Implications of Magnesium Deficiency in Type 2 Diabetes: A Review

Magnesium is the fourth most abundant cation in the body and plays an important physiological role in many of its functions. It plays a fundamental role as a cofactor in various enzymatic reactions involving energy metabolism. Magnesium is a cofactor of various enzymes in carbohydrate oxidation and plays an important role in glucose transporting mechanism of the cell membrane. It is also involved in insulin secretion, binding, and activity. Magnesium deficiency and hypomagnesemia can result from a wide variety of causes, including deficient magnesium intake, gastrointestinal, and renal losses. Chronic magnesium deficiency has been associated with the development of insulin resistance. The present review discusses the implications of magnesium deficiency in type 2 diabetes.     

Reversible Hypomagnesaemia-Induced Subacute Cerebellar Syndrome

Magnesium is the second most abundant intracellular cation and is a fundamental cofactor in a multitude of cellular enzymatic reactions. Magnesium deficiency causes diverse clinical features predominantly due to cardio- and neurotoxicity. We describe a case of severe hypomagnesaemia associated with intermittent downbeat nystagmus, cerebellar ataxia, generalised convulsions and a supraventricular tachycardia. On MRI imaging, a transient lesion of the cerebellar nodulus was observed, which has not, to our knowledge, been previously described in isolated hypomagnesaemia.     

Magnesium: nutrition and metabolism

Magnesium is an essential mineral that is needed for a broad variety of physiological functions. The usual daily magnesium uptake with a western diet is sufficient to avoid deficiency but seems not to be high enough to establish high normal serum magnesium concentrations that are protective against various diseases. Changes in magnesium homeostasis mainly concern the extracellular space, as the intracellular magnesium concentration is well regulated and conserved. The extracellular magnesium concentration is primarily regulated by the kidney, the mechanisms of this regulation have been elucidated recently. Due to the growing knowledge about the regulation of extra- and intracellular magnesium concentrations and the effects of changed extracellular magnesium levels the use of magnesium in therapy gains more widespread attention.     

Intravenous Magnesium Sulfate With and Without EDTA as a Magnesium Load Test—Is Magnesium Deficiency Widespread?

Serum/plasma measurements do not reflect magnesium deficits in clinical situations, and magnesium load tests are used as a more accurate method to identify magnesium deficiency in a variety of disease states as well as in subclinical conditions. The objective of this study was to determine if people are indeed magnesium deficient or if the apparent magnesium deficiency is due to the composition of the infusate used in the load test. Magnesium load tests were performed on seven patients using three different Mg solution infusions-a Mg-EDTA (ethylene diamine tetraacetic acid)-nutrient cocktail used in EDTA chelation therapy containing several components including vitamins and minerals, and the same cocktail without EDTA and an infusion of an identical amount of magnesium in normal saline solution. There was no significant difference in the amount of magnesium retained in the 24 h after infusion among the three infusates. All infusates resulted in very high magnesium retention compared to previous published magnesium load studies. Magnesium deficiency may be widespread, and the relationship of Mg deficiency to related diseases requires further study.     

Role of magnesium in hypertension

Magnesium affects blood pressure by modulating vascular tone and reactivity. It acts as a calcium channel antagonist, it stimulates production of vasodilator prostacyclins and nitric oxide and it alters vascular responses to vasoactive agonists. Magnesium deficiency has been implicated in the pathogenesis of hypertension with epidemiological and experimental studies demonstrating an inverse correlation between blood pressure and serum magnesium levels. Magnesium also influences glucose and insulin homeostasis, and hypomagnesemia is associated with metabolic syndrome. Although most epidemiological and experimental studies support a role for low magnesium in the pathophysiology of hypertension, data from clinical studies have been less convincing. Furthermore, the therapeutic value of magnesium in the management of hypertension is unclear. The present review addresses the role of magnesium in the regulation of vascular function and blood pressure and discusses the implications of magnesium deficiency in experimental and clinical hypertension, in metabolic syndrome and in pre-eclampsia.     

Diuretic-associated hypomagnesaemia.

Clinically suspected hypomagnesaemia was confirmed in 21 patients over 12 months; all patients had been exposed to either short-term vigorous diuretic treatment or moderate-dosage long-term treatment. Magnesium depletion was compounded by a hospital diet surprisingly low in magnesium, a local soft water supply, and, in some patients, high alcohol intake. Common presenting symptoms included depression, muscle weakness, refractory hypokalaemia, and atrial fibrillation refractory to digoxin treatment. The administration of magnesium supplements resulted in prompt improvement of all symptoms particularly in the case of refractory atrial fibrillation. Chronic low-grade magnesium deficiency from diuretic treatment is more common than published reports suggest. Older patients are at risk, particularly those who have excessive alcohol intake, a diet low in magnesium, or a soft water supply.     

