|
|
Magnesium Deficiency in South Africa
|
Abstract:
Background: Magnesium is an essential micronutrient, the deficiency of which is associated with chronic diseases such as neurological, cardiovascular and musculoskeletal disorders, posing a considerable health burden. Despite its importance for a healthy life, dietary magnesium intake among South Africans is generally low, increasing the risk of deficiency. In addition, magnesium deficiency often goes unrecognised in clinical practice, highlighting the need for increased awareness and guidance on its diagnosis and management. This article provides practical recommendations from experts, to guide healthcare professionals in the timely diagnosis and management of magnesium deficiency. Methods: An expert panel comprising four experts in endocrinology, pharmacology, clinical nutrition and general practice from India and South Africa convened to develop management recommendations for magnesium deficiency. A literature review was conducted to identify key studies on the prevalence, risk factors, diagnosis and treatment of magnesium deficiency. Consensus statements were created based on literature findings and panel discussions. Results: The expert panel established nine recommendations focusing on the identification of risk groups, diagnosis, the need for a simplified screening tool and the use of oral magnesium supplementation for the treatment of magnesium deficiency. Conclusion: Magnesium deficiency is a prevalent yet often overlooked condition in clinical practice. The expert panel recommends identifying at-risk groups, using a simple screening tool, and treating with oral magnesium supplements to help healthcare professionals in South Africa diagnose and manage the condition more effectively.
| [1] | Cotruvo, J. and Bartram, J. (2009) Calcium and Magnesium in Drinking-Water: Public Health Significance. World Health Organization. https://iris.who.int/bitstream/handle/10665/43836/9789241563550_eng.pdf?sequence=1 |
| [2] | Schwalfenberg, G.K. and Genuis, S.J. (2017) The Importance of Magnesium in Clinical Healthcare. Scientifica, 2017, Article ID: 4179326. https://doi.org/10.1155/2017/4179326 |
| [3] | Fiorentini, D., Cappadone, C., Farruggia, G. and Prata, C. (2021) Magnesium: Biochemistry, Nutrition, Detection, and Social Impact of Diseases Linked to Its Deficiency. Nutrients, 13, Article 1136. https://doi.org/10.3390/nu13041136 |
| [4] | Żarnowski, A., Jankowski, M. and Gujski, M. (2022) Public Awareness of Diet-Related Diseases and Dietary Risk Factors: A 2022 Nationwide Cross-Sectional Survey among Adults in Poland. Nutrients, 14, Article 3285. https://doi.org/10.3390/nu14163285 |
| [5] | Piuri, G., Zocchi, M., Della Porta, M., Ficara, V., Manoni, M., Zuccotti, G.V., et al. (2021) Magnesium in Obesity, Metabolic Syndrome, and Type 2 Diabetes. Nutrients, 13, Article 320. https://doi.org/10.3390/nu13020320 |
| [6] | DiNicolantonio, J.J., O’Keefe, J.H. and Wilson, W. (2018) Subclinical Magnesium Deficiency: A Principal Driver of Cardiovascular Disease and a Public Health Crisis. Open Heart, 5, e000668. https://doi.org/10.1136/openhrt-2017-000668 |
| [7] | Charlton, K.E., Steyn, K., Levitt, N.S., Zulu, J.V., Jonathan, D., Veldman, F.J., et al. (2005) Diet and Blood Pressure in South Africa: Intake of Foods Containing Sodium, Potassium, Calcium, and Magnesium in Three Ethnic Groups. Nutrition, 21, 39-50. https://doi.org/10.1016/j.nut.2004.09.007 |
