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González-Acedo A, Manzano-Moreno FJ, García-Recio E, Ruiz C, de Luna-Bertos E, Costela-Ruiz VJ. Assessment of Supplementation with Different Biomolecules in the Prevention and Treatment of COVID-19. Nutrients 2024; 16:3070. [PMID: 39339670 PMCID: PMC11434975 DOI: 10.3390/nu16183070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/30/2024] Open
Abstract
Consequences of the disease produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have led to an urgent search for preventive and therapeutic strategies. Besides drug treatments, proposals have been made for supplementation with biomolecules possessing immunomodulatory and antioxidant properties. The objective of this study was to review published evidence on the clinical usefulness of supplementation with vitamin D, antioxidant vitamins (vitamin A, vitamin E, and vitamin C), melatonin, lactoferrin and natural products found in food (curcumin, luteolin, ginger, allicin, magnesium and zinc) as supplements in SARS-CoV-2 infection. In general, supplementation of conventional treatments with these biomolecules has been found to improve the clinical symptoms and severity of the coronavirus disease (COVID-19), with some indications of a preventive effect. In conclusion, these compounds may assist in preventing and/or improving the symptoms of COVID-19. Nevertheless, only limited evidence is available, and findings have been inconsistent. Further investigations are needed to verify the therapeutic potential of these supplements.
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Affiliation(s)
- Anabel González-Acedo
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, Avda. Ilustración 60, 18016 Granada, Spain; (A.G.-A.); (E.G.-R.); (C.R.); (V.J.C.-R.)
| | - Francisco Javier Manzano-Moreno
- Biomedical Group (BIO277), Department of Stomatology, School of Dentistry, University of Granada, 18016 Granada, Spain;
- Institute of Biosanitary Research, ibs.Granada, Avda. de Madrid, 15 Pabellón de Consultas Externas, 2ª Planta, 18012 Granada, Spain
| | - Enrique García-Recio
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, Avda. Ilustración 60, 18016 Granada, Spain; (A.G.-A.); (E.G.-R.); (C.R.); (V.J.C.-R.)
- Institute of Biosanitary Research, ibs.Granada, Avda. de Madrid, 15 Pabellón de Consultas Externas, 2ª Planta, 18012 Granada, Spain
| | - Concepción Ruiz
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, Avda. Ilustración 60, 18016 Granada, Spain; (A.G.-A.); (E.G.-R.); (C.R.); (V.J.C.-R.)
- Institute of Biosanitary Research, ibs.Granada, Avda. de Madrid, 15 Pabellón de Consultas Externas, 2ª Planta, 18012 Granada, Spain
- Institute of Neuroscience, University of Granada, 18016 Granada, Spain
| | - Elvira de Luna-Bertos
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, Avda. Ilustración 60, 18016 Granada, Spain; (A.G.-A.); (E.G.-R.); (C.R.); (V.J.C.-R.)
- Institute of Biosanitary Research, ibs.Granada, Avda. de Madrid, 15 Pabellón de Consultas Externas, 2ª Planta, 18012 Granada, Spain
| | - Víctor Javier Costela-Ruiz
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, Avda. Ilustración 60, 18016 Granada, Spain; (A.G.-A.); (E.G.-R.); (C.R.); (V.J.C.-R.)
- Institute of Biosanitary Research, ibs.Granada, Avda. de Madrid, 15 Pabellón de Consultas Externas, 2ª Planta, 18012 Granada, Spain
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Eker ES, Ataoğlu HE. The relationship between hypomagnesemia and albuminuria in patients with type 2 diabetes mellitus. Clin Endocrinol (Oxf) 2024; 101:216-222. [PMID: 38837454 DOI: 10.1111/cen.15094] [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: 12/10/2023] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE Diabetic nephropathy is a prevalent cause of chronic kidney disease worldwide. Magnesium plays a critical role in insulin resistance, and insulin, in turn, regulates magnesium levels. We aimed to investigate the association between hypomagnesemia and albuminuria in patients with type 2 diabetes mellitus (T2DM). DESIGN, PATIENTS AND MEASUREMENTS This retrospective single-centre study encompassed 1178 patients aged 18 and above with T2DM, who attended our outpatient clinic between January 2019 and August 2020. Albuminuria levels were categorised according to Kidney Disease Outcomes Quality Initiative guidelines. In the literature, when examining cut-off values for hypomagnesemia, it is observed that studies typically use hospital normal level as a reference point. Hypomagnesemia, defined as magnesium levels below 1.6 mg/dL, was compared to normomagnesemia (magnesium between 1.6 and 2.4 mg/dL). The primary objective was to explore the impact of magnesium levels on albuminuria, while the secondary objective was to determine the prevalence of hypomagnesemia. The multivariate logistic regression analyses were performed according to age, gender (male), HbA1c, and presence of hypomagnesemia. RESULTS The mean age of the participants was 58.7 ± 12.2 years, with 44% being male. Hypomagnesemia was identified in 5.3% of the patients. Advanced age and female gender were more common among patients with hypomagnesemia (p = .001). Magnesium levels exhibited a negative correlation with HbA1c and fasting blood glucose, and a positive correlation with creatinine levels (r = -.117, r = -.131, r = .117, p < .001 for all three variables). Hypomagnesemia was significantly more prevalent in patients with albuminuria (15.9% vs. 4.7%, p < .001). Moreover, participants with the presence of hypomagnesemia were independently associated with a higher risk of albuminuria (odds ratio 3,64 1.76-7.52, p = .001). CONCLUSION Albuminuria is more frequently observed in patients with hypomagnesemia.
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Affiliation(s)
- Edibe S Eker
- Department of Internal Medicine, Haseki Research and Training Hospital, Istanbul, Turkey
| | - Hayriye E Ataoğlu
- Department of Internal Medicine, Haseki Research and Training Hospital, Istanbul, Turkey
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Koh HB, Kim HJ, Heo GY, Kim HW, Jung CY, Han SH, Yoo TH, Kang SW, Park JT. Association between dietary magnesium intake and incident chronic kidney disease: a prospective observational cohort study. Am J Clin Nutr 2024:S0002-9165(24)00668-3. [PMID: 39163977 DOI: 10.1016/j.ajcnut.2024.08.009] [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: 04/09/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Although serum magnesium deficiency is linked to higher cardiovascular disease risk, its association with chronic kidney disease (CKD) remains unclear. OBJECTIVES This study aimed to evaluate the relationship between dietary magnesium intake and CKD development in adults with clinically normal kidney function. METHODS The prospective observational cohort study evaluated 188,510 participants (median age, 57.0 y; female, 54.1%) from the UK Biobank. Dietary magnesium intake was assessed through a 24-h dietary recall questionnaire compromising a list of 206 foods and 32 beverages and categorized into quintiles. The primary outcome was incident CKD diagnosed through International Classification of Diseases-10 and Office of Population Censuses and Surveys 4 codes. Incident CKD, defined as estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2, was also assessed in a subcohort with creatinine follow-up data. RESULTS The median magnesium intake amount per person was 323.2 mg/d [interquartile range (IQR): 269.4-382.7 mg/d]. During 1,826,038.1 person-years of follow-up (median: 9.6 y; IQR: 9.3-10.3 y), CKD developed in 5,878 participants. The incidence of CKD was progressively higher in participants with lower magnesium intake (2.8%, 2.8%, 3.0%, 3.2%, and 3.7% in Q5-Q1, respectively). Cox regression analysis revealed that the hazard ratios (HRs) for incident CKD increased in a stepwise manner toward lower magnesium intake quintiles {adjusted HR (95% confidence interval [CI])-Q4: 0.97 (0.89, 1.06); Q3: 1.05 (0.96, 1.14); Q2: 1.12 (1.03, 1.21); Q1: 1.30 (1.20, 1.41)} relative to Q5 (P-linearity < 0.001). Similar results were observed with eGFR-defined CKD outcome [adjusted HR (95% CI)-Q4: 1.09 (0.92, 1.28); Q3: 1.15 (0.98, 1.35); Q2: 1.21 (1.03, 1.42); Q1: 1.41 (1.20, 1.65) relative to Q5; P-linearity < 0.001]. CONCLUSIONS Lower dietary magnesium intake was associated with higher risk of incident CKD in adults with clinically normal kidney function. Further controlled studies are required to establish the potential benefit of adequate magnesium intake.
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Affiliation(s)
- Hee Byung Koh
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea; Catholic Kwandong University International Saint Mary's Hospital, Seo-gu, Incheon, South Korea
| | - Hyo Jeong Kim
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ga Young Heo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Chan-Young Jung
- Department of Internal Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea.
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Hakimi S, Dutta P, Layton AT. Renal calcium and magnesium handling during pregnancy: modeling and analysis. Am J Physiol Renal Physiol 2024; 327:F77-F90. [PMID: 38721663 DOI: 10.1152/ajprenal.00001.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/15/2024] [Accepted: 05/05/2024] [Indexed: 06/21/2024] Open
Abstract
Pregnancy is associated with elevated demand of most nutrients, with many trace elements and minerals critical for the development of fetus. In particular, calcium (Ca2+) and magnesium (Mg2+) are essential for cellular function, and their deficiency can lead to impaired fetal growth. A key contributor to the homeostasis of these ions is the kidney, which in a pregnant rat undergoes major changes in morphology, hemodynamics, and molecular structure. The goal of this study is to unravel the functional implications of these pregnancy-induced changes in renal handling of Ca2+ and Mg2+, two cations that are essential in a healthy pregnancy. To achieve that goal, we developed computational models of electrolyte and water transport along the nephrons of a rat in mid and late pregnancy. Model simulations reveal a substantial increase in the reabsorption of Mg2+ along the proximal tubules and thick ascending limbs. In contrast, the reabsorption of Ca2+ is increased in the proximal tubules but decreased in the thick ascending limbs, due to the lower transepithelial concentration gradient of Ca2+ along the latter. Despite the enhanced transport capacity, the marked increase in glomerular filtration rate results in elevated urinary excretions of Ca2+ and Mg2+ in pregnancy. Furthermore, we conducted simulations of hypocalcemia and hypomagnesemia. We found that hypocalcemia lowers Ca2+ excretion substantially more than Mg2+ excretion, with this effect being more pronounced in virgin rats than in pregnant ones. Conversely, hypomagnesemia reduces the excretion of Mg2+ and Ca2+ to more similar degrees. These differences can be explained by the greater sensitivity of the calcium-sensing receptor (CaSR) to Ca2+ compared with Mg2+.NEW & NOTEWORTHY A growing fetus' demands of minerals, notably calcium and magnesium, necessitate adaptations in pregnancy. In particular, the kidney undergoes major changes in morphology, hemodynamics, and molecular structure. This computational modeling study provides insights into how these pregnancy-induced renal adaptation impact calcium and magnesium transport along different nephron segments. Model simulations indicate that, despite the enhanced transport capacity, the marked increase in glomerular filtration rate results in elevated urinary excretions of calcium and magnesium in pregnancy.
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Affiliation(s)
- Shervin Hakimi
- Department of Applied Mathematics, University of Waterloo, Waterloo, Ontario, Canada
| | - Pritha Dutta
- Department of Applied Mathematics, University of Waterloo, Waterloo, Ontario, Canada
| | - Anita T Layton
- Department of Applied Mathematics, University of Waterloo, Waterloo, Ontario, Canada
- Department of Biology, Cheriton School of Computer Science, and School of Pharmacology, University of Waterloo, Waterloo, Ontario, Canada
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Chen F, Mangano KM, Garelnabi M, Cardaleen K, Tucker KL. Associations among diabetes medication use, serum magnesium, and insulin resistance in a cohort of older Puerto Rican adults. Am J Clin Nutr 2024; 119:1523-1532. [PMID: 38599521 PMCID: PMC11196862 DOI: 10.1016/j.ajcnut.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/07/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Hypomagnesemia is commonly observed in individuals with diabetes, but how diabetes medications alter magnesium (Mg) status remains unclear. OBJECTIVES We aimed to examine the association between diabetes medication and hypomagnesemia and evaluate whether serum Mg mediates the association between diabetes medication and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) in a prospective cohort. METHODS Adults from the Boston Puerto Rican Health Study were included (n = 1106). Multivariable logistic regression models were used to estimate odds ratio (OR) and 95% confidence interval (CI) for cross-sectional association between diabetes medication and hypomagnesemia (serum Mg <0.75 mmol/L). Longitudinal mediation analysis was performed to evaluate the direct and indirect (via serum Mg) associations between diabetes medication and 4-y HOMA-IR in 341 participants with baseline hemoglobin A1c (HbA1c) of ≥6.5%. RESULTS Mean age at baseline was 59.0 ± 7.6 y, with 28.0% male and 45.8% with hypomagnesemia. Use of metformin [OR (95% CI) = 3.72 (2.53, 5.48)], sulfonylureas [OR (95% CI) = 1.68 (1.00, 2.83)], and glitazones [OR (95% CI) = 2.09 (1.10, 3.95)], but not insulin, was associated with higher odds of hypomagnesemia. Use of multiple diabetes medications and longer duration of use were associated with higher odds of hypomagnesemia. Serum Mg partially mediated the association between metformin and HOMA-IR [indirect association: β (95% CI) = 1.11 (0.15, 2.07)], which weakened the direct association [β (95% CI) = -5.16 (-9.02, -1.30)] by 22% [total association: β (95% CI) = -4.05 (-7.59, -0.51)]. Similarly, serum Mg mediated 17% of the association between sulfonylureas and elevated HOMA-IR. However, the mediation by serum Mg was weak for insulin and glitazones. CONCLUSIONS Diabetes medication, especially metformin, was associated with elevated odds of hypomagnesemia, which may weaken the association between metformin and lowering of HOMA-IR. The causal inference needs to be confirmed in further studies.
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Affiliation(s)
- Fan Chen
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States; Department of Biomedical and Nutritional Sciences, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Kelsey M Mangano
- Department of Biomedical and Nutritional Sciences, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Mahdi Garelnabi
- Department of Biomedical and Nutritional Sciences, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Kellee Cardaleen
- Department of Biomedical and Nutritional Sciences, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States.
