Magnesium intake and primary liver cancer incidence and mortality in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.

Epidemiological studies on magnesium intake and primary liver cancer (PLC) are scarce, and no prospective studies have examined the associations of magnesium intake with PLC incidence and mortality. We sought to clarify whether higher magnesium intake from diet and supplements was associated with lower risks of PLC incidence and mortality in the US population. Magnesium intake from diet and supplements was evaluated through a food frequency questionnaire in a cohort of 104,025 participants. Cox regression was employed to calculate hazard ratios for PLC incidence and competing risk regression was employed to calculate subdistribution hazard ratios for PLC mortality. Restricted cubic spline regression was employed to test nonlinearity. We documented 116 PLC cases during 1,193,513.5 person-years of follow-up and 100 PLC deaths during 1,198,021.3 person-years of follow-up. Total (diet + supplements) magnesium intake was found to be inversely associated with risks of PLC incidence (hazard ratiotertile 3 vs. 1 : 0.44; 95% confidence interval: 0.24, 0.80; ptrend = 0.0065) and mortality (subdistribution hazard ratiotertile 3 vs. 1 : 0.37; 95% confidence interval: 0.19, 0.71; ptrend = 0.0008). Similar results were obtained for dietary magnesium intake. Nonlinear inverse dose-response associations with PLC incidence and mortality were observed for both total and dietary magnesium intakes (all pnonlinearity < 0.05). In summary, in the US population, a high magnesium intake is associated with decreased risks of PLC incidence and mortality in a nonlinear dose-response manner. These findings support that increasing the consumption of foods rich in magnesium may be beneficial in reducing PLC incidence and mortality.

Magnesium and Hypertension in Old Age.

Hypertension is a complex condition in which various actors and mechanisms combine, resulting in cardiovascular and cerebrovascular complications that today represent the most frequent causes of mortality, morbidity, disability, and health expenses worldwide. In recent decades, there has been an exceptional number of experimental, epidemiological, and clinical studies confirming a close relationship between magnesium deficit and high blood pressure. Multiple mechanisms may help to explain the bulk of evidence supporting a protective effect of magnesium against hypertension and its complications. Hypertension increases sharply with advancing age, hence older persons are those most affected by its negative consequences. They are also more frequently at risk of magnesium deficiency by multiple mechanisms, which may, at least in part, explain the higher frequency of hypertension and its long-term complications. The evidence for a favorable effect of magnesium on hypertension risk emphasizes the importance of broadly encouraging the intake of foods such as vegetables, nuts, whole cereals and legumes, optimal dietary sources of magnesium, and avoiding processed foods, which are very poor in magnesium and other fundamental nutrients, in order to prevent hypertension. In some cases, when diet is not enough to maintain an adequate magnesium status, magnesium supplementation may be of benefit and has been shown to be well tolerated.

The Problematic Use of Dietary Reference Intakes to Assess Magnesium Status and Clinical Importance.

Determination of the public health concern about magnesium (Mg) in health and disease has been confounded by the lack of a practical measure of status. This has resulted in a lack of consistency in associating Mg deficiency with specific pathological conditions. Some attempts at associating Mg with a chronic disease have used the Dietary Reference Intakes (DRIs) as a status assessment measure. Use of current DRIs for Mg is problematic because recent evidence suggests that they should be updated and based on body weight. An evidence-based suggested Estimated Average Requirement (EAR) and Recommended Dietary Allowance (RDA) for a 70-kg individual is 175 and 250 mg/day, respectively. However, numerous dietary and physiological factors can affect the need for Mg and thus affect the use of the current or suggested new DRIs to assess Mg status. Calcium intakes above normal requirements can decrease Mg balance and exacerbate signs of Mg deficiency. Mg deficiency apparently occurs often in obesity because of increased need to counteract the inflammatory stress induced by adipose tissue dysfunction. Deficiency in anti-oxidant nutrients such as vitamin E and selenium can exacerbate a response to low dietary Mg indicated by increased oxidative stress which can lead to chronic disease. Dietary modifiers of Mg absorption and excretion affect balance and thus the need for Mg. Factors decreasing Mg balance include low dietary protein and non-fermentable fiber, while factors that can increase balance include fructose and fermentable fiber and fructose-containing oligosaccharides. Use of the DRIs to assess the Mg status of a population or group needs to consider their physiological characteristics and dietary habits and be aware that the DRIs may need updating. The DRIs only can be considered a component of a toolbox that presently includes serum Mg concentration and the daily urinary Mg excretion to assess the Mg status of an individual.

Effects of dietary gelatin hydrolysates on bone mineral density in magnesium-deficient rats.

