High insulin requirement versus high chromium requirement in patients nourished with total parenteral nutrition

Wongseelashote, Onnipa; Daly, Mary K.; Frankel, Eric H.

doi:10.1016/j.nut.2003.11.001

Cited by 13 publications

(3 citation statements)

References 10 publications

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“…Chromium supplementation of the TPN solution of five acute-care patients, receiving TPN only upon hospital admission, provided inconclusive results, with two patients showing a possible benefit through a decrease in the amount of insulin needed to control blood glucose and three patients reporting a slight or no benefit in terms of the amount of insulin needed to control blood glucose (results not given) (Wongseelashote et al, 2004).…”

Section: Deficiencymentioning

confidence: 99%

Scientific Opinion on Dietary Reference Values for chromium

Products¹

2014

EFSA Journal

177

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Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies (NDA) considered the evidence for setting Dietary Reference Values for chromium. Trivalent chromium (Cr(III)) has been postulated to be necessary for the efficacy of insulin in regulating the metabolism of carbohydrates, lipids and proteins. However, the mechanism(s) for these roles and the essential function of Cr(III) in metabolism have not been substantiated. The criteria for the essentiality of a trace element were considered. It was noted that attempts to create chromium deficiency in animal models have not produced consistent results, and that there is no evidence of essentiality of Cr(III) in animal nutrition. Evaluating the possibility of Cr(III) as an essential element for humans, the evidence from reported improvements associated with chromium supplementation in patients on total parenteral nutrition was considered to be the most convincing, but overall data do not provide sufficient information on the reversibility of the possible deficiencies and the nature of any dose-response curve in order to identify a dietary requirement for humans. The Panel concludes that no Average Requirement and no Population Reference Intake for chromium can be defined. Several studies assessed the effect of chromium supplementation on glucose and/or lipid metabolism. In the only study for which information on total chromium intake was available, there was no difference in parameters of glucose metabolism of normoglycaemic subjects between the placebo and chromium-supplemented periods. The Panel considered that there is no evidence of beneficial effects associated with chromium intake in healthy subjects. The Panel concluded that the setting of an Adequate Intake for chromium is also not appropriate. In 1993, the Scientific Committee for Food was unable to define a specific physiological requirement of chromium and did not propose DRVs for chromium, but other authorities have subsequently proposed DRVs for chromium. © European FoodTrivalent chromium (Cr(III)) has been reported as an essential trace element in that it has been postulated to be necessary for the efficacy of insulin in regulating the metabolism of carbohydrates, lipids and proteins. However, at present, the mechanism(s) for these roles and the essential function of chromium in metabolism have not been substantiated. The postulation of chromium's essentiality for humans was almost entirely based on case reports of patients on long-term total parenteral nutrition (TPN) who developed metabolic and neurological defects, which were reported to respond to supplementation with Cr(III). The Panel noted that the chromium concentrations in the TPN solutions that induced the presumed deficiency symptoms were not reported in all the patients studied. In the three studies in which the concentration of chromium in the TPN solution was reported, the daily chromium supply was between 5 and 10 µg; at an absorption efficiency of 5 % this amount of infused chromium ...

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Section: Deficiencymentioning

confidence: 99%

Scientific Opinion on Dietary Reference Values for chromium

Products¹

2014

EFSA Journal

177

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“…The inclusion of Cr(III) in the form of Cr-chloride to TPN resulted in an amelioration of diabetes symptoms in those patients (Jeejeebhoy et al, 1977;Freund et al, 1979;Brown et al, 1986; Verhage et , 1996). In a study applying short-term Cr(III) supplementation, only two out of five patients on TPN showed a benefit induced by Cr(III) addition (Wongseelashote et al, 2004). The interpretation of the above findings as evidence of Cr(III) deficiency and essentiality in humans has been questioned due to the severe health problems of subjects involved in those studies, the uncertainties about Cr background in TPN solutions (Anonymous, 1988;Stearns, 2000) and the low rate of patients reacting positively to Cr(III) administration (Stearns, 2007).…”

Section: Evaluation Of Evidence Of Chromium Deficiency and Essentialitymentioning

confidence: 99%

Safety and efficacy of chromium methionine (Availa® Cr) as feed additive for all species

2009

EFS2

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“…The author suggested that patients who develop hyperglycemia and neuropathy should be treated with chromium and observed for resolution of symptoms 57 . A study of 5 PN patients reported that 2 of the 5 patients had a decreased insulin requirement when they received a standard trace element preparation (containing chromium) supplemented with an additional 40 μg chromium for 2 days 58 . Long‐term supplementation of chromium at the recommended doses has resulted in elevated serum levels of chromium in pediatric patients 9 , 22 .…”

Section: Reports Of Specific Micronutrient Abnormalities In Long‐termmentioning

confidence: 99%

Micronutrient Assessment in Long‐Term Home Parenteral Nutrition Patients

Fuhrman¹

2006

Nut in Clin Prac

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Assessment of micronutrient status of patients requiring long-term parenteral nutrition (PN) continues to be a challenge for clinicians. The scientific literature primarily consists of small studies and case reports. There are no evidence-based guidelines available. Clinicians rely on clinical assessment according to the patient's disease process, medication regimen, physical examination, and history of nutrient intake to determine existence or risk of micronutrient deficiency and toxicity. This paper will examine current scientific evidence and existing recommendations for the micronutrient assessment and management of patients requiring long-term PN.

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High insulin requirement versus high chromium requirement in patients nourished with total parenteral nutrition

Cited by 13 publications

References 10 publications

Scientific Opinion on Dietary Reference Values for chromium

Scientific Opinion on Dietary Reference Values for chromium

Safety and efficacy of chromium methionine (Availa® Cr) as feed additive for all species

Micronutrient Assessment in Long‐Term Home Parenteral Nutrition Patients

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