Chromium deficiency: Difference between revisions

'''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,<ref>{{cite journal|last1=SCHWARZ|first1=K|last2=MERTZ|first2=W|title=Chromium(III) and the glucose tolerance factor.|journal=Archives of Biochemistry and Biophysics|date=November 1959|volume=85|pages=292–295|pmid=14444068|doi=10.1016/0003-9861(59)90479-5}}</ref> andbut wasits widelybiological acceptedfunction ashas beingnot suchbeen by the 1990sidentified.<ref>{{cite journal|last1=Mertz|first1=W|title=Chromium in human nutrition: a review.|journal=The Journal of Nutrition|date=April 1993|volume=123|issue=4|pages=626–633|pmid=8463863|doi=10.1093/jn/123.4.626|doi-access=free}}</ref> Cases of deficiency were described in people who [[Parenteral nutrition|received all of their nutrition intravenously]] for long periods of time.<ref name=Expert>{{cite web|title=Review of Chromium |date=August 2002 |url=http://www.food.gov.uk/multimedia/pdfs/reviewofchrome.pdf |accessdate=24 February 2013 |author=Expert group on Vitamins and Minerals |url-status=dead |archive-url=https://web.archive.org/web/20120207123911/http://www.food.gov.uk/multimedia/pdfs/reviewofchrome.pdf |archive-date=7 February 2012 }}</ref>

The essentiality of chromium has been challenged.<ref name=Vincent>{{cite journal|last=Vincent|first=John B.|title=Chromium: celebrating 50 years as an essential element?|journal=Dalton Transactions|year=2010|volume=39|issue=16|pages=3787–3794|doi=10.1039/B920480F|pmid=20372701}}</ref><ref>{{cite journal |doi=10.1111/j.1753-4887.1999.tb06909.x |last=Jeejeebhoy |first=Khursheed N. |title=The role of chromium in nutrition and therapeutics and as a potential toxin |journal=Nutrition Reviews |volume=57 |issue=11 |pages=329–335 |year=1999 |pmid=10628183|doi-access=free }}</ref><ref name=Vincent2>{{cite book|last1=Vincent|first1=JB|titlechapter=InterrelationsChromium: betweenIs It Essential, MetalPharmacologically IonsRelevant, andor HumanToxic? Diseases|chaptertitle=Chromium:Interrelations isbetween itEssential essential,Metal pharmacologicallyIons relevant,and orHuman toxic?Diseases|year=2013|volume=13|pages=171–198|pmid=24470092|doi=10.1007/978-94-007-7500-8_6|isbn=978-94-007-7499-5|series=Metal Ions in Life Sciences}}</ref> Whereas the authorities in the European Union do not recognize chromium as an essential nutrient,<ref name="EFSA" /> 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.<ref name=ChromiumDRI/> [[Dietary supplement]]s 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.<ref name=Costello2016/><ref name=Onakpoya2013>{{cite journal |vauthors=Onakpoya I, Posadzki P, Ernst E |title=Chromium supplementation in overweight and obesity: a systematic review and meta-analysis of randomized clinical trials |journal=Obes Rev |volume=14 |issue=6 |pages=496–507 |date=2013 |pmid=23495911 |doi=10.1111/obr.12026 |s2cid=21832321 }}</ref>

Japan designatedesignates chromium as an essential nutrient, identifying 10 μg/day as an Adequateadequate Intakeintake for adults.<ref name=Japan>[http://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/Overview.pdf Overview of Dietary Reference Intakes for Japanese (2015)]</ref>

