Chromium deficiency
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2008-06-23T22:53:46Z
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{{Infobox_Disease |
Name = Chromium deficiency |
Image = Cr-TableImage.png |
Caption = [[Chromium]] |
DiseasesDB = 2625 |
ICD10 = {{ICD10|E|61|4|e|50}} |
ICD9 = |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
MeshID = |
}}
'''Chromium deficiency''' is a disorder that results from an insufficient dietary intake of [[chromium]]. If such a deficiency ever occurs in people eating a normal diet is debated,<ref>{{cite journal |author=Jeejeebhoy KN |title=The role of chromium in nutrition and therapeutics and as a potential toxin |journal=Nutr. Rev. |volume=57 |issue=11 |pages=329–35 |year=1999 |pmid=10628183}}</ref><ref name=Porter>{{cite journal |author=Porter DJ, Raymond LW, Anastasio GD |title=Chromium: friend or foe? |journal=Arch Fam Med |volume=8 |issue=5 |pages=386–90 |year=1999 |pmid=10500510 |url=http://archfami.ama-assn.org/cgi/pmidlookup?view=long&pmid=10500510 |doi=10.1001/archfami.8.5.386}}</ref> and clear cases of deficiency have only been observed in hospital patients who were fed defined liquid diets intravenously for long periods of time.<ref name=Expert>[http://www.food.gov.uk/multimedia/pdfs/reviewofchrome.pdf Review of Chromium] Expert group on vitamins and minerals: Review of chromium, 12 August 2002</ref> Although chromium is an essential [[trace element]] in humans the basis for this need is not fully understood, since no chromium-containing biomolecules with beneficial effects have been characterized.<ref name=Vincent>John B. Vincent "Chromium: Biological Relevance" in Encyclopedia of Inorganic Chemistry, John Wiley: New York, 2005.</ref><ref name=Stearns>{{cite journal |author=Stearns DM |title=Is chromium a trace essential metal? |journal=Biofactors |volume=11 |issue=3 |pages=149–62 |year=2000 |pmid=10875302}}</ref>
==Use of chromium in the body==
[[Trivalent]] chromium is the state that has been discussed as a possible essential [[trace metal]], [[hexavalent chromium]] is toxic and [[mutagenic]].
Trivalent chromium was thought to be a constituent in the so-called glucose tolerance factor (GTF). GTF has been hypothesised to be a metalloprotein complex that is formed when the oligopeptide chromodulin, which consists of the four amino acid residues aspartate, cysteine, glutamate, and glycine, is bonded with four (Cr<sup>3+</sup>) centers. Some studies have suggested that chromodulin could bind to the [[insulin receptor]] and stimulate insulin signaling.<ref>{{cite journal |author=Vincent JB |title=Recent advances in the nutritional biochemistry of trivalent chromium |journal=Proc Nutr Soc |volume=63 |issue=1 |pages=41–7 |year=2004 |pmid=15070438 |doi=10.1079/PNS2003315}}</ref> However, the existence of this glucose tolerance factor remains uncertain, a recent academic review concluded that "To date, no chromium-containing glucose tolerance factor has been characterized, the purpose of the low-molecular-weight chromium-binding protein is questionable, and no direct interaction between chromium and insulin has been found."<ref name=Stearns/>
==Dietary guidelines==
The US dietary guidelines for adequate daily chromium intake were lowered in 2001 from 50–200 µg for an adult to 30–35 µg (adult male) and to 20–25 µg (adult female).<ref>{{cite journal |author=Trumbo P, Yates AA, Schlicker S, Poos M |title=Dietary reference intakes: vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc |journal=J Am Diet Assoc |volume=101 |issue=3 |pages=294–301 |year=2001 |pmid=11269606 |doi=10.1016/S0002-8223(01)00078-5}}</ref> These amounts were set to be the same as the average amounts consumed by healthy individuals, consequently it is thought that few Americans are chromium deficient.<ref>{{cite journal |author=Vincent JB |title=Recent advances in the nutritional biochemistry of trivalent chromium |journal=Proc Nutr Soc |volume=63 |issue=1 |pages=41–7 |year=2004 |pmid=15070438 |doi=10.1079/PNS2003315}}</ref>