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Pitliya A, Vasudevan SS, Batra V, Patel MB, Desai A, Nethagani S, Pitliya A. Global prevalence of hypomagnesemia in type 2 diabetes mellitus - a comprehensive systematic review and meta-analysis of observational studies. Endocrine 2024; 84:842-851. [PMID: 38159172 DOI: 10.1007/s12020-023-03670-7] [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: 09/18/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Hypomagnesemia, characterized by low magnesium levels, has been implicated in the pathophysiology of Type 2 Diabetes Mellitus (T2DM). This meta-analysis aims to provide a comprehensive assessment of hypomagnesemia prevalence in individuals with T2DM as well as its potential implications for diabetes management and complications. METHODS We conducted a comprehensive systematic review and meta-analysis using databases like PubMed, Google Scholar, Science Direct, and Research Gate to identify relevant studies between January 2008 and August 2023. We focused on observational studies related to serum magnesium levels and Type 2 Diabetes in individuals aged 19 and older. Newcastle Ottawa tool was used for quality assessment. A random effect meta-analysis was performed to calculate the prevalence of hypomagnesemia in T2DM. RESULTS We identified a total of 671 studies, and after screening 383 abstracts and full texts by two independent reviewers, we identified 19 eligible studies encompassing 4192 patients diagnosed with T2DM. The mean age was 55.4 (SD, 4.39) years with a mean HbA1C level of 8.01. The pooled prevalence of hypomagnesemia in T2DM was 32% (95% CI: 22-36%) out of 4192 cases. On subgroup analysis, the prevalence of hypomagnesemia in male and female were 19.8% and 20.1%, respectively. Geographically, Asia had the highest prevalence of hypomagnesemia with 31.9% (95% CI: 24-41.1%). CONCLUSION This meta-analysis highlights a significant prevalence of hypomagnesemia in individuals with T2DM, emphasizing the need for further investigation due to the intricate nature of the association between serum magnesium levels and T2DM.
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Affiliation(s)
- Aakanksha Pitliya
- Pamnani Hospital and Research Center, (Department of Medicine), Mandsaur, Madhya Pradesh, India
| | | | - Vanshika Batra
- SGT Medical College, (Student), Gurugram, Haryana, India
| | | | - Anjali Desai
- Surat Municipal Institute of Medical Education and Research, (Department of Medicine), Surat, Gujarat, India
| | - Sanjana Nethagani
- Camden Clark Medical Center/University of West Virginia, (Resident Physician, Department of Internal Medicine), Parkersburg, WV, USA
| | - Anmol Pitliya
- Camden Clark Medical Center/University of West Virginia, (Hospitalist, Department of Internal Medicine), Parkersburg, WV, USA
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Al Harasi S, Al-Maqbali JS, Falhammar H, Al-Mamari A, Al Futisi A, Al-Farqani A, Kumar S, Osman A, Al Riyami S, Al Riyami N, Al Farai Q, Al Alawi H, Al Alawi AM. Prevalence of Dysmagnesemia among Patients with Diabetes Mellitus and the Associated Health Outcomes: A Cross-Sectional Study. Biomedicines 2024; 12:1068. [PMID: 38791030 PMCID: PMC11117732 DOI: 10.3390/biomedicines12051068] [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] [Received: 04/18/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Introduction: Magnesium is a vital intracellular cation crucial for over 320 enzymatic reactions related to energy metabolism, musculoskeletal function, and nucleic acid synthesis and plays a pivotal role in human physiology. This study aimed to explore the prevalence of dysmagnesemia in patients with diabetes mellitus and evaluate its correlations with glycemic control, medication use, and diabetic complications. Methods: A cross-sectional study was conducted at Sultan Qaboos University Hospital, including 316 patients aged 18 years or older with diabetes mellitus. Data included demographics, medical history, medications, and biochemical parameters. Serum total magnesium concentrations were measured, and dysmagnesemia was defined as magnesium ≤ 0.69 mmol/L for hypomagnesemia and ≥1.01 mmol/L for hypermagnesemia. Results: The prevalence of hypomagnesemia in patients with diabetes was 17.1% (95% CI: 13.3-21.7%), and hypermagnesemia was 4.1% (95% CI: 2.4-7.0%). Females were significantly overrepresented in the hypomagnesemia group, while the hypermagnesemia group showed a higher prevalence of hypertension, retinopathy, an increased albumin/creatinine ratio, chronic kidney disease (CKD), elevated creatinine levels, and a lower adjusted calcium concentration. The multinominal logistic regression exhibited that the female sex and higher serum-adjusted calcium were independent risk factors of hypomagnesemia. In contrast, the presence of hypertension, higher levels of albumin/creatinine ratio, and stage 5 CKD were independent risk factors of hypermagnesemia. Conclusions: Hypomagnesemia was common among patients with diabetes mellitus; however, hypermagnesemia was associated with microvascular complications.
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Affiliation(s)
- Salwa Al Harasi
- Internal Medicine Residency Training Program, Oman Medical Specialty Board, Muscat 130, Oman;
| | - Juhaina Salim Al-Maqbali
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Science, Sultan Qaboos University, Muscat 123, Oman;
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat 123, Oman
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, 17165 Stockholm, Sweden;
- Department of Molecular Medicine and Surgery, Karolinska Institute, 17177 Stockholm, Sweden
| | - Ali Al-Mamari
- Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman; (A.A.-M.); (A.A.F.); (A.A.-F.); (S.K.); (A.O.)
| | - Abdullah Al Futisi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman; (A.A.-M.); (A.A.F.); (A.A.-F.); (S.K.); (A.O.)
| | - Ahmed Al-Farqani
- Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman; (A.A.-M.); (A.A.F.); (A.A.-F.); (S.K.); (A.O.)
| | - Suneel Kumar
- Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman; (A.A.-M.); (A.A.F.); (A.A.-F.); (S.K.); (A.O.)
| | - Alaa Osman
- Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman; (A.A.-M.); (A.A.F.); (A.A.-F.); (S.K.); (A.O.)
| | - Sulaiman Al Riyami
- Department of Biochemistry, Sultan Qaboos University Hospital, Muscat 123, Oman; (S.A.R.); (N.A.R.); (Q.A.F.); (H.A.A.)
| | - Nafila Al Riyami
- Department of Biochemistry, Sultan Qaboos University Hospital, Muscat 123, Oman; (S.A.R.); (N.A.R.); (Q.A.F.); (H.A.A.)
| | - Qatiba Al Farai
- Department of Biochemistry, Sultan Qaboos University Hospital, Muscat 123, Oman; (S.A.R.); (N.A.R.); (Q.A.F.); (H.A.A.)
| | - Hiba Al Alawi
- Department of Biochemistry, Sultan Qaboos University Hospital, Muscat 123, Oman; (S.A.R.); (N.A.R.); (Q.A.F.); (H.A.A.)
| | - Abdullah M. Al Alawi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman; (A.A.-M.); (A.A.F.); (A.A.-F.); (S.K.); (A.O.)
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Shah CV, Sparks MA, Lee CT. Sodium/Glucose Cotransporter 2 Inhibitors and Magnesium Homeostasis: A Review. Am J Kidney Dis 2024; 83:648-658. [PMID: 38372686 DOI: 10.1053/j.ajkd.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/21/2023] [Accepted: 11/11/2023] [Indexed: 02/20/2024]
Abstract
Magnesium (Mg2+), also known as "the forgotten ion," is the second most abundant intracellular cation and is essential in a broad range of intracellular physiological and biochemical reactions. Its deficiency, hypomagnesemia (Mg2+<1.8mg/dL), is a prevalent condition and routinely poses challenges in its management in clinical practice. Sodium/glucose cotransporter 2 (SGLT2) inhibitors have emerged as a new class of drugs with treating hypomagnesemia as their unique extraglycemic benefit. The beneficial effect of SGLT2 inhibitors on magnesium balance in patients with diabetes with or without hypomagnesemia has been noted as a class effect in recent meta-analysis data from randomized clinical trials. Some reports have demonstrated their role in treating refractory hypomagnesemia in patients with or without diabetes. Moreover, studies on animal models have attempted to illustrate the effect of SGLT2 inhibitors on Mg2+homeostasis. In this review, we discuss the current evidence and possible pathophysiological mechanisms, and we provide directions for further research. We conclude by suggesting the effect of SGLT2 inhibitors on Mg2+homeostasis is a class effect, with certain patients gaining significant benefits. Further studies are needed to examine whether SGLT2 inhibitors can become a desperately needed novel class of medicines in treating hypomagnesemia.
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Affiliation(s)
- Chintan V Shah
- Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida.
| | - Matthew A Sparks
- Division of Nephrology and Department of Medicine, Duke University, and Durham VA Health Care System, Durham, North Carolina
| | - Chien-Te Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Kaohsiung Municipal Feng-Shan Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Pluquet M, Kamel S, Alencar de Pinho N, Mansencal N, Combe C, Metzger M, Massy ZA, Liabeuf S, Laville SM. Ionized and total magnesium levels in patients with chronic kidney disease: associated factors and outcomes. Clin Kidney J 2024; 17:sfae046. [PMID: 38572502 PMCID: PMC10986257 DOI: 10.1093/ckj/sfae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Indexed: 04/05/2024] Open
Abstract
Background The association between hypo- and/or hypermagnesaemia and cardiovascular (CV) outcomes or mortality has shown conflicting results in chronic kidney disease (CKD) and has been conducted on total magnesium (tMg) levels. Thus, the objectives of the present study were to (i) describe the serum ionized Mg (iMg) concentration in patients at various CKD stages, (ii) measure the correlation between iMg and tMg concentrations, (iii) identify their associated factors and (iv) determine whether serum tMg and/or iMg concentrations are associated with major adverse cardiovascular events (MACE) and mortality before kidney replacement therapy in CKD patients. Methods Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) is a prospective cohort of CKD patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Baseline iMg and tMg serum concentrations were centrally measured. Adjusted cause-specific Cox proportional hazard models were used to estimate hazard ratios (HRs) for first MACE and for mortality. Results Of the 2419 included patients, median age was 68 years, and the mean eGFR was 34.8 mL/min/1.73 m2. Concentrations of serum iMg and tMg were strongly correlated (r = 0.89, P < .001) and were independently associated with eGFR. The adjusted HR [95% confidence interval (CI)] for MACE associated with the baseline serum tMg level was 1.27 (0.95; 1.69) for patients in Tertile 1 and 1.56 (1.18; 2.06) for patients in Tertile 3, relative to patients in Tertile 2. The HR (95% CI) of death according to serum tMg concentration was increased in Tertile 3 [1.48 (1.11; 1.97)]. The adjusted risk for MACE and mortality (all-cause or CV) associated with the baseline serum iMg level was not significantly different between tertiles. Conclusions Our analysis of a large cohort of patients with moderate-to-advanced CKD demonstrated that individuals with higher serum tMg concentrations, although still within the normal range, had a greater likelihood of MACE and mortality. However, serum iMg levels were not associated with these outcomes.
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Affiliation(s)
- Maxime Pluquet
- MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
| | - Said Kamel
- MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
- Department of Biochemistry, Amiens-Picardie University Medical Center, Amiens, France
| | - Natalia Alencar de Pinho
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
| | - Nicolas Mansencal
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
- Department of Cardiology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM, U1026, Univ Bordeaux Segalen, Bordeaux, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif, France
- Department of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France
| | - Sophie Liabeuf
- MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens, France
| | - Solène M Laville
- MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens, France
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Zhang H, Yang J, Cao Y, Shan X, Yang L. Study on the Dose-Response Relationship between Magnesium and Type 2 Diabetes of Childbearing Women in the China Adult Chronic Disease and Nutrition Surveillance 2015. Nutrients 2024; 16:1018. [PMID: 38613051 PMCID: PMC11013345 DOI: 10.3390/nu16071018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Magnesium (Mg) is an essential element and participates in many metabolic pathways. Many studies have found a certain negative correlation between magnesium and blood glucose parameters, but the dose-response relationship between them is still a relatively narrow research field. We aim to explore the dose-response relationship between plasma and dietary Mg and type 2 diabetes (T2DM) among childbearing women in a nationally representative sample. And we will also initially explore the threshold of dietary and plasma magnesium in the prevention of T2DM and their consistency. Methods: A total of 2912 18-44 year-old childbearing women were recruited from the China Adult Chronic Disease and Nutrition Surveillance (2015). Multivariate logistic regression was used to explore the dose-response relationship between plasma and dietary Mg and glucose parameters. The threshold effect between Mg and T2DM was explored by a restricted cubic spline regression. Results: It was found that when plasma Mg was increased by 0.041 mmol/L, the risk of T2DM, impaired fasting glucose (IFG), and HbA1c-hyperglycemia was reduced by 18%, 19%, and 18%, respectively. The possible threshold value for plasma Mg to prevent the risk of T2DM was 0.87 mmol/L. Through the quality control of the sample dietary survey data, 2469 cases were finally included for dietary analysis. And the possible threshold value for dietary Mg to prevent the risk of T2DM was 408 mg/d. Taking the recommended dietary Mg intake of 330 mg/d as the reference group, when the Mg intake reached 408 mg/d, the risk of T2DM was significantly reduced. And the average plasma Mg level of the people whose dietary intake reached 408 mg/d was 0.87 mmol/L. Conclusions: These results indicate that dietary Mg and plasma Mg have good consistency on the threshold effect of glucose parameters in women of childbearing age.
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Affiliation(s)
| | | | | | | | - Lichen Yang
- Key Laboratory of Public Health and Nutrition, National Health Commission of the People’s Republic of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (H.Z.); (J.Y.); (Y.C.); (X.S.)
