editor: Robert
B. Bradfield,
J.D.,
international
Magnesium supplementation calorie malnutrition1’ 2 B.
L. Nichols,
M.D.,
J. Alvarado,3
M.D.,
Ph.D.
nutrition
in protein-
C. F. Hazlewood,
Ph.D.,
and
F. Viteri,3M.D. ABSTRACT tion
has
The been
widespread
confirmed
observation
in Guatemalan
of magnesium children
The
.
depletion
magnesium
in edematous requirement
malnutriduring
initial
stages of therapy has been estimated as 2.7 mEq/kg per day. This may be achieved by adding 0.5 % MgSO4 . 7 H2O to a solution containing 15 % dextromaltase and 1 .5 % KCI which is used to dilute whole mil’ ; two parts milk and one part dilution mixture . The replacement of magnesium deficits was not essential for recovery from edematous malnutrition, however, the present evidence suggested that the rate of recovery was accelerated by approximately 2 weeks in those children who received the supplement. Am. J. din. Nutr. 31 : 176-188, 1978.
Magnesium
to occur
depletion
been
reported
in protein-calorie
numerous
malnutrition by 5). The lines of the reduced concentration
investigators
evidence of
has
are two;
magnesium
(1-1
in
serum
(1-6,
8,
14,
16)
and tissue (1-4, 8 1 1 1 2 1 5) along with excessive retention of magnesium in balance study (2 3 5 6 1 0, 1 6) and an analysis of ,
,
clinical therapy
,
,
,
,
,
benefits in response (7 9, 1 3 1 5) The ,
these findings is obscured in the observed chemical serum and muscle supplementation. mine the quantity
umented position. Materials Children
tion the Panama
magnesium
and clinical In this report, of magnesium
to meet the deficits from admission and magnesium
to
significance of by the variability composition of
.
,
present evaluate
supplement
to restore
and continuing the effect of a
which
serum
response to we deternecessary
has
and
been
doc-
muscle
com-
endematous
protein-calorie
The
general
clinical
features
of
these subjects are identical to those previously described by this unit (1 7). Informed consent was received from parent or guardian at the time of admission to the metabolic ward. 176
The American
which
make
Journal
ofClinical
Nutrition
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/1/176/4650523 by Washington University at St Louis user on 02 July 2018
up the magnesium
treated
in Table 1 . Nine of this second received from admission, magnesium into the gluteal muscles over a 9 (Table 1). Fatal cases were excluded
group is given study population
sulfate injections to 23 day period from the present
series. i
From
the
Section
of Nutrition
and
Gastroenterol-
ogy, Department of Pediatrics, Baylor College of Mcdicine, Houston, Texas. 2 Research support is acknowledged from the United States Public Health Service Research Grant RR-00188 from the General Clinical Research Centers
Hospital,
malnutri-
have been studied at the Biomedical Division of Institute of Nutrition of Central America and (INCAP).
changed after that study in order to increase oral magnesium intake from 0.12 to 0.42 mEq/kg per day. The clinical description of the 23 additional subjects
Program, Institutes of the
and methods with
This study consists of opportunistic observations on magnesium metabolism in children undergoing studies of nitrogen requirements during recovery from malnutrition. An initial group of 12 subjects were described in detail in our 1972 publication (14) on muscle potassium depletion in malnutrition. Because preliminary balance data suggested inadequate magnesium intake , the protocol of clinical management was
Division of Research Resources, of Health through the administrative Clinical Research Center, Texas
Houston,
Texas.
Research
support
National support Children’s
is also
acknowledged from the David Underwood Trust, the National Dairy Council, the National Aeronautics and Space Administration NGR-44-003-053, and the National Institutes of Health 29-05721. 3 From the Biomedical Division, Instituto de Nutricion de Centro America y Panama, Guatemala City, Guatemala.
31: JANUARY
1978,
pp.
176-188.
Printed
in U.S.A.
