{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:02:48Z","timestamp":1791414168942,"version":"4.3.3"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T00:00:00Z","timestamp":1737331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82374367"],"award-info":[{"award-number":["82374367"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004479","name":"Natural Science Foundation of Jiangxi Province","doi-asserted-by":"publisher","award":["20232BAB206144"],"award-info":[{"award-number":["20232BAB206144"]}],"id":[{"id":"10.13039\/501100004479","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004479","name":"Natural Science Foundation of Jiangxi Province","doi-asserted-by":"publisher","award":["20242BAB26163"],"award-info":[{"award-number":["20242BAB26163"]}],"id":[{"id":"10.13039\/501100004479","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Jiangxi Province Key Laboratory of Traditional Chinese Medicine for Cardiovascular Diseases","award":["20242BCC32096"],"award-info":[{"award-number":["20242BCC32096"]}]},{"name":"NATCM's Project of High-level Construction of Key TCM Disciplines","award":["zyyzdxk-2023113"],"award-info":[{"award-number":["zyyzdxk-2023113"]}]},{"name":"Project of Key Discipline Construction Fund of Jiangxi University of Chinese Medicine","award":["2023jzzdxk032"],"award-info":[{"award-number":["2023jzzdxk032"]}]},{"name":"Science and Technology Innovation Team Development Program of Jiangxi University of Chinese Medicine","award":["CXTD22011"],"award-info":[{"award-number":["CXTD22011"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Both dietary magnesium and serum magnesium are associated with the prognosis of diabetic patients. However, the impact of the magnesium depletion score (MDS), which assesses systemic magnesium deficiency, on the prognosis of diabetic patients remains unclear. This cohort study aims to explore the potential association between the MDS and all-cause and cardiovascular mortality in diabetic patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In this study, we analyzed data from 5,219 diabetic individuals from National Health and Nutrition Examination Survey (NHANES) 2003\u20132018. Participant mortality information was sourced from the National Death Index records. MDS was divided into lower MDS (0\u20131 points), middle MDS (2 points), and higher MDS (3\u20135 points) groups. Weighted multivariable Cox regression was utilized to explore the potential association between MDS and mortality in diabetic patients. Stratified analyses and sensitivity analyses were employed to validate the robustness of our findings.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among the 5,219 participants included in this study, 1,212 experienced all-cause mortality, and 348 experienced cardiovascular mortality. Weighted multivariable Cox regression indicated that higher MDS was strongly linked to a heightened risk of mortality in all models, including the fully adjusted model (all-cause mortality: HR = 1.58, 95% CI: 1.20\u20132.08; cardiovascular mortality: HR = 1.92, 95% CI: 1.28\u20132.88). In the stratified analysis, we found that the association between MDS and all-cause mortality was stronger among individuals aged &lt;60 years. No significant differences were found in the relationship between MDS and mortality within other subgroups. In the sensitivity analyses, our results remained robust.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>An increase in MDS is significantly correlated with a higher risk of all-cause and cardiovascular mortality in diabetic patients. The risk of all-cause mortality was higher in diabetic patients aged &lt;60. Early monitoring and management of MDS, as well as optimizing magnesium nutritional status, may benefit diabetic patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0314298","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T18:45:43Z","timestamp":1737398743000},"page":"e0314298","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Higher magnesium depletion score increases the risk of all\u2011cause and cardiovascular mortality in US adults with diabetes"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2688-7910","authenticated-orcid":true,"given":"Hao","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"Kuang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5653-1968","authenticated-orcid":true,"given":"Qiang","family":"Wan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,20]]},"reference":[{"key":"pone.0314298.ref001","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1016\/S0140-6736(20)32374-6","article-title":"The Lancet Commission on diabetes: using data to transform diabetes care and patient lives","volume":"396","author":"JCN Chan","year":"2021","journal-title":"Lancet (London, England)."