Serum and urine chromium concentrations in elderly diabetics

Individual, sociodemographic, and lifestyle influence on blood chromium, cobalt, and nickel levels in healthy population living in Belgrade, Serbia

The rapid trend of industrialization and urbanization can lead to greater exposure of the general population to chromium, cobalt, and nickel. Their total body burden from all routes of recent exposure, as well as interindividual variability in exposure levels, metabolism, and excretion rates, are reflected in the blood metal concentrations. The main goals in this study were as follows: observing the reference levels of chromium, cobalt, and nickel in the blood of the population living in Belgrade, identification of individual and sociodemographic factors that most affect their blood levels, and comprehension of recent exposure to chromium, cobalt, and nickel. Blood was sampled from 984 participants, voluntary blood donors, who agreed to participate in this study. Individual and sociodemographic data were collected using questionnaire adapted for different subpopulations. Blood metal analyses were measured using ICP-MS method (7700×, Agilent, USA). Our study provided reference values of chromium, cobalt, and nickel in blood for adult population (18-65 years) and confirmed that blood cobalt and nickel levels were mostly influenced by age and gender, and age, respectively. Furthermore, weight status affected blood chromium and cobalt levels, while national origin affected blood chromium levels. The present study highlighted the importance of human biomonitoring studies to monitor exposure status and identify subpopulations with increased exposure to chromium, cobalt, and nickel.

Blood Chromium Levels and Their Association with Cardiovascular Diseases, Diabetes, and Depression: National Health and Nutrition Examination Survey (NHANES) 2015-2016

Currently, there is no global consensus about the essentiality of dietary chromium. To provide evidence to this debate, an examination of blood chromium levels and common chronic health conditions was undertaken. Using a subsample from the 2015−2016 US National Health and Nutrition Examination Survey (n = 2894; 40 years+), chi-square and binary logistic regression analyses were conducted to examine blood chromium levels (0.7−28.0 vs. <0.7 µg/L) and their associations with cardiovascular diseases (CVDs; self-report), diabetes mellitus (DM; glycohemoglobin ≥5.7%), and depression (Patient Health Questionnaire-9 score ≥5), while controlling for socio-demographic (age/sex/income/education/relationship status) and health-related (red blood cell folate/medications/co-morbidities/body mass index (BMI)/substance use) factors. The sample was almost evenly distributed between men and women (n = 1391, 48.1% (men); n = 1503, 51.9% (women)). The prevalence estimates of low blood chromium levels tended to be higher among those with CVDs (47.4−47.6%) and DM (50.0−51.6%). Comparisons between those with low vs. normal blood chromium levels indicate men have increased odds of CVDs (adjusted odds ratio (aOR) = 1.86, 95% confidence interval (CI): 1.22−2.85, p < 0.001) and DM (aOR = 1.93, 95% CI: 1.32−2.83, p < 0.001) and lower odds of depression (aOR = 0.42, 95% CI: 0.22−0.77, p < 0.05). Dietary chromium may be important in the prevention and management of CVDs and DM for men. Continued exploration of chromium’s role in chronic diseases, including differences by biological factors, is needed.

Association of plasma chromium with metabolic syndrome among Chinese adults: a case-control study

Backgroud

Chromium has been suggested playing a role in alleviating diabetes, insulin resistance and lipid anomalies, but the effect on metabolic syndrome (MetS) in humans remains controversial.

Methods

We conducted a matched case-control study in a Chinese population, involving 2141 MetS cases and 2141 healthy controls, which were 1:1 matched by age (±2 years) and sex. Plasma chromium was measured by inductively coupled plasma mass spectrometry.

Results

Plasma chromium levels were lower in MetS group than in control group (mean: 4.36 μg/L and 4.66 μg/L, respectively, P < 0.001), and progressively decreased with the number of MetS components (P for trend < 0.001). After adjustment for potential confounding factors, the odds ratios (95% confidence intervals) for MetS across increasing quartiles of plasma chromium levels were 1 (reference), 0.84 (0.67–1.05), 0.76 (0.61–0.95), and 0.62 (0.49–0.78), respectively (P for trend < 0.001). For the components of MetS (high waist circumference, high triglycerides and high blood glucose), the odds ratios (95% confidence intervals) of the highest quartiles were 0.77 (0.61–0.95), 0.67 (0.55–0.80), and 0.53 (0.44–0.64), respectively (P for trend < 0.05).

Conclusions

Our results indicated that plasma chromium levels were inversely associated with MetS in Chinese adults. The association may be explained by the relations between plasma chromium levels and high waist circumference, and the triglycerides and blood glucose levels.

Serum Chromium Level is Increased in Jordanian Smokers, Decreased in Jordanians with Prediabetes and type 2 Diabetes, But not Altered in Jordanians with Hypertension, With Obesity, or With Family History of Diabetes

Background

Chromium was found to be crucial for several biochemical processes in the human body, including, in particular, carbohydrate and lipid metabolism whereas the exact mechanisms of its actions have yet to be explored. Here, we asked whether low serum chromium levels are present in Jordanian smokers and Jordanians with prediabetes and type 2 diabetes (T2D), with hypertension, with overweight and obesity, and with a family history of diabetes.

Methods

A total of 360 patients (120 with T2D, 120 with prediabetes, and 120 healthy controls) were recruited randomly based on the American Diabetes Association criteria. Smokers (n = 26), and patients with hypertension (n = 46), with overweight (n = 47) and obesity (n = 57), and with family history of diabetes (n = 63) were included in the tested population. Serum chromium concentration was measured using the graphite furnace atomic absorption spectrometry.