Approximately 2% of chromium 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.<ref name=Lukaski>{{cite journal |author=Lukaski HC |title=Chromium as a supplement |journal=Annu. Rev. Nutr. |volume=19 |issue= |pages=279–302 |year=1999 |pmid=10448525 |doi=10.1146/annurev.nutr.19.1.279}}</ref> 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.<ref name=Lukaski/> Most fruits and vegetables and dairy products only contain low amounts.<ref name=Expert/> Most of the chromium in people's diet comes from processing or storing food in pans and cans made of [[stainless steel]], which can contain up to 18% chromium.<ref name=Expert/>
The amount of chromium in the body can be decreased as a result of a diet high in simple sugars, which increases the excretion of the metal through urine.<ref>{{cite journal |author=Kozlovsky AS, Moser PB, Reiser S, Anderson RA |title=Effects of diets high in simple sugars on urinary chromium losses |journal=Metab. Clin. Exp. |volume=35 |issue=6 |pages=515–8 |year=1986 |pmid=3713513}}</ref> Because of the high excretion rates and the very low absorption rates of most forms of chromium, [[acute toxicity]] is uncommon.
==Symptoms==
The symptoms of chromium deficiency caused by long-term [[total parenteral nutrition]] are severely [[impaired glucose tolerance]], a loss of weight, and confusion.<ref name=Freund/> Another patient also developed nerve damage ([[peripheral neuropathy]]).<ref>{{cite journal |author=Jeejeebhoy KN, Chu RC, Marliss EB, Greenberg GR, Bruce-Robertson A |title=Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition |journal=Am. J. Clin. Nutr. |volume=30 |issue=4 |pages=531–8 |year=1977 |pmid=192066 |url=http://www.ajcn.org/cgi/pmidlookup?view=long&pmid=192066}}</ref>
==Supplementation==
[[Image:Chromium picolinate.png|thumb|[[Chromium picolinate]]]]
[[Chromium picolinate]] is the most commonly used synthetic supplement. However, recent studies "have concluded that such supplements have no demonstrated effects on healthy individuals."<ref name=Vincent/> A [[meta-analysis]] in 2002 found no effect on blood [[glucose]] or [[insulin]] in healthy people, and the data were inconclusive for diabetics.<ref>{{cite journal |author=Althuis MD, Jordan NE, Ludington EA, Wittes JT |title=Glucose and insulin responses to dietary chromium supplements: a meta-analysis |journal=Am. J. Clin. Nutr. |volume=76 |issue=1 |pages=148–55 |year=2002 |pmid=12081828 |url=http://www.ajcn.org/cgi/pmidlookup?view=long&pmid=12081828}}</ref> Subsequent trials gave mixed results, with one finding no effect in people with impaired glucose tolerance,<ref>{{cite journal |author=Gunton JE, Cheung NW, Hitchman R, ''et al'' |title=Chromium supplementation does not improve glucose tolerance, insulin sensitivity, or lipid profile: a randomized, placebo-controlled, double-blind trial of supplementation in subjects with impaired glucose tolerance |journal=Diabetes Care |volume=28 |issue=3 |pages=712–3 |year=2005 |pmid=15735214 |url=http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=15735214 |doi=10.2337/diacare.28.3.712}}</ref> but another seeing a small improvement in glucose resistance.<ref>{{cite journal |author=Singer GM, Geohas J |title=The effect of chromium picolinate and biotin supplementation on glycemic control in poorly controlled patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized trial |journal=Diabetes Technol. Ther. |volume=8 |issue=6 |pages=636–43 |year=2006 |pmid=17109595 |doi=10.1089/dia.2006.8.636}}</ref> In a 2007 review of these and other clinical trials it was again concluded that chromium supplements had no beneficial effect on healthy people, but that there might be an improvement in glucose metabolism in diabetics, although the authors stated that the evidence for this effect remains weak.<ref>{{cite journal |author=Balk EM, Tatsioni A, Lichtenstein AH, Lau J, Pittas AG |title=Effect of chromium supplementation on glucose metabolism and lipids: a systematic review of randomized controlled trials |journal=Diabetes Care |volume=30 |issue=8 |pages=2154–63 |year=2007 |pmid=17519436 |url=http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=17519436 |doi=10.2337/dc06-0996}}</ref>
