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Magnesium imbalances commonly exist in septic patients. However, the association of serum magnesium levels with mortality in septic patients remains uncertain. Herein, we elucidated the association between serum magnesium and all-cause mortality in septic patients from American and Chinese cohorts by analyzing data from 9099 patients in the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and 1727 patients from a university-affiliated hospital' intensive care unit in China. Patients in both cohorts were categorized into five groups based on serum magnesium quintiles from the MIMIC-IV dataset. Patients with higher serum magnesium levels exhibited an increased risk of 28-day mortality in both cohorts. The restricted cubic spline (RCS) curves revealed a progressively elevated risk of 28-day mortality with increasing serum magnesium in MIMIC-IV cohort, while a J-shaped correlation was observed in institutional cohort. Our findings have validated the association between high serum magnesium and high mortality in sepsis across different races and medical conditions. Serum magnesium levels might be useful in identifying septic patients at higher mortality risk.

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Background: Considerable morbidity and death are associated with acute kidney damage (AKI) following total aortic arch replacement (TAAR). The relationship between AKI following TAAR and serum magnesium levels remains unknown. The intention of this research was to access the predictive value of serum magnesium levels on admission to the Cardiovascular Surgical Intensive Care Unit (CSICU) for AKI in patients receiving TAAR. Methods: From May 2018 to January 2020, a prospective, observational study was performed in the Guangdong Provincial People's Hospital CSICU. Patients accepting TAAR admitted to the CSICU were studied. The Kidney Disease: Improving Global Outcomes (KDIGO) definition of serum creatinine was used to define AKI, and KDIGO stages two or three were used to characterize severe AKI. Multivariable logistic regression and area under the curve receiver-operator characteristic curve (AUC-ROC) analysis were conducted to assess the predictive capability of the serum magnesium for AKI detection. Finally, the prediction model for AKI was established and internally validated. Results: Of the 396 enrolled patients, AKI occurred in 315 (79.5%) patients, including 154 (38.8%) patients with severe AKI. Serum magnesium levels were independently related to the postoperative AKI and severe AKI (both, P < 0.001), and AUC-ROCs for predicting AKI and severe AKI were 0.707 and 0.695, respectively. Across increasing quartiles of serum magnesium, the multivariable-adjusted odds ratios (95% confidence intervals) of postoperative AKI were 1.00 (reference), 1.04 (0.50-2.82), 1.20 (0.56-2.56), and 6.19 (2.02-23.91) (P for Trend < 0.001). When serum magnesium was included to a baseline model with established risk factors, AUC-ROC (0.833 vs 0.808, P = 0.050), reclassification (P < 0.001), and discrimination (P = 0.002) were further improved. Conclusions: Serum magnesium levels on admission are an independent predictor of AKI. In TAAR patients, elevated serum magnesium levels were linked to an increased risk of AKI. In addition, the established risk factor model for AKI can be considerably improved by the addition of serum magnesium in TAAR patients hospitalized in the CSICU.

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Hypomagnesemia is defined as serum magnesium levels less than 0.7mmol/L and can result in a plethora of symptoms ranging from mild gastrointestinal symptoms to serious conditions such as cardiac arrhythmias and neurological complications. When considering the etiological factors, drug-induced hypomagnesemia is highlighted because commonly used medications such as proton pump inhibitors (PPIs), aminoglycoside antibiotics, and loop and thiazide diuretics can cause low magnesium levels. A 49-year-old male presented to the emergency department with severe vomiting worsening over three days complicated with generalized tonic-clonic seizures. He was an averagely built male, a non-smoker, and a non-alcoholic with no significant co-morbidities. He had a history of chronic over-the-counter pantoprazole intake over the last one year, and apart from that, his medication history was unremarkable. Initial investigations revealed severe hypomagnesemia (with serum magnesium level of 0.1mmol/L), with marginal hypokalemia, hypophosphatemia, and hypocalcemia. Following the initial resuscitation and magnesium supplementation, the patient's clinical condition significantly improved. Due to the lack of proper knowledge, the patient continued to take omeprazole 20mg tablets after discharge, and up until proper education and total cessation of PPIs, marginal hypomagnesemia, with serum magnesium level of 0.5mmol/L, persisted without any significant overt clinical manifestations. In this case report, we intend to highlight the importance of assessing for all possible electrolyte abnormalities in a patient presenting with neurological symptoms, relevance of taking a thorough drug history including all undocumented over-the-counter medications, and importance of patient education in the prevention of further episodes.

