Low Serum Magnesium Concentrations Research Articles

Orthodontic status of children of Bukovina region in the age aspect

There are three groups of patients with abnormalities of magnesium homoeostasis. The first one include patients with magnesium deficiency (low total body magnesium content) and a resultant hypomagnesaemia (low serum magnesium concentration). Patients with hypomagnesaemia (serum magnesium concentration <0.75 mmol/L) in the absence of magnesium deficiency (i.e., a normal total body magnesium content) consist the second group. The third group include patients with magnesium deficiency (low total body magnesium content) but no evidence of hypomagnesaemia (i.e., a normal serum magnesium concentration). Magnesium deficiency can be caused by decreased magnesium intake from the diet, decreased magnesium absorption, or increased renal magnesium excretion (renal magnesium wasting). The narrative review examines the causes, clinical and laboratory signs of magnesium deficiency in the body, and the effect of magnesium supplementation on health indices. Groups of people who are more likely to suffer from magnesium deficiency are outlined. Emphasis is placed on the use of questionnaires to identify individuals with possible magnesium deficiency. The changes on the electrocardiograms that are characteristic of the initial magnesium deficiency and that occur in case of its increase are given. The effect of additional intake of magnesium salts on blood pressure changes in individuals with and without baseline hypertension is discussed in detail. Factors that make it difficult to assess the relationship between magnesium intake and abnormalities in lipid and carbohydrate metabolism are listed. An association between increased dietary magnesium intake and reduced risk of certain cardiovascular diseases, diabetes mellitus, and overall mortality has been demonstrated. Keywords: children, dentoalveolar anomalies, prevalence, primary dentition, changing dentition, permanent dentition.

Diagnosis and clinical significance of magnesium deficiency in the body

There are three groups of patients with abnormalities of magnesium homoeostasis. The first one include patients with magnesium deficiency (low total body magnesium content) and a resultant hypomagnesaemia (low serum magnesium concentration). Patients with hypomagnesaemia (serum magnesium concentration <0.75 mmol/L) in the absence of magnesium deficiency (i.e., a normal total body magnesium content) consist the second group. The third group include patients with magnesium deficiency (low total body magnesium content) but no evidence of hypomagnesaemia (i.e., a normal serum magnesium concentration). Magnesium deficiency can be caused by decreased magnesium intake from the diet, decreased magnesium absorption, or increased renal magnesium excretion (renal magnesium wasting). The narrative review examines the causes, clinical and laboratory signs of magnesium deficiency in the body, and the effect of magnesium supplementation on health indices. Groups of people who are more likely to suffer from magnesium deficiency are outlined. Emphasis is placed on the use of questionnaires to identify individuals with possible magnesium deficiency. The changes on the electrocardiograms that are characteristic of the initial magnesium deficiency and that occur in case of its increase are given. The effect of additional intake of magnesium salts on blood pressure changes in individuals with and without baseline hypertension is discussed in detail. Factors that make it difficult to assess the relationship between magnesium intake and abnormalities in lipid and carbohydrate metabolism are listed. An association between increased dietary magnesium intake and reduced risk of certain cardiovascular diseases, diabetes mellitus, and overall mortality has been demonstrated. Keywords: hypomagnesaemia, blood pressure, diabetes mellitus.

Monitoring of serum magnesium levels during long-term use of proton pump inhibitors in elderly japanese patients: is it really necessary or not?

