Chromium effects on glucose tolerance and insulin sensitivity in persons at risk for diabetes mellitus

Chromium Picolinate Regulates Bone Metabolism and Prevents Bone Loss in Diabetic Rats

Diabetic osteoporosis (DOP) is an abnormal metabolic disease caused by long-term hyperglycemia. In this study, a model rat of streptozotocin (STZ)-induced diabetes was established, and chromium picolinate (5 mg·kg-1) was given; the changes in blood glucose and body weight were detected before and after administration; and bone mineral density (BMD), bone morphology, bone turnover markers, inflammatory cytokines, and oxidative stress indicators were observed in each group. We found that after chromium picolinate (CP) intervention for 8 weeks, the blood glucose level was decreased; the BMD, the bone histomorphology parameters, and the pathological structure were improved; the expression of bone resorption-related proteins was downregulated; and the expression of bone formation-related proteins was upregulated. Meanwhile, serum antioxidant activity was increased, and inflammatory cytokine levels were decreased. In conclusion, CP could alleviate DOP by anti-oxidation, inhibition of bone turnover, anti-inflammation, and regulation of the OPG/RANKL/RANK signaling pathway. Therefore, CP has important application values for further development as a functional food or active medicine in DOP treatment.

A Narrative Review on Strategies for the Reversion of Prediabetes to Normoglycemia: Food Pyramid, Physical Activity, and Self-Monitoring Innovative Glucose Devices

In 2019, "Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report" was published. This consensus report, however, did not provide an easy way to illustrate to subjects with prediabetes (SwPs) how to follow a correct dietary approach. The purpose of this review is to evaluate current evidence on optimum dietary treatment of SwPs and to provide a food pyramid for this population. The pyramid built shows that everyday consumption should consist of: whole-grain bread or potatoes eaten with their skins (for fiber and magnesium) and low glycemic index carbohydrates (GI < 55%) (three portions); fruit and vegetables (5 portions), in particular, green leafy vegetables (for fiber, magnesium, and polyphenols); EVO oil (almost 8 g); nuts (30 g, in particular, pistachios and almonds); three portions of dairy products (milk/yogurt: 300-400 g/day); mineral water (almost 1, 5 L/day for calcium intake); one glass of wine (125 mL); and three cups of coffee. Weekly portions should include fish (four portions), white meat (two portions), protein plant-based food (four portions), eggs (egg portions), and red/processed meats (once/week). At the top of the pyramid, there are two pennants: a green one means that SwPs need some personalized supplementation (if daily requirements cannot be satisfied through diet, vitamin D, omega-3, and vitamin B supplements), and a red one means there are some foods and factors that are banned (simple sugar, refined carbohydrates, and a sedentary lifestyle). Three to four times a week of aerobic and resistance exercises must be performed for 30-40 min. Finally, self-monitoring innovative salivary glucose devices could contribute to the reversion of prediabetes to normoglycemia.

The role of chromium supplementation in cardiovascular risk factors: A comprehensive reviews of putative molecular mechanisms

In the recent years, micronutrients play an important role in improving body health with preventing and treating of chronic diseases. Chromium is one of the vital minerals involved in the regulation of insulin action. According to abundant evidences this mineral seems to be an essential factor involved in the reduction of insulin resistance and decreasing the risk of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVDs). Moreover, it has been proposed that Chromium supplementation affects mechanisms involved in blood pressure, lipid metabolism, inflammation, and oxidative stress. For instance, it may affect blood pressure through alteration of the renin-angiotensin system, as well as reducing the angiotensin-converting enzyme activity. Furthermore, Chromium supplementation might help reduce the coronary heart disease rates. This study aims to provide a comprehensive review regarding to the effects of Chromium supplementation on CVDs risk factors with an emphasis on possible molecular mechanisms.

SXRF for Studying the Distribution of Trace Metals in the Pancreas and Liver

Transition metals such as iron, copper and zinc are required for the normal functioning of biological tissues, whereas others, such as cadmium, are potentially highly toxic. Any disturbances in homeostasis caused by lack of micronutrients in the diet, pollution or genetic heredity result in malfunction and/or diseases. Here, we used synchrotron X-ray fluorescence, SXRF, microscopy and mice with altered functions of major antioxidant enzymes to show that SXRF may become a powerful tool to study biologically relevant metal balance in the pancreas and liver of mice models with disturbed glucose homeostasis.

