title: A study of water hardness and the prevalence of hypomagnesaemia and hypocalcaemia in healthy subjects of Surat district (Gujarat).
abstract: BACKGROUND
  Various sources of drinking water, with varying levels of total hardness, and calcium and magnesium concentrations, are used by populations in different regions. The use of water purifiers can compound the problem of maintaining the desired levels of hardness. An inverse relationship between various conditions, including cardiovascular disease, and hard water has been reported. Until this study, investigation of the hardness of drinking water from different sources, and serum magnesium and calcium in normal subjects from the Surat district, had not been undertaken.
  
  
  OBJECTIVE
  This study was performed to assess the concentrations of calcium and magnesium, and total hardness in filtered and non-filtered water and the relationship with serum magnesium and calcium levels in normal subjects consuming such water.
  
  
  METHODS
  Three water samples were collected, at 15-day intervals, from 12 urban and rural areas of Surat; and also 10 different brands of bottled water. Samples were analyzed for total hardness and calcium by complexometric and EDTA methods respectively. Magnesium concentrations were obtained by subtraction of the calcium concentration from total hardness. Serum samples from healthy individuals were analyzed for magnesium and calcium using calmagite and arsenazo methods respectively. The independent t-test was used to establish significance at a level of 95%. A p-value <0.05 was considered significant.
  
  
  RESULTS
  Mean total hardness, and calcium and magnesium concentrations in non-filtered, rural tube-well water were much higher than in filtered water from the same area, and the magnesium concentrations were significantly higher (p = 0.038). Filtered urban municipal had lower hardness and concentrations of calcium and magnesium (p = 0.01) compared to corresponding non-filtered water. Significantly lower levels were observed in bottled water compared to rural and urban sources of water. Serum magnesium was significantly lower in the population who were consuming filtered water compared to those drinking non-filtered water (p<0.05). No such difference was observed for serum calcium.
  
  
  CONCLUSIONS
  Hypomagnesemia correlates with lower magnesium concentrations in drinking water (both rural tube-well and urban municipal waters), which can be attributed to the use of water purifiers. Assuming that a person consumes two liters of drinking water per day, it is estimated that there is an average loss of 160 mg (79%) of magnesium from total waterborne magnesium levels as a result of the filtration of both rural and urban water supplies. Bottled water is too hardness as in calcium and magnesium concentrations.
authors: Biochemistry, Surat Municipal Institute of Medical Education and Research, near Sahara Gate, Umarwada, Surat.
authors: Kirti C
authors: KC
authors: Kanadhia
authors: Biochemistry, Surat Municipal Institute of Medical Education and Research, near Sahara Gate, Umarwada, Surat.
authors: Divvi Venkata Subrahmanya Shri
authors: DV
authors: Ramavataram
authors: Biochemistry, Surat Municipal Institute of Medical Education and Research, near Sahara Gate, Umarwada, Surat.
authors: Shreeyas Prasad Dhanpal
authors: SP
authors: Nilakhe
authors: Biochemistry, Surat Municipal Institute of Medical Education and Research, near Sahara Gate, Umarwada, Surat.
authors: Swati
authors: S
authors: Patel
mesh_terms: D002118:Calcium / Q000032:analysis*; D060766:Drinking Water / Q000032:analysis* / Q000592:standards; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D006996:Hypocalcemia / Q000175:diagnosis / Q000453:epidemiology*; D007194:India / Q000453:epidemiology; D008274:Magnesium / Q000032:analysis*; D008275:Magnesium Deficiency / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D014881:Water Supply / Q000032:analysis* / Q000592:standards
chemical_list: D060766:Drinking Water; D008274:Magnesium; D002118:Calcium
keywords: RO water purifiers; calcium; cardiovascular diseases; hypomagnesemia; magnesium; water filters; water hardness