},{"key":"pone.0314298.ref002","doi-asserted-by":"crossref","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF diabetes atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"H Sun","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"key":"pone.0314298.ref003","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/S0140-6736(23)01301-6","article-title":"Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: A systematic analysis for the global burden of disease study 2021.","volume":"402","author":"GBD 2021 Diabetes Collaborators","year":"2023","journal-title":"Lancet"},{"key":"pone.0314298.ref004","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1016\/j.phrs.2016.09.040","article-title":"Prevalence and prevention of cardiovascular disease and diabetes mellitus","volume":"113","author":"P Balakumar","year":"2016","journal-title":"Pharmacol Res"},{"key":"pone.0314298.ref005","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1038\/nrneph.2015.173","article-title":"Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease","volume":"12","author":"MC Thomas","year":"2016","journal-title":"Nature Reviews Nephrology"},{"key":"pone.0314298.ref006","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1007\/s11892-019-1212-8","article-title":"Epidemiology of peripheral neuropathy and lower extremity disease in diabetes","volume":"19","author":"CW Hicks","year":"2019","journal-title":"Curr Diab Rep"},{"key":"pone.0314298.ref007","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1161\/ATVBAHA.119.310961","article-title":"Diabetes mellitus and cardiovascular disease","volume":"39","author":"AM Schmidt","year":"2019","journal-title":"Arteriosclerosis, Thrombosis, and Vascular Biology"},{"key":"pone.0314298.ref008","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.ecl.2021.05.001","article-title":"The changing nature of mortality and morbidity in patients with diabetes","volume":"50","author":"J Pearson-Stuttard","year":"2021","journal-title":"Endocrinol Metab Clin North Am"},{"key":"pone.0314298.ref009","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.3390\/nu13041136","article-title":"Magnesium: Biochemistry, Nutrition, Detection, and Social Impact of Diseases Linked to Its Deficiency.","volume":"13","author":"D Fiorentini","year":"2021","journal-title":"Nutrients"},{"key":"pone.0314298.ref010","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.3390\/ijms20061351","article-title":"Effects of magnesium deficiency on mechanisms of insulin resistance in type 2 diabetes: Focusing on the processes of insulin secretion and signaling","volume":"20","author":"K. Kostov","year":"2019","journal-title":"Int J Mol Sci"},{"key":"pone.0314298.ref011","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1210\/endrev\/bnac028","article-title":"Hypomagnesemia and cardiovascular risk in type 2 diabetes","volume":"44","author":"LJ Oost","year":"2023","journal-title":"Endocr Rev"},{"key":"pone.0314298.ref012","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s12916-016-0742-z","article-title":"Dietary magnesium intake and the risk of cardiovascular disease, type 2 diabetes, and all-cause mortality: A dose-response meta-analysis of prospective cohort studies.","volume":"14","author":"X Fang","year":"2016","journal-title":"BMC Med."},{"key":"pone.0314298.ref013","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.1093\/jn\/nxab138","article-title":"Magnesium depletion score (MDS) predicts risk of systemic inflammation and cardiovascular mortality among US adults.","volume":"151","author":"L Fan","year":"2021","journal-title":"J 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England)."},{"key":"pone.0314298.ref030","article-title":"Magnesium depletion score and metabolic syndrome in US adults: Analysis of NHANES 2003\u20132018.","author":"W X","year":"2024","journal-title":"The Journal of clinical endocrinology and metabolism"},{"key":"pone.0314298.ref031","doi-asserted-by":"crossref","first-page":"3062","DOI":"10.1007\/s12011-024-04073-z","article-title":"The association between dietary magnesium intake with chronic obstructive pulmonary disease and lung function in US population: A cross-sectional study","volume":"202","author":"Z-F Lin","year":"2024","journal-title":"Biol Trace Elem Res"},{"key":"pone.0314298.ref032","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1007\/s40620-022-01489-5","article-title":"Magnesium Depletion Score is Associated with Long-Term Mortality in Chronic Kidney Diseases: A Prospective Population-Based Cohort Study.","volume":"36","author":"S Yin","year":"2022","journal-title":"J Nephrol."},{"key":"pone.0314298.ref033","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1007\/s13300-024-01543-4","article-title":"Trends of HbA1c and BMI in people with type 2 diabetes: A japanese claims-based study","volume":"15","author":"K Hara","year":"2024","journal-title":"Diabetes Ther"},{"key":"pone.0314298.ref034","doi-asserted-by":"crossref","first-page":"156724","DOI":"10.1016\/j.cyto.2024.156724","article-title":"Inflammation-related miRNAs in obesity, CVD, and NAFLD","volume":"182","author":"SM Aghaei","year":"2024","journal-title":"Cytokine"},{"key":"pone.0314298.ref035","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.2337\/dc22-1353","article-title":"CRP, C-peptide, and risk of first-time cardiovascular events and mortality in early type 2 diabetes: A danish cohort study","volume":"46","author":"A Gedebjerg","year":"2023","journal-title":"Diabetes 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