Chromium deficiency

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Chromium deficiency
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Chromium
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Chromium deficiency is described as the consequence of an insufficient dietary intake of the mineral chromium. Chromium was first proposed as an essential element for normal glucose metabolism in 1959, [1] but its biological function has not been identified. [2] Cases of deficiency were described in people who received all of their nutrition intravenously for long periods of time. [3]

Contents

The essentiality of chromium has been challenged. [4] [5] [6] Whereas the authorities in the European Union do not recognize chromium as an essential nutrient, [7] those in the United States do, and identify an adequate intake for adults as between 25 and 45 μg/day, depending on age and sex. [8] Dietary supplements containing chromium are widely available in the United States, with claims for benefits for fasting plasma glucose, hemoglobin A1C and weight loss. Reviews report the changes as modest, and without scientific consensus that the changes have a clinically relevant impact. [9] [10]

Signs and symptoms

The claimed symptoms of chromium deficiency caused by long-term total parenteral nutrition are severely impaired glucose tolerance, weight loss, peripheral neuropathy and confusion. [8] [11]

Diagnosis

According to the Dietary Reference Intake review, neither plasma nor urine concentrations can serve as useful clinical indicators of chromium status. Before chromium became a standard ingredient in total parenteral nutrition (TPN), people receiving TPN as their sole source of nutrition developed symptoms that were reversed within two weeks of chromium being added. [8]

Dietary recommendations

The U.S. Institute of Medicine (IOM) updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for chromium in 2001. For chromium, there was not sufficient information to set EARs and RDAs, so needs are described as estimates for Adequate Intakes (AIs). The current AIs for chromium for women are 25 μg/day for women ages 14–50 and 20 μg/day for older women. AI for pregnancy is 30 μg/day. AI for lactation is 45 μg/day. AI for men is 35 μg/day for ages 14–50 and 30 μg/day for older. For infants to children ages 1–13 years, the AI increases with age from 0.2 to 25 μg/day. As for safety, the IOM sets Tolerable upper intake levels (ULs) for vitamins and minerals when evidence is sufficient. In the case of chromium, there is not yet enough information and hence no UL. Collectively the EARs, RDAs, AIs and ULs are referred to as Dietary Reference Intakes (DRIs). [8]

Japan designates chromium as an essential nutrient, identifying 10 μg/day as an adequate intake for adults. [12]

The European Food Safety Authority (EFSA) refers to the collective set of information as Dietary Reference Values, with Population Reference Intake (PRI) instead of RDA, and Average Requirement instead of EAR. AI and UL are defined the same as in the United States. The EFSA does not consider chromium to be an essential nutrient, and so has not set PRIs, AIs or ULs. Chromium is the only mineral for which the United States and the European Union disagree on essentiality. [7] [13]

For U.S. food and dietary supplement labeling purposes, the amount in a serving is expressed as a percent of Daily Value (%DV). For chromium labeling purposes, 100% of the Daily Value was 120 μg, but as of 27 May 2016, it was revised to 35 μg to bring it into agreement with the RDA. [14] [15] Compliance with the updated labeling regulations was required by 1 January 2020, for manufacturers with $10 million or more in annual food sales, and by 1 January 2021 for manufacturers with less than $10 million in annual food sales. [16] [17] [18] During the first six months following the 1 January 2020 compliance date, the FDA plans to work cooperatively with manufacturers to meet the new Nutrition Facts label requirements and will not focus on enforcement actions regarding these requirements during that time. [16] A table of the old and new adult Daily Values is provided at Reference Daily Intake.

Sources

Approximately 2% of ingested chromium(III) is absorbed, with the remainder being excreted in the feces. Amino acids, vitamin C and niacin may enhance the uptake of chromium from the intestinal tract. After absorption, this metal accumulates in the liver, bone, and spleen. Trivalent chromium is found in a wide range of foods, including whole-grain products, processed meats, high-bran breakfast cereals, coffee, nuts, green beans, broccoli, spices, and some brands of wine and beer. [19] Most fruits and vegetables and dairy products contain only low amounts. [3]

