1Department of Endocrinology and Metabolism, Tianjin Medical College Common Hospital, No154 Anshan Highway, Heping District, Tianjin, 300052 China
1Department of Endocrinology and Metabolism, Tianjin Medical College Common Hospital, No154 Anshan Highway, Heping District, Tianjin, 300052 China
2Department of Diet and Meals Hygiene, Faculty of Public Well being, Tianjin Medical College, No22 Qixiangtai Highway, Heping District, Tianjin, 300070 China
3Department of Nuclear Drugs, Zhujiang Hospital of Southern Medical College, No 253 Gongye Highway, Guangzhou, Guangdong Province 510282 China
1Department of Endocrinology and Metabolism, Tianjin Medical College Common Hospital, No154 Anshan Highway, Heping District, Tianjin, 300052 China
4Department of Endocrinology, Huaihe Hospital of Henan College, Kaifeng, No 8 Baobei Highway, Henan Province 475000 China
2Department of Diet and Meals Hygiene, Faculty of Public Well being, Tianjin Medical College, No22 Qixiangtai Highway, Heping District, Tianjin, 300070 China
1Department of Endocrinology and Metabolism, Tianjin Medical College Common Hospital, No154 Anshan Highway, Heping District, Tianjin, 300052 China
1Department of Endocrinology and Metabolism, Tianjin Medical College Common Hospital, No154 Anshan Highway, Heping District, Tianjin, 300052 China
1Department of Endocrinology and Metabolism, Tianjin Medical College Common Hospital, No154 Anshan Highway, Heping District, Tianjin, 300052 China
1Department of Endocrinology and Metabolism, Tianjin Medical College Common Hospital, No154 Anshan Highway, Heping District, Tianjin, 300052 China
1Department of Endocrinology and Metabolism, Tianjin Medical College Common Hospital, No154 Anshan Highway, Heping District, Tianjin, 300052 China
5Department of Endocrinology and Metabolism and Institute of Endocrinology, The First Hospital of China Medical College, Shenyang, Liaoning Province 110001 China
1Department of Endocrinology and Metabolism, Tianjin Medical College Common Hospital, No154 Anshan Highway, Heping District, Tianjin, 300052 China
Related Knowledge
Summary
Introduction
Magnesium is the fourth most plentiful important mineral within the human physique after sodium, potassium, and calcium1, and is a cofactor for greater than 300 enzymes that regulate quite a lot of biochemical processes, equivalent to DNA/RNA synthesis, protein synthesis, oxidative phosphorylation, and glycolysis1,2. Magnesium is especially absorbed by means of the weight-reduction plan, and high-magnesium meals embody nuts, seeds, complete grains, and leafy greens. Epidemiological surveys present that magnesium deficiency exists in lots of areas worldwide3–5. Based on knowledge from the Nationwide Well being and Diet Examination (2001–2010) in america, the magnesium intakes of solely 18.8% of male contributors and 24.8% of feminine contributors met the really helpful dietary allowance3. The Diet and Well being Survey in Taiwan (NAHSIT) additionally confirmed that the day by day intakes of magnesium in 75% of male contributors and 81% of feminine contributors have been decrease than the dietary reference intakes (DRIs)4. It’s estimated that the prevalence of low serum magnesium within the inhabitants is 2.5–15percent5. Inadequate magnesium consumption and low serum magnesium are related to quite a lot of power ailments, together with insulin resistance and sort 2 diabetes mellitus6,7, metabolic syndrome3,8, hypertension9, cardiovascular disease10, stroke11, migraine12, consideration deficit disorder13, Alzheimer’s disease14, and asthma15.
Magnesium is intently associated to the immune system; in vitro experiments have confirmed that intracellular free magnesium ions are an vital second messenger within the immune activation of T lymphocytes16 and B lymphocytes17, and magnesium channels and transport proteins play an vital position in regular immune function16,18,19. Furthermore, magnesium can be related to mobile oxidative stress and inflammatory reactions20. The homeostasis of magnesium ions in mitochondria is vital for mobile power metabolism and for the power to reply to oxidative stress21. The synthesis of glutathione, which is a vital mobile antioxidant, is an ATP-dependent response and is subsequently critically depending on magnesium1. Research have discovered that magnesium consumption was inversely related to ranges of C-reactive protein, interleukin-6, and different inflammatory factors6,22, and that magnesium citrate supplementation can downregulate genes associated to metabolic and inflammatory pathways23.
