Systematic review and meta-analysis of the efficacy and safety of chromium supplementation in diabetes

The association between the urinary chromium and blood pressure: a population-based study

BACKGROUND AND AIM

The impact of trace elements and heavy metals on human health has attracted widespread attention. However, the correlation between urinary chromium concentrations and blood pressure remains unclear and inadequately reported, and the aim of this study was to investigate the relationship between urinary chromium concentrations and blood pressure in adults in the United States (US).

METHODS

We utilized data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 for this study. Multivariate logistic regression and multivariate linear regression were used to explore the association of urinary chromium concentrations with hypertension and blood pressure. Additionally, we also performed subgroup analysis and restricted cubic splines (RCS).

RESULTS

A total of 2958 participants were enrolled in this study. The overall mean systolic blood pressure and diastolic blood pressure were 123.98 ± 0.60, 72.66 ± 0.57 mmHg, respectively. The prevalence of hypertension was found in 41.31% of the whole participants. In the fully adjusted model, we did not observe a correlation between urinary chromium concentrations and the risk of hypertension and systolic blood pressure. However, we found a negative association between urinary chromium concentrations and diastolic blood pressure. In subgroup analysis, we observed a positive association between urinary chromium and the risk of hypertension among participants older than 60 years of age and those who were Non-Hispanic Black. The interaction term highlighted the influence of age and race on this positive association. We also found a negative association of urinary chromium with diastolic blood pressure in male, participants who were current smokers, overweight, and other races, as well as those without alcohol use and anti-hypertensive drug use. However, the interaction term only revealed the influence of alcohol consumption on the negative association.

CONCLUSION

Our study suggested that urinary chromium concentrations may show a negative association with diastolic blood pressure and this association was significantly dependent on alcohol consumption. Besides, a positive association between urinary chromium and the risk of hypertension was also found among participants older than 60 years of age and those who were Non-Hispanic Black.

Metalloestrogens exposure and risk of gestational diabetes mellitus: Evidence emerging from the systematic review and meta-analysis

BACKGROUND

Metalloestrogens are metals and metalloid elements with estrogenic activity found everywhere. Their impact on human health is becoming more apparent as human activities increase.

OBJECTIVE

Our aim is to conduct a comprehensive systematic review and meta-analysis of observational studies exploring the correlation between metalloestrogens (specifically As, Sb, Cr, Cd, Cu, Se, Hg) and Gestational Diabetes Mellitus (GDM).

METHODS

PubMed, Web of Science, and Embase were searched to examine the link between metalloestrogens (As, Sb, Cr, Cd, Cu, Se, and Hg) and GDM until December 2023. Risk estimates were derived using random effects models. Subgroup analyses were conducted based on study countries, exposure sample, exposure assessment method, and detection methods. Sensitivity analyses and adjustments for publication bias were carried out to assess the strength of the findings.

RESULTS

Out of the 389 articles identified initially, 350 met our criteria and 33 were included in the meta-analysis, involving 141,175 subjects (9450 cases, 131,725 controls). Arsenic, antimony, and copper exposure exhibited a potential increase in GDM risk to some extent (As: OR = 1.28, 95 % CI [1.08, 1.52]; Sb: OR = 1.73, 95 % CI [1.13, 2.65]; Cu: OR = 1.29, 95 % CI [1.02, 1.63]), although there is a high degree of heterogeneity (As: Q = 52.93, p < 0.05, I2 = 64.1 %; Sb: Q = 31.40, p < 0.05, I2 = 80.9 %; Cu: Q = 21.14, p < 0.05, I2 = 71.6 %). Conversely, selenium, cadmium, chromium, and mercury exposure did not exhibit any association with the risk of GDM in our study.

DISCUSSION

Our research indicates that the existence of harmful metalloestrogens in the surroundings has a notable effect on the likelihood of GDM. Hence, we stress the significance of environmental elements in the development of GDM and the pressing need for relevant policies and measures.

Micronutrients in early life and offspring metabolic health programming: a promising target for preventing non-communicable diseases

Chronic non-communicable diseases are the leading cause of morbidity and mortality worldwide. Developing and implementing effective preventive strategies is the best way to ensure the overall metabolic health status of the population and to counter the global burden of non-communicable diseases. Predisposition to obesity and other non-communicable diseases is due to a combination of genetic and environmental factors throughout life, but the early environment, particularly the environment during the fetal period and the early years of life, is crucial in determining metabolic health, hence the concept of 'fetal programming'. The origins of this causal link between environmental factors and disease lie in epigenetic mechanisms. Among the environmental factors, diet plays a crucial role in this process. Substantial evidence documented the key role of macronutrients in the programming of metabolic diseases early in life. Recently, the effect of maternal micronutrient intake on offspring metabolic health in later life emerged. The purpose of this narrative review is to bring to light available evidence in the literature on the effect of maternal micronutrient status on offspring metabolic health and underlying epigenetic mechanisms that drive this link to highlight its potential role in the prevention of non-communicable diseases.

Key Nutrients for Optimal Blood Glucose Control and Mental Health in Individuals with Diabetes: A Review of the Evidence

Diabetes is associated with an increased risk of mental disorders, including depression, anxiety, and cognitive decline. Mental disorders can also contribute to the development of diabetes through various mechanisms including increased stress, poor self-care behaviors, and adverse effects on glucose metabolism. Consequently, individuals suffering from either of these conditions frequently experience comorbidity with the other. Nutrition plays an important role in both diabetes and mental health disorders including depression and anxiety. Deficiencies in specific nutrients such as omega-3 fatty acids, vitamin D, B vitamins, zinc, chromium, magnesium, and selenium have been implicated in the pathogenesis of both diabetes and mental disorders. While the impact of nutrition on the progression and control of diabetes and mental disorders is broadly acknowledged, there is a notable knowledge gap concerning the implications of distinct nutrients in preventing and mitigating symptoms of both conditions when they coexist. The aim of this study was to examine the role of nutrition in improving glucose homeostasis and promoting mental well-being among individuals with diabetes. Further, we evaluated the preventive or delaying effects of key nutrients on the simultaneous manifestation of these conditions when one of them is present. Our findings indicated that the use of personalized dietary interventions and targeted nutrient supplementation can improve metabolic and mental health outcomes in patients with type 2 diabetes.

A Comprehensive Review of the Impact of Chromium Picolinate on Testicular Steroidogenesis and Antioxidant Balance

Low testosterone (T) levels are a major cause of male infertility, as this hormone is crucial for several processes throughout the entire male reproductive tract. Leydig cells (LC) produce T through testicular steroidogenesis. Disrupted LC function can hinder steroid production and fertility. Among the factors that affect steroidogenesis, endocrine-disrupting chemicals (EDCs) raise concerns, as they disturb hormonal signaling. Chromium is classified as an EDC, and its main forms are hexavalent (Cr(VI)) and trivalent chromium (Cr(III)). While Cr(III) is controversially regarded as an essential metal, its compound Cr(III) picolinate (CrPic3) is used as a nutritional supplement due to its antidiabetic and antioxidant properties. This review aims to identify the possible effects of CrPic3 on testicular steroidogenesis and thus, on male fertility. The detriments caused by CrPic3 in LC include the inhibition of enzymes involved in steroidogenesis, and, as in other cells, the induction of mutagenesis and apoptosis. Remarkably, CrPic3 impacts male fertility through the alteration of reactive oxygen species (ROS), T levels, and sperm parameters (sperm motility and abnormal sperm count). However, gaps and inconsistencies exist in the literature concerning its effects on male fertility. Thus, further research is imperative to comprehend the underlying mechanisms of CrPic3 in the physiological processes relevant to male fertility, ensuring the supplement's safety for use by men.

A change-point regression approach for estimating no observed adverse effect level from systematic review

Systematic reviews can be used not only to evaluate the efficacy and usefulness of a drug or food ingredient, but also as a safety assessment method. One of the aims of safety assessment is to estimate the no observed adverse effect level and the lowest observed adverse effect level. However, no methodology to statistically estimate the no observed adverse effect level from systematic review results has yet been reported. Estimation of the no observed adverse effect level involves a search for the dose above which adverse events occur is even exploration of the thresholds in dose response. To search for the dose above which adverse events occur, we examined an estimation method using the weighted change-point regression model, which includes the weights of each study used for systematic reviews in the model. This model could be applied to safety data of an omega-3 study in the form of a systematic review. We demonstrated that the dose response to omega-3 intake regarding adverse events had a threshold value and that the no observed adverse effect level could be estimated using the developed model.