| [8] | Drewnowski, A. and Darmon, N. (2005) Food Choices and Diet Costs: An Economic Analysis. The Journal of Nutrition, 135, 900-904. https://doi.org/10.1093/jn/135.4.900 |
| [9] | The World Bank (2024) Overcoming Poverty and Inequality in South Africa. An Assessment of Drivers, Constraints and Opportunities. https://documents1.worldbank.org/curated/en/530481521735906534/pdf/Overcoming-Poverty-and-Inequality-in-South-Africa-An-Assessment-of-Drivers-Constraints-and-Opportunities.pdf |
| [10] | Reardon, T., Tschirley, D., Liverpool-Tasie, L.S.O., Awokuse, T., Fanzo, J., Minten, B., et al. (2021) The Processed Food Revolution in African Food Systems and the Double Burden of Malnutrition. Global Food Security, 28, Article 100466. https://doi.org/10.1016/j.gfs.2020.100466 |
| [11] | Romani, A.M.P. (2008) Magnesium Homeostasis and Alcohol Consumption. Magnesium Research, 21, 197-204. |
| [12] | National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC) and ICF (2024) South Africa Demographic and Health Survey 2016. https://dhsprogram.com/pubs/pdf/FR337/FR337.pdf |
| [13] | Cheungpasitporn, W., Thongprayoon, C. and Qian, Q. (2015) Dysmagnesemia in Hospitalized Patients: Prevalence and Prognostic Importance. Mayo Clinic Proceedings, 90, 1001-1010. https://doi.org/10.1016/j.mayocp.2015.04.023 |
| [14] | Dominguez, L.J., Gea, A., Ruiz-Estigarribia, L., Sayón-Orea, C., Fresán, U., Barbagallo, M., et al. (2021) Low Dietary Magnesium and Overweight/Obesity in a Mediterranean Population: A Detrimental Synergy for the Development of Hypertension. the SUN Project. Nutrients, 13, Article 125. https://doi.org/10.3390/nu13010125 |
| [15] | Micklesfield, L.K., Kolkenbeck-Ruh, A., Mukoma, G., Prioreschi, A., Said-Mohamed, R., Ware, L.J., et al. (2022) The Healthy Aging Adult South Africa Report Card: A Systematic Review of the Evidence between 2013 and 2020 for Middle-Aged South African Men and Women. Cardiovascular Journal of Africa, 33, 38-57. https://doi.org/10.5830/cvja-2022-015 |
| [16] | Hruby, A., Guasch-Ferré, M., Bhupathiraju, S.N., Manson, J.E., Willett, W.C., McKeown, N.M., et al. (2017) Magnesium Intake, Quality of Carbohydrates, and Risk of Type 2 Diabetes: Results from Three U.S. Cohorts. Diabetes Care, 40, 1695-1702. https://doi.org/10.2337/dc17-1143 |
| [17] | Chrysant, S.G. and Chrysant, G.S. (2019) Association of Hypomagnesemia with Cardiovascular Diseases and Hypertension. International Journal of Cardiology Hypertension, 1, Article 100005. https://doi.org/10.1016/j.ijchy.2019.100005 |
| [18] | Dey, R., Rajappa, M., Parameswaran, S. and Revathy, G. (2015) Hypomagnesemia and Atherogenic Dyslipidemia in Chronic Kidney Disease: Surrogate Markers for Increased Cardiovascular Risk. Clinical and Experimental Nephrology, 19, 1054-1061. https://doi.org/10.1007/s10157-015-1097-z |
| [19] | Fabian, J., Gondwe, M., Mayindi, N., Chipungu, S., Khoza, B., Gaylard, P., et al. (2022) Chronic Kidney Disease (CKD) and Associated Risk in Rural South Africa: A Population-Based Cohort Study. Wellcome Open Research, 7, Article 236. https://doi.org/10.12688/wellcomeopenres.18016.2 |
| [20] | Abdelatif, N., Peer, N. and Manda, S.O. (2021) National Prevalence of Coronary Heart Disease Andstroke in South Africa from 1990-2017: A Systematicreview and Meta-Analysis. Cardiovascular Journal of Africa, 32, 46-50. https://doi.org/10.5830/cvja-2020-045 |
