Bo, Simona

Cassader, Maurizio

Cavallo Perin, Paolo

Durazzo, Marilena

Gentile, Luigi

Milanesio, Nadia

Schiavone, Claudia

Villois, Paola

English

CAVALLO PERIN, Paolo

Institutional Research Information System University of Turin

 1   This Accepted Author Manuscript (AAM) is copyrighted and published by Elsevier. It is posted here by agreement between Elsevier and the University of Turin. Changes resulting from the publishing process - such as editing, corrections, structural formatting, and other quality control mechanisms - may not be reflected in this version of the text. The definitive version of the text was subsequently published in Nutrition. 2011 Jan;27(1):108-10. doi: 10.1016/j.nut.2010.04.005. Epub 2010 Jul 10.    You may download, copy and otherwise use the AAM for non-commercial purposes provided that your license is limited by the following restrictions:  (1) You may use this AAM for non-commercial purposes only under the terms of the CC-BY-NC-ND license.  (2) The integrity of the work and identification of the author, copyright owner, and publisher must be preserved in any copy.  (3) You must attribute this AAM in the following format: Creative Commons BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/deed.en), http://www.sciencedirect.com.offcampus.dam.unito.it/science/article/pii/S0899900710001292.               2 Magnesium and trace element intake after a lifestyle intervention. Running title: Mg, trace elements and lifestyle intervention Simona Bo1, MD, Nadia Milanesio1, MD, Claudia Schiavone1, MD, Paola Villois1, MD, Marilena Durazzo1, MD, Luigi Gentile2, MD, Maurizio Cassader1, PhD, Paolo Cavallo-Perin1, MD 1Department of Internal Medicine, University of Turin, Italy; 2Diabetic Clinic, Hospital of Asti, Italy  Simona Bo: participated in the conception and design of the study, supervision of data collection, data analysis, interpretation of the findings of the study, manuscript writing and revision. Nadia Milanesio participated in the data analysis, manuscript writing and revision. Claudia Schiavone participated in the data analysis, interpretation of the findings of the study and manuscript revision. Paola Villois participated in the data analysis, interpretation of the findings of the study and manuscript revision. Marilena Durazzo participated in the data analysis, manuscript writing and revision. Luigi Gentile participated in the data collection and manuscript revision. Maurizio Cassader participated in the data collection and manuscript revision. Paolo Cavallo Perin participated in the conception and design of the study, interpretation of the findings of the study, manuscript writing and revision. All authors have approved the final version of the manuscript. Word count: 993, 1 table  Corresponding author:  Simona Bo, Department of Internal Medicine, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy Telephone +(39)(011)6967864    Fax+(39)(011)6634751   E-mail: sbo@molinette.piemonte.it                                                         3 Abstract Objective: Observational studies suggest that some trace elements and magnesium (Mg) improve glucose metabolism, markers of inflammation and oxidative stress, but supplementation studies have yielded inconsistent results. Our objective was to evaluate if a lifestyle intervention trial, aimed at reducing total and saturated fat and increasing fiber intake, can affect also the intake of selenium (Se), zinc (Zn), copper (Cu), chromium (Cr) and Mg. Research Methods & Procedures: Dietary intake of Se, Cr, Zn, Cu and Mg was evaluated at baseline and at the end of a lifestyle intervention trial performed in 335 dysmetabolic adults. Results: At baseline, trace element and Mg intake in the intervention (n=169) and control (n=166) groups of the trial were not significantly different. The former significantly increased their intake of Se, Mg, and Cr, while the latter reduced the intake of Mg, Zn and Cr. Between-group differences were significant for Mg, Cr and Se.  Conclusion: Healthier lifestyle recommendations might improve the pattern of micronutrient and Mg intake, which might play an independent role in ameliorating some metabolic, inflammatory and oxidative markers.  Key words: trace elements, magnesium, lifestyle intervention, metabolic syndrome, glucose          4 Introduction Dietary magnesium (Mg) and trace elements may play a role in the pathogenesis of metabolic disorders. The antioxidant selenium (Se) may exert beneficial effects on glucose metabolism, by insulin-like actions, even if recent studies suggest that Se status and supplementation may increase diabetes risk [1-2]. Zinc (Zn) stabilizes the structure of insulin granules and displays insulinomimetic effects; its deficiency might be implicated in the development of insulin resistance and increased susceptibility to oxidative damage [3]. Data about copper (Cu) are conflicting: inverse and direct relationships between serum/dietary Cu and glucose and total cholesterol concentrations were reported [4-5]. Finally, chromium (Cr) might act as an insulin-mimetic factor and antioxidant. The supplementation with