Results

The results from this study revealed significant increase (P = 0.001 univariate, P = 0.038 multivariate) and significant decrease (P = 0.046 univariate,P = 0.038 multivariate) in serum chromium concentrations in smokers and people with T2D and prediabetes, respectively. In addition, serum chromium insignificantly altered (P > 0.05) in people with hypertension, with a family history of diabetes, and with overweight or obesity.

Conclusions

Higher levels of serum chromium were observed in smokers, whereas lower levels were found to be present in patients with T2D and patients with prediabetes. In addition, serum chromium level may not be affected by hypertension, overweight and obesity, and family history of diabetes.

Urinary chromium is associated with changes in leukocyte miRNA expression in obese subjects

BACKGROUND/OBJECTIVES

Epidemiological studies suggest a link between chromium (Cr) status and cardiovascular disease. Increased urinary excretion of Cr was reported in subjects with diabetes compared with non-diabetic controls and those with non-diabetic insulin resistance. Epigenetic alterations have been linked to the presence of Cr, and microRNA (miRNA) expression has been implicated in the pathogenesis of metabolic diseases and cardiovascular diseases (CVDs). We investigated the association between Cr excretion and miRNA expression in leukocytes from obese subjects. We also examined the relationship between altered miRNA expression and selected clinical parameters to further investigate mechanisms linking Cr to metabolic diseases and CVDs.

SUBJECTS/METHODS

We analyzed urinary Cr in 90 Italian subjects using inductively coupled plasma-mass spectrometry. Peripheral blood miRNA levels were screened with TaqMan Low-Density Array Human MicroRNA A. Cr level-associated expression of miRNAs was detected with multivariate regression analyses, and the top 10 candidate miRNAs were selected for validation. We also used multivariate regression analyses to assess possible associations between validated miRNAs and glycated hemoglobin (A1c) and blood pressure (BP). The validated miRNAs were further investigated by functional analysis with Ingenuity Pathway Analysis software.

RESULTS

Urinary Cr levels (mean: 0.35 μg/l; s.d.=0.24) ranged from 0.05 to 1.27 μg/l. In the screening phase, 43 miRNAs were negatively associated with Cr. Of the top 10 miRNAs selected for validation, nine (miR-451, miR-301, miR-15b, miR-21, miR-26a, miR-362-3p, miR-182, miR-183 and miR-486-3p) were downregulated in association with Cr (P-false discovery rate (FDR)<0.10). miR-451 expression was associated with A1c (β=-0.06; P=0.0416), whereas miR-486-3p expression was associated both with diastolic (β=2.1; P=0.004) and systolic BP (β=3.3; P=0.003).

CONCLUSIONS

These results indicate that miR-451 and miR-486-3p are involved in the link between Cr levels and metabolic diseases and CVDs.

Evaluation of serum ferritin and some metal elements in type 2 diabetes mellitus patients: comparative cross-sectional study

BACKGROUND

The chronic hyperglycemia of diabetes has been associated with an imbalance of some trace metal elements in the blood sample of type 2 diabetes patients.

AIM

To evaluate the status of serum ferritin and some selected metal elements among type 2 diabetes mellitus (T2DM) patients.

METHODS

Facility-based comparative cross-sectional study was conducted from February 15, 2015 to October 30, 2015, at Jimma University Specialized Hospital, Ethiopia. A total of 428 type 2 diabetes and nondiabetes study subjects were recruited to the study. After overnight fasting, 10 mL of venous blood samples were taken for biochemical and trace metal element analysis. Data were entered into EpiData version 3.5.1 and exported to SPSS version 20 for Windows for analysis.

RESULTS

Serum concentration of Zn+2, Mg+2, Cr+3, ferritin, and Fe+3 in patients with type 2 diabetes was significantly lower (p<0.0001) than nondiabetes patients. In contrast, serum Cu+2 was significantly higher (p<0.0001) in type 2 diabetes patients than nondiabetics. In addition, significant differences were not seen in both groups with regard to serum Mn+2, Ca+2, and Po4-3. Waist-to-hip ratio (WHR), serum Fe+3, ferritin, and Mn+2 were significantly higher among oral hypoglycemic agent users of type 2 diabetes patients than the injectable insulin users. Serum Zn+2 had significant positive correlation with serum Mg+2 (r=0.738), Cr+3 (r=0.233), Ca+2 (r=0.238), and Po4-3 (r=0.222). In addition, serum Zn+2 had shown significant and negative correlation with body mass index (BMI, r=-0.331), WHR (r=-0.340), and fasting blood glucose (FBG, r=-0.186). Likewise, serum Mg+2 and Po4-3 are significantly and negatively correlated with BMI, WHR, and FBG.

CONCLUSION

The imbalance of trace metal elements in the blood sample of diabetes is uncertain. Thus, we recommend a prospective cohort study to find out the principal factors behind the problem.

Correlation of serum chromium, zinc, magnesium and SOD levels with HbA1c in type 2 diabetes: A cross sectional analysis

The loss of dynamic integrity between homoeostasis of free radicals and antioxidants causes the development of complications like retinopathy, nephropathy, neuropathy, atherosclerosis and cardiovascular diseases in T2DM.

AIMS AND OBJECTIVES

To assess the concentrations of serum chromium, zinc, magnesium and SOD in subjects of T2DM and control and to investigate the effect of these variables versus HbA1c.