| [21] | Orlova, S., Dikke, G., Pickering, G., Yaltseva, N., Konchits, S., Starostin, K., et al. (2021) Risk Factors and Comorbidities Associated with Magnesium Deficiency in Pregnant Women and Women with Hormone-Related Conditions: Analysis of a Large Real-World Dataset. BMC Pregnancy and Childbirth, 21, Article No. 76. https://doi.org/10.1186/s12884-021-03558-2 |
| [22] | Siwela, L., Khan, N. and Mudau, A. (2022) A Radiological Assessment of the Prevalence of Osteoporosis in Male Patients Seen in a South African Hospital: A Retrospective Analysis. Journal of Osteoporosis, 2022, Article ID: 1238927. https://doi.org/10.1155/2022/1238927 |
| [23] | Kruger, M.J. and Nell, T.A. (2017) The Prevalence of the Metabolic Syndrome in a Farm Worker Community in the Boland District, South Africa. BMC Public Health, 17, Article No. 61. https://doi.org/10.1186/s12889-016-3973-1 |
| [24] | Lin, L., Tan, W., Pan, X., Tian, E., Wu, Z. and Yang, J. (2022) Metabolic Syndrome-Related Kidney Injury: A Review and Update. Frontiers in Endocrinology, 13, Article ID: 904001. https://doi.org/10.3389/fendo.2022.904001 |
| [25] | Ju, S., Choi, W., Ock, S., Kim, C. and Kim, D. (2014) Dietary Magnesium Intake and Metabolic Syndrome in the Adult Population: Dose-Response Meta-Analysis and Meta-Regression. Nutrients, 6, 6005-6019. https://doi.org/10.3390/nu6126005 |
| [26] | U.S. Food and Drug Administration (2011) FDA Drug Safety Communication: Low Magnesium Levels Can Be Associated with Long-Term Use of Proton Pump Inhibitor Drugs (PPIs). https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-low-magnesium-levels-can-be-associated-long-term-use-proton-pump |
| [27] | Srinutta, T., Chewcharat, A., Takkavatakarn, K., Praditpornsilpa, K., Eiam-Ong, S., Jaber, B.L., et al. (2019) Proton Pump Inhibitors and Hypomagnesemia. Medicine, 98, e17788. https://doi.org/10.1097/md.0000000000017788 |
| [28] | Nielsen, F.H. and Lukaski, H.C. (2006) Update on the Relationship between Magnesium and Exercise. Magnesium Research, 19, 180-189. |
| [29] | Keen, C.L. (1993) The Effect of Exercise and Heat on Mineral Metabolism and Requirements. In: Marriott, B.M., Ed., Nutritional Needs in Hot Environments: Applications for Military Personnel in Field Operations, National Academies Press, 124-125. |
| [30] | Arab, A., Rafie, N., Amani, R. and Shirani, F. (2023) The Role of Magnesium in Sleep Health: A Systematic Review of Available Literature. Biological Trace Element Research, 201, 121-128. https://doi.org/10.1007/s12011-022-03162-1 |
| [31] | Zhang, Y., Chen, C., Lu, L., Knutson, K.L., Carnethon, M.R., Fly, A.D., et al. (2021) Association of Magnesium Intake with Sleep Duration and Sleep Quality: Findings from the CARDIA Study. Sleep, 45, zsab276. https://doi.org/10.1093/sleep/zsab276 |
| [32] | Schreuder, K.J., Roelen, C.A.M., Koopmans, P.C. and Groothoff, J.W. (2008) Job Demands and Health Complaints in White and Blue Collar Workers. WORK: A Journal of Prevention, Assessment & Rehabilitation, 31, 425-432. https://doi.org/10.3233/wor-2008-00756 |
| [33] | Cernak, I., Savic, V., Kotur, J., Prokic, V., Kuljic, B., Grbovic, D., et al. (2000) Alterations in Magnesium and Oxidative Status during Chronic Emotional Stress. Magnesium Research, 13, 29-36. |
| [34] | Pickering, G., Mazur, A., Trousselard, M., Bienkowski, P., Yaltsewa, N., Amessou, M., et al. (2020) Magnesium Status and Stress: The Vicious Circle Concept Revisited. Nutrients, 12, Article 3672. https://doi.org/10.3390/nu12123672 |