MAGNESIUM TABLE Clinical
1 description
of subjects
Subject
SUPPLEMENTATION
IN
PCM
177
at time of admission
Age
Percent
Weight’
ofweight/
Percent
heit
0101cal de-
Infec-
of
height/age
tion
History
History of diarrhea
hydra-
of
Parenteral magnesium
edema
tion mo
Series
I” oral
magnesium 41.5±6
179-197
Series 199 201
kg
II oral
intake
magnesium
0.12 8.5±.4
mEq/kg/day
0.42
mEq/kg/day
intake
72.5±2.1
26 69
7.8 11.2
202
21
4.7
204 207
25 19
7.5 6.2
208 209
37 41
8.5 8.3
210
24
212 214
217 Mean
±
Series
III
SE Oral
66 68
86 83
+
65
11.5
78
85
+
5.3
±
magnesium
8.2
intake
0.6
±
0.41
218
30
219 220
35 52
221 222
19 49
225 226
34 32
7.9 5.1
227
45
9.4 ± 0.6
35.9 weights
of Reference
TABLE
14,
9.9 7.2
3.1
only
the
0 +
35
0
0
4/11
of dietary Dietary
36/8 45/10 43/20 34/16 34/16 32/16
52
32/16
0
4
22
40/19
0 0 0 1/10
1 5 1
35 12 3
47/22 6/2 0/0 31/13
7 ± 3
18 ± 5
5
18
0/0
+
+
8
16
0/0
0
0
5
0/0
98
91
+
7.6 11.3
84
80
+
2 8
96
91
+
0 0 0
40 5
10.4
87 62 93 83
88 93 87 83
74 90
73 80
8.6
85
following
summation
loss
is recorded
±
2.9
86
of edema here,
.
b
12 subjects
± 2
The
12 20
0/0 0/0 0/0
0/0
0
0
5
52
+
+
4
8
0/0
0
0
5
7
0/0
+
0
4
8
0/0
0
+
+
0 3/11
8 2
8 2
0/0 0/0
7/11 individual
studied.
Not
C
16 ± 4
5 ± 1
subjects
are
0/0
described
included
in Table
in Table
periods
and
1
4.
abbreviations
period
Abbreviation
Days
on diet
Protein
Caloric
intake
Admission
A,
0-1
0
35
A2 A3
2-7 8+
0.7 0.7
70 70
3.0-4.0
120
3.0-4.0 3.0-4.0 3.0-4.0 3.0-4.0 3.0+
120 120 120 120 120+
Therapeutic
T1
1-7
Recovery
T, T3 T4 T5 R
8-14 15-21 22-28 29-35 35+
Admission
These
controla subjects height
F had
all
been
on
intake
kcal!kg!day
g!kg!day
creatine
4 8 8 4 4 52
2
Summary
a
0/0
95 93 74
10.1
minimums
?
0 0 0
+
85 ± 1
2.7
±
+
4 8 12 0 2 4
7±1
94 79 84
5.8
±
are
72.2
6±1
total!
days
mEq/kg/day’
8.5 10.4
SE
0 0 0 0
6.8 8.1
39 40
±
0 0
26 47
215 216
Given
1/12
9.7
39 17
a
7/12
83 81 78 87 87 84 84 94
198 200
Mean
85±2
80 62 62 72 67 76 71 92
36.4
nEq
wk
10+
the
R diet
until
they
0.5-1 had
reached
100%
of
.0
normal
70
weight
for height
and
index.
