ArticlePDF Available

Association Between Magnesium Intake and Depression and Anxiety in Community-Dwelling Adults: The Hordaland Health Study

Authors:

Abstract and Figures

Systemic inflammation is associated with both the dietary intake of magnesium, and depression. Limited experimental and clinical data suggest an association between magnesium and depression. Thus, there are reasons to consider dietary magnesium as a variable of interest in depressive disorders. The aim of the present study was to examine the association between magnesium intake and depression and anxiety in a large sample of community-dwelling men and women. This sample consisted of 5708 individuals aged 46-49 or 70-74 years who participated in the Hordaland Health Study in Western Norway. Symptoms of depression and anxiety were self-reported using the Hospital Anxiety and Depression Scale, and magnesium intake was assessed using a comprehensive food frequency questionnaire. There was an inverse association between standardized energy-adjusted magnesium intake and standardized depression scores that was not confounded by age, gender, body habitus or blood pressure (beta=-0.16, 95% confidence interval (CI)=-0.22 to -0.11). The association was attenuated after adjustment for socioeconomic and lifestyle variables, but remained statistically significant (beta=-0.11, 95%CI=-0.16 to -0.05). Standardized magnesium intake was also related to case-level depression (odds ratio (OR)=0.70, 95%CI=0.56-0.88), although the association was attenuated when adjusted for socioeconomic and lifestyle factors (OR=0.86, 95%CI=0.69-1.08). The inverse relationship between magnesium intake and score and case-level anxiety was weaker and not statistically significant in the fully adjusted models. The hypothesis that magnesium intake is related to depression in the community is supported by the present findings. These findings may have public health and treatment implications.
Content may be subject to copyright.
PLEASE SCROLL DOWN FOR ARTICLE
This article was downloaded by:
[ABM Utvikling STM / SSH packages]
On:
30 December 2008
Access details:
Access Details: [subscription number 792960668]
Publisher
Informa Healthcare
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,
37-41 Mortimer Street, London W1T 3JH, UK
Australian and New Zealand Journal of Psychiatry
Publication details, including instructions for authors and subscription information:
http://www.informaworld.com/smpp/title~content=t768481832
Association between magnesium intake and depression and anxiety in
community-dwelling adults: the Hordaland Health Study
Felice N. Jacka a; Simon Overland b; Robert Stewart c; Grethe S. Tell d; Ingvar Bjelland de; Arnstein Mykletun bf
a Department of Clinical and Biomedical Sciences: Barwon Health, University of Melbourne, Geelong, Vic.,
Australia b Department of Education and Health Promotion, University of Bergen, Norway c King's College
London (Institute of Psychiatry), London, UK d Department of Public Health and Primary Health Care,
University of Bergen, Bergen, Norway e Clinic of Child and Adolescent Mental Health Services, Haukeland
University Hospital, Bergen, Norway f Norwegian Institute of Public Health, Oslo, Norway
Online Publication Date: 01 January 2009
To cite this Article Jacka, Felice N., Overland, Simon, Stewart, Robert, Tell, Grethe S., Bjelland, Ingvar and Mykletun,
Arnstein(2009)'Association between magnesium intake and depression and anxiety in community-dwelling adults: the Hordaland
Health Study',Australian and New Zealand Journal of Psychiatry,43:1,45 — 52
To link to this Article: DOI: 10.1080/00048670802534408
URL: http://dx.doi.org/10.1080/00048670802534408
Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf
This article may be used for research, teaching and private study purposes. Any substantial or
systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or
distribution in any form to anyone is expressly forbidden.
The publisher does not give any warranty express or implied or make any representation that the contents
will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses
should be independently verified with primary sources. The publisher shall not be liable for any loss,
actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly
or indirectly in connection with or arising out of the use of this material.
Association between magnesium intake and
depression and anxiety in community-dwelling
adults: the Hordaland Health Study
Felice N. Jacka, Simon Overland, Robert Stewart, Grethe S. Tell,
Ingvar Bjelland, Arnstein Mykletun
Objective: Systemic inflammation is associated with both the dietary intake of magnesium,
and depression. Limited experimental and clinical data suggest an association between
magnesium and depression. Thus, there are reasons to consider dietary magnesium as a
variable of interest in depressive disorders. The aim of the present study was to examine
the association between magnesium intake and depression and anxiety in a large sample
of community-dwelling men and women. This sample consisted of 5708 individuals aged
4649 or 7074 years who participated in the Hordaland Health Study in Western Norway.
Methods: Symptoms of depression and anxiety were self-reported using the Hospital
Anxiety and Depression Scale, and magnesium intake was assessed using a
comprehensive food frequency questionnaire.
Results: There was an inverse association between standardized energy-adjusted
magnesium intake and standardized depression scores that was not confounded by
age, gender, body habitus or blood pressure (b0.16, 95% confidence interval (CI)
0.22 to 0.11). The association was attenuated after adjustment for socioeconomic and
lifestyle variables, but remained statistically significant (b0.11, 95%CI0.16 to
0.05). Standardized magnesium intake was also related to case-level depression (odds
ratio (OR)0.70, 95%CI0.560.88), although the association was attenuated when
adjusted for socioeconomic and lifestyle factors (OR 0.86, 95%CI 0.691.08). The
inverse relationship between magnesium intake and score and case-level anxiety was
weaker and not statistically significant in the fully adjusted models.
Conclusion: The hypothesis that magnesium intake is related to depression in the
community is supported by the present findings. These findings may have public health
and treatment implications.
Key words: anxiety, depression, diet, magnesium, nutrition.
Australian and New Zealand Journal of Psychiatry 2009; 43:45
52
Felice Jacka, Research Fellow (Correspondence)
University of Melbourne, Department of Clinical and Biomedical
Sciences: Barwon Health, PO Box 281, Geelong, Vic. 3220, Australia.
Email: felice@barwonhealth.org.au
Simon Overland, Associate Professor
Department of Education and Health Promotion, University of Bergen,
Norway
Robert Stewart, Reader and Head of Section
King’s College London (Institute of Psychiatry), London, UK
Grethe S. Tell, Professor
Department of Public Health and Primary Health Care, University of
Bergen, Bergen,Norway
Ingvar Bjelland, Associate Professor
Department of Public Health and Primary Health Care, University of
Bergen, Bergen, Norway Clinic of Child and Adolescent Mental Health
Services, Haukeland University Hospital, Bergen, Norway
Arnstein Mykletun, Research Fellow
Norwegian Institute of Public Health, Oslo, Norway Department of
Education and Health Promotion, University of Bergen, Norway
Received 17 September 2008; accepted 22 September 2008.
#2009 The Royal Australian and New Zealand College of Psychiatrists
Downloaded By: [ABM Utvikling STM / SSH packages] At: 13:58 30 December 2008
Due to industrialization and globalization, habi-
tual diets are increasingly dominated by energy-
dense, nutrient-poor foods at the expense of
high-fibre, unprocessed foods [1]. There is now
some evidence to suggest that diet and nutrition
play a role in the aetiology of depression [26], but
there is a paucity of data concerning this relation-
ship to date. Depressive illness is influenced by
genetic, hormonal, immunological, biochemical,
and neurodegenerative factors; nutrients and habi-
tual diet modulate each of these factors and, as such,
these large-scale dietary changes have the potential
to affect prevalence rates of depression within the
community [7].
The mineral magnesium may be of particular
interest in depressive illness. Depression is associated
with systemic inflammation [811], which is also
associated with low intakes of magnesium [12,13].
Serum magnesium deficiency has been shown in
depressive disorders [1416] but these findings are
not uniform, with one study showing higher serum
magnesium in patients with major depressive disorder
compared to healthy controls [17]. A magnesium-
deficient diet has been shown to increase depression-
and anxiety-related behaviour in mice [18], while
magnesium treatment has demonstrated antidepres-
sant- and anxiolytic-like effects in animal models
[19,20]. Moreover, magnesium treatment improves
symptoms of depression in chronic fatigue syndrome
[21] and in patients with premenstrual syndrome [22],
while two open-label studies showed a beneficial
effect of magnesium treatment on symptoms of mania
[23,24]. Additionally, biological pathways involved in
the pathophysiology of depression, as well as im-
portant transduction pathways, are modulated by
magnesium [25].