BackgroundLong-term use of proton pump inhibitors (PPIs) has been found to significantly lower serum magnesium levels in patients in the USA and Europe. The package inserts of PPIs in these countries clearly state that healthcare professionals should consider monitoring magnesium levels prior to initiation of PPI treatment and periodically thereafter. However, the package inserts of PPIs in Japan do not clearly mention the monitoring of magnesium levels. In this study, we evaluated the relationship between long-term use of PPIs and the lower serum magnesium concentrations in elderly Japanese patients.MethodsUsing a retrospective observational approach, a total of 264 Japanese outpatients were included in the study. Patients over the age of 75 years were considered elderly. Serum magnesium levels of the patients were measured in units of 0.1 mg/dL between January 2016 and June 2022 at the Higo Internal Medicine Clinic and Ai Pharmacy in Kyoto, Japan.ResultsFour of the 264 eligible patients were diagnosed with hypomagnesemia. Three were PPI non-users, and one was a PPI user. Serum magnesium concentrations were significantly lower in PPI users (n = 47) than in non-users (n = 85; 2.1 ± 0.2 vs. 2.2 ± 0.3 mg/dL, p < 0.05) in the 132 elderly patients. Comorbidity included diabetes mellitus in both PPI users (23.4%) and non-users (57.6%) and hyperlipidemia in both PPI users (61.7%) and non-users (41.2%).ConclusionPPIs are commonly used oral drugs for elderly patients. There was an association between the long-term use of PPIs and lower serum magnesium concentrations in elderly patients. Although the difference in the decrease in serum magnesium concentrations was within the normal range of serum magnesium levels, health care professionals should consider monitoring serum magnesium levels periodically in elderly patients receiving long-term PPIs.

Correlation of serum magnesium with HbA1c in patients with diabetes mellitus

Background and objectives: Diabetes mellitus (DM) is a leading cause of death and disability world wide. Magnesium acts as a cofactor in glucose metabolism and its decreased level causes insulin resistance and many complications in diabetic patients. The present study evaluated the correlation of serum magnesium with HbA1c in DM patients. Materials and methods: This cross sectional study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka from July 2016 to June 2017. A total number of 100 individuals with and without diabetes mellitus were included in the study. HbA1c was measured by high performance liquid chromatography and estimation of serum magnesium was done by automatic biochemistry analyzer. Results: Out of 100 enrolled participants, 50 were diagnosed patients of DM (Group-A) and 50 were age and sex matched apparently healthy individuals (Group-B). The mean age of Group-A and B individuals was 50.5 ± 6.0 and 50.4 ± 5.1 years respectively. Group-A had significantly (p &lt; 0.001) lower serum magnesium concentration compared to Group-B (1.5 ± 0.6 mg/dl vs 2.3 ± 0.5 mg/dl). Serum magnesium levels showed significant negative correlations with HbA1c (r = -0.511, p &lt; 0.001). Conclusion: DM patients showed significant negative correlation of serum magnesium with HbA1c level. Routine screening for serum magnesium status would be helpful for the better management of diabetic cases. IMC J Med Sci. 2023. 17(1): 005. DOI: https://doi.org/10.55010/imcjms.17.005 *Correspondence: Farzana Ahmed, Department of Biochemistry, Ibrahim Medical College, 1/A Ibrahim Sarani, Shegunbagicha, Dhaka, Bangladesh. Email: tanvy1108@gmail.com

Randomised trial of intravenous thiamine and/or magnesium sulphate administration on erythrocyte transketolase activity, lactate concentrations and alcohol withdrawal scores

Alcohol withdrawal syndrome (AWS) occurs in 2% of patients admitted to U.K. hospitals. Routine treatment includes thiamine and benzodiazepines. Laboratory studies indicate that thiamine requires magnesium for optimal activity, however this has not translated into clinical practice. Patients experiencing AWS were randomized to three groups: (group 1) thiamine, (group 2) thiamine plus MgSO4 or (group 3) MgSO4. Pre- and 2-h post-treatment blood samples were taken. AWS severity was recorded using the Glasgow Modified Alcohol Withdrawal Score (GMAWS). The primary outcome measure was 15% change in erythrocyte transketolase activity (ETKA) in group 3. Secondary outcome measures were change in plasma lactate concentrations and time to GMAWS = 0. 127 patients were recruited, 115 patients were included in the intention-to-treat analysis. Pre-treatment, the majority of patients had normal or high erythrocyte thiamine diphosphate (TDP) concentrations (≥ 275–675/> 675 ng/gHb respectively) (99%), low serum magnesium concentrations (< 0.75 mmol/L) (59%), and high plasma lactate concentrations (> 2 mmol/L) (67%). Basal ETKA did not change significantly in groups 1, 2 or 3. Magnesium deficient patients (< 0.75 mmol/L) demonstrated less correlation between pre-treatment basal ETKA and TDP concentrations than normomagnesemic patients (R2 = 0.053 and R2 = 0.236). Median plasma lactate concentrations normalized (≤ 2.0 mmol/L) across all three groups (p < 0.001 for all groups), but not among magnesium deficient patients in group 1 (n = 22). The median time to achieve GMAWS = 0 for groups 1, 2 and 3 was 10, 5.5 and 6 h respectively (p < 0.001). No significant difference was found between groups for the primary endpoint of change in ETKA. Co-administration of thiamine and magnesium resulted in more consistent normalization of plasma lactate concentrations and reduced duration to achieve initial resolution of AWS symptoms.ClinicalTrials.gov: NCT03466528.