RESULTS

Insignificant difference (P=0.493) was reported in age (50±4.7 year compared with 50±7.2 year), while body mass Index (23±2kg/m(2) compared with 26±4.5kg/m(2)) between the T2DM subjects and control subject showed significant difference (<0.0001). Inverse Pearson correlation coefficient, r (-0.376), (-0.689), (-0.05), (-0.05), (-0.40), (-0.14), (-0.342) and (-0.548) were established when HbA1c of control and T2DM patients were compared with control and T2DM patients of serum Cr, Zn, Mg and SOD variables in that order. The overall "p"-value demonstrated highly significant result at p<0.0001 between the T2DM subjects and controls.

CONCLUSION

Strong association between serum chromium and SOD in relation to HbA1c in this study gives a strong point that these variables could be used as markers of cell injury with the intention in further part of life en route to progressive complications in T2DM.

Serum Chromium Levels in Type 2 Diabetic Patients and Its Association with Glycaemic Control

INTRODUCTION

Chromium is an essential micronutrient which is required for the normal functioning of insulin and regulation of blood sugar levels. It acts as a vital antioxidant for maintaining insulin homeostasis. In diabetes mellitus, the free radical production is increased and levels of antioxidants like chromium, vanadium, selenium and manganese are reduced. There have been previous studies to suggest that low serum levels of chromium are associated with poorer glycaemic control.

AIM

To study the level of serum chromium in newly diagnosed patients with type 2 diabetes mellitus and its association with glycaemic control.

MATERIALS AND METHODS

Serum chromium concentration was determined by using inductively coupled Plasma - Optical Emission Spectophotometry in 42 newly diagnosed type 2 diabetes mellitus patients without any pre-existing complications. They were divided into 2 groups - well controlled (HbA1c ≤7.0%) and uncontrolled groups (HbA1c >7.0%).

RESULTS

Mean serum chromium concentration measured in uncontrolled type 2 diabetic patients was significantly lower (0.065 ± 0.03 mcg/L vs 0.103 ± 0.04 mcg/L, p< 0.05). There was a statistically significant inverse linear correlation of the HbA1c values and the serum chromium concentration (r= -0.6514, p < 0.0001). There was also a decrease in chromium levels across both the groups with advancing age and the decrease being significant beyond 40 years of age (p<0.05).

CONCLUSION

The results of our study describes the relationship between serum chromium levels and control of type 2 diabetes mellitus. Significant reduction in chromium levels are probable indicators of metabolic response to oxidative stress in patients with type 2 diabetes mellitus. Further large scale studies relating serum chromium and type 2 diabetes mellitus may help to understand more about the exact relationship.

Chromium level in prediction of diabetes in pre-diabetic patients

BACKGROUND

Chromium supplementations (Cr) have been shown to exert beneficial effects in the management of type-2 diabetes. Prevalence of Cr deficiency in pre-diabetic patients is not well-understood, therefore, the aim of this study was to evaluate the extent of this prevalence.

MATERIALS AND METHODS

In this cross-sectional descriptive study, 132 pre-diabetic patients were recruited. The participants were randomly selected from those who referred to the Shariati Hospital in Isfahan, Iran. Blood samples are collected for measurement of Cr, insulin, fasting blood sugar (FBS), and two-hour post-load plasma glucose. The body mass index (BMI) was calculated. Determination of Cr was carried out by atomic absorption spectrometry.

RESULTS

Thirty-four (31.5%) patients had Cr deficiency and 74 (68.5%) patients had normal Cr. There was no significant difference between sex, age groups (<50 years and ≥50 years) and between patients with and without a family history of diabetes in both the groups. No significant differences in age, BMI, FBS or insulin were observed between two groups. In the group with a normal level of Cr, there was a significant reversed correlation between the Cr level and age, but no significant correlation existed between the Cr level and other factors in both groups.

CONCLUSION

The levels of Cr deficiency are relatively common in patients with pre-diabetes, and it is necessary to screen patients with diabetes and pre-diabetes according to the American Diabetes Association guidelines, with regard to the Cr level and action should be taken to eliminate the Cr deficiency in these patients.

The effects of chromium picolinate and chromium histidinate administration on NF-κB and Nrf2/HO-1 pathway in the brain of diabetic rats

The objective of this experiment was to investigate the effects of supplemental chromium picolinate (CrPic) and chromium histidinate (CrHis) on nuclear factor-kappa B (NF-κB p65) and nuclear factor (erythroid-derived 2)-like 2 (Nrf2) signaling pathway in diabetic rat brain. Nondiabetic (n = 45) and diabetic (n = 45) male Wistar rats were either not supplemented or supplemented with CrPic or CrHis via drinking water to consume 8 μg elemental chromium (Cr) per day for 12 weeks. Diabetes was induced by streptozotocin injection (40 mg/kg i.p., for 2 weeks) and maintained by high-fat feeding (40 %). Diabetes was associated with increases in cerebral NF-κB and 4-hydroxynonenal (4-HNE) protein adducts and decreased in cerebral nuclear factor of kappa light polypeptide gene enhancer in B cells inhibitor, alpha (IκBα) and Nrf2 levels. Both Cr chelates were effective to decrease levels of NF-κB and 4-HNE protein adducts and to increase levels of IκBα and Nrf2 in the brain of diabetic rats. However, responses of these increases and decreases were more notable when Cr was supplemented as CrHis than as CrPic. In conclusion, Cr may play a protective role in cerebral antioxidant defense system in diabetic subjects via the Nrf2 pathway by reducing inflammation through NF-κB p65 inhibition. Histidinate form of Cr was superior to picolinate form of Cr in reducing NF-κB expression and increasing Nrf2 expression in the brain of diabetic rats.