BACKGROUND: The major types of commercially available gelatin hydrolysates are prepared from mammals or fish. Dietary gelatin hydrolysates from mammals were reported to improve bone mineral density (BMD) in some animal models. In contrast, there is limited study showing the effects of dietary gelatin hydrolysates from fish on BMD. The quantity and structure of peptides in the plasma after oral administration of gelatin hydrolysates depend on the gelatin source, which suggests that the biological activity of gelatin hydrolysates depend on the gelatin source. This study examined the effects of fish-derived gelatin hydrolysate (FGH) or porcine-derived gelatin hydrolysate (PGH) intake on BMD and intrinsic biomechanical properties in magnesium (Mg)-deficient rats as a model showing the decrease in both BMD and intrinsic biomechanical properties. METHODS: Four-week-old male Wistar rats were assigned into four groups: a normal group was fed a normal diet (48 mg Mg/100 g diet), a Mg-deficient (MgD) group was fed a MgD diet (7 mg Mg/100 g diet), a FGH group was fed a MgD + FGH diet (5% FGH), and a PGH group was fed a MgD + PGH diet (5% PGH) for 8 weeks. At the end of the study, BMD and intrinsic biomechanical properties of the femur were measured. RESULTS: The MgD group showed significantly lower Young's modulus, an intrinsic biomechanical property, and trabecular BMD of the femur than the normal group; however, the MgD diet did not affect cortical BMD and cortical thickness. Both the FGH and the PGH groups showed significantly higher cortical thickness and ultimate displacement of the femur than the normal group, but neither type of gelatin hydrolysate affected Young's modulus. Furthermore, the FGH group, but not the PGH group, showed significantly higher trabecular BMD than the MgD group. CONCLUSIONS: This study indicates that FGH and PGH increase cortical thickness but only FGH prevents the decrease in trabecular BMD seen in Mg-deficient rats, while neither type of gelatin hydrolysate affect intrinsic biomechanical properties.

The Role of Elements in Anxiety.

Elements (bioelements) are necessary factors required for the physiological function of organisms. They are critically involved in fundamental processes of life. Extra- and intracellular message and metabolic pathway factors as well as structural components include one or many elements in their functional structure. Recent years have seen an intensification in terms of knowledge gained about the roles of elements in anxiety disorders. In this chapter we present a review of the most important current data concerning the involvement of zinc, magnesium, copper, lithium, iron, and manganese, and their deficiency, in the pathophysiology and treatment of anxiety.

Magnesium and depression.

Magnesium is one of the most important elements in the human body and is involved in a number of biochemical processes crucial for the proper functioning of the cardiovascular, alimentary, endocrine, and osteoarticular systems. It also plays a vital modulatory role in brain biochemistry, influencing several neurotransmission pathways associated with the development of depression. Personality changes, including apathy, depression, agitation, confusion, anxiety, and delirium are observed when there is a deficiency of this element. Rodents receiving a diet deficient in magnesium displayed depressive behaviour that was reversed by antidepressant drugs. Poor nutrition, gastrointestinal and renal diseases, insulin resistance and/or type 2 diabetes, alcoholism, stress, and certain medications may lead to magnesium deficiency. Since the extracellular concentration of magnesium ions may not reflect their intracellular level, none of the current methods of evaluating magnesium status is regarded as satisfactory. The mood-improving potential of magnesium compounds have been confirmed by the results of numerous pre-clinical and clinical studies. It seems that magnesium supplementation is well-tolerated and enhances the efficacy of conventional antidepressant treatments, and as such could be a valuable addition to the standard treatments for depression, although differences in bioavailability between inorganic and organic compounds should be taken into consideration.

Protocol for the detection and nutritional management of high-output stomas.

INTRODUCTION: An issue of recent research interest is excessive stoma output and its relation to electrolyte abnormalities. Some studies have identified this as a precursor of dehydration and renal dysfunction. A prospective study was performed of the complications associated with high-output stomas, to identify their causes, consequences and management. MATERIALS AND METHODS: This study was carried out by a multidisciplinary team of surgeons, gastroenterologists, nutritionists and hospital pharmacists. High-output stoma (HOS) was defined as output ≥1500 ml for two consecutive days. The subjects included in the study population, 43 patients with a new permanent or temporary stoma, were classified according to the time of HOS onset as early HOS (<3 weeks after initial surgery) or late HOS (≥3 weeks after surgery). Circumstances permitting, a specific protocol for response to HOS was applied. Each patient was followed up until the fourth month after surgery. RESULTS: Early HOS was observed in 7 (16%) of the sample population of 43 hospital patients, and late HOS, in 6 of the 37 (16%) non-early HOS population. By type of stoma, nearly all HOS cases affected ileostomy, rather than colostomy, patients. The patients with early HOS remained in hospital for 18 days post surgery, significantly longer than those with no HOS (12 days). The protocol was applied to the majority of EHOS patients and achieved 100% effectiveness. 50% of readmissions were due to altered electrolyte balance. Hypomagnesaemia was observed in 33% of the late HOS patients. CONCLUSION: The protocol developed at our hospital for the detection and management of HOS effectively addresses possible long-term complications arising from poor nutritional status and chronic electrolyte alteration.

