Perspective: The case for an evidence-based reference interval for serum magnesium: The time has come

Authors: COSTELLO, REBECCA - Center For Magnesium Education And Research; ELIN, RONALD - University Of Louisville; ROSANOFF, ANDREA - Center For Magnesium Education And Research; WALLACE, TAYLOR - George Mason University; GUERRERO-ROMERO, FERNANDO - Mexican Social Security Institute; HRUBY, ADELA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; LUTSEY, PAMELA - University Of Minnesota; Nielsen, Forrest - Frosty; RODGRIGUEZ-MORAN, MARTHA - Mexican Social Security Institute; SONG, YIQING - Indiana University; VAN HORN, LINDA - Northwestern University

Submitted to: Advances in Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/24/2016
Publication Date: 11/1/2016
Citation: Costello, R.B., Elin, R.J., Rosanoff, A., Wallace, T.C., Guerrero-Romero, F., Hruby, A., Lutsey, P.L., Nielsen, F.H., Rodgriguez-Moran, M., Song, Y., Van Horn, L.V. 2016. The case for an evidence based reference interval for serum magnesium - The time has come. Advances in Nutrition. doi: 10.3945/an.116.012765.

Interpretive Summary: About half of Americans do not consume enough magnesium, which is an important dietary mineral critical to the normal function of the body and brain. Although we know that Americans do not typically consume enough magnesium, scientists are not yet sure how many Americans also have low magnesium levels: that is, people who have a magnesium deficiency. Magnesium in the body can be measured in many ways, but it is most often measured in the blood. The last time blood magnesium was measured in the American population was in the 1970s. Since then, scientists have learned a lot about the importance of magnesium in the body, especially in certain conditions like diabetes, which today affects roughly 1 in 10 Americans. For example, scientists have learned that many people with diabetes may also have a magnesium deficiency. Although scientists have a good idea of how much magnesium should appear in the blood when they measure it in healthy people, these reference levels are based on the 1970s data and do not reflect how much scientists have learned since then about magnesium. The 1970s reference levels also do not reflect today's population, which is predominantly overweight or obese with high rates of diabetes and heart disease. This paper reviews the evidence that is mounting about magnesium's role in the body and in health and disease and calls for a re-evaluation of the existing blood reference levels for magnesium given how much scientists have learned and how much the American population has changed since the 1970s.

Technical Abstract: The 2015 Dietary Guidelines Advisory Committee indicated magnesium was a shortfall nutrient that was underconsumed relative to the Estimated Average Requirement (EAR) for many Americans. Approximately 50% of Americans consume less than the EAR for magnesium, and some age groups consume substantially less. A growing body of literature amassed from animal, epidemiologic, and clinical studies has demonstrated a varied pathologic role for magnesium deficiency which includes electrolyte, neurologic, musculoskeletal, and inflammatory disorders; osteoporosis; hypertension; cardiovascular diseases; metabolic syndrome; and diabetes. Studies have also demonstrated that magnesium deficiency is associated with several chronic diseases and that a reduced risk of these diseases is observed with higher magnesium intake or supplementation. Subclinical magnesium deficiency can exist despite the presentation of a normal status as defined within the current serum magnesium reference interval of 0.75-0.95 mmol/L. This reference interval was derived from NHANES I (1974), which was based on the distribution of serum magnesium in a normal population rather than clinical outcomes. What is needed is an evidenced-based serum magnesium reference interval that reflects optimal health and the current food environment and population. We present herein data from an array of scientific studies to support the perspective that subclinical deficiencies in magnesium exist, that they contribute to a number of chronic diseases, and that adopting a revised serum magnesium reference interval would improve clinical care and public health.