Diabetes

Little strong evidence exists that chromium supplementation benefits people who have type 2 diabetes. One meta-analysis reported a statistically significant decrease in fasting plasma glucose levels (FPG) and a non-significant trend in lower hemoglobin A1C (HbA1C). [20] A second reported the same, [21] a third reported significant decreases for both measures, [22] while a fourth reported no benefit for either. [23] A review published in 2016 listed 53 randomized clinical trials that were included in one or more of six meta-analyses. It concluded that whereas there may be modest decreases in FPG and/or HbA1C that achieve statistical significance in some of these meta-analyses, few of the trials achieved decreases large enough to be expected to be relevant to clinical outcome. The authors also mentioned that trial design was for chromium as an addition to standard glycemic control medications, and so did not evaluate chromium as a first treatment for type 2 diabetes, or for prevention of progression from pre-diabetes to diabetes. The conclusion was that "...there is still little reason to recommend chromium dietary supplements to achieve clinically meaningful improvements in glycemic control." [9] The American Diabetes Association publishes a standards of care review every year. The 2018 review makes no mention of chromium supplementation as a possible treatment. [24]

Supplementation

Chromium supplementation in general is subject to a certain amount of controversy as it is by no means clear that chromium is an essential element in human biology. [25] Nevertheless, chromium is an ingredient in total parenteral nutrition, along with other trace minerals. [26] It is also in nutritional products for preterm infants. [27] Many chromium-containing products, including chromium chloride, chromium citrate, chromium(III) picolinate, chromium(III) polynicotinate are sold as non-prescription dietary supplements. [28]

Government-approved health claims

In 2005, the U.S. Food and Drug Administration approved a Qualified Health Claim for chromium picolinate with a requirement for very specific label wording: "One small study suggests that chromium picolinate may reduce the risk of insulin resistance, and therefore possibly may reduce the risk of type 2 diabetes. FDA concludes, however, that the existence of such a relationship between chromium picolinate and either insulin resistance or type 2 diabetes is highly uncertain." [29] In 2010, chromium(III) picolinate was approved by Health Canada to be used in dietary supplements. Approved labeling statements included: "...provides support for healthy glucose metabolism." [30] The European Food Safety Authority (EFSA) approved claims in 2010 that chromium contributed to normal macronutrient metabolism and maintenance of normal blood glucose concentration. [31]

See also

Related Research Articles

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<span class="mw-page-title-main">Vitamin</span> Nutrients required by organisms in small amounts

Vitamins are organic molecules that are essential to an organism in small quantities for proper metabolic function. Essential nutrients cannot be synthesized in the organism in sufficient quantities for survival, and therefore must be obtained through the diet. For example, vitamin C can be synthesized by some species but not by others; it is not considered a vitamin in the first instance but is in the second. Most vitamins are not single molecules, but groups of related molecules called vitamers. For example, there are eight vitamers of vitamin E: four tocopherols and four tocotrienols.

<span class="mw-page-title-main">Vitamin K</span> Fat-soluble vitamers

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Vitamin E is a group of eight fat soluble compounds that include four tocopherols and four tocotrienols. Vitamin E functions as a fat-soluble antioxidant which may help protect cell membranes from reactive oxygen species. Symptomatic vitamin E deficiency, which is rare and is usually caused by an underlying problem with digesting dietary fat rather than from a diet low in vitamin E, can cause neurological disorders. Various government organizations recommend that adults consume between 3 and 15 mg per day, whereas a worldwide review reported a median dietary intake of 6.2 mg per day. Foods rich in vitamin E include seeds, nuts, seed oils, peanut butter, and vitamin E-fortified foods.

Vitamin B<sub>6</sub> Class of chemically related vitamins

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<span class="mw-page-title-main">Dietary fiber</span> Portion of plant-derived food that cannot be completely digested

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A nutrient is a substance used by an organism to survive, grow and reproduce. The requirement for dietary nutrient intake applies to animals, plants, fungi and protists. Nutrients can be incorporated into cells for metabolic purposes or excreted by cells to create non-cellular structures such as hair, scales, feathers, or exoskeletons. Some nutrients can be metabolically converted into smaller molecules in the process of releasing energy such as for carbohydrates, lipids, proteins and fermentation products leading to end-products of water and carbon dioxide. All organisms require water. Essential nutrients for animals are the energy sources, some of the amino acids that are combined to create proteins, a subset of fatty acids, vitamins and certain minerals. Plants require more diverse minerals absorbed through roots, plus carbon dioxide and oxygen absorbed through leaves. Fungi live on dead or living organic matter and meet nutrient needs from their host.

