Lessons from Observational Studies Evaluating Magnesium Intakes: Can They Predict Outcomes for Clinical Interventions

Lessons from Observational Studies Evaluating Magnesium Intakes: Can They Predict Outcomes for Clinical Interventions?

W.H. Linda Kao, Ph.D

Abstract

Type 2 diabetes mellitus imposes a substantial public health burden in the United States. It affects approximately 15 million Americans and leads to an excess risk of blindness, renal failure, lower extremity amputation, and cardiovascular disease. Several lines of evidence suggest a possible, novel risk factor for type 2 diabetes S magnesium deficiency. First, several large observational studies have demonstrated strong cross-sectional associations between low serum magnesium and type 2 diabetes. Second, in vitro studies have shown an effect of magnesium on the secretion of insulin by the pancreas and on the responsiveness to insulin by peripheral tissues. Third, magnesium supplementation prevents the development of diabetes in a rat model of spontaneous type 2 diabetes. Finally, clinical intervention studies demonstrated that daily magnesium supplementation can improve short-term insulin response and glucose handling in diabetic individuals. Results from large, prospective, observational studies of the associations between serum magnesium and magnesium intake and the risk of developing type 2 diabetes will be reviewed. Although results from these studies support the notion that low serum magnesium levels and low dietary magnesium intake may be important in the development of type 2 diabetes, whether pharmacologic doses of magnesium used as dietary supplement can reduce the long-term risk for type 2 diabetes remains to be investigated.

Reference List

(1) Yajnik CS, Smith RF, Hockaday TD, Ward NI. Fasting plasma magnesium concentrations and glucose disposal in diabetes. Br Med J (Clin Res Ed) 1984; 288(6423):1032-1034.

(2) Rsnick LM, Altura BT, Gupta RK, Laragh JH, Alderman MH, Altura BM. Intracellular and extracellular magnesium depletion in type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 1993; 36(8):767-770.

(3) Paolisso G, Ravussin E. Intracellular magnesium and insulin resistance: results in Pima Indians and Caucasians. J Clin Endocrinol Metab 1995; 80(4):1382-1385.

(4) Paolisso G, Scheen A, D'Onofrio F, Lefebvre P. Magnesium and glucose homeostasis. Diabetologia 1990; 33(9):511-514.

(5) Levin GE, Mather HM, Pilkington TR. Tissue magnesium status in diabetes mellitus. Diabetologia 1981; 21(2):131-134.

(6) Alzaid AA, Dinneen SF, Moyer TP, Rizza RA. Effects of insulin on plasma magnesium in noninsulin-dependent diabetes mellitus: evidence for insulin resistance. J Clin Endocrinol Metab 1995; 80(4):1376-1381.

(7) McNair P, Christensen MS, Christiansen C, Madsbad S, Transbol I. Renal hypomagnesaemia in human diabetes mellitus: its relation to glucose homeostasis. Eur J Clin Invest 1982; 12(1):81-85.

(8) Mather HM, Nisbet JA, Burton GH, Poston GJ, Bland JM, Bailey PA et al. Hypomagnesaemia in diabetes. Clin Chim Acta 1979; 95(2):235-242.

(9) White JR, Jr., Campbell RK. Magnesium and diabetes: a review. Ann Pharmacother 1993; 27(6):775-780.

(10) Ma J, Folsom AR, Melnick SL, Eckfeldt JH, Sharrett AR, Nabulsi AA et al. Associations of serum and dietary magnesium with cardiovascular disease, hypertension, diabetes, insulin, and carotid arterial wall thickness: the ARIC study. Atherosclerosis Risk in Communities Study. J Clin Epidemiol 1995; 48(7):927-940.

(11) Hwang DL, Yen CF, Nadler JL. Insulin increases intracellular magnesium transport in human platelets. J Clin Endocrinol Metab 1993; 76(3):549-553.

(12) Gueux E, Rayssiguier Y. The effect of magnesium deficiency on glucose stimulated insulin secretion in rats. Horm Metab Res 1983; 15(12):594-597.

(13) Balon TW, Gu JL, Tokuyama Y, Jasman AP, Nadler JL. Magnesium supplementation reduces development of diabetes in a rat model of spontaneous NIDDM. Am J Physiol 1995; 269(4:Pt 1):Pt 1):E745-52.

(14) Paolisso G, Sgambato S, Gambardella A, Pizza G, Tesauro P, Varricchio M et al. Daily magnesium supplements improve glucose handling in elderly subjects. Am J Clin Nutr 1992; 55(6):1161-1167.

(15) Paolisso G, Sgambato S, Pizza G, Passariello N, Varricchio M, D'Onofrio F. Improved insulin response and action by chronic magnesium administration in aged NIDDM subjects. Diabetes Care 1989; 12(4):265-269.

(16) Paolisso G, Scheen A, Cozzolino D, Di Maro G, Varricchio M, D'Onofrio F et al. Changes in glucose turnover parameters and improvement of glucose oxidation after 4-week magnesium administration in elderly noninsulin-dependent (type II) diabetic patients. J Clin Endocrinol Metab 1994; 78(6):1510-1514.

(17) Paolisso G, Passariello N, Pizza G, Marrazzo G, Giunta R, Sgambato S et al. Dietary magnesium supplements improve B-cell response to glucose and arginine in elderly non-insulin dependent diabetic subjects. Acta Endocrinol (Copenh) 1989; 121(1):16-20.

(18) Paolisso G, Sgambato S, Giugliano D, Torella R, Varricchio M, Scheen AJ et al. Impaired insulin-induced erythrocyte magnesium accumulation is correlated to impaired insulin-mediated glucose disposal in type 2 (non-insulin-dependent) diabetic patients. Diabetologia 1988; 31(12):910-915.

(19) Colditz GA, Manson JE, Stampfer MJ, Rosner B, Willett WC, Speizer FE. Diet and risk of clinical diabetes in women. Am J Clin Nutr 1992; 55(5):1018-1023.

(20) Meyer KA, Kushi LH, Jacobs DR, Jr., Slavin J, Sellers TA, Folsom AR. Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr 2000; 71(4):921-930.

(21) Kao WH, Folsom AR, Nieto FJ, Mo JP, Watson RL, Brancati FL. Serum and dietary magnesium and the risk for type 2 diabetes mellitus: the Atherosclerosis Risk in Communities Study. Arch Intern Med 1999; 159(18):2151-2159.