Nutrition Risk is Associated With Falls Risk in an Observational Study of Community-Dwelling, Rural, Older Adults.

OBJECTIVES: Poor nutritional status is a risk factor for falls and impedes recovery from falls in older adults. The primary objective of this study was to investigate the relationship between nutrition status and fall risk over time in a cohort of older adults. METHODS: Using an observational analytic study design, we collected demographic, fall risk, nutrition risk, food insecurity, and incident falls data from community-dwelling older Vermonters. RESULTS: Data from 708 participants (70.3 years ± 6.6; 82% female) indicate a significant association between fall risk and nutrition risk (p < 0.001), fall risk and food insecurity (p < 0.001), and food insecurity and nutrition risk (p < 0.001). After adjusting for potential confounders, elevated nutrition risk was significantly associated with an incident fall over the next 6 months (p < 0.05). CONCLUSION: Given the evidence for an association between nutrition status and falls, additional research, in a more diverse population, is needed to understand the nuances of these relationships.

Relationship between Magnesium Intake and Chronic Pain in U.S. Adults.

Chronic pain is a public health concern and additional treatment options are essential. Inadequate magnesium intake has been associated with chronic pain in some populations. We sought to examine the relationship between dietary magnesium intake and chronic pain in a large, representative cohort of U.S. adults (NHANES). Of the 13,434 eligible adults surveyed between 1999 and 2004, 14.5% reported chronic pain while 66% reported inadequate magnesium intake. The univariate analysis showed a protective effect of increased magnesium intake adjusted for body weight (odds ratio 0.92; 95%; CI 0.88, 0.95; p < 0.001). It remained so even after correcting for socioeconomic and clinical factors as well as total calorie intake (odds ratio 0.93; 95% CI 0.87, 0.99; p = 0.02). The association was stronger in females (odds ratio 0.91; 95% CI 0.85, 0.98; p = 0.01) than males (odds ratio 0.96; 95% CI 0.89, 1.04; p = 0.32). The potential protective effect of magnesium intake on chronic pain warrants further investigation.

The Association between Serum Magnesium Levels and Depression in an Adult Primary Care Population.

Depression is common, places a large burden on the patient, their family and community, and is often difficult to treat. Magnesium supplementation is associated with improved depressive symptoms, but because the mechanism is unknown, it is unclear whether serum magnesium levels act as a biological predictor of the treatment outcome. Therefore, we sought to describe the relationship between serum magnesium and the Patient Health Questionnaire (PHQ, a measure of depression) scores. A cross-sectional analysis of medical records from 3604 adults (mean age 62 years; 42% men) seen in primary care clinics between 2015 and 2018, with at least one completed PHQ were included. The relationship between serum magnesium and depression using univariate analyses showed a significant effect when measured by the PHQ-2 (-0.19 points/mg/dL; 95% CI -0.31, -0.07; P = 0.001) and the PHQ-9 (-0.93 points/mg/dL; 95% CI -1.81, -0.06; P = 0.037). This relationship was strengthened after adjusting for covariates (age, gender, race, time between serum magnesium and PHQ tests, and presence of diabetes and chronic kidney disease) (PHQ-2: -0.25 points/mg/dL; 95% CI -3.33, -0.09; P < 0.001 and PHQ-9: -1.09 95% CI -1.96 -0.21; P = 0.015). For adults seen in primary care, lower serum magnesium levels are associated with depressive symptoms, supporting the use of supplemental magnesium as therapy. Serum magnesium may help identify the biological mechanism of depressive symptoms and identify patients likely to respond to magnesium supplementation.

Factors influencing magnesium consumption among adults in the United States.

The negative health effects of inadequate magnesium intake are well established, but the extent of the problem of deficiency warrants further exploration. This review explores the dietary factors, such as changes in agricultural practices and dietary patterns, that affect magnesium consumption over time and examines the current adequacy of magnesium intake among adults in the United States. Large, cross-sectional, population-based data sets confirm over half the adult population in the United States does not consume adequate amounts of magnesium, although recent population-based studies show a steady and consistent recovery in magnesium consumption over the last several decades. Because there is no simple, rapid, accurate test to determine whole-body magnesium status, continued monitoring of magnesium consumption is essential to determine whether the trend of increasing magnesium consumption will continue. In the meantime, since the clinical consequences of inadequate magnesium status are well established, there are few reasons not to encourage increased magnesium intake in adults, especially since magnesium is found in healthy foods that should be consumed more often and there are no reported cases of hypermagnesemia from food alone.

