The effects of choline, magnesium and combined choline and magnesium supplementation on the components of inflammatory and coagulation markers in patients with type 2 diabetes mellitus

Abstract

Background and aims: Diabetes mellitus is the most prevalent metabolic disease which has affected approximately 8.5% of adult population worldwide in 2013. Recent data have pointed out the important role of chronic low-grade inflammation in the pathophysiology of diabetes and metabolic defects. Metabolic failure is associated with dyslipidemia and coagulation which can result in a higher risk of cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). Several studies have shown that magnesium deficiency is associated with increased pro-inflammatory proteins involved in endothelial dysfunction, insulin resistance and development of T2DM. Choline is reported to have anti-inflammatory and anti-coagulant effect in animal models. The aims of this study were to assess the effects of choline and magnesium co-supplementation on metabolic parameters, inflammation and coagulation parameters in patients with T2DM.

Methods: In this randomized, double-blind, placebo-controlled trial, supplements of choline bitartrate (1000 mg/d), magnesium oxide (500 mg/d), choline plus magnesium at the same doses or placebo were administered for 2 months to 96 diabetic patients of both genders aged 30 - 60 years. Anthropometric characteristics [wieght, body mass index (BMI), body fat percent (BFP), waist circumference (WC), hip circumference (HP), waist to hip ratio (WHR)], dietary intake, physical activity, lipid profile [triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c ), high-density lipoprotein cholesterol (HDL-c)], metabolic state [fasting blood sugar (FBS), insulin, homeostasis model of assessment-estimated insulin resistance (HOMA-IR), glycosylated hemoglobin (HbA1c)], serum magnesium level, blood pressure [Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP)], inflammatory [interleukin-6 (IL-6), vascular cell adhesion molecule-1 (VCAM-1)] and coagulation [plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA)] markers were measured in all subjects. Food intake data were analyzed using Nutritionist IV. Data were analyzed by paired samples t-test, Wilcoxon, Chi-square, ANOVA and ANCOVA tests.

Results: The baseline characteristics were not significantly different among four groups. There were no significant differences in baseline daily intake of energy, carbohydrates, proteins, fats and magnesium. There were no significant differences in daily intake of energy among and within four groups. There was a significant change in serum magnesium in both magnesium (P = 0.02) and choline-magnesium groups (P < 0.001). In choline group, insulin (P = 0.04) and HOMA-IR (P = 0.01), BMI (P = 0.05), BFP (P = 0.01) significantly were decreased. Moreover, a significant change was found in SBP in magnesium group (P = 0.04). Patients who consumed choline-magnesium had a greater decrease in weight, BMI, BFP, WC, HR, and WHR, compared with baseline values. However, no significant differences were noticed among the four groups (P < 0.05); Compared to baseline values, there were significant differences in HDL-c (P = 0.01) and TG (P = 0.04), following choline-magnesium co-supplementation. HOMA-IR (P = 0.04) and DBP (P = 0.01) decreased significantly in the choline-magnesium group, compared to the baseline levels. Howevere, there were no significant differences in anthropometric measurements, lipid profile, and metabolic factors among four groups. Only a marginal difference was found in BMI among the study groups (P = 0.07). VCAM-1 levels decreased in choline group (P = 0.01).Significant differences were observed in PAI-1 (P = 0.01) and IL-6 (P = 0.02) levels in the magnesium group. When adjusted for potential confounders, inflammatory factors [IL-6 (P =0.01) and VCAM-1 (P =0.03)] and PAI-1 (P =0.03) decreased significantly in the choline-magnesium group as compared to other groups. Also a marginally significant increase was found in tPA compared to other groups (P = 0.05).

Conclusions: Overall, co-supplementation of magnesium and choline is more effective than their separate use to improve inflammation and coagulation in subjects with T2DM. However, further research is warrented to advise this supplements for preventaion of T2DM.