Association of Serum Magnesium with Insulin Resistance and Type 2 Diabetes among Adults in China.

Magnesium is an essential mineral for the human body and a cofactor or activator for more than 300 enzymatic reactions, including blood glucose control and insulin release. Diabetes is a well-known global burden of disease with increasing global prevalence. In China, the prevalence of diabetes in adults is higher than the global average. Evidence shows that magnesium is a predictor of insulin resistance and diabetes. However, the majority of studies focus on dietary magnesium instead of serum magnesium concentration. We study the correlation of serum magnesium levels with insulin resistance and Type 2 diabetes. In this prospective cohort study, we included 5044 participants aged 18 years and older without insulin resistance (IR) and diabetes at the baseline from China Health and Nutrition Survey (CHNS). A fasting blood sample was taken for the measurement of both types of magnesium, fasting blood glucose, hemoglobin A1c (HbA1c), and fasting insulin. The homeostatic model (HOMA-IR) was calculated. Demographic characteristics of participants, and risk factors such as intensity of physical activities, smoking status, drinking habit, and anthropometric information were recorded. IR was defined as HOMA-IR ≥ 2.5, and Type 2 diabetes mellitus was defined as fasting plasma glucose ≥ 7.0 mmol/L or HbA1c ≥ 6.5%, or a self-reported diagnosis or treatment of diabetes. A total of 1331 incident insulin resistance events and 429 incident diabetic events were recorded during an average follow-up of 5.8 years. The serum magnesium concentration was categorized into quintiles. After adjusting for relevant covariates, the third quintile of serum magnesium (0.89–0.93 mmol/L) was correlated with 29% lower risk of incident insulin resistance (hazard ratio = 0.71, 95% CI 0.58, 0.86) and with a lower risk of Type 2 diabetes. Multivariable-adjusted hazard ratios (95% confidence intervals) for insulin resistance were compared with the lowest quintile of serum magnesium (<0.85). We found similar results when evaluating serum magnesium as a continuous measure. Restricted cubic spline (RCS) curves showed a nonlinear dose–response correlation in both serum magnesium levels and insulin resistance, and in serum magnesium levels and Type 2 diabetes. Lower serum magnesium concentration was associated with a higher risk of insulin resistance and diabetes.

355 Mineral Metabolism

Abstract This presentation will highlight historic discoveries in mineral metabolism in ruminants. At least 15 minerals can be classified as essential based on their involvement in one or more metabolic functions in mammals. Deficiencies of all essential minerals have occurred naturally or have been induced experimentally in ruminants. Cobalt was shown to be essential for ruminants in 1935 based on its ability to correct naturally occurring deficiency signs in Australia. This discovery occurred 13 years before cobalt was shown to a component of vitamin B12. Low serum magnesium concentrations also were associated with grass tetany in cattle before magnesium was found to be essential for the rat in 1931. The value of supplemental salt for cattle was demonstrated in the 1800’s and a salt deficiency was experimentally induced in dairy cows in 1905. Over 50 years later sodium was identified as the mineral primarily responsible for salt deficiency. Naturally occurring deficiencies of phosphorus and copper were observed in grazing ruminants shortly after they were reported to be essential for rats. Copper toxicosis also became recognized as a practical problem, especially in some breeds of sheep. Selenium was shown to prevent white muscle disease in 1958. Because of its known toxicity and lack of a specific metabolic function, it was not until 1979 that Food and Drug Administration approved the addition of 0.1 mg Se/kg DM (later increased to 0.3 mg/kg) from inorganic sources to ruminant diets. This approval occurred after the identification of glutathione peroxidase as a selenium metalloenzyme in 1972. In 2009, the Food and Drug Administration approved the use of chromium propionate as a source of supplemental chromium for cattle at levels up to 0.5 mg Cr/kg DM. The approval of chromium propionate was based on its safety and ability to enhance insulin sensitivity in cattle.