Chromium and manganese levels in biological samples of Pakistani myocardial infarction patients at different stages as related to controls

It has been speculated that trace elements may play a role in the pathogenesis of heart diseases In the present study, we aimed to access the levels of chromium (Cr) and manganese (Mn) in biological samples (whole blood, urine, and scalp hair) of myocardial infarction (MI) patients of both gender age ranged (45-60 years) at first, second, and third heart attack (n = 130), hospitalized in cardiac ward of National Hospital of Hyderabad city (Pakistan). For comparison, healthy age-matched referent subjects (n = 61), of both gender were also selected. The Cr and Mn in biological samples were measured by electrothermal atomic absorption spectrometry, prior to microwave-assisted acid digestion. The validity of the methodology was checked by the biological certified reference materials. During this study, 78% of 32 registered patients of third MI attack (aged >50 years) were died. In these subjects the concentration of Cr and Mn were decreased by 24.7% and 19.8% in scalp hair, while in blood samples 17.9% and 12.4%, respectively, as compared to those who tolerated third MI attack (p = 0.063). Although these data do not prove a causal relationship, these results are consistent with the hypothesis that heart disease may cause deficiencies of certain essential trace elements. The excretion levels of Cr and Mn in urine samples of first MCI were higher than controls at p values (0.029 and 0.011), respectively, whereas the excretion rates of both elements were further enhance after second myocardial infarction attack. The Cr and Mn concentration was inversely associated with the risk of myocardial infarction attacks in both genders. These results add to an increasing body of evidence that, Cr and Mn are importance for cardiovascular health.

Hyperketonemia decreases mitochondrial membrane potential and its normalization with chromium (III) supplementation in monocytes

Altered cellular mitochondrial membrane potential (MMP) has been implicated in the increased insulin resistance and the risk for diabetes. Hyperketonemia is increasingly being identified in type 2 diabetic patients in addition to those with type 1 diabetes. No previous study has examined the effect of hyperketonemia and trivalent chromium on cellular mitochondrial membrane potential (MMP) in any cell type. Using a U937 monocyte cell culture model, this study examined the hypothesis that hyperketonemia decreases and trivalent chromium normalizes the cellular MMP level. Cells were cultured with control and ketone bodies [acetoacetate (AA), β-hydroxybutyrate (BHB)] in the absence or the presence (0.5-100 μM) of Cr(3+) at 37°C for 24 h. The MMP was determined using DiOC6 and flow cytometry. The results show a significant decrease in MMP in cells treated with AA, but not in the cells treated with BHB. The effect of AA on cellular MMP was prevented in chromium (III)-pretreated cells. Thus, hyperketonemia decreases the MMP, and supplementation with chromium (III) normalizes altered MMP, which may play a role in the improvement in glucose metabolism seen after chromium (III) supplementation in some studies with diabetic animals and patients.

Chromium status and glucose tolerance in Saudi men with and without coronary artery disease

Chromium deficiency is associated with impaired glucose tolerance (IGT) and dyslipidemia. Hence, the objective of the current study was to investigate chromium status among Saudi men with and without established cardiovascular disease (CVD) and its relationship to glucose tolerance, lipid profile and other established CVD risk factors. We measured serum and urine chromium concentrations, fasted lipid profile, plasma glucose, and serum lipid peroxide in 130 Saudi men with an established history of myocardial infarction and 130 age-matched controls without established CVD. Patients with established CVD had higher serum triglycerides (p < 0.05) and plasma glucose (p < 0.0001) and lower serum and urinary chromium concentrations (p < 0.0001) than controls. Serum chromium was inversely correlated with plasma glucose among cases and controls (r = -0.189, p < 0.05 and r = -0.354, p < 0.00001, respectively). Plasma glucose (OR 1.127, CI 1.0-1.269, p < 0.05), serum chromium (OR 0.99, CI 0.985-0.995, p < 0.0001), and urinary chromium (OR 0.988, CI 0.981-0.995, p < 0.001) were independently associated with the presence of established coronary disease applying this model. While chromium metabolism appears to be altered in individuals with CVD, it is unclear whether chromium supplementation would be effective in CVD prevention among patients with IGT. This would need to be tested in long-term outcome trials.

The effects of chromium histidinate on mineral status of serum and tissue in fat-fed and streptozotocin-treated type II diabetic rats

The present study was conducted to investigate the effects of chromium histidinate (CrHis) against experimentally induced type II diabetes and on chromium (Cr), zinc (Zn), selenium (Se), manganese (Mn), iron (Fe), and copper (Cu) in serum, liver, and kidney of diabetic rats. The male Wistar rats (n = 60, 8 weeks old) were divided into four groups. Group I received a standard diet (12% of calories as fat); group II were fed standard diet and received CrHis (110 mcg CrHis/kg body weight per day); group III received a high-fat diet (HFD; 40% of calories as fat) for 2 weeks and then were injected with streptozotocin (STZ) on day 14 (STZ, 40 mg/kg i.p.; HFD/STZ); group IV were treated as group III (HFD/STZ) but supplemented with 110 mcg CrHis/kg body weight per day. The mineral concentrations in the serum and tissue were determined by atomic absorption spectrometry. Compared to the HFD/STZ group, CrHis significantly increased body weight and reduced blood glucose in diabetic rats (p < 0.001). Concentrations of Cr, Zn, Se, and Mn in serum, liver, and kidney of the diabetic rats were significantly lower than in the control rats (p < 0.0001). In contrast, higher Fe and Cu levels were found in serum and tissues from diabetic versus the non-diabetic rats (p < 0.001). Chromium histidinate supplementation increased serum, liver, and kidney concentrations of Cr and Zn both in diabetic and non-diabetic rats (p < 0.001). Chromium supplementation increased Mn and Se levels in diabetic rats (p < 0.001); however, it decreased Cu levels in STZ-treated group (p < 0.001). Chromium histidinate supplementation did not affect Fe levels in both groups (p > 0.05). The results of the present study conclude that supplementing Cr to the diet of diabetic rats influences serum and tissue Cr, Zn, Se, Mn, and Cu concentrations.