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Magnesium (Mg) plays a key role in neurological functioning and manifestations. However, the evidence from randomized controlled trials (RCTs) and cohorts on Mg and cognitive health among adults has not been systematically reviewed. We aimed to examine the associations of various Mg forms (supplements, dietary intake, and biomarkers) with cognitive outcomes by summarizing evidence from RCTs and cohorts. PubMed, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched for relevant peer-reviewed articles published up to May 3, 2024. Three random-effects models were performed, when appropriate, to evaluate the relationship between Mg and cognitive outcomes: 1) linear meta-regression, 2) nonlinear (quadratic) meta-regression, and 3) meta-analysis using Mg variables categorized based on pre-existing recommendations. Three RCTs and 12 cohort studies were included in this systematic review. Evidence from the limited number of RCTs was insufficient to draw conclusions on the effects of Mg supplements. Cohort studies showed inconsistent dose-response relationships between dietary Mg and cognitive disorders, with high heterogeneity across populations. However, consistent U-shape associations of serum Mg with all-cause dementia and cognitive impairment were found in cohorts, suggesting an optimal serum Mg concentration of ∼0.85 mmol/L. This nonlinear association was detected in meta-regression (Pquadratic = 0.003) and in meta-analysis based on the reference interval of serum Mg (0.75-0.95 mmol/L) [<0.75 compared with 0.85 mmol/L: pooled hazard ratio (HR) = 1.43; 95% confidence interval (CI) = 1.05, 1.93; >0.95 compared with 0.85 mmol/L: pooled HR = 1.30; 95% CI = 1.03, 1.64]. More evidence from RCTs and cohorts is warranted. Future cohort studies should evaluate various Mg biomarkers and collect repeated measurements of Mg intake over time, considering different sources (diet or supplements) and factors affecting absorption (for example, calcium-to-Mg intake ratio). This systematic review was preregistered in PROSPERO (CRD42023423663).

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The association between short-term changes in serum magnesium level and risk of in-hospital mortality was investigated in patients with acute myocardial infarction (AMI). In this retrospective cohort study, data of 2,716 patients with AMI were extracted from the Medical Information Mart for Intensive Care (MIMIC-III and MIMIC-IV) database for 2001-2012. Univariate and multivariate Cox proportional hazards models were used to explore the association between serum magnesium level and short-term change and in-hospital mortality in patients with AMI. In addition, subgroups according to age, gender, Sequential Organ Failure Assessment (SOFA) score, and Simplified Acute Physiology Score (SAPS-II) were also analysed. In total, 504 (18.6%) patients died in hospital. After adjusting for covariates, all AMI patients with high magnesium levels at ICU admission (HR=1.03, 95% CI: 0.83-1.27) or 48 hours after ICU admission (all p<0.05), or those demonstrating a change in magnesium level within the first 48 hours of ICU stay (all p<0.05) were shown to have a high risk of in-hospital mortality. Moreover, this correlation was retained irrespective of age, gender, SOFA score, and SAPS-II (all p<0.05). Serum magnesium levels at different time points after ICU admission and change in serum magnesium level during the first 48 hours were associated with in-hospital mortality in patients with AMI, indicating that clinical attention should be paid to short-term changes in serum magnesium levels regarding treatment adjustment, which may further reduce the risk of mortality.

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Introduction: Serum magnesium is a crucial mineral within the human body. It is imperative for diabetic patients to maintain optimal serum magnesium levels. We focus on the relationship between glycemic control and serum magnesium in type 2 diabetes mellitus (T2DM). Methods: The retrospective, observational, cross-sectional study comprised 1694 patients recruited from the People's Hospital of Yuxi. Fasting blood samples were collected for analysis, accompanied by the recording of participants' demographic characteristics. Patients were categorized into two groups based on whether their glycosylated hemoglobin (HbA1c) levels < 7%. A t-test was employed to identify significant differences between the two groups. Correlation coefficients were calculated using Pearson's method. A Logistic regression analysis was conducted to assess the association between variables and glycemic control. A linear regression analysis was performed to assess the relationship between serum magnesium levels and HbA1c. Results: Patients with poor glycemic control exhibited elevated age, low-density lipoprotein (LDL-C), fasting plasma glucose (FPG), and homeostasis model assessment (HOMA-IR) compared to those with good glycemic control (P < 0.001). Additionally, total cholesterol (TC) levels were significantly higher in patients with poor glycemic control. Conversely, high-density lipoprotein (HDL-C) and serum magnesium levels were lower in patients with poor glycemic control. Serum magnesium levels exhibited negative correlations with HOMA-IR (r = -0.05, P < 0.05), HbA1c (r = -0.29, P < 0.05), and FPG (r = -0.20, P < 0.05). Moreover, serum magnesium was significantly associated with reduced odds of glycemic control (OR = 0.0005, 95% CI 0.0001-0.0027, P < 0.001). Conclusion: The serum magnesium level in patients with T2DM is closely associated with glycemic control.