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11
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Kazmi SKS, Farooq M, Iftikhar I, Fatima N, Shahzad M, Ijaz AU, Khalid H. Association of Hypomagnesemia With Diabetic Complications. Cureus 2024; 16:e56605. [PMID: 38646230 PMCID: PMC11032126 DOI: 10.7759/cureus.56605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE The study aimed to study the association of hypomagnesemia with diabetic complications in type 2 diabetics. MATERIALS AND METHOD This cross-sectional study, conducted at a Ghurki Trust Teaching Hospital, spanned from January to June 2023 and included 100 randomly selected diabetic patients aged 30-70. With institutional board approval and informed consent, the study focused on assessing hypomagnesemia, using a standard level of below 1.6 mg/dL, ensuring participant confidentiality and privacy. Data collected through physical assessments were analyzed using IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, New York, United States), including descriptive statistics, analysis of variance (ANOVA), and paired t-test. RESULTS A total of 100 diabetic admitted patients were randomly selected for the study ages from 30 to 70 years irrespective of their gender. The mean age of the participants was 53.86±9.74 years. The mean HbA1c of the participants was 8.7±2.32. Forty-eight percent of them had HbA1c less than 8, while 52% had greater than 8 HbA1c. The mean HbA1c in the hypomagnesemia group was 10.8±1.98, while in the normomagnesemia group, it was 8.9±2.2. There were 58.97% of foot ulcers in Group 1, while in Group 2, there were 31.14%. Around 38.46% and 14.75% had neuropathy in Groups 1 and 2, respectively. Nephropathy in Group 1 was 28.20%, while in Group 2, it was 11.47%. Around 69.23% of Group 1 had retinopathy and 37.70% had retinopathy in Group 2. Hypertension was 23.07% in Group 1 and 37.70% in Group 2; moreover, 7.69% and 8.19% had coronary diseases in Groups 1 and 2 accordingly. CONCLUSION The current study concluded that hypomagnesemia was found to have an association with diabetic complications like neuropathy, nephropathy, foot ulcers, and poor glycemic control as evidenced by HbA1c.
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Affiliation(s)
- Syed Khurram Shehzad Kazmi
- General Medicine, Lahore Medical and Dental College, Lahore, PAK
- General Medicine, Ghurki Trust Teaching Hospital, Lahore, PAK
| | - Mehrin Farooq
- Internal Medicine, Ghurki Trust Teaching Hospital, Lahore, PAK
- Internal Medicine, Lahore Medical and Dental College, Lahore, PAK
| | - Iqra Iftikhar
- Internal Medicine, Ghurki Trust Teaching Hospital, Lahore, PAK
| | | | - Mahwish Shahzad
- Biochemistry, Lahore Medical and Dental College, Lahore, PAK
| | - Asad Ullah Ijaz
- Internal Medicine, Lahore Medical and Dental College, Lahore, PAK
| | - Humna Khalid
- Internal Medicine/Dermatology, Bahawal Victoria Hospital, Bahawalpur, PAK
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12
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Zaslow SJ, Oliveira-Paula GH, Chen W. Magnesium and Vascular Calcification in Chronic Kidney Disease: Current Insights. Int J Mol Sci 2024; 25:1155. [PMID: 38256228 PMCID: PMC10816532 DOI: 10.3390/ijms25021155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
Magnesium (Mg) plays crucial roles in multiple essential biological processes. As the kidneys are the primary organ responsible for maintaining the blood concentration of Mg, people with chronic kidney disease (CKD) may develop disturbances in Mg. While both hyper- and hypomagnesemia may lead to adverse effects, the consequences associated with hypomagnesemia are often more severe and lasting. Importantly, observational studies have shown that CKD patients with hypomagnesemia have greater vascular calcification. Vascular calcification is accelerated and contributes to a high mortality rate in the CKD population. Both in vitro and animal studies have demonstrated that Mg protects against vascular calcification via several potential mechanisms, such as inhibiting the formation of both hydroxyapatite and pathogenic calciprotein particles as well as limiting osteogenic differentiation, a process in which vascular smooth muscle cells in the media layer of the arteries transform into bone-like cells. These preclinical findings have led to several important clinical trials that have investigated the effects of Mg supplementation on vascular calcification in people with CKD. Interestingly, two major clinical studies produced contradictory findings, resulting in a state of equipoise. This narrative review provides an overview of our current knowledge in the renal handling of Mg in health and CKD and the underlying mechanisms by which Mg may protect against vascular calcification. Lastly, we evaluate the strength of evidence from clinical studies on the efficacy of Mg supplementation and discuss future research directions.
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Affiliation(s)
- Shari J. Zaslow
- Department of Medicine, Nephrology Division, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Gustavo H. Oliveira-Paula
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Wei Chen
- Department of Medicine, Nephrology Division, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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13
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Drenthen LCA, de Baaij JHF, Rodwell L, van Herwaarden AE, Tack CJ, de Galan BE. Oral magnesium supplementation does not affect insulin sensitivity in people with insulin-treated type 2 diabetes and a low serum magnesium: a randomised controlled trial. Diabetologia 2024; 67:52-61. [PMID: 37922013 PMCID: PMC10709477 DOI: 10.1007/s00125-023-06029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/30/2023] [Indexed: 11/05/2023]
Abstract
AIMS/HYPOTHESIS Hypomagnesaemia has been associated with insulin resistance and an increased risk of type 2 diabetes. Whether magnesium supplementation improves insulin sensitivity in people with type 2 diabetes and a low serum magnesium level is unknown. METHODS Using a randomised, double-blind (both participants and investigators were blinded to the participants' treatment sequences), placebo-controlled, crossover study design, we compared the effect of oral magnesium supplementation (15 mmol/day) for 6 weeks with that of matched placebo in individuals with insulin-treated type 2 diabetes (age ≥18 years, BMI 18-40 kg/m2, HbA1c <100 mmol/mol [11.3%], serum magnesium ≤0.79 mmol/l). Participants were recruited from the outpatient clinic and through advertisements. Randomisation to a treatment sequence order was done using a randomisation list. We used block randomisation and the two possible treatment sequences were evenly distributed among the trial population. The primary outcome was the mean glucose infusion rate during the final 30 min of a hyperinsulinaemic-euglycaemic clamp (i.e. M value). Secondary outcomes included variables of glucose control, insulin need, BP, lipid profile and hypomagnesaemia-related symptoms during follow-up. RESULTS We recruited 14 participants (50% women, 100% White, mean ± SD age 67±6 years, BMI 31±5 kg/m2, HbA1c 58±9 mmol/mol [7.4±0.9%]) with insulin-treated type 2 diabetes. Magnesium supplementation increased both mean ± SEM serum magnesium level (0.75±0.02 vs 0.70±0.02 mmol/l, p=0.016) and urinary magnesium excretion (magnesium/creatinine ratio, 0.23±0.02 vs 0.15±0.02, p=0.005), as compared with placebo. The M value of the glucose clamp did not differ between the magnesium and placebo study arms (4.6±0.5 vs 4.4±0.6 mg kg-1 min-1, p=0.108). During the 6 weeks of treatment, continuous glucose monitoring outcomes, HbA1c, insulin dose, lipid profile and BP also did not differ, except for a lower HDL-cholesterol concentration after magnesium compared with placebo (1.14±0.08 vs 1.20±0.09 mmol/l, p=0.026). Symptoms potentially related to hypomagnesaemia were similar for both treatment arms. CONCLUSIONS/INTERPRETATION Despite an albeit modest increase in serum magnesium concentration, oral magnesium supplementation does not improve insulin sensitivity in people with insulin-treated type 2 diabetes and low magnesium levels. TRIAL REGISTRATION EudraCT number 2021-001243-27. FUNDING This study was supported by a grant from the Dutch Diabetes Research Foundation (2017-81-014).
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Affiliation(s)
| | | | - Laura Rodwell
- Department for Health Evidence, Section Biostatistics, Radboudumc, Nijmegen, the Netherlands
| | | | - Cees J Tack
- Department of Internal Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboudumc, Nijmegen, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
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Mokhtar A, Souhila T, Nacéra B, Amina B, Alghonaim MI, Öztürk M, Alsalamah SA, Miara MD, Boufahja F, Bendif H. In Vitro Antibacterial, Antioxidant, Anticholinesterase, and Antidiabetic Activities and Chemical Composition of Salvia balansae. Molecules 2023; 28:7801. [PMID: 38067531 PMCID: PMC10708212 DOI: 10.3390/molecules28237801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
CONTEXT Salvia balansae de Noé (S. balansae) (Lamiaceae) is known to be an important plant used in folk medicine as an herbal remedy in Algeria. OBJECTIVE The purpose of the present study was to demonstrate the phytochemical composition, antioxidant activities, enzyme inhibitory activities, and antimicrobial activities of S. balansae extracts. MATERIALS AND METHODS A methanolic extract and a petroleum ether extract from the aerial parts of the plant were assessed for their chemical composition. HPLC-MS and HPLC-DAD assessed the content of phenols, GC-MS the fatty acid composition, and ICP-MS the mineral profiles of the plant. Additionally, we evaluated the bioactivities of S. balansae extracts by the DPPH, ABTS, and CUPRAC assays, including the antioxidant potential against AChE, BChE, α-amylase, and α-glucosidase for enzyme inhibition. The antibacterial and antifungal activities of the methanolic extract were determined by the disc diffusion test against several strains of bacteria and yeasts. RESULTS Our findings revealed that the aerial parts of S. balansae were rich in phytochemical components and contained large amounts of minerals. Quantitative analysis of phenolic compounds by HPLC-DAD revealed the presence of 12 compounds in three major classes, flavonoids, hydroxycinnamic acid, and phenolic acid derivatives, with 0.61, 0.45, and 0.29 mg/g of extract, respectively. Nine phenolic constituents were quantified by HPLC-MS analysis; catechin (72.5%) was the main compound, followed by myricetin (21.7%). The fatty acid composition of the S. balansae petroleum ether extract by GC-MS analysis was quantified. Seventeen compounds, including palmitic acid, were identified as the major fatty acids. The antioxidant activity of the S. balansae extracts was measured by three different methods: the methanol extract provided better results than the petroleum ether extract, and interesting values were noted for the DPPH, ABTS, and CUPRAC assays of 242.7 ± 7.44, 124.1 ± 9.70, and 222.9 ± 6.05 µg/mL, respectively. The enzyme inhibition activity of the plant could not be determined. The antimicrobial results of the methanolic extract obtained from the disc diffusion method, followed by measurements of MIC, MBC, and MFC against several bacteria and yeasts, indicated that S. balansae exhibited noticeable antimicrobial and antifungal activities. CONCLUSIONS These results provided new data about the main phenolic compounds and biological activities of extracts of the aerial parts of S. balansae, which might be an alternative source for synthetic bioactive compounds.
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Affiliation(s)
- Amırat Mokhtar
- Institute of Veterinary Sciences, University Ibn-Khaldoun of Tiaret, Tiaret 14000, Algeria;
| | - Tabak Souhila
- Department of Nature and Life Sciences, Faculty of Life and Nature Sciences, University of Tiaret, Tiaret 14000, Algeria; (T.S.); (B.N.); (M.D.M.)
| | - Bouriah Nacéra
- Department of Nature and Life Sciences, Faculty of Life and Nature Sciences, University of Tiaret, Tiaret 14000, Algeria; (T.S.); (B.N.); (M.D.M.)
| | - Benabdallah Amina
- Department of Agronomy, Faculty of Life and Nature Sciences, University Chadli Bendjedid, El-Tarf 36000, Algeria;
| | - Mohammed I. Alghonaim
- Biology Department, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11623, Saudi Arabia; (M.I.A.); (S.A.A.)
| | - Mehmet Öztürk
- Department of Chemistry, Faculty of Sciences, Muğla Sıtkı Koçman University, Muğla 48121, Türkiye;
| | - Sulaiman A. Alsalamah
- Biology Department, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11623, Saudi Arabia; (M.I.A.); (S.A.A.)
| | - Mohamed Djamel Miara
- Department of Nature and Life Sciences, Faculty of Life and Nature Sciences, University of Tiaret, Tiaret 14000, Algeria; (T.S.); (B.N.); (M.D.M.)
| | - Fehmi Boufahja
- Biology Department, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11623, Saudi Arabia; (M.I.A.); (S.A.A.)
| | - Hamdi Bendif
- Laboratory of Ethnobotany and Natural Substances, ENS de Kouba, Algiers 16308, Algeria;
- Faculty of Sciences, University of M’sila, P.O. Box 166, M’Sila 28000, Algeria
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Soliman N, Almishal R, Elsayed B, Ahmed A, Al-Amri S, Al-Kuwari A, Al-Muhannadi S, Nadeer M, Chivese T. Association between Diabetes and Levels of Micronutrients in Qatar-A Case-Control Study. Biomedicines 2023; 11:3045. [PMID: 38002047 PMCID: PMC10669072 DOI: 10.3390/biomedicines11113045] [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: 09/15/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE The objectives of this study were to investigate associations between micronutrient levels and diabetes and to explore the association in individuals with controlled and uncontrolled diabetes. METHODS A case-control study, matched on age and gender, was performed on participants with (cases) and without diabetes (controls), who were Qatari or long-term residents (≥15 years of residence). Participants with diabetes were divided into those with controlled and uncontrolled diabetes using an HbA1c cutoff of 7%. Levels of micronutrients were measured from serum and categorized into normal and abnormal levels. RESULTS A total of 1118 participants (374 cases and 744 controls) were included with a mean age of 41.7 years (SD 9.9), of whom 53.9% were female. Of those with diabetes, 229 had controlled diabetes and 145 had uncontrolled diabetes. Compared to those without diabetes, participants with diabetes had significantly lower mean magnesium (0.80 mmol/L (SD 0.07) vs. 0.84 mmol/L (SD 0.06), respectively, p < 0.001). Lower magnesium and iron were observed in participants with uncontrolled compared to participants with controlled diabetes. After multivariable logistic regression, diabetes was associated with hypomagnesemia (OR 3.2, 95% CI 3.4-213.9) and low iron (OR 1.49, 95% CI 1.03-2.15). Uncontrolled diabetes showed stronger odds of association with hypomagnesemia (OR 5.57, 95% CI 3.65-8.52). CONCLUSION In an affluent setting in the MENA region, diabetes was associated with low magnesium and low iron, and this association was stronger in individuals with uncontrolled diabetes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tawanda Chivese
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (N.S.); (R.A.); (B.E.); (A.A.); (S.A.-A.); (A.A.-K.); (S.A.-M.); (M.N.)