Mitochondrial ATP synthase as a direct molecular target of chromium(III) to ameliorate hyperglycaemia stress

Chromium(III) is extensively used as a supplement for muscle development and the treatment of diabetes mellitus. However, its mode of action, essentiality, and physiological/pharmacological effects have been a subject of scientific debate for over half a century owing to the failure in identifying the molecular targets of Cr(III). Herein, by integrating fluorescence imaging with a proteomic approach, we visualized the Cr(III) proteome being mainly localized in the mitochondria, and subsequently identified and validated eight Cr(III)-binding proteins, which are predominately associated with ATP synthesis. We show that Cr(III) binds to ATP synthase at its beta subunit via the catalytic residues of Thr213/Glu242 and the nucleotide in the active site. Such a binding suppresses ATP synthase activity, leading to the activation of AMPK, improving glucose metabolism, and rescuing mitochondria from hyperglycaemia-induced fragmentation. The mode of action of Cr(III) in cells also holds true in type II diabetic male mice. Through this study, we resolve the long-standing question of how Cr(III) ameliorates hyperglycaemia stress at the molecular level, opening a new horizon for further exploration of the pharmacological effects of Cr(III).

Preliminary Studies of Bio-Fortification of Yoghurt with Chromium

Yoghurt is a delectable fermented milk product suitable for all ages. Chromium (Cr), a trace mineral is found in two forms: trivalent and hexavalent. Recent studies have shown that the Cr (III), or chromium picolinate (Cri), is beneficial for carbohydrate metabolism. Thus, Cr supplements are used to treat diabetes and manage blood sugar. However, the effect of the incorporation of Cri on starter growth and the quality of yoghurt still needs to be determined. In this study, we aim to produce Cr (CrPi)-fortified yoghurt to fulfil the proposed recommended daily allowance (RDA) of Cr (35–50 µg/day for adults). Additionally, it might act as a nutraceutical for persons with special medical conditions, such as patients with obesity or type 2 diabetes mellitus disease. In this respect, the effect of different concentrations of CrPi, (1, 2, 5, 10, 20 ppm) chromium chloride [Cr (III)] (1, 2, 3, 4, 5 ppm), and potassium chromate [Cr (VI)] (1, 2 ppm) on the activity of yoghurt starter culture were investigated in vitro on de Man, Rogosa, and Sharpe (MRS) media. Compared to the control (without Cr), the obtained data revealed significant inhibition of the yoghurt starter culture by Cr (VI) at 2 ppm compared to Cr (III), which did not affect the bacterial growth up to 5 ppm and was comparable with CrPi [Cr (III)]. We also produced yoghurt supplemented with two doses of Cr (0.25 and 0.5 ppm). We did not observe any significant differences in the physicochemical, rheological, microbiological, and sensory properties of the Cr-fortified yoghurt and the control up to 2 weeks in cold storage. These results clearly indicate that CrPi (0.25 and 0.5 ppm) can be used to manufacture yoghurt with the RDA for intact Cr without affecting its quality.

The association between essential trace element mixture and atherosclerotic cardiovascular disease risk among Chinese community-dwelling older adults

The evidence about the association of the essential trace element (ETE) mixture with atherosclerotic cardiovascular disease (ASCVD) amongst older adults is limited. This study aims to evaluate the associations of single ETEs and the ETE mixture with the 10-year ASCVD risks and its predicting factors in Chinese community-dwelling older adults. A total of 607 community-dwelling older adults were included in this study. Blood levels of vanadium (V), chromium (Cr), manganese (Mn), cobalt (Co), nickel (Ni), and selenium (Se) were assessed by inductively coupled plasma mass spectrometry. The predicted 10-year ASCVD risk was calculated using the Prediction for ASCVD Risk in China (China-PAR) equations. Traditional linear regressions and Bayesian kernel machine regression (BKMR) were used to assess the associations of single ETEs and the ETE mixture with the 10-year ASCVD risks and its predicting factors such as systolic blood pressure (SBP), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), diabetes, and waist circumference (WC). In linear regression models, blood Cr levels were negatively associated with the 10-year ASCVD risks after adjustment for covariates (β =  - 0.07, 95% CI =  - 0.11 ~  - 0.03); The 3th quartile (Q3) of Se levels was also associated with a lower 10-year ASCVD risks when compared with the lowest quartile (Q1) of Se levels (β_Q3 vs. _Q1: - 0.12, 95% CI =  - 0.22 ~  - 0.02). In BKMR models, the negative associations of Cr and Se with the 10-year ASCVD risks were observed. Higher blood levels of ETE mixture were associated with decreased 10-year ASCVD risks in a dose-response pattern, with Cr having the highest value of the posterior inclusion probability (PIP) within the mixture. Furthermore, a positive association between Cr and HDL-C and a negative association between Se and SBP were found in both linear regression and BKMR models. Cr and Se were negatively associated with the 10-year ASCVD risks, individually and as a mixture. ETE mixture showed a linear dose-response association with decreased 10-year ASCVD risks, with Cr being the most important component within the mixture. The negative association of the ETE mixture with the 10-year ASCVD risks may be attributed to Cr and Se, mainly mediated by HDL-C and SBP, respectively. Further cohort studies are needed to clarify this association.

Effects of Chromium Supplementation on Lipid Profile: an Umbrella of Systematic Review and Meta-analysis

Dyslipidemia is one of the most well-established modifiable risk factors for cardiovascular disease (CVD) development. Several meta-analyses have revealed the improving effects of chromium on dyslipidemia, while some studies have reported controversial results. This study aimed to summarize meta-analyses of randomized controlled trials (RCTs) that examined the effects of chromium supplementation on lipid profiles in adults. The literature search was conducted using Embase, Scopus, Web of Science, Cochrane Central Library, and PubMed databases with appropriate keywords from the beginning to May 2022. Based on the pooled analysis results, a random-effects model was used to determine the effects of chromium on blood lipid levels. Heterogeneity, publication bias, and sensitivity analysis were also evaluated using standard methods. A total of eight meta-analyses were included in this study. The pooled analysis of eight meta-analyses did not find any significant effect of chromium supplementation on triglycerides (TG) (ES =  - 0.20 mg/dl; 95% CI: - 0.50, 0.10, p = 0.185), total cholesterol (TC) (ES =  - 0.14 mg/dl, 95% CI: - 0.43, 0.16; p = 0.369), low-density lipoprotein cholesterol (LDL-c) (ES =  - 0.08 mg/dl; 95% CI: - 0.19, 0.03; p = 0.142), and high-density lipoprotein cholesterol (HDL-C) levels (ES: 0.05 mg/dl, 95% CI: - 0.05, 0.14, p = 0.312). However, subgroup analysis by the intervention dose suggested that chromium supplementation in doses higher than 500 µg/day could significantly decrease TG. The available evidence proposes no beneficial effects of chromium intervention on blood lipids. As a result, it cannot be used as a single therapy to treat adults with lipid abnormalities.

A Comparative Study of Chromium: Therapeutic Uses and Toxicological Effects on Human Health

Chromium is an essential trace element whose deficiency can cause impairment of glucose tolerance, growth and various biological functions. There are two isotopes of chromium-trivalent chromium and hexavalent chromium. Both the isotopes of chromium have quite different effects on the human body. The objective of this narrative review is to compile the different effects of the two isotopes of chromium and give a comprehensive analysis of the effects of hexavalent and trivalent chromium. Data from various studies across different forums were compared to provide a concrete analysis of the therapeutic and harmful effects of two isotopes of chromium on human health. Chromium plays a vital role in the biological functions of the body. It might be helpful in balancing the glycaemic levels, triglyceride levels and cholesterol levels in the body. Excessive intake of chromium is harmful for health. Overexposure to chromium can lead to carcinogenic effects. Consumption of an insufficient amount of chromium might not be adequate as well. Trivalent chromium can be quite beneficial if taken in proper quantities. Hexavalent chromium can cause cancer. Trivalent chromium is beneficial, while hexavalent chromium is harmful to human health.