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OBJECTIVES: Aortic valve sclerosis has been proposed to signify greater cardiovascular risk; the correlation between serum trace elements and aortic valve sclerosis has been reported. Therefore, an in-depth exploration of the risk factors for aortic valve sclerosis and early intervention may reduce the risk of cardiovascular disease. METHODS: In this study, Patients with aortic valve sclerosis and non-aortic valve sclerosis who underwent echocardiographic diagnosis in the People's Hospital of Xinjiang Uygur Autonomous Region during the period from 2019 to 2021 were selected for this study. The correlation between aortic valve sclerosis and serum phosphorus, calcium, and magnesium levels was explored using the propensity score matching technique by pairing the two groups of patients 1:1. RESULTS: A total of 1,533 non-aortic valve sclerosis and 1,533 aortic valve sclerosis patients were included. Logistic regression analysis showed that serum magnesium [OR: 0.346; 95%CI: 0.227, 0.528] and serum calcium [OR: 7.022; 95%CI: 4.755, 10.369] were influential factors. Patients with low, intermediate, and high serum magnesium levels had a significantly lower risk of aortic valve sclerosis compared to patients with very low micronutrient levels (p < 0.05). Comparatively, patients with low or high serum calcium levels had an elevated risk of aortic valve sclerosis (p < 0.05). CONCLUSION: Serum magnesium may have a protective role against aortic valve sclerosis, while both low and high levels of serum calcium could be risk factor for the condition. These serum micronutrients may be indications of cardiovascular disease risk prediction or prevention, and more research is required.

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O diabetes mellitus tipo 2 (DM2) é uma doença que apresenta mecanismos fisiopatológicos multifatoriais e complexos, tendo como base a resistência insulínica (RI) e como consequências as doenças cardiovasculares (DCV). A hipomagnesemia tem sido implicada tanto na RI como em complicações micro e macrovasculares, incluindo-se as DCV que são consideradas a causa mais importante de morbimortalidade no DM2. Neste contexto, o presente estudo visa avaliar níveis séricos de magnésio (Mg) em pacientes diabéticos e sua possível associação com complicações crônicas e comorbidades, tendo como ênfase as doenças cardiovasculares; e identificar possível valor do nível sérico a ser considerado em nossa população a fim de rever sua verdadeira aplicabilidade clínica. Trata-se de estudo transversal, descritivo e analítico, envolvendo 99 pacientes com DM2 de ambos os sexos, atendidos em ambulatório público na cidade de Salvador (BA). Utilizou-se como instrumentos de pesquisa questionário de dados sociodemográficos e antropométricos; recordatório alimentar de 24 horas e análise bioquímica do magnésio sérico. Também foram registradas comorbidades e complicações crônicas dos pacientes, tais como hipertensão arterial, doença arterial coronariana, doença arterial obstrutiva periférica, arritmia cardíaca, acidente vascular cerebral, dislipidemia, neuropatia sensitiva periférica, retinopatia e nefropatia diabéticas. Os dados foram expressos por tabelas de forma descritiva e analítica. Os indivíduos foram divididos em dois grupos, magnésio baixo e normal/alto, e suas variáveis foram comparadas por meio de testes de hipóteses. Nossos achados evidenciaram nível sérico médio de magnésio de 1,97 mg% (IC 1,69 a 2,25 mg%) no total da amostra. Entre aqueles com magnésio baixo, níveis subclínicos estavam presentes em 29 sujeitos (29,3%), e níveis de hipomagnesemia em 34 indivíduos (34,3%). O nível médio do Mg no total da amostra diferiu significativamente (p<0,001) do valor normal ideal, mas não diferiu do considerado subclínico (p 0,311). No grupo com hipomagnesemia houve predomínio do sexo feminino e de pacientes com maior escolaridade. Glicemia de jejum foi mais elevada no grupo Mg baixo, e hemoglobina glicada no grupo Mg normal/alto, mas ambos sem diferença estatística. Níveis baixos de vitamina B12 foram encontrados em 12 pacientes (12,1%) e os níveis mais baixos de magnésio estavam presentes nos pacientes com deficiência de vitamina B12 (1,81±0,24 versus 2,01±0,29) com p=0,027. Antidiabéticos orais foram mais utilizados no grupo com Mg baixo. Não houve diferença entre magnésio sérico, ingestão calórica e magnésio e cálcio alimentares. Pacientes com DCV tiveram média de 2,01 mg% (IC 1,69-2,33 mg%) para o Mg. A doença cardiovascular esteve presente em 47,5% da amostra e pacientes com esta morbidade apresentaram 29,8% de prevalência de hipomagnesemia; infarto agudo do miocárdio (IAM) foi mais frequente no grupo com Mg normal/alto. Nossos dados apontam que hipomagnesemia em pacientes diabéticos deve ser considerada em níveis clínicos e subclínicos. Níveis baixos de Mg também estiveram associados à vitamina B12 baixa. Pacientes que apresentaram doenças cardiovasculares associadas também tiveram importante prevalência de hipomagnesemia incluindo níveis subclínicos, com exceção nos casos de IAM, em que níveis do magnésio sérico mantiveram-se no intervalo considerado normal ideal evidenciado por significativa diferença estatística (p<0,005).

