Yingting Zuo
- Department of Epidemiology and Health StatisticsSchool of Public Health, Capital Medical UniversityBeijingChina,Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Yijun Zhang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Ping Sun
- The Second People's Hospital of GuiyangGuizhouChina
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina,Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina,Center for Excellence in Brain Science and Intelligence TechnologyChinese Academy of SciencesShanghaiChina
| | - Xia Meng
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina,China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
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10
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Escobedo-Monge MF, Barrado E, Parodi-Román J, Escobedo-Monge MA, Torres-Hinojal MC, Marugán-Miguelsanz JM. Magnesium Status and Ca/Mg Ratios in a Series of Children and Adolescents with Chronic Diseases. Nutrients 2022; 14:2941. [PMID: 35889897 PMCID: PMC9315923 DOI: 10.3390/nu14142941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
Magnesium (Mg) is an essential divalent cation involved in various enzymatic reactions that regulate vital biological functions. The main goal was to evaluate Mg status and its association with nutritional indicators in 78 children and adolescents with chronic diseases. We assessed anthropometric, biochemical, diet, body composition, and bone densitometry valuations. Serum Mg and Ca levels were determined using the standardized method and diet calcium (Ca) and Mg consumption by a prospective 72 h diet survey. Mean serum Ca (9.9 mg/dL), Mg (2.08 mg/dL) dietary Ca (102% DRI: Dietary Reference Intake), and Mg intake (105% DRI) were normal. A total of 45% had hypomagnesemia, 12% had hypermagnesemia, and 26% and 24% had inadequate and high Mg intake, respectively. Only 6% of patients had poor Mg intake and hypomagnesemia, and 54% and 90% of our series had an elevated serum Ca/Mg ratio > 4.70 (mean 4.79) and a low Ca/Mg intake ratio < 1.70 (mean 1.06), respectively. Both Ca/Mg ratios were linked with the risk of developing other chronic conditions such as cardiovascular disease, type 2 diabetes, syndrome metabolic, and even several cancers. Therefore, 79% of children and adolescents with chronic diseases were at elevated risk of having abnormal Mg status and developing other chronic illnesses.
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Affiliation(s)
| | - Enrique Barrado
- Department of Analytical Chemistry, Science Faculty, Campus Miguel Delibes, University of Valladolid, Calle Paseo de Belén, 7, 47011 Valladolid, Spain;
| | | | | | | | - José Manuel Marugán-Miguelsanz
- Department of Pediatrics, Faculty of Medicine, Valladolid University, Avenida Ramón y Cajal, 7, 47005 Valladolid, Spain;
- Section of Gastroenterology and Pediatric Nutrition, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 3, 47003 Valladolid, Spain
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11
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Theisen CF, Wodschow K, Hansen B, Schullehner J, Gislason G, Ersbøll BK, Ersbøll AK. Drinking water magnesium and cardiovascular mortality: A cohort study in Denmark, 2005-2016. ENVIRONMENT INTERNATIONAL 2022; 164:107277. [PMID: 35551005 DOI: 10.1016/j.envint.2022.107277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Cardiovascular diseases are globally a major cause of death. Magnesium deficiency is associated with several diseases including cardiovascular diseases. OBJECTIVE To examine if a low concentration of magnesium in drinking water is associated with increased cardiovascular mortality and mortality due to acute myocardial infarction and stroke. METHODS A nationwide population-based cohort study using national health registries was used. A total of 4,274,132 individuals aged 30 years or more were included. Magnesium concentration in drinking water was estimated by linkage of residential addresses in the period 2005-2016 with the national drinking water quality monitoring database. The association between magnesium concentration in drinking water and cardiovascular mortality and mortality due to acute myocardial infarction and stroke was examined using a Poisson regression of number of deaths and logarithmic transformation of follow-up time as offset. The incidence rate ratio (IRR) was adjusted for differences in age, sex, calendar year, cohabitation, country of origin, and socioeconomic status. RESULTS Median magnesium concentration in drinking water at inclusion was 12.4 mg/L (range: 1.37-54.2 mg/L). The adjusted IRR for cardiovascular mortality was 0.96 (95% CI: 0.94; 0.97) for the lowest magnesium quintile (<6.5 mg/L) as compared to the highest magnesium quintile (>21.9 mg/L). The adjusted IRR for mortality due to acute myocardial infarction and stroke was 1.22 (1.17; 1.27) and 0.96 (0.93; 0.99), respectively, for the lowest magnesium quintile as compared to the highest quintile A decreasing mortality due to acute myocardial infarction was seen with an increasing magnesium concentration in a dose-response manner. CONCLUSION Low concentrations of magnesium in drinking water were associated with an increased mortality due to acute myocardial infarction. Low concentrations of magnesium in drinking water were associated with decreased cardiovascular mortality, and mortality due to stroke.
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Affiliation(s)
- C F Theisen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; DTU Compute, Technical University of Denmark, Kgs Lyngby, Denmark
| | - K Wodschow
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - B Hansen
- Geological Survey of Denmark and Greenland, GEUS, Aarhus, Denmark
| | - J Schullehner
- Geological Survey of Denmark and Greenland, GEUS, Aarhus, Denmark; Department of Public Health, Research Unit for Environment, Work and Health, Aarhus University, Aarhus, Denmark
| | - G Gislason
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Department of Cardiology, The Cardiovascular Research Centre, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - B K Ersbøll
- DTU Compute, Technical University of Denmark, Kgs Lyngby, Denmark
| | - A K Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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12
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Guo N, Zhu Y, Tian D, Zhao Y, Zhang C, Mu C, Han C, Zhu R, Liu X. Role of diet in stroke incidence: an umbrella review of meta-analyses of prospective observational studies. BMC Med 2022; 20:194. [PMID: 35606791 PMCID: PMC9128224 DOI: 10.1186/s12916-022-02381-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 04/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Stroke is one of the major challenges for the global healthcare system, which makes it necessary to explore the relationship between various modifiable factors and stroke risk. Recently, numerous meta-analyses of prospective observational studies have reported that dietary factors played a key role in the occurrence of stroke. However, the conclusions of previous studies have remained controversial and unclear. Accordingly, we conducted an umbrella review synthesizing and recalculating available evidence to assess the certainty of the associations between dietary factors and stroke. METHODS Relevant meta-analyses examining the associations between dietary factors and stroke were searched in PubMed and Embase databases up to September 1, 2021. For each eligible meta-analysis, two independent reviewers appraised the methodologic quality using the AMSTAR 2 criteria and estimated the summary effect size, 95% confidence intervals, 95% prediction intervals, heterogeneity between studies, and small-study effects. Moreover, we further assessed the associations between dietary factors and ischemic stroke as well as hemorrhagic stroke. Lastly, a set of pre-specified criteria was applied to qualitatively evaluate the epidemiological credibility of each dietary factor. RESULTS Overall, our umbrella review included 122 qualified meta-analyses for qualitative synthesis, involving 71 dietary factors related to food groups, foods, macronutrients, and micronutrients. Using the AMSTAR 2 criteria, 5 studies were assessed as high quality, 4 studies as moderate quality, and 113 studies as low or critically low quality. We identified 34 dietary factors associated with stroke occurrence, 25 dietary factors related to ischemic stroke, and 11 factors related to hemorrhagic stroke. Among them, high/moderate certainty epidemiological evidence demonstrated an inverse association between intake of fruits (RR: 0.90) and vegetables (RR: 0.92) and stroke incidence, but a detrimental association between red meat (RR: 1.12), especially processed red meat consumption (RR:1.17), and stroke incidence. Besides, the evidence of high/moderate certainty suggested that the intake of processed meat, fruits, coffee, tea, magnesium, and dietary fiber was associated with ischemic stroke risk, while consumption of tea, fruits, and vegetables was relevant to hemorrhagic stroke susceptibility. CONCLUSIONS Our study has reported that several dietary factors have a significant impact on stroke risk and offered a new insight into the relationship between dietary modification and stroke occurrence. Our results may provide an effective strategy for stroke prevention.
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Affiliation(s)
- Na Guo
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Ying Zhu
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Dandan Tian
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Yating Zhao
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Chenguang Zhang
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Changqing Mu
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Chen Han
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Ruixia Zhu
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Xu Liu
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China.
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13
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Isakov O, Patibandla BK, Christopher KB, Chandraker A, Hod T. Impact of Post-Transplantation Hypomagnesemia on Long-Term Graft and Patient Survival after Transplantation. Kidney Blood Press Res 2022; 47:341-353. [PMID: 35196662 DOI: 10.1159/000522233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Post-transplant hypomagnesemia is commonly observed among patients prescribed calcineurin inhibitor (CNIs). METHODS We conducted a retrospective single-center analysis (2000-2013, N = 726) to examine the association of hypomagnesemia with long-term patient and allograft outcomes in kidney transplant recipients. A median serum magnesium (Mg) level of all measured Mg levels from 1 month to 1 year posttransplant was calculated. RESULTS For every increase in Mg of 0.1 mg/dL, the risk for either graft loss or death, overall mortality, and death with a functioning graft increased by 11%, 14%, and 12%, respectively (p < 0.01). In a multivariate model, patients with median Mg level ≥1.7 mg/dL had a reduced overall survival rate (HR 1.57, 95% CI: 1.04-2.38, p = 0.033) compared to those with median Mg level <1.7 mg/dL. This association was observed in subgroups of patients above 60 years old, in those who had a slow graft function (SGF) and in females. CONCLUSIONS Posttransplant hypomagnesemia is associated with better patient and allograft survival up to 10 years posttransplant. This relationship remained significant after accounting for baseline allograft function, presence of SGF and CNI trough levels.
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Affiliation(s)
- Ofer Isakov
- Department of Internal Medicine "T", Tel Aviv Souraski Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Bhanu K Patibandla
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Kenneth B Christopher
- Renal Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Anil Chandraker
- Renal Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Transplant Research Center, Renal Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tammy Hod
- Department of Nephrology, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel.,Renal Transplant Center, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
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14
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Ryu H, Ahn SY, Kim CK, Oh K, Han JH, Lee DW, Kim SH, Kim HJ. Hypomagnesemia as a prognostic marker of ischemic stroke. JOURNAL OF NEUROCRITICAL CARE 2022. [DOI: 10.18700/jnc.210035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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15
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Escobedo-Monge MF, Barrado E, Parodi-Román J, Escobedo-Monge MA, Marcos-Temprano M, Marugán-Miguelsanz JM. Magnesium Status and Calcium/Magnesium Ratios in a Series of Cystic Fibrosis Patients. Nutrients 2022; 14:1793. [PMID: 35565764 PMCID: PMC9104329 DOI: 10.3390/nu14091793] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023] Open
Abstract
Magnesium (Mg) is an essential micronutrient that participates in various enzymatic reactions that regulate vital biological functions. The main aim was to assess the Mg status and its association with nutritional indicators in seventeen cystic fibrosis (CF) patients. The serum Mg and calcium (Ca) levels were determined using standardized methods and the dietary Mg intake by prospective 72 h dietary surveys. The mean serum Ca (2.45 mmol/L) and Mg (0.82 mmol/L) had normal levels, and the mean dietary intake of the Ca (127% DRI: Dietary Reference Intake) and Mg (125% DRI) were high. No patients had an abnormal serum Ca. A total of 47% of the subjects had hypomagnesemia and 12% insufficient Mg consumption. One patient had a serum Mg deficiency and inadequate Mg intake. A total of 47 and 82% of our series had a high serum Ca/Mg ratio of >4.70 (mean 4.89) and a low Ca/Mg intake ratio of <1.70 (mean 1.10), respectively. The likelihood of a high Ca/Mg ratio was 49 times higher in patients with a serum Mg deficiency than in normal serum Mg patients. Both Ca/Mg ratios were associated with the risk of developing cardiovascular disease (CVD), type 2 diabetes (T2D), metabolic syndrome (MetS), and even several cancers. Therefore, 53% of the CF patients were at high risk of a Mg deficiency and developing other chronic diseases.