The aim of the present study was thus to examine
the cross-sectional association between magnesium
intake and depression and anxiety in a large sample
of community-dwelling middle-aged and older
adults. We hypothesized that lower intakes of
magnesium would be associated with higher levels
of depressive and anxiety symptoms and case-level
illness.
Methods
Study population
The Hordaland Health Study was conducted from 1997 to 1999.
A subsample of this study, consisting of 9187 participants from
four selected communities and born in the years 19251927 or
19501951, were invited to participate in a dietary substudy. Of
these, 7074 (77%) agreed to participate and underwent a health
examination that included comprehensive questionnaires regarding
diet, mental health, and other lifestyle and medical parameters. In
total 6140 subjects completed the dietary assessments (87%).
Individuals with diagnosed kidney disease (n 2) were removed
from the analyses, because kidney disease is known to alter
magnesium status. Individuals with very low (B2000 kJ, n41)
or very high (15 000 kJ, n 152) estimated daily energy intakes
were excluded from the analyses, as were those with missing data
on relevant dietary variables and covariates (n237). Participants
with complete data on at least 13 of the 15 variables used were
included in all analyses using pairwise exclusion. These adjustments
resulted in a final sample of 5708 individuals (male, n 2461;
female, n3247). All participants gave written, informed consent
to participate. The study was granted ethics approval by the
Western Norway Regional Committee for Medical Research Ethics
and by the Norwegian Data Inspectorate.
Exposure: magnesium intake
Dietary intakes were assessed by utilization of a self-adminis-
tered, optically readable food frequency questionnaire (FFQ) [26],
originally developed at the Department of Nutrition, University of
Oslo [27], and designed to obtain information on usual food intake
during the past year. This comprehensive questionnaire consisted
of questions regarding 169 food items, and included frequency
alternatives (from once per month to several times per day), the
number of food units eaten and the portion sizes. It also assessed
the number and timing of meals per day. The foods were grouped
in order to reflect normal Norwegian meals. From this informa-
tion, dietary intakes of magnesium were calculated using a database
and software system based on the Norwegian Food Composition
table [28].
Outcome: Hospital Anxiety and Depression Scale
In this study, symptoms of depression and anxiety were self-
reported using the Hospital Anxiety and Depression Scale (HADS)
[29]. The HADS is a self-administered questionnaire consisting of
14 4-point Likert-scale items, seven for anxiety (HADS-A subscale)
and seven for depression (HADS-D subscale), encompassing the
past week. The HADS is a widely used instrument designed to
assess both caseness and symptomatology of depression and
anxiety in epidemiological research and specialist care [30]. In the
present study, scores on HADS-A and HADS-D were summed to
give a total continuous score for each subscale that had the
potential range of 021, and these scores were scaled so that 1 unit
represents the distance between the 25th and 75th percentiles [31].
For those participants with fewer than three missing values on the
HADS, scores were replaced with individual means. In additional
analyses, case-level depression was defined as a HADS-D score
]8, while case-level anxiety was defined as a HADS-A score ]8
[31]. Both depression and anxiety symptomatology and case-level
depression and anxiety were examined as outcomes in testing the
hypothesis.
46 MAGNESIUM INTAKE AND DEPRESSION
Downloaded By: [ABM Utvikling STM / SSH packages] At: 13:58 30 December 2008
Covariates
Covariates were identified a priori, based on previous literature.
These included total energy intake, gender, age group (4749 years
or 7074 years), waisthip ratio (WHR), body mass index (BMI),
blood pressure (BP), income, education, physical activity (PA),
current smoking and alcohol use. Folate intake was initially
included as a possible confounding variable, due to its previously
identified association with depression [2,6]. Due to the high
correlation, however, between folate and magnesium intake found
in the present study (Pearson’s R 0.855, p B0.001) and issues of
collinearity, we decided not to include folate in further analyses
[32]. Income consisted of nine categories ranging from zero to ]
500 000 Norwegian kroner per annum. Current smoking was
categorized as individuals reporting the smoking of cigarettes,
cigars or pipes on a daily basis (yes/no). PA consisted of four
categories: no PA or light PAB1 h week
1
; light PA]
1 h week
1
; hard PAB2 h week
1
; hard PA]2 h week
1
. Edu-
cation included the categories of basic schooling, finished high
school, 13 years of university and ]4 years of university. Alcohol
use was measured as units of alcohol consumed per fortnight, and
categorized into three levels: no drinking, drinking 115 units per
fortnight, and drinking 15 units per fortnight. In all analyses,
diabetes and cardiovascular disease (CVD) were also checked as
possible mediating factors.
Statistical analysis
The association between magnesium intake and both depression
and anxiety scores was evaluated using linear regression analyses.
Multivariate models were developed using magnesium intake
(mg day
1
) as the exposure variable and depression or anxiety
scores as the dependent variables. Effects were reported with
adjustment for energy intake, followed by adjustments for gender
and age, then WHR, BMI and BP, with the final model adjusted
for education, income and health behaviours: smoking, PA and
alcohol consumption.
All analyses were replicated with case-level anxiety or depression
as the outcome variables, using logistic regression models to
estimate odds ratios with 95% confidence intervals. In each set of
analyses, model 1 included magnesium intake (mg day
1
) adjusted
for energy intake; model 2 included additional adjustments for
gender and age; model 3 included WHR, BMI and BP; model 4
further adjusted for education, income and health behaviours:
smoking, PA and alcohol consumption. In all statistical analyses
the level of significance was a0.05. In validating the models,
interaction terms were tested for significance.
Results
Subject characteristics are summarized and presented in Table 1.
Because there were no age or gender interaction in the association
of interest (all interaction tests p 0.05), and no a priori reason to
expect any such interaction, further statistical analyses were
conducted for the entire study population. Univariate associations
between each of the covariates and magnesium intake as the
outcome variable were examined (Table 2), and all covariates
except WHR, BP and age, were related to magnesium intake.
Higher education, higher income, higher PA levels, higher alcohol
consumption, lower BMI and non-smoking were all associated with
higher magnesium intake, adjusted for energy, age group and
gender. Women had a higher energy-adjusted magnesium intake,
whereas there were no differences between age groups in energy-
adjusted magnesium intake.
In analyses with continuous standardized scores as the outcome,
there was an inverse association between magnesium intake and
depression scores (Table 3). This relationship was not confounded
by age group, gender, body habitus or BP. It was somewhat
attenuated, but remained statistically significant, after further
adjustments for socioeconomic and lifestyle variables. Because
both depression and magnesium were standardized scores, the
effect size for this association was a 0.17 SD (adjusted for energy
only) or 0.11 SD (fully adjusted) decrease in symptoms of depres-
sion for every energy-adjusted standard deviation increase in
magnesium intake. For symptoms of anxiety, we found a similar
but weaker association. While the association adjusting for energy
intake only was not significant, further adjustments for gender, age
group, WHR, BMI and systolic BP strengthened the association,
which became significant. In the fully adjusted model, however, the
association was no longer significant (Table 3). We further
examined the association of both education and PA, as established
risk factors for depression, to depression scores in order to compare
the effect size of the magnesium association. After adjustments for
age group and gender, there was a 0.08 SD decrease in symptoms of
depression for every standard deviation increase in education and a
0.14 SD decrease in symptoms of depression for every standard
deviation increase in PA.
In the present study 517 people (9.1%) met criteria for case-level
depression (HADS-D ]8) and 874 (15.3%) for case-level anxiety
(HADS-A ]8). In the logistic regression analyses, with case-level
anxiety or depression as the outcome variables, magnesium intake
was related to case-level depression across initial levels of adjust-
ments, but the association was attenuated when adjusted for
socioeconomic and lifestyle factors (Table 4). The association
between magnesium and case-level anxiety was weaker and border-
line significant throughout adjustments, and non-significant in the
fully adjusted model (Table 4). Neither diabetes nor CVD mediated
the observed relationships.
