Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition

Abstract

A white female, now age 40 and receiving total parenteral nutrition for more than 5 years, developed unexpected 15% weight loss after 3 1/2 years of regimen, together with peripheral neuropathy confirmed by nerve conduction measurements. An intravenous glucose tolerance test showed that the fractional rate (K) had decreased to 0.89%/min (normal greater than 1.2). There was observed during this glucose infusion a borderline normal insulin response with a fall in plasma free fatty acids and in plasma leucine. During daily infusion of well over 400 g of glucose, the respiratory quotient was 0.66. Chromium balance was negative. Chromium levels were, in blood 0.55 ng/ml (normal 4.9 to 9.5) and in hair 154 to 175 ng/g (normal greater than 500). Regular insulin daily (45 micron) in the infusate nearly maintained euglycemia but despite this, and even with further glucose intake to restore weight loss, intravenous glucose tolerance test (K) and respiratory quotient were unchanged. Administration of insulin was then stopped and 250 microng of Cr added to the daily total parenteral nutrition infusate for 2 weeks. After this the intravenous glucose tolerance test (K) and respiratory quotient became normal (1.35 and 0.78, respectively). Over the next 5 months insulin was not needed and glucose intake had to be reduced substantially to avoid overweight. In this period nerve conduction and well-being returned to normal. With a maintenance addition of chromium to the total parenteral nutrition infusate (tentatively this addition is 20 microng/day) the patient has remained well for 18 months (to July 1976). These results suggest that relatively isolated chromium deficiency in man, hitherto poorly documented, causes 1) glucose intolerance, 2) inability to utilize glucose for energy, 3) neuropathy with normal insulin levels, 4) high free fatty acid levels and low respiratory quotient and, 5) abnormalities of nitrogen metabolism.

Chromium (d‐Phenylalanine)3 Improves Obesity‐Induced Cardiac Contractile Defect in ob/ob Mice

“…One of the compounds drawing some attention is the mineral chromium, which is thought to play a key role in carbohydrate metabolism by potentiating the action of insulin, leading to increased insulin sensitivity in type 2 diabetes and obesity (8). Dietary deficiency in chromium has been shown to be positively associated with the risk of diabetes (9). Consistently, reduced levels of chromium have been documented in diabetic subjects with existing cardiovascular diseases (10,11).…”

Chromium supplements for glycemic control in type 2 diabetes: limited evidence of effectiveness

“…4 Because acute chromium deficiency can cause reversible insulin resistance and diabetes, chromium is routinely added to total parenteral nutrition solutions. 5,6 In 2005 the US Food and Drug Administration permitted a qualified health claim indicating that the evidence for chromium picolinate supplements in reducing the risk of insulin resistance and, possibly, T2DM is highly uncertain. 7 Data from clinical and observational studies since then have been mixed.…”

Chromium chloride increases insulin‐stimulated glucose uptake in the perfused rat hindlimb

“…Many studies have shown that chromium supplementation increases glucose metabolism in insulin resistant populations (16,38,51). However, when healthy subjects have been examined, it has been shown that chromium has no effect on glucose metabolism (14,70).…”

“…A classic case report published in 1977 was one of the first accounts of the necessity of chromium in the diet (38). A woman who had her intestines removed had to rely on intravenous nutrition.…”

“…One of the earliest studies showing the necessity of chromium in humans involved a patient who was receiving total parenteral nutrition (38). The patient began showing signs of insulin resistance, needing large amounts of insulin to dispose of glucose.…”