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Magnesium and the Risk for Type 2 Diabetes Mellitus

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Risk Assessment Group Seminar Magnesium and the Risk for Type 2 Diabetes Mellitus 2004/08/03 INTRODUCTION Type 2 Diabetes Mellitus Definition Hyperglycemia ... – PowerPoint PPT presentation

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Title: Magnesium and the Risk for Type 2 Diabetes Mellitus


1
Magnesium and the Risk for Type 2 Diabetes
Mellitus
Risk Assessment Group Seminar
  • ???
  • 2004/08/03

2
INTRODUCTION
3
Type 2 Diabetes Mellitus
  • Definition
  • Hyperglycemia resulted from insulin resistance
    with an insulin secretory defect
  • Excess risk for
  • Blindness
  • Renal failure
  • Cardiovascular disease

4
Hypomagnesemia in diabetes
  • Intracellular magnesium
  • Cofactor for enzymes in glucose metabolism
  • Maintain tyrosine kinase activity
  • at insulin receptor
  • Insulin as a regulatory hormone
  • Stimulate magnesium uptake by cell
  • Insulin receptor-mediated process

5
Hypothesis
6
Magnesium status in pathogenesis of diabetes
  • Serum magnesium
  • Dietary intake of magnesium

7
Reference 1Serum and Dietary Magnesium and the
Risk for Type 2 Diabetes Mellitus
  • The Atherosclerosis Risk in Communities Study
  • Arch Intern Med. 19991592151-2159

8
PARTICIPANTS AND METHODS
9
The Atherosclerosis Risk in Communities Study
  • Study design
  • Prospective study
  • 6 years of follow-up (2 visits)
  • Etiology of atherosclerosis and its clinical
    sequelae
  • Participants
  • Aged 45-64 years
  • Four US communities
  • --- Forsyth County, North Carolina
  • --- Jackson, Mississippi
  • --- Suburbs of Minneapolis, Minnesota
  • --- Washington County, Maryland

10
Participants
  • Exclude
  • Ethnicity other than black or white
  • Had diabetes at baseline
  • Missing exposure or outcome information
  • Nonfasting (lt 8 hours)
  • Unavailable for follow-up
  • Dead
  • 10871 participants

11
Exposure assessment
  • Blood collection
  • Fasting ? 12 hrs
  • Serum magnesium, glucose level, insulin level,
    calcium level, potassium level
  • Dietary intake
  • 61-item food frequency questionnaire (FFQ)
  • Mg intake milligrams/4.2 kJ daily energy intake
  • Lack of validity study for magnesium

12
Outcome assessment
  • Diabetes mellitus definition
  • Fasting glucose level ? 126 mg/dL
  • Non-fasting glucose level ? 200 mg/dL
  • Current use of diabetic medication
  • Doctor ever told that he/she had diabetes
  • Met any of these conditions at visit 2 or visit 3
  • ?incident cases of diabetes

13
Statistical analysis
  • Stratified by race
  • Serum Mg level
  • Categorized into 6 groups
  • Highest level ?0.95 mmol/L (Reference group)
  • Dietary Mg intake
  • Categorize into quartiles
  • Highest quartile as reference group

14
Statistical analysis (cont.)
  • Statistical significance
  • Analysis of variance
  • ?2 analysis
  • Association between Mg and diabetes
  • Logistic regression model
  • Odds ratio

15
RESULT
16
Baseline characteristics (Black)
17
Baseline characteristics (White)
18
Incidence of type 2 diabetes
19
Serum Mg and risk for type 2 diabetes
20
Comparison of cross-sectional and prospective
association
Cross-sectional
Prospective
21
Dietary Mg Intake
22
CONCLUSIONS
23
Three main conclusions
  • Inverse relationship between serum Mg level and
    development of type 2 diabetes
  • ---White middle-aged adults.
  • Cross-sectional relationship
  • ---Effect of diabetes on serum Mg level
  • No association between dietary Mg intake and
    incident type 2 diabetes.

24
Dietary Magnesium Intake in Relation to Plasma
Insulin Levels and Risk of Type 2 Diabetes in
Women
Reference 2
  • Diabetes Care 2759-65,2004

25
RESEARCH DESIGN AND METHODS
26
Womens Health Study (WHS)
  • Study design
  • Randomized, double-blind, placebo controlled
    trial
  • Low-dose aspirin and vitamin E
  • Primary prevention of cardiovascular disease and
    cancer
  • Participants
  • Aged ? 45 years
  • 39876 female health professionals
  • Free of coronary heart disease, stroke, and
    cancer.

27
Assessment of Mg intake
  • 131-item SFFQ
  • Commonly used unit or portion size
  • 9 possible responses
  • never 6 or more times per day
  • Good validity for magnesium
  • SFFQ vs. 2 weeks of diet records
  • r 0.76

28
Ascertainment of incident type 2 diabetes
  • Ask annually about type 2 diabetes diagnosis
  • ?
  • Questionnaire
  • Onset of disease
  • Symptoms
  • Diagnostic tests
  • Hypoglycemic treatment
  • ?
  • Confirm type 2 diabetes
  • Guidelines of the American Diabetes Association

29
Assessment of fasting insulin levels
  • 349 randomly selected health women
  • (Serve as control in WHS)
  • Double antibody systems
  • --- lt 0.2 cross-reactivity between insulin
  • and its precursors

30
Data analysis
  • Magnesium intake
  • --- Categorized into quintiles
  • --- Lowest quintile as reference
  • Cox proportional hazard model
  • ? rate ratio
  • Stratified analyses
  • by BMI (lt or ? 25 kg/m2)

31
Data analysis (cont.)
  • Cross-sectional analysis
  • Natural logarithm of insulin level
  • Multiple linear regression models
  • Modifying effect of BMI
  • --- Stratified by BMI

32
RESULTS
33
Baseline characteristics
34
RRs of type 2 diabetes
35
RRs stratified by BMI
36
Plasma fasting insulin level
37
Fasting insulin level in two BMI categories
BMI ? 25
38
CONCLUSIONS
39
For middle-aged women
  • risk of
    type 2 diabetes
  • Magnesium intake
  • plasma
    insulin level
  • Inverse association
  • Significant among overweight (? 25 kg/m2)
  • --- Highest quintile had a 22 lower risk
  • Beneficial effects
  • --- Greater among overweight people
  • --- Who are prone to insulin resistance.

40
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