Preparation and hypoglycemic effects of chromium- and zinc-rich Acetobacter aceti

BACKGROUND

At present, there is no ideal method to cure diabetes, and there are few reports on the treatment of diabetes with probiotics.

AIM

To propose a method for preparing a new type of chromium- and zinc-rich Acetobacter aceti (A. aceti) and explore its ability to enhance the hypoglycemic effects of probiotics in the treatment of diabetes.

METHODS

A. aceti was cultured in a liquid medium that contained chromium trichloride and zinc chloride, both at a concentration of 64 mg/mL, with the initial concentration of the bacterial solution 1 × 10⁴ CFU/mL. After the bacterial solution had been inducted for 48 h, the culture media was changed and the induction was repeated once. The levels of chromium and zinc in the bacteria were detected by inductively coupled plasma mass spectrometry, and the contents of NADH and glucose dehydrogenase were determined using an NAD/NADH kit and glucose dehydrogenase kit, respectively. Streptozotocin was used to establish a mouse model to evaluate the hypoglycemic effects of the proposed chromium- and zinc-rich A. aceti. Ten-times the therapeutic dose was administered to evaluate its biological safety. The effect on MIN6 islet cells was also assessed in vitro.

RESULTS

The levels of chromium metal, metallic zinc, NADH coenzyme, and glucose dehydrogenase in A. aceti prepared by this method were 28.58-34.34 mg/kg, 5.35-7.52 mg/kg, 5.13-7.26 μM, and 446.812-567.138 U/g, respectively. The use of these bacteria resulted in a better hypoglycemic effect than metformin, promoting the repair of tissues and cells of pancreatic islets in vivo and facilitating the growth of MIN6 pancreatic islet cells and increasing insulin secretion in vitro. Ten-times the therapeutic dose of treatment was non-toxic to mice.

CONCLUSION

Chromium trichloride and zinc chloride can be employed to induce the preparation of chromium- and zinc-rich A. aceti, which can then promote the hypoglycemic effect found in normal A. aceti. The bacteria biotransforms the chromium and zinc in a way that could increase their safety as a treatment for diabetes.

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.

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.

Hypoxia-inducible factors and diabetes

Hypoxia can be defined as a relative deficiency in the amount of oxygen reaching the tissues. Hypoxia-inducible factors (HIFs) are critical regulators of the mammalian response to hypoxia. In normal circumstances, HIF-1α protein turnover is rapid, and hyperglycemia further destabilizes the protein. In addition to their role in diabetes pathogenesis, HIFs are implicated in development of the microvascular and macrovascular complications of diabetes. Improving glucose control in people with diabetes increases HIF-1α protein and has wide-ranging benefits, some of which are at least partially mediated by HIF-1α. Nevertheless, most strategies to improve diabetes or its complications via regulation of HIF-1α have not currently proven to be clinically useful. The intersection of HIF biology with diabetes is a complex area in which many further questions remain, especially regarding the well-conducted studies clearly describing discrepant effects of different methods of increasing HIF-1α, even within the same tissues. This Review presents a brief overview of HIFs; discusses the range of evidence implicating HIFs in β cell dysfunction, diabetes pathogenesis, and diabetes complications; and examines the differing outcomes of HIF-targeting approaches in these conditions.

The effects of chromium supplementation on lipidprofile in humans: A systematic review and meta-analysis ofrandomized controlled trials

BACKGROUND AND AIM

This systematic review and meta-analysis aimed to evaluate the effects of chromium supplementation on lipid profile consisting of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and very low-density lipoprotein (VLDL) in humans.

METHODS

The PubMed/Medline, Scopus, Web of sciences, Google Scholar and Cochrane library were systematically searched for randomised control trails (RCTs) available which published before August 2020. The meta-analysis was conducted using Random or fixed-effects models, and between-study heterogeneity was assessed by I².

RESULTS

Thirty-eight studies comprising 41 treatment arms and 7605 participants included to the present meta-analysis. Our results of overall analysis show only a significant reduction in serum TC level in response to chromium supplementation (WMD: -0.17 mmol/l, 95 % CI: -0.27, -0.07, P = 0.001). In accordance with the results of the subgroup analyses, the lowering-effect of chromium supplementation may be synergist during short-term (less than 12 weeks), low dose (less than 200), diabetics patient, younger adults (less than 54 years) and picolinate and elemental form for TC, older and non-obese subjects (>54 years and ≤ 29 kg/m2, respectively), women, Asian and Australian and picolinate form for TG, short-term, low dose, non-obese subjects, women, and Asian for VLDL, and nicotinate form for HDL-C, but had no effect on LDL-C.

