Methods of Assessment of Magnesium Status in Humans: a Systematic Review Michal Witkowski, Jane Hubert, Andrzej Mazur
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Methods of assessment of magnesium status in humans: a systematic review Michal Witkowski, Jane Hubert, Andrzej Mazur To cite this version: Michal Witkowski, Jane Hubert, Andrzej Mazur. Methods of assessment of magnesium status in humans: a systematic review. Magnesium Research, John Libbey Eurotext, 2011, 24 (4), pp.163-180. 10.1684/mrh.2011.0292. hal-02647715 HAL Id: hal-02647715 https://hal.inrae.fr/hal-02647715 Submitted on 29 May 2020 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Journal Identification = MRH Article Identification = 0292 Date: January 4, 2012 Time: 10:26 am Magnesium Research 2011; 24 (4): 163-80 REVIEW ARTICLE Methods of assessment of magnesium status in humans: a systematic review Michał Witkowski, Jane Hubert, Andrzej Mazur INRA, UMR 1019, UNH, CRNH Auvergne, and Clermont Université, Université d’Auvergne, Unité de Nutrition Humaine, BP 10448, Clermont-Ferrand, 63000, France Correspondence: Dr A. Mazur, Unité de Nutrition Humaine, INRA, Theix, 63122 St Genès Champanelle, France <[email protected]> Abstract. To understand humans’ requirements for magnesium and the effect of magnesium on health, it is important to identify sensitive and population- specific biomarkers of magnesium status. Thus, we assessed the effectiveness of different magnesium status biomarkers through a systematic review of pub- lished magnesium supplementation and depletion trials in healthy humans. The methods used in this study included a structured search on Ovid MEDLINE, EMBASE (Ovid) and Cochrane databases up to September 2008, followed by the use of formal inclusion/exclusion criteria, data extraction, validity assessment, and meta-analysis. A total of 20 potential biomarkers of magnesium status were assessed from 21 included publications. The majority of studies included were magnesium supplementation studies. Fewer magnesium depletion studies were identified. Available data analysis suggests that serum/plasma magne- sium concentration, red blood cell (RBC) concentration and urinary magnesium excretion responded to dietary manipulation. For other biomarkers with availa- ble data, it was not possible to draw any conclusions about their usefulness as magnesium status biomarkers. The lack of data prevented detailed subgroup analysis. In conclusion, although limited data were available, serum/plasma magnesium concentration, RBC magnesium concentration and urinary mag- nesium excretion appear to be useful biomarkers of magnesium status in the general population. Further high-quality studies are needed to assess the effec- tiveness of existing and newly developed biomarkers, especially in populations that are vulnerable to magnesium deficiency. Key words: magnesium, status, systematic review Magnesium (Mg2+) is the second most abun- vided in the “Dietary Reference Intakes (DRIs)” dant cation within the cell. Magnesium plays [4] and in the “Apports nutritionnels conseil- an essential role in a wide range of fundamen- lés pour la population franc¸aise (ANC)” [5]. The tal biochemical reactions and cellular functions, magnesium content of food in the Western coun- including cell cycle, channel regulation, mem- tries is consistently decreasing; currently, dietary brane and nucleic acid stability and is a cofactor magnesium in many adults does not meet the for hundreds of enzymes [1]. Therefore, it is recommended intake [6-11]. This low magne- not surprising that many clinical disorders are sium intake leads to an increased risk of latent associated with magnesium deficiency [2, 3]. magnesium deficiency, which is difficult to diag- Recommendations for magnesium intake are pro- nose. It is generally accepted that assessments of magnesium status are problematic [12, 13]. This manuscript does not necessarily reflect the views The assessment difficulty results from the dis- of the Commission of the European Communities and in tribution of magnesium in the body. About half doi:10.1684/mrh.2011.0292 no way anticipates their future policy in this area. of the total body magnesium is in the bone and 163 To cite this article: Witkowski M, Hubert J, Mazur A. Methods of assessment of magnesium status in humans: a systematic review. Magnes Res 2011; 24(4): 163-80 doi:10.1684/mrh.2011.0292 Journal Identification = MRH Article Identification = 0292 Date: January 4, 2012 Time: 10:26 am M. WITKOWSKI ET AL. the other half is in the soft tissues. Extracellu- humans (including supplementation and/or deple- lar magnesium