Steviol Glycoside, L-Arginine, and Chromium(III) Supplementation Attenuates Abnormalities in Glucose Metabolism in Streptozotocin-Induced Mildly Diabetic Rats Fed a High-Fat Diet

Stevia rebaudiana Bertoni and its glycosides are believed to exhibit several health-promoting properties. Recently, the mechanisms of the anti-diabetic effects of steviol glycosides (SG) have been the subject of intense research. The following study aims to evaluate the results of SG (stevioside (ST) and rebaudioside A (RA)) combined with L-arginine (L-Arg) and chromium(III) (CrIII) supplementation in streptozotocin- (STZ) induced mild type 2 diabetic rats fed a high-fat diet (HFD), with particular emphasis on carbohydrate and lipid metabolisms. The experiment was carried out on 110 male Wistar rats, 100 of which were fed an HFD to induce insulin resistance, followed by an intraperitoneal injection of streptozotocin to induce mild type 2 diabetes. After confirmation of hyperglycemia, the rats were divided into groups. Three groups served as controls: diabetic untreated, diabetic treated with metformin (300 mg/kg BW), and healthy group. Eight groups were fed an HFD enriched with stevioside or rebaudioside A (2500 mg/kg BW) combined with L-arginine (2000 or 4000 mg/kg BW) and Cr(III) (1 or 5 mg/kg BW) for six weeks. The results showed that supplementation with SG (ST and RA) combined with L-arg and Cr(III) could improve blood glucose levels in rats with mild type 2 diabetes. Furthermore, ST was more effective in improving blood glucose levels, insulin resistance indices, and very low-density lipoprotein cholesterol (VLDL-C) concentrations than RA. Although L-arg and Cr(III) supplementation did not independently affect most blood carbohydrate and lipid indices, it further improved some biomarkers when combined, particularly with ST. Notably, the beneficial impact of ST on the homeostatic model assessment–insulin resistance (HOMA-IR) and on the quantitative insulin-sensitivity check index (QUICKI) was strengthened when mixed with a high dose of L-arg, while its impact on antioxidant status was improved when combined with a high dose of Cr(III) in rats with mild type 2 diabetes. In conclusion, these results suggest that supplementary stevioside combined with L-arginine and Cr(III) has therapeutic potential for mild type 2 diabetes. However, further studies are warranted to confirm these effects in other experimental models and humans.

Maternal Chromium Levels in Gestational Diabetes: Systematic Review and Meta-Analysis

The topic of maternal Chromium (Cr) levels in Gestational Diabetes Mellitus (GDM) has remained controversial; some studies have found lower levels of Cr in GDM population, whereas others found no significant changes in Cr status in GDM. Therefore, this systematic review and meta-analysis was aimed at qualitatively and quantitatively synthesizing past studies to find the relationship of maternal Cr levels with GDM. The study protocol was registered at International prospective register for systematic reviews (PROSPERO) (ID CRD42021272979). Strict adherence to the Preferred Reporting Items for Systematic review and Meta-analysis checklist, 2009 was followed during the entire study. Random-effect model for calculation of distribution of true effect sizes was used for the meta-analysis with a confidence interval (CI) of 95%. The pooled Standard Mean Difference of control and GDM groups were compared using Z statistics with a P value of <.05 as significant. Six studies were included for the systematic review and four studies entered meta-analysis. The test of overall effect revealed that the pooled Cr values did not differ significantly between controls and GDM group (Z = 1.52, P =0.13). Heterogeneity between the studies was high (I2 = 97%). A subgroup analysis revealed that results varied as per place of study, trimester of pregnancy, and Cr estimation technique. Results from meta regression analysis revealed that sample size of individual studies (Q = 0.003, P =0.67) and year of publication of studies (Q = 0.22, P =.48) had no significant effect on the overall Standard Mean Difference. Factors such as ethnicity, lack of history of infection, and diet history can influence the results of this study.

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.

Efficacy and Safety of Nutrient Supplements for Glycaemic Control and Insulin Resistance in Type 2 Diabetes: An Umbrella Review and Hierarchical Evidence Synthesis

Background: Nutrient supplements are widely used for type 2 diabetes (T2D), yet evidence-based guidance for clinicians is lacking. Methods: We searched the four electronic databases from November 2015−December 2021. The most recent, most comprehensive, high-ranked systematic reviews, meta-analyses, and/or umbrella reviews of randomised controlled trials in adults with T2D were included. Data were extracted on study characteristics, aggregate outcome measures per group (glycaemic control, measures of insulin sensitivity and secretion), adverse events, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessments. Quality was assessed using A Measurement Tool to Assess Systematic Reviews Version 2.0 (AMSTAR 2). Results: Twelve meta-analyses and one umbrella review were included. There was very low certainty evidence that chromium, Vitamin C, and omega-3 polyunsaturated fatty acids (Ω-3 PUFAs) were superior to placebo for the primary outcome of glycated hemoglobin (HbA1c) (Mean Difference/MD −0.54, −0.54 and ES −0.27, respectively). Probiotics were superior to placebo for HbA1c (Weighted Mean Difference/WMD −0.43%). There was very low certainty evidence that Vitamin D was superior to placebo for lowering HbA1c in trials of <6 months (MD −0.17%). Magnesium, zinc, Vitamin C, probiotics, and polyphenols were superior to placebo for FBG. Vitamin D was superior to placebo for insulin resistance. Data on safety was limited. Conclusions: Future research should identify who may benefit from nutrient supplementation, safety, and optimal regimens and formulations.

Hypolipidemic effect of chromium-modified enzymatic product of sulfated rhamnose polysaccharide from Enteromorpha prolifera in type 2 diabetic mice

Sulfated rhamnose polysaccharide (SRP) derived from Enteromorpha prolifera is a metal-ion chelating agent that could potentially be used to treat diabetes. The aim of our study was to determine the effect of a variant of SRP on DIABETES. First, we synthesized and characterized SRPE-3 chromium(III) [SRPE-3-Cr(III)] complex using an enzymatic method. The maximum chelation rate was 18.2% under optimal chelating conditions of pH 6.0, time 4 h, and temperature 60 °C. Fourier transform infrared spectroscopy results showed important sites for Cr(III)-binding were O-H and C=O groups. We then studied the hypolipidemic effects of SRPE-3-Cr(III) on type 2 diabetes mellitus (T2DM) induced by a high-fat, high-sucrose diet (HFSD). Decreased blood glucose content, body fat ratio, serum TG, TC, LDL-C, and increased serum HDL-C were observed after treatment with SRPE-3-Cr(III). In addition, SRPE-3-Cr(III) significantly reduced leptin, resistin, and TNF-α levels, and increased adiponectin contents relative to T2DM. Histopathology results also showed that SRPE-3-Cr(III) could alleviate the HFSD-lesioned tissues. SRPE-3-Cr(III) also improved lipid metabolism via a reduction in aspartate aminotransferase, alanine aminotransferase, fatty acid synthase, and acetyl-CoA carboxylase activities in the liver. SRPE-3-Cr(III) at low doses exhibited better lipid-lowering activities, hence, could be considered to be a novel compound to treat hyperlipidemia and also act as an anti-diabetic agent.

Biological Properties of Transition Metal Complexes with Metformin and Its Analogues

Metformin is a widely prescribed medication for the treatment and management of type 2 diabetes. It belongs to a class of biguanides, which are characterized by a wide range of diverse biological properties, including anticancer, antimicrobial, antimalarial, cardioprotective and other activities. It is known that biguanides serve as excellent N-donor bidentate ligands and readily form complexes with virtually all transition metals. Recent evidence suggests that the mechanism of action of metformin and its analogues is linked to their metal-binding properties. These findings prompted us to summarize the existing data on the synthetic strategies and biological properties of various metal complexes with metformin and its analogues. We demonstrated that coordination of biologically active biguanides to various metal centers often resulted in an improved pharmacological profile, including reduced drug resistance as well as a wider spectrum of activity. In addition, coordination to the redox-active metal centers, such as Au(III), allowed for various activatable strategies, leading to the selective activation of the prodrugs and reduced off-target toxicity.