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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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Segev A, Shechter M, Tsur AM, Belkin D, Cohen H, Sharon A, Morag NK, Grossman E, Maor E. Serum Magnesium Is Associated with Long-Term Survival of Non-ST-Elevation Myocardial Infarction Patients. Nutrients 2023; 15:4299. [PMID: 37836583 PMCID: PMC10574643 DOI: 10.3390/nu15194299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Low serum magnesium (sMg) is associated with cardiovascular risk factors and atherosclerotic disease. OBJECTIVE To evaluate the association between sMg levels on admission and clinical outcomes in hospitalized non-ST-elevation myocardial infarction (NSTEMI) patients. METHODS A retrospective analysis of all patients admitted to a single tertiary center with a primary diagnosis of NSTEMI. Patients with advanced chronic kidney disease were excluded. Clinical data were collected and compared between lower sMg quartile patients (Q1; sMg < 1.9 mg/dL) and all other patients (Q2-Q4; sMg ≥ 1.9 mg/dL). RESULTS The study cohort included 4552 patients (70% male, median age 69 [IQR 59-79]) who were followed for a median of 4.4 (IQR 2.4-6.6) years. The median sMg level in the low sMg group was 1.7 (1.6-1.8) and 2.0 (2.0-2.2) mg/dL in the normal/high sMg group. The low sMg group was older (mean of 72 vs. 67 years), less likely to be male (64% vs. 72%), and had higher rates of comorbidities, including diabetes, hypertension, and atrial fibrillation (59% vs. 29%, 92% vs. 85%, and 6% vs. 5%; p < 0.05 for all). Kaplan-Meier survival analysis demonstrated significantly higher cumulative death probability at 4 years in the low sMg group (34% vs. 22%; p log rank <0.001). In a multivariable analysis model adjusted for sex, significant comorbidities, coronary interventions during the hospitalization, and renal function, the low sMg group exhibited an independent 24% increased risk of death during follow up (95% CI 1.11-1.39; p < 0.001). CONCLUSIONS Low sMg is independently associated with higher risk of long-term mortality among patients recovering from an NSTEMI event.
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Affiliation(s)
- Amitai Segev
- The Leviev Cardiothoracic & Vascular Center, Sheba Medical Center, Ramat Gan 5262504, Israel; (M.S.); (E.M.)
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (D.B.); (H.C.); (E.G.)
| | - Michael Shechter
- The Leviev Cardiothoracic & Vascular Center, Sheba Medical Center, Ramat Gan 5262504, Israel; (M.S.); (E.M.)
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (D.B.); (H.C.); (E.G.)
| | - Avishai M. Tsur
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (D.B.); (H.C.); (E.G.)
- Department of Medicine, Sheba Medical Center, Ramat Gan 5262504, Israel
- Israel Defense Forces, Medical Corps, Ramat Gan 5262504, Israel
| | - David Belkin
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (D.B.); (H.C.); (E.G.)
| | - Hofit Cohen
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (D.B.); (H.C.); (E.G.)
- The Bert W. Strassburger Lipid Center, Sheba Medical Center, Ramat Gan 5262504, Israel
| | - Amir Sharon
- The Leviev Cardiothoracic & Vascular Center, Sheba Medical Center, Ramat Gan 5262504, Israel; (M.S.); (E.M.)
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (D.B.); (H.C.); (E.G.)
| | - Nira Koren Morag
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (D.B.); (H.C.); (E.G.)
| | - Ehud Grossman
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (D.B.); (H.C.); (E.G.)
- Department of Medicine, Sheba Medical Center, Ramat Gan 5262504, Israel
| | - Elad Maor
- The Leviev Cardiothoracic & Vascular Center, Sheba Medical Center, Ramat Gan 5262504, Israel; (M.S.); (E.M.)
- The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (D.B.); (H.C.); (E.G.)
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18
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Mamilla M, Yartha SGR, Tuli R, Konipineni S, Rayaprolu DT, Borgharkar G, Kalluru PKR, Thugu TR. Role of Magnesium in Diabetic Nephropathy for Better Outcomes. Cureus 2023; 15:e43076. [PMID: 37692668 PMCID: PMC10484355 DOI: 10.7759/cureus.43076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Diabetic nephropathy (DN) is a major cause of end-stage renal disease worldwide, resulting from uncontrolled diabetes. Oxidative stress plays a critical role in the pathophysiology of DN, leading to cellular damage and disease progression. Magnesium, an essential mineral, has emerged as a potential therapeutic agent due to its antioxidative, anti-inflammatory, and antifibrotic properties. An extensive literature search was conducted on Medline using the keywords "Diabetic nephropathy," "Magnesium," and "Chronic Kidney Disease," and the results published after 2000 were exclusively studied to build this review. This review aims to summarize the role of magnesium in DN and explore its therapeutic potential. Magnesium acts as a cofactor for antioxidant enzymes, directly scavenges reactive oxygen species, and enhances the expression of antioxidant proteins. Furthermore, magnesium exhibits anti-inflammatory effects by suppressing pro-inflammatory cytokine production and inhibiting inflammatory signaling pathways. Magnesium supplementation has been shown to reduce oxidative stress markers and improve antioxidant enzyme activities in clinical studies. Additionally, magnesium has been found to mitigate renal fibrosis, maintain tubular integrity and function, improve endothelial function, and modulate renal hemodynamics. Although limited clinical trials suggest the renoprotective effects of magnesium in DN, further research is needed to determine the optimal dosage, duration, and long-term effects of magnesium supplementation. Despite existing drawbacks and gaps in the literature, magnesium holds promise as adjunctive therapy for DN by targeting oxidative stress and preserving renal function.
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Affiliation(s)
- Mahesh Mamilla
- Internal Medicine, Sri Venkateswara Medical College, Tirupati, IND
| | | | - Richa Tuli
- Internal Medicine, School of Medicine, Xiamen University, Xiamen, CHN
| | - Sunil Konipineni
- Internal Medicine, Zaporizhzhia State Medical University, Zaporizhzhia, UKR
| | | | - Gargi Borgharkar
- Public Health, University of Alabama at Birmingham, Birmingham, USA
| | | | - Thanmai Reddy Thugu
- Internal Medicine, Sri Padmavathi Medical College for Women, Sri Venkateswara Institute of Medical Sciences, Tirupati, IND
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19
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Khajavi N, Riçku K, Schreier PCF, Gentz T, Beyerle P, Cruz E, Breit A, Reinach PS, Gudermann T. Chronic Mg 2+ Deficiency Does Not Impair Insulin Secretion in Mice. Cells 2023; 12:1790. [PMID: 37443824 PMCID: PMC10340716 DOI: 10.3390/cells12131790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Magnesium is an essential mediator of a vast number of critical enzymatic cellular reactions in the human body. Some clinical epidemiological studies suggest that hypomagnesemia accounts for declines in insulin secretion in patients with type 2 diabetes (T2D); however, the results of various experimental studies do not support this notion. To address this discrepancy, we assessed the short- and long-term effects of hypomagnesemia on β-cell function and insulin secretion in primary mouse islets of Langerhans and in a mouse model of hypomagnesemia known as Trpm6Δ17 /fl;Villin1-Cre mice. We found that lowering the extracellular Mg2+ concentration from 1.2 mM to either 0.6 or 0.1 mM remarkably increased glucose-induced insulin secretion (GIIS) in primary islets isolated from C57BL/6 mice. Similarly, both the plasma insulin levels and GIIS rose in isolated islets of Trpm6Δ17 /fl;Villin1-Cre mice. We attribute these rises to augmented increases in intracellular Ca2+ oscillations in pancreatic β-cells. However, the glycemic metabolic profile was not impaired in Trpm6Δ17 /fl;Villin1-Cre mice, suggesting that chronic hypomagnesemia does not lead to insulin resistance. Collectively, the results of this study suggest that neither acute nor chronic Mg2+ deficiency suppresses glucose-induced rises in insulin secretion. Even though hypomagnesemia can be symptomatic of T2D, such deficiency may not account for declines in insulin release in this disease.
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Affiliation(s)
- Noushafarin Khajavi
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, 80539 Munich, Germany; (K.R.); (P.C.F.S.); (T.G.); (P.B.); (E.C.); (A.B.)
| | - Klea Riçku
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, 80539 Munich, Germany; (K.R.); (P.C.F.S.); (T.G.); (P.B.); (E.C.); (A.B.)
| | - Pascale C. F. Schreier
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, 80539 Munich, Germany; (K.R.); (P.C.F.S.); (T.G.); (P.B.); (E.C.); (A.B.)
| | - Tanja Gentz
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, 80539 Munich, Germany; (K.R.); (P.C.F.S.); (T.G.); (P.B.); (E.C.); (A.B.)
| | - Philipp Beyerle
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, 80539 Munich, Germany; (K.R.); (P.C.F.S.); (T.G.); (P.B.); (E.C.); (A.B.)
| | - Emmanuel Cruz
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, 80539 Munich, Germany; (K.R.); (P.C.F.S.); (T.G.); (P.B.); (E.C.); (A.B.)
| | - Andreas Breit
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, 80539 Munich, Germany; (K.R.); (P.C.F.S.); (T.G.); (P.B.); (E.C.); (A.B.)
| | - Peter S. Reinach
- Ophthalmology Department, Wenzhou Medical University, Wenzhou 325015, China;
| | - Thomas Gudermann
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, 80539 Munich, Germany; (K.R.); (P.C.F.S.); (T.G.); (P.B.); (E.C.); (A.B.)
- German Center for Lung Research, 81377 Munich, Germany
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20
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Segev A, Sagir A, Matetzky S, Segev A, Atar S, Shechter M. Admission Serum Magnesium Levels Is Associated with Short and Long-Term Clinical Outcomes in COVID-19 Patients. Nutrients 2023; 15:2016. [PMID: 37432174 PMCID: PMC10180728 DOI: 10.3390/nu15092016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND In the face of the global pandemic that the coronavirus disease 2019 (COVID-19) has created, readily available prognostic markers may be of great use. OBJECTIVE To evaluate the association between serum magnesium (sMg) levels on admission and clinical outcomes in hospitalized COVID-19 patients. METHODS We retrospectively analyzed all patients admitted to a single tertiary center with a primary de novo diagnosis of COVID-19. Patients were followed for a mean of 10 ± 7 months. Demographic, clinical and laboratory data were collected and compared between five groups of patients according to sMg quintiles on hospital admission. RESULTS The cohort included 1522 patients (58% male, 69 ± 17 years old). A low sMg level (1st quintile) was associated with higher rates of diabetes and steroid use, whereas a high sMg level (5th quintile) was associated with dyslipidemia, renal dysfunction, higher levels of inflammatory markers and stay in the intensive care unit. All-cause in-hospital and long-term mortality was higher in patients with both low and high sMg levels, compared with mid-range sMg levels (2nd, 3rd and 4th quintiles; 19% and 30% vs. 9.5%, 10.7% and 17.8% and 35% and 45.3% vs. 23%, 26.8% and 27.3% respectively; p < 0.001 for all). After adjusting for significant clinical parameters indicating severe disease and renal dysfunction, only low sMg state was independently associated with increased mortality (HR = 1.57, p < 0.001). CONCLUSIONS Both low and high sMg levels were associated with increased mortality in a large cohort of hospitalized COVID-19 patients. However, after correction for renal dysfunction and disease severity, only low sMg maintained its prognostic ability.
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Affiliation(s)
- Amitai Segev
- The Leviev Cardiothoracic & Vascular Center, Chaim Sheba Medical Center, Ramat Gan 5236723, Israel; (S.M.); (A.S.); (M.S.)
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Adam Sagir
- Cardiovascular Division, Galilee Medical Center, Nahariya 2210001, Israel; (A.S.); (S.A.)
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan 5290002, Israel
| | - Shlomi Matetzky
- The Leviev Cardiothoracic & Vascular Center, Chaim Sheba Medical Center, Ramat Gan 5236723, Israel; (S.M.); (A.S.); (M.S.)
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Amit Segev
- The Leviev Cardiothoracic & Vascular Center, Chaim Sheba Medical Center, Ramat Gan 5236723, Israel; (S.M.); (A.S.); (M.S.)
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shaul Atar
- Cardiovascular Division, Galilee Medical Center, Nahariya 2210001, Israel; (A.S.); (S.A.)
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan 5290002, Israel
| | - Michael Shechter
- The Leviev Cardiothoracic & Vascular Center, Chaim Sheba Medical Center, Ramat Gan 5236723, Israel; (S.M.); (A.S.); (M.S.)
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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21
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Bonilla M, Workeneh BT, Uppal NN. Hypomagnesemia in Patients With Cancer: The Forgotten Ion. Semin Nephrol 2023; 42:151347. [PMID: 37086496 DOI: 10.1016/j.semnephrol.2023.151347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
Abstract
Magnesium is crucial for various cellular and enzymatic processes, yet it often is overlooked or underappreciated. Hypomagnesemia, a deficiency of magnesium in the blood, is a frequent problem in cancer patients and can lead to severe symptoms and morbidity. In this review, we provide an in-depth analysis of the physiology and regulation of magnesium, and signs and symptoms of hypomagnesemia in cancer patients. We also examine the causes and mechanisms of magnesium imbalances in cancer patients, specifically focusing on cancer-specific therapies that can lead to hypomagnesemia. Finally, we provide updates on the management of hypomagnesemia, including oral and parenteral supplementation, as well as the role of drugs in cases that are resistant to treatment. This review aims to raise awareness among health care providers caring for cancer patients about the significance of monitoring magnesium levels in cancer patients and function as a guide. Future clinical studies should focus on magnesium monitoring, its impact on cancer progression, and its potential for preventing acute kidney injury.
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Affiliation(s)
- Marco Bonilla
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL
| | - Biruh T Workeneh
- Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nupur N Uppal
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY.