GivenLittle thestrong evidence forexists chromium deficiency causing problems with glucose management in the context of intravenous nutrition products formulated without chromium,<ref name=Stehle2016>{{cite journal |vauthors=Stehle P, Stoffel-Wagner B, Kuhn KS |title=Parenteral trace element provision: recent clinical research and practical conclusions |journal=Eur J Clin Nutr |volume=70 |issue=8 |pages=886–893 |date=2016 |pmid=27049031 |pmc=5399133 |doi=10.1038/ejcn.2016.53 }}</ref> research interest turned to whetherthat chromium supplementation forbenefits people who have type 2 diabetes but are not chromium deficient could benefit. Looking at the results from fourOne meta-analyses, oneanalysis reported a statistically significant decrease in fasting [[plasma glucose]] levels (FPG) and a non-significant trend in lower [[Glycated hemoglobin|hemoglobin A1C]] (HbA1C).<ref name=Mauro2016>{{cite journal |vauthors=San Mauro-Martin I, Ruiz-León AM, et al.|title=[Chromium supplementation in patients with type 2 diabetes and high risk of type 2 diabetes: a meta-analysis of randomized controlled trials] |language=es|journal=Nutr Hosp |volume=33 |issue=1 |pages=27 |date=2016 |pmid=27019254 |doi= 10.20960/nh.27|doi-access=free |url=https://www.redalyc.org/pdf/3092/309245772026.pdf }}</ref> A second reported the same,<ref name=Abdoll2013>{{cite journal |vauthors=Abdollahi M, Farshchi A, Nikfar S, Seyedifar M |title=Effect of chromium on glucose and lipid profiles in patients with type 2 diabetes; a meta-analysis review of randomized trials |journal=J Pharm Pharm Sci |volume=16 |issue=1 |pages=99–114 |date=2013 |pmid=23683609 |doi= 10.18433/j3g022|doi-access=free |url=http://pdfs.semanticscholar.org/40c6/0770c72b2d49c52548eef13cf3b4e2f031ea.pdf }}</ref> a third reported significant decreases for both measures,<ref name=Suk2014>{{cite journal |vauthors=Suksomboon N, Poolsup N, Yuwanakorn A |title=Systematic review and meta-analysis of the efficacy and safety of chromium supplementation in diabetes |journal=J Clin Pharm Ther |volume=39 |issue=3 |pages=292–306 |date=2014 |pmid=24635480 |doi=10.1111/jcpt.12147 |s2cid=22326435 |doi-access=free }}</ref> while a fourth reported no benefit for either.<ref>{{cite journal |vauthors=Bailey CH |title=Improved meta-analytic methods show no effect of chromium supplements on fasting glucose |journal=Biol Trace Elem Res |volume=157 |issue=1 |pages=1–8 |date=January 2014 |pmid=24293356 |doi=10.1007/s12011-013-9863-9 |s2cid=2441511 }}</ref> A review published in 2016 listed 53 [[randomized clinical trial]]s that were included in one or more of six [[meta-analysis|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."<ref name=Costello2016>{{cite journal |vauthors=Costello RB, Dwyer JT, Bailey RL |title=Chromium supplements for glycemic control in type 2 diabetes: limited evidence of effectiveness |journal=Nutr. Rev. |volume=74 |issue=7 |pages=455–468 |date=2016 |pmid=27261273 |doi=10.1093/nutrit/nuw011 |pmc=5009459 }}</ref> 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.<ref>[https://diabetesed.net/wp-content/uploads/2017/12/2018-ADA-Standards-of-Care.pdf Standards of Medical Care for Diabetes - 2018] Diabetes Care 2008:41:Supplement 1.</ref>

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.<ref>{{cite book |last1=Maret|first1=Wolfgang |editor1-last=Sigel|editor1-first=Astrid|editor2-last=Freisinger|editor2-first=Eva|editor3-last=Sigel|editor3-first=Roland K. O. |editor4-last=Carver|editor4-first=Peggy L. (Guest editor) |title=Essential Metals in Medicine:Therapeutic Use and Toxicity of Metal Ions in the Clinic|journal=Metal Ions in Life Sciences |volume=19 |date=2019 |publisher=de Gruyter GmbH|location=Berlin|isbn=978-3-11-052691-2|doi=10.1515/9783110527872-015|pmid=30855110|pages=231–251|chapter=Chapter 9. Chromium Supplementation in Human Health, Metabolic Syndrome, and Diabetes}}</ref> Nevertheless, chromium is an ingredient in [[total parenteral nutrition]], along with other trace minerals.<ref name=Stehle2016>{{cite journal |vauthors=Stehle P, Stoffel-Wagner B, Kuhn KS |title=Parenteral trace element provision: recent clinical research and practical conclusions |journal=Eur J Clin Nutr |volume=70 |issue=8 |pages=886–893 |date=2016 |pmid=27049031 |pmc=5399133 |doi=10.1038/ejcn.2016.53 }}</ref> It is also in nutritional products for [[preterm infant]]s.<ref>{{cite journal|pmid=25527182|year=2015|last1=Finch|first1=C. W|title=Review of trace mineral requirements for preterm infants: What are the current recommendations for clinical practice?|journal=Nutrition in Clinical Practice|volume=30|issue=1|pages=44–58|doi=10.1177/0884533614563353|citeseerx=10.1.1.957.4763}}</ref> Many chromium-containing products, including [[chromium chloride]], [[chromium citrate]], [[chromium(III) picolinate]], [[Chromium polynicotinate|chromium(III) polynicotinate]] are sold as non-prescription dietary supplements.<ref name=ods>{{cite web | url=https://ods.od.nih.gov/factsheets/Chromium-HealthProfessional/#h2 | title=Chromium | publisher=Office of Dietary Supplements, US National Institutes of Health | date=2016 | accessdate=26 June 2016}}</ref>