Low serum magnesium concentration is associated with the presence of viable hepatocellular carcinoma tissue in cirrhotic patients

This study aimed to ascertain, for the first time, whether serum magnesium (Mg) concentration is affected by the presence of hepatocellular carcinoma (HCC). We retrospectively enrolled consecutive cirrhotic patients with a diagnosis of HCC (n = 130) or without subsequent evidence of HCC during surveillance (n = 161). Serum levels of Mg were significantly (P < 0.001) lower in patients with HCC than in those without (median [interquartile range]: 1.80 [1.62–1.90] mg/dl vs. 1.90 [1.72–2.08] mg/dl). On multivariate logistic regression, low serum Mg was associated with the presence of HCC (OR 0.047, 95% CI 0.015–0.164; P < 0.0001), independently from factors that can influence magnesaemia and HCC development. In a subset of 94 patients with HCC, a linear mixed effects model adjusted for confounders showed that serum Mg at diagnosis of HCC was lower than before diagnosis of the tumor (β = 0.117, 95% CI 0.039–0.194, P = 0.0035) and compared to after locoregional treatment of HCC (β = 0.079, 95% CI 0.010–0.149, P = 0.0259), with two thirds of patients experiencing these changes of serum Mg over time. We hypothesize that most HCCs, like other cancers, may be avid for Mg and behave like a Mg trap, disturbing the body’s Mg balance and resulting in lowering of serum Mg levels.

The relation between acute changes in the systemic inflammatory response and circulating thiamine and magnesium concentrations after elective knee arthroplasty

Thiamine diphosphate (TDP) and magnesium are co-factors for key enzymes in human intermediary metabolism. However, their role in the systemic inflammatory response (SIR) is not clear. Therefore, the aim of the present study was to examine the relation between acute changes in the SIR and thiamine and magnesium dependent enzyme activity in patients undergoing elective knee arthroplasty (a standard reproducible surgical injury in apparently healthy individuals). Patients (n = 35) who underwent elective total knee arthroplasty had venous blood samples collected pre- and post-operatively for 3 days, for measurement of whole blood TDP, serum and erythrocyte magnesium, erythrocyte transketolase activity (ETKA), lactate dehydrogenase (LDH), glucose and lactate concentrations. Pre-operatively, TDP concentrations, erythrocyte magnesium concentrations, ETKA and plasma glucose were within normal limits for all patients. In contrast, 5 patients (14%) had low serum magnesium concentrations (< 0.75 mmol/L). On post-operative day1, both TDP concentrations (p < 0.001) and basal ETKA (p < 0.05) increased and serum magnesium concentrations decreased (p < 0.001). Erythrocyte magnesium concentrations correlated with serum magnesium concentrations (rs = 0.338, p < 0.05) and remained constant during SIR. Post-operatively 14 patients (40%) had low serum magnesium concentrations. On day1 serum magnesium concentrations were directly associated with LDH (p < 0.05), WCC (p < 0.05) and neutrophils (p < 0.01). Whole blood TDP and basal ETKA increased while serum magnesium concentrations decreased, indicating increased requirement for thiamine and magnesium dependent enzyme activity during SIR. Therefore, thiamine and magnesium represent potentially modifiable therapeutic targets that may modulate the host inflammatory response. Erythrocyte magnesium concentrations are likely to be reliable measures of status, whereas serum magnesium concentrations and whole blood TDP may not.ClinicalTrials.gov: NCT03554668.