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22
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Ray E, Mohan K, Ahmad S, Wolf MTF. Physiology of a Forgotten Electrolyte-Magnesium Disorders. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:148-163. [PMID: 36868730 DOI: 10.1053/j.akdh.2022.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/26/2022] [Accepted: 12/06/2022] [Indexed: 03/05/2023]
Abstract
Magnesium (Mg2+) is the second most common intracellular cation and the fourth most abundant element on earth. However, Mg2+ is a frequently overlooked electrolyte and often not measured in patients. While hypomagnesemia is common in 15% of the general population, hypermagnesemia is typically only found in preeclamptic women after Mg2+ therapy and in patients with ESRD. Mild to moderate hypomagnesemia has been associated with hypertension, metabolic syndrome, type 2 diabetes mellitus, CKD, and cancer. Nutritional Mg2+ intake and enteral Mg2+ absorption are important for Mg2+ homeostasis, but the kidneys are the key regulators of Mg2+ homeostasis by limiting urinary excretion to less than 4% while the gastrointestinal tract loses over 50% of the Mg2+ intake in the feces. Here, we review the physiological relevance of Mg2+, the current knowledge of Mg2+ absorption in the kidneys and the gut, the different causes of hypomagnesemia, and a diagnostic approach on how to assess Mg2+ status. We highlight the latest discoveries of monogenetic conditions causing hypomagnesemia, which have enhanced our understanding of tubular Mg2+ absorption. We will also discuss external and iatrogenic causes of hypomagnesemia and advances in the treatment of hypomagnesemia.
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Affiliation(s)
- Evan Ray
- Renal-Electrolyte Division, Department of Internal Medicine, University of Pittsburgh, PA
| | - Krithika Mohan
- Department of Nephrology, Hosmat Hospital, HBR Layout, Bangalore, India
| | - Syeda Ahmad
- Renal-Electrolyte Division, Department of Internal Medicine, University of Pittsburgh, PA
| | - Matthias T F Wolf
- Pediatric Nephrology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
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23
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Abstract
Mg2+ is essential for many cellular and physiological processes, including muscle contraction, neuronal activity, and metabolism. Consequently, the blood Mg2+ concentration is tightly regulated by balanced intestinal Mg2+ absorption, renal Mg2+ excretion, and Mg2+ storage in bone and soft tissues. In recent years, the development of novel transgenic animal models and identification of Mendelian disorders has advanced our current insight in the molecular mechanisms of Mg2+ reabsorption in the kidney. In the proximal tubule, Mg2+ reabsorption is dependent on paracellular permeability by claudin-2/12. In the thick ascending limb of Henle's loop, the claudin-16/19 complex provides a cation-selective pore for paracellular Mg2+ reabsorption. The paracellular Mg2+ reabsorption in this segment is regulated by the Ca2+-sensing receptor, parathyroid hormone, and mechanistic target of rapamycin (mTOR) signaling. In the distal convoluted tubule, the fine tuning of Mg2+ reabsorption takes place by transcellular Mg2+ reabsorption via transient receptor potential melastatin-like types 6 and 7 (TRPM6/TRPM7) divalent cation channels. Activity of TRPM6/TRPM7 is dependent on hormonal regulation, metabolic activity, and interacting proteins. Basolateral Mg2+ extrusion is still poorly understood but is probably dependent on the Na+ gradient. Cyclin M2 and SLC41A3 are the main candidates to act as Na+/Mg2+ exchangers. Consequently, disturbances of basolateral Na+/K+ transport indirectly result in impaired renal Mg2+ reabsorption in the distal convoluted tubule. Altogether, this review aims to provide an overview of the molecular mechanisms of Mg2+ reabsorption in the kidney, specifically focusing on transgenic mouse models and human hereditary diseases.
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Affiliation(s)
- Jeroen H F de Baaij
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
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24
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Khajavi N, Beck A, Riçku K, Beyerle P, Jacob K, Syamsul SF, Belkacemi A, Reinach PS, Schreier PC, Salah H, Popp T, Novikoff A, Breit A, Chubanov V, Müller TD, Zierler S, Gudermann T. TRPM7 kinase is required for insulin production and compensatory islet responses during obesity. JCI Insight 2023; 8:163397. [PMID: 36574297 PMCID: PMC9977431 DOI: 10.1172/jci.insight.163397] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Most overweight individuals do not develop diabetes due to compensatory islet responses to restore glucose homeostasis. Therefore, regulatory pathways that promote β cell compensation are potential targets for treatment of diabetes. The transient receptor potential cation channel subfamily M member 7 protein (TRPM7), harboring a cation channel and a serine/threonine kinase, has been implicated in controlling cell growth and proliferation. Here, we report that selective deletion of Trpm7 in β cells disrupted insulin secretion and led to progressive glucose intolerance. We indicate that the diminished insulinotropic response in β cell-specific Trpm7-knockout mice was caused by decreased insulin production because of impaired enzymatic activity of this protein. Accordingly, high-fat-fed mice with a genetic loss of TRPM7 kinase activity displayed a marked glucose intolerance accompanied by hyperglycemia. These detrimental glucoregulatory effects were engendered by reduced compensatory β cell responses because of mitigated protein kinase B (AKT)/ERK signaling. Collectively, our data identify TRPM7 kinase as a potentially novel regulator of insulin synthesis, β cell dynamics, and glucose homeostasis under obesogenic diet.
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Affiliation(s)
- Noushafarin Khajavi
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, Munich, Germany
| | - Andreas Beck
- Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University, Homburg, Germany
| | - Klea Riçku
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, Munich, Germany
| | - Philipp Beyerle
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, Munich, Germany
| | - Katharina Jacob
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, Munich, Germany
| | - Sabrina F. Syamsul
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, Munich, Germany
| | - Anouar Belkacemi
- Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University, Homburg, Germany
| | - Peter S. Reinach
- Wenzhou Medical University, Ophthalmology Department, Wenzhou, China
| | - Pascale C.F. Schreier
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, Munich, Germany
| | - Houssein Salah
- Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University, Homburg, Germany
| | - Tanja Popp
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Aaron Novikoff
- Institute of Diabetes and Obesity, Helmholtz Center Munich, Neuherberg, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Andreas Breit
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, Munich, Germany
| | - Vladimir Chubanov
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, Munich, Germany
| | - Timo D. Müller
- Institute of Diabetes and Obesity, Helmholtz Center Munich, Neuherberg, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Susanna Zierler
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, Munich, Germany.,Institute of Pharmacology, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Gudermann
- Walther Straub Institute of Pharmacology and Toxicology, LMU Munich, Munich, Germany.,German Center for Lung Research, Munich, Germany
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25
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Impact of magnesium sulfate therapy in improvement of renal functions in high fat diet-induced diabetic rats and their offspring. Sci Rep 2023; 13:2273. [PMID: 36755074 PMCID: PMC9908981 DOI: 10.1038/s41598-023-29540-w] [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: 07/25/2022] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
The role of magnesium sulfate (MgSO4) administration to prevent diabetic nephropathy (DN) by reducing insulin resistance (IR) and the relationship of this action with gender and the expression of NOX4 and ICAM1 genes in the parents and their offspring were studied. Males and females rat, and their pups were used. Type 2 diabetes induced by high-fat diet (HFD) administration and a low dose of streptozotocin. Animals were divided into the: non-treated diabetic (DC), the diabetic group received insulin (Ins), and the diabetic group received MgSO4. Two groups of parents received just a normal diet (NDC). Following each set of parents for 16 weeks and their pups for 4 months, while eating normally. We assessed the amount of water consumed, urine volume, and blood glucose level. The levels of glucose, albumin, and creatinine in the urine were also measured, as well as the amounts of sodium, albumin, and creatinine in the serum. Calculations were made for glomerular filtration rate (GFR) and the excretion rates of Na and glucose fractions (FE Na and FE G, respectively). The hyperinsulinemic-euglycemic clamp was done. NOX4 and ICAM1 gene expressions in the kidney were also measured. MgSO4 or insulin therapy decreased blood glucose, IR, and improved GFR, FE Na, and FE G in both parents and their offspring compared to D group. MgSO4 improved NOX4 and ICAM1 gene expressions in the parents and their offspring compared to D group. Our results indicated that MgSO4 could reduce blood glucose levels and insulin resistance, and it could improve kidney function.
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26
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Xu M, Cai J, Mo X, Liu Q, Zhang J, Wei Y, Liu S, Lin Y, Huang S, Mo C, Mai T, Tan D, Zhang Z, Qin J. Association of Dietary and Plasma Magnesium with Glycaemic Markers in a Chinese Population. Biol Trace Elem Res 2023; 201:549-558. [PMID: 35294745 DOI: 10.1007/s12011-022-03172-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/18/2022] [Indexed: 01/21/2023]
Abstract
Certain metals play a role in the pathogenesis of diabetes. This study aimed to investigate the potential association of plasma magnesium (Mg) and dietary intake of Mg with glycaemic markers. A cross-sectional study was conducted on 2373 subjects in Guangxi, China. Dietary Mg was obtained through a food frequency questionnaire containing 109 common foods. Plasma Mg concentration was determined by inductively coupled plasma mass spectrometry. Multiple linear regression combined with multivariable restricted cubic spline (RCS) functions was applied to evaluate the association of plasma Mg and dietary Mg with haemoglobin A1c (HbA1c) and fasting plasma glucose (FPG). In linear regression, dietary Mg was significantly associated with FPG in the overall population (β = - 0.087, P < 0.05) and in women (β = - 0.098, P < 0.05). Plasma Mg was significantly associated with FPG in the overall population (β = - 0.096, P < 0.05) and in men (β = - 0.110, P < 0.05) and women (β = - 0.088, P < 0.05). In the RCS model, no non-linear association was found between dietary and plasma Mg and HbA1c levels. Dietary and plasma Mg are significantly negatively associated with fasting glucose.
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Affiliation(s)
- Min Xu
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Jiansheng Cai
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin, 541004, Guangxi, China
| | - Xiaoting Mo
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Qiumei Liu
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Junling Zhang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Yanfei Wei
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Shuzhen Liu
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Yinxia Lin
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Shenxiang Huang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Chunbao Mo
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, 541004, Guangxi, China
| | - Tingyu Mai
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, 541004, Guangxi, China
| | - Dechan Tan
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, 541004, Guangxi, China
| | - Zhiyong Zhang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, 541004, Guangxi, China.
| | - Jian Qin
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
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27
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MM S, JS N, M BC, AP M, MJ F, F M, MJ F, D S, J P, V G, E L, A V, P F, D C. Higher magnesium levels are associated with better glycaemic control and diabetes remission post-bariatric surgery. BMC Endocr Disord 2022; 22:303. [PMID: 36471364 PMCID: PMC9724332 DOI: 10.1186/s12902-022-01210-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Low Magnesium (Mg) dietary intake has been associated with increased risk of type 2 diabetes mellitus (T2DM). Furthermore, in patients with T2DM, hypomagnesemia is associated with worst glycaemic control. Bariatric surgery (BS) remains the most effective treatment in severe obesity and also provides resolution/improvement of T2DM. Our aim is to evaluate the association between Mg supplementation post-BS and Mg serum levels with diabetes status after BS. METHODS We performed an observational study on patients with obesity and T2DM who underwent BS. Data was assessed pre-BS and one-year post-BS. RESULTS We included a total of 403 patients with T2DM. At baseline, 43.4% of the patients had Mg deficiency. Pre-BS, patients with Mg deficiency had poorer glycaemic control - HbA1c 7.2 ± 1.6% vs 6.4 ± 1.0% (p < 0.001), fasting plasma glucose 146.2 ± 58.8 mg/dL vs 117.5 ± 36.6 mg/dL (p < 0.001) and were under a greater number of anti-diabetic drugs 1.0 (IQR 0-2.0) vs 1.0 (IQR 0-1.0) (p = 0.002). These findings persisted at one-year post-BS. At the first-year post-BS, 58.4% of the patients had total remission of T2DM and 4.1% had partial remission. Patients without Mg deficiency at one-year post-BS had higher rates of total and partial remission. Higher serum Mg levels at baseline is an independent predictor of total T2DM remission (p < 0.0001). The optimal cut-off of baseline Mg to predict total T2DM remission was 1.50 mg/dL with a sensitivity of 73% and a specificity of 58% (area under ROC = 0.65). Patients that were under Mg supplementation post-BS had serum Mg values, glycaemic control and total remission of T2DM similar to patients non-supplemented. CONCLUSION In patients with T2DM submitted to BS, higher Mg serum levels at baseline and 1-year after BS were associated with better glycaemic control and higher rates of total T2DM remission at the first year post-BS.
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Affiliation(s)
- Silva MM
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Neves JS
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
- Departamento de Cirurgia E Fisiologia, Faculdade de Medicina da Universidade Do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Borges-Canha M
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
- Departamento de Cirurgia E Fisiologia, Faculdade de Medicina da Universidade Do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Mendes AP
- Medical and Performance Department, Sporting Clube de Portugal, Estrada da Malhada de Meias, Barroca d’Alva, 2890-529 Lisboa, Portugal
| | - Fonseca MJ
- Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal
| | - Mendonça F
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Ferreira MJ
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Salazar D
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Pedro J
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Guerreiro V
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Lau E
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Varela A
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Freitas P
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
| | - Carvalho D
- Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Investigação E Inovação Em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal
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Albaker WI, Al-Hariri MT, Al Elq AH, Alomair NA, Alamoudi AS, Voutchkov N, Ihm S, Namazi MA, Alsayyah AA, AlRubaish FA, Alohli FT, Zainuddin FA, Alobaidi AA, Almuzain FA, Elamin MO, Alamoudi NB, Alamer MA, Alghamdi AA, AlRubaish NA. Beneficial effects of adding magnesium to desalinated drinking water on metabolic and insulin resistance parameters among patients with type 2 diabetes mellitus: a randomized controlled clinical trial. NPJ CLEAN WATER 2022; 5:63. [PMID: 36408199 PMCID: PMC9660218 DOI: 10.1038/s41545-022-00207-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
There is evidence that increasing the consumption of water containing magnesium can improve glucose metabolism and insulin resistance in patients with type 2 diabetes mellitus (T2DM). This trial was undertaken with the objective of evaluating the effect of adding different concentrations of magnesium chloride to the desalinated drinking water on the glycemic, metabolic, and insulin resistance parameters among patients with T2DM. A randomized cross-sectional controlled clinical trial was conducted to evaluate the effects of adding magnesium chloride supplement to desalinated drinking water consumed by patients with T2DM on the glycemic and metabolic parameters and indicators of insulin sensitivity. The total number of patients with T2DM who successfully completed the trial is 102. Patients were randomly allocated into three groups: the first group received bottled water without added magnesium (0 mg/L) (Group A, n = 37); the second group received bottled water with a low level of magnesium (20 mg/L) (Group B, n = 33); and the third group received drinking water with a high level of magnesium (50 mg/L) (Group C, n = 32). The daily consumption of elemental magnesium for a period of 3 months resulted in significant improvement in HbA1C (8.0 vs 8.2%, p = 0.04), insulin level (7.5 vs 9.9 μIU/mL, p = 0.03), and homeostasis model assessment-estimated insulin resistance (HOMA.IR) (2.5 vs 2.9, p = 0.002) in group C. However, there was no significant improvement in fasting blood glucose (FBS) level or lipid profile. The results of this study suggest that oral magnesium supplementation at the given dose of 50 mg/L daily added to drinking water could improve long-term glycemic control indicators and reduce insulin resistance in patients with T2DM.