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Affiliation(s)
- Marlene Fabiola Escobedo-Monge
- Department of Pediatrics of the Faculty of Medicine, Valladolid University, Avenida Ramón y Cajal, 7, 47005 Valladolid, Spain;
| | - Enrique Barrado
- Department of Analytical Chemistry, Science Faculty, Campus Miguel Delibes, University of Valladolid, Calle Paseo de Belén, 7, 47011 Valladolid, Spain;
| | | | | | - Marianela Marcos-Temprano
- Pediatric Service, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain;
| | - José Manuel Marugán-Miguelsanz
- Department of Pediatrics of the Faculty of Medicine, Valladolid University, Avenida Ramón y Cajal, 7, 47005 Valladolid, Spain;
- Section of Gastroenterology and Pediatric Nutrition, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 3, 47003 Valladolid, Spain
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16
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Pelczyńska M, Moszak M, Bogdański P. The Role of Magnesium in the Pathogenesis of Metabolic Disorders. Nutrients 2022; 14:nu14091714. [PMID: 35565682 PMCID: PMC9103223 DOI: 10.3390/nu14091714] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 12/11/2022] Open
Abstract
Magnesium (Mg) is an essential nutrient for maintaining vital physiological functions. It is involved in many fundamental processes, and Mg deficiency is often correlated with negative health outcomes. On the one hand, most western civilizations consume less than the recommended daily allowance of Mg. On the other hand, a growing body of evidence has indicated that chronic hypomagnesemia may be implicated in the pathogenesis of various metabolic disorders such as overweight and obesity, insulin resistance (IR) and type 2 diabetes mellitus (T2DM), hypertension (HTN), changes in lipid metabolism, and low-grade inflammation. High Mg intake with diet and/or supplementation seems to prevent chronic metabolic complications. The protective action of Mg may include limiting the adipose tissue accumulation, improving glucose and insulin metabolism, enhancing endothelium-dependent vasodilation, normalizing lipid profile, and attenuating inflammatory processes. Thus, it currently seems that Mg plays an important role in developing metabolic disorders associated with obesity, although more randomized controlled trials (RCTs) evaluating Mg supplementation strategies are needed. This work represents a review and synthesis of recent data on the role of Mg in the pathogenesis of metabolic disorders.
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17
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Poupore N, Chosed R, Arce S, Rainer R, Goodwin RL, Nathaniel TI. Metabolomic Profiles of Men and Women Ischemic Stroke Patients. Diagnostics (Basel) 2021; 11:diagnostics11101786. [PMID: 34679483 PMCID: PMC8534835 DOI: 10.3390/diagnostics11101786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Stroke is known to affect both men and women; however, incidence and outcomes differ between them. Therefore, the discovery of novel, sex-specific, blood-based biomarkers for acute ischemic stroke (AIS) patients has the potential to enhance the understanding of the etiology of this deadly disease in the content of sex. The objective of this study was to identify serum metabolites associated with male and female AIS patients. Methods: Metabolites were measured with the use of untargeted, reverse-phase ultra-performance liquid chromatography-tandem mass spectrometry quantification from blood specimens collected from AIS patients. Samples were collected from 36 patients comprising each of 18 men and women with matched controls. Metabolic pathway analysis and principal component analysis (PCA) was used to differentiate metabolite profiles for male and female AIS patients from the control, while logistic regression was used to determine differences in metabolites between male and female AIS patients. Results: In female AIS patients, 14 distinct altered metabolic pathways and 49 corresponding metabolites were identified, while 39 metabolites and 5 metabolic pathways were identified in male patients. Metabolites that are predictive of ischemic stroke in female patients were 1-(1-enyl-palmitoyl)-2-arachidonoyl-GPC (P-16:0/20:4) (AUC = 0.914, 0.765–1.000), 1-(1-enyl-palmitoyl)-2-palmitoyl-GPC (P-16:0/16:0) (AUC = 0.840, 0.656–1.000), and 5,6-dihydrouracil (P-16:0/20:2) (AUC = 0.815, 0.601–1.000). Significant metabolites that were predictive of stroke in male patients were 5alpha-androstan-3alpha,17beta-diol disulfate (AUC = 0.951, 0.857–1.000), alpha-hydroxyisocaproate (AUC = 0.938, 0.832–1.000), threonate (AUC = 0.877, 0.716–1.000), and bilirubin (AUC = 0.817, 0.746–1.000). Conclusions: In the current study, the untargeted serum metabolomics platform identified multiple pathways and metabolites associated with male and female AIS patients. Further research is necessary to characterize how these metabolites are associated with the pathophysiology in male and female AIS patients.
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Affiliation(s)
- Nicolas Poupore
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA; (N.P.); (R.C.); (S.A.); (R.L.G.)
| | - Renee Chosed
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA; (N.P.); (R.C.); (S.A.); (R.L.G.)
| | - Sergio Arce
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA; (N.P.); (R.C.); (S.A.); (R.L.G.)
| | | | - Richard L. Goodwin
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA; (N.P.); (R.C.); (S.A.); (R.L.G.)
| | - Thomas I. Nathaniel
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA; (N.P.); (R.C.); (S.A.); (R.L.G.)
- Correspondence: ; Tel.: +1-8644559846; Fax: +1-8644558404
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18
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Ajoolabady A, Wang S, Kroemer G, Penninger JM, Uversky VN, Pratico D, Henninger N, Reiter RJ, Bruno A, Joshipura K, Aslkhodapasandhokmabad H, Klionsky DJ, Ren J. Targeting autophagy in ischemic stroke: From molecular mechanisms to clinical therapeutics. Pharmacol Ther 2021; 225:107848. [PMID: 33823204 PMCID: PMC8263472 DOI: 10.1016/j.pharmthera.2021.107848] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 01/18/2023]
Abstract
Stroke constitutes the second leading cause of death and a major cause of disability worldwide. Stroke is normally classified as either ischemic or hemorrhagic stroke (HS) although 87% of cases belong to ischemic nature. Approximately 700,000 individuals suffer an ischemic stroke (IS) in the US each year. Recent evidence has denoted a rather pivotal role for defective macroautophagy/autophagy in the pathogenesis of IS. Cellular response to stroke includes autophagy as an adaptive mechanism that alleviates cellular stresses by removing long-lived or damaged organelles, protein aggregates, and surplus cellular components via the autophagosome-lysosomal degradation process. In this context, autophagy functions as an essential cellular process to maintain cellular homeostasis and organismal survival. However, unchecked or excessive induction of autophagy has been perceived to be detrimental and its contribution to neuronal cell death remains largely unknown. In this review, we will summarize the role of autophagy in IS, and discuss potential strategies, particularly, employment of natural compounds for IS treatment through manipulation of autophagy.
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Affiliation(s)
- Amir Ajoolabady
- University of Wyoming College of Health Sciences, Laramie, WY 82071, USA
| | - Shuyi Wang
- University of Wyoming College of Health Sciences, Laramie, WY 82071, USA; School of Medicine Shanghai University, Shanghai 200444, China
| | - Guido Kroemer
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris, France; Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France; Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Suzhou Institute for Systems Medicine, Chinese Academy of Medical Sciences, Suzhou, China; Karolinska Institute, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Josef M Penninger
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna Biocenter (VBC), Vienna, Austria; Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
| | - Vladimir N Uversky
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; Institute for Biological Instrumentation of the Russian Academy of Sciences, Federal Research Center "Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences", Pushchino, Moscow region 142290, Russia
| | - Domenico Pratico
- Alzheimer's Center at Temple, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts, Worcester, Massachusetts, USA; Department of Psychiatry, University of Massachusetts, Worcester, Massachusetts, USA
| | - Russel J Reiter
- Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Askiel Bruno
- Department of Neurology, Medical College of Georgia, Augusta University, GA 30912, USA
| | - Kaumudi Joshipura
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Center for Clinical Research and Health Promotion, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936-5067, Puerto Rico
| | | | - Daniel J Klionsky
- Life Sciences Institute and Departments of Molecular, Cellular and Developmental Biology and Biological Chemistry, University of Michigan, Ann Arbor 48109, USA.
| | - Jun Ren
- Department of Laboratory Medicine and Pathology, University of Washington Seattle, Seattle, WA 98195, USA; Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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19
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Oost LJ, van der Heijden AAWA, Vermeulen EA, Bos C, Elders PJM, Slieker RC, Kurstjens S, van Berkel M, Hoenderop JGJ, Tack CJ, Beulens JWJ, de Baaij JHF. Serum Magnesium Is Inversely Associated With Heart Failure, Atrial Fibrillation, and Microvascular Complications in Type 2 Diabetes. Diabetes Care 2021; 44:1757-1765. [PMID: 34385344 DOI: 10.2337/dc21-0236] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/04/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We investigated whether serum magnesium (Mg2+) was prospectively associated with macro- or microvascular complications and mediated by glycemic control (hemoglobin A1c [HbA1c]), in type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS We analyzed in 4,348 participants the association of serum Mg2+ with macrovascular disease and mortality (acute myocardial infarction [AMI], coronary heart disease [CHD], heart failure [HF], cerebrovascular accident [CVA], and peripheral arterial disease [PAD]), atrial fibrillation (AF), and microvascular complications (chronic kidney disease [CKD], diabetic retinopathy, and diabetic foot) using Cox regression, adjusted for confounders. Mediation analysis was performed to assess whether HbA1c mediated these associations. RESULTS The average baseline serum Mg2+ concentration was 0.80 ± 0.08 mmol/L. During 6.1 years of follow-up, serum Mg2+ was inversely associated with major macrovascular, 0.87 (95% CI 0.76; 1.00); HF, 0.76 (95% CI 0.62; 0.93); and AF, 0.59 (95% CI 0.49; 0.72). Serum Mg2+ was not associated with AMI, CHD, CVA, and PAD. During 5.1 years of follow-up, serum Mg2+ was inversely associated with overall microvascular events, 0.85 (95% CI 0.78; 0.91); 0.89 (95% CI 0.82; 0.96) for CKD, 0.77 (95% CI 0.61; 0.98) for diabetic retinopathy, and 0.85 (95% CI 0.78; 0.92) for diabetic foot. HbA1c mediated the associations of serum Mg2+ with HF, overall microvascular events, diabetic retinopathy, and diabetic foot. CONCLUSIONS Serum Mg2+ concentration is inversely associated with the risk to develop HF and AF and with the occurrence of CKD, diabetic retinopathy, and foot complications in T2D. Glycemic control partially mediated the association of serum Mg2+ with HF and microvascular complications.
