Magnesium intake, bone mineral density, and fractures: results from the Women's Health Initiative Observational Study.

BACKGROUND: Magnesium is a necessary component of bone, but its relation to osteoporotic fractures is unclear. OBJECTIVE: We examined magnesium intake as a risk factor for osteoporotic fractures and altered bone mineral density (BMD). DESIGN: This prospective cohort study included 73,684 postmenopausal women enrolled in the Women's Health Initiative Observational Study. Total daily magnesium intake was estimated from baseline food-frequency questionnaires plus supplements. Hip fractures were confirmed by a medical record review; other fractures were identified by self-report. A baseline BMD analysis was performed in 4778 participants. RESULTS: Baseline hip BMD was 3% higher (P < 0.001), and whole-body BMD was 2% higher (P < 0.001), in women who consumed >422.5 compared with <206.5 mg Mg/d. However, the incidence and RR of hip and total fractures did not differ across quintiles of magnesium. In contrast, risk of lower-arm or wrist fractures increased with higher magnesium intake [multivariate-adjusted HRs of 1.15 (95% CI: 1.01, 1.32) and 1.23 (95% CI: 1.07, 1.42) for quintiles 4 and 5, respectively, compared with quintile 1; P-trend = 0.002]. In addition, women with the highest magnesium intakes were more physically active and at increased risk of falls [HR for quintile 4: 1.11 (95% CI: 1.06, 1.16); HR for quintile 5: 1.15 (95% CI: 1.10, 1.20); P-trend < 0.001]. CONCLUSIONS: Lower magnesium intake is associated with lower BMD of the hip and whole body, but this result does not translate into increased risk of fractures. A magnesium consumption slightly greater than the Recommended Dietary Allowance is associated with increased lower-arm and wrist fractures that are possibly related to more physical activity and falls.

Evaluation of a short-term medical mission to Syrian refugee camps in Turkey.

BACKGROUND: The escalating political and humanitarian crisis in Syria has left thousands detained, killed or displaced in neighboring countries. Given the permission and co-operation of the Turkish health authorities, a short-term medical mission to the Syrian refugee camps in the Hatay province was arranged. MATERIALS AND METHODS: To assess this mission's impact and potential expansion to serve other more emergently inflicted areas both inside and outside the Syrian borders, an evaluation was conducted via survey questionnaire of participating physicians. RESULTS: While almost all respondents found the experience worthwhile and fulfilling, medical, social and educational challenges as well as possible solutions were outlined. CONCLUSION: The use of several specified principles to further guide efforts towards providing service, education, relief, and awareness would result in greater effect, sustainability and growth of the mission.

The effect of glycemic variability on counterregulatory hormone responses to hypoglycemia in young children and adolescents with type 1 diabetes.

BACKGROUND: Glycemic variability (GV) is associated with hypoglycemia and possibly diabetes-related outcomes. We hypothesized that GV and glucose excursion risk may predict counterregulatory (CR) hormone responses to hypoglycemia. RESEARCH DESIGN AND METHODS: This is a secondary analysis of a Diabetes Research in Children Network study containing continuous interstitial glucose monitoring records for 28 patients with type 1 diabetes between 3 to <8 or 12 to <18 years of age. GV and excursion measures, including continuous overall net glycemic action (CONGA), High Blood Glucose Index (HBGI), Low Blood Glucose Index (LBGI), and coefficient of variation (CV), were calculated 72 h prior to insulin-induced hypoglycemia. CR hormones were measured during the progressive fall in plasma glucose. RESULTS: CV was inversely correlated with change in glucagon concentration (r=-0.41, P=0.046), but CONGA (log-transformed for better fit of the models) was not statistically significant in univariate analysis (r=-0.34, P=0.10). Other CR hormones were not significantly associated with measures of variability. In multivariate analysis, higher CONGA, but not CV, was associated with a smaller rise in glucagon following induced hypoglycemia (estimate=-9.73, P=0.048), independent of hemoglobin A1c, duration of diabetes, and insulin dose. HBGI, LBGI, and antecedent time spent in hypoglycemia were not significantly correlated with CR response to subsequent hypoglycemia. CONCLUSIONS: CV and CONGA may be predictors of impaired glucagon responses to insulin-induced hypoglycemia in patients with type 1 diabetes. Further study is indicated to characterize the role of GV and glycemic excursions on the defensive response to hypoglycemia.