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<span class="mw-page-title-main">Mineral (nutrient)</span> Chemical element required as an essential nutrient by organisms to perform life functions

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<span class="mw-page-title-main">Chromium(III) picolinate</span> Chemical compound

Chromium(III) picolinate is a chemical compound with the formula Cr(C5H4N(CO2H))3, commonly abbreviated as CrPic3. It is sold as a nutritional supplement to treat type 2 diabetes and promote weight loss. This bright-red coordination compound is derived from chromium(III) and picolinic acid. Trace amounts (25-35 mcg) of chromium are needed for glucose utilization by insulin in normal health, but deficiency is extremely uncommon and has been observed usually in people receiving 100% of their nutrient needs intravenously, i.e., total parenteral nutrition diets. Chromium has been identified as regulating insulin by increasing the sensitivity of the insulin receptor. As such, chromium(III) picolinate has been proposed as a treatment for type 2 diabetes, although its effectiveness remains controversial due to conflicting evidence from human trials.

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<span class="mw-page-title-main">Manganese in biology</span> Use of manganese by organisms

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<span class="mw-page-title-main">Selenium in biology</span> Use of Selenium by organisms

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Chromium is claimed to be an essential element involved in the regulation of blood glucose levels within the body. More recent reviews have questioned this, however.

References

  1. ↑ SCHWARZ, K; MERTZ, W (November 1959). "Chromium(III) and the glucose tolerance factor". Archives of Biochemistry and Biophysics. 85: 292–295. doi:10.1016/0003-9861(59)90479-5. PMID   14444068.
  2. ↑ Mertz, W (April 1993). "Chromium in human nutrition: a review". The Journal of Nutrition. 123 (4): 626–633. doi: 10.1093/jn/123.4.626 . PMID   8463863.
  3. 1 2 Expert group on Vitamins and Minerals (August 2002). "Review of Chromium" (PDF). Archived from the original (PDF) on 7 February 2012. Retrieved 24 February 2013.
  4. ↑ Vincent, John B. (2010). "Chromium: celebrating 50 years as an essential element?". Dalton Transactions. 39 (16): 3787–3794. doi:10.1039/B920480F. PMID   20372701.
  5. ↑ Jeejeebhoy, Khursheed N. (1999). "The role of chromium in nutrition and therapeutics and as a potential toxin". Nutrition Reviews. 57 (11): 329–335. doi: 10.1111/j.1753-4887.1999.tb06909.x . PMID   10628183.
  6. ↑ Vincent, JB (2013). "Chromium: Is It Essential, Pharmacologically Relevant, or Toxic?". Interrelations between Essential Metal Ions and Human Diseases. Metal Ions in Life Sciences. Vol. 13. pp. 171–198. doi:10.1007/978-94-007-7500-8_6. ISBN   978-94-007-7499-5. PMID   24470092.
  7. 1 2 "Overview on Dietary Reference Values for the EU population as derived by the EFSA Panel on Dietetic Products, Nutrition and Allergies" (PDF). 2017.
  8. 1 2 3 4 Chromium. IN: Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Chromium, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Chromium National Academy Press. 2001, pp. 197-223.
  9. 1 2 Costello RB, Dwyer JT, Bailey RL (2016). "Chromium supplements for glycemic control in type 2 diabetes: limited evidence of effectiveness". Nutr. Rev. 74 (7): 455–468. doi:10.1093/nutrit/nuw011. PMC   5009459 . PMID   27261273.
  10. ↑ Onakpoya I, Posadzki P, Ernst E (2013). "Chromium supplementation in overweight and obesity: a systematic review and meta-analysis of randomized clinical trials". Obes Rev. 14 (6): 496–507. doi:10.1111/obr.12026. PMID   23495911. S2CID   21832321.
  11. ↑ Freund, Herbert; Atamian, Susan; Fischer, Josef E. (February 1979). "Chromium deficiency during total parenteral nutrition". JAMA. 241 (5): 496–498. doi:10.1001/jama.1979.03290310036012. PMID   104057.
  12. ↑ Overview of Dietary Reference Intakes for Japanese (2015)
  13. ↑ Tolerable Upper Intake Levels For Vitamins And Minerals (PDF), European Food Safety Authority, 2006