As in the previous ment was divided into
protocol is outlined period (period A),
study
(14),
the
clinical
manage-
two general periods. This dietary in Table 2. During the admission
each
child
received
a maintenance
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/1/176/4650523 by Washington University at St Louis user on 02 July 2018
diet sufficient admission diet
to approximate nitrogen contained a casein based
provide 0.7 g of protein per kilogram per kilogram per day . The patient
cal
balance preparation
.
per day and was
kept
on
The to
70 the
NICHOLS
178
ET
AL.
maintenance diet for 2 or more weeks. As indicated elsewhere, this delayed institution of therapy has been well tolerated (21). At the beginning of the therapeutic period (period T), the dietary intake was adjusted over a four day period so that protein intake was 3 or 4 g and caloric intake was 120 per kilogram per day. The caloric adjustments were made by varying the quantity of sucrose, corn starch, casein, and corn oil in the diet (7). In the first series, the subjects received a dietary supplement of 4 mEq/kg per day of potassium given as a KC1 solution separate from the diet and a commercial electrolyte mix was given which provided an additional supplement of sodium, potassium, calcium , magnesium, and sulfate (see prior publication (14)). In the present series, an oral mineral mixture was formulated and given which included the K supplement and which provided 6 mEq K, 1 mEq Na, 0.5 mEq Ca, and 0.42 mEq mg per kilogram per day. A
vitamin mixture, as previously described given daily. All patients received penicillin for the first 10 days of hospitalization. The
children
were
cry, the R period. made after more diet. An additional dren
who
had
also
studied
(14),
nitrogen
at the
time
recovered
as
evidenced
plays
febrile
infections sis.
in inorganic
illnesses
were
0
excluded
from
the
to
n
U
The
and
fat-free
dry
expressed
Sub-
been
adjusted
creatinine
excretion
creatinine
height
index
surements
were
referred
serum The
proteins difference
were
(23).
The
ideal
to
all means
fully
height
is referred
to
anthropometric
Z
sium
clinical
group
oo 0
-
N
0 ret
‘-‘
Os
N
+1 +1 +1 +1 +1
+1
m
+1
so
N
so so
N
E
a
so C’
0. 0
a
.C
0
V
.c CO Ca C
I
a
0
ret
ret ret
N
ret
N
+1
+1 +1 +1 +1 Os 00 0 In
as
0
In
In
so
N
0000
N
ret
N
N
ret
ret
+1
+1
H U
N
‘.4
ret
et N
N N
N
+1 -
+1 0 Os
m
N
+1 +1 +1 +1
+1
0
ret
N
-
N
‘1
00
00
00
0
05
0
ret 0
Os “1’
In
ret 00
In
so
N
0
z
V
+1
00
‘‘
‘O
.E ‘C DO V ‘C V
‘-‘
N -
C
N
N
+1
+1 +1 +1 +1 +1 00 0 0 Os N 00 N N
+1 +1
so so
ret
0
00 00
N
so.ri 000
00000
+1
+1 +1 +1 +1 +1
CO
V
U
00
ret
a
+1 +1
ret
In
0
so
00
N
N
so ‘o
+1
N
I.. DO
ri
C
N
to
C
0
so
so
ret ret
+1 +1
+1 +1
In
+1
+1
Ca
-
+1
0005 00 00
V
N
so
0
0
N
0000
N
so m
CO
+1
+1 +1 +1
“1W In
N
m
N
Os
N
+1 +1
+1
+1 +1
00 N
In N
-
N
“1
N
+1
+1
E
-
000005
.C
a
0
H
0
to
N
ret ret
C
with the variance. ± standard
N
ret
I
Total
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/1/176/4650523 by Washington University at St Louis user on 02 July 2018
In
.
0
the
identical
C
‘C
The
.
N
N
+1
V
of the magnewere
so
00000
0
0.
CO
n
a
0. mto:
-
00
00
“1W
so
N
so ‘o
In N
-
In
0 -
In
0
00
so o
ret
N
N
a
0
U
characteristics
N
N .
a
F-U
supplemented
z
C
E
00,
Results The
CI)
ci) ri
+1 +1 +1 riN.N
+1
00 CO
mea-
standards.
are given
)
C
muscle for (Table 2). the chemical (14, 18, 19). at the same
measured by refractometry. between groups was tested t test or by analysis of
two-tail Student’s Unless otherwise noted error of the mean (SE).