Effects of chromium histidinate on renal function, oxidative stress, and heat-shock proteins in fat-fed and streptozotocin-treated rats

OBJECTIVE

Chromium is an essential element for carbohydrate, fat, and protein metabolism. The therapeutic potential of chromium histidinate (CrHis) in the treatment of diabetes has been elucidated. The present study investigated the effects of CrHis on serum parameters of renal function, on oxidative stress markers (malondialdehyde [MDA] and 8-isoprostane), and on the expression of heat-shock proteins (HSPs) in rats.

METHODS

Male Wistar rats (n=60, 8 weeks old) were divided into four groups. Group 1 received a standard diet (12% of calories as fat). Group 2 received a standard diet, plus CrHis. Group 3 received a high-fat diet (40% of calories as fat) for 2 weeks, and was then injected with streptozotocin (STZ) on day 14 (STZ, 40 mg/kg intraperitoneally). Group 4 was treated in the same way as group 3 (HFD/STZ), but was supplemented with 110 microg CrHis/kg/body weight/day. Oxidative stress in the kidneys of diabetic rats was evidenced by an elevation in levels of MDA and 8-isoprostane. Protein concentrations of HSP60 and HSP70 in renal tissue were determined by Western blot analyses.

RESULTS

Chromium histidinate supplementation lowered kidney concentrations of MDA, 8-isoprostane levels, serum urea-N, and creatinine, and reduced the severity of renal damage in the STZ-treated group (i.e., the diabetes-induced group). The expression of HSP60 and HSP70 was lower in the STZ group that received CrHis than in the group that did not. No significant effect of CrHis supplementation was detected in regard to the overall measured parameters in the control group.

CONCLUSIONS

Chromium histidinate significantly decreased lipid peroxidation levels and HSP expression in the kidneys of experimentally induced diabetic rats. This study supported the efficacy of CrHis in reducing renal risk factors and impairment because of diabetes.

Effect of zinc supplementation on serum homocysteine in type 2 diabetic patients with microalbuminuria

OBJECTIVES

Elevated homocysteine levels are considered to be an independent risk factor for cardiovascular complications in diabetic patients. The aim of this study was to find out if zinc supplementation improves homocysteine levels, which may exert vascular-protective effects in type 2 diabetes subjects with microalbuminuria.

METHODS

In a randomized, double-blind, controlled, crossover study, 50 type 2 diabetic patients with microalbuminuria were subdivided into two groups and supplemented with 30 mg/d of zinc (group 1) or placebo (group 2) for three months with a four-week wash out period. Serum creatinine, vitamin B(12), folate, fasting plasma glucose, HbA1c, lipid profiles, zinc, homocysteine levels and random urine albumin were measured before and after the first and second phase of the study in all participants.

RESULTS

Mean serum zinc was significantly increased after zinc supplementation (from 76 +/- 16 mug/dl to 93 +/- 20 microg/dl; p < 0.05), while there was no change in the placebo group (75 +/- 16 microg/dl to 75 +/- 15 microg/dl). With zinc supplementation, homocysteine levels reduced significantly (from 13.71 +/- 3.84 mumol/l to 11.79 +/- 3.06 mumol/l; p < 0.05), which did not occur on placebo (from 12.59 +/- 2.13 mumol/l to 13.36 +/- 2.03 mumol/l). Simple regression was used to show a positive correlation between urine albumin excretion and serum homocysteine (r = 0.37, p = 0.023). Vitamin B(12) and folate levels increased significantly in patients who received zinc in comparison to those who received placebo. A negative correlation was observed between homocysteine and vitamin B(12) concentration (r = -0.36, p = 0.025).

CONCLUSION

Zinc supplementation reduced serum homocysteine and increased vitamin B(12) and folate concentrations in type 2 diabetic patients with microalbuminuria.

Chromium supplementation enhances insulin signalling in skeletal muscle of obese KK/HlJ diabetic mice

AIM

Chromium is an essential nutrient required for glucose and lipid metabolism. Laboratory and clinical evidences indicate that chromium supplementation may improve insulin sensitivity by enhancing intracellular signalling. Considerable evidence suggests that serine phosphorylation of insulin receptor substrate 1 (IRS1) at 307 residue (IRS1-Ser307) inhibits insulin signalling and results in peripheral insulin resistance. Therefore, we investigated whether chromium-associated insulin action was mediated by modulation of IRS1-Ser307 phosphorylation.

METHODS

Male KK/HlJ mice (genetically obese and insulin resistant) were supplemented daily with chromium-containing milk powder or placebo for 7 weeks. In analysing functionally characterized insulin resistance, the changes of blood biochemicals, inflammatory factors and insulin signalling molecules in skeletal muscle were analysed.