Discussion
The main finding of the present cross-sectional
study is that of an inverse relationship between
magnesium intake and depressive symptoms in com-
munity-dwelling middle-age and older adults; the
associations persisted after adjustments for age,
gender, body habitus, BP and socioeconomic and
lifestyle factors. A similar trend was found for
magnesium intake and anxiety symptoms, although
the associations were weaker and not significant after
F.N. JACKA, S. OVERLAND, R. STEWART, G.S. TELL, I. BJELLAND, A. MYKLETUN 47
Downloaded By: [ABM Utvikling STM / SSH packages] At: 13:58 30 December 2008
adjustments. The strength of the association between
magnesium intake and depression score was compar-
able to (and perhaps exceeding) that of low education
and PA, both of which are established risk factors for
depression [3338].
While recognizing that the cross-sectional nature of
this study prevents any determination of causality,
these data do offer support for the hypothesis that the
intake of magnesium is related to mental health in
community dwelling adults. They are also concordant
with a growing body of literature suggesting a role for
other aspects of habitual diet in depression. For
example, in most [35,39], but not all [40], cross-
sectional population studies, both long-chain omega-
3 fatty acid and fish consumption have been shown to
be inversely associated with depressive symptomatol-
ogy, while two prospective population studies have
demonstrated increased odds of developing clinically
significant depression for those with low serum folate
[6] and low folate intakes [2]. Magnesium and folate,
however, are found in many of the same foods and it
may be the case that unrecognized confounding by
magnesium intake or status influenced previous
studies identifying a relationship between folate and
depression.
There are a number of important limitations to the
present study: although the results are compatible
with our hypothesis, the cross-sectional design of this
study prevents any exposition regarding the direction
of the relationship. It may be the case that a poor-
quality diet is a result of mental health symptoms,
rather than a causative factor. Although measures of
socioeconomic status and health-related behaviours,
as well as metabolic parameters that are related to
both depressive illness and dietary patterns, were
examined as covariates in the analyses and excluded
Table 1. Characteristics of the Hordaland Health Study participants
46
49 years 70
74 years
Men
(n1220)
Women
(n1726)
Men
(n1241)
Women
(n1521)
Magnesium (mg day
1
), mean9SD 391.2996.6 321.2986.5 333.7989.0 275.4982.9
Energy (kJ day
1
), mean9SD 9980.892308 7766.992091 8360.092207 6525.692049
Energy-adjusted magnesium
(mg day
1
), mean (95%CI)
322.8 (320.0324.9) 330.7 (328.6332.9) 322.4 (319.8324.9) 328.7 (326.3331.1)
Waisthip ratio, mean9SD 0.9190.06 0.8090.06 0.9590.06 0.8390.07
BMI (kg m
2
), mean9SD 26.193.3 24.994.1 26.093.2 26.294.4
SBP (mmHg), mean9SD 130.6914.8 124.4915.4 145.7919.4 147.8921.9
Education, n (%)
Primary 198 (16.2) 398 (22.5) 448 (36.1) 854 (56.1)
Secondary 493 (40.4) 740 (42.9) 504 (40.6) 501 (32.9)
13 years higher education 234 (19.2) 290 (16.8) 157 (12.7) 101 (6.6)
]4 years higher education 295 (24.2) 307 (17.8) 132 (10.6) 65 (4.3)
Annual income (NOK), n (%)
0299 900 298 (24.4) 650 (37.6) 1010 (81.4) 1334 (87.8)
300 000499 900 502 (41.1) 560 (32.4) 166 (13.4) 102 (6.7)
]500 000 420 (34.4) 516 (29.9) 65 (5.2) 85 (5.6)
Non-smokers, n (%) 819 (67.1) 1095 (63.4) 954 (76.9) 1244 (81.8)
Smokers, n (%) 386 (31.6) 588 (34.1) 196 (15.8) 214 (14.1)
PA per week, n (%)
No PA or light PA B1 h 125 (10.2) 157 (9.1) 117 (9.4) 208 (13.7)
Light PA]1 h 167 (13.7) 389 (22.5) 466 (37.6) 758 (49.8)
Hard PAB2 h 733 (60.1) 962 (55.7) 450 (36.3) 369 (24.3)
Hard PA]2 h 186 (15.2) 207 (12.0) 180 (14.5) 83 (5.5)
Alcohol consumption, n (%)
Non-drinker 180 (14.8) 476 (27.6) 457 (36.8) 877 (57.7)
115 units fortnight
1
882 (72.3) 1196 (69.3) 680 (54.8) 611 (40.2)
]16 units fortnight
1
156 (12.8) 51 (3.0) 101 (8.1) 18 (1.2)
HADS-D, mean9SD 3.4592.94 2.9692.87 3.5892.89 3.5492.88
HADS-A, mean9SD 4.3493.16 4.9493.44 3.3092.88 4.6093.37
HADS-D]8, n (%) 116 (9.5) 131 (7.6) 122 (9.8) 150 (9.9)
HADS-A]8, n (%) 171 (14.0) 339 (19.6) 99 (8.0) 266 (17.5)
BMI, body mass index; HADS-A, Hospital Anxiety and Depression ScaleAnxiety subscale; HADS-D, Hospital Anxiety and Depression
ScaleDepression subscale; NOK, Norwegian kroner; PA, physical activity; SBP, systolic blood pressure.
48 MAGNESIUM INTAKE AND DEPRESSION
Downloaded By: [ABM Utvikling STM / SSH packages] At: 13:58 30 December 2008
as confounders, we cannot rule out the possibility
that the present findings may be biased by unmea-
sured confounders or by residual confounding. The
major strength of the present study lies in its large,
population-based sample of both genders, including
both middle-age and older participants. The FFQ
utilized in the present study was of a very high
quality, being comprehensive and well validated [27],
and the size of the sample reduces the impact of
measurement error. The data regarding relevant
socioeconomic status and lifestyle covariates were
also of a high standard.
Another important issue in studies of dietary
variables as predictors of illness outcomes is that of
‘fishing’. It is essential in these studies that an a priori
hypothesis exists before analyses are undertaken, to
avoid the potential for simply reporting any statisti-
cally significant associations in large datasets such as
the Health Study of Hordaland County Norway
(HUSK). In the present study, a hypothesis was
developed on the basis of the literature, and a study
proposal developed for approval from the HUSK
steering committee, months before the study was
undertaken. In proceeding with analyses, only those
variables identified as exposure, covariate and out-
come variables in the proposal were examined. This is
an important aspect of the study because it reduces
the risk of the results being a type I error.
While being cognisant of the limitations of our
study, there is some cause to hypothesize that the
demonstrated relationship between habitual magne-
sium intake and depressive symptoms is mediated by
biological mechanisms. Previous literature has de-
monstrated an association between low magnesium
and increased inflammation in both rodents [41,42]
and humans [12,13]; as well as between depression
and inflammation in clinical and epidemiological
studies [8,9,4345]. This suggests that one mechanism
behind our finding of an association between magne-
sium intake and depression may be related to the
immune system. Studies in animal models have
shown that induced magnesium deficiency in rats
results in a systemic pro-inflammatory/pro-oxidant
state [46], associated with elevations in circulating
inflammatory cells and inflammatory cytokines, such
as interleukin-6, tumour necrosis factor-aand posi-
tive acute phase proteins [41,42] as well as increased
neutrophil activity [47]. Thus, habitually inadequate
intakes of magnesium may result in a chronic state of
systemic inflammation, potentially contributing to
increased depressive symptoms.
If our findings do reflect a role for magnesium in
modulating symptoms of depression, these data
from community dwelling adults in Norway may
underestimate the impact of magnesium-deficient
diets. Approximately 68% of US adults consume
less than the American recommended daily allowance
(RDA) of magnesium (420 mg day
1
for men,
320 mg day
1
for women [48]), with 19% consuming
less than half of the RDA [12]. Moreover, intake of
magnesium is known to be inadequate in many
Table 2. Association of magnesium intake and
covariates: Hordaland Health Study
Covariates Magnesium intake
$
b(95%CI)
Waisthip ratio 0.01 (0.03 to 0.01)
Body mass index (kg m
2
) 0.01 (0.000.03)
Systolic blood pressure
(mmHg)
0.01 (0.02 to 0.00)
Education 0.06 (0.040.07)
Income 0.02 (0.010.03)
Physical activity 0.06 (0.050.07)
Smoking (yes1) 0.07 (0.09 to 0.04)
Alcohol consumption 0.04 (0.020.06)
Gender (female1) 0.08 (0.050.10)
Age group (4749 years1) 0.03 (0.01 to 0.05)
CI, confidence interval; $Adjusted for energy intake, age and
gender (except for age and gender, which are adjusted for
energy only). All exposure and outcome variables (except
smoking, gender and age group) included as continuous
z-scored variables to support comparisons.