Cet N
+1 +1 Os N
analy-
for
to the Boston
z
000
N
0.
of
Cl)
+1 +1 +1 +1 +1 ret - so m Os ri so Os Os
Os so
concentrations were calculated of fat-free wet weight (FFWW)
percent
Cl) Cl) Cl)
C 00
I
weight.
as
i H
Creatinine excretion was determined by the analytical procedure of Clark and Thompson (22). Both creatinine excretion and weight were adjusted to height and
N
0
z©zzz
N N
“
0
U
C
intervals. The muscle with the denominators
z
to
used to obtain 10-mg samples of quadriceps chemical analyses at each dietary subperiod The details of the biopsy procedure and analyses have been previously published Serum samples were obtained for analyses
have
Cl)
cOsso
C’
height inas part of Inclusion role that
scribed in prior publications (19, 20). The subjects were at bed rest only during the periods of observation. A percutaneous needle biopsy technique (18) was
techniques
0
CI) Cl) Cl)
N
C 0
analytical
In
0
In
0
and
In N
I..
de-
pIes,
C,,
NriN
The sam-
.
U
a
in periods
carmine
0
a normal
data
conducted
0
ocZZZ
+1 +1 +1
U
expressed on the basis of the three day periods. method of collection of dietary, fecal and urine
or
z
ZZtooZ
zzz
as
a
V
were
carbon
CI) Cl)
zzz .
are
studies by
C.,,
In
U
of 3
balance marked
Cl)
0
results
The
0
InO
Cl)
CI) Cl) Cl)
a
a
days
ZZZZo
0.
gastrointestinal
present
C,) Cl) Cl) Cl)
oZZ
was
retentions.
or specific
Cl)
In
of reoov-
by
00
zzz
In
This period reflected observations than 50 days on a full’ therapeutic series (F) was studied when chil-
retention
with
In
C,,
parenterally
percentage of weight/height and creatinine dcx, were placed on reduced protein intakes a separate protocol on protein requirements. of these subjects allows an evaluation of the jects
U
>
In >5
so
0.
4)
CO
C,)
+1 C CO V
MAGNESIUM
those
of the
previously
reported
SUPPLEMENTATION
group
except for a slight but significant in percent of ideal weight for
(14)
difference subjects in
series III (Table 1). The later group had a mean of 82 ± 2 compared to 73 ± 2 and 72 ± 3 in groups I and II, respectively (P < 0.005). The historical duration of edema was greater (17 ± 4 weeks) in the supplemented subjects of series II and III than in the unsupplemented subjects (7 ± 1 weeks).
All ous
other
clinical
in the
total
The
clinical
findings study
were
homogene-
of the supplemented
and unsupplemented patients to nutritional rehabilitation is outlined in Table 3 initial study (A1), the clinical indices lowed were identical except for a small statistically significant elevation in total
At
.
rum
proteins
nesium ± 0.1
in the
group
supplements; 4.3 g/100 ml, respectively.
In
order
to
to receive ± 0.2
differentiate
the
magnesium supplementation apeutic response to increased
folbut Se-
mag-
versus
3.9
effects
of
from the therprotein intake
a two-factor analysis of variance was performed (Table 4) In this statistical procedure the subjects in series I and II were .
divided
into
mate They
periods
A,
the therapeutic were also divided
supplemented supplemented
T, and
R to discrim-
response to protein. into those receiving
Mg (series (series I)
II) .
The
and
those
results
TABLE 4 Effects of dietary protein and supplementary two-factor analysis of variance Dependent
Total
serum
variable
proteins
Creatinine height indcx Weight/height index
Dietary
un-
of this
magnesium
protein
The
response
magnesium children recorded
obtained
during
muscle those
samples
of diet
period
the effect on serum
on recovery
Supplementary
magnesium
.
Interaction
0.001
1 .8OtNS
0.72tNS
0.66tNS
1 .21/NS
chloride
0.3OtNS
19.3/
B. Bradfield,
J.D.,
international
Magnesium supplementation calorie malnutrition1’ 2 B.