CONCLUSION

Our meta-analysis reveals that there was only an overall significant association between chromium supplementation with decreases in the concentration of TC. Additionally, we found considerable evidence of subgroup analysis that support a significant lowering effect of chromium supplementation on TC, TG and VLDL. Further RCTs with short-term and low dose chromium supplementation in subjects with diabetes are necessitated for a firm conclusion of the lipid-modulating properties.

Nutritional Strategies in Prediabetes: A Scoping Review of Recent Evidence

Nutritional therapy has been conventionally recommended for people with prediabetes as a method to delay or halt progression to type 2 diabetes. However, recommended nutritional strategies evolve over time. Hence, we performed a scoping review on recently reported nutritional interventions for individuals with prediabetes. Ovid MEDLINE, PubMed, Embase, Scopus, CINAHL and PsycINFO databases were searched to identify relevant research articles published within the past 10 years. Ninety-five articles involving a total of 11,211 participants were included in this review. Nutritional strategies were broadly classified into four groups: low calorie diet, low glycemic index diet, specific foods, and a combination of diet and exercise. The most frequently assessed outcomes were plasma glucose, serum insulin, serum lipid profile, body mass index and body weight. More than 50% of reported interventions resulted in significant improvements in these parameters. Nutritional interventions have demonstrated feasibility and practicality as an effective option for prediabetes management. However, the intervention variability demonstrates the challenges of a 'one-size-fits-all' approach. Investigations in genetically diverse populations and objective assessment of progression rate to diabetes are necessary to better comprehend the impact of these nutritional strategies in prediabetes.

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.

Trace Elements in Human Nutrition (II) - An Update

The dietary requirement for an essential trace element is an intake level which meets a specified criterion for adequacy and thereby minimizes risk of nutrient deficiency or excess. Disturbances in trace element homeostasis may result in the development of pathologic states and diseases. This article is an update of a review article "Trace Elements in Human Nutrition-A Review" previously published in 2013. The previous review was updated to emphasis in detail the importance of known trace elements so far in humans' physiology and nutrition and also to implement the detailed information for practical and effective management of trace elements' status in clinical diagnosis and health care situations. Although various classifications for trace elements have been proposed and may be controversial, this review will use World Health Organization( WHO) classification as previously done. For this review a traditional integrated review format was chosen and many recent medical and scientific literatures for the new findings on bioavailability, functions, and state of excess/deficiency of trace elements were assessed. The results indicated that for the known essential elements, essentiality and toxicity are unrelated and toxicity is a matter of dose or exposure. Little is known about the essentiality of some of the probably essential elements. In regard to toxic heavy metals, a toxic element may nevertheless be essential. In addition, the early pathological manifestations of trace elements deficiency or excess are difficult to detect until more specific pathologically relevant indicators become available. Discoveries and many refinements in the development of new techniques and continual improvement in laboratory methods have enabled researchers to detect the early pathological consequences of deficiency or excess of trace elements. They all are promises to fulfill the gaps in the present and future research and clinical diagnosis of trace elements deficiencies or intoxications. However, further investigations are needed to complete the important gaps in our knowledge on trace elements, especially probably essential trace elements' role in health and disease status.

Impact of a Formulation Containing Unusual Polyunsaturated Fatty Acids, Trace Elements, Polyphenols and Plant Sterols on Insulin Resistance and Associated Disturbances

INTRODUCTION

To evaluate the effect of a lipid-based formulation containing unusual polyunsaturated fatty acids, trace elements, polyphenols and plant sterols on insulin resistance and its associated disturbances among adults at risk of diabetes.

METHODS

This was an 8-week, three-arm, open-label randomized clinical trial. We studied individuals aged ≥ 18 years old with diabetes risk given by a body mass index ≥ 25 kg/m² or a FinnRisc score ≥ 13/20. Participants were randomly assigned to receive: 7 ml sunflower oil (control group), 3.5 ml of the study formulation + 3.5 ml of sunflower oil (low-dose group) or 7 ml of study formulation (high-dose group).