RESULTS

Using KK mice model, we demonstrated that daily supplementation of trivalent chromium-containing milk powder reduced serum levels of glucose, insulin and triglycerides, and improved glucose and insulin tolerance. Mechanistic study showed that chromium supplementation activated postreceptor insulin signalling such as increasing IRS1, IRS1 tyrosine phosphorylation, p85alpha regulatory subunit of phosphatidylinositol 3-kinase and glucose transporter 4 expression, stimulating Akt activity, downregulating c-Jun N-terminal kinase (JNK) activity and decreasing IRS1 ubiquitinization and insulin resistance-associated IRS1 phosphorylation (IRS1-Ser307) in skeletal muscle. In addition, chromium supplementation attenuated pro-inflammatory cytokine expression in both blood circulation and skeletal muscle.

CONCLUSION

Our data suggest that chromium-containing milk powder supplementation can provide a beneficial effect in diabetic subjects by enhancing insulin signalling in skeletal muscle. The improvement in insulin signalling by chromium was associated with the decreased IRS1-Ser307 phosphorylation, JNK activity and pro-inflammatory cytokine production.

Antioxidant effects and insulin resistance improvement of chromium combined with vitamin C and e supplementation for type 2 diabetes mellitus

To determine the effects of combined supplementation with chromium (Cr) and vitamins C and E on oxidative stress in type 2 diabetes, adult subjects with HbA1c >8.5%. Subjects (n = 30) in this randomized, double blind, placebo-control study were divided into three groups (placebo, Cr or Cr + C + E) on daily treatment. The Cr group received 1000 microg of Cr (as Cr yeast); the Cr + C + E group received Cr (1000 microg as Cr yeast) together with vitamins C (1000 mg) and E (800 IU); and, a control group received a placebo. Baseline plasma Cr levels were not significant differences comparing the supplementation and placebo groups. Thiobarbituric acid reactive substances (TBARS) and total antioxidative status (TAS) were also not significant different. Following the 6-month study period, the plasma TBARS levels, fasting glucose, HbA1c and insulin resistance were significantly decreased in the Cr and Cr + C + E groups, but not for the placebo group. Plasma TAS and glutathione peroxidase were significantly higher for Cr and Cr + C + E groups relative to the placebo group. These findings suggest that Cr supplementation alone and combined of Cr together with vitamins C and E was effective for minimization of oxidative stress and improvement of glucose metabolism in type 2 DM patients.

Longitudinal hair chromium profiles of elderly subjects with normal glucose tolerance and type 2 diabetes mellitus

Longitudinal hair chromium (H-Cr) profiles in a group of patients with type 2 diabetes mellitus (n = 59; age, 62 +/- 9 years) and healthy elderly (control) subjects (n = 49; age, 59 +/- 10 years) matched by age and sex were measured by solid sampling electrothermal atomic absorption spectrometry, providing data on the magnitude of variation of Cr content along the hair length. H-Cr average (H-Cr(av)) and H-Cr proximal (H-Cr(pr))(.), relating to the average Cr content of the whole hair and the proximal 3-mm hair length, respectively, were also obtained. No significant difference between the healthy and diabetic group was found in mean H-Cr(av) or H-Cr(pr) contents (248 +/- 108 vs 247 +/- 143 and 233 +/- 98 vs 278 +/- 195 ng/g, respectively. However, women in the control group had significantly lower H-Cr values (P < .01) compared with men, but this difference was absent in the diabetic population. The distribution of log H-Cr(pr) values in the control population displayed a Gaussian shape, in contrast to the substantially wider distribution, skewed toward lower H-Cr(pr) values, observed in the diabetic group. The magnitude of variation in H-Cr content in the patient group over an interval of approximately 2 to 3 months (time of growth of the hair sampled) was found to be a factor of more than 2 larger than that in the control population (+/- 58% vs +/- 26%). A strong relationship (R = 0.656; P < .01) between log H-Cr(pr) and log fasting plasma Cr was observed in the diabetic group (n = 20). The mean fasting plasma Cr value of this group was 0.41 +/- 0.10 microg Cr per liter. No correlation between H-Cr(av.) and duration of diabetes was observed. A strong positive association was observed in the control population between H-Cr(pr) and fasting plasma insulin (n = 22; R = 0.6157; P < .01), and H-Cr(pr) and fasting plasma glucose (n = 24; R = 0.4118; P < .05), which is indicative of the interrelation of these parameters. In the control population, H-Cr(av) showed a slight decrease with age (n = 54; R = 0.2691; P < .05), which is assumed to be the result of increased insulin resistance caused by various age-associated factors including Cr deficiency. None of the above relationships was significant in the diabetic group. Evidence is presented that justifies the assumption that the longitudinal H-Cr profile resembles the variation in Cr metabolic rate over the time span of growing hair, which is not appreciably affected by external contamination. This suggests that glucose intolerance (type 2 diabetes mellitus) is an important factor that disturbs Cr metabolism.