L. Nichols,
M.D.,
J. Alvarado,3
M.D.,
Ph.D.
nutrition
in protein-
C. F. Hazlewood,
Ph.D.,
and
F. Viteri,3M.D. ABSTRACT tion
has
The been
widespread
confirmed
observation
in Guatemalan
of magnesium children
The
.
depletion
magnesium
in edematous requirement
malnutriduring
initial
stages of therapy has been estimated as 2.7 mEq/kg per day. This may be achieved by adding 0.5 % MgSO4 . 7 H2O to a solution containing 15 % dextromaltase and 1 .5 % KCI which is used to dilute whole mil’ ; two parts milk and one part dilution mixture . The replacement of magnesium deficits was not essential for recovery from edematous malnutrition, however, the present evidence suggested that the rate of recovery was accelerated by approximately 2 weeks in those children who received the supplement. Am. J. din. Nutr. 31 : 176-188, 1978.
Magnesium
to occur
depletion
been
reported
in protein-calorie
numerous
malnutrition by 5). The lines of the reduced concentration
investigators
evidence of
has
are two;
magnesium
(1-1
in
serum
(1-6,
8,
14,
16)
and tissue (1-4, 8 1 1 1 2 1 5) along with excessive retention of magnesium in balance study (2 3 5 6 1 0, 1 6) and an analysis of ,
,
clinical therapy
,
,
,
,
,
benefits in response (7 9, 1 3 1 5) The ,
these findings is obscured in the observed chemical serum and muscle supplementation. mine the quantity
umented position. Materials Children
tion the Panama
magnesium
and clinical In this report, of magnesium
to meet the deficits from admission and magnesium
to
significance of by the variability composition of
.
,
present evaluate
supplement
to restore
and continuing the effect of a
which
serum
response to we deternecessary
has
and
been
doc-
muscle
com-
endematous
protein-calorie
The
general
clinical
features
of
these subjects are identical to those previously described by this unit (1 7). Informed consent was received from parent or guardian at the time of admission to the metabolic ward. 176
The American
which
make
Journal
ofClinical
Nutrition
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/1/176/4650523 by Washington University at St Louis user on 02 July 2018
up the magnesium
treated
in Table 1 . Nine of this second received from admission, magnesium into the gluteal muscles over a 9 (Table 1). Fatal cases were excluded
group is given study population
sulfate injections to 23 day period from the present
series. i
From
the
Section
of Nutrition
and
Gastroenterol-
ogy, Department of Pediatrics, Baylor College of Mcdicine, Houston, Texas. 2 Research support is acknowledged from the United States Public Health Service Research Grant RR-00188 from the General Clinical Research Centers
Hospital,
malnutri-
have been studied at the Biomedical Division of Institute of Nutrition of Central America and (INCAP).
changed after that study in order to increase oral magnesium intake from 0.12 to 0.42 mEq/kg per day. The clinical description of the 23 additional subjects
Program, Institutes of the
and methods with
This study consists of opportunistic observations on magnesium metabolism in children undergoing studies of nitrogen requirements during recovery from malnutrition. An initial group of 12 subjects were described in detail in our 1972 publication (14) on muscle potassium depletion in malnutrition. Because preliminary balance data suggested inadequate magnesium intake , the protocol of clinical management was
Division of Research Resources, of Health through the administrative Clinical Research Center, Texas
Houston,
Texas.
Research
support
National support Children’s
is also
acknowledged from the David Underwood Trust, the National Dairy Council, the National Aeronautics and Space Administration NGR-44-003-053, and the National Institutes of Health 29-05721. 3 From the Biomedical Division, Instituto de Nutricion de Centro America y Panama, Guatemala City, Guatemala.
31: JANUARY
1978,
pp.
176-188.
Printed
in U.S.A.