RESULTS

We randomized 25 individuals. After one withdrawal in the high-dose group, the study sample comprised nine patients in the control, nine in the low-dose and six in the high-dose groups. The insulin sensitivity increased significantly and in a dose-dependent fashion, up to 10% in the high-dose group. At week 8 the low-dose group exhibited lower glycemic excursions during the oral glucose tolerance test (OGTT), especially 1 h after the glucose challenge (32 mg/dl or 23% lower vs. control group). The incremental area under the glucose curve in the OGTT was 17.1% lower in the low-dose group vs. the control group. Waist circumference increased in the control group, remained constant in the low-dose group and decreased in the high-dose group. C-reactive protein decreased in both formulation groups, up to 50% in the high-dose group. Participants in the formulation groups exhibited increased secretion of GLP-1 and plasma irisin at week 8 vs. the control group.

CONCLUSION

The formulation induced favorable changes in insulin sensitivity, glucose tolerance, abdominal obesity and inflammation. These effects and their durability will need to be assessed in larger studies.

TRIAL REGISTRATION

NCT03512665.

FUNDING

Team Foods Colombia.

The effects of chromium and vitamin D3 co-supplementation on insulin resistance and tumor necrosis factor-alpha in type 2 diabetes: a randomized placebo-controlled trial

The current study was conducted to assess the effects of simultaneous usage with vitamin D₃ and chromium picolinate (CrPic) supplementations on homeostasis model assessment of insulin resistance (HOMA-IR), fasting blood glucose (FBS), hemoglobin A1c (HbA1c), tumor necrosis factor-α (TNF-α), and lipid profile in type 2 diabetes mellitus (T2DM). Ninety-two patients with T2DM were randomly allocated to the following 4 groups for 4 months: (I) placebo of vitamin D₃ (n = 23); (II) vitamin D₃ supplement at a dose of 50 000 IU/week (n = 23); (III) CrPic supplement at a dose of 500 μg/day (n = 23); and (IV) both vitamin D₃ at a dose of 50 000 IU/week and CrPic at a dose of 500 μg/day (n = 23). HOMA-IR levels increased significantly in groups I and II after the intervention. However, this increase in group I was significantly higher than that in group II after the treatment. HOMA-IR levels were controlled in groups III and IV during the intervention. TNF-α decreased significantly in groups II, III, and IV after the intervention. FBS, HbA1c, and lipid profile did not change significantly in total groups after the intervention. It seems that chromium and vitamin D₃ co-supplementation are probably effective in controlling HOMA-IR by decreasing TNF-α in T2DM. Novelty Chromium alone and/or in simultaneous pretreatment with vitamin D₃ is more effective than vitamin D₃ in controlling HOMA-IR in T2DM. Chromium and vitamin D₃ alone and/or in simultaneous pretreatment decrease TNF-α in T2DM.

Nigella sativa Oil and Chromium Picolinate Ameliorate Fructose-Induced Hyperinsulinemia by Enhancing Insulin Signaling and Suppressing Insulin-Degrading Enzyme in Male Rats

In vivo and in vitro studies suggested that chromium enhances insulin sensitivity by promoting insulin receptor signaling. However, its effect on insulin clearance has not been yet identified. Nigella sativa, a widely used spice, possesses an antidiabetic activity. We, therefore, hypothesized that chromium picolinate may alter insulin clearance by modulating insulin-degrading enzyme (IDE) in insulin-resistant rats. We evaluated also the effect of Nigella sativa oil on insulin signaling and degradation with respect to chromium picolinate. To assess these hypotheses, insulin resistance was induced in 30 male Wistar albino rats through daily oral administration of high-fructose water (HFW, 20% w/v) for 45 days. These rats were then divided into three groups (n = 10/group). They were given either no treatment (control group) or Nigella sativa oil (500 mg/kg bw/day) or chromium picoloinate (200 μg/kg bw/day) orally along with HFW (20% w/v) for 45 days. Nigella sativa oil or chromium picolinate concurrent administration with HFW significantly decreased body weight, serum lipids, glucagon, insulin resistance, and hepatic IDE level but increased its mRNA expression and insulin receptor phosphorlyation as well as high-density lipoprotein cholesterol (HDL-C) level as compared to control group values, suggesting their potential as modulators for insulin signaling and clearance. However, Nigella sativa oil exerted better improvement in feeding efficacy ratio as well as the levels of glucagon, insulin, insulin resistance, hepatic IDE level and insulin receptor phosphorylation than chromium picolinate, suggesting its greater insulin sensitizing capacity. Our data, for the first time, prove that Nigella sativa oil and chromium picolinate monotherapy can reduce fructose-induced insulin resistance by reduction of hepatic IDE protein and activation of insulin receptor signaling.