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Affiliation(s)
- Waleed I. Albaker
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province Saudi Arabia
| | - Mohammed T. Al-Hariri
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province Saudi Arabia
| | - Abdulmohsen H. Al Elq
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province Saudi Arabia
| | - Nuhad A. Alomair
- Department of Chemistry, Science College, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province Saudi Arabia
| | - Ahmed S. Alamoudi
- Desalination Technologies Research Institute, Saline Water Conversation Corporation, Riyadh, Saudi Arabia
| | - Nikalay Voutchkov
- Desalination Technologies Research Institute, Saline Water Conversation Corporation, Riyadh, Saudi Arabia
| | - Seungwon Ihm
- Desalination Technologies Research Institute, Saline Water Conversation Corporation, Riyadh, Saudi Arabia
| | - Mohammed A. Namazi
- Desalination Technologies Research Institute, Saline Water Conversation Corporation, Riyadh, Saudi Arabia
| | - Ahmed A. Alsayyah
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province Saudi Arabia
| | - Fatima A. AlRubaish
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province Saudi Arabia
| | - Fadwa T. Alohli
- Department of Family Medicine, Armed Forces Hospital, Dhahran, Eastern Province Saudi Arabia
| | - Fatma A. Zainuddin
- Department of Medical Allied Services, Imam Abdulrahman Bin Faisal University -King Fahd Hospital of the University Eastern Province, Dammam, Saudi Arabia
| | - Anwar A. Alobaidi
- Department of Medical Allied Services, Imam Abdulrahman Bin Faisal University -King Fahd Hospital of the University Eastern Province, Dammam, Saudi Arabia
| | - Fatimah A. Almuzain
- Department of Medical Allied Services, Imam Abdulrahman Bin Faisal University -King Fahd Hospital of the University Eastern Province, Dammam, Saudi Arabia
| | - Mohamed O. Elamin
- Department of Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province Saudi Arabia
| | - Naela B. Alamoudi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province Saudi Arabia
- Present Address: Emergency Medicine Department, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Eastern Province Saudi Arabia
| | - Mashael A. Alamer
- Intern, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province Saudi Arabia
| | - Abdulrahman A. Alghamdi
- Intern, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province Saudi Arabia
| | - Nafie A. AlRubaish
- Intern, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province Saudi Arabia
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Oost LJ, Tack CJ, de Baaij JHF. Hypomagnesemia and Cardiovascular Risk in Type 2 Diabetes. Endocr Rev 2022; 44:357-378. [PMID: 36346820 PMCID: PMC10166267 DOI: 10.1210/endrev/bnac028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/22/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
Hypomagnesemia is tenfold more common in individuals with type 2 diabetes (T2D), compared to the healthy population. Factors that are involved in this high prevalence are low Mg2+ intake, gut microbiome composition, medication use and presumably genetics. Hypomagnesemia is associated with insulin resistance, which subsequently increases the risk to develop T2D or deteriorates glycaemic control in existing diabetes. Mg2+ supplementation decreases T2D associated features like dyslipidaemia and inflammation; which are important risk factors for cardiovascular disease (CVD). Epidemiological studies have shown an inverse association between serum Mg2+ and the risk to develop heart failure (HF), atrial fibrillation (AF) and microvascular disease in T2D. The potential protective effect of Mg2+ on HF and AF may be explained by reduced oxidative stress, fibrosis and electrical remodeling in the heart. In microvascular disease, Mg2+ reduces the detrimental effects of hyperglycemia and improves endothelial dysfunction. Though, clinical studies assessing the effect of long-term Mg2+ supplementation on CVD incidents are lacking and gaps remain on how Mg2+ may reduce CVD risk in T2D. Despite the high prevalence of hypomagnesemia in people with T2D, routine screening of Mg2+ deficiency to provide Mg2+ supplementation when needed is not implemented in clinical care as sufficient clinical evidence is lacking. In conclusion, hypomagnesemia is common in people with T2D and is both involved as cause, probably through molecular mechanisms leading to insulin resistance, and consequence and is prospectively associated with development of HF, AF and microvascular complications. Whether long-term supplementation of Mg2+ is beneficial, however, remains to be determined.
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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
| | - Cees J Tack
- Department of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, 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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Hamarshih M, Hamshari S, Nazzal Z, Snobar F, Mletat R, Abu-Mazen O, Maraqa B. Hypomagnesemia and Poor Glycemic Control among Type 2 Diabetic Patients: A Cross-Sectional Study. Indian J Endocrinol Metab 2022; 26:575-580. [PMID: 39005513 PMCID: PMC11245293 DOI: 10.4103/ijem.ijem_213_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/09/2022] [Accepted: 11/20/2022] [Indexed: 02/05/2023] Open
Abstract
Background/Aim Hypomagnesaemia has been shown to have a significant impact on both glycaemic control and diabetes complications in type 2 diabetes mellitus (T2DM) patients. This study aims to assess the prevalence of hypomagnesaemia in T2DM patients and find the association between serum magnesium levels and outcomes relevant to glycaemic control and diabetic complications in primary care unit. Methods A cross-sectional study was conducted and included 373 patients (222 males and 151 females) from primary care unit. Serum magnesium levels were measured by the colorimetric endpoint method using the Cobas C501 system. Hypomagnesaemia was determined to be a serum magnesium level <1.6 mg/dL. In addition, the following data was also obtained: patients' characteristics, anthropometric measurements, smoking status, HbA1c, comorbidities and therapeutic management. Results Patients' mean age was 56.2 ± 10.8 years, 24.6% were smokers, and most were overweight or obese. About 60% have a history of hypertension, and the majority have had diabetes for more than 10 years. Their mean HbA1c level was 8.5 ± 2%. The prevalence of hypomagnesaemia was 11% (95% CI: 8%-14.6%). It was found to be significantly higher among females (adjusted OR: 2.7, 95%CI: 1.2%-5.8%), patients with HbA1c ≥8% (adjusted OR: 2.4, 95%CI: 1.1%-5.5%) and patients with a history of diabetic retinopathy (adjusted OR: 2.7, 95%CI: 1.1%-7.1%). Conclusion The study showed that hypomagnesaemia is more prevalent in females and is associated with diabetic retinopathy and poor glycaemic control. Having a sufficient magnesium level may be associated with better glycaemic control and a reduced occurrence of complications.
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Affiliation(s)
- Mohammad Hamarshih
- Consultant Family Medicine, and Diabetology, Palestine Diabetes Institute, Ramallah, Palestine
| | - Suha Hamshari
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Zaher Nazzal
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Farha Snobar
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Rawa Mletat
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Ola Abu-Mazen
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Salehidoost R, Taghipour Boroujeni G, Feizi A, Aminorroaya A, Amini M. Effect of oral magnesium supplement on cardiometabolic markers in people with prediabetes: a double blind randomized controlled clinical trial. Sci Rep 2022; 12:18209. [PMID: 36307427 PMCID: PMC9616938 DOI: 10.1038/s41598-022-20277-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/12/2022] [Indexed: 12/31/2022] Open
Abstract
To evaluate the effect of magnesium supplementation on insulin resistance and cardiovascular markers in people with prediabetes. A 12 week double-blind placebo-controlled randomized clinical trial was conducted at Isfahan Endocrine and Metabolism Research Center, Iran, on people with prediabetes (n = 86) to compare the effects of magnesium oxide 250 mg/day versus a placebo on anthropometric indices, blood pressure, fasting glucose, insulin, HOMA-IR index, C-reactive protein, uric acid and lipid profile. Both groups had similar distributions of anthropometric and biochemical variables at baseline. Those who received magnesium supplementation had significantly higher levels of HDL-cholesterol compared to the placebo group at the end of the study (49.7 ± 10.9 vs 43.6 ± 7.2 mg/dL, P = 0.003). The mean changes of HOMA-IR index, total cholesterol, LDL-cholesterol, triglyceride, uric acid and C-reactive protein levels as well as anthropometric indices and blood pressure in supplemented and placebo groups did not differ significantly. Magnesium supplementation increased HDL-cholesterol levels in people with prediabetes. However, other cardiometabolic markers were not improved by magnesium supplementation at the above dosage and duration.
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Affiliation(s)
- Rezvan Salehidoost
- grid.411036.10000 0001 1498 685XIsfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Golshan Taghipour Boroujeni
- grid.440800.80000 0004 0382 5622Internal Medicine Department, Medical University of Shahrekord, Shahrekord, Iran
| | - Awat Feizi
- grid.411036.10000 0001 1498 685XBiostatistics and Epidemiology Department, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Aminorroaya
- grid.411036.10000 0001 1498 685XIsfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, 8187698191 Iran
| | - Masoud Amini
- grid.411036.10000 0001 1498 685XIsfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, 8187698191 Iran
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Pulido Perez P, Póndigo de los Angeles JA, Perez Peralta A, Ramirez Mojica E, Torres Rasgado E, Hernandez-Hernandez ME, Romero JR. Reduction in Serum Magnesium Levels and Renal Function Are Associated with Increased Mortality in Obese COVID-19 Patients. Nutrients 2022; 14:nu14194054. [PMID: 36235704 PMCID: PMC9571102 DOI: 10.3390/nu14194054] [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: 08/25/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
Several studies provide evidence that obesity is a significant risk factor for adverse outcomes in coronavirus disease 2019 (COVID-19). Altered renal function and disturbances in magnesium levels have been reported to play important pathophysiological roles in COVID-19. However, the relationship between obesity, renal function, circulating magnesium levels, and mortality in patients with COVID-19 remains unclear. In this retrospective cohort study, we characterized 390 hospitalized patients with COVID-19 that were categorized according to their body mass index (BMI). Patients were clinically characterized and biochemical parameters, renal function, and electrolyte markers measured upon admission. We found that in patients who died, BMI was associated with reduced estimated glomerular filtration rate (eGFR, Rho: −0.251, p = 0.001) and serum magnesium levels (Rho: −0.308, p < 0.0001). Multiple linear regression analyses showed that death was significantly associated with obesity (p = 0.001). The Cox model for obese patients showed that magnesium levels were associated with increased risk of death (hazard ratio: 0.213, 95% confidence interval: 0.077 to 0.586, p = 0.003). Thus, reduced renal function and lower magnesium levels were associated with increased mortality in obese COVID-19 patients. These results suggest that assessment of kidney function, including magnesium levels, may assist in developing effective treatment strategies to reduce mortality among obese COVID-19 patients.
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Affiliation(s)
- Patricia Pulido Perez
- Faculty of Medicine, Autonomous University of Puebla, 13 Sur 2901 Col. Volcanes, Puebla 72420, Mexico
| | | | - Alonso Perez Peralta
- Internal Medicine Department, University Hospital of Puebla, Mexico. Av 27 Poniente, Los Volcanes, Puebla 72410, Mexico
| | - Eloisa Ramirez Mojica
- Internal Medicine Department, University Hospital of Puebla, Mexico. Av 27 Poniente, Los Volcanes, Puebla 72410, Mexico
| | - Enrique Torres Rasgado
- Faculty of Medicine, Autonomous University of Puebla, 13 Sur 2901 Col. Volcanes, Puebla 72420, Mexico
- Correspondence: ; Tel.: +52-(222)-229-5500; Fax: +52-(222)-240-5032
| | - Maria Elena Hernandez-Hernandez
- Faculty of Medicine, Autonomous University of Puebla, 13 Sur 2901 Col. Volcanes, Puebla 72420, Mexico
- Doctorate in Biological Science, Autonomous University of Tlaxcala, La Loma Xicohtencatl, Tlaxcala 90070, Mexico
| | - Jose R. Romero
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Xiang X, Ji Z, Jiang T, Huang Z, Yan J. Reduced serum magnesium is associated with the occurrence of diabetic macular edema in patients with diabetic retinopathy: A retrospective study. Front Med (Lausanne) 2022; 9:923282. [PMID: 36203780 PMCID: PMC9530391 DOI: 10.3389/fmed.2022.923282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Serum magnesium levels have been reported to reflect the risk of diabetic retinopathy (DR); however, the effect of serum magnesium level on diabetic macular edema (DME) remains unclear. Here, we investigated the association between the serum magnesium levels and DME in patients with DR. Patients with DR were recruited between January 2018 and June 2021. A total of 519 such patients were included in this study. All patients underwent a standardized clinical ophthalmic examination by an experienced ophthalmologist, and an assay was conducted to determine the serum magnesium concentration. Compared with the non-DME group, the DME group had a higher proportion of insulin use and a higher level of serum ischemia-modified albumin and fasting plasma glucose. The serum magnesium and calcium levels were lower in the DME group than in the non-DME group (P < 0.05). Higher magnesium levels were negatively associated with DME after adjustment for relevant covariates. Compared with the participants in the lowest magnesium quartile, those in the fourth quartile showed a significantly lower risk of DME after adjustment [odds ratio (OR), 0.294; 95% confidence interval, 0.153–0.566; P < 0.0001]. Considering the potentially different effects of serum magnesium on the development of DME in patients with DR based on age, DR staging and insulin use, stratified analysis was performed by considering these factors. Among insulin-using patients with non-proliferative DR who were < 66 years of age, those in the third and fourth quartile of serum magnesium were less likely to develop DME than those in the lowest quartile of serum magnesium [OR (95% CI), 0.095 (0.014–0.620), 0.057 (0.011–0.305); P = 0.014, 0.001]. Overall, a higher serum magnesium level was associated with a lower risk of DME in patients with DR. Furthermore, patients with DR who used insulin were more likely to develop DME. Long-term studies on oral magnesium supplements are needed to determine whether maintaining the serum magnesium levels in a higher physiological range can reduce the risk of DME in patients with DR.