Autoimmune thyroiditis is a typical endocrine dysfunction that’s brought on by quite a lot of environmental elements and relies on genetic susceptibility. A variety of hint components are associated to the pathogenesis of autoimmune thyroiditis, amongst which crucial is iodine, adopted by iron, selenium, and others24,25. There are few research on the connection between magnesium and thyroid illness. For instance, a research on sufferers with Graves’ illness discovered that they exhibited a decrease serum magnesium focus than regular management contributors, and that the serum magnesium focus was negatively correlated with lymphocyte activation26. An Austrian research discovered that low serum magnesium was related to irregular thyroid operate, which was improved after supplemental magnesium therapy27. To additional make clear the connection between serum magnesium ranges and autoimmune thyroiditis, in addition to thyroid operate, we carried out a cross-sectional research among the many everlasting residents of Tianjin.
Outcomes
Dialogue – “magnesium and iodine”
Magnesium within the human physique is usually positioned within the cells and bone tissues; only one% of whole physique magnesium is positioned in extracellular fluids, and solely 0.3% of whole physique magnesium is current in serum1. Nonetheless, the detection of intracellular magnesium ions is troublesome, whereas the detection of serum magnesium ions is easy and handy. Due to this fact, serum magnesium remains to be used to evaluate people’ magnesium dietary statuses1. Hypermagnesaemia and magnesium poisoning are uncommon in medical observe, and solely happen in sufferers with extreme renal failure. The principle medical manifestation of magnesium diet imbalance is low serum magnesium, the definition of which varies amongst completely different populations and strategies of detection. Current evaluations of serum magnesium as an indicator of magnesium standing have indicated that people with serum magnesium values >0.85 mmol/L most definitely have ample magnesium levels20,28,29. Due to this fact, in our research, serum magnesium ranges ≤0.85 mmol/L have been thought-about low. Moreover, serum magnesium ranges ≤0.55 mmol/L have been thought-about severely low in our research, as beforehand described within the literature30,31.
Furthermore, the median serum magnesium stage was 0.89 (0.73–1.06) mmol/L in our research; the proportion of topics with insufficient magnesium ranges (≤0.85 mmol/L) was 45.1%, whereas the proportion of individuals with severely low serum magnesium was 5.9%. The NAHSIT4 confirmed that the imply serum magnesium ranges of female and male contributors have been 0.861 and 0.866 mmol/L, respectively; moreover, 12.3% and 23.7% of female and male contributors had low serum magnesium ranges (outlined as <0.8 mmol/L in the NAHSIT), which were lower rates than in our study. Using the Food Frequency Questionnaire, the NAHSIT found that the daily magnesium intakes of 75% in male participants and 81% in female participants were lower than the DRI; the daily magnesium intake of middle-aged individuals (ages 45–64 years) was the highest, while that of elderly individuals (≥65 years) was the lowest. Our study also found that the proportion of elderly subjects (≥65 years) was significantly higher in the lowest serum magnesium quartile group. Moreover, the proportion of young people (18–39 years) tended to decrease in the higher (>0.55 mmol/L) quartile teams, whereas the proportion of people ≥40 years previous tended to extend. On the one hand, this is likely to be associated to the consumption stage of magnesium within the weight-reduction plan; then again, these outcomes may also be defined by the decline of intestinal absorption capability within the aged vs. fast metabolism in younger people. Our research additionally discovered that people with decrease instructional and earnings ranges have been extra more likely to exhibit low serum magnesium; this is likely to be associated to dietary construction in addition to meals affordability. In a cross-sectional research of 13,226 American contributors, the proportion of people with serum magnesium ranges <0.75 mmol/L was 26.5%, whereas that of people with ranges <0.70 mmol/L was 10.3%. In that research, contributors with decrease schooling and earnings ranges have been extra more likely to have low serum magnesium levels32, which was in line with our knowledge.