Dietary magnesium deficiency alters gut microbiota and leads to depressive-like behaviour.

OBJECTIVE: Gut microbiota (GM) has previously been associated with alterations in rodent behaviour, and since the GM is affected by the diet, the composition of the diet may be an important factor contributing to behavioural changes. Interestingly, a magnesium restricted diet has been shown to induce anxiety and depressive-like behaviour in humans and rodents, and it could be suggested that magnesium deficiency may mediate the effects through an altered GM. METHODS: The present study therefore fed C57BL/6 mice with a standard diet or a magnesium deficient diet (MgD) for 6 weeks, followed by behavioural testing in the forced swim test (FST) to evaluate depressive-like behaviour. An intraperitoneal glucose tolerance test (GTT) was performed 2 day after the FST to assess metabolic alterations. Neuroinflammatory markers were analysed from hippocampus. GM composition was analysed and correlated to the behaviour and hippocampal markers. RESULTS: It was found that mice exposed to MgD for 6 weeks were more immobile than control mice in the FST, suggesting an increased depressive-like behaviour. No significant difference was detected in the GTT. GM composition correlated positively with the behaviour of undisturbed C57BL/6 mice, feeding MgD diet altered the microbial composition. The altered GM correlated positively to the hippocampal interleukin-6. CONCLUSION: In conclusion, we hypothesise that imbalances of the microbiota-gut-brain axis induced by consuming a MgD diet, contributes to the development of depressive-like behaviour.

[Influence of magnesium deficiency correction on the effectiveness of bronchial asthma pharmacotherapy in children].

We have performed 24-week open-labeled comparative randomized parallel-group study of the basic therapy efficacy of uncontrolled and partly controlled atopic asthma children with magnesium deficiency. The additional correction of magnesium deficiency increases the efficacy of atopic asthma basic therapy. It leads to more pronounced inhibition of local allergic inflammation in respiratory system, decreases the exacerbation frequency (9.5%, p = 0.02), and increases the number of asymptomatic days and the 12-week constant asthma control frequency (71.4%, p = 0.145) as compared to the group without magnesium deficiency correction.

Effect of oral magnesium supplementation on physical performance in healthy elderly women involved in a weekly exercise program: a randomized controlled trial.

BACKGROUND: Magnesium deficiency is associated with poor physical performance, but no trials are available on how magnesium supplementation affects elderly people's physical performance. OBJECTIVE: The aim of our study was to investigate whether 12 wk of oral magnesium supplementation can improve physical performance in healthy elderly women. DESIGN: In a parallel-group, randomized controlled trial, 139 healthy women (mean ± SD age: 71.5 ± 5.2 y) attending a mild fitness program were randomly allocated to a treatment group (300 mg Mg/d; n = 62) or a control group (no placebo or intervention; n = 77) by using a computer-generated randomization sequence, and researchers were blinded to their grouping. After assessment at baseline and again after 12 wk, the primary outcome was a change in the Short Physical Performance Battery (SPPB); secondary outcomes were changes in peak torque isometric and isokinetic strength of the lower limbs and handgrip strength. RESULTS: A total of 124 participants allocated to the treatment (n = 53) or control (n = 71) group were considered in the final analysis. At baseline, the SPPB scores did not differ between the 2 groups. After 12 wk, the treated group had a significantly better total SPPB score (Δ = 0.41 ± 0.24 points; P = 0.03), chair stand times (Δ = -1.31 ± 0.33 s; P < 0.0001), and 4-m walking speeds (Δ = 0.14 ± 0.03 m/s; P = 0.006) than did the control group. These findings were more evident in participants with a magnesium dietary intake lower than the Recommended Dietary Allowance. No significant differences emerged for the secondary outcomes investigated, and no serious adverse effects were reported. CONCLUSIONS: Daily magnesium oxide supplementation for 12 wk seems to improve physical performance in healthy elderly women. These findings suggest a role for magnesium supplementation in preventing or delaying the age-related decline in physical performance.