MAGNESIUM TABLE Clinical
1 description
of subjects
Subject
SUPPLEMENTATION
IN
PCM
177
at time of admission
Age
Percent
Weight’
ofweight/
Percent
heit
0101cal de-
Infec-
of
height/age
tion
History
History of diarrhea
hydra-
of
Parenteral magnesium
edema
tion mo
Series
I” oral
magnesium 41.5±6
179-197
Series 199 201
kg
II oral
intake
magnesium
0.12 8.5±.4
mEq/kg/day
0.42
mEq/kg/day
intake
72.5±2.1
26 69
7.8 11.2
202
21
4.7
204 207
25 19
7.5 6.2
208 209
37 41
8.5 8.3
210
24
212 214
217 Mean
±
Series
III
SE Oral
66 68
86 83
+
65
11.5
78
85
+
5.3
±
magnesium
8.2
intake
0.6
±
0.41
218
30
219 220
35 52
221 222
19 49
225 226
34 32
7.9 5.1
227
45
9.4 ± 0.6
35.9 weights
of Reference
TABLE
14,
9.9 7.2
3.1
only
the
0 +
35
0
0
4/11
of dietary Dietary
36/8 45/10 43/20 34/16 34/16 32/16
52
32/16
0
4
22
40/19
0 0 0 1/10
1 5 1
35 12 3
47/22 6/2 0/0 31/13
7 ± 3
18 ± 5
5
18
0/0
+
+
8
16
0/0
0
0
5
0/0
98
91
+
7.6 11.3
84
80
+
2 8
96
91
+
0 0 0
40 5
10.4
87 62 93 83
88 93 87 83
74 90
73 80
8.6
85
following
summation
loss
is recorded
±
2.9
86
of edema here,
.
b
12 subjects
± 2
The
12 20
0/0 0/0 0/0
0/0
0
0
5
52
+
+
4
8
0/0
0
0
5
7
0/0
+
0
4
8
0/0
0
+
+
0 3/11
8 2
8 2
0/0 0/0
7/11 individual
studied.
Not
C
16 ± 4
5 ± 1
subjects
are
0/0
described
included
in Table
in Table
periods
and
1
4.
abbreviations
period
Abbreviation
Days
on diet
Protein
Caloric
intake
Admission
A,
0-1
0
35
A2 A3
2-7 8+
0.7 0.7
70 70
3.0-4.0
120
3.0-4.0 3.0-4.0 3.0-4.0 3.0-4.0 3.0+
120 120 120 120 120+
Therapeutic
T1
1-7
Recovery
T, T3 T4 T5 R
8-14 15-21 22-28 29-35 35+
Admission
These
controla subjects height
F had
all
been
on
intake
kcal!kg!day
g!kg!day
creatine
4 8 8 4 4 52
2
Summary
a
0/0
95 93 74
10.1
minimums
?
0 0 0
+
85 ± 1
2.7
±
+
4 8 12 0 2 4
7±1
94 79 84
5.8
±
are
72.2
6±1
total!
days
mEq/kg/day’
8.5 10.4
SE
0 0 0 0
6.8 8.1
39 40
±
0 0
26 47
215 216
Given
1/12
9.7
39 17
a
7/12
83 81 78 87 87 84 84 94
198 200
Mean
85±2
80 62 62 72 67 76 71 92
36.4
nEq
wk
10+
the
R diet
until
they
0.5-1 had
reached
100%
of
.0
normal
70
weight
for height
and
index.