The influence of chromium chloride-containing milk to glycemic control of patients with type 2 diabetes mellitus: a randomized, double-blind, placebo-controlled trial

The aim of this study is to evaluate the effect and safety of chromium-containing milk powder in patients with type 2 diabetes mellitus. A randomized, double-blind, placebo-controlled trial was conducted in Taiwan. A total of 60 patients with type 2 diabetes mellitus, aged 30 to 75 years, and on a dose of gliclazide sulfonylurea agent (< or =160 mg/d) for at least 3 months were enrolled. Their glycosylated hemoglobin ranged from 7.5% to 12%, fasting plasma glucose (FPG) from 140 to 250 mg/dL, and body mass index from 20 to 35 kg/m(2). The subjects were divided into 2 groups, one group to receive chromium-containing milk powder (chromium 200 microg/20 g milk powder) and the other to receive placebo twice a day for 16 weeks. Frequently sampled intravenous glucose tolerance test (IVGTT) was performed before and after treatment. The chromium group demonstrated a lower FPG and fasting insulin (-38.1 +/- 9.2 vs 63 +/- 8. 5 mg/dL and -1.7 +/- 0.2 vs 1.9 +/- 0.3 microU/mL, respectively; P < .05), especially in male patients (-41 +/- 9.2 vs 85 +/- 11.7 mg/dL and -2.7 +/- 0.2 vs 3.1 +/- 0.3 microU/mL, respectively; P < .01), at the end of the study. Lower glycosylated hemoglobin was observed in chromium-treated male patients (-1.1 +/- 0. 5 vs 0.7 +/- 0. 2; P < .05). However, there were no significant changes in other metabolic parameters (lipid profiles including total cholesterol, triglyceride, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol), except improvement of insulin resistance (homeostasis model assessment for insulin resistance and insulin sensitivity index from frequently sampled intravenous glucose tolerance test) observed in male patients (-2.1 +/- 1.1 vs -0.41 +/- 1.12 and 0.18 +/- 0.11 vs -0.15 +/- 0. 2, respectively; P < .05). There were no adverse events in both groups, except for mild complaints in the chromium group on constipation (5%) and flatulence (5%). Intake of milk powder containing 400 microg/d of chromium for 16 weeks in subjects with type 2 diabetes mellitus resulted in lowering of FPG, fasting insulin, and improvement of metabolic control in male patients.

Trivalent chromium inhibits protein glycosylation and lipid peroxidation in high glucose-treated erythrocytes

Epidemiological studies have shown lower levels of chromium among men with diabetes and cardiovascular disease (CVD) compared with healthy control subjects. The mechanism by which chromium may decrease the incidence of CVD and insulin resistance is not known. Using erythrocytes as a model, this study demonstrates that chromium inhibits the glycosylation of proteins and oxidative stress, both risk factors in the development of CVD. Erythrocytes were treated with high levels of glucose (mimicking diabetes) in the presence or absence of chromium chloride in the medium at 37 degrees C for 24 hours. Chromium supplementation prevented the increases in protein glycosylation and oxidative stress caused by the high levels of glucose in erythrocytes. This study demonstrates for the first time that chromium supplementation inhibits protein glycosylation in erythrocytes exposed to high glucose medium, which appears to be mediated by its antioxidative effect. This provides evidence for a novel mechanism by which chromium supplementation may decrease incidence of CVD in diabetic patients.

Antioxidant effects of chromium supplementation with type 2 diabetes mellitus and euglycemic subjects

To determine the effects of chromium (Cr) supplementations on oxidative stress of type 2 diabetes and euglycemic (EU) subjects, adult having HbA(1C) values of <6.0% (EU), 6.8-8.5% (mildly hyperglycemic, MH), and >8.5% (severely hyperglycemic, SH) were supplemented for 6 months with 1000 microg/day of Cr (as Cr yeast) or with a placebo. In the beginning, the levels of the plasma Cr in the MH and SH groups were 25-30% lower than those of the EU subjects. The values of thiobarbituric acid reactive substances (TBARS) and total antioxidative status (TAS) of the MH and SH groups were significantly higher than those of the EU ones. Following supplementations, the levels of plasma TBARS in the Cr groups of MH and SH groups were significantly decreased (the inverse was found in the EU) and showed no significant changes in the placebo group. The levels of plasma TAS in the Cr groups of EU and MH were significantly decreased (the inverse was found in the SH) and showed no significant changes in the placebo group. No significant difference was found in the antioxidant enzyme (superoxide dismutase, glutathione peroxidase, catalase) activities during supplementations. These data suggest that Cr supplementation was an effective treatment strategy to minimize increased oxidative stress in type 2 diabetes mellitus patients whose HbA(1C) level was >8.5%, and the Cr in EU groups might act as a prooxidant.

Chromium as adjunctive treatment for type 2 diabetes

OBJECTIVE

To review the chemistry, pharmacology, efficacy, and safety of trivalent chromium in the treatment of type 2 diabetes and hyperlipidemia.

DATA SOURCES

The English literature was searched from 1966 through May 2002 using MEDLINE, International Pharmaceutical Abstracts, and EMBASE. The key words included chromium, glucose, lipids, and diabetes. Pertinent references from review articles and studies were used as additional sources.

DATA SYNTHESIS

Trivalent chromium is an essential nutrient and has a key role in lipid and glucose metabolism. Supplementation with chromium does not appear to reduce glucose levels in euglycemia. It may, however, have some efficacy in reducing glucose levels in hyperglycemia. The effects of chromium on lipid levels are variable. Chromium in doses <1000 microg/d appears to be safe for short-term administration. Kidney function and dermatologic changes need to be monitored.

CONCLUSIONS

Chromium appears to be a safe supplement and may have a role as adjunctive therapy for treatment of type 2 diabetes. Additional large-scale, long-term, randomized, double-blind studies examining the effect of various doses and forms of chromium are needed.