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Affiliation(s)
- Lynette J Oost
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Amber A W A van der Heijden
- Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Center - location VUmc, Amsterdam, the Netherlands
| | - Emma A Vermeulen
- Department of Nephrology, Amsterdam University Medical Center - location Academic Medical Center, Amsterdam, the Netherlands
| | - Caro Bos
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Center - location VUmc, Amsterdam, the Netherlands
| | - Roderick C Slieker
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam Cardiovascular Sciences Research Institutes, Amsterdam University Medical Center - location VUmc, Amsterdam, the Netherlands.,Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Steef Kurstjens
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Laboratory Clinical Chemistry and Hematology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Miranda van Berkel
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost G J Hoenderop
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam Cardiovascular Sciences Research Institutes, Amsterdam University Medical Center - location VUmc, Amsterdam, the Netherlands
| | - Jeroen H F de Baaij
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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20
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Hanaoka H, Kikuchi J, Kaneko Y, Seki N, Tsujimoto H, Chiba K, Takeuchi T. Proton Pump Inhibitor and Tacrolimus Uses are Associated With Hypomagnesemia in Connective Tissue Disease: a Potential Link With Renal Dysfunction and Recurrent Infection. Front Pharmacol 2021; 12:616719. [PMID: 34093176 PMCID: PMC8173076 DOI: 10.3389/fphar.2021.616719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Low levels of serum magnesium perturb renal tubular cell function and lymphocytes, resulting in renal deterioration and an imbalance in mononuclear cells. This study investigated the mechanism and influence of hypomagnesemia in patients with connective tissue disease. Methods: We retrospectively evaluated patients with connective tissue disease and available serum magnesium data who visited Keio University Hospital in 2019. Patients were divided into two groups: those with (serum magnesium < 1.8 mg/dl) and those without hypomagnesemia; their rates of hospitalization for severe infection and cumulative renal deterioration were compared. Patients’ fractions of lymphocytes and natural killer and dendritic cell subsets, as measured by fluorescence-activated cell sorting (FACS) analysis, were also compared. Results: Among 284 patients, hypomagnesemia was detected in 63 (22.2%). Multivariate analysis revealed that the use of proton pump inhibitors [odds ratio (OR), 1.48; p = 0.01] and tacrolimus (OR, 6.14; p < 0.01) was independently associated with hypomagnesemia. In addition, the renal deterioration rate was significantly higher in tacrolimus and/or proton pump inhibitor users with hypomagnesemia (p = 0.01). The hospitalization rate for severe infection was also higher in patients with hypomagnesemia (p = 0.04). FACS analysis showed lower CD8+ T cell, CD19+ B cell, natural killer cell, and dendritic cell counts in patients with hypomagnesemia (p = 0.03, p = 0.02, p = 0.02, and p = 0.03, respectively). Conclusion: The use of tacrolimus and proton pump inhibitors may be associated with hypomagnesemia and lead to poor renal outcomes and severe infection in patients with connective tissue disease.
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Affiliation(s)
- Hironari Hanaoka
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Jun Kikuchi
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Noriyasu Seki
- Mitsubishi Tanabe Pharma Corporation, Yokohama, Japan
| | | | - Kenji Chiba
- Mitsubishi Tanabe Pharma Corporation, Yokohama, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
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21
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Thomassen JQ, Tolstrup JS, Nordestgaard BG, Tybjærg-Hansen A, Frikke-Schmidt R. Plasma Concentrations of Magnesium and Risk of Dementia: A General Population Study of 102 648 Individuals. Clin Chem 2021; 67:899-911. [PMID: 33846733 DOI: 10.1093/clinchem/hvab041] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/18/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Low and high concentrations of plasma magnesium are associated with increased risk of future all-cause dementia; however, the underlying reasons remain elusive. The magnesium ion is an important electrolyte serving as a cofactor in many enzymatic processes in the human organism. Magnesium affects both neuronal and vascular functions. We investigated the associations of plasma concentrations of magnesium associate with common subtypes of dementia as Alzheimer dementia and non-Alzheimer dementia, and potential pathways by which magnesium may affect risk of dementia. METHODS Plasma concentrations of magnesium were measured in 102 648 individuals from the Copenhagen General Population Study. Cox regression and natural effects mediation analyses evaluated associations with either Alzheimer dementia or non-Alzheimer dementia. RESULTS Multifactorially adjusted hazard ratios for non-Alzheimer dementia were 1.50(95% confidence interval (CI):1.21-1.87) for the lowest and 1.34(1.07-1.69) for the highest vs the fourth quintile (reference) of plasma magnesium concentrations. Diabetes, cumulated smoking, stroke, and systolic blood pressure mediated 10.4%(3.1-22.8%), 6.8%(1.2-14.0%), 1.3%(0.1-3.6%), and 1.0%(0.2-2.6%), respectively, in the lowest quintile, whereas stroke mediated 3.2%(0.4-11.9%) in the highest quintile. No associations were observed for Alzheimer dementia. CONCLUSIONS Low and high plasma magnesium concentrations were associated with high risk of vascular-related non-Alzheimer dementia, with the lowest risk observed at a concentration of 2.07 mg/dL (0.85 mmol/L). No association was observed for Alzheimer dementia. Mediation analysis suggested that diabetes may be in the causal pathway between low plasma magnesium concentrations and high risk of non-Alzheimer dementia, while cumulated smoking, stroke, and systolic blood pressure played minor mediating roles.
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Affiliation(s)
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Herlev, Denmark.,The Copenhagen General Population Study, Herlev and Gentofte Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Tybjærg-Hansen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.,The Copenhagen General Population Study, Herlev and Gentofte Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.,The Copenhagen General Population Study, Herlev and Gentofte Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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22
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Kunutsor SK, Laukkanen JA. Circulating Serum Magnesium and the Risk of Venous Thromboembolism in Men: A Long-Term Prospective Cohort Study. Pulse (Basel) 2021; 8:108-113. [PMID: 34307207 DOI: 10.1159/000515409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background and Objective Serum magnesium, an essential trace element involved in processes that regulate cardiovascular function, has been linked to the risk of atherosclerotic cardiovascular disease. However, the potential association between serum magnesium and venous thromboembolism (VTE) has not been previously investigated. We aimed to assess the prospective association of serum magnesium with the risk of VTE. Methods Serum magnesium was measured using atomic absorption spectrometry in 2,361 men aged 42-61 years with no history of VTE at baseline in the Kuopio Ischemic Heart Disease prospective cohort. Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for VTE. Results A total of 159 incident VTE events were recorded during a median follow-up of 27.1 years. The risk of VTE per 1 SD increase in serum magnesium in the age-adjusted analysis was (HR 1.30; 95% CI 0.46-3.69). The association remained consistent in analyses adjusted for systolic blood pressure, body mass index, total cholesterol, triglycerides, smoking status, a history of type 2 diabetes, a history of coronary heart disease, medication for dyslipidemia, alcohol consumption, physical activity, socioeconomic status, serum active calcium, high-sensitivity C-reactive protein, and a history of cancer (HR 1.38; 95% CI 0.48-3.96). Comparing the extreme tertiles of serum magnesium, the corresponding adjusted HRs were 1.17 (95% CI 0.81-1.70) and 1.17 (95% CI 0.81-1.70), respectively. Conclusion In a middle-aged Caucasian male population, serum-circulating magnesium was not associated with a future risk of VTE. Further studies in women, other age groups, and other populations are required to generalize these findings.
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Affiliation(s)
- Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom.,Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, United Kingdom
| | - Jari A Laukkanen
- Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Central Finland Health Care District, Jyväskylä, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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23
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Aghayari Sheikh Neshin S, Shahjouei S, Koza E, Friedenberg I, Khodadadi F, Sabra M, Kobeissy F, Ansari S, Tsivgoulis G, Li J, Abedi V, Wolk DM, Zand R. Stroke in SARS-CoV-2 Infection: A Pictorial Overview of the Pathoetiology. Front Cardiovasc Med 2021; 8:649922. [PMID: 33855053 PMCID: PMC8039152 DOI: 10.3389/fcvm.2021.649922] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/01/2021] [Indexed: 12/15/2022] Open
Abstract
Since the early days of the pandemic, there have been several reports of cerebrovascular complications during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Numerous studies proposed a role for SARS-CoV-2 in igniting stroke. In this review, we focused on the pathoetiology of stroke among the infected patients. We pictured the results of the SARS-CoV-2 invasion to the central nervous system (CNS) via neuronal and hematogenous routes, in addition to viral infection in peripheral tissues with extensive crosstalk with the CNS. SARS-CoV-2 infection results in pro-inflammatory cytokine and chemokine release and activation of the immune system, COVID-19-associated coagulopathy, endotheliitis and vasculitis, hypoxia, imbalance in the renin-angiotensin system, and cardiovascular complications that all may lead to the incidence of stroke. Critically ill patients, those with pre-existing comorbidities and patients taking certain medications, such as drugs with elevated risk for arrhythmia or thrombophilia, are more susceptible to a stroke after SARS-CoV-2 infection. By providing a pictorial narrative review, we illustrated these associations in detail to broaden the scope of our understanding of stroke in SARS-CoV-2-infected patients. We also discussed the role of antiplatelets and anticoagulants for stroke prevention and the need for a personalized approach among patients with SARS-CoV-2 infection.
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Affiliation(s)
| | - Shima Shahjouei
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, United States
| | - Eric Koza
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | - Isabel Friedenberg
- Department of Biology, Pennsylvania State University, State College, PA, United States
| | | | - Mirna Sabra
- Neurosciences Research Center (NRC), Lebanese University/Medical School, Beirut, Lebanon
| | - Firas Kobeissy
- Program of Neurotrauma, Neuroproteomics and Biomarker Research (NNBR), University of Florida, Gainesville, FL, United States
| | - Saeed Ansari
- National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, United States
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Jiang Li
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA, United States
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA, United States.,Biocomplexity Institute, Virginia Tech, Blacksburg, VA, United States
| | - Donna M Wolk
- Molecular and Microbial Diagnostics and Development, Diagnostic Medicine Institute, Laboratory Medicine, Geisinger Health System, Danville, PA, United States
| | - Ramin Zand
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, United States
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24
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Hod T, Isakov O, Patibandla BK, Christopher KB, Hershkoviz R, Schwartz IF, Chandraker A. Posttransplantation Hypomagnesemia as a Predictor of Better Graft Function after Transplantation. Kidney Blood Press Res 2020; 45:982-995. [PMID: 33152728 DOI: 10.1159/000510797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypomagnesemia is frequently seen after transplantation and is particularly associated with the use of calcineurin inhibitors (CNIs). METHODS We conducted a retrospective, single-center analysis (2000-2013, N = 726) to explore the relationship between hypomagnesemia and long-term allograft outcome in kidney transplant recipients. For this study, a median serum magnesium (Mg) level of all measured Mg levels from 1 month to 1 year after renal transplantation was calculated. RESULTS For every increase in Mg by 0.1 mg/dL, the GFR decreased by 1.1 mL/min at 3 years posttransplant (p < 0.01) and by 1.5 mL/min at 5 years posttransplant. A median blood Mg level of ≥1.7 was found to be an independent predictor of a GFR <60 mL/min at 3 years posttransplant. The odds of having a GFR <60 mL/min 3 years posttransplant was almost 2-fold higher in the high Mg group than in the low Mg group. CONCLUSIONS Hypomagnesemia from 1 to 12 months after renal transplantation is associated with a better allograft function up to 5 years posttransplant. This relationship was found to hold true after accounting for baseline allograft function and the presence of slow graft function.