Could nutrient supplements provide additional glycemic control in diabetes management? A systematic review and meta-analysis of randomized controlled trials of as an add-on nutritional supplementation therapy

This systematic review and meta-analysis assessed the antidiabetic effect of pharmaconutrients as an add-on in type 2 diabetes mellitus patients by pooling data from currently available randomized controlled trials (RCTs). Data sources included the PubMed and EMBASE, Cochrane Central Register of Controlled Trials. RCTs reporting changes in glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), or homeostasis model assessment of insulin resistance (HOMA-IR) levels following add-on pharmaconutritional therapies for T2DM patients consuming antidiabetic drugs were targeted. Using random-effects meta-analyses, we identified pharmaconutrients with effects on glycemic outcomes. Heterogeneity among studies was presented using I² values. Among 9537 articles, 119 RCTs with nine pharmaconutrients (chromium; coenzyme Q10; omega-3 fatty acids; vitamins C, D, and E; alpha-lipoic acid; selenium; and zinc) were included. Chromium (HbA1c, FBG, and HOMA-IR), coenzyme Q10 (HbA1c and FBG), vitamin C (HbA1c and FBG), and vitamin E (HbA1c and HOMA-IR) significantly improved glycemic control. Baseline HbA1c level and study duration influenced the effects of chromium and vitamin E on HbA1c level. Sensitivity analyses did not modify the pooled effects of pharmaconutrients on glycemic control. Administration of chromium, coenzyme Q10, and vitamins C and E for T2DM significantly improved glycemic control. This study has been registered in PROSPERO (CRD42018115229).

The effects of chromium supplementation on blood pressure: a systematic review and meta-analysis of randomized clinical trials

Results of studies on the effect of chromium supplementation on blood pressure (BP) are contradictory. The purpose of the current study was to carry out a meta-analysis on the effects of chromium supplementation on systolic blood pressure (SBP) and diastolic blood pressure (DBP). We conducted a systematic literature search of PubMed, SCOPUS, Cochrane Library, Web of Science, and Embase databases from inception up to July 2020 for randomized controlled trials (RCTs) that evaluate the impacts of chromium on SBP and DBP. A random-effects model was used to compute weighted mean differences (WMDs) with 95% confidence intervals (CIs). Heterogeneity was determined by I² statistics and the Cochrane Q test. Sensitivity analysis was performed by eliminating each study one by one and recalculating the pooled effect. Ten studies comprising a total of 624 subjects were included in our meta-analysis. Chromium supplementation did not significantly change SBP (WMD: -0.642: 95% CI: (-2.15, 1.30) mmHg; p = 0.312; I² = 12.7%) and DBP (WMD: -0.10; 95% CI: (-1.39, 1.18) mmHg; p = 0.070; I² = 37.6%). Subgroup analysis based on dose and duration of chromium supplementation also did not significantly change the mean of SBP and DBP. The present meta-analysis of RCTs did not show the beneficial effects of chromium supplementation on BP in adults.

Effect of a high-fat diet and chromium on hormones level and Cr retention in rats

AIMS

The aim of the study was to determine how the administration of a high-fat diet supplemented with various forms of chromium to rats affects accumulation of this element in the tissues and levels of leptin, ghrelin, insulin, glucagon, serotonin, noradrenaline and histamine, as well as selected mineral elements.

METHODS

The experiment was conducted on 56 male Wistar rats, which were divided into 8 experimental groups. The rats received standard diet or high fat diet (HFD) with addition of 0.3 mg/kg body weight of chromium(III) picolinate (Cr-Pic), chromium(III)-methioninate (Cr-Met), or chromium nanoparticles (Cr-NP).

RESULTS

Chromium in organic forms was found to be better retained in the body of rats than Cr in nanoparticles form. However, Cr-Pic was the only form that increased the insulin level, which indicates its beneficial effect on carbohydrate metabolism. In blood plasma of rats fed a high-fat diet noted an increased level of serotonin and a reduced level of noradrenaline. The addition of Cr to the diet, irrespective of its form, also increased the serotonin level, which should be considered a beneficial effect. Rats fed a high-fat diet had an unfavourable reduction in the plasma concentrations of Ca, P, Mg and Zn. The reduction of P in the plasma induced by supplementation with Cr in the form of Cr-Pic or Cr-NP may exacerbate the adverse effect of a high-fat diet on the level of this element.

CONCLUSION

A high-fat diet was shown to negatively affect the level of hormones regulating carbohydrate metabolism (increasing leptin levels and decreasing levels of ghrelin and insulin).

Effect of Chromium Supplementation on Blood Glucose and Lipid Levels in Patients with Type 2 Diabetes Mellitus: a Systematic Review and Meta-analysis

In recent years, the prevalence and incidence of diabetes mellitus (DM) have increased sharply worldwide. In order to evaluate the effect of chromium supplementation on patients with type 2 diabetes, a meta-analysis was conducted by searching the relevant literature. Randomized controlled trials on the effects of chromium supplements on glucose metabolism or lipid profile in patients with type 2 diabetes were retrieved from multiple databases. Literature screening, quality evaluation, and data extraction were conducted according to the inclusion and exclusion criteria, and Review Manager 5.4.0 was used for data analysis. A total of 10 randomized controlled trials involving 509 patients were included, including 269 cases in the experimental group and 240 cases in the placebo control group. Statistical analysis was conducted on the glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) to evaluate the blood glucose and lipid levels. Meta-analysis results showed that the differences between the experimental group and the control group in only one indicator of HbA1c were statistically significant, while there were no statistically significant differences in other indicators. The use of chromium supplements can reduce the glycosylated hemoglobin of type 2 diabetic patients to a certain extent, but it cannot effectively improve the fasting blood glucose and blood lipid levels of type 2 diabetic patients.

The effects of dietary supplements and natural products targeting glucose levels: an overview

Identifying effective dietary supplements and medicinal herbs has attracted the attention of clinicians and researchers to complement the standard treatment in controlling diabetes mellitus. In the present overview, we aimed to collect studies with the highest level of evidence to shed light on detecting the most effective dietary supplements and medicinal herbs for controlling glycemic status. For the current overview, four electronic databases, including PubMed, Scopus, Web of Science, and Cochrane Library, were systematically searched from inception to 31 December 2020 and then updated until 1 October 2021 to obtain eligible meta-analyses on either dietary supplements or medicinal herbs and their effects on glycemic status. Fasting blood sugar (FBS) and Hemoglobin A1C (HbA1C) were considered as primary outcomes. Finally, ninety-one meta-analyses on dietary supplements (n = 55) and herbs (n = 36) were included. Evidence showed positive effects of chromium, zinc, propolis, aloe vera, milk thistle, fenugreek, cinnamon, ginger, and nettle on FBS and/or HbA1C. However, mostly the heterogeneity (I2) was high. Other supplements and herbs also showed no reduction in glucose levels or their effects were small. Although some dietary supplements and medicinal herbs showed a significant reduction in FBS and/or HbA1C, mostly their effects from the clinical point of view were not remarkable. In addition, due to high heterogeneity, publication bias, and a limited number of included studies in most cases further clinical trials are needed for making decision on anti-diabetic supplement efficacy.

Different trends of Cr, Fe and Zn contents in hair between obese, overweight and normal-weight men

OBJECTIVES

Overweight and obesity are risk factors for many diseases, nutrition leading to these phenomena is not only a question of disbalance between energy intake and expenditure, but also the presence of micronutrients. In our study, we focused on measuring residues of chromium, zinc and iron in the hair of men with different BMI.

METHODS

Hair samples and anthropometric questionnaires were collected from 45 males. Numbers of subjects and age structure were comparable between the three BMI groups. The determination of metal levels was performed by inductively coupled plasma mass spectrometry after mineralization of the hair.

RESULTS

The hair of obese men contained significantly higher chromium (0.096 μg/g vs. 0.045 μg/g, p = 0.0039) and iron (9.42 μg/g vs. 5.84 μg/g, p = 0.0009) concentrations than that of overweight men, but no significant difference between the normal-weight group and the obese group were found. The concentration of zinc was lower in obese subjects compared to overweight subjects (183.5 μg/g vs. 206.2 μg/g, p = 0.038). Also, statistically significant correlations between chromium and iron concentrations in hair and BMI were found (r = 0.307, p = 0.040, r = 0.360, p = 0.015, respectively). According to our results, age did not significantly affect chromium, iron and zinc concentrations in hair.

CONCLUSION

Consistent with some published studies, we have found that obese men have higher chromium and iron concentrations and lower zinc concentrations in hair.

The effect of chromium intake on oxidative stress parameters: A systematic review and meta-analysis

BACKGROUND

Trivalent chromium is a trace element thought to have a beneficial effect on oxidative stress (OS) parameters and inflammation. This review aimed to investigate the dose-response of chromium and summarize the effects of chromium supplementation on OS parameters in the literature.

METHODS

MEDLINE, Scopus, Web of Science and Cochrane CENTRAL databases were searched for RCTs published from inception to January 2021 evaluating the effect of chromium supplementation on OS parameters, namely MDA, TBARS, SOD, TAS, CAT, GPx, and GSH. A random-effects model was used to pool data and calculated standard mean difference and 95 % confidence intervals. Quantified heterogeneity among studies was assessed through Cochrane's I² values.