  14. ↑ "Federal Register May 27, 2016 Food Labeling: Revision of the Nutrition and Supplement Facts Labels. FR page 33982" (PDF).
  15. ↑ "Daily Value Reference of the Dietary Supplement Label Database (DSLD)". Dietary Supplement Label Database (DSLD). Archived from the original on 7 April 2020. Retrieved 16 May 2020.
  16. 1 2 "FDA provides information about dual columns on Nutrition Facts label". U.S. Food and Drug Administration (FDA). 30 December 2019. Retrieved 16 May 2020.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  17. ↑ "Changes to the Nutrition Facts Label". U.S. Food and Drug Administration (FDA). 27 May 2016. Retrieved 16 May 2020.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  18. ↑ "Industry Resources on the Changes to the Nutrition Facts Label". U.S. Food and Drug Administration (FDA). 21 December 2018. Retrieved 16 May 2020.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  19. ↑ Lukaski, Henry C. (1999). "Chromium as a supplement". Annual Review of Nutrition. 19 (1): 279–302. doi:10.1146/annurev.nutr.19.1.279. PMID   10448525.
  20. ↑ San Mauro-Martin I, Ruiz-León AM, et al. (2016). "[Chromium supplementation in patients with type 2 diabetes and high risk of type 2 diabetes: a meta-analysis of randomized controlled trials]" (PDF). Nutr Hosp (in Spanish). 33 (1): 27. doi: 10.20960/nh.27 (inactive 22 June 2024). PMID   27019254.{{cite journal}}: CS1 maint: DOI inactive as of June 2024 (link)
  21. ↑ Abdollahi M, Farshchi A, Nikfar S, Seyedifar M (2013). "Effect of chromium on glucose and lipid profiles in patients with type 2 diabetes; a meta-analysis review of randomized trials" (PDF). J Pharm Pharm Sci. 16 (1): 99–114. doi: 10.18433/j3g022 . PMID   23683609. S2CID   22391896.
  22. ↑ Suksomboon N, Poolsup N, Yuwanakorn A (2014). "Systematic review and meta-analysis of the efficacy and safety of chromium supplementation in diabetes". J Clin Pharm Ther. 39 (3): 292–306. doi: 10.1111/jcpt.12147 . PMID   24635480. S2CID   22326435.
  23. ↑ Bailey CH (January 2014). "Improved meta-analytic methods show no effect of chromium supplements on fasting glucose". Biol Trace Elem Res. 157 (1): 1–8. doi:10.1007/s12011-013-9863-9. PMID   24293356. S2CID   2441511.
  24. ↑ Standards of Medical Care for Diabetes - 2018 Diabetes Care 2008:41:Supplement 1.
  25. ↑ Maret, Wolfgang (2019). "Chapter 9. Chromium Supplementation in Human Health, Metabolic Syndrome, and Diabetes". In Sigel, Astrid; Freisinger, Eva; Sigel, Roland K. O.; Carver, Peggy L. (eds.). Essential Metals in Medicine:Therapeutic Use and Toxicity of Metal Ions in the Clinic. Vol. 19. Berlin: de Gruyter GmbH. pp. 231–251. doi:10.1515/9783110527872-015. ISBN   978-3-11-052691-2. PMID   30855110.
  26. ↑ Stehle P, Stoffel-Wagner B, Kuhn KS (2016). "Parenteral trace element provision: recent clinical research and practical conclusions". Eur J Clin Nutr. 70 (8): 886–893. doi:10.1038/ejcn.2016.53. PMC   5399133 . PMID   27049031.
  27. ↑ Finch, C. W (2015). "Review of trace mineral requirements for preterm infants: What are the current recommendations for clinical practice?". Nutrition in Clinical Practice. 30 (1): 44–58. CiteSeerX   10.1.1.957.4763 . doi:10.1177/0884533614563353. PMID   25527182.
  28. ↑ "Chromium". Office of Dietary Supplements, US National Institutes of Health. 2016. Retrieved 26 June 2016.
  29. ↑ FDA Qualified Health Claims: Letters of Enforcement Discretion, Letters of Denial U.S. Food and Drug Administration, Docket #2004Q-0144 (August 2005).
  30. ↑ "Monograph: Chromium (from Chromium picolinate)". Health Canada. 9 December 2009. Retrieved 24 March 2015.
  31. ↑ Scientific Opinion on the substantiation of health claims related to chromium and contribution to normal macronutrient metabolism (ID 260, 401, 4665, 4666, 4667), maintenance of normal blood glucose concentrations (ID 262, 4667), contribution to the maintenance or achievement of a normal body weight (ID 339, 4665, 4666), and reduction of tiredness and fatigue (ID 261) pursuant to Article 13(1) of Regulation (EC) No 1924/2006 Archived 21 April 2020 at the Wayback Machine European Food Safety Authority EFSA J 2010;8(10)1732.

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