Role of magnesium supplementation in the treatment of depression: A randomized clinical trial.

Current treatment options for depression are limited by efficacy, cost, availability, side effects, and acceptability to patients. Several studies have looked at the association between magnesium and depression, yet its role in symptom management is unclear. The objective of this trial was to test whether supplementation with over-the-counter magnesium chloride improves symptoms of depression. An open-label, blocked, randomized, cross-over trial was carried out in outpatient primary care clinics on 126 adults (mean age 52; 38% male) diagnosed with and currently experiencing mild-to-moderate symptoms with Patient Health Questionnaire-9 (PHQ-9) scores of 5-19. The intervention was 6 weeks of active treatment (248 mg of elemental magnesium per day) compared to 6 weeks of control (no treatment). Assessments of depression symptoms were completed at bi-weekly phone calls. The primary outcome was the net difference in the change in depression symptoms from baseline to the end of each treatment period. Secondary outcomes included changes in anxiety symptoms as well as adherence to the supplement regimen, appearance of adverse effects, and intention to use magnesium supplements in the future. Between June 2015 and May 2016, 112 participants provided analyzable data. Consumption of magnesium chloride for 6 weeks resulted in a clinically significant net improvement in PHQ-9 scores of -6.0 points (CI -7.9, -4.2; P<0.001) and net improvement in Generalized Anxiety Disorders-7 scores of -4.5 points (CI -6.6, -2.4; P<0.001). Average adherence was 83% by pill count. The supplements were well tolerated and 61% of participants reported they would use magnesium in the future. Similar effects were observed regardless of age, gender, baseline severity of depression, baseline magnesium level, or use of antidepressant treatments. Effects were observed within two weeks. Magnesium is effective for mild-to-moderate depression in adults. It works quickly and is well tolerated without the need for close monitoring for toxicity.

Dietary saturated fat and monounsaturated fat have reversible effects on brain function and the secretion of pro-inflammatory cytokines in young women.

BACKGROUND: Previous literature suggests that a higher ratio of palmitic acid (PA)/oleic acid (OA) in the diet induces inflammation, which may result in deficient brain insulin signaling, and, secondarily, impaired physical activity, sleep efficiency, and cognitive functioning. OBJECTIVE: We hypothesized that lowering the typical dietary PA/OA would affect the activation of relevant brain networks during a working memory task and would also lower secretion of pro-inflammatory cytokines. DESIGN: In 12 female subjects participating in a randomized, cross-over trial comparing 3-week high PA diet (HPA) and low PA and a high OA diet (HOA), we evaluated functional magnetic resonance imaging (fMRI) using an N-back test of working memory, cytokine secretion by lipopolysaccharide (LPS)-stimulated peripheral blood mononuclear cells (PBMC), and plasma cytokine concentrations. RESULTS: Brain activation during the HPA diet compared to the HOA diet was increased in regions of the basal ganglia including the caudate and putamen (p<0.005). In addition, compared to the HOA diet, during the HPA diet, the plasma concentrations of IL-6 (p=0.04) and IL-1ß (p=0.05) were higher, and there was a higher secretion of IL-18 (p=0.015) and a trend for higher IL-1ß secretion (p=0.066) from LPS-stimulated PBMCs. CONCLUSIONS: The HPA diet resulted in increased brain activation in the basal ganglia compared to the HOA diet as well as increased secretion of pro-inflammatory cytokines. These data provide evidence that short-term (2week) diet interventions impact brain network activation during a working memory task and that these effects are reversible since the order of the study diets was randomized. These data are consistent with the hypothesis that lowering the dietary PA content via substitution with OA also could affect cognition.

Primer for nutritionists: Managing the side effects of antidepressants.

Depression is a chronic disease affecting a significant portion of the U.S. POPULATION: Due to the popularity of ADs most nutrition professionals working in the outpatient setting will encounter patients taking one of these medications. Nutritionist can assist patients in managing the short and long term side effects of ADs and, taking into account other nutritional issues, improve overall wellbeing of the patient. The objective of this paper is to identify what side effects nutritionists can help manage, provide the information necessary to help nutritionists feel comfortable assisting with that management, and, as a result, play a valuable role in the team that is vested in the health and wellbeing of the patient.