As in the previous ment was divided into
protocol is outlined period (period A),
study
(14),
the
clinical
manage-
two general periods. This dietary in Table 2. During the admission
each
child
received
a maintenance
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/1/176/4650523 by Washington University at St Louis user on 02 July 2018
diet sufficient admission diet
to approximate nitrogen contained a casein based
provide 0.7 g of protein per kilogram per kilogram per day . The patient
cal
balance preparation
.
per day and was
kept
on
The to
70 the
NICHOLS
178
ET
AL.
maintenance diet for 2 or more weeks. As indicated elsewhere, this delayed institution of therapy has been well tolerated (21). At the beginning of the therapeutic period (period T), the dietary intake was adjusted over a four day period so that protein intake was 3 or 4 g and caloric intake was 120 per kilogram per day. The caloric adjustments were made by varying the quantity of sucrose, corn starch, casein, and corn oil in the diet (7). In the first series, the subjects received a dietary supplement of 4 mEq/kg per day of potassium given as a KC1 solution separate from the diet and a commercial electrolyte mix was given which provided an additional supplement of sodium, potassium, calcium , magnesium, and sulfate (see prior publication (14)). In the present series, an oral mineral mixture was formulated and given which included the K supplement and which provided 6 mEq K, 1 mEq Na, 0.5 mEq Ca, and 0.42 mEq mg per kilogram per day. A
vitamin mixture, as previously described given daily. All patients received penicillin for the first 10 days of hospitalization. The
children
were
cry, the R period. made after more diet. An additional dren
who
had
also
studied
(14),
nitrogen
at the
time
recovered
as
evidenced
plays
febrile
infections sis.
in inorganic
illnesses
were
0
excluded
from
the
to
n
U
The
and
fat-free
dry
expressed
Sub-
been
adjusted
creatinine
excretion
creatinine
height
index
surements
were
referred
serum The
proteins difference
were
(23).
The
ideal
to
all means
fully
height
is referred
to
anthropometric
Z
sium
clinical
group
oo 0
-
N
0 ret
‘-‘
Os
N
+1 +1 +1 +1 +1
+1
m
+1
so
N
so so
N
E
a
so C’
0. 0
a
.C
0
V
.c CO Ca C
I
a
0
ret
ret ret
N
ret
N
+1
+1 +1 +1 +1 Os 00 0 In
as
0
In
In
so
N
0000
N
ret
N
N
ret
ret
+1
+1
H U
N
‘.4
ret
et N
N N
N
+1 -
+1 0 Os
m
N
+1 +1 +1 +1
+1
0
ret
N
-
N
‘1
00
00
00
0
05
0
ret 0
Os “1’
In
ret 00
In
so
N
0
z
V
+1
00
‘‘
‘O
.E ‘C DO V ‘C V
‘-‘
N -
C
N
N
+1
+1 +1 +1 +1 +1 00 0 0 Os N 00 N N
+1 +1
so so
ret
0
00 00
N
so.ri 000
00000
+1
+1 +1 +1 +1 +1
CO
V
U
00
ret
a
+1 +1
ret
In
0
so
00
N
N
so ‘o
+1
N
I.. DO
ri
C
N
to
C
0
so
so
ret ret
+1 +1
+1 +1
In
+1
+1
Ca
-
+1
0005 00 00
V
N
so
0
0
N
0000
N
so m
CO
+1
+1 +1 +1
“1W In
N
m
N
Os
N
+1 +1
+1
+1 +1
00 N
In N
-
N
“1
N
+1
+1
E
-
000005
.C
a
0
H
0
to
N
ret ret
C
with the variance. ± standard
N
ret
I
Total
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/1/176/4650523 by Washington University at St Louis user on 02 July 2018
In
.
0
the
identical
C
‘C
The
.
N
N
+1
V
of the magnewere
so
00000
0
0.
CO
n
a
0. mto:
-
00
00
“1W
so
N
so ‘o
In N
-
In
0 -
In
0
00
so o
ret
N
N
a
0
U
characteristics
N
N .
a
F-U
supplemented
z
C
E
00,
Results The
CI)
ci) ri
+1 +1 +1 riN.N
+1
00 CO
mea-
standards.
are given
)
C
muscle for (Table 2). the chemical (14, 18, 19). at the same
measured by refractometry. between groups was tested t test or by analysis of
two-tail Student’s Unless otherwise noted error of the mean (SE).