Diabetes mellitus type 2 (DM2) is a multifactorial disease with complex physiopathological mechanisms, in which insulin resistance (IR) and its consequences, such as cardiovascular diseases (CVD), form its basis. Hypomagnesemia has been implicated in IR and micro and macrovascular complications, including CVD, which is considered the most important cause of morbidity and mortality in DM2. This study aims to evaluate serum magnesium (Mg) levels in diabetic patients and its possible association with chronic complications and comorbidities (especially cardiovascular diseases) and to find a possible serum level value to be considered in its population to review its true clinical applicability. This cross-sectional, descriptive, and analytical study involved 99 DM2 patients of all sexes who were served in a public outpatient clinic in Salvador-Ba. A sociodemographic and anthropometric data questionnaire, a 24-hour food recall, and serum magnesium analysis were used as research instruments. The comorbidities and chronic complications of patients, such as hypertension, coronary artery disease, peripheral arterial obstructive disease, cardiac arrhythmia, cerebrovascular accident, dyslipidemia, peripheral sensory neuropathy, diabetic retinopathy, and nephropathy, were also recorded. The data were expressed in descriptive and analytical tables. The individuals were divided into two groups, low and normal/high magnesium, and their variables were compared using hypothesis tests. Our findings showed an average serum magnesium level of 1.97 mg% (IC 1.69 to 2.25 mg%) in the whole sample. In those with low magnesium, subclinical levels occurred in 29 subjects (29.3%)and hypomagnesemia, in 34 individuals (34.3%). The median Mg level in the total sample significantly differed (p<0.001) from the ideal normal value, but failed to do in relation to the subclinical value (p=0.311). The hypomagnesemia group showed a predominance of women and patients with higher education. Fasting glucose was higher in the low Mg group and glycated hemoglobin in the normal/high Mg group, both without statistical differences. Low levels of vitamin B12 occurred in 12 patients (12.1%) and the lowest magnesium levels, in patients with vitamin B12 deficiency (1.81±0.24 versus 2.01±0.29) (p=0.027). Oral antidiabetics were more used in the group with low Mg. Serum magnesium, caloric intake, and dietetic magnesium and calcium showed no differences. Patients with CVD had an Mg average of 2.01 mg% (IC 1.69-2.33 mg%). Cardiovascular disease occurred in 47.5% of the sample. Patients with this morbidity had a 29.8% prevalence of hypomagnesemia. Moreover, myocardial infarction occurred more often in the normal/high Mg group. Data suggest that hypomagnesemia in diabetic patients should be considered at clinical and subclinical levels. Low Mg levels were also associated with low vitamin B12. Patients who showed cardiovascular diseases also had a high prevalence of hypomagnesemia, including subclinical levels, except in cases of myocardial infarction, in which serum magnesium levels remained within the normal ideal range, as evinced by its significant statistical difference (p<0.005).

La diabetes mellitus tipo 2 (DM2) es una enfermedad con mecanismos fisiopatológicos multifactoriales y complejos caracterizada por la resistencia a la insulina (RI) y sus consecuencias, como las enfermedades cardiovasculares (ECV). La hipomagnesemia está asociada con la RI y las complicaciones micro y macrovasculares, incluyendo las ECV, que se consideran la principal causa de morbimortalidad por la DM2. En este contexto, este estudio tiene como objetivo evaluar los niveles séricos de magnesio (Mg) en pacientes diabéticos y la posible asociación con complicaciones crónicas y comorbilidades, con énfasis en las enfermedades cardiovasculares; e identificar un posible valor de nivel sérico para considerar en esta población con el fin de revisar su verdadera aplicabilidad clínica. Se trata de un estudio transversal, descriptivo y analítico, en el cual participaron 99 pacientes con DM2 de ambos sexos, atendidos en un centro ambulatorio público en la ciudad de Salvador (Bahía, Brasil). Se utilizaron un cuestionario de datos sociodemográficos y antropométricos, un recordatorio alimentario de 24 horas y un análisis bioquímico del magnesio sérico. También se registraron las comorbilidades y complicaciones crónicas de los pacientes, como hipertensión arterial, enfermedad arterial coronaria, enfermedad arterial obstructiva periférica, arritmia cardíaca, accidente cerebrovascular, dislipidemia, neuropatía sensorial periférica, retinopatía y nefropatía diabética. Los datos se dispusieron en tablas para su análisis y descripción. Los individuos se separaron en dos grupos: bajo magnesio y normal/alto magnesio, y se compararon sus variables mediante pruebas de hipótesis. Los hallazgos evidenciaron un nivel sérico medio de magnesio de 1,97 mg% (IC 1,69 a 2,25 mg%) en el total de la muestra. Los bajos niveles subclínicos de magnesio estaban presentes en 29 sujetos (29,3%), y la hipomagnesemia en 34 individuos (34,3%). El nivel medio de Mg en el total de la muestra tuvo una diferencia significativa (p<0,001) del valor normal ideal, pero no difirió del valor subclínico (p=0,311). En el grupo con hipomagnesemia hubo predominio del sexo femenino y de pacientes con mayor nivel de estudios. La glucemia en ayunas fue más alta en el grupo de bajo Mg, y la hemoglobina glucosilada en el grupo de normal/alto Mg, pero en ninguno de los dos se encontró diferencia estadística. Los bajos niveles de vitamina B12 se encontraron en 12 pacientes (12,1%), y los niveles más bajos de magnesio estaban presentes en los pacientes con deficiencia de vitamina B12 (1,81±0,24 versus 2,01±0,29) con p=0,027. Los antidiabéticos orales se utilizaron más en el grupo con bajo Mg. No hubo diferencia entre el magnesio sérico, la ingesta calórica, el magnesio y el calcio en la dieta. Los pacientes con ECV tuvieron una media de 2,01 mg% (IC 1,69-2,33 mg%) para Mg. La enfermedad cardiovascular estuvo presente en el 47,5% de la muestra, y los pacientes con esta morbilidad tuvieron una prevalencia del 29,8% de hipomagnesemia; el infarto agudo de miocardio (IAM) fue más frecuente en el grupo con normal/alto Mg. Los resultados demuestran que la hipomagnesemia en los pacientes diabéticos debe considerarse en los niveles clínicos y subclínicos. Los bajos niveles de Mg también estuvieron asociados a bajos niveles de vitamina B12. Los pacientes que presentaron enfermedades cardiovasculares asociadas también tuvieron una alta prevalencia de hipomagnesemia, incluidos los niveles subclínicos, con excepción de los casos de IAM en los que los niveles séricos de magnesio se mantuvieron dentro del intervalo considerado normal ideal, evidenciado por una diferencia estadísticamente significativa (p<0,005).