Cr-picolinate significantly improved insulin sensitivity, glucose control, and reduced body weight gain in type 2 diabetic patients [6-7]. Increased Mg intake reduced the incidence of diabetes, metabolic syndrome, hypertension, and cardiovascular disease, by ameliorating insulin resistance, serum lipid profiles, and lowering inflammation, endothelial dysfunction, and oxidative stress [8]. We have recently demonstrated with a randomised controlled trial that a lifestyle intervention based on general recommendations significantly reduced total/saturated fat intake and increased polyunsaturated fat and fiber intake in the intervention group of the trial and that these dietary variations favourably affect the prevalence of multiple metabolic/inflammatory abnormalities [9-10]. The aim of the present paper was to evaluate if this lifestyle intervention aimed at reducing total and saturated fat and increasing fiber intake can affect also the intake of Mg, Se, Zn, Cu and Cr. Materials and Methods  The trial was performed in 335 dysmetabolic patients from a population-based cohort [9]. From December 2004 to December 2005, the patients were randomized to receive either the lifestyle intervention program according to recommendations carried out by trained professionals (intervention group, n=169), or standard counseling given by the family physician (control group,  5 n=166) [9]. This 1-year randomised, prospective open trial was approved by the local Ethical Committee, all patients gave their written informed consent, and procedures conformed to the Helsinki Declaration principles.  The patients were randomised to receive either a lifestyle intervention program according to recommendations carried out by trained professionals (intervention group, n=169), or standard counselling given by the family physician (control group, n=166) [9]. This 1-year randomised, prospective open trial was approved by the local Ethical Committee, all patients gave their written informed consent, and procedures conformed to the Helsinki Declaration principles. The intervention group received detailed verbal and written individualised dietary and exercise recommendations from trained professionals during dedicated sessions [9]. An individually prescribed diet was given (50-60% carbohydrates, 15-20% proteins, <30% fat, <10% saturated fat, up to 10% polyunsaturated fat, 20-30 g fiber). Before and after the study, all patients completed a validated semi-quantitative food-frequency questionnaire [9].  Each nutrient was adjusted for total energy, using the residual method [9].  No patient is using or had used in the past year micronutrient or Mg supplements. The t-test for paired-data was applied to investigate within-group variable variations (after-before); the t-test for independent samples was performed to assess between-group differences in these variations. Results  No significant difference was evident at baseline between groups, both for clinical and laboratory characteristics and intake of macronutrients [9]. The intake of Mg, Se, Zn, Cu and Cr did not differ between groups at baseline (Table 1). Intake of Mg, Se, and Cr increased in cases (Table 1), while Mg, Zn, and Cr decreased in the controls. The between-group differences resulted significant for Mg, Se and Cr intake. Discussion  6 Healthier lifestyle recommendations increased the dietary intakes of Mg and some trace elements, which might play an independent and additive role in improving some metabolic or inflammatory abnormalities, as reported in literature. Increased Mg intake was reported to ameliorate insulin resistance, serum lipid profiles, and to lower inflammation, endothelial dysfunction, and oxidative stress, ultimately reducing the risk for cardiovascular disease [8]. Cr significantly increased in our intervention group; Cr supplementation significantly improved insulin sensitivity and glucose concentrations in type 2 diabetic patients [6-7]. A systematic review of randomised controlled trials showed that Cr supplementation improved fasting glucose by –1.0 mmol/l [7].  The intervention group increased the intake of Se, which is required for activity of key antioxidant enzymes, playing a protective role against oxidative stress [2].  Zn deficiency might led to insulin resistance [3], however, intervention studies found no beneficial effects for Zn supplementation on plasma glucose and lipid values [1], but an adverse effect on HDL-cholesterol; it did not protect against protein oxidation, but may promote toxic reactive oxygen species [11]. In our patients, no significant between-group difference in zinc dietary intake was found.  Variation in dietary Cu intake after the trial in both our groups was minimal. Inverse relationships between serum/dietary Cu and total cholesterol concentrations were reported [4]. Indeed, the reported pro-oxidant effect of Cu and its increased concentrations during various chronic inflammatory diseases well described the controversy around this element, due both to the adverse metabolic pattern linked to its deficiency and the unfavourable associations of increased Cu intake [5].  