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Shugaa Addin, Nuha ORCID logoORCID: https://orcid.org/0000-0002-1499-9885; Schuppert, Christopher ORCID logoORCID: https://orcid.org/0000-0002-9675-803X; Full, Peter M; Brenner, Hermann; Dörr, Marcus; Keil, Thomas; Krüchten, Ricarda von; Meinel, Felix G.; Niendorf, Thoralf ORCID logoORCID: https://orcid.org/0000-0001-7584-6527; Pischon, Tobias; Schmidt, Börge; Schulz-Menger, Jeanette ORCID logoORCID: https://orcid.org/0000-0003-3100-1092; Schwichtenberg, Julia; Völzke, Henry ORCID logoORCID: https://orcid.org/0000-0001-7003-399X; Willich, Stefan N. ORCID logoORCID: https://orcid.org/0009-0006-1270-2597; Bamberg, Fabian ORCID logoORCID: https://orcid.org/0000-0002-7460-3942; Peters, Annette ORCID logoORCID: https://orcid.org/0000-0001-6645-0985; Schlett, Christopher L. ORCID logoORCID: https://orcid.org/0000-0002-1576-1481 und Rospleszcz, Susanne ORCID logoORCID: https://orcid.org/0000-0002-4788-2341 (2025): Magnesium Depletion, Metabolic Impairment, and Cardiac Alterations: The NAKO-MRI Study With Mendelian Randomization. In: Journal of Clinical Endocrinology & Metabolism [Forthcoming]

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Abstract

Context: Magnesium deficiency may contribute to subclinical cardiac changes, particularly metabolic diastolic cardiomyopathy.

Objective: To investigate the association between magnesium depletion, metabolic syndrome (MetS), and MRI-derived cardiac alterations in a population-based sample.

Methods: We cross-sectionally analyzed N = 9568 participants from the baseline examination of the German National Cohort (NAKO) who underwent whole-body MRI. Associations of serum magnesium and magnesium depletion score (MDS) with MetS and cardiac alterations were assessed using multivariable logistic and linear regression, respectively. Two-sample Mendelian Randomization was performed to evaluate the potential causal relationship between serum magnesium and MRI-derived cardiac parameters.

Results: Our analysis revealed no correlation between serum magnesium and MDS (Spearman's rho = 0.065; p < 0.001). A 1-SD increase in serum magnesium was associated with lower MetS prevalence (OR 0.93 [95% CI: 0.88, 0.99]) and reduced left and right ventricular systolic and diastolic volumes. Higher MDS, indicating magnesium deficiency, was linked to increased MetS prevalence (OR per 1-unit 1.32 [95% CI: 1.23, 1.41]) and its individual components. Furthermore, higher MDS was associated with increased LVRI (Estimate 0.012 g/mL [95% CI: 0.008, 0.017]) and decreased left ventricular end-diastolic volume (Estimate -1.132 mL/m2 [95% CI: -1.538, -0.727]), indicating concentric hypertrophy. Two-sample Mendelian Randomization suggested no causal relationship between serum magnesium and MRI-derived cardiac markers.

Conclusion: Magnesium depletion may serve as an early indicator of cardiac impairment. However, Mendelian Randomization results do not support a causal role of serum magnesium on cardiac structure and morphology.

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