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Objective The objective of this study was to assess the prevalence of hypomagnesemia and its association with the severity of acute ischemic stroke (AIS) in patients presenting at a tertiary care hospital. Methodology A total of 100 patients with AIS were included in the study. Demographic data, including age, gender, and severity of stroke, were collected. Serum magnesium levels were measured at admission, and the severity of stroke was classified as mild, moderate, or severe based on clinical criteria. The presence of hypomagnesemia was defined as a serum magnesium level below 1.8 mg/dL determined within 72 hours of onset of stroke. Statistical analysis was performed to assess the association between hypomagnesemia, stroke severity, age, and gender. Results The mean age of the patients with standard deviation was 65.45 ± 11.8 years, with the majority (38, 38%) aged 60-74 years. There were 53 (53%) male and 47 (47%) female patients. Hypomagnesemia was found in 35 (35%) patients, with an average magnesium level of 1.93 mg/dL and a standard deviation of 0.37 at admission. There was no statistically significant difference in the distribution of stroke severity (P = 0.779; P = 0.406) or hypomagnesemia (P = 0.287; P = 0.591) based on gender or age group, respectively. Stratification based on stroke severity showed that 16 (39%) patients with mild stroke, 10 (31.3%) with moderate stroke, and 9 (33.3%) with severe stroke had hypomagnesemia. The correlation between stroke severity and hypomagnesemia was weak (r = 0.099). Further, among hypomagnesemia patients, the majority were females aged 60-74 years. Conclusions This study found a weak positive relationship between the severity of AIS and the presence of hypomagnesemia. However, no statistically significant association was observed between gender or age group and stroke severity or hypomagnesemia. These findings suggest that further research is needed to understand the role of hypomagnesemia in AIS and its potential implications for patient management.

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BACKGROUND: Hypomagnesemia is commonly observed in individuals with diabetes, but how diabetes medications alter magnesium (Mg) status remains unclear. OBJECTIVES: We aimed to examine the association between diabetes medication and hypomagnesemia and evaluate whether serum Mg mediates the association between diabetes medication and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) in a prospective cohort. METHODS: Adults from the Boston Puerto Rican Health Study were included (n = 1106). Multivariable logistic regression models were used to estimate odds ratio (OR) and 95% confidence interval (CI) for cross-sectional association between diabetes medication and hypomagnesemia (serum Mg <0.75 mmol/L). Longitudinal mediation analysis was performed to evaluate the direct and indirect (via serum Mg) associations between diabetes medication and 4-y HOMA-IR in 341 participants with baseline hemoglobin A1c (HbA1c) of ≥6.5%. RESULTS: Mean age at baseline was 59.0 ± 7.6 y, with 28.0% male and 45.8% with hypomagnesemia. Use of metformin [OR (95% CI) = 3.72 (2.53, 5.48)], sulfonylureas [OR (95% CI) = 1.68 (1.00, 2.83)], and glitazones [OR (95% CI) = 2.09 (1.10, 3.95)], but not insulin, was associated with higher odds of hypomagnesemia. Use of multiple diabetes medications and longer duration of use were associated with higher odds of hypomagnesemia. Serum Mg partially mediated the association between metformin and HOMA-IR [indirect association: ß (95% CI) = 1.11 (0.15, 2.07)], which weakened the direct association [ß (95% CI) = -5.16 (-9.02, -1.30)] by 22% [total association: ß (95% CI) = -4.05 (-7.59, -0.51)]. Similarly, serum Mg mediated 17% of the association between sulfonylureas and elevated HOMA-IR. However, the mediation by serum Mg was weak for insulin and glitazones. CONCLUSIONS: Diabetes medication, especially metformin, was associated with elevated odds of hypomagnesemia, which may weaken the association between metformin and lowering of HOMA-IR. The causal inference needs to be confirmed in further studies.

