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Cited by 84Magnesium in Health and DiseaseNutritional Studies and DietMental Health Treatment and Access

Dietary magnesium and calcium intake and risk of depression in the general population: A meta-analysis

Open access
Li, Bingrong, Lv, Jing, Wang, Weijing, Zhang, Dongfeng·2017·Australian & New Zealand Journal of Psychiatry
DOI 10.1177/0004867416676895
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Abstract

Objective: Several epidemiological studies have evaluated the associations between dietary magnesium (Mg) and calcium (Ca) intake and the risk of depression. However, the results of these studies remain controversial. Thus, we performed a meta-analysis to explore these associations and to investigate the possible dose–response relationship between dietary Mg intake and risk of depression. Methods: MEDLINE, Web of Science, Embase, Cochrane CENTRAL, CINAHL database, Chinese National Knowledge Infrastructure, Wan fang databases and Databases of Chinese Scientific and Technical Periodicals were searched for eligible publications up to September 2016. Pooled relative risks with 95% confidence intervals were calculated using random-effects model. Publication bias was estimated using Egger’s test and the funnel plot. Dose–response relationship was assessed by restricted cubic spline functions. Results: A total of 17 epidemiological studies from 12 articles were included in the present meta-analysis. Among these studies, 11 studies evaluated the association between dietary Mg intake and risk of depression and 6 studies evaluated the association between dietary Ca intake and risk of depression. When comparing the highest with the lowest intake, the pooled relative risks of depression were 0.81 (95% confidence interval = [0.70, 0.92]) for Mg and 0.66 (95% confidence interval = [0.42, 1.02]) for Ca. Dietary Mg intake was significantly associated with a reduced risk of depression among studies conducted in Asia (relative risk = 0.57; 95% confidence interval = [0.44, 0.74]) and in studies adjusting for energy intake (relative risk = 0.73; 95% confidence interval = [0.58, 0.92]). For dose–response analysis, evidence of a nonlinear relationship was found between dietary Mg intake and risk of depression, and the largest risk reductions were observed for 320 mg/day. Conclusion: This meta-analysis indicated that moderate Mg intake may be inversely associated with the risk of depression, which still needs to be confirmed by larger prospective cohort studies.

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis of 17 observational studies found that higher dietary magnesium intake was associated with lower risk of depression, while dietary calcium intake was not significantly associated. A nonlinear dose-response analysis suggested the largest risk reduction around 320 mg/day of magnesium.

Key findings

  • Comparing highest vs lowest intake, pooled RR for depression was 0.81 (95% CI 0.70–0.92) for dietary magnesium and 0.66 (95% CI 0.42–1.02) for dietary calcium.
  • Magnesium intake was significantly associated with reduced depression risk in studies conducted in Asia (RR 0.57; 95% CI 0.44–0.74) and in studies adjusting for energy intake (RR 0.73; 95% CI 0.58–0.92).
  • Dose-response analysis found a nonlinear relationship between dietary magnesium and depression (p for nonlinearity = 0.0038), with RRs of 0.93 (0.88–0.98), 0.86 (0.77–0.97), 0.87 (0.78–0.98), 0.93 (0.81–1.06), and 1.03 (0.86–1.24) at 138, 320, 361, 465, and 581 mg/day, respectively; largest risk reductions were observed at 320 mg/day.
  • After excluding studies contributing to heterogeneity, magnesium remained significant (RR 0.72; 95% CI 0.60–0.86), and calcium became inversely associated (RR 0.71; 95% CI 0.56–0.91).

Methods

  • Systematic review and dose-response meta-analysis following PRISMA; searched MEDLINE, Web of Science, Embase, Cochrane CENTRAL, CINAHL, CNKI, Wanfang, and VIP up to September 2016.
  • Included 17 epidemiological studies from 12 articles: 11 studies on dietary magnesium and depression, 6 on dietary calcium and depression; eligible designs were cohort, case-control, or cross-sectional in general-population samples.
  • Pooled relative risks with 95% CIs using a random-effects model; heterogeneity assessed with I²; meta-regression, leave-one-out sensitivity, influence analysis, Egger’s test/funnel plot, and restricted cubic spline dose-response analysis were used.

