# Association between Magnesium Depletion Score and Advanced Cardiovascular-Kidney-Metabolic Syndrome Stages in US Adults

## TL;DR

This study finds that low magnesium levels are linked to more severe cardiovascular-kidney-metabolic syndrome in US adults.

## Contribution

The study introduces the magnesium depletion score (MgDS) as a novel predictor of advanced CKM syndrome stages.

## Key findings

- High MgDS levels (MgDS ≥ 2) are associated with increased odds of advanced CKM stages.
- MgDS shows a positive linear relationship with advanced CKM stages (P = 0.0003).
- The optimal MgDS cutoff for predicting advanced CKM stages is 2 with an ROC area of 0.7577.

## Abstract

Background: Cardiovascular-kidney-metabolic (CKM) syndrome is highly prevalent. Advanced CKM stages have the potential for multiorgan disease, premature mortality, and excess morbidity. Magnesium deficiency has a prominent impact on the components of CKM syndrome. However, the relationship between magnesium depletion score (MgDS) and the risk of developing advanced stages of CKM syndrome is still unclear.

Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. To investigate the relationship between MgDS categories and advanced CKM stages, we employed weighted multivariable logistic regression. Stratified and interaction analysis was conducted to find whether some demographics and lifestyle factors modified the association. Restricted cubic spline (RCS) analysis was implemented to investigate the dose-response relationships. Additionally, receiver operating characteristic (ROC) curve was plotted to assess the diagnostic accuracy of MgDS for advanced CKM stages.

Results: The study population comprised 18,038 participants aged 20 to 79 years. The multivariable logistic regression suggested that high MgDS levels (MgDS = 2 and ≥ 3) were associated with higher odds of having advanced CKM stages compared with low MgDS level (MgDS = 0) in all adjusted models (P < 0.05). Stratified and interaction analysis indicated that PIR had significant effects on the association (P for interaction < 0.05). The RCS regression analyses demonstrated a positive linear association between MgDS and the incidence of advanced CKM stages (P for overall = 0.0003, P for nonlinear = 0.1374). The MgDS predicted the area of the ROC curve of 0.7577 (P < 0.05) and the optimal cutoff value was 2.

Conclusions: Magnesium-depleted state as quantified by MgDS (MgDS ≥ 2) is a significant risk factor for advanced CKM stages, which suggests that identifying magnesium deficiency and improving the nutritional status of magnesium might mitigate the risk of advanced CKM stages.