| [35] | Cox, I.M., Campbell, M.J. and Dowson, D. (1991) Red Blood Cell Magnesium and Chronic Fatigue Syndrome. The Lancet, 337, 757-760. https://doi.org/10.1016/0140-6736(91)91371-z |
| [36] | Zhang, X., Li, Y., Del Gobbo, L.C., Rosanoff, A., Wang, J., Zhang, W., et al. (2016) Effects of Magnesium Supplementation on Blood Pressure: A Meta-Analysis of Randomized Double-Blind Placebo-Controlled Trials. Hypertension, 68, 324-333. https://doi.org/10.1161/hypertensionaha.116.07664 |
| [37] | Veronese, N., Dominguez, L.J., Pizzol, D., Demurtas, J., Smith, L. and Barbagallo, M. (2021) Oral Magnesium Supplementation for Treating Glucose Metabolism Parameters in People with or at Risk of Diabetes: A Systematic Review and Meta-Analysis of Double-Blind Randomized Controlled Trials. Nutrients, 13, Article 4074. https://doi.org/10.3390/nu13114074 |
| [38] | Verma, H. and Garg, R. (2017) Effect of Magnesium Supplementation on Type 2 Diabetes Associated Cardiovascular Risk Factors: A Systematic Review and Meta‐Analysis. Journal of Human Nutrition and Dietetics, 30, 621-633. https://doi.org/10.1111/jhn.12454 |
| [39] | Scaturro, D., Vitagliani, F., Terrana, P., Tomasello, S., Camarda, L. and Letizia Mauro, G. (2022) Does the Association of Therapeutic Exercise and Supplementation with Sucrosomial Magnesium Improve Posture and Balance and Prevent the Risk of New Falls? Aging Clinical and Experimental Research, 34, 545-553. https://doi.org/10.1007/s40520-021-01977-x |
| [40] | Brzezińska, O., Łukasik, Z., Makowska, J. and Walczak, K. (2020) Role of Vitamin C in Osteoporosis Development and Treatment—A Literature Review. Nutrients, 12, Article 2394. https://doi.org/10.3390/nu12082394 |
| [41] | Li, J., Hovey, K.M., Andrews, C.A., Quddus, A., Allison, M.A., Van Horn, L., et al. (2020) Association of Dietary Magnesium Intake with Fatal Coronary Heart Disease and Sudden Cardiac Death. Journal of Women’s Health, 29, 7-12. https://doi.org/10.1089/jwh.2019.7775 |
| [42] | Guo, G., Zhou, J., Xu, T., Sheng, Z., Huang, A., Sun, L., et al. (2022) Effect of Magnesium Supplementation on Chronic Kidney Disease-Mineral and Bone Disorder in Hemodialysis Patients: A Meta-Analysis of Randomized Controlled Trials. Journal of Renal Nutrition, 32, 102-111. https://doi.org/10.1053/j.jrn.2021.07.009 |
| [43] | Rodríguez-Morán, M., Simental-Mendía, L.E., Gamboa-Gómez, C.I. and Guerrero-Romero, F. (2018) Oral Magnesium Supplementation and Metabolic Syndrome: A Randomized Double-Blind Placebo-Controlled Clinical Trial. Advances in Chronic Kidney Disease, 25, 261-266. https://doi.org/10.1053/j.ackd.2018.02.011 |
| [44] | Cundy, T. and Dissanayake, A. (2008) Severe Hypomagnesaemia in Long‐Term Users of Proton‐Pump Inhibitors. Clinical Endocrinology, 69, 338-341. https://doi.org/10.1111/j.1365-2265.2008.03194.x |
| [45] | Chapron, D.J., Korman, L.B. and Barry, W.L. (1994) Gastric Retention of Enteric-Coated Magnesium Chloride Tablets. Annals of Pharmacotherapy, 28, 874-877. https://doi.org/10.1177/106002809402800710 |
| [46] | Reno, A.M., Green, M., Killen, L.G., O’Neal, E.K., Pritchett, K. and Hanson, Z. (2020) Effects of Magnesium Supplementation on Muscle Soreness and Performance. Journal of Strength & Conditioning Research, 36, 2198-2203. https://doi.org/10.1519/jsc.0000000000003827 |