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Affiliation(s)
- Tammy Hod
- Sheba Medical Center, Nephrology Department, Tel Aviv University, Tel Aviv, Israel,
| | - Ofer Isakov
- Department of Internal Medicine "T", Tel Aviv Souraski Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Bhanu K Patibandla
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Kenneth B Christopher
- Renal Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rami Hershkoviz
- Department of Internal Medicine "T", Tel Aviv Souraski Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Idit F Schwartz
- Department of Internal Medicine "T", Tel Aviv Souraski Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Anil Chandraker
- Transplant Research Center, Renal Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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25
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Quantitative Association Between Serum/Dietary Magnesium and Cardiovascular Disease/Coronary Heart Disease Risk: A Dose-Response Meta-analysis of Prospective Cohort Studies. J Cardiovasc Pharmacol 2020; 74:516-527. [PMID: 31815866 DOI: 10.1097/fjc.0000000000000739] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The quantitative association between serum/dietary magnesium and cardiovascular disease (CVD) remains unclear. We conducted a dose-response meta-analysis to evaluate the quantitative association between serum/dietary magnesium and CVD, including coronary heart disease (CHD). METHODS PubMed, China National Knowledge Infrastructure, and Web of Science were searched for publications. STATA 12.0 was used to analyze data. We used the random-effects model to reduce heterogeneity. RESULTS Eighteen prospective cohort studies with 544,581 participants and 22,658 CVD cases were included. The follow-up duration was 1-28 years. The pooled relative risk (RR) of CVD for the relatively normal versus lowest serum and dietary magnesium level was 0.64 {[95% confidence interval (CI): 0.51-0.80] and 0.90 [95% CI: 0.84-0.96]}. The pooled RR of CHD for the relatively normal versus lowest serum and dietary magnesium level was 0.70 (95% CI: 0.57-0.85) and 0.86 (95% CI: 0.77-0.94). We noted a significant association between increasing serum magnesium levels (per 0.1-mg/dL increase) and risk of CVD (RR: 0.93, 95% CI: 0.88-0.97) and CHD (RR: 0.90, 95% CI: 0.84-0.96) and between dietary magnesium levels (per 100-mg/d increase) and risk of CVD (RR: 0.90, 95% CI: 0.83-0.96) and CHD (RR: 0.92, 95% CI: 0.82-0.98). Serum/dietary Mg level comparisons presented a 7%-10% decrease in CVD/CHD risk. The dose-response meta-analyses showed linear relationships between serum magnesium and CVD (Pnonlinearity = 0.833) or CHD (Pnonlinearity = 0.193) and dietary magnesium and CVD (Pnonlinearity = 0.463) or CHD (Pnonlinearity = 0.440). CONCLUSIONS Increasing dietary magnesium or serum magnesium level is linearly and inversely associated with the risk of total CVD and CHD events.
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26
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Wu WC, Huang M, Taveira TH, Roberts MB, Martin LW, Wellenius GA, Johnson KC, Manson JE, Liu S, Eaton CB. Relationship Between Dietary Magnesium Intake and Incident Heart Failure Among Older Women: The WHI. J Am Heart Assoc 2020; 9:e013570. [PMID: 32192409 PMCID: PMC7428611 DOI: 10.1161/jaha.119.013570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Women represent a large proportion of the growing heart failure (HF) epidemic, yet data are lacking regarding optimal dietary and lifestyle prevention strategies for them. Specifically, the association between magnesium intake and HF in a multiracial cohort of women is uncertain. Methods and Results We included 97 725 postmenopausal women from the WHI (Women's Health Initiative) observational studies and placebo arms of the hormone trial. Magnesium intake was measured at baseline by a 122‐item validated food‐frequency questionnaire and stratified into quartiles based on diet only, total intake (diet with supplements), and residual intake (calibration by total energy). Incident hospitalized HF (2153 events, median follow‐up 8.1 years) was adjudicated by medical record abstraction. In Cox proportional hazards models, we evaluated the association between magnesium intake and HF adjusting for potential confounders. Analyses were repeated on a subcohort (n=18 745; median‐follow‐up, 13.2 years) for whom HF cases were subclassified into preserved ejection fraction (526 events), reduced ejection fraction (291 events) or unknown (168 events). Most women were white (85%) with a mean age of 63. Compared with the highest quartile of magnesium intake, women in the lowest quartile had an increased risk of incident HF, with adjusted hazard ratios of 1.32 (95% CI, 1.02–1.71) for diet only (P trend=0.03), 1.26 (95% CI, 1.03–1.56) for total intake, and 1.31 (95% CI, 1.02–1.67) for residual intake. Results did not significantly vary by race. Subcohort analyses showed low residual magnesium intake was associated with HF with reduced ejection fraction (hazard ratio, 1.81, lowest versus highest quartile; 95% CI, 1.08–3.05) but not HF with preserved ejection fraction. Conclusions Low magnesium intake in a multiracial cohort of postmenopausal women was associated with a higher risk of incident HF, especially HF with reduced ejection fraction.
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Affiliation(s)
- Wen-Chih Wu
- Division of Cardiology Veterans Affairs Medical Center & The Miriam Hospital Alpert Medical School Brown University Providence RI.,Department of Epidemiology Brown University School of Public Health Providence RI
| | - Mengna Huang
- Channing Division of Network Medicine Brigham and Women's Hospital Boston MA
| | - Tracey H Taveira
- Division of Cardiology Veterans Affairs Medical Center & The Miriam Hospital Alpert Medical School Brown University Providence RI.,University of Rhode Island, College of Pharmacy Kingston RI
| | - Mary B Roberts
- Center for Primary Care and Prevention and the Department of Family Medicine Memorial Hospital of Rhode Island Pawtucket RI
| | - Lisa W Martin
- Division of Cardiology George Washington University School of Medicine and Health Sciences Washington DC
| | - Gregory A Wellenius
- Department of Epidemiology Brown University School of Public Health Providence RI
| | - Karen C Johnson
- Department of Preventive Medicine University of Tennessee Health Science Center Memphis TN
| | - JoAnn E Manson
- Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Simin Liu
- Department of Epidemiology Brown University School of Public Health Providence RI
| | - Charles B Eaton
- Center for Primary Care and Prevention and the Department of Family Medicine Memorial Hospital of Rhode Island Pawtucket RI.,Department of Epidemiology Brown University School of Public Health Providence RI
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27
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Yang AM, Lo K, Zheng TZ, Yang JL, Bai YN, Feng YQ, Cheng N, Liu SM. Environmental heavy metals and cardiovascular diseases: Status and future direction. Chronic Dis Transl Med 2020; 6:251-259. [PMID: 33336170 PMCID: PMC7729107 DOI: 10.1016/j.cdtm.2020.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 12/19/2022] Open
Abstract
Cardiovascular disease (CVD) and environmental degradation are leading global health problems of our time. Recent studies have linked exposure to heavy metals to the risks of CVD and diabetes, particularly in populations from low- and middle-income countries, where concomitant rapid development occurs. In this review, we 1) assessed the totality, quantity, and consistency of the available epidemiological studies, linking heavy metal exposures to the risk of CVD (including stroke and coronary heart disease); 2) discussed the potential biological mechanisms underlying some tantalizing observations in humans; and 3) identified gaps in our knowledge base that must be investigated in future work. An accumulating body of evidence from both experimental and observational studies implicates exposure to heavy metals, in a dose-response manner, in the increased risk of CVD. The limitations of most existing studies include insufficient statistical power, lack of comprehensive assessment of exposure, and cross-sectional design. Given the widespread exposure to heavy metals, an urgent need has emerged to investigate these putative associations of environmental exposures, either independently or jointly, with incident CVD outcomes prospectively in well-characterized cohorts of diverse populations, and to determine potential strategies to prevent and control the impacts of heavy metal exposure on the cardiometabolic health outcomes of individuals and populations.
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Affiliation(s)
- Ai-Min Yang
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China.,Centre for Global Cardiometabolic Health, Department of Epidemiology, Surgery, and Medicine, Brown University, Providence, RI 02903, USA.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02903, USA
| | - Kenneth Lo
- Centre for Global Cardiometabolic Health, Department of Epidemiology, Surgery, and Medicine, Brown University, Providence, RI 02903, USA.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02903, USA
| | - Tong-Zhang Zheng
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02903, USA
| | - Jing-Li Yang
- Department of Epidemiology, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Ya-Na Bai
- Department of Epidemiology, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Ying-Qing Feng
- Department of Cardiology and Endocrinology, Guangdong Provincial People's Hospital, Guandong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Ning Cheng
- Department of Epidemiology, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Si-Min Liu
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China.,Centre for Global Cardiometabolic Health, Department of Epidemiology, Surgery, and Medicine, Brown University, Providence, RI 02903, USA
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28
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Zhao B, Zeng L, Zhao J, Wu Q, Dong Y, Zou F, Gan L, Wei Y, Zhang W. Association of magnesium intake with type 2 diabetes and total stroke: an updated systematic review and meta-analysis. BMJ Open 2020; 10:e032240. [PMID: 32198298 PMCID: PMC7103847 DOI: 10.1136/bmjopen-2019-032240] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The detailed associations between type 2 diabetes (T2D) and total stroke and magnesium intake as well as the dose-response trend should be updated in a timely manner. DESIGN Systematic review and meta-analyses. DATA SOURCES PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov were rigorously searched from inception to 15 March 2019. ELIGIBILITY CRITERIA Prospective cohort studies investigating these two diseases were included. DATA SYNTHESIS Relative risk (RR) and 95% CI in random effects models as well as absolute risk (AR) were pooled to calculate the risk of T2D and stroke. Methodological quality was assessed by the Newcastle-Ottawa Scale. RESULTS Forty-one studies involving 53 cohorts were included. The magnitude of the risk was significantly reduced by 22% for T2D (RR 0.78 (95% CI 0.75 to 0.81); p<0.001; AR reduction 0.120%), 11% for total stroke (RR 0.89 (95% CI 0.83 to 0.94); p<0.001; AR reduction 0.281%) and 12% for ischaemic stroke (RR 0.88 (95% CI 0.81 to 0.95); p=0.001; AR reduction 0.246%) when comparing the highest magnesium intake to the lowest. The inverse association still existed when studies on T2D were adjusted for cereal fibre (RR 0.79; p<0.001) and those on total stroke were adjusted for calcium (RR 0.89; p=0.040). Subgroup analyses suggested that the risk for total and ischaemic stroke was significantly decreased in females, participants with ≥25 mg/m2 body mass index and those with ≥12-year follow-up; the reduced risk in Asians was not as notable as that in North American and European populations. CONCLUSIONS Magnesium intake has significantly inverse associations with T2D and total stroke in a dose-dependent manner. Feasible magnesium-rich dietary patterns may be highly beneficial for specific populations and could be highlighted in the primary T2D and total stroke prevention strategies disseminated to the public. PROSPERO REGISTRATION NUMBER CRD42018092690.