Limitations

  • The paper states that potential confounders adjusted for differed across studies, and residual confounding should be of concern.
  • The paper states that publication bias was found in the magnesium analysis, though it was not evident after removing two studies with strong effects on heterogeneity; depression assessment methods and cut-offs were inconsistent across included studies.
  • The paper states that in subgroup analysis by study design, the inverse association between magnesium intake and depression risk in cohort studies was not statistically significant, possibly due to the limited number of cohort studies; further prospective cohort studies are needed.
  • Evident from the text: the calcium pooled estimate was not statistically significant, and moderate heterogeneity was present in both magnesium (I² = 69.6%) and calcium (I² = 51.6%) analyses.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1177/0004867416676895

Cites

54 of 54 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 8 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The pooled relative risk of depression remained significant for studies conducted in adults after excluding the single study conducted in adolescents (RR = 0.83; 95% CI 0.72-0.94).

    “The results remained significant (RR = 0.83; 95% CI = [0.72,0.94]) for studies conducted in adults, after excluding the single study conducted in adolescents.”
    Quote in the paperSubstantial claim
  • Findingown data

    The association between dietary magnesium intake and depression became significant when intake was above 76 mg/day and below 360 mg/day.

    “The association became significant when the dietary Mg intake was above 76 mg/day and below 360 mg/day”
    Quote in the paperSubstantial claim
  • Findingown data

    Moderate heterogeneity was found in the analysis of dietary calcium intake and depression (I2 = 51.6%; p for heterogeneity = 0.066).

    “Moderate heterogeneity was found in the analyses of dietary Mg (I 2 = 69.6%;p for heterogeneity < 0.001) and Ca intake (I 2 = 51.6%;p for heterogeneity = 0.066) and risk of depression.”
    Quote in the paperNot a substantial claim
  • Findingown data

    After removing two studies (Aparicio et al., 2013; Tarleton and Littenberg, 2015), no significant publication bias was found in the magnesium-depression analysis (p = 0.06).

    “However, no significant publication bias was found (p = 0.06; Figure 5) after removing two studies (Aparicio et al., 2013;Tarleton and Littenberg, 2015), which had strong effect on heterogeneity.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The pooled relative risk of depression for studies without adjustment for BMI was 0.80 (95% CI 0.67-0.95).

    “and 0.80 (95% CI = [0.67,0.95]) for those without adjustment for BMI.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 7
  • Classified as probably not a substantial claim. 18

  • May combine two claims.

    Findingown data

    After excluding the two studies that contributed to heterogeneity, heterogeneity decreased (I2 = 24.1%, p = 0.229) and the result remained significant (RR = 0.72; 95% CI 0.60-0.86).

    “After further excluding these two studies, the heterogeneity decreased (I 2 = 24.1%,p = 0.229) and the result remained significant (RR = 0.72; 95% CI = [0.60,0.86]).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    After excluding the study that contributed to heterogeneity, heterogeneity decreased (I2 = 0.0%, p = 0.791) and an inverse association was found between dietary calcium intake and risk of depression (RR = 0.71; 95% CI 0.56-0.91).

    “After further excluding this single study, the heterogeneity decreased (I 2 = 0.0%, p = 0.791), and an inverse association was found between dietary Ca intake and risk of depression (RR = 0.71; 95% CI = [0.56,0.91]).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A moderate level of Mg intake was found.

    “A moderate level of Mg intake was found”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    The meta-analysis included a large number of participants.

    “this study included a large number of participants”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the subgroup analysis stratified by study design, an inverse association between Mg intake and depression risk was found in cohort studies, but it was not statistically significant.

    “in the subgroup analysis stratified by study design, an inverse association between Mg intake and depression risk was found in cohort studies, but it was not statistically significant.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In subgroup analyses by continent, heterogeneity decreased to 0% for studies in Asia, 0% in America, and 5.8% in Europe.