accounts for only about 1 percent tion studies) with no restrictions in study design, of total body magnesium. Therefore, the measure- including randomised controlled trials (RCTs), ment of blood plasma/serum magnesium does not controlled clinical trials (CCTs), and before-and- exactly reflect its intracellular level. In healthy after studies (B/A); 2) report the magnesium subjects, there is a balance between intesti- status in humans at baseline and after sup- nal magnesium absorption and urinary excretion plementation or depletion; 3) report the daily with the latter being of greater importance. Uri- dose of the supplement and involve magnesium nary excretion increases when magnesium intake supplementation with magnesium salts that are is in excess, whereas the increased kidney re- considered bioavailable; and 4) involve healthy absorption conserves magnesium in the case of participants who had not recently used mineral magnesium deprivation. Therefore, urine magne- or vitamin supplements. sium reflects magnesium intake and can provide Study inclusion was not limited by the age of information on an individual’s magnesium status. the participants and included studies of infants However, factors affecting kidney filtration, such through the elderly. Studies were excluded if they as diabetes, diuretics, and renal dialysis, strongly included subjects receiving concomitant therapy influence urinary magnesium, limiting its value for chronic illnesses, nutritional deficiencies other in several pathophysiological conditions. Home- than magnesium, or if the studies’ subjects had a ostasis of magnesium is mainly maintained via condition known to affect magnesium metabolism, bone stores. Approximately one third of magne- such as diabetes, severe kidney diseases, renal sium in bone is freely exchangeable and acts as dialysis, or alcoholism. Studies were excluded if a reserve for maintaining extracellular magne- suitable baseline data were unavailable, if infor- sium concentrations [13]. For these magnesium mation on the statistical variance of the data metabolism-related evidences, extensive research was not accessible, and if methods for the status has been conducted on the evaluation of magne- assessment were not found. sium in a variety of blood cells and on techniques measuring magnesium concentrations in tissues. Recently published reviews [12, 13] provide an Data collection extensive update on the assessment of magnesium status. We searched Ovid MEDLINE (www.ovid.com), The aim of this systematic review is to assess EMBASE (Ovid; www.ovid.com), and the the usefulness of magnesium status biomarkers in Cochrane Library CENTRAL (www.thecochra- healthy humans to determine which biomarkers nelibrary.com) databases from inception to appropriately reflect changes in magnesium September 2008 for magnesium intervention status in response to supplementation or deple- studies using text terms with appropriate trun- tion. The methodology of this review is based on cation and relevant indexing terms. The general the standard methodology developed for the set structure of the search was “magnesium” and of reviews within the Eurreca project (EURopean “intervention OR supplementation OR depletion” micronutrient RECommendations Aligned) (14) and “humans.” and also related to other minerals [15-18]. Titles and abstracts were screened for inclu- sion by a single reviewer. The full text of all articles collected was screened for inclusion by Methods using an inclusion and exclusion form by two independent reviewers. Data for each included study were extracted into an Access (Microsoft An abbreviated version of the methodology used Corp, Redmond, WA) database file by a single in this review is provided below with differences reviewer. In unclear cases, studies were discussed from the main methodology noted [14]. with the review team before beginning full data extraction, and, in some cases, study authors Study selection were contacted for clarification. When necessary, units of measurement were converted to a stan- To be included, a study needed to meet all of dard form to facilitate comparison across studies. the following criteria: 1) an intervention study in Data extraction and synthesis for primary and 164 Journal Identification = MRH Article Identification = 0292 Date: January 4, 2012 Time: 10:26 am Mg status assessment secondary measures of interest were undertaken table 1. The quality of the included studies varied; as discussed in the methodology article [14]. To 12 RCTs were included in the review, but the claim whether a biomarker was useful, the fol- method of randomisation