Impact of Serum Magnesium Levels on Kidney and Cardiovascular Prognosis and Mortality in CKD Patients

In the general population, hypomagnesemia has been associated with cardiovascular events and hypermagnesemia with overall mortality. In chronic kidney disease (CKD) the evidence is not so strong. The objective of our study was to investigate the relationship between serum magnesium (SMg) concentration and cardiovascular morbidity and mortality, all-cause mortality, and the progression to kidney failure in a population with CKD. Observational study of a cohort of 746 patients with CKD. Baseline characteristics and analytical profile were collected at the first visit, and patients were followed for a mean of 42.6months. A cohort of 746 patients were analyzed, age 70±13years, 62.9% were male, 45.2% had CKD grade 3, and 35.9% grade 4. The mean SMg concentration was 2.09±0.33mg/dL, with a close correlation between SMg concentration and serum creatinine, phosphorus, and intact parathyroid hormone (iPTH) values. Use of calcitriol was associated with higher SMg (SMgH) concentration, while calcium supplements and proton pump inhibitors (PPIs) were associated with lower SMg concentration. For risk of cardiovascular events, patients with hypermagnesemia had an overall higher risk on a crude analysis (Log Rank 4.83, P=.28) and adjusted analysis (HR=1.34, CI 1.02-1.77, P=.037). For risk of all-cause mortality, patients with hypermagnesemia had an overall higher risk on crude analysis (Log Rank 13.11, P>.001) and adjusted analysis (HR=1.5424, IC=1.002-2.319, P=.049). After performing a propensity score matching for SMg concentration, we achieved two comparable groups of 287 patients, finding again higher all-cause mortality in the hypermagnesemia group (LogRank 15.147, P<.001), that persisted in the Cox model adjusted for calcium, phosphorus, and iPTH. No association was found between SMg concentration and initiation of kidney replacement therapy (KRT). Magnesium concentration increases with decreasing kidney function. Hypermagnesemia predicts cardiovascular events and all-cause mortality in this same population. Thus, magnesium supplementation should be used with caution in these patients.

Identifying optimal magnesium replenishment points based on risk of severe hypomagnesemia in colorectal cancer patients treated with cetuximab or panitumumab.

Cetuximab and panitumumab are monoclonal antibodies that target the epidermal growth factor receptor (EGFR). Treatment with cetuximab and panitumumab commonly causes hypomagnesemia, and optimal management of this adverse effect remains unclear. Here, we evaluated the optimal magnesium replacement points based on the risk of severe hypomagnesemia in colorectal cancer patients who received cetuximab or panitumumab. We retrospectively evaluated 184 patients who received cetuximab or panitumumab for colorectal cancer at Ogaki Municipal Hospital (Ogaki, Japan) between January 2010 and December 2019. Univariate analyses were conducted to evaluate the relationship between patient baseline characteristics and development of hypomagnesemia following cetuximab or panitumumab treatment. Variables that were significantly associated with hypomagnesemia in the univariate analyses as well as previously reported risk factors were entered into a multivariate logistic regression model. The incidence of hypomagnesemia was associated with panitumumab treatment, pre-replenishment serum magnesium concentration, treatment duration, and treatment line. Severe hypomagnesemia post-cetuximab or panitumumab treatment was significantly associated with low baseline magnesium concentrations (< 1.8mg/dL; odds ratio 18.100, 95% confidence interval 1.570-210.000; p = 0.020) and low serum magnesium concentrations during treatment (< 1.1mg/dL; odds ratio 93.800, 95% confidence interval 3.510-2510.000; p = 0.007). To minimize the risk of severe hypomagnesemia during anti-EGFR treatment, magnesium replenishment should be initiated in patients with pre-replenishment concentrations of < 1.8mg/dL, preferably before reaching intra-treatment concentrations of < 1.1mg/dL.

Lower Serum Magnesium Concentrations are associated With Specific Heavy Drinking Markers, Pro-Inflammatory Response and Early-Stage Alcohol-associated Liver Injury§.