Table 3. Relationship between magnesium intake and depression and anxiety scores
$
: Hordaland Health Study
Depression b(95%CI) Anxiety b(95%CI)
Adjusted total energy intake 0.17 (0.23 to 0.11) 0.06 (0.11 to 0.01)
Adjusted gender, age 0.16 (0.22 to 0.10) 0.09 (0.14 to 0.03)
Adjusted WHR, BMI, SBP 0.16 (0.22 to 0.11) 0.09 (0.14 to 0.03)
Adjusted education, income and health behaviours 0.11 (0.16 to 0.05) 0.05 (0.11 to 0.01)
BMI, body mass index; CI, confidence interval; SBP, systolic blood pressure; WHR, waisthip ratio.; $All exposure and outcome scores
standardized.
F.N. JACKA, S. OVERLAND, R. STEWART, G.S. TELL, I. BJELLAND, A. MYKLETUN 49
Downloaded By: [ABM Utvikling STM / SSH packages] At: 13:58 30 December 2008
Western countries [4953]. Intake of magnesium in
Norway, however, is generally higher than that in
other Western countries, due to a greater consump-
tion of whole grains [54].
To our knowledge this study is the first to test the
hypothesis that magnesium intake is related to
anxiety and depression in an epidemiological setting.
While being cognisant of the limitations of the study,
the present findings of an inverse association between
magnesium intake and depression may have both
public health and treatment implications. In primary
and specialist care settings, as well as in the public
sphere, recommendations regarding lifestyle modifi-
cations are commonly made on the basis of reducing
the risk of cancer, CVD or type II diabetes. In
contrast, psychiatry lacks such prevention recom-
mendations based on lifestyle factors. In common
with both folate and omega-3 fatty acids, magnesium
intake is likely to act as a proxy for a healthy diet
because it is found primarily in foods that comprise
many aspects of the Mediterranean diet [55]. If an
evidence-based preventive health-care strategy incor-
porating dietary improvement can be developed for
mental illness, it is likely to overlap heavily with
existing strategies for other common, chronic, non-
communicable diseases, with the hope of reducing the
burden of illness and improving outcomes for people
suffering from mental ill health.
Acknowledgements
The Hordaland Health Study was conducted from
1997 to 1999 as a collaboration between the National
Health Screening Service, the University of Bergen in
Norway, the University of Oslo in Norway and local
health services in the Bergen region. F. Jacka was
funded by the Australian Rotary Health Research
Fund and a University of Melbourne Postgraduate
Overseas Research Scholarship. R. Stewart is funded
by the NIHR Biomedical Research Centre for Mental
Health, South London and Maudsley NHS Founda-
tion Trust and Institute of Psychiatry, King’s College
London. A. Mykletun is funded by the Norwegian
Institute of Public Health.
References
1. Popkin BM. Global nutrition dynamics: the world is shifting
rapidly toward a diet linked with noncommunicable diseases.
Am J Clin Nutr 2006; 84:289298.
2. Tolmunen T, Hintikka J, Ruusunen A et al. Dietary folate
and the risk of depression in Finnish middle-aged men. A
prospective follow-up study. Psychother Psychosom 2004;
73:334339.
3. Timonen M, Horrobin D, Jokelainen J, Laitinen J, HervaA,
Rasanen P. Fish consumption and depression: the Northern
Finland 1966 birth cohort study. J Affect Disord 2004;
82:447452.
4. Tanskanen A, Hibbeln JR, Tuomilehto J et al. Fish
consumption and depressive symptoms in the general
population in Finland. Psychiatr Serv2001; 52:529531.
5. Silvers KM, Scott KM. Fish consumption and self-reported
physical and mental health status. Public Health Nutr 2002;
5:427431.
6. Kim JM, Stewart R, Kim SW, Yang SJ, Shin IS, Yoon JS.
Predictivevalue of folate, vitamin B12 and homocysteine
levels in late-life depression. Br J Psychiatry 2008; 192:268
274.
7. Jacka FN, Berk M. Food for thought. Acta Neuropsychiatr
2007; 19:321323.
8. Maes M, Bosmans E, De Jongh R, Kenis G, Vandoolaeghe E,
Neels H. Increased serum IL-6 and IL-1 receptor antagonist
concentrations in major depression and treatment resistant
depression. Cytokine 1997; 9:853858.
9. Maes M, Meltzer HY, Bosmans E et al. Increased plasma
concentrations of interleukin-6, soluble interleukin-6, soluble
interleukin-2 and transferrin receptor in major depression.
J Affect Disord 1995; 34:301309.
10. Herbert TB, Cohen S. Depression and immunity: a meta-
analytic review. Psychol Bull 1993; 113:472486.
11. Connor TJ, Leonard BE. Depression, stress and
immunological activation: the role of cytokines in depressive
disorders. Life Sci 1998; 62:583606.
Table 4. Association of magnesium intake
$
and
case level depression and anxiety
%
: Hordaland
Health Study
Depression OR
(95%CI)
Anxiety OR
(95%CI)
Adjusted total
energy in-
take
0.70 (0.56 0.88) 0.90 (0.761.06)
Adjusted
gender, age
0.72 (0.570.90) 0.84 (0.711.00)
Adjusted
WHR, BMI,
SBP
0.72 (0.570.90) 0.84 (0.711.00)
Adjusted
education,
income and
health
behaviours
0.86 (0.691.08) 0.91 (0.771.08)
BMI, body mass index; CI, confidence interval; HADS-A,
Hospital Anxiety and Depression ScaleAnxiety subscale;
HADS-D, Hospital Anxiety and Depression ScaleDepression
subscale; NOK, Norwegian kroner; OR, odds ratio; SBP,
systolic blood pressure; WHR, waisthip ratio; $All exposure
scores standardized; %HADS -A or -D scores]8.
50 MAGNESIUM INTAKE AND DEPRESSION
Downloaded By: [ABM Utvikling STM / SSH packages] At: 13:58 30 December 2008
12. King DE, Mainous AG 3rd, Geesey ME, Woolson RF.
Dietary magnesium and C-reactive protein levels. J Am Coll
Nutr 2005; 24:166171.
13. Song Y, Ridker PM, Manson JE, Cook NR, Buring JE, Liu
S. Magnesium intake, C-reactive protein, and the prevalence
of metabolic syndrome in middle-aged and older U.S. women.
Diabetes Care 2005; 28:14381444.
14. Rasmussen HH, Mortensen PB, Jensen IW. Depression and
magnesium deficiency. Int J Psychiatry Med 1989; 19:5763.
15. Hashizume N, Mori M. An analysis of hypermagnesemia and
hypomagnesemia. Jpn J Med 1990; 29:368372.
16. Zieba A, Kata R, Dudek D, Schlegel-Zawadzka M, Nowak
G. Serum trace elements in animal models and human
depression: part III. Magnesium. Relationship with copper.
Hum Psychopharmacol 2000; 15:631635.
17. Imada Y, Yoshioka S, Ueda T, Katayama S, Kuno Y,
Kawahara R. Relationships between serum magnesium levels
and clinical background factors in patients with mood
disorders. Psychiatry Clin Neurosci 2002; 56:509514.
18. Singewald N, Sinner C, Hetzenauer A, Sartori SB, Murck H.
Magnesium-deficient diet alters depression- and anxiety-
related behavior in mice: influence of desipramine and
Hypericum perforatum extract. Neuropharmacology 2004;
47:11891197.
19. Poleszak E, Szewczyk B, Kedzierska E, Wlaz P, Pilc A,
Nowak G. Antidepressant- and anxiolytic-like activity of
magnesium in mice. Pharmacol Biochem Behav2004; 78:712.
20. Poleszak E, Wlaz P, Kedzierska E et al. Effects of acute and
chronic treatment with magnesium in the forced swim test in
rats. Pharmacol Rep 2005; 57:654658.
21. Cox IM, Campbell MJ, Dowson D. Red blood cell
magnesium and chronic fatigue syndrome. Lancet 1991;
337:757760.