| [47] | Brilla, L.R. and Haley, T.F. (1992) Effect of Magnesium Supplementation on Strength Training in Humans. Journal of the American College of Nutrition, 11, 326-329. https://doi.org/10.1080/07315724.1992.10718233 |
| [48] | Moss, K., Kreutzer, A., Graybeal, A.J., Zhang, Y., Braun-Trocchio, R., Porter, R.R., et al. (2023) Nutrient Adequacy in Endurance Athletes. International Journal of Environmental Research and Public Health, 20, Article 5469. https://doi.org/10.3390/ijerph20085469 |
| [49] | Lin, C., Lin, Y., Chen, S., Hsu, M. and Hsu, C. (2021) American Ginseng Attenuates Eccentric Exercise-Induced Muscle Damage via the Modulation of Lipid Peroxidation and Inflammatory Adaptation in Males. Nutrients, 14, Article 78. https://doi.org/10.3390/nu14010078 |
| [50] | Abbasi, B., Kimiagar, M., Sadeghniiat, K., Sadeghniiat, K., Shirazi, M.M., Hedayati, M. and Ra-shidkhani, B. (2012) The Effect of Magnesium Supplementation on Primary Insomnia in Elderly: A Double-Blind Placebo-Controlled Clinical Trial. Journal of Research in Medical Sciences, 17, 1161-1169. |
| [51] | Pouteau, E., Kabir-Ahmadi, M., Noah, L., Mazur, A., Dye, L., Hellhammer, J., et al. (2018) Superiority of Magnesium and Vitamin B6 over Magnesium Alone on Severe Stress in Healthy Adults with Low Magnesemia: A Randomized, Single-Blind Clinical Trial. PLOS ONE, 13, e0208454. https://doi.org/10.1371/journal.pone.0208454 |
| [52] | Arring, N.M., Millstine, D., Marks, L.A. and Nail, L.M. (2018) Ginseng as a Treatment for Fatigue: A Systematic Review. The Journal of Alternative and Complementary Medicine, 24, 624-633. https://doi.org/10.1089/acm.2017.0361 |
| [53] | Shechter, M. and Eilat-Adar, S. (2021) Dietary Recommendations of Magnesium for Cardiovascular Prevention and Treatment. A Position Paper of the Israel Heart Society and the Israel Dietetic Association. Magnesium Research, 34, 35-42. |
| [54] | Negri, E., Pagano, R., Decarli, A. and La Vecchia, C. (1988) Body Weight and the Prevalence of Chronic Diseases. Journal of Epidemiology and Community Health, 42, 24-29. https://doi.org/10.1136/jech.42.1.24 |
| [55] | Steinmetz, T., Fortmann-Mölling, B., Wenisch, S. and Leonhäuser, I. (1999) Availability of Magnesium from Various Commercially Available Oral Preparations in a Variety of Dosage Forms: Comparative in Vitro Study. Journal of Medicinal Food, 2, 65-71. https://doi.org/10.1089/jmf.1999.2.65 |
| [56] | Campbell, S.C., Stockmann, C., Balch, A., Clark, E.A.S., Kamyar, M., Varner, M., et al. (2014) Intrapartum Magnesium Sulfate and the Potential for Cardiopulmonary Drug-Drug Interactions. Therapeutic Drug Monitoring, 36, 544-548. https://doi.org/10.1097/ftd.0000000000000050 |
| [57] | Workinger, J.L., Doyle, R.P. and Bortz, J. (2018) Challenges in the Diagnosis of Magnesium Status. Nutrients, 10, Article 1202. https://doi.org/10.3390/nu10091202 |
| [58] | Orlova, S., Dikke, G., Pickering, G., Konchits, S., Starostin, K. and Bevz, A. (2020) Magnesium Deficiency Questionnaire: A New Non-Invasive Magnesium Deficiency Screening Tool Developed Using Real-World Data from Four Observational Studies. Nutrients, 12, Article 2062. https://doi.org/10.3390/nu12072062 |
| [59] | Sukumar, D., DeLuccia, R., Cheung, M., Ramadoss, R., Ng, T. and Lamoureux, A. (2019) Validation of a Newly Developed Food Frequency Questionnaire to Assess Dietary Intakes of Magnesium. Nutrients, 11, Article 2789. https://doi.org/10.3390/nu11112789 |