Logistic regression evaluation revealed that the morbidity danger owing to medical and subclinical hypothyroidism was elevated within the lowest serum magnesium stage (≤0.55 mmol/L) quartile group. Early research on magnesium and thyroid operate revealed that serum magnesium ranges in sufferers with hyperthyroidism are decreased whereas these in sufferers with hypothyroidism are elevated; this alteration is likely to be associated to thyroid hormones inflicting elevated magnesium excretion within the urine33. Nonetheless, subsequent research have produced contrasting findings; animal model34 and medical studies35,36 discovered hypothyroidism to be related to decreased serum magnesium ranges, and the position of thyroid hormones on the magnesium urinary excretion fee was primarily associated to their impact on the diploma of urinary focus. There have been no variations within the ranges of urinary magnesium or creatinine ranges in sufferers with various thyroid functionality35. Moreover, a earlier research confirmed that the inhibition of mitochondrial oxidative phosphorylation might result in decreased iodine uptake by thyroid cells, as such uptake is achieved by a sodium iodide cotransporter that requires a mitochondrial power supply37. Magnesium, as an enzyme cofactor, performs a crucial position in mitochondrial oxidative phosphorylation and ATP synthesis, and its deficiency can have an effect on these capabilities and result in decreased iodine uptake by thyroid cells and a subsequent drop in thyroid hormone synthesis, thereby inflicting the secretion of thyroid-stimulating hormone (TSH). Animal experiments have proven that magnesium supplementation can considerably enhance radioactive iodine uptake by thyroid cells, whereas its deficiency does the opposite34. Notably, nearly all of contributors with hypothyroidism on this research exhibited subclinical hypothyroidism; these with medical hypothyroidism have been too few in quantity to analyse individually utilizing logistic regression evaluation. Due to this fact, our conclusions are primarily relevant to subclinical hypothyroidism. Our research discovered that serum magnesium ranges ≤0.55 mmol/L have been associated to the chance of TGAb positivity and prevalence of HT. There are at the least two explanations for this: first, severely low serum magnesium can enhance TGAb through the irregular activation of immune cells and induction of an autoimmune response. A research on sufferers with Graves’ illness discovered that their serum magnesium concentrations have been decrease than in regular people, and that the serum magnesium focus was inversely associated to the activation ranges of CD3+, CD4+, CD8+T, and CD19+B cells. It was speculated that low serum magnesium would possibly result in decreased immune tolerance and irregular activation of immune cells26. Second, given its operate as a coenzyme, magnesium is concerned in quite a lot of antioxidant metabolism pathways, equivalent to glutathione synthesis; low serum magnesium may subsequently cut back the antioxidant response capability in cells and permit the buildup of free radicals, leading to oxidative stress and tissue damage21,38,39. Epidemiological research have proven that inadequate magnesium consumption is related to quite a lot of power inflammatory ailments and elevated serum C-reactive protein levels6,22,23,40. Our research revealed that severely low serum magnesium ranges weren't associated to elevated TPOAb positivity. The medical significance of TPOAb is distinct from that of TGAb, as it's the most delicate and particular index for the analysis of autoimmune thyroiditis and is intently associated to hypothyroidism41. Nonetheless, as a serological marker of autoimmune thyroiditis, TGAb doesn't injury the thyroid gland42. The completely different results of severely low serum magnesium on the 2 autoantibodies examined in our research indicated that its impact on the thyroid autoantibody would possibly primarily be brought on by irritation and oxidative stress, slightly than by activating autoimmune responses. In different phrases, severely low serum magnesium isn't the initiating issue of autoimmune thyroiditis, however is likely to be an aggravating issue through irritation. This research discovered that non-severely low serum magnesium (0.551–0.85 mmol/L) isn't related to thyroid autoantibody ranges or thyroid operate. One other research on the connection between low serum magnesium and metabolic syndrome with low-grade irritation additionally discovered that inflammatory elements have been elevated solely when magnesium ranges have been severely low (<0.5 mmol/L)31. Animal research discovered that the inflammatory response brought on by mild-to-moderate magnesium deficiency may very well be compensated for, or aggravated, by different factors39. Hegsted et al. discovered that decreasing the magnesium consumption in rats to 50% of their required ranges didn't inhibit their development; nevertheless, putting these rats in a chilly atmosphere (13 levels) lowered their development fee considerably in contrast with management rats with regular magnesium intake43. This indicated that the results of gentle versus reasonable magnesium deficiency in several people is likely to be extra complicated; subsequently, research of various populations might effectively produce completely different outcomes. Moreover, outcomes can differ primarily based on completely different definitions of low serum magnesium ranges and ranging cut-off factors. This research included some limitations. First, as a result of many of the physique’s magnesium content material is intracellular, serum magnesium doesn't totally symbolize the physique’s magnesium dietary standing. Nonetheless, in a large-scale epidemiological investigation, serum magnesium remains to be probably the most possible and consultant index. Second, dietary magnesium consumption was not investigated on this research. If serum magnesium and the dietary questionnaire have been analysed collectively, extra complete knowledge on the dietary standing of magnesium might have been obtained. Third, all topics included on this research have been residents of Tianjin; whereas the background knowledge in every group have been comparatively constant, different confounding elements would possibly nonetheless be current. Lastly, as an observational research, our outcomes may solely reveal the associations between severely low serum magnesium ranges, TGAb, HT, and thyroid operate; potential interventional research are required to substantiate the conclusion and reveal any cause-and-effect relationships.Conclusions
Our cross-sectional survey revealed that the proportion of Tianjin residents with insufficient magnesium standing (serum magnesium ranges ≤0.85 mmol/L) was 28.2%, and that with extreme magnesium deficiency (serum magnesium ranges ≤0.55 mmol/L) was 5.9%. Serum magnesium ranges ≤0.55 mmol/L have been related to elevated dangers of TGAb positivity, the prevalence of HT, and (primarily subclinical) hypothyroidism, indicating that serum magnesium ranges needs to be evaluated in sufferers with autoimmune thyroiditis and hypothyroidism. Elevated magnesium consumption or magnesium supplementation could also be useful for sufferers with severely low blood magnesium who’re identified with these problems.
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