This was the first study to examine the potential impact of a three-month Mg-focused nutritional education as a practical intervention on participants’ lipid profiles in Saudi Arabia [19]. Our research indicates that higher Mg intake correlates with better TC levels in patients with T2DM. However, TG, LDL, and HDL levels exhibited no significant changes. The findings highlight the critical role of Mg in lipid metabolism for this high-risk group. Considering the high prevalence of T2DM in Saudi Arabia, focusing on educating patients about Mg-rich foods provides a culturally tailored approach to addressing potential nutritional deficiencies. This strategy aligns with global efforts to integrate sustainable dietary modifications into diabetes management, emphasizing the broader relevance of such interventions for similar populations.

Our findings are consistent with previous work showing that low Mg intake is linked to high TC levels [25]. Numerous studies have suggested that serum Mg is linked to the lipid profile; specifically, patients with elevated levels of TC, TG, and LDL and reduced levels of HDL often exhibit lower Mg concentrations [16, 26, 27]. A systematic review of 12 randomized controlled trials demonstrated that Mg supplementation significantly reduced serum LDL levels (P = 0.006) but resulted in no significant improvement in TC, TG, or HDL levels among T2DM patients compared with controls. However, subgroup analysis showed that after receiving over 12 weeks of Mg supplementation, participants exhibited significantly lower serum TC levels. Additionally, supplementation doses below 300 mg significantly reduced serum LDL levels (P = 0.001). Doses over 300 mg were associated with increased serum HDL levels (P = 0.026), indicating that the effect of Mg treatment might be influenced by dose and duration [16]. Furthermore, a systematic review by Rodrigues et al. found that low serum Mg levels were linked to higher TC, TG, and LDL levels, as well as lower HDL levels in patients with diabetes [26].

According to Xu et al., the presence of T2DM appears to modify the association between the lipid profile and serum Mg, especially for LDL-C [28]. A study involving 8,163 Chinese adults, exploring the complex interplay between serum Mg, blood lipids, and T2DM found that blood lipid levels, excluding HDL-C, were generally correlated with serum Mg levels, with T2DM significantly influencing this relationship, particularly concerning LDL-C. Additionally, a recent study in American adults found that Mg-rich foods may prevent hyperlipidemia and diabetes [14].

It is difficult to reach a definite understanding of the nature of the association between Mg and lipid parameters due to the heterogeneity of the studies and the need to account for factors such as age, sex, BMI, glucose levels, and kidney function. Magnesium plays a crucial role in various cellular functions, influencing numerous aspects of the endocrine system. It also has a regulatory role on the activity of several enzymes involved in lipid metabolism, including lecithin-cholesterol acyl transferase, lipoprotein lipase, and desaturase. When individuals experience Mg deficiency, the activity of these enzymes is suppressed, resulting in undesirable changes in TG, LDL, HDL, and very low-density lipoprotein (VLDL) levels [29]. Low Mg levels may also increase the activity of HMG-CoA reductase, an enzyme responsible for cholesterol synthesis, resulting in hypercholesterolemia [7, 29]. A study emphasizing Mg’s potential role in influencing the connection between lipid profiles and cardiovascular risk revealed that Mg levels can impact the relationship between lipid parameters and a marker of atherosclerosis, specifically, the carotid intima media thickness (cIMT). When Mg levels were low, higher TG and LDL levels were linked to increased cIMT, and this association weakened when Mg levels were higher. These findings suggest that Mg may have a protective effect against the detrimental impact of dyslipidemia on cardiovascular health. Therefore, sufficient Mg levels may help mitigate the adverse effects of elevated TG and LDL on the development of atherosclerosis, as measured by cIMT [30].

Our study revealed that HDL-C was less responsive to the intervention. Indeed, raising HDL-C through dietary interventions is often challenging, because HDL-C levels are influenced by complex metabolic pathways [31]. Additionally, dietary limitations or individual variations in how the body responds to dietary components might have influenced the HDL-C response. For example, the specific types of fats and carbohydrates consumed can significantly impact HDL-C levels. Diets high in refined carbohydrates may counteract the benefits of healthy fats [32]. In addition, individual genetic predispositions can affect HDL-C metabolism, making it less responsive to dietary changes [31].

On the other hand, the observed changes in TG, TC, and LDL-C suggest a favorable shift in the lipid profile and have important clinical implications for cardiovascular risk in patients with T2DM. These alterations are associated with a decreased risk of atherosclerotic cardiovascular disease, which is prevalent in T2DM due to dyslipidemia and insulin resistance [28]. Research indicates that dietary Mg derived from whole food sources demonstrates superior health outcomes compared with supplemental forms, particularly in cardiovascular health management and hypertension control [33]. The advantages of food-based Mg are several, including enhanced bioavailability and natural nutrient synergy with compounds such as fiber and antioxidants, which are absent in supplemental forms [33]. Studies have shown that regular consumption of Mg-rich foods promotes sustainable long-term health benefits while minimizing the risk of excessive intake that can occur with supplementation [34].

Certainly, a significant contributor to dyslipidemia is an unhealthy diet, especially one rich in sugar, fat, and calories while lacking in vegetables, fruits, and whole grains [35]. Fruits, whole grains, and vegetables are excellent dietary sources of Mg. Therefore, it is plausible to hypothesize that the Mg content in the diet may be a potential risk factor for the development of dyslipidemia. However, more research is needed to establish a clear causal relationship between the amount of Mg consumed in the diet and lipid profile disturbances.

Additionally, it is crucial to recognize that much of the evidence linking Mg to serum lipid profiles comes from clinical studies involving oral Mg supplements, and that there is limited direct evidence on the efficacy of a Mg-focused diet in improving Mg intake. We conclude from our study that a Mg-focused educational program is effective as a standalone intervention. A systematic review found that structured nutrition-focused programs significantly improved dietary habits, including increased intake of essential nutrients, among specific populations. These programs can lead to measurable improvements in nutrient consumption, including Mg-rich foods [36].

There are several important limitations to consider. Firstly, the study's relatively small sample size and the female predominance may impact the generalizability of the findings. Secondly, the reliance on the MgFFQ and self-reported adherence for data on Mg intake may introduce limitations regarding data reliability. Recall could introduce bias and inaccuracies, which may impact the perceived effectiveness of the intervention. Future studies should focus on tackling factors hindering participant recruitment to increase sample size and gender diversity. In addition, repeated administration of the MgFFQ should be considered to enhance data accuracy and provide a clearer picture of adherence. Several strengths deserve attention, including the intervention's low cost and educational aspect, which significantly enhance its feasibility for wider implementation, especially in resource-constrained environments. Focusing on dietary intake through tailored education offers a sustainable and accessible solution for improving the intake of specific nutrients and, thus, nutritional habits in T2DM. Also, the study used the MgFFQ, which is a valid tool for measuring Mg intake, and followed up with patients every three weeks, which can help improve their adherence to consuming Mg-rich foods. The participants recruited in our sample were similar to individuals who may benefit from the study’s results. Furthermore, this study included a low-cost intervention involving nutritional education to enhance dietary Mg. It also incorporated repeated laboratory assessments, before and after the intervention, as an integral part of the within-subject design.