Chromium Supplementation Reduces Resting Heart Rate in Patients with Metabolic Syndrome and Impaired Glucose Tolerance

Chromium (Cr) is considered as an important mineral, involved in biochemical reactions in human metabolic pathways. Organically bound Cr supplementation has been suggested to improve glycemia especially in patients with type 2 diabetes mellitus, but there are conflicting reports on efficacy. Effect of Cr is not clear in prediabetes status. Seventy patients with metabolic syndrome and impaired glucose tolerance (IGT), who are observed and treated in the Center of Preventive Cardiology of the University Hospital in Pilsen, were included in the prospective, randomized, double-blind, and placebo-controlled clinical study. Effect of Cr-enriched yeast (200 μg of elementary Cr in the morning and 100 μg in the evening) on glucose, lipid metabolism, fat tissue hormones, oxidative stress, and DNA damage markers was analyzed. There were no significant changes in glucose and lipid parameters, oxidative stress, or other laboratory markers. Only resting heart rate was significantly reduced in patients treated by Cr yeast, reflecting reduced sympathetic activity. This could represent an important cardiovascular risk reduction in patients with high cardiometabolic risk.

Nutraceutical Effects on Glucose and Lipid Metabolism in Patients with Impaired Fasting Glucose: A Pilot, Double-Blind, Placebo-Controlled, Randomized Clinical Trial on a Combined Product

INTRODUCTION

A number of natural compounds have individually demonstrated to improve glucose and lipid levels in humans.

AIM

To  evaluate the short-term glucose and lipid-lowering activity in subjects with impaired fasting glucose.

METHODS

To assess the effects of a combination of nutraceuticals based on Lagerstroemia speciosa, Berberis aristata, Curcuma longa, Alpha-lipoic acid, Chrome picolinate and Folic acid, we performed a double-blind, parallel group, placebo-controlled, randomized clinical trial in 40 adults affected by impaired fasting glucose (FPG = 100-125 mg/dL) in primary prevention of cardiovascular disease. After a period of 2 weeks of dietary habits correction only, patients continued the diet and began a period of 8 weeks of treatment with nutraceutical or placebo. Data related to lipid pattern, insulin resistance, liver function and hsCRP were obtained at the baseline and at the end of the study.

RESULTS

No side effects were detected in both groups of subjects. After the nutraceutical treatment, and compared to the placebo-treated group, the enrolled patients experienced a significant improvement in TG (-34.7%), HDL-C (+13.7), FPI (-13.4%), and HOMA-Index (-25%) versus the baseline values. No significant changes were observed in the other investigated parameters in both groups (Body Mass Index, LDL-C, hsCRP).

CONCLUSIONS

The tested combination of nutraceuticals showed clinical efficacy in the improvement of TG, HDL-C, FPI and HOMA-Index, with an optimal tolerability profile. Further confirmation is needed to verify these observations on the middle and long term with a larger number of subjects.

LOW SERUM CHROMIUM IS RARE IN PATIENTS THAT UNDERWENT ENDOSCOPIC GASTROSTOMY FOR LONG TERM ENTERAL FEEDING

BACKGROUND

Patients that underwent Percutaneous Endoscopic Gastrostomy (PEG) present with protein-energy malnutrition. Trace elements are required in small quantities and Chromium (Cr) displays a major role in the metabolism.

OBJECTIVE

This study aims to evaluate Cr levels and its relationship with serum proteins, BMI and underlying diseases during the first 3 months of PEG feeding.

METHODS

Prospective observational study during 3-months, when PEG was performed (T0), after 4 (T1), and 12 weeks (T3). Initial evaluation included: age, gender, underlying disease, NRS-2002, BMI, serum albumin, transferrin and Cr concentration. At T1 and T3 a blood sample was collected for Cr, albumin and transferrin. A Graphite Furnace Atomic Absorption Spectroscopy was used to assess Cr. According with the underlying disease, patients were divided into two groups: head and neck cancer (HNC) and neurological dysphagia (ND). All patients were fed with homemade meals.