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Affiliation(s)
- Binghao Zhao
- Department of Cardio-Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lianli Zeng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiani Zhao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qian Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yifei Dong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fang Zou
- Department of Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li Gan
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiping Wei
- Department of Cardio-Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wenxiong Zhang
- Department of Cardio-Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Levy J, Miranda AAM, De Carli E, Bittencourt MS, Benseñor IJ, Lotufo PA, Marchioni DM. Ingestion of magnesium was not associated with coronary calcium score in a cross-sectional study. INT J VITAM NUTR RES 2019; 91:217-223. [PMID: 31711405 DOI: 10.1024/0300-9831/a000618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background and aims: Magnesium plays a key role in glucose metabolism, vascular tone, and inflammation. Therefore, it might be a dietary risk factor for cardiovascular diseases. In vitro and animal studies have suggested a decrease in vascular calcification with an increase in the magnesium intake. The objective of the present study was to investigate the association between magnesium intake and coronary artery calcium (CAC) score among participants of the ELSA-Brasil. Methods: This is an observational, cross-sectional study undertaken with a sub-sample from the ELSA-Brasil baseline data. In this sub-sample, only participants with CAC examination data were included (n = 4,306). Dietary intake was assessed by a validated food frequency questionnaire. The association between magnesium intake and presence of CAC (0 versus > 0) was investigated using multiple logistic regression models. Results: The participants were predominantly female (54.4 %), with self-reported white skin color (59.1 %), no smoking habit (53.7 %) and undergraduate or postgraduate education (44.4 %). The range of magnesium consumption was 37.24 - 1266.31 mg/day. CAC prevalence was 28.4 %. No significant association was found between magnesium intake and CAC after adjustments for diet, lifestyle, and clinical characteristics. In a first univariate model, the fifth quintile of magnesium intake, in comparison to the first quintile (lowest intake), resulted in an OR = 1.25, 95 % CI: 1.01 - 1.54 (P-linear trend = 0.005). However, in the last fully adjusted model, the fifth quintile of magnesium intake resulted in OR = 0.86, 95 % CI: 0.64 - 1.17 (P-linear trend = 0.239). Conclusions: In ELSA-Brasil, the intake of magnesium was not associated with the presence of coronary artery calcification.
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Affiliation(s)
- Jéssica Levy
- School of Public Health/University of São Paulo, Brazil
| | | | | | - Marcio Sommer Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, Brazil
| | - Isabela Judith Benseñor
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, Brazil
| | - Paulo Andrade Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, Brazil
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Zhao B, Hu L, Dong Y, Xu J, Wei Y, Yu D, Xu J, Zhang W. The Effect of Magnesium Intake on Stroke Incidence: A Systematic Review and Meta-Analysis With Trial Sequential Analysis. Front Neurol 2019; 10:852. [PMID: 31447767 PMCID: PMC6692462 DOI: 10.3389/fneur.2019.00852] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/23/2019] [Indexed: 12/30/2022] Open
Abstract
Background: The effect of magnesium on stroke has been consistently discussed less, and the results of previous studies have been contradictory. We reviewed the latest literature and quantified robust evidence of the association between magnesium intake and stroke risk. Methods: PubMed, EMBASE, the Cochrane Library, the Web of Science and ClinicalTrials.gov were searched through inception to January 15, 2019 for prospective cohort studies on magnesium intake and the incidence of stroke. Results: Fifteen studies with low bias involving 18 cohorts were entered into this study. The summary relative risk (RR) was significantly reduced by 11% for total stroke (RR: 0.89 [95% CI, 0.83-0.94]; P < 0.001) and by 12% for ischemic stroke (RR: 0.88 [95% CI, 0.81-0.95]; P = 0.001), comparing the highest magnesium intake category to the lowest. After adjusting for calcium intake, the inverse association still existed for total stroke (RR: 0.89 ([95% CI, 0.80-0.99]; P = 0.040). There was an inverse but non-significant association for hemorrhagic stroke, subarachnoid hemorrhage and intracerebral hemorrhage. The quantitative associations for total and ischemic stroke were robust. Importantly, high-risk females who had a body mass index (BMI) ≥25 kg/m2 and who were subjected to a ≥12 y follow-up exhibited a greater decrease in RRs as a result of magnesium intake. For each 100 mg/day increase in magnesium, the risk for total stroke was reduced by 2% and the risk for ischemic stroke was reduced by 2%. Conclusions: Increasing magnesium intake may be a crucial component of stroke prevention that acts in a dose-dependent manner. However, the conclusion is limited by the observational nature of the studies examined, and further randomized controlled trials are still needed.
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Affiliation(s)
- Binghao Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Departments of Neurosurgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Hu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yifei Dong
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jingsong Xu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiping Wei
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dongliang Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianjun Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Serum Magnesium is associated with Carotid Atherosclerosis in patients with high cardiovascular risk (CORDIOPREV Study). Sci Rep 2019; 9:8013. [PMID: 31142774 PMCID: PMC6541600 DOI: 10.1038/s41598-019-44322-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/13/2019] [Indexed: 01/05/2023] Open
Abstract
This study aimed to ascertain whether there is an independent association between serum magnesium (Mg) and the Carotid Intima-Media Thickness (IMT-CC), a well-accepted atherosclerotic-biomarker surrogate of cardiovascular disease (CVD), in a population with high cardiovascular risk. Serum Mg and traditional atherosclerotic risk factors were recorded in 939 patients (mean age, 59.6 ± 0.3 years, 83.2% men) with coronary heart disease (CHD) enrolled in the CORDIOPREV trial. Serum Mg strongly associated with IMT-CC. Before adjusting for potential confounding factors, IMT-CC decreased by 0.111 ± 0.011 mm per mg/dl increase in serum Mg (p < 0.001). After adjustment, the effect of Mg did not appear mediated through factors related to glucose metabolism, the lipid profile or the mineral metabolism and renal function. Multivariate models showed the lower Mg levels (quartile 1) as a strong independent factor contributing to IMT-CC along with age, sex, SBP, HDL-C, and diuretic use. Logistic regression analysis confirmed the predictive ability of serum Mg to differentiate patients at higher atherosclerotic risk as defined by an IMT-CC ≥ 1.0 mm, yielding a OR for the lower quartile of 10.623 (95%CI 2.311–48.845; P = 0.002) and a ROC-derived cutoff of 1.61 mg/dl. Therefore, our findings outline low serum magnesium as a possible independent risk factor for carotid atherosclerosis.
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Ferrè S, Li X, Adams-Huet B, Maalouf NM, Sakhaee K, Toto RD, Moe OW, Neyra JA. Low serum magnesium is associated with faster decline in kidney function: the Dallas Heart Study experience. J Investig Med 2019; 67:987-994. [PMID: 30826804 DOI: 10.1136/jim-2018-000966] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2019] [Indexed: 01/07/2023]
Abstract
Hypomagnesemia associates with inflammation and risk of diabetes and hypertension, which may contribute to kidney function decline. We hypothesized that low serum magnesium (SMg) levels independently associate with a significant decline in estimated glomerular filtration rate (eGFR). We analyzed SMg levels in 2056 participants from the Dallas Heart Study, a longitudinal, population-based, multiethnic, cohort study involving residents of Dallas County, Texas, USA. The primary study outcome was the change in eGFR using multivariable linear regression models adjusted for demographics, anthropometric and biochemical parameters, medications, C reactive protein levels, prevalent hypertension and diabetes. During a median follow-up of 7.0 years (25th, 75th percentile: 6.5, 7.6), the median decrease in eGFR was -0.71 (25th, 75th percentile: -2.43, +0.68) mL/min/1.73 m2 per year in the entire cohort. In a fully adjusted model, the lowest SMg quintile (≤1.9 mg/dL or ≤0.8 mM) was associated with a -0.50 mL/min/1.73 m2 per year drop in eGFR (95% CI -0.95 to -0.05; p=0.028) compared with the highest SMg quintile (≥2.3 mg/dL or ≥1.0 mM). Every 0.2 mg/dL (0.08 mM) decrease in SMg was associated with an eGFR decline of -0.23 mL/min/1.73 m2 per year (95% CI -0.38 to -0.08; p=0.003), a decline that was more pronounced in participants with prevalent diabetes compared with patients without diabetes (-0.51 vs -0.18 mL/min/1.73 m2 per year, respectively). In conclusion, low SMg was independently associated with eGFR decline. Further studies are needed to determine whether Mg repletion can ameliorate inflammation, lower blood pressure and serum glucose and ultimately prevent or retard kidney function decline.
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Affiliation(s)
- Silvia Ferrè
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, Division of Mineral Metabolism, UT Southwestern Medical Center, Dallas, TX, USA
| | - Xilong Li
- Department of Clinical Sciences, Division of Biostatistics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Beverley Adams-Huet
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Clinical Sciences, Division of Biostatistics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Naim M Maalouf
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, Division of Mineral Metabolism, UT Southwestern Medical Center, Dallas, TX, USA
| | - Khashayar Sakhaee
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, Division of Mineral Metabolism, UT Southwestern Medical Center, Dallas, TX, USA
| | - Robert D Toto
- Department of Clinical Sciences, Division of Biostatistics, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, Division of Nephrology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Orson W Moe
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, Division of Nephrology, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Physiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Javier A Neyra
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, Division of Mineral Metabolism, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
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Anderson CD, Rosand J. The yin and yang of magnesium and calcium. Neurology 2019; 92:403-404. [DOI: 10.1212/wnl.0000000000006991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Larsson SC, Traylor M, Burgess S, Boncoraglio GB, Jern C, Michaëlsson K, Markus HS. Serum magnesium and calcium levels in relation to ischemic stroke: Mendelian randomization study. Neurology 2019; 92:e944-e950. [PMID: 30804065 PMCID: PMC6404465 DOI: 10.1212/wnl.0000000000007001] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/24/2018] [Indexed: 12/15/2022] Open
Abstract
Objective To determine whether serum magnesium and calcium concentrations are causally associated with ischemic stroke or any of its subtypes using the mendelian randomization approach. Methods Analyses were conducted using summary statistics data for 13 single-nucleotide polymorphisms robustly associated with serum magnesium (n = 6) or serum calcium (n = 7) concentrations. The corresponding data for ischemic stroke were obtained from the MEGASTROKE consortium (34,217 cases and 404,630 noncases). Results In standard mendelian randomization analysis, the odds ratios for each 0.1 mmol/L (about 1 SD) increase in genetically predicted serum magnesium concentrations were 0.78 (95% confidence interval [CI] 0.69–0.89; p = 1.3 × 10−4) for all ischemic stroke, 0.63 (95% CI 0.50–0.80; p = 1.6 × 10−4) for cardioembolic stroke, and 0.60 (95% CI 0.44–0.82; p = 0.001) for large artery stroke; there was no association with small vessel stroke (odds ratio 0.90, 95% CI 0.67–1.20; p = 0.46). Only the association with cardioembolic stroke was robust in sensitivity analyses. There was no association of genetically predicted serum calcium concentrations with all ischemic stroke (per 0.5 mg/dL [about 1 SD] increase in serum calcium: odds ratio 1.03, 95% CI 0.88–1.21) or with any subtype. Conclusions This study found that genetically higher serum magnesium concentrations are associated with a reduced risk of cardioembolic stroke but found no significant association of genetically higher serum calcium concentrations with any ischemic stroke subtype.