Lipidomic evidence that lowering the typical dietary palmitate to oleate ratio in humans decreases the leukocyte production of proinflammatory cytokines and muscle expression of redox-sensitive genes.

We recently reported that lowering the high, habitual palmitic acid (PA) intake in ovulating women improved insulin sensitivity and both inflammatory and oxidative stress. In vitro studies indicate that PA can activate both cell membrane toll-like receptor-4 and the intracellular nucleotide oligomerization domain-like receptor protein (NLRP3). To gain further insight into the relevance to human metabolic disease of dietary PA, we studied healthy, lean and obese adults enrolled in a randomized, crossover trial comparing 3-week, high-PA (HPA) and low-PA/high-oleic-acid (HOA) diets. After each diet, both hepatic and peripheral insulin sensitivities were measured, and we assessed cytokine concentrations in plasma and in supernatants derived from lipopolysaccharide-stimulated peripheral blood mononuclear cells (PBMCs) as well as proinflammatory gene expression in skeletal muscle. Insulin sensitivity was unaffected by diet. Plasma concentration of tumor necrosis factor-α was higher during the HPA diet. Lowering the habitually high PA intake by feeding the HOA diet resulted in lower secretion of interleukin (IL)-1ß, IL-18, IL-10, and tumor necrosis factor-α by PBMCs, as well as lower relative mRNA expression of cJun and NLRP3 in muscle. Principal components analysis of 156 total variables coupled to analysis of covariance indicated that the mechanistic pathway for the differential dietary effects on PBMCs involved changes in the PA/OA ratio of tissue lipids. Our results indicate that lowering the dietary and tissue lipid PA/OA ratio resulted in lower leukocyte production of proinflammatory cytokines and muscle expression of redox-sensitive genes, but the relevance to diabetes risk is uncertain.

Increased palmitate intake: higher acylcarnitine concentrations without impaired progression of ß-oxidation.

Palmitic acid (PA) is associated with higher blood concentrations of medium-chain acylcarnitines (MCACs), and we hypothesized that PA may inhibit progression of FA ß-oxidation. Using a cross-over design, 17 adults were fed high PA (HPA) and low PA/high oleic acid (HOA) diets, each for 3 weeks. The [1-(13)C]PA and [13-(13)C]PA tracers were administered with food in random order with each diet, and we assessed PA oxidation (PA OX) and serum AC concentration to determine whether a higher PA intake promoted incomplete PA OX. Dietary PA was completely oxidized during the HOA diet, but only about 40% was oxidized during the HPA diet. The [13-(13)C]PA/[1-(13)C]PA ratio of PA OX had an approximate value of 1.0 for either diet, but the ratio of the serum concentrations of MCACs to long-chain ACs (LCACs) was significantly higher during the HPA diet. Thus, direct measurement of PA OX did not confirm that the HPA diet caused incomplete PA OX, despite the modest, but statistically significant, increase in the ratio of MCACs to LCACs in blood.

Magnesium intake and depression in adults.

BACKGROUND: Depression is a common and often disabling disorder. Magnesium supplementation has been linked to improvement in depressive symptoms, but consensus on the relationship between magnesium and depression has not been reached. METHODS: The purpose of this study was to test the existence of an association between dietary magnesium intake and depression in the adult US population. A cross-sectional, population-based data set (National Health and Nutrition Examination Survey) was used to explore the relationship of magnesium intake and depression in 8894 US adults (mean age, 46.1 years; 47.4% men) from 2007 to 2010. Using logistic regression to model the relationship between the presence of depression (Patient Health Questionnaire score ≥5) and low magnesium intake (<184 mg/day), we examined the risk ratio (RR) of magnesium intake and its 95% confidence interval. RESULTS: After adjusting for all potential confounders, the strength of the association of very low magnesium intake with depression was statistically significant (RR = 1.16; 95% CI, 1.06-1.30). Adjusting for all other covariates, low magnesium intake was associated with depression in subjects younger than age 65 (RR, 1.22; 95% CI, 1.06-1.40; P = .007) but seemed to be protective in seniors (RR, 0.75; 95% CI, 0.56-0.98; P = .032). CONCLUSIONS: We found a significant association between very low magnesium intake and depression, especially in younger adults. The finding of the potential protective effect of low magnesium intake in older adults is surprising and warrants further investigation.