Pathogenetic role of magnesium deficiency in ophthalmic diseases

Magnesium is one of the most important regulatory cation involved in several biological processes. It is important for maintaining the structural and functional integrity of several vital ocular tissues such as cornea, lens and retina. The magnesium content of lens, especially in its peripheral part, is higher than that in aqueous and vitreous humor. Magnesium has also been shown to play critically important role in retinal functions. Magnesium plays significant role as a cofactor for more than 350 enzymes in the body and regulates neuroexcitability and several ion channels. Membrane associated ATPase functions that are crucial in regulating the intracellular ionic environment, are magnesium-dependent. Moreover, the enzymes involved in ATP production and hydrolysis are also magnesium-dependent. Magnesium deficiency by interfering with ATPase functions causes increased intracellular calcium and sodium and decreases intracellular potassium concentration. Such ionic imbalances in turn alter the other cellular enzymatic reactions and form the basis of the association of magnesium deficiency with ophthalmic diseases such as cataract. In presence of magnesium deficiency, an imbalance between mediators of vasoconstriction and vasorelaxation may underlie the vasospasm, which is one of the pathogenic factors in primary open angle glaucoma. Furthermore, magnesium deficiency is also a contributing factor in increased oxidative stress and inducible NOS stimulation that can further contribute in the initiation and progression of ocular pathologies such as cataract, glaucoma and diabetic retinopathy. In this paper we review the association of disturbances of magnesium homeostasis with several ophthalmic diseases.     

Magnesium deficiency in the Japanese quail

Morphological effects of magnesium deficiency on liver cells and general aspects of its influence on the metabolism were investigated in young quails. Magnesium deficiency was characterized by a depressed growth, a high mortality rate, a decrease in hematocrit and magnesium and calcium plasma concentrations. Magnesium deficiency reduced the magnesium concentration in heart by 44%, but did not affect the concentration in liver. Ultrastructural aspect of liver parenchymal cells revealed that the number of mitochondria per cell section was decreased and the average area of a mitochondrion was greater in deficient quails than in control animals. The significance of these morphological changes was discussed in relation to disturbances in energy metabolism of these organelles. From these results, japanese quail appeared as an interesting experimental model for studies on metabolic disturbances in magnesium deficiency.     

A clinical approach to common electrolyte problems: 4. Hypomagnesemia.

Magnesium plays a critical role in many cell functions. Hypomagnesemia may occur because of decreased intake or absorption, internal redistribution or increased loss of this element through either renal or nonrenal routes. Manifestations of magnesium deficiency include alterations in calcium, phosphate and potassium homeostasis along with cardiac disorders such as malignant ventricular arrhythmias refractory to conventional therapy, enhanced sensitivity to digoxin and, possibly, coronary artery vasospasm and sudden death. Other features of magnesium deficiency include a host of neuromuscular and neuropsychiatric disorders. In this review we detail mechanisms that may lead to magnesium deficiency, summarize the clinical features of the deficiency and provide a clinical approach to the diagnosis and treatment of this electrolyte disorder.     

Plasma Magnesium Concentration in Primary Hyperparathyroidism

The plasma magnesium concentration has been determined in 73 patients with primary hyperparathyroidism. In most patients it lay within the normal range (1·7-2·3 mg./100 ml.), but in five it was less than 1·6 mg./100 ml. These patients had relatively high urinary magnesium outputs, and one of them, studied in greater detail, failed to retain parenterally administered magnesium. Hence hypomagnesaemia in hyperparathyroidism may be associated with a defect in renal magnesium conservation, which may be reversible.     