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Affiliation(s)
- Susanna C Larsson
- From the Unit of Cardiovascular and Nutritional Epidemiology (S.C.L.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Department of Clinical Neurosciences (M.T., H.S.M.), MRC Biostatistics Unit (S.B.), and Department of Public Health and Primary Care (S.B.), University of Cambridge, UK; Department of Cerebrovascular Diseases (G.B.B.), Fondazione IRCCS-Istituto Neurologico Carlo Besta, Milano, Italy; Department of Clinical Pathology and Genetics (C.J.), Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg; and Department of Surgical Sciences (K.M.), Uppsala University, Sweden.
| | - Matthew Traylor
- From the Unit of Cardiovascular and Nutritional Epidemiology (S.C.L.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Department of Clinical Neurosciences (M.T., H.S.M.), MRC Biostatistics Unit (S.B.), and Department of Public Health and Primary Care (S.B.), University of Cambridge, UK; Department of Cerebrovascular Diseases (G.B.B.), Fondazione IRCCS-Istituto Neurologico Carlo Besta, Milano, Italy; Department of Clinical Pathology and Genetics (C.J.), Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg; and Department of Surgical Sciences (K.M.), Uppsala University, Sweden
| | - Stephen Burgess
- From the Unit of Cardiovascular and Nutritional Epidemiology (S.C.L.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Department of Clinical Neurosciences (M.T., H.S.M.), MRC Biostatistics Unit (S.B.), and Department of Public Health and Primary Care (S.B.), University of Cambridge, UK; Department of Cerebrovascular Diseases (G.B.B.), Fondazione IRCCS-Istituto Neurologico Carlo Besta, Milano, Italy; Department of Clinical Pathology and Genetics (C.J.), Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg; and Department of Surgical Sciences (K.M.), Uppsala University, Sweden
| | - Giorgio B Boncoraglio
- From the Unit of Cardiovascular and Nutritional Epidemiology (S.C.L.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Department of Clinical Neurosciences (M.T., H.S.M.), MRC Biostatistics Unit (S.B.), and Department of Public Health and Primary Care (S.B.), University of Cambridge, UK; Department of Cerebrovascular Diseases (G.B.B.), Fondazione IRCCS-Istituto Neurologico Carlo Besta, Milano, Italy; Department of Clinical Pathology and Genetics (C.J.), Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg; and Department of Surgical Sciences (K.M.), Uppsala University, Sweden
| | - Christina Jern
- From the Unit of Cardiovascular and Nutritional Epidemiology (S.C.L.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Department of Clinical Neurosciences (M.T., H.S.M.), MRC Biostatistics Unit (S.B.), and Department of Public Health and Primary Care (S.B.), University of Cambridge, UK; Department of Cerebrovascular Diseases (G.B.B.), Fondazione IRCCS-Istituto Neurologico Carlo Besta, Milano, Italy; Department of Clinical Pathology and Genetics (C.J.), Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg; and Department of Surgical Sciences (K.M.), Uppsala University, Sweden
| | - Karl Michaëlsson
- From the Unit of Cardiovascular and Nutritional Epidemiology (S.C.L.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Department of Clinical Neurosciences (M.T., H.S.M.), MRC Biostatistics Unit (S.B.), and Department of Public Health and Primary Care (S.B.), University of Cambridge, UK; Department of Cerebrovascular Diseases (G.B.B.), Fondazione IRCCS-Istituto Neurologico Carlo Besta, Milano, Italy; Department of Clinical Pathology and Genetics (C.J.), Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg; and Department of Surgical Sciences (K.M.), Uppsala University, Sweden
| | - Hugh S Markus
- From the Unit of Cardiovascular and Nutritional Epidemiology (S.C.L.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Department of Clinical Neurosciences (M.T., H.S.M.), MRC Biostatistics Unit (S.B.), and Department of Public Health and Primary Care (S.B.), University of Cambridge, UK; Department of Cerebrovascular Diseases (G.B.B.), Fondazione IRCCS-Istituto Neurologico Carlo Besta, Milano, Italy; Department of Clinical Pathology and Genetics (C.J.), Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg; and Department of Surgical Sciences (K.M.), Uppsala University, Sweden
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Kirkland AE, Sarlo GL, Holton KF. The Role of Magnesium in Neurological Disorders. Nutrients 2018; 10:E730. [PMID: 29882776 PMCID: PMC6024559 DOI: 10.3390/nu10060730] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 12/14/2022] Open
Abstract
Magnesium is well known for its diverse actions within the human body. From a neurological standpoint, magnesium plays an essential role in nerve transmission and neuromuscular conduction. It also functions in a protective role against excessive excitation that can lead to neuronal cell death (excitotoxicity), and has been implicated in multiple neurological disorders. Due to these important functions within the nervous system, magnesium is a mineral of intense interest for the potential prevention and treatment of neurological disorders. Current literature is reviewed for migraine, chronic pain, epilepsy, Alzheimer’s, Parkinson’s, and stroke, as well as the commonly comorbid conditions of anxiety and depression. Previous reviews and meta-analyses are used to set the scene for magnesium research across neurological conditions, while current research is reviewed in greater detail to update the literature and demonstrate the progress (or lack thereof) in the field. There is strong data to suggest a role for magnesium in migraine and depression, and emerging data to suggest a protective effect of magnesium for chronic pain, anxiety, and stroke. More research is needed on magnesium as an adjunct treatment in epilepsy, and to further clarify its role in Alzheimer’s and Parkinson’s. Overall, the mechanistic attributes of magnesium in neurological diseases connote the macromineral as a potential target for neurological disease prevention and treatment.
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Affiliation(s)
- Anna E Kirkland
- Department of Psychology, Behavior, Cognition and Neuroscience Program, American University, Washington, DC 20016, USA.
| | - Gabrielle L Sarlo
- Department of Psychology, Behavior, Cognition and Neuroscience Program, American University, Washington, DC 20016, USA.
| | - Kathleen F Holton
- Department of Health Studies, American University, Washington, DC 20016, USA.
- Center for Behavioral Neuroscience, American University, Washington, DC 20016, USA.
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Rosique-Esteban N, Guasch-Ferré M, Hernández-Alonso P, Salas-Salvadó J. Dietary Magnesium and Cardiovascular Disease: A Review with Emphasis in Epidemiological Studies. Nutrients 2018; 10:nu10020168. [PMID: 29389872 PMCID: PMC5852744 DOI: 10.3390/nu10020168] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 12/15/2022] Open
Abstract
Magnesium (Mg) is an essential dietary element for humans involved in key biological processes. A growing body of evidence from epidemiological studies, randomized controlled trials (RCTs) and meta-analyses have indicated inverse associations between Mg intake and cardiovascular diseases (CVD). The present review aims to summarize recent scientific evidence on the topic, with a focus on data from epidemiological studies assessing the associations between Mg intake and major cardiovascular (CV) risk factors and CVD. We also aimed to review current literature on circulating Mg and CVD, as well as potential biological processes underlying these observations. We concluded that high Mg intake is associated with lower risk of major CV risk factors (mainly metabolic syndrome, diabetes and hypertension), stroke and total CVD. Higher levels of circulating Mg are associated with lower risk of CVD, mainly ischemic heart disease and coronary heart disease. Further, RCTs and prospective studies would help to clarify whether Mg intake and Mg circulating levels may also protect against other CVDs and CVD death.
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Affiliation(s)
- Nuria Rosique-Esteban
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, University Hospital of Sant Joan de Reus, Pere Virgili Institute for Health Research, Rovira i Virgili University, St/Sant Llorenç 21, 43201 Reus, Spain.
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain.
| | - Marta Guasch-Ferré
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, University Hospital of Sant Joan de Reus, Pere Virgili Institute for Health Research, Rovira i Virgili University, St/Sant Llorenç 21, 43201 Reus, Spain.
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Pablo Hernández-Alonso
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, University Hospital of Sant Joan de Reus, Pere Virgili Institute for Health Research, Rovira i Virgili University, St/Sant Llorenç 21, 43201 Reus, Spain.
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain.
| | - Jordi Salas-Salvadó
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, University Hospital of Sant Joan de Reus, Pere Virgili Institute for Health Research, Rovira i Virgili University, St/Sant Llorenç 21, 43201 Reus, Spain.
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain.
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Al Alawi AM, Majoni SW, Falhammar H. Magnesium and Human Health: Perspectives and Research Directions. Int J Endocrinol 2018; 2018:9041694. [PMID: 29849626 PMCID: PMC5926493 DOI: 10.1155/2018/9041694] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/22/2018] [Accepted: 03/05/2018] [Indexed: 12/13/2022] Open
Abstract
Magnesium is the fourth most abundant cation in the body. It has several functions in the human body including its role as a cofactor for more than 300 enzymatic reactions. Several studies have shown that hypomagnesemia is a common electrolyte derangement in clinical setting especially in patients admitted to intensive care unit where it has been found to be associated with increase mortality and hospital stay. Hypomagnesemia can be caused by a wide range of inherited and acquired diseases. It can also be a side effect of several medications. Many studies have reported that reduced levels of magnesium are associated with a wide range of chronic diseases. Magnesium can play important therapeutic and preventive role in several conditions such as diabetes, osteoporosis, bronchial asthma, preeclampsia, migraine, and cardiovascular diseases. This review is aimed at comprehensively collating the current available published evidence and clinical correlates of magnesium disorders.
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Affiliation(s)
- Abdullah M. Al Alawi
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sandawana William Majoni
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
- Menzies School of Health Research, Darwin, NT, Australia
- Northern Territory Medical Program, Flinders University School of Medicine, Darwin, NT, Australia
| | - Henrik Falhammar
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
- Menzies School of Health Research, Darwin, NT, Australia
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Ilyas A, Shah MH. Disparities of Selected Metal Levels in the Blood and Scalp Hair of Ischemia Heart Disease Patients and Healthy Subjects. Biol Trace Elem Res 2017; 180:191-205. [PMID: 28424967 DOI: 10.1007/s12011-017-1021-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/10/2017] [Indexed: 12/22/2022]
Abstract
Imbalances in the concentrations of trace metals have become an increasingly recognized source of infirmity worldwide particularly in the development of ischemia heart disease (IHD). Present study is intended to analyze the concentrations of Ca, Cd, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Na, Pb, Sr, and Zn in the blood and scalp hair of the patients and counterpart controls by flame atomic absorption spectrometry after wet-acid digestion. On the average, Cd, Co, Cr, Fe, K, Li, Mn, Na, and Pb revealed significantly elevated concentrations in the blood of the patients compared with the controls (p < 0.05), whereas mean levels of Ca, Cd, Fe, K, Li, Pb, and Sr in the scalp hair were significantly higher in the patients than the controls (p < 0.05). Most of the metals exhibited noticeable disparities in their concentrations based on gender, abode, dietary/smoking habits, and occupations of both donor groups. The correlation study and multivariate statistical analyses revealed some significantly divergent associations and apportionment of the metals in both donor groups. Overall, comparative variations of the metal contents in blood/scalp hair of the patients were significantly different than the controls; thus, evaluation of trace metals status may be indicative of pathological disorders, such as IHD.