Chronic heavy alcohol intake frequently causes liver inflammation/injury, and altered mineral metabolism may be involved in this liver pathology. In this study, we evaluated the association of heavy drinking, changes in serum magnesium levels and biochemical evidence of liver injury in alcohol-use-disorder (AUD) patients who had no clinical signs or symptoms of liver injury. We also aimed to identify any sex-based differences in patients with mild or no biochemical evidence of liver injury induced by heavy drinking. 114 heavy drinking alcohol-dependent (AD) female and male patients aged 21-65years without clinical manifestations of liver injury, who were admitted to an alcohol treatment program, were grouped by alanine aminotransaminase (ALT) levels: ≤ 40IU/L, as no liver injury (GR.1), and ALT>40IU/L as mild liver injury (GR.2). Patients were actively drinking until the day of admission. Comprehensive metabolic biochemistry results, fatty acid panel, serum magnesium and drinking history data were collected at admission; and study-specific measures were evaluated. In all AD patients, lower magnesium was significantly associated with the heavy drinking marker and heavy drinking days past 90days (HDD90). A lower serum magnesium concentration was observed in AD patients with mild liver injury. Females of both groups had mean levels of magnesium in the deficient range. A clinically significant drop in magnesium levels was observed only in the GR.2 (mild liver injury) male AD patients. Females showed a significant association between low magnesium levels and the ω6:ω3 polyunsaturated fatty acids (PUFAs) ratio. Specific heavy drinking markers showed an association with lower magnesium levels. Low serum magnesium levels are common in subjects with AUD and appear to be associated with the onset of liver injury.

Serum magnesium and the incidence of coronary artery disease over a median 27 years of follow-up in the Atherosclerosis Risk in Communities (ARIC) Study and a meta-analysis

Low serum magnesium (Mg) concentrations have been associated with higher coronary artery disease (CAD) risk. A previous Atherosclerosis Risk in Communities (ARIC) Study article that evaluated the Mg-CAD association, based on 319 events occurring over 4-7 y, identified a sex-interaction whereby the inverse Mg-CAD association was much stronger among women than men. More than 1700 additional ARIC CAD events have since accrued. We aimed to test our hypothesis that serum Mg is inversely and independently associated with long-term CAD risk in ARIC and in a meta-analysis with other prospective studies. A total of 14,446 ARIC study participants (baseline mean±SD age: 54±6 y, 57% women, 27% African American) were followed for incident CAD through 2017. CAD events were defined by myocardial infarction or CAD mortality. Serum Mg was modeled as quintiles based on mean visit 1 (1987-1989) and visit 2 (1990-1992) concentrations. Cox regression models were used. We also conducted a random-effects meta-analysis incorporating these contemporary ARIC findings. Over a median follow-up of 27 y, 2131 incident CAD cases accrued. Overall, low serum Mg was associated with higher CAD risk after adjustment for demographics, lifestyle factors, and other CAD risk factors than was higher serum Mg (HR Q1 compared with Q5: 1.28; 95% CI: 1.11, 1.47; P-linear trend <0.001). The association was stronger among women (HR Q1 compared with Q5: 1.53; 95% CI: 1.22, 1.92) than men (HR: 1.11; 95% CI: 0.92, 1.34) (P-interaction=0.05). In the meta-analysis including 5 studies, the pooled RR (95% CI) for CAD in the lowest compared with the highest circulating Mg category was 1.18 (1.06, 1.31) (I2=22%, P-heterogeneity=0.27). In this large community-based cohort and updated meta-analysis, low circulating Mg was associated with higher CAD risk than was higher Mg. Whether increasing Mg concentrations within healthy limits is a useful strategy for CAD prevention remains to be seen.