Selected organopathies caused by experimental magnesium deficiency

A role of enzyme mediated metabolic processes is discussed. Unfavourable effect of magnesium deficiency on the functioning of various organs may lead to extensive and irreversible morphological changes of focal character. Basing on the results of several experiments and own experience, the author discusses an effect of low-magnesium diet on histological, histochemical, and microscopic lesions to the myocardium, skeletal musculature, liver, and pancreas. Magnesium deficiency predisposes to myocardial necrosis which simulates electrolyte-steroid-cardiomyopathy by necrosis (ESCN). Low-magnesium diet decreases resistance of the animals to various types of stress such as: cooling, immobilization, and noise. Insignificant degree of the lesions to skeletal musculature produced by magnesium deficiency and no progress in these lesions during the experiment may depend upon relatively stable magnesium reserve in the muscles. Low-magnesium diet increases the number of so-called Ito cells in the liver. It is probable that these cells together with hepatocytes contribute to the formation of collagen fibres. Magnesium deficiency may lead to the abnormal digestion of nutrients in the pancreas, interfering with exocytosis of zymogen granules. Supplementation of the diet with magnesium may prevent various organopathies.     

Low magnesium and atherosclerosis: an evidence-based link

Several data indicate that magnesium deficiency caused by poor diet and/or errors in its metabolism may be a missing link between diverse cardiovascular risk factors and atherosclerosis. Experimentally induced low plasma levels of magnesium accelerate atherogenesis by increasing LDL concentrations and their oxidative modifications, and by promoting inflammation. In vitro studies have shown that low magnesium determines endothelial dysfunction, the initiating event leading to the formation of the plaque. Moreover, oral magnesium therapy has been shown to improve endothelial function in patients with coronary artery disease.Magnesium, which is an inexpensive, natural and rather safe element, could be useful in preventing atherosclerosis and as an adjuvant therapy in patients with clinical manifestations of the disease.     

Magnesium: metabolism and hormonal regulation in different species

1. The magnesium ion is of great importance in physiology by its intervention in 300 enzymatic systems, its membrane role and its function in neuromuscular excitability. 2. The skeleton is the first pool of magnesium in the animal body. 3. For intestinal absorption, renal metabolism, bone accretion and resorption, magnesium shows analogies with calcium. 4. Magnesium exchange between extracellular, cellular and skeletal compartments are very precisely controlled. 5. Parathyroid hormone, 1 alpha, 25-dihydroxy-vitamin D3, calcitonin and estrogens are the principal hormone systems implicated in magnesium metabolism. 6. The kidney is the principal site of magnesium excretion and shows important magnesium regulation mechanisms.     

Mineral deficiency symptoms of the oil palm

Summary Young oil palms in sand culture experiment developed symptoms of nitrogen, potassium and magnesium deficiencies involving a homogeneous yellowing, a marginal yellowing and an orange chlorosis respectively. All these deficiencies resulted in poor growth and a reduced root development. A further experiment showed that Little Leaf Disease was caused by boron deficiency. Magnesium and potassium deficiency symptoms were also induced in this experiment. Sulphur deficiency symptoms, consisting of a yellowing of the young leaves, an interveinal chlorosis and necrosis, were induced in a factorial sand culture experiment and a second missing element trial. Insufficient available nitrogen, potassium, magnesium and boron all have an adverse effect on the production of inflorescences.It is considered that Plant Failure disease is caused by a poorly developed rooting system which may result from magnesium, boron and, possibly, potassium deficiencies.No evidence has been obtained to support the view that Confluent Orange Spotting is caused by potassium deficiency.     

Magnesium in health and disease

Introduction

Magnesium is an essential electrolyte in living organisms, which has to be supplied daily in a sufficient amount.

Methods

The clinical importance of a magnesium overload or a magnesium intoxication is seldom. However, a magnesium deficiency is of special importance in humans, despite of a normal magnesium supplementation. The primary effect of a magnesium deficiency results in a reduction of energy production. This reduced energy production can result in a disturbed membrane function, calcium magnesium antagonism and cell dysfunction.

Results

Thereby consequences may result in an organ dysfunction and an altered answer to external and internal stress. The reduced energy status is responsible for the recovery of unhealthy individuals - e.g. cardiac arrhythmias, primary hypertension, pre-eclampsia, cramps, allergic reactions—upon repletion of Mg status.

Conclusions

The importance of an oral or intravenously supplementation of magnesium has often been described in a variety of diseases. In addition of special interest is the use of magnesium in critically ill patients in intensive care medicine.     