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Affiliation(s)
- Asim Ilyas
- Department of Chemistry, Quaid-i-Azam University, Islamabad, 45320, Pakistan
| | - Munir H Shah
- Department of Chemistry, Quaid-i-Azam University, Islamabad, 45320, Pakistan.
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Kokubo Y, Saito I, Iso H, Yamagishi K, Yatsuya H, Ishihara J, Maruyama K, Inoue M, Sawada N, Tsugane S. Dietary magnesium intake and risk of incident coronary heart disease in men: A prospective cohort study. Clin Nutr 2017; 37:1602-1608. [PMID: 28843443 DOI: 10.1016/j.clnu.2017.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/04/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND & AIMS The associations between dietary magnesium intake and stroke and coronary heart disease (CHD) incidences are inconsistent and not established in Asian. We aimed to determine the association between dietary magnesium intake and the risk of stroke and CHD in a Japanese population. SUBJECTS/METHODS We studied 85,293 Japanese subjects by questionnaire at baseline (age 45-74 years, without cardiovascular disease or cancer in 1995 and 1998 for Cohorts I and II, respectively). The participants were followed until the end of 2009 and 2010 in Cohorts I and II, respectively. Dietary magnesium intake was estimated from a self-administered 138-item food-frequency questionnaire. RESULTS After 1,305,738 person-years of follow-up, 4110 strokes and 1283 cases of CHD were documented. The multivariable-adjusted hazard ratios (HRs, 95% confidence intervals, 95%CIs) of CHD for the fourth and fifth quintiles of dietary magnesium intake were 0.70 (0.50-0.99) and 0.66 (0.44-0.97) in men (P for trend = 0.036), respectively, and third quintile of dietary magnesium intake was 0.61 (0.39-0.96) in women (P for trend = 0.241), compared with the lowest quintile in men and women. We observed no decreased risks of incident stroke in men or women with higher dietary magnesium intakes. CONCLUSIONS Higher dietary magnesium intake was associated with a reduced risk of CHD in Japanese men.
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Affiliation(s)
- Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Isao Saito
- Department of Public Health, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hiroyasu Iso
- Department of Public Health, Social Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Yatsuya
- Department of Public Health, School of Medicine, Fujita Health University, Nagoya, Japan
| | - Junko Ishihara
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan; Department of Food and Life Science, School of Life and Environmental Science, Azabu University, Sagamihara City, Japan
| | - Koutatsu Maruyama
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Manami Inoue
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan; Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Norie Sawada
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shoichiro Tsugane
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Ter Braake AD, Shanahan CM, de Baaij JHF. Magnesium Counteracts Vascular Calcification: Passive Interference or Active Modulation? Arterioscler Thromb Vasc Biol 2017; 37:1431-1445. [PMID: 28663256 DOI: 10.1161/atvbaha.117.309182] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/15/2017] [Indexed: 12/24/2022]
Abstract
Over the last decade, an increasing number of studies report a close relationship between serum magnesium concentration and cardiovascular disease risk in the general population. In end-stage renal disease, an association was found between serum magnesium and survival. Hypomagnesemia was identified as a strong predictor for cardiovascular disease in these patients. A substantial body of in vitro and in vivo studies has identified a protective role for magnesium in vascular calcification. However, the precise mechanisms and its contribution to cardiovascular protection remain unclear. There are currently 2 leading hypotheses: first, magnesium may bind phosphate and delay calcium phosphate crystal growth in the circulation, thereby passively interfering with calcium phosphate deposition in the vessel wall. Second, magnesium may regulate vascular smooth muscle cell transdifferentiation toward an osteogenic phenotype by active cellular modulation of factors associated with calcification. Here, the data supporting these major hypotheses are reviewed. The literature supports both a passive inorganic phosphate-buffering role reducing hydroxyapatite formation and an active cell-mediated role, directly targeting vascular smooth muscle transdifferentiation. However, current evidence relies on basic experimental designs that are often insufficient to delineate the underlying mechanisms. The field requires more advanced experimental design, including determination of intracellular magnesium concentrations and the identification of the molecular players that regulate magnesium concentrations in vascular smooth muscle cells.
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Affiliation(s)
- Anique D Ter Braake
- From the Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands (A.D.t.B., J.H.F.d.B.); Cardiovascular Division, BHF Centre of Research Excellence, James Black Centre, King's College, London, United Kingdom (C.M.S.); and Department of Physiology, Anatomy and Genetics, University of Oxford, United Kingdom (J.H.F.d.B.)
| | - Catherine M Shanahan
- From the Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands (A.D.t.B., J.H.F.d.B.); Cardiovascular Division, BHF Centre of Research Excellence, James Black Centre, King's College, London, United Kingdom (C.M.S.); and Department of Physiology, Anatomy and Genetics, University of Oxford, United Kingdom (J.H.F.d.B.)
| | - Jeroen H F de Baaij
- From the Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands (A.D.t.B., J.H.F.d.B.); Cardiovascular Division, BHF Centre of Research Excellence, James Black Centre, King's College, London, United Kingdom (C.M.S.); and Department of Physiology, Anatomy and Genetics, University of Oxford, United Kingdom (J.H.F.d.B.).
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You S, Zhong C, Du H, Zhang Y, Zheng D, Wang X, Qiu C, Zhao H, Cao Y, Liu CF. Admission Low Magnesium Level Is Associated with In-Hospital Mortality in Acute Ischemic Stroke Patients. Cerebrovasc Dis 2017; 44:35-42. [PMID: 28419989 DOI: 10.1159/000471858] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/20/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Low magnesium levels are associated with an elevated risk of stroke. In this study, we investigated the association between magnesium levels on hospital admission and in-hospital mortality in acute ischemic stroke (AIS) patients. METHODS A total of 2,485 AIS patients, enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city, were included in this study. The patients were divided into 4 groups according to their level of admission magnesium: Q1 (<0.82 mmol/L), Q2 (0.82-0.89 mmol/L), Q3 (0.89-0.98 mmol/L), and Q4 (≥0.98 mmol/L). Cox proportional hazard model was used to estimate the effect of magnesium on all-cause in-hospital mortality in AIS patients. RESULTS During hospitalization, 92 patients (3.7%) died from all causes. The lowest serum magnesium level (Q1) was associated with a 2.66-fold increase in the risk of in-hospital mortality in comparison to Q4 (hazard ratio [HR] 2.66; 95% CI 1.55-4.56; p-trend < 0.001). After adjusting for age, sex, time from onset to hospital admission, baseline National Institutes of Health Stroke Scale score, and other potential covariates, HR for Q1 was 2.03 (95% CI 1.11-3.70; p-trend = 0.014). Sensitivity and subgroup analyses further confirmed a significant association between lower magnesium levels and a high risk of in-hospital mortality. CONCLUSIONS Decreased serum magnesium levels at admission were independently associated with in-hospital mortality in AIS patients.
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Affiliation(s)
- Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Fang X, Wang K, Han D, He X, Wei J, Zhao L, Imam MU, Ping Z, Li Y, Xu Y, Min J, Wang F. Dietary magnesium intake and the risk of cardiovascular disease, type 2 diabetes, and all-cause mortality: a dose-response meta-analysis of prospective cohort studies. BMC Med 2016; 14:210. [PMID: 27927203 PMCID: PMC5143460 DOI: 10.1186/s12916-016-0742-z] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/09/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although studies have examined the association between dietary magnesium intake and health outcome, the results are inconclusive. Here, we conducted a dose-response meta-analysis of prospective cohort studies in order to investigate the correlation between magnesium intake and the risk of cardiovascular disease (CVD), type 2 diabetes (T2D), and all-cause mortality. METHODS PubMed, EMBASE, and Web of Science were searched for articles that contained risk estimates for the outcomes of interest and were published through May 31, 2016. The pooled results were analyzed using a random-effects model. RESULTS Forty prospective cohort studies totaling more than 1 million participants were included in the analysis. During the follow-up periods (ranging from 4 to 30 years), 7678 cases of CVD, 6845 cases of coronary heart disease (CHD), 701 cases of heart failure, 14,755 cases of stroke, 26,299 cases of T2D, and 10,983 deaths were reported. No significant association was observed between increasing dietary magnesium intake (per 100 mg/day increment) and the risk of total CVD (RR: 0.99; 95% CI, 0.88-1.10) or CHD (RR: 0.92; 95% CI, 0.85-1.01). However, the same incremental increase in magnesium intake was associated with a 22% reduction in the risk of heart failure (RR: 0.78; 95% CI, 0.69-0.89) and a 7% reduction in the risk of stroke (RR: 0.93; 95% CI, 0.89-0.97). Moreover, the summary relative risks of T2D and mortality per 100 mg/day increment in magnesium intake were 0.81 (95% CI, 0.77-0.86) and 0.90 (95% CI, 0.81-0.99), respectively. CONCLUSIONS Increasing dietary magnesium intake is associated with a reduced risk of stroke, heart failure, diabetes, and all-cause mortality, but not CHD or total CVD. These findings support the notion that increasing dietary magnesium might provide health benefits.
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Affiliation(s)
- Xuexian Fang
- Department of Nutrition, Nutrition Discovery Innovation Center, Institute of Nutrition and Food Safety, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing Advanced Innovation Center for Food Nutrition and Human Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kai Wang
- The First Affiliated Hospital, Institute of Translational Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dan Han
- Department of Nutrition, Nutrition Discovery Innovation Center, Institute of Nutrition and Food Safety, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing Advanced Innovation Center for Food Nutrition and Human Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xuyan He
- Department of Nutrition, Nutrition Discovery Innovation Center, Institute of Nutrition and Food Safety, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing Advanced Innovation Center for Food Nutrition and Human Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiayu Wei
- Department of Nutrition, Nutrition Discovery Innovation Center, Institute of Nutrition and Food Safety, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing Advanced Innovation Center for Food Nutrition and Human Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Zhao
- Department of Nutrition, Nutrition Discovery Innovation Center, Institute of Nutrition and Food Safety, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing Advanced Innovation Center for Food Nutrition and Human Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mustapha Umar Imam
- Precision Nutrition Innovation Center, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhiguang Ping
- Precision Nutrition Innovation Center, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yusheng Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junxia Min
- The First Affiliated Hospital, Institute of Translational Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fudi Wang
- Department of Nutrition, Nutrition Discovery Innovation Center, Institute of Nutrition and Food Safety, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing Advanced Innovation Center for Food Nutrition and Human Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China. .,Precision Nutrition Innovation Center, College of Public Health, Zhengzhou University, Zhengzhou, China.