A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome

BackgroundAlcohol withdrawal syndrome (AWS) is routinely treated with B-vitamins. However, the relationship between thiamine status and outcome is rarely examined. The aim of the present study was to examine the relationship between thiamine and magnesium status in patients with AWS.MethodsPatients (n = 127) presenting to the Emergency Department with AWS were recruited to a prospective observational study. Blood samples were drawn to measure whole blood thiamine diphosphate (TDP) and serum magnesium concentrations. Routine biochemistry and haematology assays were also conducted. The Glasgow Modified Alcohol Withdrawal Score (GMAWS) measured severity of AWS. Seizure history and current medications were also recorded.ResultsThe majority of patients (99%) had whole blood TDP concentration within/above the reference interval (275–675 ng/gHb) and had been prescribed thiamine (70%). In contrast, the majority of patients (60%) had low serum magnesium concentrations (< 0.75 mmol/L) and had not been prescribed magnesium (93%). The majority of patients (66%) had plasma lactate concentrations above 2.0 mmol/L. At 1 year, 13 patients with AWS had died giving a mortality rate of 11%. Male gender (p < 0.05), BMI < 20 kg/m2 (p < 0.01), GMAWS max ≥ 4 (p < 0.05), elevated plasma lactate (p < 0.01), low albumin (p < 0.05) and elevated serum CRP (p < 0.05) were associated with greater 1-year mortality. Also, low serum magnesium at time of recruitment to study and low serum magnesium at next admission were associated with higher 1-year mortality rates, (84% and 100% respectively; both p < 0.05).ConclusionThe prevalence of low circulating thiamine concentrations were rare and it was regularly prescribed in patients with AWS. In contrast, low serum magnesium concentrations were common and not prescribed. Low serum magnesium was associated more severe AWS and increased 1-year mortality.

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

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

Study of Macro- and Microelement Status in Patients with Nodular Goiter Residing in Kyiv Region

Sixty-one residents of Kiev region (16 individuals with nodular goiter and 45 individuals without thyroid pathology – the control group) were examined. When studying urinary iodine excretion, median urinary iodine concentration in the control group was 65.0 μg/l, while in patients with nodular goiter, it was 72.15 μg/l indicating mild iodine deficiency. In patients with nodular goiter, there were observed decreased serum levels of calcium - 74.17 mg/l (p&lt;0.05), magnesium - 17.67 mg/l, zinc - 0.73 mg/l (p&lt;0.05) and selenium - 0.03 mg/l (p&lt;0.05) as compared to those in the control group. The relative risk of developing nodular goiter in decreased serum calcium concentration was 1.66 (95% confidence interval 1.07-2.09), (p&lt;0.05); in decreased serum concentration of both calcium and selenium, it was 2.30 (95% confidence interval 1.147–4.085), (p&lt;0.05); in low serum magnesium concentration, the relative risk was 2.6 (95% confidence interval 1.11-6.09) (p&lt;0.05).

Magnesium and Cardiovascular Disease.

Magnesium is the most abundant intracellular divalent cation and essential for maintaining normal cellular physiology and metabolism, acting as a cofactor of numerous enzymes, regulating ion channels and energy generation. In the heart, magnesium plays a key role in modulating neuronal excitation, intracardiac conduction, and myocardial contraction by regulating a number of ion transporters, including potassium and calcium channels. Magnesium also has a role in regulating vascular tone, atherogenesis and thrombosis, vascular calcification, and proliferation and migration of endothelial and vascular smooth muscle cells. As such, magnesium potentially has a major influence on the pathogenesis of cardiovascular disease. As the kidney is a major regulator of magnesium homeostasis, kidney disorders can potentially lead to both magnesium depletion and overload, and as such increase the risk of cardiovascular disease. Observational data have shown an association between low serum magnesium concentrations or magnesium intake and increased atherosclerosis, coronary artery disease, arrhythmias, and heart failure. However, major trials of supplementation with magnesium have reported inconsistent benefits and also raised potential adverse effects of magnesium overload. As such, there is currently no firm recommendation for routine magnesium supplementation except when hypomagnesemia has been proven or suspected as a cause for cardiac arrhythmias.