RESULTS

Nine studies enrolling 550 participants met the inclusion criteria. The obtained results indicate that chromium supplementation significantly increases TAC (SMD: 0.46; 95 % CI: 0.08, 0.84; I² = 00.0 % n = 2) and significantly decreases MDA levels (SMD: -0.46; 95 % CI: -0.86, -0.07; I² = 52.4 % n = 5). Supplementation did not significantly change CAT, GPx, GSH, SOD, TAS, and TBARS.

CONCLUSION

Chromium supplementation may improve OS parameters, however, due to high heterogeneity observed in the included studies, these findings should be interpreted with caution. Large RCTs on various patient groups evaluating the impact of chromium supplementation are needed to allow an adequate generalization of the benefits of chromium on human health.

Efficiency of “Neo inulin” in the complex treatment of patients with type 2 diabetes

Diabetes mellitus is one of the most serious medical, social, and economic health problems in all countries of the world. The incidence of diabetes mellitus in the world doubles every 10–15 years, acquiring the character of a non-infectious epidemic. Therefore, it is extremely important to search for new drugs that help normalize glycemia, prevent complications of diabetes mellitus, and improve the quality of life of patients. These drugs include “Neo inulin”, which has a hypoglycemic, antioxidant, hepatoprotective and angioprotective effect.The aim: to evaluate the effectiveness of “Neo inulin” in the complex treatment of patients with type 2 diabetes mellitus.Materials and methods. The study involved 18 women (average age – 64.5 ± 8.7 years, average weight – 77.8 ± 11.4 kg) and 3 men (average age – 54.6 ± 12.4 years, average weight – 114 ± 40.2 kg). The average duration of type 2 diabetes was 11.0 (7.0–12.0) years. “Neo inulin” was prescribed as 2 capsules per day for 12 weeks in the complex of basic diabetes therapy To assess the effectiveness of therapy, a study of the quality of life related to health, a biochemical blood test (glycated hemoglobin), a clinical minimum (CBC, OAM, ECG, blood glucose) was carried out, the functional characteristics of tissue blood flow were investigated, and the ankle-brachial index (ABI) was determined. Statistical processing of the results was carried out using the Statistica 6.0 software package (StatSoft Inc., USA). Differences were considered statistically significant at p < 0.05.Results. Statistically significant differences were revealed in the values of all scales of health-related quality of life in patients in the groups before and after treatment with “Neo Inulin”, including the total physical and mental components. An improvement in the functioning of microcirculatory regulation mechanisms was noted, which is confirmed by a statistically significant increase in ABI (1.0 and 0.8 on the right; 0.9 and 0.8 on the left, respectively; p < 0.05) and the coefficient of microcirculation variation (9.2 and 8.3, respectively; p < 0.05). In 57,1 % of cases (12 people), the level of glycated hemoglobin was normalized.Conclusion. The use of a treatment regimen that includes “Neo Inulin” improves the effectiveness of treatment and improves the quality of life of patients with type 2 diabetes mellitus.

The Association between Daily Total Dietary Nutrient Intake and Recent Glycemic Control States of Non-Pregnant Adults 20+ Years Old from NHANES 1999-2018 (Except for 2003-2004)

Background: Although daily total dietary nutrient intakes were potentially important factors in maintaining glycemic balance, their overall effect on glycemic control was still unclear among American adults. Objectives: We aimed to examine the association between daily total dietary nutrient intake and recent glycemic control status (RGCS). Methods: This cohort was composed of 41,302 individuals from the National Health and Nutrition Examination Survey (NHANES). The daily total intake of dietary nutrients and RGCS were independent and dependent variables, respectively. To evaluate their association, we carried out binary logistic regression, model fitting, linear discriminant analysis, and the receiver operator characteristic (ROC) analysis. Results: The result of robust check model showed that only the daily total dietary vitamin B6 intake (adjusted OR = 0.848; 95% CI: 0.738, 0.973; p-value = 0.019) was significantly negatively correlated with RGCS. When daily total dietary vitamin B6 intake and glycosylated hemoglobin (HbA1c) were used as independent variables and dependent variables, respectively, to fit the curves and lines, the established robust check model could distinguish American adults with different RGCS well. Moreover, the robust check model results of ROC analysis indicated that daily total dietary vitamin B6 intake might be a potential predictor for RGCS (AUC = 0.977; 95% CI: 0.974, 0.980; p-value < 0.001). Conclusions: This study showed that only daily total dietary vitamin B6 intake was a beneficial factor in RGCS, but it might need further multicenter or prospective studies to verify whether vitamin B6 had biological implications and public health meaning for glycemic control among American adults (specifically referred to non-pregnant participants over 20 years old).

Nutrition in Patients with Type 2 Diabetes: Present Knowledge and Remaining Challenges

Unhealthy behaviours, including diet and physical activity, coupled with genetic predisposition, drive type 2 diabetes (T2D) occurrence and severity; the present review aims to summarise the most recent nutritional approaches in T2D, outlining unmet needs. Guidelines consistently suggest reducing energy intake to counteract the obesity epidemic, frequently resulting in sarcopenic obesity, a condition associated with poorer metabolic control and cardiovascular disease. Various dietary approaches have been proposed with largely similar results, with a preference for the Mediterranean diet and the best practice being the diet that patients feel confident of maintaining in the long term based on individual preferences. Patient adherence is indeed the pivotal factor for weight loss and long-term maintenance, requiring intensive lifestyle intervention. The consumption of nutritional supplements continues to increase even if international societies do not support their systematic use. Inositols and vitamin D supplementation, as well as micronutrients (zinc, chromium, magnesium) and pre/probiotics, result in modest improvement in insulin sensitivity, but their use is not systematically suggested. To reach the desired goals, patients should be actively involved in the collaborative development of a personalised meal plan associated with habitual physical activity, aiming at normal body weight and metabolic control.

The Impact of Chromium Supplementation on Blood Pressure: A Systematic Review and Dose-Response Meta‑Analysis of Randomized‑Controlled Trials

INTRODUCTION

Potential effects of chromium supplementation on blood pressure (BP) have been examined in several interventional studies. Nevertheless, findings in this context are controversial.

AIM

Therefore, the current systematic review and meta-analysis aimed to comprehensively assess the impact of chromium supplementation on BP.

METHODS

Five online databases including Web of Science, Scopus, Embase, Google Scholar, and PubMed were systematically searched from inception to March 2020. We included all randomized clinical trials (RCTs) evaluating the effects of chromium supplementation on systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) in humans.

RESULTS

The random-effects meta-analysis of 11 eligible RCTs with 637 participants demonstrated the significant decline in both SBP (WMD - 2.51 mmHg; 95% CI - 4.97 to - 0.05, p = 0.04) and DBP (WMD - 1.04 mmHg; 95% CI - 1.96 to - 0.12, p = 0.026) following supplementation with chromium. In subgroup analysis, studies that were administered chromium yeast and brewer's yeast, showed greater decrease in SBP. Also, in stratification based on participants' health status, significant reduction in SBP only was seen in diabetic patients with chronic heart disease (CHD). Nonlinear dose-response analysis revealed a significant influence of chromium dosage on SBP changes.

CONCLUSION

The current meta-analysis, indicated that supplementation with chromium significantly decrease SBP and DBP. In subgroup analysis, administration of chromium yeast and brewer's yeast resulted in greater reduction in SBP. Further large-scale RCTs with better design are needed to confirm these findings.

Evidence-Based Recommendations for an Optimal Prenatal Supplement for Women in the U.S., Part Two: Minerals

The levels of many essential minerals decrease during pregnancy if un-supplemented, including calcium, iron, magnesium, selenium, zinc, and possibly chromium and iodine. Sub-optimal intake of minerals from preconception through pregnancy increases the risk of many pregnancy complications and infant health problems. In the U.S., dietary intake of minerals is often below the Recommended Dietary Allowance (RDA), especially for iodine and magnesium, and 28% of women develop iron deficiency anemia during their third trimester. The goal of this paper is to propose evidence-based recommendations for the optimal level of prenatal supplementation for each mineral for most women in the United States. Overall, the evidence suggests that optimal mineral supplementation can significantly reduce a wide range of pregnancy complications (including anemia, gestational hypertension, gestational diabetes, hyperthyroidism, miscarriage, and pre-eclampsia) and infant health problems (including anemia, asthma/wheeze, autism, cerebral palsy, hypothyroidism, intellectual disability, low birth weight, neural tube defects, preterm birth, rickets, and wheeze). An evaluation of 180 commercial prenatal supplements found that they varied widely in mineral content, often contained only a subset of essential minerals, and the levels were often below our recommendations. Therefore, there is a need to establish recommendations on the optimal level of mineral supplementation during pregnancy.