22. Facchinetti F, Borella P, Sances G, Fioroni L, Nappi RE,
Genazzani AR. Oral magnesium successfully relieves
premenstrual mood changes. Obstet Gynecol 1991; 78:177
181.
23. Chouinard G, Beauclair L, Geiser R, Etienne P. A pilot study
of magnesium aspartate hydrochloride (Magnesiocard) as a
mood stabilizer for rapid cycling bipolar affective disorder
patients. Prog Neuropsychopharmacol Biol Psychiatry 1990;
14:171180.
24. Heiden A, Frey R, Presslich O, Blasbichler T, Smetana R,
Kasper S. Treatment of severe mania with intravenous
magnesium sulphate as a supplementary therapy. Psychiatry
Res 1999; 89:239246.
25. Murck H. Magnesium and affective disorders. Nutr Neurosci
2002; 5:375389.
26. Konstantinova SV, Vollset SE, Berstad P et al. Dietary
predictors of plasma total homocysteine in the Hordaland
Homocysteine Study. Br J Nutr 2007; 98:201210.
27. Nes M, Frost Andersen L, Solvoll K et al. Accuracy of a
quantitative food frequency questionnaire applied in elderly
Norwegian women. Eur J Clin Nutr 1992; 46:809821.
28. Rimestad A, Borgejordet A, Vesterhus K et al.[The
Norwegian Food composition table.] Oslo: National Nutrition
Council, Gyldendal undervisning, 2001.
29. Zigmond AS, Snaith RP. The Hospital Anxiety and
Depression Scale. Acta Psychiatr Scand 1983; 67:361370.
30. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity
of the Hospital Anxiety and Depression Scale. An updated
literature review. J Psychosom Res 2002; 52:6977.
31. Mykletun A, Bjerkeset O, Dewey M, Prince M, Overland S,
Stewart R. Anxiety, depression, and cause-specific mortality:
the HUNT study. Psychosom Med 2007; 69:323331.
32. McGee D, Reed D, Yano K. The results of logistic analyses
when the variables are highly correlated: an empirical example
using diet and CHD incidence. J Chronic Dis 1984; 37:713
719.
33. Bjelland I, Krokstad S, Mykletun A, Dahl AA, Tell GS,
Tambs K. Does a higher educational level protect against
anxiety and depression? The HUNT study. Soc Sci Med 2008;
66:13341345.
34. Farmer M, Locke B, Moscicki E, Dannenberg A, Larson D,
Radloff L. Physical activity and depressive symptoms: the
NHANES I epidemiologic follow-up study. Am J Epidemiol
1988; 128:13401351.
35. Camacho TC, Roberts RE, Lazarus NB, Kaplan GA, Cohen
RD. Physical activity and depression: evidence from the
Alameda County Study. Am J Epidemiol 1991; 134:220231.
36. Strawbridge WJ, Deleger S, Roberts RE, Kaplan GA.
Physical activity reduces the risk of subsequent depression for
older adults. Am J Epidemiol 2002; 156:328334.
37. Wiles NJ, Haase AM, Gallacher J, Lawlor DA, Lewis G.
Physical activity and common mental disorder: results from
the Caerphilly study. Am J Epidemiol 2007; 165:946954.
38. Brown WJ, Ford JH, Burton NW, Marshall AL, Dobson AJ.
Prospective study of physical activity and depressive
symptoms in middle-aged women. Am J PrevMed 2005;
29:265272.
39. Raeder MB, Steen VM, Vollset SE, Bjelland I. Associations
between cod liver oil use and symptoms of depression: the
Hordaland Health Study. J Affect Disord 2007; 101:245249.
40. Hakkarainen R, Partonen T, Haukka J, Virtamo J, Albanes
D, Lonnqvist J. Is low dietary intake of omega-3 fatty acids
associated with depression? Am J Psychiatry 2004; 161:567
569.
41. Malpuech-Brugere C, Nowacki W, Daveau M et al.
Inflammatory response following acute magnesium deficiency
in the rat. Biochim Biophys Acta 2000; 1501:9198.
42. Weglicki WB, Phillips TM, Freedman AM, Cassidy MM,
Dickens BF. Magnesium-deficiency elevates circulating levels
of inflammatory cytokines and endothelin. Mol Cell Biochem
1992; 110:169173.
43. Liukkonen T, Silvennoinen-Kassinen S, Jokelainen J et al.
The association between C-reactive protein levels and
depression: results from the northern Finland 1966 birth
cohort study. Biol Psychiatry 2006; 60:825830.
44. Elovainio M, Keltikangas-Jarvinen L, Pulkki-Raback L et al.
Depressive symptoms and C-reactive protein: the
Cardiovascular Risk in Young Finns Study. Psychol Med
2006; 36:797805.
45. Penninx BW, Kritchevsky SB, Yaffe K et al. Inflammatory
markers and depressed mood in older persons: results from
the Health, Aging and Body Composition study. Biol
Psychiatry 2003; 54:566572.
46. Weglicki WB, Bloom S, Cassidy MM, Freedman AM,
Atrakchi AH, Dickens BF. Antioxidants and the
cardiomyopathy of Mg-deficiency. Am J Cardiovasc Pathol
1992; 4:210215.
47. Bussiere FI, Mazur A, Fauquert JL, Labbe A, Rayssiguier Y,
Tridon A. High magnesium concentration in vitro decreases
human leukocyte activation. Magnes Res 2002; 15:4348.
48. Food and Nutrition Board. Dietary reference intakes: the
essential reference for dietary planning and assessment.
Washington, DC: Institute of Medicine of the National
Academies, 2006.
49. Pennington JA, Schoen SA. Total diet study: estimated
dietary intakes of nutritional elements, 19821991. Int J Vitam
Nutr Res 1996; 66:350362.
50. Galan P, Preziosi P, Durlach V et al. Dietary magnesium
intake in a French adult population. Magnes Res 1997;
10:321328.
51. Ford ES, Mokdad AH. Dietary magnesium intake in a
national sample of US adults. J Nutr 2003; 133:28792882.
52. Dolega-Cieszkowski JH, Bobyn JP, Whiting SJ. Dietary
intakes of Canadians in the 1990s using population-weighted
F.N. JACKA, S. OVERLAND, R. STEWART, G.S. TELL, I. BJELLAND, A. MYKLETUN 51
Downloaded By: [ABM Utvikling STM / SSH packages] At: 13:58 30 December 2008
data derived from the provincial nutrition surveys. Appl
Physiol Nutr Metab 2006; 31:753758.
53. Bannerman E, Magarey AM, Daniels LA. Evaluation of
micronutrient intakes of older Australians: the National
Nutrition Survey1995. J Nutr Health Aging 2001; 5:243247.
54. Jacobs DR Jr, Meyer HE, Solvoll K. Reduced mortality
among whole grain bread eaters in men and women in the
Norwegian County Study. Eur J Clin Nutr 2001; 55:
137143.
55. Schroder H. Protective mechanisms of the Mediterranean diet
in obesity and type 2 diabetes. J Nutr Biochem 2007; 18:149
160.
52 MAGNESIUM INTAKE AND DEPRESSION
Downloaded By: [ABM Utvikling STM / SSH packages] At: 13:58 30 December 2008
... Magnesium may also have beneficial effect on skin lesions and acne; for instance, previous studies have shown that magnesium improves collagen production in the skin, whilst low magnesium intake may cause inflammation [14]. Also, serum magnesium levels have been shown to be low in patients with acne [15], and co-supplementation of magnesium and myoinositol was reported to improve acne [16] Magnesium may have favorable effect on components of quality of life including depression [17,18], where previous studies showed that magnesium supplementation improved depression in diabetic and non-diabetic patients [19,20]. ...
... Magnesium supplementation in women with PCOS improved emotional and mental aspects of quality of life. Previous studies showed that low magnesium intake was significantly associated with externalizing behaviors [59], whilst another study found an inverse relationship between dietary magnesium intake and incidence of depression [17]. A review study asserted favorable effects of magnesium supplementation on different types of mental disorder including depressive symptoms, anxiety disorders, attention deficit hyperactivity disorder, autism, obsessivecompulsive disorder, and eating disorders [60]. ...