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Costello RB, Elin RJ, Rosanoff A, Wallace TC, Guerrero-Romero F, Hruby A, Lutsey PL, Nielsen FH, Rodriguez-Moran M, Song Y, Van Horn LV. Perspective: The Case for an Evidence-Based Reference Interval for Serum Magnesium: The Time Has Come. Adv Nutr 2016; 7:977-993. [PMID: 28140318 PMCID: PMC5105038 DOI: 10.3945/an.116.012765] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
| | - Ronald J Elin
- Department of Pathology and Laboratory Medicine, University of Louisville, KY
| | | | - Taylor C Wallace
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA
| | | | - Adela Hruby
- Nutritional Epidemiology Program, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Pamela L Lutsey
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | | | | | - Yiqing Song
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN; and
| | - Linda V Van Horn
- Division of Nutrition, Department of Preventive Medicine, Northwestern University, Chicago, IL
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Serum magnesium and risk of new onset heart failure in men: the Kuopio Ischemic Heart Disease Study. Eur J Epidemiol 2016; 31:1035-1043. [DOI: 10.1007/s10654-016-0164-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
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Li H, Zeng C, Wei J, Yang T, Gao SG, Li YS, Luo W, Xiao WF, Xiong YL, Lei GH. Serum Calcium Concentration Is Inversely Associated With Radiographic Knee Osteoarthritis: A Cross-Sectional Study. Medicine (Baltimore) 2016; 95:e2838. [PMID: 26871857 PMCID: PMC4753953 DOI: 10.1097/md.0000000000002838] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
To examine the relationship between serum calcium (Ca) concentration and radiographic knee osteoarthritis (OA).This study covered a total of 2855 subjects. The serum Ca concentration was detected by the Arsenazo III method. The radiographic OA of the knee was defined as changes equivalent to Kellgren-Lawrence grade 2 on 1 side at least. The serum Ca concentration was categorized into 4 quartiles, which are ≤2.27, 2.28-2.34, 2.35-2.41, and ≥2.42 mmol/L, respectively. The relationship between serum Ca and radiographic knee OA was examined using the multivariable logistic analysis after adjusting a series of potential confounding factors. For each quartile of the relationship between serum Ca concentration and radiographic knee OA, the OR with 95% CI was calculated, and the one with the lowest value was considered to be the reference.An inverse association existed between serum Ca concentration and radiographic OA of the knee in the multivariable model and the model where the factors of age, sex, and BMI were adjusted. The multivariable-adjusted OR (95% CI) for radiographic knee OA in the second, third, and fourth quartiles of serum Ca concentration were 1.05 (95% CI: 0.83-1.31), 1.01 (95% CI: 0.80-1.27), and 0.79 (95% CI: 0.62-1.00), respectively, in comparison with the reference (first) quartile. A trend approaching to statistical significant (P = 0.06) was observed. Meanwhile, the relative odds of radiographic OA of the knee were decreased by 0.79 times in the fourth quartile in comparison with the reference.There is likely to be an inverse association between serum Ca concentration and radiographic OA of the knee.
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Affiliation(s)
- Hui Li
- From the Department of Orthopaedics (HL, CZ, TY, S-GG, Y-SL, WL, W-FX, Y-LX, G-HL); Health Management Center (JW), Xiangya Hospital; and Department of Epidemiology and Health Statistics (JW), School of Public Health, Central South University, Changsha, Hunan Province, China
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Markovits N, Kurnik D, Halkin H, Margalit R, Bialik M, Lomnicky Y, Loebstein R. Database evaluation of the association between serum magnesium levels and the risk of atrial fibrillation in the community. Int J Cardiol 2015; 205:142-146. [PMID: 26736089 DOI: 10.1016/j.ijcard.2015.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 12/03/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND In population studies, mild hypomagnesemia, determined by a single measurement, was associated with incident atrial fibrillation, over ~20 years of follow-up. We sought to determine whether mild (≤ 1.7 mg/dL) and moderate (≤ 1.5mg/dL) hypomagnesemia are temporally associated with increased incidence of atrial fibrillation (AF) in the community. METHODS Health Maintenance Organization (HMO) database cohort study including beneficiaries with ≥ 1 serum magnesium measurement between 2004 and 2013. The follow-up period was defined from the first magnesium measurement to first listing in an AF registry (for cases) and December 2013 or date of death or loss to follow-up (for controls). We analyzed the association between serum magnesium quintiles, as well as the above clinically relevant hypomagnesemia thresholds, and incident AF using Cox proportional hazard regression analysis, adjusting for confounders. The association between serum magnesium and AF occurring within 3 months was also examined. RESULTS Among 162,162 subjects, 2228 (1.4%) developed AF over a median follow-up of 25.3 months. Compared to the middle quintile the lowest magnesium quintile (≤ 1.9 mg/dL) had a significantly higher risk of AF (HR, 1.21; 95% CI: 1.07-1.37). Increased AF risk was also associated with mild (HR, 1.44; 95% CI: 1.20-1.73) and moderate hypomagnesemia (HR, 1.57; 95% CI: 1.14-2.15). No association was found when limiting the follow-up period to 3 months. CONCLUSIONS In our study, hypomagnesemia was associated with incident AF over prolonged but not short-term follow-up periods, suggesting that this association may not be causal.
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Affiliation(s)
- Noa Markovits
- Institute of Clinical Pharmacology, Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Kurnik
- Division of Clinical Pharmacology and Toxicology, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hillel Halkin
- Department of Pharmacy and Clinical Pharmacology, Maccabi Healthcare Services, Israel; Institute of Clinical Pharmacology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reuma Margalit
- Institute of Clinical Pharmacology, Sheba Medical Center, Tel Hashomer, Israel
| | - Martin Bialik
- Department of Pharmacy and Clinical Pharmacology, Maccabi Healthcare Services, Israel
| | - Yossi Lomnicky
- Department of Pharmacy and Clinical Pharmacology, Maccabi Healthcare Services, Israel
| | - Ronen Loebstein
- Department of Pharmacy and Clinical Pharmacology, Maccabi Healthcare Services, Israel; Institute of Clinical Pharmacology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Cheungpasitporn W, Thongprayoon C, Qian Q. Dysmagnesemia in Hospitalized Patients: Prevalence and Prognostic Importance. Mayo Clin Proc 2015; 90:1001-10. [PMID: 26250725 DOI: 10.1016/j.mayocp.2015.04.023] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/12/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the prevalence of serum magnesium (Mg) alterations and outcomes in hospitalized patients. PATIENTS AND METHODS All admissions to Mayo Clinic in Rochester, Minnesota, from January 1, 2009, through December 31, 2013 (288,120 patients), were screened. Admission Mg from each unique patient and relevant clinical data were extracted from the institutional electronic database. RESULTS After excluding patients aged less than 18 years, those without Mg measurement, and readmission episodes, a total of 65,974 patients were studied. Magnesium levels of 2.1 mg/dL or higher were found in 20,777 patients (31.5%), and levels less than 1.7 mg/dL were noted in 13,320 (20.2%). Hypomagnesemia was common in patients with hematologic/oncological disorders, and hypermagnesemia was common in those with cardiovascular disease. The lowest hospital mortality, assessed by restricted cubic spline and percentage death, occurred in patients with Mg levels between 1.7 and 1.89 mg/dL. An Mg level of less than 1.7 mg/dL was independently associated with an increased risk of hospital mortality after adjusting for all variables except the admission diagnosis; risk for longer hospital stay and being discharged to a care facility were increased in the fully adjusted model. An elevated Mg level of 2.3 mg/dL or higher was a predictor for all adverse outcomes. The magnitude of Mg elevations in patients with levels of 2.3 mg/dL or higher (N=7908) was associated with worse hospital mortality in a dose-response manner. In patients with cardiovascular diseases, Mg levels of 1.5 to 1.69 mg/dL and 2.3 mg/dL or higher both independently predicted poor outcomes including hospital mortality. CONCLUSION Dysmagnesemia in hospitalized patients is common, with hypermagnesemia being most prevalent. Compared with hypomagnesemia, hypermagnesemia is a stronger predictor for poor outcomes. Magnesium supplementation for patients without Mg deficiency should be avoided in the absence of randomized controlled trials documenting a benefit.
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Affiliation(s)
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | - Qi Qian
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
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Adebamowo SN, Spiegelman D, Willett WC, Rexrode KM. Association between intakes of magnesium, potassium, and calcium and risk of stroke: 2 cohorts of US women and updated meta-analyses. Am J Clin Nutr 2015; 101:1269-77. [PMID: 25948665 PMCID: PMC4441806 DOI: 10.3945/ajcn.114.100354] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 04/02/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Prospective data on the relation of magnesium, potassium, and calcium intakes with stroke risk are inconsistent, and to our knowledge, the effect of a combined mineral diet score has not been examined. OBJECTIVE We examined associations between intakes of magnesium, potassium, and calcium and risk of incident stroke in 86,149 women in the Nurses' Health Study (NHS) I and 94,715 women in the NHS II. DESIGN In this prospective cohort study, we calculated HRs of stroke by quintiles of intake for each mineral and for a combined diet score of all 3 minerals by using multivariate Cox proportional hazard models. In addition, we updated meta-analyses on dietary intakes of these minerals and risk of stroke. RESULTS During follow-up (30 y in the NHS I; 22 y in the NHS II) a total of 3780 incident stroke cases were documented. Pooled multivariate RRs of total stroke for women in the highest compared with the lowest quintiles were 0.87 (95% CI: 0.78, 0.97) for total magnesium, 0.89 (95% CI: 0.80, 0.99) for total potassium, and 0.97 (95% CI: 0.87, 1.09) for total calcium intake. Pooled RRs for women in the highest compared with the lowest quintiles of a combined mineral diet score were 0.72 (95% CI: 0.65, 0.81) for total stroke, 0.78 (95% CI: 0.66, 0.92) for ischemic stroke, and 0.80 (95% CI: 0.61, 1.04) for hemorrhagic stroke. In the updated meta-analyses of all prospective studies to date, the combined RR of total stroke was 0.87 (95% CI: 0.83, 0.92) for a 100-mg/d increase in magnesium intake, 0.91 (95% CI: 0.88, 0.94) for a 1000-mg/d increase in potassium intake, and 0.98 (95% CI: 0.94, 1.02) for a 300-mg/d increase in calcium intake. CONCLUSIONS A combined mineral diet score was inversely associated with risk of stroke. High intakes of magnesium and potassium but not calcium were also significantly associated with reduced risk of stroke in women.
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Affiliation(s)
- Sally N Adebamowo
- From the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (SNA and KMR); the Departments of Department of Nutrition (SNA, DS, and WCW), Biostatistics (DS), Epidemiology (DS and WCW), and Global Health and Population (DS), Harvard T.H. Chan School of Public Health, Boston, MA; and the Channing Division of Network Medicine, Boston, MA (WCW).
| | - Donna Spiegelman
- From the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (SNA and KMR); the Departments of Department of Nutrition (SNA, DS, and WCW), Biostatistics (DS), Epidemiology (DS and WCW), and Global Health and Population (DS), Harvard T.H. Chan School of Public Health, Boston, MA; and the Channing Division of Network Medicine, Boston, MA (WCW)
| | - Walter C Willett
- From the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (SNA and KMR); the Departments of Department of Nutrition (SNA, DS, and WCW), Biostatistics (DS), Epidemiology (DS and WCW), and Global Health and Population (DS), Harvard T.H. Chan School of Public Health, Boston, MA; and the Channing Division of Network Medicine, Boston, MA (WCW)
| | - Kathryn M Rexrode
- From the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (SNA and KMR); the Departments of Department of Nutrition (SNA, DS, and WCW), Biostatistics (DS), Epidemiology (DS and WCW), and Global Health and Population (DS), Harvard T.H. Chan School of Public Health, Boston, MA; and the Channing Division of Network Medicine, Boston, MA (WCW)
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