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Affiliation(s)
- Xiaoli Xiang
- Department of Ophthalmology, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, China
| | - Zijia Ji
- Department of Ultrasonography, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, China
| | - Tingwang Jiang
- Department of Key Laboratory, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, China
| | - Zhengru Huang
- Department of Ophthalmology, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, China
- *Correspondence: Zhengru Huang,
| | - Jing Yan
- School of Health Service Management, Anhui Medical University, Hefei, China
- Jing Yan,
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Magnesium Supplementation Is Associated with a Lower Cardio-Metabolic Risk in Patients Submitted to Bariatric Surgery. Obes Surg 2022; 32:3056-3063. [PMID: 35864288 DOI: 10.1007/s11695-022-06207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Literature has demonstrated an inverse relation between magnesium (Mg) consumption and development of type 2 diabetes mellitus (T2DM), hypertension (HT), and dyslipidemia. After bariatric surgery (BS), micronutrients deficiencies are common, it being important to ensure appropriate supplementation. There is no recommendation about Mg supplementation and to our knowledge, its effect has not been studied to date. Our aim was to evaluate the effect of Mg supplementation in cardio-metabolic risk factors on post-bariatric patients. MATERIALS AND METHODS A retrospective observational study of patients with obesity who underwent BS was performed. Data was assessed preoperatively and yearly (4-year follow-up). RESULTS A total of 3363 patients were included. In the first year of follow-up, 79.8% (n = 2123) of the patients were supplemented with Mg, with evidence of slightly decreased percentages in the following years. Mg deficiency (serum Mg < 1.52 mEq/L) was more common among patients who were not supplemented during each year of follow-up (p < 0.05). Among those who underwent Mg supplementation, the percentage of T2DM, HT, or low-density lipoprotein cholesterol (LDL-C) > 130 mg/dL was significantly lower. In the first year post-surgery, the supplementation group had a lower risk of T2DM (OR = 0.545, p < 0.0001), LDL-C > 130 mg/dL (OR = 0.612, p < 0.0001), and HT (OR = 0.584, p < 0.0001). The OR for having these metabolic comorbidities persisted lower during the 4 years' follow-up. Patients who had Mg deficiency had higher prevalence of T2DM and HT. CONCLUSION Mg supplementation seems to have a protective effect on the development of T2DM, HT, and LDL-C > 130 mg/dL in post-bariatric patients.
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HEYBELİ C, TAN SG, KAZANCIOĞLU R, SMITH L, SOYSAL P. Prevalence of Electrolyte Impairments Among Outpatient Elderly Subjects. BEZMIALEM SCIENCE 2022. [DOI: 10.14235/bas.galenos.2021.6290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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36
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le Goff S, Godin JP, Albalat E, Nieves JMR, Balter V. Magnesium stable isotope composition, but not concentration, responds to obesity and early insulin-resistant conditions in minipig. Sci Rep 2022; 12:10941. [PMID: 35768618 PMCID: PMC9243132 DOI: 10.1038/s41598-022-14825-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Hypomagnesemia is frequently associated with type 2 diabetes and generally correlates with unfavorable disease progression, but the magnesium status in pre-diabetic conditions remains unclear. Here, the magnesium metabolism is scrutinized in a minipig model of obesity and insulin resistance by measuring variations of the metallome—the set of inorganic elements—and the magnesium stable isotope composition in six organs of lean and obese minipigs raised on normal and Western-type diet, respectively. We found that metallomic variations are most generally insensitive to lean or obese phenotypes. The magnesium stable isotope composition of plasma, liver, kidney, and heart in lean minipigs are significantly heavier than in obese minipigs. For both lean and obese minipigs, the magnesium isotope composition of plasma and liver were negatively correlated to clinical phenotypes and plasma lipoproteins concentration as well as positively correlated to hyperinsulinemic-euglycemic clamp output. Because the magnesium isotope composition was not associated to insulin secretion, our results suggest that it is rather sensitive to whole body insulin sensitivity, opening perspectives to better comprehend the onset of insulin-resistant diabetic conditions.
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Affiliation(s)
- Samuel le Goff
- Laboratoire de Géologie de Lyon, ENS de Lyon, Université de Lyon, CNRS, Lyon, France
| | - Jean-Philippe Godin
- Nestlé Research, Institute of Food Safety and Analytical Sciences, Lausanne, Switzerland
| | - Emmanuelle Albalat
- Laboratoire de Géologie de Lyon, ENS de Lyon, Université de Lyon, CNRS, Lyon, France
| | | | - Vincent Balter
- Laboratoire de Géologie de Lyon, ENS de Lyon, Université de Lyon, CNRS, Lyon, France.
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37
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De Silva N, Pathmanathan S, Sumanatilleke M, Dematapitiya C, Dissanayake P, Wijenayake U, Subasinghe V, Dissanayake V. A novel mutation of SLC12A3 gene causing Gitelman syndrome. SAGE Open Med Case Rep 2022; 10:2050313X221102294. [PMID: 35693921 PMCID: PMC9178994 DOI: 10.1177/2050313x221102294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
A 48-year-old patient with a history of diabetes mellitus, presented to a surgical ward with abdominal pain. She was found to have hypokalemia. Her younger sister had passed away due to sudden cardiac death at the age of 25 years. Further evaluation revealed an elevated trans-tubular potassium gradient suggestive of renal potassium loss, normal blood pressure, hypomagnesemia, hypocalciuria, and alkalosis. Moreover, there was evidence of secondary hyperaldosteronism. Genetic studies revealed two heterozygous mutations of the SLC12A3 gene, including a novel mutation which has not been reported before anywhere in the world. She was treated with intravenous potassium supplementation and was later converted to oral potassium and oral magnesium supplementation with spironolactone. Her potassium and magnesium levels normalized and glycaemic control also improved. Hypokalemia and hypomagnesemia found in Gitelman syndrome may be associated with insulin resistance and correction of electrolytes can lead to better glycaemic control.
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Affiliation(s)
- Neomal De Silva
- Diabetes and Endocrinology Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | | | | | - Preethi Dissanayake
- Diabetes and Endocrinology Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Umesha Wijenayake
- Diabetes and Endocrinology Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Vindya Subasinghe
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Vajira Dissanayake
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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38
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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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39
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Xing B, Xu X, Li C, Zhao Y, Wang Y, Zhao W. Reduced Serum Magnesium Levels Are Associated with the Occurrence of Retinopathy in Patients with Type 2 Diabetes Mellitus: a Retrospective Study. Biol Trace Elem Res 2022; 200:2025-2032. [PMID: 34275107 DOI: 10.1007/s12011-021-02824-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/07/2021] [Indexed: 01/01/2023]
Abstract
The aim of this study is to explore the relationship between serum magnesium (Mg2+) level and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). The clinical data of 2222 patients with T2DM, including 713 patients with DR and 1509 patients without DR, between September 2016 and August 2020 in our hospital, were analyzed retrospectively. Further, the role and predictive value of serum Mg2+ on the prevalence of DR were determined through logistic regression and the receiver operating characteristic (ROC) curve respectively. The level of serum Mg2+ was lower in DR group than that in non-DR group (0.92 vs 0.88 mmol/L, P < 0.001). Stratified serum Mg2+ levels into quartiles (Q1-Q4), the first (Q1, Mg2+ ≤ 0.85 mmol/L) and fourth quartile (Q4, ≥ 0.96 mmol/L) represented the lowest and highest quartile, respectively. And the incidence of DR was obviously higher in Q1 and Q2 than that in Q3 and Q4 (50.9% and 30.2% vs 23.5% and 21%, respectively). Logistic regression demonstrated that there remained an independent association between lower serum Mg2+ levels and the occurrence of DR (OR were 3.907 and 1.709 in Q1 and Q2, respectively) no matter whether the interference of confounding variables. ROC curve showed the best cut-off value of serum Mg2+ level in predicting the occurrence of DR was 0.875 mmol/L. Lower Mg2+ levels are related with an increased risk of developing DR. Serum Mg2+ level can be a potential clinical indicator to help identify DR in patients with T2DM.
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Affiliation(s)
- Baodi Xing
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Xiang Xu
- Department of International Medical Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chengqian Li
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Yuhang Zhao
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Yangang Wang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Wenjuan Zhao
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China.
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40
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Oost LJ, van Heck JIP, Tack CJ, de Baaij JHF. The association between hypomagnesemia and poor glycaemic control in type 1 diabetes is limited to insulin resistant individuals. Sci Rep 2022; 12:6433. [PMID: 35440685 PMCID: PMC9018833 DOI: 10.1038/s41598-022-10436-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/01/2022] [Indexed: 11/30/2022] Open
Abstract
In a cohort of adults with type 1 diabetes, we examined the prevalence of hypomagnesemia and the correlation of serum magnesium levels with metabolic determinants, such as glycaemic control (as HbA1c), inflammatory markers and circulating cytokines. Furthermore, we assessed if a surrogate for insulin resistance is essential for the possible association of serum magnesium with metabolic determinants. Individuals with type 1 diabetes, aged above 18 years, were included and clinical characteristics were obtained from questionnaires and clinical records. In venous blood samples we measured cytokines and adipose-tissue specific secretion proteins. Serum magnesium concentrations were measured and correlated with clinical data and laboratory measurements using univariate and multivariate regression models. Hierarchical multiple regression of serum magnesium with insulin resistance was adjusted for diabetes and potential magnesium confounders. The prevalence of hypomagnesemia (serum magnesium levels < 0.7 mmol/L) was 2.9% in a cohort consisting of 241 individuals with type 1 diabetes. The magnesium concentration in the cohort was not associated with HbA1c (r = − 0.12, P-value = 0.068) nor with any inflammatory marker or adipokine. However, insulin dose (IU/kg), a surrogate measure of resistance in type 1 diabetes, moderated the association of serum magnesium (mmol/L) with HbA1c (mmol/mol) with a B coefficient of − 71.91 (95% CI: − 119.11; -24.71), P-value = 0.003) and Log10 high-sensitivity C-reactive protein (Log10 mg/L) − 2.09 (95% CI: − 3.70; − 0.48), P-value = 0.011). The association of low serum magnesium levels with glycaemic control (HbA1c) and high-sensitivity C-reactive protein in individuals with type 1 diabetes is limited to subjects using a high insulin dose and suggests that insulin resistance, a type 2 diabetes feature, is a prerequisite for hypomagnesemia.
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Affiliation(s)
- Lynette J Oost
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Julia I P van Heck
- Department of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands
| | - Jeroen H F de Baaij
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
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41
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Peride I, Tiglis M, Neagu TP, Niculae A, Checherita IA. Magnesium—A More Important Role in CKD–MBD than We Thought. Diagnostics (Basel) 2022; 12:diagnostics12040880. [PMID: 35453928 PMCID: PMC9031465 DOI: 10.3390/diagnostics12040880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/13/2022] [Accepted: 03/30/2022] [Indexed: 12/17/2022] Open
Abstract
Chronic kidney disease (CKD) is associated with different complications, including chronic kidney disease–mineral and bone disorder (CKD–MBD), which represents a systemic disorder that involves the presence of different mineral or bone structure abnormalities (i.e., modification of bone turnover, strength, volume, etc.), including even vascular calcification development. Even if, over the years, different pathophysiological theories have been developed to explain the onset and progression of CKD–MBD, the influence and importance of serum magnesium level on the evolution of CKD have only recently been highlighted. So far, data are inconclusive and conflicting; therefore, further studies are necessary to validate these findings, which could be useful in developing a better, more adequate, and personalized management of CKD patients.
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Affiliation(s)
- Ileana Peride
- Clinical Department No. 3, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Correspondence: (I.P.); (A.N.)
| | - Mirela Tiglis
- Clinical Department No. 14, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Tiberiu Paul Neagu
- Clinical Department No. 11, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Andrei Niculae
- Clinical Department No. 3, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Correspondence: (I.P.); (A.N.)
| | - Ionel Alexandru Checherita
- Clinical Department No. 3, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
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Effect of Dapagliflozin and Magnesium Supplementation on Renal Magnesium Handling and Magnesium Homeostasis in Metabolic Syndrome. Nutrients 2021; 13:nu13114088. [PMID: 34836340 PMCID: PMC8625451 DOI: 10.3390/nu13114088] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/30/2021] [Accepted: 11/11/2021] [Indexed: 01/10/2023] Open
Abstract
The prevalence of metabolic syndrome (MetS) is increasing, and patients with MetS are at an increased risk of cardiovascular disease and diabetes. There is a close link between hypomagnesemia and MetS. Administration of sodium-glucose transporter 2 (SGLT2) inhibitors has been reported to increase serum magnesium levels in patients with diabetes. We investigated the alterations in renal magnesium handling in an animal model of MetS and analyzed the effects of SGLT2 inhibitors. Adult rats were fed a fructose-rich diet to induce MetS in the first 3 months and were then treated with either dapagliflozin or magnesium sulfate-containing drinking water for another 3 months. Fructose-fed animals had increased insulin resistance, hypomagnesemia, and decreased urinary magnesium excretion. Dapagliflozin treatment improved insulin resistance by decreasing glucose and insulin levels, increased serum magnesium levels, and reduced urinary magnesium excretion. Serum vitamin D and parathyroid hormone levels were decreased in fructose-fed animals, and the levels remained low despite dapagliflozin and magnesium supplementation. In the kidney, claudin-16, TRPM6/7, and FXDY expression was increased in fructose-fed animals. Dapagliflozin increased intracellular magnesium concentration, and this effect was inhibited by TRPM6 blockade and the EGFR antagonist. We concluded that high fructose intake combined with a low-magnesium diet induced MetS and hypomagnesemia. Both dapagliflozin and magnesium sulfate supplementation improved the features of MetS and increased serum magnesium levels. Expression levels of magnesium transporters such as claudin-16, TRPM6/7, and FXYD2 were increased in fructose-fed animals and in those administered dapagliflozin and magnesium sulfate. Dapagliflozin enhances TRPM6-mediated trans-epithelial magnesium transport in renal tubule cells.