Effects of magnesium deficiency on photosynthesis and carbohydrate partitioning

Magnesium nutrition is often forgotten, while its absence adversely affects numerous functions in plants. Magnesium deficiency is a growing concern for crop production frequently observed in lateritic and leached acid soils. Competition with other cations (Ca²⁺, Na⁺, and K⁺) is also found to be an essential factor, inducing magnesium deficiency in plants. This nutrient is required for chlorophyll formation and plays a key role in photosynthetic activity. Moreover, it is involved in carbohydrate transport from source-to-sink organs. Hence, sugar accumulation in leaves that results from the impairment of their transport in phloem is considered as an early response to Mg deficiency. The most visible effect is often recorded in root growth, resulting in a significant reduction of root/shoot ratio. Carbohydrate accumulation in source leaves is attributed to the unique chemical proprieties of magnesium. As magnesium is a nutrient with high mobility in plants, it is preferentially transported to source leaves to prevent severe declines in photosynthetic activity. In addition, Mg is involved in the source-to-sink transport of carbohydrates. Hence, an inverse relationship between Mg shortage and sugar accumulation in leaves is often observed. We hereby review all these aspects with a special emphasis on the role of Mg in photosynthesis and the structural and functional effects of its deficiency on the photosynthetic apparatus.     

Role of magnesium in alleviation of aluminium toxicity in plants

Magnesium is pivotal for activating a large number of enzymes; hence, magnesium plays an important role in numerous physiological and biochemical processes affecting plant growth and development. Magnesium can also ameliorate aluminium phytotoxicity, but literature reports on the dynamics of magnesium homeostasis upon exposure to aluminium are rare. Herein existing knowledge on the magnesium transport mechanisms and homeostasis maintenance in plant cells is critically reviewed. Even though overexpression of magnesium transporters can alleviate aluminium toxicity in plants, the mechanisms governing such alleviation remain obscure. Possible magnesium-dependent mechanisms include (i) better carbon partitioning from shoots to roots; (ii) increased synthesis and exudation of organic acid anions; (iii) enhanced acid phosphatase activity; (iv) maintenance of proton-ATPase activity and cytoplasmic pH regulation; (v) protection against an aluminium-induced cytosolic calcium increase; and (vi) protection against reactive oxygen species. Future research should concentrate on assessing aluminium toxicity and tolerance in plants with overexpressed or antisense magnesium transporters to increase understanding of the aluminium-magnesium interaction.     

Superoxide-mediated activation of cardiac fibroblasts by serum factors in hypomagnesemia

Magnesium deficiency is known to produce myocardial fibrosis in different animal models, but the underlying mechanisms are unclear. However, circulating levels of pro-oxidant and mitogenic factors are reported to be elevated in a rodent model of acute magnesium deficiency, suggesting a role for humoral factors in the pathogenesis of the cardiovascular lesions. Probing the mechanism of cardiac fibrogenesis in magnesium deficiency, the present study furnished evidence that serum from magnesium-deficient rats has a more marked effect than serum from magnesium-sufficient rats on mitogenesis, net collagen production, and superoxide generation in cardiac fibroblasts from young adult rats. The enhanced mitogenic response was abolished by superoxide dismutase and N-acetyl cysteine, showing that it is mediated by superoxide anion. Further, a modest inhibitory effect of the neurokinin-1 receptor antagonist, spantide, suggested that factors acting via neurokinin-1 receptors may partly modulate cardiac fibroblast function in magnesium deficiency. The findings are consistent with the postulation that serum factors may activate cardiac fibroblasts via a superoxide-mediated mechanism and contribute to the fibrogenic response in the heart in magnesium deficiency.     

Dissolution and growth of calcium oxalate monohydrate I. Effect of magnesium and pH

The rate of dissolution of calcium oxalate monohydrate and of a calcium oxalate renal stone was measured in 0.9% NaCl solution at different levels of magnesium concentration and pH. The growth of calcium oxalate obtained by chemical reaction between Ca²⁺ and oxalate ions at a concentration similar to that existing in normal urine was also investigated as a function of pH and magnesium concentration. It was found that both magnesium and pH exert a fine kinetic control on the precipitation and growth of calcium oxalate monohydrate. Magnesium had no effect on the dissolution. The possible role of magnesium and pH in calcium oxalate urolithiasis has been discussed in the light of previous reports and of the data presented in this study.     

镁离子与肿瘤的相关关系

镁离子是人体内重要的阳离子,参与多种生理活动,其摄入的失衡不仅能导致低镁血症及高镁血症产生的相应临床症状,还与肿瘤的发生发展密切相关。最新的研究还表明高浓度镁离子具有抗肿瘤的作用。针对镁离子与肿瘤的发生、发展、治疗等方面的研究进展进行了综述,以期为镁离子与肿瘤的流行病学调查及抗肿瘤研究提供进一步的参考依据。