Exposure to some trace element supplementation might be harmful, since higher incidence of diabetes, cardiovascular risk factors, thrombogenesis , mortality have been described. The relatively narrow therapeutic range of many elements might be due to the generation of reactive oxygen  7 species [11]. Furthermore, in the absence of underlying specific deficiency, no dietary mineral supplement has proven definitively useful so far for the prevention of metabolic diseases in the general population [1]. The discrepancy might be due to the fact that their increased dietary intakes are indirect surrogate markers of fruit and vegetable intakes, that are related to a healthier lifestyle. Therefore, the protection might derive from multiple nutrients and their combination, rather than from a single substance. Accordingly, in our lifestyle intervention study, a healthier style was associated with a better overall micronutrient pattern. Limitations  Dietary assessments were carried out using a semi-quantitative food-frequency questionnaire, and validity and reliability of trace element intake assessment are unknown (e.g. the level of Se in different food may widely vary depending on the soil content; dietary Cr content is quite variable in food sources, etc). Measurement errors, however, could have rather reduced the differences in the intakes. Furthermore, randomisation procedures should have minimised the likelihood of confounding by uncontrolled or unknown factors. Conclusion   A healthier lifestyle is an efficacious modality to improve the intake of Mg and many trace elements contemporarily, without the need for exogenous micronutrient supplementation.  8 Conflict of interest There is no conflict of interest.  References 1) Czernichow S, Couthouis A, Bertrais S, Vergnaud AC, Dauchet L, Galan P,et al. Antioxidant supplementation does not affect fasting plasma glucose in the Supplementation with Antioxidant Vitamins and Minerals (SU.VI.MAX) study in France: association with dietary intake and plasma concentrations. Am J Clin Nutr 2006;84:395-399. 2) Stranges S, Marshall JR, Natarajan R, Donahue RP, Trevisan M, Combs GF, et al. Effects of long-term selenium supplementation on the incidence of type 2 diabetes. Ann Intern Med 2007;147:217-223. 3) Haase H, Maret W. Protein tyrosine phosphatases as targets of the combined insulinomimetic effects of zinc and oxidants. Biometals 2005;18:333-338. 4) Bo S, Durazzo M, Gambino R, Berutti C, Milanesio N, Caropreso A, et al. Associations of dietary and serum copper with inflammation, oxidative stress, and metabolic variables in adults. J Nutr 2008;138:305-310. 5) Walter RM jr, Uriu-Hare JY, Olin KL, Oster MH, Anawalt BD, Critchfield JW, et al. Copper, zinc, manganese, and magnesium status and complications of diabetes mellitus. Diabetes Care 1991;14:1050-1056.  6) Martin J, Wang ZQ, Zhang XH, Wachtel D, Volaufova J, Matthews DE, et al. Chromium picolinate supplementation attenuates body weight gain and increases insulin sensitivity in subjects with type 2 diabetes. Diabetes Care 2006;29:1826-1832. 7) Balk EM, Tatsioni A, Lichtenstein AH, Lau J, Pittas AG. Effect of chromium supplementation on glucose metabolism and lipids. Diabetes Care 2007;30:2154-2163. 8) Bo S, Pisu E. Role of dietary magnesium in cardiovascular prevention, insulin sensitivity and diabetes. Curr Opin Lipid 2008;19:50-56.  9 9) Bo S, Ciccone G, Baldi C, Benini L, Dusio F, Forestiere G, et al. Effectiveness of a lifestyle intervention on metabolic syndrome. A randomized controlled trial. Journal of General Internal Medicine 2007;22:1695-1703. 10) Bo S, Ciccone G, Guidi S, Gambino R, Durazzo M, Gentile L, et al. Diet or exercise: what is more effective in preventing or reducing metabolic alterations? Eur J Endocrinol 2008; 159:685-691 11) Bishop GM, Dringen R, Robinson SR. Zinc stimulates the production of toxic reactive oxygen species (ROS) and inhibits gluthatione reductase in astrocytes. Free Radic Biol Med 2007;42:1222-1230.                               10 Table 1. Variations in magnesium and trace element dietary intake before-and-after the lifestyle intervention, by group1  Intervention Group (n=169) Control Group (n=166)  Variables Before After Difference P2 Before After Difference P2 P3 Mg (mg/day) 302.9±81.2 340.4±73.2 37.5 <.001 310.8±90.9 289.3±90.3 -21.5 <.001 <.001 Se (µg/day) 54.6±10.7 60.5±9.6 5.95 <.001 54.1±13.1 55.5±9.2 1.44 .13 <.001 Zn (mg/day) 12.4±4.8 12.1±4.3 -0.26 .06 12.4±4.5 12.1±4.5 -0.28 .04 .92 Cu (mg/day) 1.7±0.7 1.7±0.1 0.01 .85 1.7±0.8 1.7±0.1 0.02 .80 .94 Cr (µg/day) 65.1±20.9 68.5±22.6 3.41 <.001 64.2±17.0 61.3±20.1 -2.89 .02 <.001 1Values are means ± SD. 2 p values obtained by comparing differences in the variable values within each group, using t-test for paired-data 3p values obtained by comparing differences in the variable values between the two groups, using Student’s t-test. 

Magnesium and trace element intake after a lifestyle intervention.

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Magnesium and trace element intake after a lifestyle intervention.

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