Article
Full-text available
Background Abnormal uterine bleeding (AUB), alopecia, low quality of life, and acne are considered as complications of polycystic ovary syndrome (PCOS). We hypothesized that magnesium supplementation would yield beneficial effects on PCOS related complications. Objective To examine the effects of magnesium supplementation on AUB, alopecia, quality of life, and acne. Methods In this parallel randomized clinical trial, we randomly assigned 64 women with PCOS to the magnesium group (n = 32) or placebo group (n = 32) for 10 weeks. AUB, alopecia, quality of life, and acne were assessed by the International Federation of Gynecology and Obstetrics criterion, the Sinclair Scale, the Health Survey Quality of Life Questionnaire, and the Global Acne Grading System, respectively. This randomized clinical trial was registered at IRCT.ir (IRCT20130903014551N9). Results Magnesium supplementation significantly improved the components of quality of life including physical functioning (p = 0.011), role limitations due to physical health (p = 0.012), role limitations due to emotional problems (p < 0.001), energy/fatigue (p = 0.005), emotional wellbeing (p < 0.001), social functioning (p = 0.002), general health (p = 0.013), and total quality of life (p < 0.001), compared with placebo. No significant effect was observed on acne, alopecia, and AUB. Conclusion Magnesium supplementation in women with PCOS had a significant positive effect on improving total quality of life. Trial registration This randomized clinical trial was registered at IRCT.ir on 2020–10-18 (Registration Code: IRCT20130903014551N9).
... A relationship between Mg status and anxiety is also evident in humans [9,23]. Mg intake was shown to be inversely associated with subjective anxiety in a large community-based survey [24]. Furthermore, Mg supplementation has been shown to attenuate the activity of the stress response via the HPAA [25,26]. ...
Article
Full-text available
Introduction: Low magnesium levels have been implicated in the pathophysiology of stress, anxiety, depression, and other quality
... Although sleep (21). Previous studies on rodents indicated that Mg 2+ ions serve as a critical signal for synapse formation and increased intraneuronal Mg 2+ concentration was associated with an increase in synaptic density and plasticity in the prefrontal cortex and hippocampus in young and old rats (22)(23)(24), as well as enhancement of short/long-term memory, reduction of anxiety, reduction in depression (25)(26)(27). Besides, increased Mg 2+ via various substances was suggested to improve memory of patients with Alzheimer's disease by inhibiting the neuroinflammation (22,28,29). Moreover, molecular and animal studies have shown that Mg 2+ pretreatment shows neuroprotective effects (30,31). ...
Article
Full-text available
L-Theanine is commonly used to improve sleep quality through inhibitory neurotransmitters. On the other hand, Mg 2+ , a natural NMDA antagonist and GABA agonist, has a critical role in sleep regulation. Using the caffeine-induced brain electrical activity model, here we investigated the potency of L-theanine and two novel Mg-L-theanine compounds with different magnesium concentrations on electrocorticography (ECoG) patterns, GABAergic and serotonergic receptor expressions, dopamine, serotonin, and melatonin levels. Furthermore, we evaluated the sleep latency and duration in the pentobarbital induced sleep model. We herein showed that L-theanine, particularly its various complexes with magnesium increases the expression of GABAergic, serotonergic, and glutamatergic receptors, which were associated with decreased ECoG frequency, increased amplitude, and enhanced delta wave powers. Besides increased dopamine, serotonin, and melatonin; decreased MDA and increased antioxidant enzyme levels were also observed particularly with Mg-complexes. Protein expression analyses also showed that Mg-L-theanine complexes decrease inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) levels significantly. In accordance with these results, Mg complexes improved the sleep latency and duration even after caffeine administration. As a result, our data indicate that Mg-L-theanine compounds potentiate the effect of L-theanine on sleep by boosting slow-brain waves, regulating brain electrical activity, and increasing neurotransmitter and GABA receptor levels.
... 62 Jacka'nın yaptığı bir çalışmada, serum magnezyum seviyeleri ile depresyonun ciddiyeti arasında bir ilişki bulunamamış olsa da yetersiz magnezyum alımının tedaviye dirençli ve intihar eğilimli depresyon oluşumunda etkisi bulunmaktadır. 63 Çalışmaların gösterdiğine göre, ilaç tedavisi almayan depresyon hastalarının eritrosit magnezyum seviyeleri yüksek bulunmuştur. Bu durum, magnezyumun hücre içinden hücre dışına akışını ve beyinden kana yer değiştirmesini göstermiştir. ...
Article
Full-text available
Depression is a common mood disorder seen in over 300 million people worldwide. Causes of depression may be caused by ge�netic factors or environmental factors. Nutritional status is one of the most important environmental factors. In addition to many factors such as socioeconomic status, various psychological factors, chronic dis�eases, pregnancy, postpartum, menopause, stress factors, sleep patterns; nutrition-related factors such as inadequate or unbalanced nutritional habits, caffeine consumption levels and so on, play an important role in the development of depression symptoms. On the other hand, the elim�ination of certain nutrient deficiencies, especially vitamins and miner�als, can prevent the development of or help treating depression. Among the factors related to nutrition, one of the most investigated subjects is micronutrient deficiencies. Both vitamin and mineral deficiencies are among the most important factors affecting neurological pathways and neurological functions. Therefore, it is thought that vitamins and min�erals might be involved in the prevention and treatment of depres�sion.Many researches and clinical studies have been done in this area, especially on minerals; however, there is still a need for more data to reach a definitive conclusion. The important effect of minerals on neu�rological functions and enzymes involved in this level has been demon�strated in many studies. In this review, various databases were scanned and publications investigating the roles of iron, zinc, copper and mag�nesium elements in the prevention of depression and the treatment of depression are examined.
... The difference between the effects of unrefined wheat and wheat endosperm could be explained from the perspective of mineral contents. Whole grains include abundant minerals, such as magnesium and zinc 27,28 ; these mineral deficiencies increase the risk of depression 30,31 . Furthermore, it has been reported that magnesium supplementation is effective in the treatment of depression 32,33 ; moreover, zinc elicited antidepressant-like effects in rodents 34,35 . ...
Article
The neurotrophic hypothesis of depression, that is, a deficiency in hippocampal brain-derived neurotrophic factor (BDNF) leads to depression, has gained widespread acceptance. BDNF is synthesized in various peripheral tissues such as the lung, kidney, liver, heart and testis, besides the brain. Peripheral BDNF can traverse the blood–brain barrier and reach the hippocampus; accordingly, substances that upregulate BDNF production in peripheral tissues may be useful in the treatment of depression. The Mediterranean diet, containing high amounts of whole grains including unrefined wheat, vegetables, fruits, nuts, and olive oil, reportedly reduces the risk of depression. The association between the high consumption of unrefined wheat in the Mediterranean diet and BDNF production in peripheral tissues is unclear. In this study, we investigated the BDNF production capacity of human lung adenocarcinoma cell line A549 and the effect of wheat on BDNF in the cells. Methanol extracts of whole-wheat flour and wheat bran, which are forms of unrefined wheat, increased the BDNF level in the culture medium of A549 cells. However, methanol extract of wheat endosperm had no effect on the BDNF level in these cells. Our findings suggest that wheat bran contains ingredients that upregulate BDNF production in peripheral tissues, and unrefined wheat potentially contributes to the elevation in peripheral BDNF level.
... Mg is a particularly relevant nutrient in the treatment of stress and anxiety since Mg status is closely aligned with stress levels: exposure to psychosocial stress increases Mg excretion, resulting in Mg deficiency [6] which increases endocrine stress reactivity [7], further depleting Mg levels. Dietary levels of Mg intake are also modestly inversely associated with subjective anxiety [8]. Further, Mg supplementation can reduce anxiety-related symptomology in anxiety vulnerable populations (e.g. ...