    “In subgroup analyses by continent, the heterogeneity decreased to 0% for studies carried out in Asia, 0% in America and 5.8% in Europe.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Clinical interview methods were used to assess depression symptoms in two included studies, a minority of the included studies.

    “Clinical interview methods were used to assess depression symptoms in two included studies.”
    • Also stated in: § Australian & New Zealand Journal of Psychiatry, 51(3) · plain
      “Clinical interview methods were used in the minority of the included studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    320 mg/day is approximate to the recommended intake level in China.

    “As a matter of fact, 320 mg/day is approximate to recommended intake level in China (Cheng Yiyong, 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Cheng Yiyong, 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The meta-analysis was conducted following the PRISMA guideline.

    “We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline in this meta-analysis (Moher et al., 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Moher et al., 2010

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two investigators independently searched articles and reviewed all retrieved studies, with disagreements resolved by a third investigator.

    “Two investigators (B.R.L. and W.J.W.) searched articles and reviewed all retrieved studies independently.If the two investigators disagreed about the eligibility of an article, it was solved through discussion with a third investigator (D.F.Z. or J.L.).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Publication bias was assessed with visual inspection of the funnel plot and Egger test.

    “Publication bias was assessed with visual inspection of the funnel plot (Higgins et al., 2011) and Egger test (Egger et al., 1997).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Higgins et al., 2011

      Not checked in the free run.

    • cites Egger et al., 1997

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Leave-one-out sensitivity analysis was carried out to evaluate key studies affecting between-study heterogeneity.

    “The leave-one-out sensitivity analysis (Patsopoulos et al., 2008) was carried out to evaluate the key studies that have substantial impacts on the between-study heterogeneity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Patsopoulos et al., 2008

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Differences in adjusted confounders may affect the results to some extent.

    “it may affect the results to some extent”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The non-significant inverse association in cohort studies may be due to the limited number of cohort studies.

    “It may be due to the limited number of cohort studies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Differences in depression assessment methods may have contributed to between-study heterogeneity.

    “Presumably, differences in depression assessment methods may have contributed to the heterogeneity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The significant association in both BMI-adjusted and unadjusted studies indicates the stability and accuracy of the results.

    “indicating the stability and accuracy of the results.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Study design and conductreasoning

    Adjustment for potential confounders increases the credibility of the results.

    “increasing the credibility of the results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data

    The accuracy of the results in this study may contribute to the heterogeneity due to the small sample size.

    “The accuracy of the results in this study may contribute to the heterogeneity due to the small sample size.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The validity and reliability of different scales may affect the results.

    “The validity and reliability of different scales may affect the results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    An influence analysis was carried out with one study removed at a time to assess whether results could be affected by a single study.

    “To assess whether the results could have been affected distinctly by a single study, an influence analysis was carried out with one study removed at a time (Tobias, 1999).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Tobias, 1999

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Study design and conductreasoning

    Including a large number of participants allows a much greater possibility of reaching reasonable conclusions.

    “allowing a much great possibility of reaching reasonable conclusions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Differences in estimated methods of nutrient intake may be an important determinant of between-study heterogeneity.

    “Furthermore, many different estimated methods of nutrient intake were reported, such as Nutrica software, Norwegian Food Composition table and so on, which may be an important determinant in the heterogeneity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The strongest association in studies conducted in Asia may be due to the majority of included studies being conducted in Asia.

    “The pooled results of studies conducted in Asia showed the strongest association may be due to that the majority of included studies were conducted in Asia.”
    Quote in the paperNot a substantial claim
23 of 23

  • The paper relies on this without support.

    Between-study heterogeneity in meta-analysis is commonly caused by sample characteristics, population stratification, measurement of Mg and Ca intake, and variation in covariates.