Preoperative Management of Surgical Patients Using Dietary Supplements: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

The widespread use of complementary products poses a challenge to clinicians in the perioperative period and may increase perioperative risk. Because dietary supplements are regulated differently from traditional pharmaceuticals and guidance is often lacking, the Society for Perioperative Assessment and Quality Improvement convened a group of experts to review available literature and create a set of consensus recommendations for the perioperative management of these supplements. Using a modified Delphi method, the authors developed recommendations for perioperative management of 83 dietary supplements. We have made our recommendations to discontinue or continue a dietary supplement based on the principle that without a demonstrated benefit, or with a demonstrated lack of harm, there is little downside in temporarily discontinuing an herbal supplement before surgery. Discussion with patients in the preoperative visit is a crucial time to educate patients as well as gather vital information. Patients should be specifically asked about use of dietary supplements and cannabinoids, as many will not volunteer this information. The preoperative clinic visit provides the best opportunity to educate patients about the perioperative management of various supplements as this visit is typically scheduled at least 2 weeks before the planned procedure.

A Comprehensive insight into the effect of chromium supplementation on oxidative stress indices in diabetes mellitus: A systematic review

Diabetes mellitus is a metabolic disorder defined as an increase in blood glucose levels (hyperglycaemia) and insufficient production or action of insulin produced by the pancreas. Chronic hyperglycaemia leads to increased reactive oxygen species (ROS) production and oxidative stress, which consequently results in insulin resistance, beta cell degeneration, dyslipidaemia, and glucose intolerance in diabetic patients. Chromium has an essential role in the metabolism of proteins, lipids, and carbohydrates through increasing insulin efficiency. This systematic review aimed to evaluate chromium supplementation's potential roles in oxidative stress indices in diabetes mellitus. A systematic search was performed in PubMed, Scopus, Google Scholar, Cochrane, and Science Direct databases until November 2020. All clinical trials and animal studies that assessed chromium's effect on oxidative stress indices in diabetes mellitus and were published in English-language journals were included. Finally, only 33 out of 633 articles met the required criteria for further analysis. Among 33 papers, 25 studies were performed on animals, and eight investigations were conducted on humans. Twenty-eight studies of chromium supplementation lead to reducing oxidative stress indices. Also, 23 studies showed that chromium supplementation markedly increased antioxidant enzymes' activity and improved levels of antioxidant indices. In conclusion, chromium supplementation decreased oxidative stress in diabetes mellitus. However, further clinical trials are suggested in a bid to determine the exact mechanisms.

The Double Face of Metals: The Intriguing Case of Chromium

Chromium (Cr) is a common element in the Earth’s crust. It may exist in different oxidation states, Cr(0), Cr(III) and Cr(VI), with Cr(III) and Cr(VI) being relatively stable and largely predominant. Chromium’s peculiarity is that its behavior relies on its valence state. Cr(III) is a trace element in humans and plays a major role in glucose and fat metabolism. The beneficial effects of Cr(III) in obesity and types 2 diabetes are known. It has been long considered an essential element, but now it has been reclassified as a nutritional supplement. On the other hand, Cr(VI) is a human carcinogen and exposure to it occurs both in occupational and environmental contexts. It induces also epigenetic effects on DNA, histone tails and microRNA; its toxicity seems to be related to its higher mobility in soil and swifter penetration through cell membranes than Cr(III). The microorganisms Acinetobacter sp. Cr1 and Pseudomonas sp. Cr13 have been suggested as a promising agent for bioremediation of Cr(VI). This review intends to underline the important role of Cr(III) for human health and the dangerousness of Cr(VI) as a toxic element. The dual and opposing roles of this metal make it particularly interesting. An overview of the recent literature is reported in support.

A pilot study of the effects of chromium picolinate supplementation on serum fetuin-A, metabolic and inflammatory factors in patients with nonalcoholic fatty liver disease: A double-blind, placebo-controlled trial

BACKGROUND

Evaluating the impact of chromium picolinate supplementation on glycemic status, lipid profile, inflammatory markers and fetuin-A in patients with non-alcoholic fatty liver disease (NAFLD).

METHODS

In present research, participants (N = 46) were randomized to (400 mcg/day, n = 23) chromium picolinate and placebo (n = 23) for 3 months.

RESULTS

Glucose indices, and lipid profiles, inflammatory biomarker and fetuin-A were measured before and after the intervention. Chromium reduced triglyceride (TG), atherogenic index of plasma (AIP), very-low-density lipoprotein (VLDL), insulin, homeostatic model assessment for insulin resistance (HOMA-IR), high-sensitivity C-reactive protein (hs-CRP), interleukin (IL) -6, tumor necrosis factor-alpha (TNF-α) and fetuin-A significantly compared to placebo group (p < 0.05). Furthermore, chromium significantly increased the quantitative insulin sensitivity check index (QUICKI). There were no significant differences in total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), fasting blood sugar (FBS), Hemoglobin A1c (HbA1C), interleukin (IL)-17 between the two groups (p < 0.05).

CONCLUSION

Chromium picolinate significantly decreased TG, insulin, HOMA-IR, fetuin-A, the number of inflammatory factors, and increased QUICKI without changing FBS, HbA1C, TC, LDL, HDL, IL-17 levels and liver steatosis intensity in patients with NAFLD. Further studies by examining the effect of different doses of chromium and mechanisms of cellular action, would help further clarify the subject.

An antidiabetic nutraceutical combination of red yeast rice (Monascus purpureus), bitter gourd (Momordica charantia), and chromium alleviates dedifferentiation of pancreatic β cells in db/db mice

Antidiabetic properties of red yeast rice, bitter gourd, and chromium have gained scientific support. This study aimed to test whether a nutraceutical combination of these 3 materials prevented dedifferentiation of pancreatic β cells. Male db/db mice (8 weeks of age) were allocated into four groups (DB, DB/L, DB/M, and DB/H; n = 8-10) and fed a high-fat diet containing 0%, 0.2%, 0.4%, or 1% nutraceutical, respectively, whereas wild-type mice receiving a standard diet served as a healthy control (C; n = 10). The nutraceutical contained 10 mg/g monacolin K, 165 µg/g chromium, and 300 mg/g bitter gourd. After 8-weeks dietary treatment, diabetic syndromes (including hyperglycemia, hyperphagia, excessive drinking, polyuria, glucosuria, albuminuria, and glucose intolerance), were improved by the nutraceutical in a dose-dependent fashion. Decreased insulin and increased glucagon in serum and pancreatic islets in db/db mice were abolished in the DB/H group. Furthermore, supplementation curtailed dedifferentiation of β cells, as evidenced by decreasing the dedifferentiation marker (Aldh1a3) and increasing β-cell-enriched genes and transcription factors (Ins1, Ins2, FOXO1, and NKX6.1), as well as nuclear localization of NKX6.1 in pancreatic islets when compared to the DB group. We concluded that this nutraceutical, a combination of Monascus purpureus, Momordica charantia, and chromium, could be used as an adjunct for type 2 diabetes treatment and delay disease progression by sustaining β-cell function.

Effects of chromium supplementation on glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

We aimed to investigate the effect of chromium supplementation on glycemic control indices in patients with type 2 diabetes (T2DM).

METHODS

Randomized controlled trials examining the effect of chromium supplementation on glycemic control indices and published before February 2020 were detected by searching online databases, including PubMed, Scopus, Embase, Web of sciences and The Cochrane Library, using a combination of suitable keywords. Mean change and standard deviation (SD) of the outcome measures were used to estimate the mean difference between the supplementation group and the control group at follow-up.

RESULTS

Twenty-eight studies reported fasting plasma glucose (FPG), insulin, hemoglobin A1C (HbA1C) and homeostatic model assessment for insulin resistance (HOMA-IR) as an outcome measure. Results revealed significant reduction in FPG (weighted mean difference (WMD): -19.00 mg/dl, 95% CI: -36.15, -1.85, P = 0.030; I²: 99.8%, p < 0.001), insulin level (WMD: -12.35 pmol/l, 95% CI: -17.86, -6.83, P < 0.001), HbA1C (WMD: -0.71 %, 95% CI: -1.19, -0.23, P = 0.004) and HOMA-IR (WMD: -1.53, 95% CI: -2.35, -0.72, P < 0.001; I²: 89.9%, p < 0.001) after chromium supplementation.