Article
Full-text available
Background: Magnesium (Mg), green tea and rhodiola extracts have, in isolation, been shown to possess stress and anxiety relieving effects. Green tea and rhodiola have been shown to modulate EEG oscillatory brain activity associated with relaxation and stress perception. The combined capacity of these ingredients to confer protective effects under conditions of acute stress has yet to be examined. We tested the hypothesis that a combination of Mg (with B vitamins) + green tea + rhodiola would acutely moderate the effects of stress exposure. Methods: A double blind, randomised, placebo controlled, parallel group design was employed (Clinicaltrials.gov:NCT03262376; 25/0817). One hundred moderately stressed adults received oral supplementation of either (i) Mg + B vitamins + green tea + rhodiola; (ii) Mg + B vitamins + rhodiola; (iii) Mg + B vitamins + green tea; or (iv) placebo. After supplementation participants were exposed to the Trier Social Stress Test. The effects of the study treatments on electroencephalogram (EEG) resting state alpha and theta, subjective state/mood, blood pressure, heart rate variability and salivary cortisol responses after acute stress exposure were assessed. Results: The combined treatment significantly increased EEG resting state theta (p < .02) - considered indicative of a relaxed, alert state, attenuated subjective stress, anxiety and mood disturbance, and heightened subjective and autonomic arousal (p < .05). Conclusions: Mg, B vitamins, rhodiola and green tea extracts are a promising combination of ingredients that may enhance coping capacity and offer protection from the negative effects of stress exposure.Trial registration: ClinicalTrials.gov identifier: NCT03262376.
Article
Background The prevention of postpartum depression is an important area of investigation given its association with major maternal and neonatal sequelae, yet few evidence-based treatments to reduce the frequency of postpartum depression are utilized. Recent data suggest that N-methyl-D-aspartate receptor antagonists may lead to rapid improvement of depressive symptoms lasting up to 2 weeks. We hypothesized that the N-methyl-D-aspartate receptor antagonist magnesium sulfate would elicit antidepressant effects subsequent to its receipt by women receiving peripartum seizure prophylaxis for a hypertensive disorder of pregnancy. Objective To compare the frequency of depressive symptoms at 2 weeks and 6 weeks postpartum between women who did or did not receive peripartum magnesium sulfate for a hypertensive disorder of pregnancy. Study Design This prospective cohort study included women with a hypertensive disorder of pregnancy ≥34 weeks of gestation with singleton gestations. Magnesium sulfate for seizure prophylaxis was administered at obstetrician discretion. The Quick Inventory of Depressive Symptomatology was administered prior to hospital discharge and again at 2 weeks and 6 weeks postpartum to assess for postpartum depressive symptoms. The primary outcome for this study was the change in Quick Inventory of Depressive Symptomatology score from baseline to 2 weeks postpartum, which was analyzed both continuously and categorically (any symptom worsening versus stability/improvement). Secondary outcomes included the change in Quick Inventory of Depressive Symptomatology score from baseline to 6 weeks postpartum and the proportion of women who experienced an increase in Quick Inventory of Depressive Symptomatology score at 6 weeks postpartum. Results Of the 342 women enrolled, 39% (N=134) received magnesium sulfate. Compared to women who did not receive magnesium, women who received magnesium had a significantly smaller change in their mean Quick Inventory of Depressive Symptomatology score (0.6 ± 3.4 vs. 1.6 ± 3.0, p= 0.015) and also were less likely to have an increase in Quick Inventory of Depressive Symptomatology score at 2 weeks postpartum (52% vs. 67%, p=0.022). These differences were not present at 6 weeks postpartum. After controlling for potential confounders, women who received magnesium continued to have a lower odds of having an increased Quick Inventory of Depressive Symptomatology score from baseline at 2 weeks postpartum compared to women who did not receive magnesium (aOR 0.88, 95% CI 0.78-0.98). Conclusion Peripartum magnesium was associated with less of an exacerbation in depressive symptoms in the immediate postpartum period. Given the implications of postpartum depression on maternal and child health and the lack of existing prophylaxis, randomized trials should examine this novel potential prophylactic therapy.
Article
Hostility is a complex personality trait associated with many cardiovascular risk factor phenotypes. Although magnesium intake has been related to mood and cardio-metabolic disease, its relation with hostility remains unclear. We hypothesize that high total magnesium intake is associated with lower levels of hostility because of its putative antidepressant mechanisms. To test the hypothesis, we prospectively analyzed data in 4,716 young adults aged 18-30 years at baseline (1985-1986) from four U.S. cities over five years of follow-up using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Magnesium intake was estimated from a dietary history questionnaire plus supplements at baseline. Levels of hostility were assessed using the Cook-Medley scale at baseline and year 5 (1990-1991). Generalized estimating equations were applied to estimate the association of magnesium intake with hostility as repeated measures at the two time-points (baseline and year 5). General linear model was used to determine the association between magnesium intake and change in hostility over 5 years. After adjustment for socio-demographic and major lifestyle factors, a significant inverse association was observed between magnesium intake and hostility level over 5 years of follow-up. Beta coefficients (95% CI) across higher quintiles of magnesium intake were 0 (reference), -1.28 (-1.92, -0.65), -1.45 (-2.09, -0.81), -1.41 (-2.08, -0.75) and -2.16 (-2.85, -1.47), respectively (Plinear-trend<.01). The inverse association was independent of socio-demographic and major lifestyle factors, supplement use, and depression status at year 5. This prospective study provides evidence that in young adults, high magnesium intake was inversely associated with hostility level independent of socio-demographic and major lifestyle factors.
Article
Introduction.Stress and stress-induced disorders are not uncommon in pediatric practice. The range of causal stressors (information environment, gadgets, pandemic, armed conflicts, etc.) has expanded significantly these days. The article depicts the main clinical manifestations of stress reactions, pathogenetic mechanisms of their development, provides rational approaches to the therapy of elimination of stress manifestations and consequences in children and adolescents from a pediatric perspective. Objective:To study the influence of stress on the psychoemotional sphere and cognitive functions in children aged 7 to 9 years from the armed conflict zone in the Donbass. Materials and methods. 234 children of primary school age were included in the study, of whom 123 children had lived at the armed conflict zone in Donbass for a year. The psychoemotional state and cognitive functions status were determined by children’s tests using a scoring method to assess test results. Results and discussion.The tests with a scoring method to assess test results showed that 100% of children from the armed conflict zone had a chronic stress, 63% had a moderate to severe stress, a high frequency of various types of phobias, as well as impaired concentration and memory. Therapeutic approaches to the management of stress reactions directly depend on the cause and clinical manifestations of such reactions. The therapy strategy includes among other things general strengthening actions, psychotherapy, symptomatic and pathogenetic methods of treatment. In addition, both acute and chronic stress leads to intracellular magnesium deficiency and increased urinary magnesium wasting, as a large amount of catecholamines is released under stress conditions, which contributes to shifting magnesium out of cells. The magnesium deficiency results in increased permeability of cell membranes for calcium ions, which creates conditions for electrical instability and excessive excitability of cells, most significantly of neurons. This is reflected in the fact that the process of excitation prevails over inhibitory reactions, and stress reactions develop as the clinical manifestations. It has been established that an adequate balance of magnesium increases the adaptive capabilities in people. Its neurotropic effects made it possible to consider magnesium as an effective pathogenetic agent that can increase stress resistance, stress management, and activate the body’s adaptive reserves. Conclusion. The causal stressors are manifold, the paediatrician has to deal with stress reactions in children much more often than doctors of other specialties. Magnesium supplements currently form the basis of treatment and rehabilitation actions in children with stress.
