Chromium deficiency

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Chromium deficiency
Cr-TableImage.png
Chromium
Classification and external resources
Specialty endocrinology
ICD-10 E61.4
DiseasesDB 2625

Chromium deficiency is a proposed disorder that results from an insufficient dietary intake of chromium. Chromium was first proposed as an essential element for normal glucose metabolism in 1959,[1] and was widely accepted as being such by the 1990s.[2] Cases of deficiency have been claimed in hospital patients who were fed defined liquid diets intravenously for long periods of time.[3] By the turn of the century, these views were being challenged,[4][5][6] with subsequent work suggesting that chromium supplements may present a health risk.[7] In spite of this, dietary supplements containing chromium remain widely available.

Signs and symptoms[edit]

The symptoms of chromium deficiency caused by long-term total parenteral nutrition are severely impaired glucose tolerance, weight loss, and confusion.[8] However, subsequent studies questioned the validity of these findings.[9]

Supplementation[edit]

The European Food Safety Authority concluded that chromium is not an essential nutrient, making this the only mineral for which the United States and the European Union disagree.[10] The proposed mechanism for cellular uptake of CrIII via transferrin has been called into question.[11] There is no proof that chromium supplementation has physiological effects on body mass or composition, and its use as a supplement may be unsafe.[7] A 2014 systematic review concluded that chromium supplementation had no effect on glycemic control, fasting plasma glucose levels, or body weight in people with or without diabetes.[12]

Chromium may be needed as an ingredient in total parenteral nutrition (TPN), since deficiency may occur after months of intravenous feeding with chromium-free TPN.[8] For this reason, chromium is added to normal TPN solutions for people with diabetes,[13] and in nutritional products for preterm infants.[14]

Diagnosis[edit]

Dietary recommendations[edit]

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 ages 14 and up is 25 μg/day up to age 50 and 20 μg/day for older. AI for pregnancy is 30 μg/day. AI for lactation is 45 μg/day. For men ages 14 and up 35 μg/day up to age 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).[15]

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 defined the same as in 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.[10][16]

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 May 27, 2016 it was revised to 35 μg to bring it into agreement with the RDA.[17] A table of the old and new adult Daily Values is provided at Reference Daily Intake. Food and supplement companies have until July 28, 2018 to comply with the change.

It is thought that few Americans are chromium deficient.[4]

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.[18] 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.[18] Most fruits and vegetables and dairy products contain only low amounts.[3] Most of the chromium in people's diets comes from processing or storing food in pans and cans made of stainless steel, which can contain up to 18% chromium.[3] 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.[citation needed] Because of the high excretion rates and the very low absorption rates of most forms of chromium, acute toxicity is uncommon.

See also[edit]

References[edit]

  1. ^ SCHWARZ, K; MERTZ, W (November 1959). "Chromium(III) and the glucose tolerance factor". Archives of Biochemistry and Biophysics. 85: 292–5. PMID 14444068. 
  2. ^ Mertz, W (April 1993). "Chromium in human nutrition: a review". The Journal of Nutrition. 123 (4): 626–33. PMID 8463863. 
  3. ^ a b c 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. ^ a b 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. ^ Porter, David J.; Raymond, Lawrence W.; Anastasio, Geraldine D. (1999). "Chromium: friend or foe?" (PDF). Archives of Family Medicine. 8 (5): 386–390. doi:10.1001/archfami.8.5.386. PMID 10500510. Archived from the original on 9 January 2005. Retrieved 24 February 2013. 
  7. ^ a b Vincent, JB (2013). "Chromium: is it essential, pharmacologically relevant, or toxic?". Metal Ions in Life Sciences. Metal Ions in Life Sciences. 13: 171–98. doi:10.1007/978-94-007-7500-8_6. ISBN 978-94-007-7499-5. PMID 24470092. 
  8. ^ a b 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. 
  9. ^ John B. Vincent, Kristin R. Di Bona; Sharifa Love; Nicholas R. Rhodes; DeAna McAdory; Sarmistha Halder Sinha; Naomi Kern; Julia Kent; Jessyln Strickland; Austin Wilson; Janis Beaird; James Ramage; Jane F. Rasco (March 2011). "Chromium is not an essential trace element for mammals: effects of a "low-chromium" diet". Journal of Biological Inorganic Chemistry. 16 (3): 381–390. doi:10.1007/s00775-010-0734-y. PMID 21086001. 
  10. ^ a b "Overview on Dietary Reference Values for the EU population as derived by the EFSA Panel on Dietetic Products, Nutrition and Allergies" (PDF). 2017. 
  11. ^ Levina, Aviva; Pham, T. H. Nguyen; Lay, Peter A. (1 May 2016). "Binding of Chromium(III) to Transferrin Could be Involved in Detoxification of Dietary Chromium(III) Rather Than Transport of an Essential Trace Element". Angewandte Chemie International Edition. 55 (28): 8104–8107. doi:10.1002/anie.201602996. ISSN 1521-3773. PMID 27197571. 
  12. ^ Landman, G. W; Bilo, H. J; Houweling, S. T; Kleefstra, N (2014). "Chromium does not belong in the diabetes treatment arsenal: Current evidence and future perspectives". World Journal of Diabetes. 5 (2): 160–164. doi:10.4239/wjd.v5.i2.160 (inactive 2017-10-14). PMC 3990317Freely accessible. 
  13. ^ Anderson, R. A. (1995). "Chromium and parenteral nutrition". Nutrition. 11 (1 Suppl): 83–86. PMID 7749258. 
  14. ^ 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. doi:10.1177/0884533614563353. PMID 25527182. 
  15. ^ 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.
  16. ^ Tolerable Upper Intake Levels For Vitamins And Minerals (PDF), European Food Safety Authority, 2006 
  17. ^ "Federal Register May 27, 2016 Food Labeling: Revision of the Nutrition and Supplement Facts Labels. FR page 33982" (PDF). 
  18. ^ a b 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. 

Further reading[edit]