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BACKGROUND: Physiological processes rely on phosphate, which is an essential component of adenosine triphosphate (ATP). Hypophosphatasia can affect nearly every organ system in the body. It is crucial to monitor newborns with risk factors for hypophosphatemia and provide them with the proper supplements. We aimed to evaluate the risk factors and develop a nomogram for early hypophosphatemia in term infants. METHODS: We conducted a retrospective study involving 416 term infants measured serum phosphorus within three days of birth. The study included 82 term infants with hypophosphatemia (HP group) and 334 term infants without hypophosphatemia (NHP group). We collected data on the characteristics of mothers, newborn babies, and childbirth. Furthermore, univariate and multivariate logistic regression analyses were performed to identify independent risk factors for hypophosphatemia in term infants, and a nomogram was developed and validated based on the final independent risk factors. RESULTS: According to our analysis, the multivariate logistic regression analysis showed that male, maternal diabetes, cesarean delivery, lower serum magnesium, and lower birth weight were independent risk factors for early hypophosphatemia in term infants. In addition, the C-index of the developed nomogram was 0.732 (95% CI = 0.668-0.796). Moreover, the calibration curve indicated good consistency between the hypophosphatemia diagnosis and the predicted probability, and a decision curve analysis (DCA) confirmed the clinical utility of the nomogram. CONCLUSIONS: The analysis revealed that we successfully developed and validated a nomogram for predicting early hypophosphatemia in term infants.

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OBJECTIVES: To assess the association of serum magnesium with prevalent and incident metabolic syndrome (MetS) and its individual components in the general population and to examine any effect modification by chronic kidney disease (CKD) status. METHODS: We analysed longitudinal data from the population-based KORA F4/FF4 study, including 2996 participants (387 with CKD) for cross-sectional analysis and 1446 participants (88 with CKD) for longitudinal analysis. Associations with MetS, as well as single components of MetS, were assessed by adjusted regression models. Nonlinearity was tested by restricted cubic splines and analyses were stratified by CKD. Causality was evaluated by two-sample Mendelian randomization (MR). RESULTS: Serum magnesium (1 SD) was inversely associated with prevalent MetS (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.83, 0.98). The association was more pronounced in individuals with CKD (OR 0.75, 95% CI 0.59, 0.94). Among MetS components, serum magnesium was negatively associated with elevated fasting glucose (OR 0.78, 95% CI 0.71, 0.88) and, again, this association was more pronounced in individuals with CKD (OR 0.67, 95% CI 0.53, 0.84). Serum magnesium was not associated with incident MetS or its components. Restricted cubic spline analysis revealed a significant nonlinear inverse relationship of serum magnesium with MetS and elevated fasting glucose. MR analysis suggested an inverse causal effect of serum magnesium on MetS (OR 0.91, 95% CI 0.85, 0.97). CONCLUSION: Serum magnesium is associated with prevalent, but not incident MetS, and this effect is stronger in individuals with CKD. MR analysis implies a potential, albeit weak, causal role of magnesium in MetS.

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INTRODUCTION: The dose-response relationship between serum magnesium (sMg) and atrial fibrillation (AF) and the contribution of dysmagnesemia to AF among hemodialysis patients remain unknown. Hence, we examined the dose-response correlation between sMg and AF and estimated the extent of the contribution of dysmagnesemia to AF in this population. METHODS: This was a nationwide cross-sectional study on the Japanese Society for Dialysis Therapy registry, also known as Japanese Renal Data Registry (JRDR), encompassing a nationwide population of dialysis centers, as of the end of 2019. Eligible participants were adult patients undergoing hemodialysis three times per week. The main exposure was sMg, categorized into seven categories (≤1.5, >1.5-≤2, >2-≤2.5, >2.5-≤3, >3-≤3.5, >3.5-≤4, and ≥4.0 mg/dL). The outcome was AF reported by dialysis facilities. The independent contribution to AF was assessed via logistic regression to generate population-attributable fractions, assuming a causal relationship between sMg and AF. RESULTS: Total 165,926 patients from 2,549 facilities were investigated. AF prevalence was 7.9%. Compared with the reference (>2.5-≤3 mg/dL), lower sMg was associated with increased AF (adjusted odds ratios (ORs) (95% confidence interval, CI) of 1.49 (1.19-1.85), 1.24 (1.17-1.32), and 1.11 (1.06-1.16) for sMg of ≤1.5, >1.5-≤2.0, and >2.0-≤2.5 mg/dL categories, respectively). Elevated sMg was associated with fewer AF (adjusted OR 0.87 [95% CI, 0.79-0.96] for sMg of >3.0-≤3.5 mg/dL). The adjusted population-attributable fraction of lower sMg and higher and lower sMg for AF was 7.4% and 6.9%, respectively. An association did indeed exist between lower sMg and AF, with the lowest percentages of AF at sMg levels above the reference range for the general population. CONCLUSION: Dysmagnesemia may be an important contributor to AF among adult hemodialysis patients. Further, longitudinal studies are warranted to determine whether sMg correction reduces the AF incidence.