Article
Full-text available
Introduction: Diet is one of the important causes that directly or indirectly affect the course of non-infectious diseases. Medical students are more susceptible to be exposed to stressors, feel more anxiety and have bad nutritional habits. The present study was conducted to investigate the relationship between rate of consumption of fast-food cuisine and levels of anxiety among medical students in Tehran in 2010. Materials and Methods: In this cross-sectional study, 204 male and 284 female were selected from students of medical sciences universities in Tehran, using stratified random sampling. Dietary assessment was done using 24- hour recall for frequency of fast food consumption in two times with a week interval. Conversion of intake foods into micronutrients was undertaken using the USDA tables. Persian version Spiel-Berger questionnaire, evaluating trait and state anxiety levels was used. A proportional odd’s regression model with adjusting the effect of probable confounder variables was used to assess the effect of consumption of fast-food cuisine on anxiety variables. Results: Rate of fast food consumption was twice in male students compared to female students. Chance of feeling either moderate or severe anxiety in those students who frequently consume fast-food cuisine was seven folds higher than those students who rarely use fast food (OR=7.0, 95% CI, 2.35-9.74, P<0.001). Conclusion: It was determined that rate of anxiety level might increase by increase in consumption of fast- food cuisine. Keywords: Anxiety, Fast foods, Students
Article
Full-text available
Global energy imbalances and related obesity levels are rapidly increasing. The world is rapidly shifting from a dietary period in which the higher-income countries are dominated by patterns of degenerative diseases (whereas the lower- and middle-income countries are dominated by receding famine) to one in which the world is increasingly being dominated by degenerative diseases. This article documents the high levels of overweight and obesity found across higher- and lower-income countries and the global shift of this burden toward the poor and toward urban and rural populations. Dietary changes appear to be shifting universally toward a diet dominated by higher intakes of animal and partially hydrogenated fats and lower intakes of fiber. Activity patterns at work, at leisure, during travel, and in the home are equally shifting rapidly toward reduced energy expenditure. Large-scale decreases in food prices (eg, beef prices) have increased access to supermarkets, and the urbanization of both urban and rural areas is a key underlying factor. Limited documentation of the extent of the increased effects of the fast food and bottled soft drink industries on this nutrition shift is available, but some examples of the heterogeneity of the underlying changes are presented. The challenge to global health is clear.
Article
Full-text available
This study examined the association between the dietary intake of omega-3 fatty acids and low mood, major depression, and suicide. A total of 29,133 men ages 50 to 69 years participated in a population-based trial in Finland. The intake of fatty acids and fish consumption were calculated from a diet history questionnaire. Self-reported depressed mood was recorded three times annually, data on hospital treatments due to a major depressive disorder were derived from the National Hospital Discharge Register, and suicides were identified from death certificates. There were no associations between the dietary intake of omega-3 fatty acids or fish consumption and depressed mood, major depressive episodes, or suicide. Dietary intake of omega-3 fatty acids showed no association with low mood level.
Article
Full-text available
Established dietary predictors of plasma total homocysteine (tHcy) include folate, riboflavin, and vitamins B6 and B12, while information is scarce regarding other dietary components. The aim of this study was to examine the relation between a variety of food groups, food items and nutrients, and plasma tHcy in a large population-based study. The study population included 5812 men and women aged 47-49 and 71-74 years who completed a 169-item FFQ. tHcy was examined across quartiles of dietary components by multiple linear regression analyses adjusting for age, sex, energy intake, various risk factors for elevated tHcy, as well as for dietary and plasma B-vitamins. Among 4578 non-users of vitamin supplements, intake of vegetables, fruits, cereals, eggs, fish and milk, as well as chicken and non-processed meats were inversely associated with tHcy level. The estimated mean difference in tHcy per increasing quartile of intake ranged from - 0.11 (95 % CI - 0.21, - 0.01) micromol/l for milk to - 0.32 (95 % CI - 0.42, - 0.22) micromol/l for vegetables. Positive associations were found for sweets and cakes. Whole-grain bread was significantly inversely related to tHcy only after additional adjustment for dietary and plasma B-vitamins. The nutrients folate, vitamin B6, B12, and riboflavin were inversely related to tHcy. Complex carbohydrates were inversely, and fat positively associated with tHcy, also after adjustment for dietary and plasma B-vitamins. In conclusion, food items rich in B-vitamins and with a low content of fat and sugar were related to lower tHcy levels. Eggs, chicken, non-processed meat, fish and milk were inversely associated with tHcy.
Article
A relation between magnesium (Mg) salts and mood disorders has been suggested. We examined in mice the effect of Mg-depletion in the forced-swim-test (FST), the open-field-test (OFT) and light-dark-test (LDT) and whether it can be reversed by pharmacotherapy. Mg-depleted mice showed reduced entry into the center area in the OFT, a reduced time spent in the light compartment in the LDT and an increased immobility in the FST compared to control mice. Chronic administration (at least 3 weeks) of Hypericum-extract LI160 (300mg/(kg x d)) or desipramin (30mg/(kg x d)) in Mg-depleted mice prevented the increase in depression-related behavior in the FST. LI160, but not desipramine, prevented the increase in anxiety related behavior of in the OFT and LDT. In conclusion, Mg-Dep leads to an enhanced depression- and anxiety-related behavior, which can be reversed by established drugs. This suggests the utility of Mg-Dep as a sceening model.
Article
Objective: The aim of this study was to assess whether self-reported mental health status, measured using the SF-36 questionnaire, was associated with fish consumption, assessed using a food-frequency questionnaire. Design: The cross-national data were collected in the 1996/97 New Zealand Health Survey and 1997 Nutrition Survey, which were conducted using the same sampling frame. Survey respondents were categorised into those who consumed no fish of any kind and those who consumed some kind of fish, at any frequency. Data were adjusted for age, household income, eating patterns, alcohol use and smoking. Other demographic variables and potential confounding nutrients were included in the preliminary analyses but were not found to have a significant relationship with fish consumption. Subjects: Data from a nationally representative sample of 4644 New Zealand adults aged 15 years and over were used in this analysis. Results: Fish consumption was significantly associated with higher self-reported mental health status, even after adjustment for possible confounders. Differences between the mean scores for fish eaters and those who never eat fish were 8.2 for the Mental Health scale (P = 0.005) and 7.5 for the Mental Component score (P = 0.001). Conversely, the association between fish consumption and physical functioning was in the opposite direction (P = 0.045). Conclusions: This is the first cross-sectional survey to demonstrate a significant relationship between fish intake and higher self-reported mental health status, therefore offering indirect support for the hypothesis that omega-3 polyunsaturated fatty acids may act as mood stabilisers.
Article
Previous studies assessing protective effects of physical activity on depression have had conflicting results; one recent study argued that excluding disabled subjects attenuated any observed effects. The authors' objective was to compare the effects of higher levels of physical activity on prevalent and incident depression with and without exclusion of disabled subjects. Participants were 1,947 community-dwelling adults from the Alameda County Study aged 50-94 years at baseline in 1994 with 5 years of follow-up. Depression was measured using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Washington, DC: American Psychiatric Association, 1994). Physical activity was measured with an eight-point scale; odds ratios are based upon a one-point increase on the scale. Even with adjustments for age, sex, ethnicity, financial strain, chronic conditions, disability, body mass index, alcohol consumption, smoking, and social relations, greater physical activity was protective for both prevalent depression (adjusted odds ratio (OR) = 0.90, 95% confidence interval (Cl): 0.79, 1.01) and incident depression (adjusted OR = 0.83, 95% Cl: 0.73, 0.96) over 5 years. Exclusion of disabled subjects did not attenuate the incidence results (adjusted OR = 0.79, 95% Cl: 0.67, 0.92). Findings support the protective effects of physical activity on depression for older adults and argue against excluding disabled subjects from similar studies.
Article
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Article
The importance of inflammatory processes in the pathology of Mg deficiency has been recently reconsidered but the sequence of events leading to the inflammatory response remains unclear. Thus, the purpose of the present study was to characterize more precisely the acute phase response following Mg deficiency in the rat. Weaning male Wistar rats were pair-fed either a Mg-deficient or a control diet for either 4 or 8 days. The characteristic allergy-like crisis of Mg-deficient rats was accompanied by a blood leukocyte response and changes in leukocytes subpopulations. A significant increase in interleukin-6 (IL-6) plasma level was observed in Mg-deficient rats compared to rats fed a control diet. The inflammatory process was accompanied by an increase in plasma levels of acute phase proteins. The concentrations of α2-macroglobulin and α1-acid glycoprotein in the plasma of Mg-deficient rats were higher than in control rats. This was accompanied in the liver by an increase in the level of mRNA coding for these proteins. Moreover, Mg-deficient rats showed a significant increase in plasma fibrinogen and a significant decrease in albumin concentrations. Macrophages found in greater number in the peritoneal cavity of Mg-deficient rats were activated endogenously and appeared to be primed for superoxide production following phorbol myristate acetate stimulation. A high plasma level of IL-6 could be detected as early as day 4 for the Mg-deficient diet. Substance P does not appear to be the initiator of inflammation since IL-6 increase was observed without plasma elevation of this neuropeptide. The fact that the inflammatory response was an early consequence of Mg deficiency suggests that reduced extracellular Mg might be responsible for the activated state of immune cells.