RESULTS

A one hundred and twenty-nine patients (80 males), 26-95 years old were studied: HNC-52; ND-77. The observed data included low mean values of BMI from 71 patients; low Cr-8, low albumin-70, low transferrin-85 and 57 with both proteins low. Albumin was associated with survival time ( P =0.024) and there was a significant correlation between albumin and Cr (r=0.217, P =0.012). A good evolution of Cr and proteins values was observed, with no low Cr levels at T3.

CONCLUSION

Low serum Cr is rare in PEG-patients, with no relationship to other studied parameters. For the minority of patients displaying low Cr before gastrostomy, homemade PEG meals seem to be effective.

Aloe QDM complex enhances specific cytotoxic T lymphocyte killing in vivo in metabolic disease mice

We developed spontaneous diet-induced metabolic disease in mice by feeding them a high-fat diet for 23 weeks and administered Aloe QDM complex for 16 weeks to examine its restorative effect on immune disorders and metabolic syndrome. A series of immune functional assays indicated Aloe QDM complex enhanced lymphocyte proliferation and antigen-specific immunity as determined by the restored functions of cytotoxic T lymphocytes (CTL) and IgG production. The elevated serum TNF-α level was also regulated by Aloe QDM complex treatment, which suggested its complex therapeutic potential. As for metabolic phenotypes, oral administration of Aloe QDM complex significantly improved diabetic symptoms, including high fasting glucose levels and glucose tolerance, and distinctly alleviated lipid accumulation in adipose and hepatic tissue. The simultaneous restoration of Aloe QDM complex on metabolic syndrome and host immune dysfunction, especially on the specific CTL killing was first elucidated in our study.

Association of trace elements with lipid profiles and glycaemic control in patients with type 1 diabetes mellitus in northern Sardinia, Italy: An observational study

Sardinia is an Italian region with a high incidence of type 1 diabetes mellitus. This study aimed to determine the associations of trace elements with lipid profiles and glycaemic control in patients with T1DM. A total of 192 patients with T1DM who attended the Unit of Diabetology and Metabolic Diseases in Sassari, Italy, were enrolled. Trace elements zinc, copper, selenium, chromium, and iron were measured in whole blood by sector field inductively coupled plasma mass spectrometry. The correlations between metabolic variables and the levels of trace elements were determined. Zinc was positively correlated with total cholesterol (P=0.023), low-density lipoprotein (P=0.0015), and triglycerides (P=0.027). Iron as significantly correlated with TC (P=0.0189), LDL (P=0.0121), and high-density lipoprotein (HDL) (P=0.0466). In males, Cr was positively correlated with HDL (P=0.0079) and Se, in females was correlated with TG (P=0.0113). The mean fasting plasma glucose was166.2mgdL(-1). Chromium was correlated with fasting plasma glucose (P=0.0149), particularly in males (P=0.0038). Overall, 63.5% of the patients had moderate HbA1c (7-9%). Copper was significantly correlated with HbA1c% in males (P=0.0155). In conclusion, the results of this study indicate that trace elements show different associations with lipid levels and glycaemic control in T1DM. Zinc, Fe, and Se were associated with lipid levels whereas Cu and Cr were associated with HbA1c%.

Dietary chromium supplementation for targeted treatment of diabetes patients with comorbid depression and binge eating

Dietary chromium supplementation for the treatment of diabetes remains controversial. The prevailing view that chromium supplementation for glucose regulation is unjustified has been based upon prior studies showing mixed, modest-sized effects in patients with type 2 diabetes (T2DM). Based on chromium's potential to improve insulin, dopamine, and serotonin function, we hypothesize that chromium has a greater glucoregulatory effect in individuals who have concurrent disturbances in dopamine and serotonin function--that is, complex patients with comorbid diabetes, depression, and binge eating. We propose, as suggested by the collective data to date, the need to go beyond the "one size fits all" approach to chromium supplementation and put forth a series of experiments designed to link physiological and neurobehavioral processes in the chromium response phenotype.

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 role of antioxidants and other agents in alleviating hyperglycemia mediated oxidative stress and injury in liver

Several antioxidants and agents having similar antioxidant effects are known to exert beneficial effects in ameliorating the injurious effects of hyperglycemia on liver in different diabetic in vitro and in vivo models. The review deals with some of the agents which have been shown to exert protective effects on liver against hyperglycemic insult and the various mechanisms involved. The different classes of agents which protect the diabetic liver or decrease the severity of hyperglycemia mediated injury include flavonoids, catechins, and other polyphenolic compounds, curcumin and its derivatives, certain vitamins, hormones and drugs, trace elements, prototypical antioxidants and amino acids. Some of the pronounced changes mediated by the antioxidants in liver exposed to hyperglycemia include decreased oxidative stress, and alterations in carbohydrate and lipid metabolism. Other mechanisms through which the agents ameliorate hyperglycemia mediated liver injury include decrease in oxidative DNA and protein damage, restoration of mitochondrial structural and functional integrity, decrease in inflammation and improved insulin signaling. Thus, antioxidants may prove to be an important mode of defense in maintaining normal hepatic functions in diabetes.