[Magnesium: a supercation misunderstood? Overview and survey of GPs in "Ille-et-Vilaine"]. / Le magnésium: un super cation méconnu? Revue générale et enquête auprès des généralistes d'Ille-et-Vilaine.

Since the introduction of the first magnesium pharmaceutical specialty in 1928, multiple medical indications were attributed to magnesium supplementation, despite rigorous scientific researches, leading to a very confuse therapeutic chapter. Real hypomagnesemia, acute or chronic, is rare, however oral magnesium drugs are numerous and widely prescribed. Moreover, in France, only proven magnesium deficiency, isolated or combined, are accepted by the HAS for magnesium supplementation. The purpose of this article is to review current knowledges on magnesium and analyze the prescribing practices of GPs. After telephone agreement, 100 doctors of Ille-et-Vilaine received an e-questionnaire that included 27 questions (38 items). These questions concerned the prescribing practices of magnesium, magnesium knowledge, and demographic data: 70% of responders say that prescribing magnesium shows an interest in their daily practice and 96% of responders that they often prescribe magnesium leading to 26% who prescribe magnesium even if they do not see the point! In only 7% of cases, prescription is the renewal of a specialist, and in 7% of cases, the request comes from the patient. GPs report that their knowledge on magnesium and its treatment indications come from the pharmaceutical industry. There is also a significant number of requirements driven by the patient himself, probably under the influence of the media especially Internet forums.

Hypomagnesemia in adolescents with eating disorders hospitalized for medical instability.

BACKGROUND: Hypomagnesemia in patients with eating disorders is poorly characterized, particularly among adolescents. METHODS: To determine the prevalence of hypomagnesemia (Mg ≤ 1.7 mg/dL) and clinical characteristics of adolescents hospitalized with a DSM-IV-diagnosed eating disorder who developed hypomagnesemia, a retrospective chart review was conducted on all adolescents aged 10-21 years with an eating disorder were hospitalized at a tertiary care children's hospital from 2007 to 2010. Patients were refed orally with standard nutrition and high-energy liquid supplements. Serum magnesium and phosphorus were obtained on admission, every 24-48 hours for the first week, and thereafter as clinically indicated. Clinical characteristics of patients with hypomagnesemia were compared with those of individuals with normal magnesium levels and those with hypophosphatemia. RESULTS: Eighty-six of 541 eligible participants (15.9%) developed hypomagnesemia. Forty (47%) with hypomagnesemia admitted to purging in the year before admission, with 88% purging during the prior month. Compared with those with normal serum magnesium levels, patients with hypomagnesemia were older (P = .0001), ill longer (P = .001), more likely to be purging (P = .04), and more likely to have an alkaline urine (P = .01). They did not differ in eating disorder diagnosis, BMI, or other electrolyte disturbances. Hypomagnesemia developed 4.9 ± 5.5 days after refeeding was initiated, significantly later than the onset of hypophosphatemia, 0.95 ± 2.6 days (P < .001). CONCLUSIONS: Hypomagnesemia is prevalent in adolescents hospitalized for an eating disorder and is associated with purging and alkaline urine. Hypomagnesemia develops later in the course of refeeding than hypophosphatemia. Magnesium levels should continue to be monitored after the more immediate risk of hypophosphatemia has passed, especially in those with alkaline urine.

[Hypomagnesaemia severe in patients with high flow ileostomy]. / Hipomagnesemia severa en paciente con ileostomía de alto débito.

The need to create a stoma is frequent in the daily clinical practice. Usually ileostomies work well within the first 24 hours. However, many times they are associated with important morbidity up to 76%. Although the complications derived from this technique may be surgical, metabolic complications, which are preceded by large losses through the stoma, are the ones going undetected. It is not rare to see patients carrying an ileostomy that come repeatedly to the hospital with severe metabolic impairments and in whom the underlying cause remains untreated. The case reported herein is just one of a series published in this journal making us aware of the need for a multidisciplinary approach of the ileostomies and the prevention of major complications derived from their poor functioning.

Thrombotic microangiopathy: a role for magnesium?