This supplement is purported to correct imbalances in [[glucose metabolism]] due to chromium deficiency, even though the occurrence of such a deficiency is extremely rare in countries where the supplement is sold. The mechanism by which this complex enters the cells in the body differs from that for the introduction of trivalent chromium found naturally in food does, and for this reason the safety or this supplement is debatable, since chromium is known to be a toxic metal.<ref>{{cite journal |author=Bagchi D, Stohs SJ, Downs BW, Bagchi M, Preuss HG |title=Cytotoxicity and oxidative mechanisms of different forms of chromium |journal=Toxicology |volume=180 |issue=1 |pages=5–22 |year=2002 |pmid=12324196 |doi=10.1016/S0300-483X(02)00378-5}}</ref> For chromium to be used in the cells it must be released from chromium picolinate, in a process in which the chromium becomes [[redox|reduced]]. This process can possibly lead to the formation of dangerous [[reactive oxygen species]].
Although it is controversial if supplements should be taken by healthy adults eating a normal diet,<ref name=Porter/> chromium is needed as a component of the defined liquid diet that is given to patients receiving [[total parenteral nutrition]] (TPN), since deficiency can occur after many months of this highly restricted diet.<ref name=Freund>{{cite journal |author=Freund H, Atamian S, Fischer JE |title=Chromium deficiency during total parenteral nutrition |journal=JAMA |volume=241 |issue=5 |pages=496–8 |year=1979 |pmid=104057 |doi=10.1001/jama.241.5.496}}</ref> As a result chromium is added to normal TPN solutions,<ref>{{cite journal |author=Anderson RA |title=Chromium and parenteral nutrition |journal=Nutrition |volume=11 |issue=1 Suppl |pages=83–6 |year=1995 |pmid=7749258}}</ref> although the trace amounts from even in supposedly "chromium free" preparations may be enough to prevent deficiency in some individuals.<ref>{{cite journal |author=Kien CL, Veillon C, Patterson KY, Farrell PM |title=Mild peripheral neuropathy but biochemical chromium sufficiency during 16 months of "chromium-free" total parenteral nutrition |journal=JPEN J Parenter Enteral Nutr |volume=10 |issue=6 |pages=662–4 |year=1986 |pmid=3099015 |doi=10.1177/0148607186010006662}}</ref> Indeed, a recent paper in ''[[The Lancet]]'' suggested that adding chromium to feeding solutions given to children produces excessive levels of this metal in their bodies.<ref>{{cite journal |author=Moukarzel AA, Song MK, Buchman AL, ''et al'' |title=Excessive chromium intake in children receiving total parenteral nutrition |journal=Lancet |volume=339 |issue=8790 |pages=385–8 |year=1992 |pmid=1346659 |doi=10.1016/0140-6736(92)90078-H}}</ref>
==References==
{{reflist|2}}
==Further reading==
*William T. Cefalu and Frank B. Hu. (2004). Role of Chromium in Human Health and in Diabetes. ''Diabetes Care,''27:2741-2751.
* Journal of the American College of Nutrition, Vol 4, Issue 1 107-120, Copyright © 1985 by American College of Nutrition
*http://ods.od.nih.gov/factsheets/chromium.asp
==External links==
* {{MerckManual|1|4|f}}
* [http://www.berkeleywellness.com/html/ds/dsChromium.php UC Berkeley]
* {{GPnotebook|-66715645}}
{{Nutritional pathology}}
[[Category:Malnutrition]]
[[Category:Chromium]]
[[pt:Deficiência de cromo]]