Nutritional supplements for diabetes sold on the internet: business or health promotion?

Background

Diabetes is one of the most widespread chronic disease. Although many medications are available for the treatment and prevention of diabetes, many people turn to nutritional supplements (NSs). In these years, the online sales have contributed to the growth of use of nutritional supplement. The aim of the research was to investigate the type of information provided by sales websites on NSs, and analyse the existence of scientific evidence about some of the most common ingredients found in available NSs for diabetes.

Methods

A web search was conducted in April 2012 to identify web sites selling NSs in the treatment of diabetes using Google, Yahoo and Bing! and the key word used was “diabetes nutritional supplements”. Website content was evaluated for the quality of information available to consumers and for the presence of a complete list of ingredients in the first NS suggested by the site. Subsequently, in order to analyze the scientific evidence on the efficacy of these supplements a PubMed search was carried out on the ingredients that were shared in at least 3 nutritional supplements.

Results

A total of 10 websites selling NSs were selected. Only half of the websites had a Food and Drug Administration disclaimer and 40% declared clearly that the NS offered was not a substitute for proper medication. A total of 10 NS ingredients were searched for on PubMed. Systematic reviews, meta-analyses or randomized control trials were present for all the ingredients except one. Most of the studies, however, were of poor quality and/or the results were conflicting.

Conclusions

Easy internet access to NSs lacking in adequate medical information and strong scientific evidence is a matter of public health concern, mainly considering that a misleading information could lead to an improper prevention both in healthy people and people suffering from diabetes. There is a clear need for more trials to assess the efficacy and safety of these NSs, better quality control of websites, more informed physicians and greater public awareness of these widely used products.

A double-blind, randomized pilot trial of chromium picolinate for binge eating disorder: results of the Binge Eating and Chromium (BEACh) study

OBJECTIVE

Chromium treatment has been shown to improve mood, appetite, and glucose regulation in various psychiatric and medical patient populations. The authors propose that chromium may be useful in the treatment of binge eating disorder (BED).

METHOD

Twenty-four overweight adults with BED were enrolled in a 6-month double-blind placebo-controlled trial and randomly assigned to receive either 1000mcg chromium/day ("high dose"; n=8) or 600mcg chromium/day ("moderate dose"; n=9) as chromium picolinate or placebo (n=7). Mixed linear regression models were used to estimate mean change in binge frequency and related psychopathology, weight, symptoms of depression, and fasting glucose.

RESULTS

Fasting glucose was significantly reduced in both chromium groups compared to the placebo group; similarly, numerically, but not significantly, greater reductions in binge frequency, weight, and symptoms of depression were observed in those treated with chromium versus placebo, although statistical power was limited in this pilot trial. For fasting glucose, the findings suggest a dose response with larger effects in the high dose compared to moderate dose group.

CONCLUSION

These initial findings support further larger trials to determine chromium's efficacy in maintaining normal glucose regulation, reducing binge eating and related psychopathology, promoting modest weight loss, and reducing symptoms of depression in individuals with BED. Studies designed to link the clinical effects of chromium with changes in underlying insulin, serotonin, and dopamine pathways may be especially informative. If efficacious, chromium supplementation may provide a useful, low-cost alternative to or augmentation strategy for selective serotonin reuptake inhibitors, which have partial efficacy in BED. ClinicalTrials.gov NCT00904306.

Effect of consumption of micronutrient enriched wheat steamed bread on postprandial plasma glucose in healthy and type 2 diabetic subjects

BACKGROUND

Steamed wheat bread have previously been shown to induce comparatively high postprandial plasma glucose responses, on the contrary, buckwheat products induced lower postprandial plasma glucose. The present study was to assess the effects of micronutrient enriched bread wheat variety Jizi439 and buckwheat on postprandial plasma glucose in healthy and diabetic subjects comparing with buckwheat and other bread wheat varieties.

