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The Atherosclerosis Risk in Communities Study

W. H. Linda Kao, MHS; Aaron R. Folsom, MD, MPH; F. Javier Nieto, MD, PhD; Jing-Ping Mo, MD, PhD; Robert L. Watson, DVM, PhD, MPH; Frederick L. Brancati, MD, MHS

Arch Intern Med. 1999;159:2151-2159.

Background  Experimental studies in animals and cross-sectional studies in humans have suggested that low serum magnesium levels might lead to type 2 diabetes; however, this association has not been examined prospectively.

Methods  We assessed the risk for type 2 diabetes associated with low serum magnesium level and low dietary magnesium intake in a cohort of nondiabetic middle-aged adults (N=12,128) from the Atherosclerosis Risk in Communities Study during 6 years of follow-up. Fasting serum magnesium level, categorized into 6 levels, and dietary magnesium intake, categorized into quartiles, were measured at the baseline examination. Incident type 2 diabetes was defined by self-report of physician diagnosis, use of diabetic medication, fasting glucose level of at least 7.0 mmol/L (126 mg/dL), or nonfasting glucose level of at least 11.1 mmol/L (200 mg/dL).

Results  Among white participants, a graded inverse relationship between serum magnesium levels and incident type 2 diabetes was observed. From the highest to the lowest serum magnesium levels, there was an approximate 2-fold increase in incidence rate (11.1, 12.2, 13.6, 12.8, 15.8, and 22.8 per 1000 person-years; P=.001). This graded association remained significant after simultaneous adjustment for potential confounders, including diuretic use. Compared with individuals with serum magnesium levels of 0.95 mmol/L (1.90 mEq/L) or greater, the adjusted relative odds of incident type 2 diabetes rose progressively across the following lower magnesium categories: 1.13 (95% CI, 0.79-1.61), 1.20 (95% CI, 0.86-1.68), 1.11 (95% CI, 0.80-1.56), 1.24 (95% CI, 0.86-1.78), and 1.76 (95% CI, 1.18-2.61) (for trend, P=.01) In contrast, little or no association was observed in black participants. No association was detected between dietary magnesium intake and the risk for incident type 2 diabetes in black or white participants.

Conclusions  Among white participants, low serum magnesium level is a strong, independent predictor of incident type 2 diabetes. That low dietary magnesium intake does not confer risk for type 2 diabetes implies that compartmentalization and renal handling of magnesium may be important in the relationship between low serum magnesium levels and the risk for type 2 diabetes.

From the Department of Epidemiology, The Johns Hopkins University School of Hygiene and Public Health (Ms Kao and Drs Nieto and Brancati), and the Department of Medicine, The Johns Hopkins University School of Medicine (Dr Brancati), Baltimore, Md; the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (Dr Folsom); the Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill (Dr Mo); and the Division of Epidemiology, University of Mississippi Medical Center, Jackson (Dr Watson).

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