Despite advances in more recent years, the pathophysiology and especially treatment modalities of thrombotic microangiopathy (TMA) largely remain enigmatic. Disruption of endothelial homeostasis plays an essential role in TMA. Considering the proven causal association between magnesium and both endothelial function and platelet aggregability, we speculate that a magnesium deficit could influence the course of TMA and the related haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura. A predisposition towards TMA is seen in many conditions with both extracellular and intracellular magnesium deficiency. We propose a rationale for magnesium supplementation in TMA, in analogy with its evidence-based therapeutic application in pre-eclampsia and suggest, based on theoretical grounds, that it might attenuate the development of TMA, minimise its severity and prevent its recurrence. This is based on several lines of evidence from both in vitro and in vivo data showing dose-dependent effects of magnesium supplementation on nitric oxide production, platelet aggregability and inflammation. Our hypothesis, which is further amenable to assessment in animal models before therapeutic applications in humans are implemented, could be explored both in vitro and in vivo to decipher the potential role of magnesium deficit in TMA and of the effects of its supplementation.

Assessment of magnesium status for diagnosis and therapy.

Magnesium is an essential element needed for health. Even though only 1% of the total body magnesium is present in blood, the serum magnesium concentration (SMC) is the predominant test used by medicine to assess magnesium status in patients. The traditional method to establish a reference interval for the SMC is flawed by the large number of "normal" individuals who have a subtle chronic negative magnesium balance due to a significant decrease in magnesium intake over the past century. Evidence-based medicine should be used to establish the appropriate lower limit of the reference interval for health and I recommend 0.85 mmol/L based on current literature. The decrease in magnesium in the diet has led to chronic latent magnesium deficiency in a large number of people since their SMC is still within the reference interval due to primarily the bone magnesium supplementing the SMC. These individuals need adjustment of their diet or magnesium supplementation to achieve a normal magnesium status for health.

Eats roots and leaves. Can edible horticultural crops address dietary calcium, magnesium and potassium deficiencies?

Human individuals require at least 20 inorganic elements ('minerals') for normal functioning. However, much of the world's population is probably deficient in one or more essential minerals and at increased risk of physiological disorders. Addressing these 'hidden hungers' is a challenge for the nutrition and agriculture sectors. Mineral deficiencies among populations are typically identified from dietary surveys because (1) minerals are acquired primarily from dietary sources and (2) (bio)assays of mineral status can be unreliable. While dietary surveys are likely to under-report energy intakes, surveys show that 9% of all UK and US adults consume Ca and Mg, and 14% of adults consume K, at quantities below the UK lower reference nutrient intake, and are therefore at risk of deficiency. Low dietary Ca, Mg and K intakes can be caused by energy-malnourishment and by cultural and economic factors driving dietary conservatism. For example, cereal grains routinely displace vegetables and fruits in the diet. Cereal grains have low concentrations of several minerals, notably Ca, as a consequence of their physiology. Low grain mineral concentrations are compounded when cereal crops are grown in soils of low mineral phytoavailability and when grain is processed. In this paper, the impact of increased vegetable consumption and horticultural biofortification, i.e. enhancing crop mineral content through breeding and agronomy, on intakes of the major minerals Ca, Mg and K is assessed. Despite low energy intake from horticultural crops generally, increased vegetable consumption and biofortification would significantly improve dietary intakes of Ca, Mg and K.

Aspectos atuais da relação entre exercício físico, estresse oxidativo e magnésio / Current aspects of the relationship between physical exercise, oxidative stress and magnesium

Este trabalho visa a contribuir com informações atualizadas sobre a relação entre exercício, estresse oxidativo e magnésio. São escassos os trabalhos que discutem a produção de radicais livres nesse contexto. A deficiência de magnésio altera a fluidez das membranas celulares e mitocondriais e promove perturbações na homeostase do cálcio e na atividade das defesas antioxidantes. No exercício, a falta de magnésio nos tecidos musculares os torna mais suscetíveis à infiltração de macrófagos e neutrófilos e ao rompimento do sarcolema, dificultando o processo de regeneração e podendo ocasionar queda no desempenho físico. Conclui-se que o papel metabólico da deficiência de magnésio no estresse oxidativo induzido pelo exercício deve ser mais pesquisado, focalizando os seus efeitos na musculatura esquelética em indivíduos que praticam exercício regular e na deficiência marginal de magnésio.

This article contributes to updated information about the relationship between exercise, oxidative stress and magnesium. There are few studies that discuss free radical production in this context. Magnesium deficiency alters cellular and mitochondrial membrane fluidity and promotes disturbances on calcium homeostasis and on the activity of antioxidant defenses. During exercise, lack of magnesium in muscle tissue turns them more susceptible to macrophage and neutrophil infiltration and to sarcolema damage, impairing the regeneration process and leading to decreased physical performance. In conclusion, the metabolic role of magnesium deficiency on exercise-induced oxidative stress should be further researched, focusing on its effects on skeletal muscle in individuals who practice regular physical exercise and in marginal magnesium deficiency.