The Biochemical Effect of Laparoscopic Sleeve Gastrectomy on Serum Magnesium Levels

Lately it is generally accepted that bariatric surgery is one of the most effective treatment of morbid obesity. Also, the importance of studying the effects of serum magnesium levels on general health comes from data that shows that a low serum magnesium concentration increases the risk of all-cause mortality when added to the conventional cardiovascular disease risk factors. Thus, in the present report we decided to study how laparoscopic sleeve gastrectomy affects the levels of serum magnesium in obese populations. Our results showed that patients that underwentlaparoscopic sleeve gastrectomy surgery had an increased circulating magnesium level. However, further detailed investigations are needed to identify the exact underlying mechanisms. Furthermore, the role of magnesium in obesity and comorbid conditions should be established, to answer the question whether or not dietary magnesium deficiency is a significant nutritional concern.

Serum magnesium concentration is independently associated with non-alcoholic fatty liver and non-alcoholic steatohepatitis.

The pathogenesis of non-alcoholic fatty liver disease (NAFLD) has not been well recognized yet. This study aimed to investigate the association between serum magnesium concentration and NAFLD. Study participants were healthy individuals who had undergone liver biopsies between January 2012 and August 2015 as a routine pre-transplant check-up before living donor liver transplantation. Liver biopsy specimens were evaluated by an expert pathologist regarding presence of hepatic steatosis and steatohepatitis. Serum magnesium concentration was measured and compared in those with normal liver biopsy and those with steatosis and steatohepatitis. A total of 226 individuals were included. Eighty-two individuals (36.2%) had hepatic steatosis and 22 (9.7%) individuals had steatohepatitis and steatosis in their liver histology. Lower serum magnesium concentration was independently associated with hepatic steatosis (OR: 0.059; 95% CI: 0.011-0.325, p = 0.001). Serum magnesium concentration was independently associated with steatohepatitis compared to those without steatohepatitis (1.80 ± 0.48 mg/dl and 2.18 ± 0.31 mg/dl) (OR: 0.11; 95% CI: 0.02-0.41, p = 0.001). Serum magnesium concentration was significantly lower in individuals with steatohepatitis (1.80 ± 0.48 mg/dl) compared to individuals without steatosis (2.23 ± 0.31 mg/dl, p < 0.001) and individuals with only steatosis (2.07 ± 0.29 mg/dl, p = 0.017). Serum magnesium concentration is independently associated with hepatic steatosis and steatohepatitis in our study population.

High Dietary Magnesium Intake is Significantly and Independently Associated with Higher Insulin Sensitivity in a Mexican-Mestizo Population: A Brief Cross-Sectional Report.

Magnesium acts as a cofactor in many intracellular reactions including phosphorylation of the insulin receptor; therefore, its imbalance can potentially cause insulin resistance. Low serum magnesium concentration has been associated with the development of metabolic syndrome and type 2 diabetes mellitus. To study the association between the daily dietary magnesium intake and insulin resistance estimated by the homeostatic model assessment of insulin resistance and homeostatic model assessment 2, as well as insulin sensitivity estimated by the Matsuda index. In a university affiliated medical center, 32 participants (22 women, 10 men) that had an indication for testing for type 2 diabetes mellitus with an oral glucose tolerance test were enrolled in this cross-sectional, comparative study. Clinical and biochemical evaluations were carried out including an oral glucose tolerance test. Hepatic insulin resistance index, homeostatic model assessment 2, homeostatic model assessment of insulin resistance, and Matsuda insulin sensitivity were calculated for each participant. They were asked to recall their food ingestion (24 hours) of three days of the past week, including a weekend day; magnesium intake was calculated according to the food nutritional information. The low dietary magnesium intake group (< 4.5 mg/kg/day) had a higher two-hour insulin concentration after an oral glucose tolerance test compared to those with high dietary magnesium (119.5 [73.0-190.6] vs. 63.5 [25.4-114.2]; p = 0.008), and insulin sensitivity assessed by the Matsuda index was higher in the high dietary magnesium intake group (4.3 ± 3.1 vs. 2.4 ± 1.5; p = 0.042). In multiple linear regression analysis a higher dietary magnesium intake was independently associated (β = 4.93; p = 0.05) with a better insulin sensitivity estimated by the Matsuda index. Our results suggest that higher magnesium intake is independently associated with better insulin sensitivity in patients at risk for type 2 diabetes mellitus.