CONCLUSION

The results of the current meta-analysis study might support the use of chromium supplementation for the improvement of glycemic control indices in T2DM patients.

The association of urine metals and metal mixtures with cardiovascular incidence in an adult population from Spain: the Hortega Follow-Up Study

BACKGROUND

The association of low-level exposure to metals and metal mixtures with cardiovascular incidence in the general population has rarely been studied. We flexibly evaluated the association of urinary metals and metal mixtures concentrations with cardiovascular diseases in a representative sample of a general population from Spain.

METHODS

Urine antimony (Sb), barium (Ba), cadmium (Cd), chromium (Cr), cobalt (Co), copper (Cu), molybdenum (Mo), vanadium (V) and zinc (Zn) were measured in 1171 adults without clinical cardiovascular diseases, who participated in the Hortega Study. Cox proportional hazard models were used for evaluating the association between single metals and cardiovascular incidence. We used a Probit extension of Bayesian Kernel Machine Regression (BKMR-P) to handle metal mixtures in a survival setting.

RESULTS

In single-metal models, the hazard ratios [confidence intervals (CIs)] of cardiovascular incidence, comparing the 80th to the 20th percentiles of metal distributions, were 1.35 (1.06, 1.72) for Cu, 1.43 (1.07, 1.90) for Zn, 1.51 (1.13, 2.03) for Sb, 1.46 (1.13, 1.88) for Cd, 1.64 (1.05, 2.58) for Cr and 1.31 (1.01, 1.71) for V. BKMR-P analysis was confirmatory of these findings, supporting that Cu, Zn, Sb, Cd, Cr and V are related to cardiovascular incidence in the presence of the other metals. Cd and Sb showed the highest posterior inclusion probabilities.

CONCLUSIONS

Urine Cu, Zn, Sb, Cd, Cr and V were independently associated with increased cardiovascular risk at levels relevant for the general population of Spain. Urine metals in the mixture were also jointly associated with cardiovascular incidence, with Cd and Sb being the most important components of the mixture.

Correlation between urinary chromium level and semen quality in men attending an andrology laboratory

Chromium is an essential element that is required for the normal physiology but can be toxic to humans above a certain level. In spite of growing interest in research on chromium exposure to human health consensus about its effect on human, semen quality has not been achieved. The aim of the present study is to evaluate the impact of chromium exposure on semen parameters. A total of 760 males attending andrology laboratory of Tongji Hospital, Wuhan, for routine semen analysis were enrolled and requested to provide semen and urine samples. The urine level of chromium was evaluated using inductively coupled plasma mass spectrometry (ICP-MS), and computer-assisted semen analysis (CASA) was applied to examine semen parameters. Associations between semen parameters and urinary chromium were analyzed by means of multivariate linear regression analysis. Multivariate analysis showed a negative association between the urinary concentrations of chromium and progressive motility (β = - 0.014, p = 0.040) and total motility (β = - 1.077, p = 0.048), while other semen parameters did not show any statistically significant changes. Urinary chromium could influence semen quality parameters and impair male fecundity.

Use and abuse of dietary supplements in persons with diabetes

The dietary supplement industry has estimated sales of over $30 billion in the US and over $100 billion globally. Many consumers believe that dietary supplements are safer and possibly more effective than drugs to treat diabetes. The sheer volume of the literature in this space makes compiling them into one review challenging, so much so that primarily narrative reviews currently exist. By applying the interactive database supplied by the Office of Dietary Supplements at the National Institutes of Health, we identified the top 100 ingredients that appeared most often in dietary supplement products. One-hundred different keyword searches using the ingredient name and the word diabetes were performed using a program developed to automatically scrape PubMed. Each search was retained in a separate Excel spreadsheet, which was then reviewed for inclusion or exclusion. The studies that met the inclusion criteria were evaluated for effect of reducing and controlling diabetes. The PubMed scrape resulted in 6217 studies. For each keyword search only the most recent 100 were retained, which refined the total to 1823 studies. Of these 425 met the screening criteria. The ingredients, fiber, selenium and zinc had the most studies associated with improvement in diabetes. Several popular supplement ingredients (phosphorus, pantothenic acid, calcium, magnesium, glutamine, isoleucine, tyrosine, choline, and creatine monohydrate) did not result in any studies meeting our screening criteria. Our study demonstrates how to automate reviews to filter and collapse literature in content areas that have an enormous volume of studies. The aggregated set of studies suggest there is little clinical evidence for the use of dietary supplements to reduce or control diabetes.

The Influences of Chromium Supplementation on Metabolic Status in Patients with Type 2 Diabetes Mellitus and Coronary Heart Disease

This investigation was conducted to determine the effects of chromium supplementation on metabolic status in diabetic patients with coronary heart disease (CHD). This randomized, double-blind, placebo-controlled trial was performed in 64 diabetic patients with CHD between October 2017 and January 2018. Patients were randomly divided into two groups to obtain either 200 μg chromium (n = 32) or placebo (n = 32) for 12 weeks. Chromium supplementation significantly reduced body weight (- 0.9 ± 1.6 vs. + 0.1 ± 0.8 kg, P = 0.001), BMI (- 0.4 ± 0.7 vs. + 0.1 ± 0.3 kg/m², P = 0.002), fasting glucose (β - 11.03 mg/dL; 95% CI, - 18.97, - 3.09; P = 0.007), insulin (β - 1.33 μIU/mL; 95% CI, - 1.90, - 0.76; P < 0.001), and insulin resistance (β - 0.44; 95% CI, - 0.62, - 0.25; P < 0.001) and significantly increased insulin sensitivity (β 0.007; 95% CI, 0.003, 0.01; P < 0.001) compared with the placebo. In addition, taking chromium led to a significant reduction in serum high-sensitivity C-reactive protein (hs-CRP) (β - 0.49 mg/L; 95% CI, - 0.91, - 0.06; P = 0.02) and plasma malondialdehyde (MDA) levels (β - 0.22 μmol/L; 95% CI, - 0.35, - 0.10; P = 0.001); also, a significant rise in total antioxidant capacity (TAC) (β 84.54 mmol/L; 95% CI, 31.05, 138.02; P = 0.002) was observed in comparison with placebo. Additionally, chromium administration significantly reduced diastolic blood pressure (DBP) (β - 5.01 mmHg; 95% CI, - 9.04, - 0.97; P = 0.01) compared with the placebo. Overall, the 12-week supplementation of chromium to diabetic patients with CHD had beneficial impacts on weight, BMI, glycemic control, hs-CRP, TAC, MDA, and DBP.Trial Registration www.irct.ir: http://www.irct.ir: IRCT20170513033941N30.

Chromium Supplementation; Negotiation with Diabetes Mellitus, Hyperlipidemia and Depression

Chromium (Cr) is an essential trace element which found naturally in a daily diet and available in the form of supplementary tablets to boost disorders like diabetes mellitus (DM) and functions like lipid metabolism and beneficial on depression too. Diabetes is one of the most prevalent endocrine diseases or in other words, the most severe metabolic syndrome (MS), which associated with high production of free-radicals which is out of bodies detoxifying machine capacity or high oxidative stress (HOS), vasculitis and elevated lipid profile. many research papers and clinical trials published about the significance of chromium on biological activities, pre and post clinical. For this review research articles, clinical trials, from 1^st Jan'10 to 31^st Dec'18 and refer literature for the biochemical, pharmacological and biological activity of Chromium. Primarily articles gathered from the above search engines. Then precisely according to our aim and goal and regarding designed objectives dismisses similar articles and finally came to 84 articles for the above said period. This review trying to cover the entire picture from what chromium is to the recent updates on their greater role in increasing insulin sensitivity of cells and enhancing lipid metabolism and even recent findings suggest its positive effects including prevention and ameliorating properties on depression. The biological activities, pharmacological features, clinical implications including efficacy and role of chromium compounds on the glycaemic index will be discussed. The outcome of this review is to bring the pros and cons of chromium supplementation along with is safety and toxicity concern beside molecular pathways, biochemistry and clinical trials, all in one comprehensive review.