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43
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Tseng MH, Konrad M, Ding JJ, Lin SH. Clinical and Genetic Approach to Renal Hypomagnesemia. Biomed J 2021; 45:74-87. [PMID: 34767995 PMCID: PMC9133307 DOI: 10.1016/j.bj.2021.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 12/03/2022] Open
Abstract
Magnesium (Mg2+) is an important intracellular cation and essential to maintain cell function including cell proliferation, immunity, cellular energy metabolism, protein and nucleic acid synthesis, and regulation of ion channels. Consequences of hypomagnesemia affecting multiple organs can be in overt or subtle presentations. Besides detailed history and complete physical examination, the assessment of urinary Mg2+ excretion is help to differentiate renal from extra-renal (gastrointestinal, tissue sequestration, and shifting) causes of hypomagnesemia. Renal hypomagnesemia can be caused by an increased glomerular filtration and impaired reabsorption in proximal tubular cells, thick ascending limb of the loop of Henle or distal convoluted tubules. A combination of renal Mg2+ wasting, familial history, age of onset, associated features, and exclusion of acquired etiologies point to inherited forms of renal hypomagnesemia. Based on clinical phenotypes, its definite genetic diagnosis can be simply grouped into specific, uncertain, and unknown gene mutations with a priority of genetic approach methods. An unequivocal molecular diagnosis could allow for prediction of clinical outcome, providing genetic counseling, avoiding unnecessary studies or interventions, and possibly uncovering the pathogenic mechanism. Given numerous identified genes responsible for Mg2+ transport in renal hypomagnesemia over the past two decades, several potential and specific molecular and cellular therapeutic strategies to correct hypomagnesemia are promising.
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Affiliation(s)
- Min-Hua Tseng
- Division of Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Pediatrics, Xiamen Chang Gung Hospital, China
| | - Martin Konrad
- Department of General Pediatrics, University Children's Hospital Münster, Münster, Germany
| | - Jhao-Jhuang Ding
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hua Lin
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Guerreiro V, Maia I, Neves JS, Salazar D, Ferreira MJ, Mendonça F, Silva MM, Viana S, Costa C, Pedro J, Varela A, Lau E, Freitas P, Carvalho D. Adequate magnesium level as an associated factor of pre-diabetes and diabetes mellitus remission in patients with obesity submitted to bariatric surgery. Sci Rep 2021; 11:21223. [PMID: 34707130 PMCID: PMC8551299 DOI: 10.1038/s41598-021-00584-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 09/14/2021] [Indexed: 01/19/2023] Open
Abstract
Bariatric surgery (BS) can lead to remission of type 2 diabetes mellitus (T2DM), however, the evidence on the influence of preoperative serum magnesium levels on this reversal is scarce. To study the influence of preoperative serum magnesium levels on the pre-T2DM and T2DM remission one year after BS. Retrospective study carried out among 1656 patients with obesity who underwent BS in the Centro Hospitalar Universitário São João. T2DM and pre-T2DM remission were defined as being normal glycaemic measures of at least one year's after BS and without pharmacological therapy. To assess the association between preoperative serum magnesium levels and pre- and T2DM remission, logistic regression models, crude and adjusted for sex, age and body mass index were computed. Patients with normoglycaemia presented hypomagnesaemia less often than those patients with pre-T2DM and T2DM (17.0% vs. 21.3% vs. 39.9%) (p < 0.001). One year after BS, 62.9% of patients with pre-T2DM or T2DM before BS showed remission. Adequate magnesium levels were positively associated with T2DM and pre-T2DM remission, one year after BS (OR 1.79; 95% CI 1.34-2.38), independently of sex, age, and body mass index. Adequate preoperative serum magnesium levels showed to be an important clinical parameter for pre-T2DM and T2DM remission.
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Affiliation(s)
- Vanessa Guerreiro
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. .,Faculdade de Medicina da Universidade do Porto, Porto, Portugal. .,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal. .,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.
| | - Isabel Maia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - João Sérgio Neves
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Daniela Salazar
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Maria João Ferreira
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Fernando Mendonça
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Maria Manuel Silva
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Sara Viana
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Serviço de Medicina Interna, Unidade de Saúde Local do Norte Alentejo EPE, Alentejo, Portugal
| | - Cláudia Costa
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Serviço de Endocrinologia, Instituto Portugês de Oncologia, Porto, Portugal
| | - Jorge Pedro
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Ana Varela
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Serviço de Endocrinologia, Instituto Portugês de Oncologia, Porto, Portugal
| | - Eva Lau
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Paula Freitas
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Davide Carvalho
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
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45
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Plasmatic Magnesium Deficiency in 101 Outpatients Living with Type 2 Diabetes Mellitus. Clin Pract 2021; 11:791-800. [PMID: 34842632 PMCID: PMC8628662 DOI: 10.3390/clinpract11040095] [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: 09/21/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 01/01/2023] Open
Abstract
(1) Background: Magnesium deficiency is usually associated with type 2 diabetes mellitus (T2DM). Individuals living with T2DM with hypomagnesemia show a more rapid disease progression and have an increased risk for diabetes complications. (2) Methods: This is a cross-sectional and descriptive study in the National Institute of Nutrition and Food Technology of Tunis in Tunisia, including all adult outpatients (≥18 years old) with a diagnosis of T2DM from 1 September 2018 to 31 August 2019. The aim of this study was to evaluate the prevalence of plasmatic magnesium deficiency in a Tunisian population of T2DM and to study the relationship between magnesium status and intake, glycemic control and long-term diabetes-related complications. (3) Results: Among the 101 T2DM outpatients, 13 (12.9%) presented with a plasmatic magnesium deficiency. The mean age was 56 ± 7.9 years with a female predominance (62%, n = 63). The mean of the plasmatic magnesium level was 0.79 ± 0.11 mmol/L (0.5–1.1), and the mean of 24 h urinary magnesium excretion was 87.8 ± 53.8 mg/24 h [4.8–486.2]. HbA1c was significantly higher in the plasmatic magnesium deficiency group than the normal magnesium status group (10% ± 1.3 vs. 8.3% ± 1.9; p = 0.04), with a significant difference in participants with a poor glycemic control (HbA1c > 7%) (100%, n = 13/13 vs. 53%, n = 47/88; p = 0.001). A weak negative relationship was also found between plasmatic magnesium and HbA1c (r = −0.2, p = 0.03). Peripheral artery disease was more commonly described in individuals with low plasmatic magnesium levels than in individuals with normal levels (39%, n = 5 vs. 0%, n = 0; p < 0.001). The mean plasmatic magnesium level in participants without diabetic nephropathy and also peripheral artery disease was significantly higher compared to individuals with each long-term diabetes-related complication (0.8 mmol/L ± 0.1 vs. 0.71 mmol/L ± 0.07; p = 0.006) and (0.8 mmol/L ± 0.1 vs. 0.6 mmol/L ± 0.08; p < 0.001), respectively. (4) Conclusions: Hypomagnesemia was identified in individuals with T2DM, causing poor glycemic control and contributing to the development and progression of diabetes-related microvascular and macrovascular complications.
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Key Words
- Absorption
- Amphotericin B
- Antibiotics, Chemotherapeutic agents, ATP
- Calcium
- Central Nervous System, CNS
- Distribution
- Excretion
- Hypokalemia, digoxin, hypertension, insulin, intestine
- Hypomagnesemia
- Magnesium
- Metabolism
- Na+ K+/ATP-ase, enolase, pyruvate kinase
- Neuromuscular
- Potassium
- Proton pump inhibitors, Diuretics
- TRPM6 and TRPM7 channels, kidney, nephron, parathyroid hormone (PTH), antidiuretic hormone (ADH)
- TRPM6, atherosclerosis, coronary artery disease, congestive heart failure
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Abubakar A, Nazifi AB, Maje IM, Tanko Y, Anuka JA, Abdurahman EM. Chlorophytum alismifolium mitigates microvascular complications of type 2 diabetes mellitus: the involvement of oxidative stress and aldose reductase. Drug Metab Pers Ther 2021; 37:69-80. [PMID: 35385895 DOI: 10.1515/dmpt-2021-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/28/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Chlorophytum alismifolium (C. alismifolium) tubers are used in the management of diabetes. This research evaluated the effect of ethylacetate extract of C. alismifolium (EACA) on microvascular complications and the possible association of oxidative stress and aldose reductase in type 2 diabetic rats. METHODS C. alismifolium tubers were subjected to sequential extraction until ethylacetate extract was obtained using a soxhlet apparatus. The LD50 was determined using the OECD 425 guideline. The animals were placed on high fat diet for 42 days and then induced with hyperglycaemia using 40 mg/kg of streptozotocin. Diabetic neuropathy was evaluated using thermal and mechanical methods. Serum was used for the assessment of oxidative stress markers and biochemical markers of retinopathy and nephropathy. Serum aldose reductase was investigated by utilizing the principle of enzyme-linked immunosorbent assay. RESULTS The median lethal dose of EACA was assessed to be above 5,000 mg/kg and it caused no mortality. Treatment with EACA significantly reduced the withdrawal times in both thermal and mechanical hyperalgesic methods (p<0.05). EACA also significantly reduced the levels of urea (p<0.001), albumin (p<0.05) and uric acid (p<0.001) in hyperglycaemic rats. EACA significantly decreased the amounts of low density lipoprotein and triglycerides (p<0.001). There was a remarkable elevation in the levels of high density lipoprotein (p<0.05). A significant (p<0.05) increase in the levels of magnesium was observed in the EACA-treated groups. EACA significantly increased catalase (p<0.05) and reduced malondialdehyde levels (p<0.05). The levels of aldose reductase was significantly (p<0.001) reduced by EACA compared to the hyperglycaemic control. CONCLUSIONS The ethylacetate extract of C. alismifolium has beneficial effects in alleviating microvascular complications of diabetes through the inhibition of oxidative stress and aldose reductase in diabetic rats.
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Affiliation(s)
- Abdulhakim Abubakar
- Department of Pharmacology and Therapeutics, Ahmadu Bello University, Zaria, Nigeria
| | | | - Idris Mohammed Maje
- Department of Pharmacology and Therapeutics, Ahmadu Bello University, Zaria, Nigeria
| | - Yusuf Tanko
- Department of Human Physiology, Ahmadu Bello University, Zaria, Nigeria
| | - Joseph Akpojo Anuka
- Department of Pharmacology and Therapeutics, Ahmadu Bello University, Zaria, Nigeria
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Abubakar A, Nazifi AB, Maje IM, Tanko Y, Anuka JA, Abdurahman EM. Chlorophytum alismifolium mitigates microvascular complications of type 2 diabetes mellitus: the involvement of oxidative stress and aldose reductase. Drug Metab Pers Ther 2021; 0:dmdi-2021-0129. [PMID: 34392635 DOI: 10.1515/dmdi-2021-0129] [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: 04/11/2021] [Accepted: 05/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Chlorophytum alismifolium (C. alismifolium) tubers are used in the management of diabetes. This research evaluated the effect of ethylacetate extract of C. alismifolium (EACA) on microvascular complications and the possible association of oxidative stress and aldose reductase in type 2 diabetic rats. METHODS C. alismifolium tubers were subjected to sequential extraction until ethylacetate extract was obtained using a soxhlet apparatus. The LD50 was determined using the OECD 425 guideline. The animals were placed on high fat diet for 42 days and then induced with hyperglycaemia using 40 mg/kg of streptozotocin. Diabetic neuropathy was evaluated using thermal and mechanical methods. Serum was used for the assessment of oxidative stress markers and biochemical markers of retinopathy and nephropathy. Serum aldose reductase was investigated by utilizing the principle of enzyme-linked immunosorbent assay. RESULTS The median lethal dose of EACA was assessed to be above 5,000 mg/kg and it caused no mortality. Treatment with EACA significantly reduced the withdrawal times in both thermal and mechanical hyperalgesic methods (p<0.05). EACA also significantly reduced the levels of urea (p<0.001), albumin (p<0.05) and uric acid (p<0.001) in hyperglycaemic rats. EACA significantly decreased the amounts of low density lipoprotein and triglycerides (p<0.001). There was a remarkable elevation in the levels of high density lipoprotein (p<0.05). A significant (p<0.05) increase in the levels of magnesium was observed in the EACA-treated groups. EACA significantly increased catalase (p<0.05) and reduced malondialdehyde levels (p<0.05). The levels of aldose reductase was significantly (p<0.001) reduced by EACA compared to the hyperglycaemic control. CONCLUSIONS The ethylacetate extract of C. alismifolium has beneficial effects in alleviating microvascular complications of diabetes through the inhibition of oxidative stress and aldose reductase in diabetic rats.
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Affiliation(s)
- Abdulhakim Abubakar
- Department of Pharmacology and Therapeutics, Ahmadu Bello University, Zaria, Nigeria
| | | | - Idris Mohammed Maje
- Department of Pharmacology and Therapeutics, Ahmadu Bello University, Zaria, Nigeria
| | - Yusuf Tanko
- Department of Human Physiology, Ahmadu Bello University, Zaria, Nigeria
| | - Joseph Akpojo Anuka
- Department of Pharmacology and Therapeutics, Ahmadu Bello University, Zaria, Nigeria
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Salinas M, Flores E, López-Garrigós M, Pomares F, Carbonell R, Leiva-Salinas C, On Behalf Of The Primlab Working Group. Potential serum magnesium under request in primary care. Laboratory interventions to identify patients with hypomagnesemia. Clin Chem Lab Med 2021; 58:e221-e223. [PMID: 32134724 DOI: 10.1515/cclm-2020-0106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/10/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Maria Salinas
- Clinical Laboratory, Hospital Universitario de San Juan, Carretera Alicante-Valencia, s/n, Alicante, Spain.,Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain
| | - Emilio Flores
- Clinical Laboratory, Hospital Universitario de San Juan, Carretera Alicante-Valencia, s/n, Alicante, Spain.,Department of Clinical Medicine, Universidad Miguel Hernandez, Elche, Spain
| | - Maite López-Garrigós
- Clinical Laboratory, Hospital Universitario de San Juan, Carretera Alicante-Valencia, s/n, Alicante, Spain
| | - Francisco Pomares
- Department of Endocrinology and Nutrition, Hospital Universitario de San Juan, San Juan de Alicante, Spain
| | - Rosa Carbonell
- Clinical Laboratory, Hospital Universitario de San Juan, Carretera Alicante-Valencia, s/n, Alicante, Spain
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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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