Perspective: The Case for an Evidence-Based Reference Interval for Serum Magnesium: The Time Has Come
Costello et al. • Advances in Nutrition
Key Finding
Proposed optimal threshold: ≥0.85 mmol/L (vs current 0.75 mmol/L); CVD risk increases at <0.75-0.85 mmol/L; T2D risk elevated at <0.74 mmol/L
Key Findings
- 1Proposed optimal threshold: ≥0.85 mmol/L
- 2Current standard 0.75 mmol/L established in 1974
- 3CVD risk increases at <0.75-0.85 mmol/L
- 410-30% of healthy populations below optimal
Original title: “Perspective: The Case for an Evidence-Based Reference Interval for Serum Magnesium”
Plain English Summary
The authors argue that subclinical magnesium deficiency can exist despite apparently normal serum readings. They propose raising the optimal serum magnesium threshold from the 1974 standard of 0.75 mmol/L to ≥0.85 mmol/L based on CVD and T2D outcome data.
In-Depth Analysis
Abstract
"Subclinical magnesium deficiency can exist despite" apparently normal serum readings under current standards.
Key Findings
Current vs. Proposed Standards
- •Existing reference interval: 0.75–0.95 mmol/L (established 1974)
- •Proposed threshold: ≥0.85 mmol/L for optimal health
- •Population prevalence: ~10–30% of healthy populations fall below optimal ranges
Disease Risk Associations
- •CVD risk increases at concentrations <0.75–0.85 mmol/L
- •Type 2 diabetes risk elevated at <0.74 mmol/L
- •Supplementation studies showed consistent dose-response improvements
Recommendations
"An evidenced-based reference interval for serum total magnesium concentration ≥0.85 mmol/L to reduce the risk of CVD, T2D, and other diseases"
Paradigm Relevance
How this study applies to different clinical perspectives:
Standard Medical
RelevantConventional clinical guidelines used by most doctors
Why it matters:
Explains why current population-based reference ranges miss subclinical deficiency.
Research Consensus
RelevantCurrent scientific understanding, often ahead of guidelines
Why it matters:
Provides scientific basis for raising the lower limit of normal to 0.85 mmol/L.
Metabolic Optimization
RelevantProactive targets for optimal health, not just disease absence
Why it matters:
Supports targeting upper-normal magnesium levels for disease prevention.
Study Details
- Type
- Review Article
- Methodology
- Systematic literature review examining cross-sectional studies, RCTs of supplementation, prospective cohort studies linking serum magnesium to cardiovascular and metabolic outcomes
Evidence Quality
Grade B - Expert consensus with systematic review. Source: PMC5105038
Related Biomarkers
Calculate & Evaluate on Metabolicum
Original Source
DOI (Digital Object Identifier) is a permanent link to this publication. Unlike website URLs that can change, a DOI always resolves to the correct source.
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Challenges in the Diagnosis of Magnesium Status
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Blood magnesium represents only 0.8% of total body stores; 45% of Americans are magnesium deficient; 60% of adults do not reach recommended intake levels
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Per 100 mg/day increment in magnesium intake: 8-13% reduction in T2D incidence (RR = 0.88-0.92, 95% CI)