Oral chromium picolinate improves carbohydrate and lipid metabolism and enhances skeletal muscle Glut-4 translocation in obese, hyperinsulinemic (JCR-LA corpulent) rats

Human studies suggest that chromium picolinate (CrPic) decreases insulin levels and improves glucose disposal in obese and type 2 diabetic populations. To evaluate whether CrPic may aid in treatment of the insulin resistance syndrome, we assessed its effects in JCR:LA-corpulent rats, a model of this syndrome. Male lean and obese hyperinsulinemic rats were randomly assigned to receive oral CrPic [80 microg/(kg. d); n = 5 or 6, respectively) in water or to control conditions (water, n = 5). After 3 mo, a 120-min intraperitoneal glucose tolerance test (IPGTT) and a 30-min insulin tolerance test were performed. Obese rats administered CrPic had significantly lower fasting insulin levels (1848 +/- 102 vs. 2688 +/- 234 pmol/L; P < 0.001; mean +/- SEM) and significantly improved glucose disappearance (P < 0.001) compared with obese controls. Glucose and insulin areas under the curve for IPGTT were significantly less for obese CrPic-treated rats than in obese controls (P < 0.001). Obese CrPic-treated rats had lower plasma total cholesterol (3.57 +/- 0.28 vs. 4.11 +/- 0.47 mmol/L, P < 0.05) and higher HDL cholesterol levels (1.92 +/- 0.09 vs. 1.37 +/- 0.36 mmol/L, P < 0.01) than obese controls. CrPic did not alter plasma glucose or cholesterol levels in lean rats. Total skeletal muscle glucose transporter (Glut)-4 did not differ among groups; however, CrPic significantly enhanced membrane-associated Glut-4 in obese rats after insulin stimulation. Thus, CrPic supplementation enhances insulin sensitivity and glucose disappearance, and improves lipids in male obese hyperinsulinemic JCR:LA-corpulent rats.

Chromium chloride inhibits oxidative stress and TNF-alpha secretion caused by exposure to high glucose in cultured U937 monocytes

Chromium supplementation has been proposed to promote the action of insulin and the lowering of blood glucose levels in diabetic patients. However, the molecular mechanism by which chromium increases insulin sensitivity is not known. Using U937 monocytes as a cell culture model, this study demonstrates that chromium inhibits the secretion of TNF-alpha, a cytokine known to inhibit the sensitivity and action of insulin. U937 cells were cultured with high levels of glucose (mimicking diabetes) in the presence or absence of chromium chloride in the medium at 37 degrees C for 24 h. This study demonstrates that chromium supplementation prevents the increase in TNF-alpha levels and oxidative stress caused by the high levels of glucose in cultured U937 monocytic cells. Similarly, chromium supplementation prevented elevated TNF-alpha secretion and lipid peroxidation levels in H(2)O(2)-treated U937 cells. This study demonstrates for the first time that chromium supplementation inhibits TNF-alpha secretion in U937 monocytes cultured in high-glucose medium, which appears to be mediated by its antioxidative effect. This provides evidence for a novel molecular mechanism by which chromium supplementation may increase insulin sensitivity and glycemic control in diabetic patients.

Potential antioxidant effects of zinc and chromium supplementation in people with type 2 diabetes mellitus

OBJECTIVE

To determine the effects of combined zinc (Zn) and chromium (Cr) supplementation on oxidative stress and glucose homeostasis of people with type 2 diabetes.

DESIGN

Tunisian adult subjects with HbA1C > 7.5% were supplemented for 6 months with 30 mg/d of Zn as Zn gluconate or 400 microg/d of Cr as Cr pidolate or combined Zn/Cr supplementation or placebo. The effects of supplementation on plasma zinc (Zn), copper (Cu), selenium (Se), urinary Zn, Cr, plasma thiobarbituric acid reactive substances (TBARS), Cu-Zn superoxide dismutase (SOD) and Se glutathione peroxidase (GPx) in red blood cells, blood lipids and lipoproteins, HbA1C and fasting glucose were measured at the beginning of the study and after six months.

RESULTS

At the beginning of the study, more than 30% of the subjects may have been Zn deficient with plasma Zn values less than 10.7 mircomol/L, whereas levels of plasma Cu, Se and antioxidant RBC enzyme activities were in the normal ranges. Following supplementation, there were significant decreases of plasma TBARS in the Cr (13.6%), Zn (13.6%) and Zn/Cr (18.2%) groups with no significant changes in the placebo group. The value for the TBARS of the control healthy Tunisian subjects was 2.08 +/- 0.04 micromol/L and that of the Tunisian subjects with diabetes was 3.32 +/- 0.05 micromol/L. This difference of 1.24 micromol/L between the control group and the subjects with diabetes was reduced from 36% to 50% in the three supplemented groups. Supplementation did not modify significantly HbAIC nor glucose homeostasis. No adverse effects of Zn supplementation were observed on Cu status. HDL cholesterol nor interactions in Zn or Cr.

CONCLUSIONS

These data suggest the potential beneficial antioxidant effects of the individual and combined supplementation of Zn and Cr in people with type 2 DM. These results are particularly important in light of the deleterious consequences of oxidative stress in people with diabetes.

Technical aspects of trace element supplementation

Routine supplementation of total parenteral nutrition mixtures with the readily available single or combination trace elements products is becoming more widespread. As more is learned about deficiency syndromes and monitoring techniques, so too must we understand more about the physicochemical interactions between individual trace elements and other nutrients, that could ultimately affect bioavailability. Expert pharmaceutical assessment of these complex reactions, that have been demonstrated to occur in solution, becomes increasingly important in order to optimize the efficacy of micronutrient therapy.