    “Between-study heterogeneity is common in meta-analysis because of characteristics of the sample, diversity in population stratification, measurement of Mg and Ca intake, variation of the covariates etc.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • According to meta-analyses, both insufficient dietary magnesium intakes and low magnesium biological status are associated with a higher risk of depression.

    “According to meta-analyses, both insufficient dietary magnesium intakes [182,183] and low magnesium biological status [184] are associated with a higher risk of depression.”

    From Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence (2020) · cites this paper as [183]

  • Depressive symptoms can be mitigated by appropriate magnesium supplementation, as suggested by a recent meta-analysis in which more than half of studies indicated a decreased risk of depression with higher magnesium intakes, the largest risk reduction being observed with 320 mg/day.

    “depressive symptoms can also be mitigated by appropriate magnesium supplementation, as suggested by a recent meta-analysis in which more than half of the studies indicated a decreased risk of depression with higher magnesium intakes, the largest risk reduction being observed with 320 mg/day [183].”

    From Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence (2020) · cites this paper as [183]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Significant magnesium association reported above the stated cutoff

    Minor

    The discussion places the significant association below 360 mg/day, but the reported estimate at 361 mg/day is also significant: its 95% confidence interval excludes 1.

  • Figure 4 is identified as two different analyses

    Minor

    The results cite Figure 4 for the pooled calcium estimate, but the Figure 4 caption identifies it as a funnel plot of magnesium intake after two studies were removed.

  • Figure 5 is identified as two different analyses

    Minor

    The results cite Figure 5 for publication bias after removing two magnesium studies, but the Figure 5 caption identifies it as a forest plot of calcium intake.

3 of 3

Cites

Flagged first, then by citations

1 of the 55 references couldn’t be matched to a known paper.

Research works printed but not linked: 7

  1. Aparicio A, 2013, Annals of Nutrition and Metabolism, 63, 744
  2. Bourre JM, 2006, The Journal of Nutrition, Health & Aging, 10, 377
  3. Cheng Yiyong CSN, 2014, Acta Nutrimenta Sinica, 36, 313
  4. Kohn R, 2004, Bulletin of the World Health Organisation, 82, 858
  5. Oishi J, 2009, Acta Medica Okayama, 63, 9
  6. Tobias A, 1999, Stata Technical Bulletin, 8, 15
  7. Wan J (2006) The protective effects of magnesium on neuro. PhD Thesis, East China Normal University, China. Available at: www.cnki.net/KCMS/detail/detail.aspx?QueryID=1&CurRec=1&recid=&filename=2006124193.nh&dbname=CMFD0506&dbcode=CMFD&pr=&urlid=&yx=&v=MzIzODNVUkx5ZVorUnRGeWpsVUwzQVYxMjdHTEs2R3RERnJKRWJQSVI4ZVgxTHV4WVM3RGgxVDNxVHJXTTFGckM= (accessed 22 October, 2016).

Cited by

Sorted by citations

Related

Authors
Li, B., Lv, J., Wang, W., & Zhang, D.
Affiliations
  • Qingdao University (CN)
  • Affiliated Hospital of Qingdao University (CN)
Corresponding author
Zhang, Dongfeng
ORCID
Venue
Australian & New Zealand Journal of Psychiatry
Publisher
SAGE Publications
Published
2016-11-02
Volume
51
Issue
3
Pages
219-229
ISSN
  • 0004-8674 (ISSN-L)
  • 1440-1614
DOI
10.1177/0004867416676895
OpenAlex
W2547997311
Semantic Scholar
78e2672c5ce54d64461c9d7245649b9815147d17
Cited by
84
References
55
Citations by year
2026: 4 · 2025: 8 · 2024: 13 · 2023: 13 · 2022: 10 · 2021: 9 · 2020: 9 · 2019: 5 · 2018: 11 · 2017: 2
FWCI
0.81
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Australian & New Zealand Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Magnesium in Health and Disease
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
dietary magnesium, dietary calcium, depression risk, dose-response relationship, nonlinear relationship, mineral intake, Asian populations
MeSH terms
Calcium, Depression, Diet, Humans, Magnesium

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