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BACKGROUND: Magnesium (Mg) is both an essential macro-element and a known catalyst, and it plays a vital role in various physiological activities and mechanisms in relation to chronic kidney disease (CKD). However, epidemiological evidence involving this is limited and not entirely consistent. This study aims to explore the association of serum Mg concentrations with the risk of CKD among general Chinese adults. METHODS: A total of 8,277 Chinese adults were included in the wave of 2009 from the China Health and Nutrition Survey (CHNS). The primary outcome was the risk of CKD, which was defined as the estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Multivariable logistic regression model was used to examine the relationship of serum Mg concentrations with the risk of CKD. RESULTS: Included were 8,277 individuals, with an overall CKD prevalence of 11.8% (n = 977). Compared with the first quartile of serum Mg, the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for participants in the second, third, and fourth quartiles of serum Mg were 0.74 (0.58, 0.93), 0.87 (0.69, 1.11) and 1.29 (1.03, 1.61), respectively. Similar results were observed in our several sensitivity analyses. Restricted cubic spline analysis demonstrated a nonlinear (similar "J"-shaped) association between serum Mg concentrations and the risk of CKD (Pnonlinearity <0.001), with a threshold at around a serum Mg value of 2.2 mg/dL. CONCLUSIONS: Our results suggested a similar "J"-shaped association between serum Mg concentration and the risk of CKD among Chinese adults. Further large prospective studies are needed to verify these findings.

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Pre-eclampsia (PE) is a pregnancy-related disorder characterized by hypertension and proteinuria occurring after 20 weeks of gestation. Several studies have been performed to determine the serum magnesium (Mg) level in PE, but most report inconclusive results. Consequently, this study was designed to resolve this controversy among African women. PubMed, Hinari, Google Scholar and African Journals Online electronic databases were searched for studies published in English. The qualities of included articles were appraised using the Newcastle-Ottawa quality assessment tool. Stata 14 software was utilized for analysis and serum Mg levels in cases and normotensive controls were compared through mean and standardized mean difference (SMD) at the 95% confidence interval (CI). In this review, we found that the mean serum Mg level was significantly reduced in cases (0.910±0.762 mmol/L) vs controls (1.167±1.060 mmol/L). The pooled SMD of serum Mg was significantly lower in cases (-1.20 [95% CI -1.64 to -0.75]). Therefore, since serum Mg is reduced in cases vs controls, we propose that Mg is involved in the pathophysiology of PE. Nevertheless, to know the exact mechanisms of Mg in PE development will require large-scale prospective studies.

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Objective: Excessive pain will have adverse effects on the mother and fetus. Labor epidural analgesia greatly reduces the pain, which is widely carried out abroad. Labor epidural anesthesia-associated fever (LEAF) is the biggest problem for labor epidural anesthesia. This study aimed to evaluate the clinical value of serum magnesium levels to predict the LEAF. Methods: Overall 528 singleton term-pregnant women who underwent labor epidural anesthesia in Fujian Provincial Maternity and Children's Health Hospital, affiliated hospital of Fujian Medical University from January 2019 to June 2019, were analyzed retrospectively. The serum magnesium level was detected using venous blood samples. The relationship between the serum magnesium level and LEAF was interpreted, and the optimal cut-off values of the serum magnesium level to predict LEAF were calculated. Results: Overall, 65 (12.30%) participants had LEAF. And a higher rate of the bulging membrane, gestational hypertension, neonatal intensive care unit (NICU) admission, and the different mode of delivery was significantly associated with LEAF. Also, the serum magnesium level demonstrated higher significantly in presence of LEAF than absence (P<0.05). What is more, it indicated that the area under the receiver operating characteristic curve (AUC) for the serum magnesium level was 0.825, and an optimal cut-off of the serum magnesium level was 0.855 mg/dl. Furthermore, it demonstrated that the serum magnesium level had the highest OR (OR= 7.49; 95% CI (4.58-14.35)) (P<0.001). The bulging membrane is an independent risk factor presence of LEAF (OR = 1.55; 95% CI (1.01-2.43)) (P=0.038). Conclusion: This study demonstrated that the baseline of serum magnesium can provide a suitable biomarker to predict LEAF. It can help to provide a useful target for LEAF treatment and enhance surveillance before fever.

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BACKGROUND: There is a lack of consensus on a reference range for ionized magnesium (iMg2+) in blood as a measure of the status of circulating iMg2+ for the screening of populations. OBJECTIVES: We estimated the reference range of iMg2+ levels for healthy adult populations and the ranges for populations with cardiovascular disease (CVD), type 2 diabetes, hypertension, and renal disease. We also estimated 95% ranges for circulating magnesium (Mg) in healthy and those with cardiometabolic diseases. METHODS: We searched Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Embase through 24 July, 2020 to identify articles. We included English, peer-reviewed, randomized controlled trials, prospective and retrospective cohort studies, case-control studies, and cross-sectional studies that measured iMg2+ in blood or circulating Mg at baseline. The protocol was registered on PROSPERO (CRD42020216100). Estimated ranges were calculated by employing a frequentist random-effects model using extracted (or calculated) means and SDs from each included study. We determined the 95% confidence interval of the pooled mean. RESULTS: A total of 95 articles were included with 53 studies having data for healthy participants and 42 studies having data for participants with cardiometabolic diseases. The estimated reference range for iMg2+ for healthy populations was 0.40-0.68 mmol/L, 0.38-0.64 mmol/L for CVD, 0.34-0.66 mmol/L for type 2 diabetes, 0.39-1.04 mmol/L for hypertension, and 0.40-0.76 mmol/L for renal disease. For circulating Mg, the estimated range was 0.72-1.0 mmol/L for healthy adults, 0.56-1.05 mmol/L for CVD, 0.58-1.14 mmol/L for type 2 diabetes, 0.60-1.08 mmol/L for hypertension, and 0.59-1.26 mmol/L for renal disease. CONCLUSIONS: Estimated reference ranges for cardiometabolic disease states for both iMg2+ and circulating Mg were broad and overlapped with the estimated range for healthy populations (0.40-0.68 mmol/L). Further studies should evaluate whether iMg2+ can be used as a biomarker of cardiometabolic disease.