METHODS

Two experiments were conducted to study the effects of bread wheat variety Jizi439 on the postprandial plasma glucose levels of the randomly selected subjects. The first experiment involved three types of steamed bread with equivalent of 50 g available carbohydrate fed to 10 normal weight young healthy subjects. Two types of steamed bread were made from two purple-grain bread wheat varieties, Jizi439 and Chu20, respectively, and the third type was made from the mixture of different white grain wheat varieties. Plasma glucose levels of each subject were measured at 15, 30, 45, 60, 120 min after eating. Glucose was used as a reference, the total area under curve (AUC) and glycemic index (GI) was calculated for test meal. The second experiment was performed among ten type 2 diabetics who were served equivalent of 50 g available carbohydrate of steamed bread made from Jizi 439, the mixture of white grain bread wheat and buckwheat, respectively. The plasma glucose increment was determined two hours thereafter.

RESULTS

In the first experiment, consumption of the steamed bread made from Jizi439 resulted in the least increase in plasma glucose and the GI was significantly lower than that of Chu20 and the mixture. In the second experiment, the average of postprandial 2 h plasma glucose increment of Jizi439 was 2.46 mmol/L which was significantly lower than that of the mixture of white wheat but was not significantly different from buckwheat.

CONCLUSIONS

The results indicated that consumption of Jizi439 steamed bread resulted in significantly lower plasma glucose in both healthy and diabetic subjects, compared with other types of test foods, except buckwheat bread. The steam bread made from Jizi439 would be an ideal food for preventing and treatment of diabetes.

Serum chromium levels in gestational diabetes mellitus

OBJECTIVE

To measure serum chromium level in women with gestational diabetes mellitus (GDM) from Chennai, South India.

MATERIALS AND METHODS

Thirty women with gestational diabetes, 60 age matched controls.

INCLUSION CRITERIA

Gestational age 22-28 weeks, age group 20-35 years.

EXCLUSION CRITERIA

Gestational age beyond 28 weeks, malnutrition or presence of infection. Serum chromium was measured using inductive couple plasma emission spectrometer.

RESULTS

Serum chromium levels of women with GDM, 1.59+/-0.02 ng/ml (range: 0.16-4.0 ng/ml) were lower than in controls (4.58+/-0.62 ng/ml; range 0.82-5.33 ng/ml) (P < 0.001). However, there were no significant differences among cases and controls when subdivided by parity.

CONCLUSIONS

Women with GDM from a South Indian city had lower levels of serum chromium compared to pregnant women without GDM. Studies may be done whether chromium supplementation is useful in this group of women.

The way of serum chromium utilization may contribute to cardiovascular risk factors in centrally obese persons

INTRODUCTION

Obesity-related disturbances are considered to be risk factors for cardiovascular disease (CVD). Chromium is shown to improve carbohydrate and lipid metabolism. Conflicting data on effects of chromium supplementation in humans are published. The aim of the study was to assess the concentrations of serum chromium during the 75-g oral glucose tolerance test (OGTT) in obese persons.

MATERIAL AND METHODS

Fourty-eight centrally obese Caucasians, apparently healthy, using neither special diet nor mineral supplementation, were enrolled in the study. During the OGTT, 0-min and 120-min concentrations of plasma glucose (G 0', G 120'), serum insulin (Ins 0', Ins 120') and chromium (Cr 0', Cr 120') were determined. Plasma lipids, apolipoproteins A and B, and serum uric acid were measured at 0 min only. For parameters assessed during the OGTT, the difference D = [(120' concentration) - (0' concentration)] was calculated. Contradictory tendencies of Cr 120' were observed; thus the difference of serum chromium concentrations, DCr = [(Cr 120') - (Cr 0')], was used to establish the positive DCr group with DCr > 0 (PosDCr: n= 24; 9 male/15 female) and the negative DCr group with DCr < 0 (NegDCr: n= 24; 8 male/16 female).

RESULTS

The studied groups were comparable as far as their metabolic parameters are concerned, except higher G 120' (p= 0.043) and DG (p = 0.048), and lower Cr 120' (p < 0.000), which were observed in the NegDCr group. The NegDCr persons showed inverse correlations between Cr 0' and systolic and diastolic blood pressure.

CONCLUSIONS

We suggest that the studied centrally obese persons differed in chromium metabolism. In subjects "consuming" Cr during the OGTT, chromium status may be associated with increased risk for CVD.