Cet N
+1 +1 Os N
analy-
for
to the Boston
z
000
N
0.
of
Cl)
+1 +1 +1 +1 +1 ret - so m Os ri so Os Os
Os so
concentrations were calculated of fat-free wet weight (FFWW)
percent
Cl) Cl) Cl)
C 00
I
weight.
as
i H
Creatinine excretion was determined by the analytical procedure of Clark and Thompson (22). Both creatinine excretion and weight were adjusted to height and
N
0
z©zzz
N N
“
0
U
C
intervals. The muscle with the denominators
z
to
used to obtain 10-mg samples of quadriceps chemical analyses at each dietary subperiod The details of the biopsy procedure and analyses have been previously published Serum samples were obtained for analyses
have
Cl)
cOsso
C’
height inas part of Inclusion role that
scribed in prior publications (19, 20). The subjects were at bed rest only during the periods of observation. A percutaneous needle biopsy technique (18) was
techniques
0
CI) Cl) Cl)
N
C 0
analytical
In
0
In
0
and
In N
I..
de-
pIes,
C,,
NriN
The sam-
.
U
a
in periods
carmine
0
a normal
data
conducted
0
ocZZZ
+1 +1 +1
U
expressed on the basis of the three day periods. method of collection of dietary, fecal and urine
or
z
ZZtooZ
zzz
as
a
V
were
carbon
CI) Cl)
zzz .
are
studies by
C.,,
In
U
of 3
balance marked
Cl)
0
results
The
0
InO
Cl)
CI) Cl) Cl)
a
a
days
ZZZZo
0.
gastrointestinal
present
C,) Cl) Cl) Cl)
oZZ
was
retentions.
or specific
Cl)
In
of reoov-
by
00
zzz
In
This period reflected observations than 50 days on a full’ therapeutic series (F) was studied when chil-
retention
with
In
C,,
parenterally
percentage of weight/height and creatinine dcx, were placed on reduced protein intakes a separate protocol on protein requirements. of these subjects allows an evaluation of the jects
U
>
In >5
so
0.
4)
CO
C,)
+1 C CO V
MAGNESIUM
those
of the
previously
reported
SUPPLEMENTATION
group
except for a slight but significant in percent of ideal weight for
(14)
difference subjects in
series III (Table 1). The later group had a mean of 82 ± 2 compared to 73 ± 2 and 72 ± 3 in groups I and II, respectively (P < 0.005). The historical duration of edema was greater (17 ± 4 weeks) in the supplemented subjects of series II and III than in the unsupplemented subjects (7 ± 1 weeks).
All ous
other
clinical
in the
total
The
clinical
findings study
were
homogene-
of the supplemented
and unsupplemented patients to nutritional rehabilitation is outlined in Table 3 initial study (A1), the clinical indices lowed were identical except for a small statistically significant elevation in total
At
.
rum
proteins
nesium ± 0.1
in the
group
supplements; 4.3 g/100 ml, respectively.
In
order
to
to receive ± 0.2
differentiate
the
magnesium supplementation apeutic response to increased
folbut Se-
mag-
versus
3.9
effects
of
from the therprotein intake
a two-factor analysis of variance was performed (Table 4) In this statistical procedure the subjects in series I and II were .
divided
into
mate They
periods
A,
the therapeutic were also divided
supplemented supplemented
T, and
R to discrim-
response to protein. into those receiving
Mg (series (series I)
II) .
The
and
those
results
TABLE 4 Effects of dietary protein and supplementary two-factor analysis of variance Dependent
Total
serum
variable
proteins
Creatinine height indcx Weight/height index
Dietary
un-
of this
magnesium
protein
The
response
magnesium children recorded
obtained
during
muscle those
samples
of diet
period
the effect on serum
on recovery
Supplementary
magnesium
.
Interaction
0.001
1 .8OtNS
0.72tNS
0.66tNS
1 .21/NS
chloride
0.3OtNS
19.3/