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Preterm labor, regarded as the onset of labor before 37 weeks of gestation, is a highly prevalent issue in obstetrics with repercussions for neonatal health. This review article presents an in-depth analysis of the alliance between serum magnesium levels and preterm labor. The review explores the physiological roles of magnesium right through pregnancy, including its significance for energy metabolism, smooth muscle contraction, deoxyribonucleic acid (DNA), and protein synthesis. It addresses cellular transport and the homeostasis of magnesium. The pathophysiological processes encompassing inflammation, oxidative stress, calcium regulation, smooth muscle contractility, and neuroendocrine pathways are investigated. The review evaluates epidemiological studies investigating the alliance between serum magnesium levels and preterm labor. The review incorporates an assortment of study varieties, such as observational studies, case-control studies, prospective cohort studies, and meta-analyses. In the course of reviewing the prognostic relevance of serum magnesium levels in premature labor, therapeutic implications involving diagnostic precision, prognostic significance, and therapeutic response assessment have additionally been addressed. Therapeutic interventions targeting magnesium levels, such as magnesium supplementation, tocolytic therapy, and the role of magnesium in antenatal corticosteroid administration, are explored. This review provides an in-depth evaluation of the correlation between serum magnesium levels and preterm labor, stressing its therapeutic significance and repercussions for future research and treatment strategies.

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Background Magnesium is an essential micronutrient for people and is crucial in maintaining healthy cardiac function. It functions as a cofactor in a number of the body's enzyme systems, and myocardial cells are one of its target tissues. The upkeep of the myocardium's normal functional integrity depends on a lot of things including magnesium ions. Magnesium plays an important role in the pathophysiology of cardiovascular disorders. Aim This study aims to estimate serum magnesium levels and their correlation with cardiac complications and mortality in patients with acute myocardial infarction (AMI). Methods Patients with acute myocardial infarction who visited the Prince Faisal Bin Khalid Cardiac Center within 12 hours of the onset of symptoms were the subjects of this study. On the first and fifth days following admission, the level of serum magnesium was assessed. Statistical Package for Social Sciences (SPSS) version 20 (IBM SPSS Statistics, Armonk, NY) was used to analyze the collected data. Results The current study comprised 160 patients with acute myocardial infarction; there were 84 (52.5%) who experienced a low level of serum magnesium on admission. Significantly higher proportions of patients who experienced low magnesium levels had diabetes mellitus (P=0.0072) and a history of diuretics (P=0.03) and were administrated beta-blockers (P=0.01), calcium channel blockers (P=0.04), and statins (P=0.007) after admission. Significantly higher proportions of patients with low serum magnesium experienced atrial fibrillation (P=0.03), angina (P=0.03), and cardiogenic shock (P=0.003). Conclusion Low magnesium levels are associated with poor outcomes in most patients admitted with acute myocardial infarction.

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AIMS: To investigate the causal role of serum magnesium and calcium in epilepsy or any of its subtypes through Mendelian randomization (MR) approach. METHODS: Single nucleotide polymorphisms (SNPs) associated with serum magnesium and calcium were used as the instrumental variables. MR analyses were performed using the summary-level data for epilepsy extracted from International League Against Epilepsy Consortium (15,212 cases and 29,677 controls) to obtain the causal estimates. The analyses were replicated using FinnGen data (7224 epilepsy cases and 208,845 controls), and a meta-analysis was then conducted. RESULTS: The result of combined analyses showed that higher serum magnesium concentrations was associated with a reduced risk of overall epilepsy (odds ratios [OR] = 0.28, 95% confidence interval [CI], 0.12-0.62, p = 0.002). In ILAE, higher serum magnesium was suggestively associated with reduced risks of focal epilepsy (OR = 0.25, 95% CI 0.10-0.62, p = 0.003). However, the results cannot be repeated in sensitivity analyses. As for serum calcium, the results did not reach statistical significance with overall epilepsy (OR = 0.60, 95% CI, 0.31-1.17, p = 0.134). However, genetically predicted serum calcium concentrations showed an inverse association with risk of generalized epilepsy (OR = 0.35, 95% CI, 0.17-0.74, p = 0.006). CONCLUSION: The current MR analysis did not support a causal relationship between serum magnesium and epilepsy, but showed a causally negative association between genetically determined serum calcium and generalized epilepsy.

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