Effects of Chromium and Carnitine Co-supplementation on Body Weight and Metabolic Profiles in Overweight and Obese Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial

The primary aim of our study was to determine the influence of taking chromium plus carnitine on insulin resistance, with a secondary objective of evaluating the influences on lipid profiles and weight loss in overweight subjects with polycystic ovary syndrome (PCOS). In a 12-week randomized, double-blind, placebo-controlled clinical trial, 54 overweight women were randomly assigned to receive either supplements (200 μg/day chromium picolinate plus 1000 mg/day carnitine) or placebo (27/each group). Chromium and carnitine co-supplementation decreased weight (- 3.6 ± 1.8 vs. - 1.0 ± 0.7 kg, P < 0.001), BMI (- 1.3 ± 0.7 vs. - 0.3 ± 0.3 kg/m², P < 0.001), fasting plasma glucose (FPG) (- 5.1 ± 6.0 vs. - 1.1 ± 4.9 mg/dL, P = 0.01), insulin (- 2.0 ± 1.4 vs. - 0.2 ± 1.2 μIU/mL, P < 0.001), insulin resistance (- 0.5 ± 0.4 vs. - 0.04 ± 0.3, P < 0.001), triglycerides (- 18.0 ± 25.2 vs. + 5.5 ± 14.4 mg/dL, P < 0.001), total (- 17.0 ± 20.3 vs. + 3.6 ± 12.0 mg/dL, P < 0.001), and LDL cholesterol (- 13.3 ± 19.2 vs. + 1.4 ± 13.3 mg/dL, P = 0.002), and elevated insulin sensitivity (+ 0.007 ± 0.005 vs. + 0.002 ± 0.005, P < 0.001). In addition, co-supplementation upregulated peroxisome proliferator-activated receptor gamma (P = 0.02) and low-density lipoprotein receptor expression (P = 0.02). Overall, chromium and carnitine co-supplementation for 12 weeks to overweight women with PCOS had beneficial effects on body weight, glycemic control, lipid profiles except HDL cholesterol levels, and gene expression of PPAR-γ and LDLR. Clinical trial registration number: http://www.irct.ir: IRCT20170513033941N38.

The Possibilities of Using Chromium Salts as an Agent Supporting Treatment of Polycystic Ovary Syndrome

The polycystic ovary syndrome (PCOS) is the most frequent endocrinopathy in women in reproductive age with the so far undetermined causes of development. In the etiopathogenesis of PCOS, the role of insulin resistance is emphasised, which was an indication for the attempts at using chromium III salts (Cr) in augmenting pharmacotherapy applied in patients. The analysis of the usefulness and efficacy of this approach was the direct goal of this thesis. Animal tests confirmed the efficacy of chromium in maintaining the appropriate level of glycaemia and insulinaemia, normalisation of plasma concentrations of microelements and also a correlation between the Cr level, insulin and dehydroepiandrosterone (DHEA) was found. A decrease in the expression of 3β-hydroxysteroid dehydrogenase and 17β-hydroxysteroid dehydrogenase was identified in adipose tissue. Clinical studies, although sparse, show that the supplementation with chromium can improve BMI and the parameters evaluating the control of glycaemia and increase the chances for ovulation and regular menstruation. However, the small number and a variability in study protocols makes comparing them very difficult. A completely new subject that has not been yet studied is the possibility of using chromium in levelling mood disorders in patients with PCOS. Currently, there are still no sufficient proofs for introducing chromium as a standard in treating and preventing insulin resistance in patients with PCOS. However, this direction remains open, and treating insulin resistance is an important challenge in clinical practice.

Naturopathy as a Model of Prevention-Oriented, Patient-Centered Primary Care: A Disruptive Innovation in Health Care

Background and Objective: The concept of a "disruptive innovation," recently extended to health care, refers to an emerging technology that represents a new market force combined with a new value system, that eventually displaces some, or all, of the current leading "stakeholders, products and strategic alliances." Naturopathy is a distinct system of traditional and complementary medicine recognized by the World Health Organization (WHO), emerging as a model of primary care. The objective here is to describe Naturopathy in the context of the criteria for a disruptive innovation. Methods: An evidence synthesis was conducted to evaluate Naturopathy as a potentially disruptive technology according to the defining criteria established by leading economists and health technology experts: (1) The innovation must cure disease; (2) must transform the way medicine is practiced; or (3) have an impact that could be disruptive or sustaining, depending on how it is integrated into the current healthcare marketplace. Results: The fact that Naturopathy de-emphasizes prescription drug and surgical interventions in favor of nonpharmacological health promotion and self-care could disrupt the present economic model that fuels health care costs. The patient-centered orientation of Naturopathy, combined with an emphasis on preventive behaviors and popular complementary and integrative health services like natural products, mind and body therapies, and other therapies not widely represented in current primary care models increase the likelihood for disruption. Conclusions: Because of its patient-centered approach and emphasis on prevention, naturopathy may disrupt or remain a durable presence in healthcare delivery depending on policymaker decisions.

Potential roles of chromium on inflammatory biomarkers in diabetes: A Systematic

Diabetes, as a low-grade chronic inflammatory disease, causes disruption in proper function of immune and metabolic system. Chromium is an important element required for normal lipid and glucose metabolism. Chromium deficiency is correlated with elevation in cardiometabolic risk, which results from increased inflammation. This systematic review was conducted to discover the potential roles of chromium on inflammatory biomarkers. Eligible studies were all in vitro, animal and human studies published in English-language journals from inception until October 2018. PubMed, Scopus, Embase, ProQuest and Google Scholar databases were searched to fined interventional studies from the effects of chromium on inflammatory biomarkers such as tumour necrosis factor a (TNF-a), C-reactive protein (CRP), interleukins, monocyte chemoattractant protein-1 (MCP-1), intercellular adhesion molecule-1 (ICAM-1) and adipocytokines in hyperglycaemia and diabetes. Out of 647 articles found in the search, only 14 articles were eligible for analysis, three in vitro studies, eight animal studies and three human studies. Twelve of the 14 studies included in this review, chromium significantly decreased inflammatory factors. The findings of this review indicate, based on in vitro and in vivo studies, that chromium might have potential anti-inflammatory properties, but some of the studies did not show anti-inflammatory effects for chromium (two studies). There are only three studies in humans with controversial results. Therefore, more consistent randomized double-blind controlled trials are needed to reach relevant clinical recommendations, as well as to determine the precise mechanism, of chromium on inflammation in diabetes.

Essential trace elements and progression and management of HIV infection

This review was written to update the review that we published in Nutrition Research in 2007 by examining studies published in the last 11 years which describe the effects of trace mineral deficiencies and micronutrient supplementation on HIV infection and its progression. In addition, we included studies that explore the interactions between Highly Active Anti-Retroviral Therapy (HAART) and micronutrient nutrition, focusing on the essential trace minerals. This review summarizes the results described in relevant articles that were identified by literature searches conducted using the OVID Medline database. Four of the nine essential trace minerals, specifically chromium, iron, selenium, and zinc, can influence HIV progression and/or its treatment. Notably, copper-containing filters may prevent transmission of the HIV virus via breastfeeding. However, there is a lack of good evidence to date that fluoride, iodine, manganese, or molybdenum influence HIV infection. Recent studies reveal that HAART can alter serum trace mineral and vitamin concentrations, but the effects vary based on the medications used. Although they have contributed useful new data, the sample sizes for most of these studies were too small to draw definitive conclusions for introducing changes in the management of HIV infection. Larger studies are needed to better understand and define the roles of trace mineral and vitamin deficiencies and micronutrient supplementation in the management and treatment of HIV-infected patients.

Systematic Review of the Effects of Chromium(III) on Chickens

Chromium supplementation has been proposed to have beneficial effects in farm animals, particularly when under stress. The last two decades, in particular, have seen an emphasis on examining the effects of supplemental chromium on a variety of variables in chicks and chickens. Thus, given the recent approval of a Cr(III) compound for use in chicken feed in the United States and the recent surge in papers on the use of Cr in chicken feed, the need for a systematic review of studies utilizing chickens is extremely urgent and timely. With the exception of studies on cold-stressed laying hens, the results of studies of Cr supplementation of chickens, whether broilers or laying hens, were found to be too inconsistent for any firm conclusions to be drawn other than that Cr supplementation generally leads to accumulation of Cr in tissues. Few potential trends in terms or beneficial or deleterious effects from Cr supplementation were found regardless of strain of chicken, Cr source, Cr dose, duration of supplementation, or variable examined. Hence, in summary, no recommendation for the use of Cr as a supplement for the diet of chickens can be made at this time.