CHROMIUM SUPPLEMENTATION DECREASES INSULIN RESISTANCE AND TRUNK FAT

1
CHROMIUM SUPPLEMENTATION DECREASES INSULIN
RESISTANCE AND TRUNK FAT Ellie Aghdassi, Ph.D.,
Irving E Salit, MD., Saira Mohammed, MSc.,Bianca
M Arendt, Ph.D., and Johane P Allard, MD. The
University Health Network, Toronto, Canada
Ellie Aghdassi, Ph.D., RD. The University Health
Network The Toronto General Hospital 200
Elizabeth Street, 10EN-242 Toronto, Ontario,
M5G-2C4, Canada Tel [phone]
emailellie.aghdassi_at_uhn.on.ca
936
ABSTRACT Chromium (Cr) is an essential
micronutrient Cr deficiency has been reported to
cause insulin resistance (IR), hyperglycemia and
hyperlipidemia. Objectives To investigate the
effect of Cr supplementation on metabolic
abnormalities, IR and body composition in people
living with HIV (PLWH). Design Randomized,
double blind, placebo-controlled trial. Setting
Tertiary hospital clinic. Subjects 59
HIV-positive subjects with evidence of body fat
redistribution (BFR), elevated lipids or glucose
and who were found to have IR based on the
calculation of homeostasis model of assessment
(HOMA). For inclusion, HOMA had to begt 2.5. Fifty
subjects, 25 in each group completed the study.
Intervention Subjects were randomized to receive
either 400 ug of Cr-nicotinate (Cr) or placebo
(P) for a period of 16 weeks. Primary outcome
Change in fasting blood insulin. Other outcomes
Changes in fasting blood glucose, lipid profile
and body composition. Results Cr
supplementation resulted in a significant
decrease in blood insulin, blood triglycerides,
HOMA, total body fat mass and trunk fat mass.
Blood glucose, C-peptide, total cholesterol, LDL
and HDL cholesterol and Hb A1c remained
unchanged. Biochemical parameters did not change
in the placebo group except for LDL cholesterol
that increased significantly post supplementation
with placebo. Body weight and medication profile
remained stable throughout the study period for
both groups. Conclusion Chromium
supplementation improved metabolic abnormalities,
insulin resistance and body composition. The use
of chromium supplements in conjunction with
antiretroviral medications may be of benefit to
PLWH and may decrease the medication-associated
side effects such as insulin resistance and body
fat redistribution .
Blood Biochemistry
Drop in insulin correlates with basal insulin
level in Cr supplemented group
SUBJECTS DESIGN
P0.009
Screened HIV patients with at least one
metabolic abnormality (n110) Glucose gt 6.1
mmol/l TG gt 2 mmol/l Total cholesterol gt 5.5
mmol/l HDL cholesterol lt 0.9 mmol/l Body fat
redistribution

P0.025
R20.725 P0.0001

• Exclusion criteria
• Cr-supplementation
• Unstable drug regimen

P0.038
P0.033
Blood levels of glucose, Hb-A1c, C-peptide, total
cholesterol and HDL cholesterol did not change in
the Cr-supplemented or the placebo group after 16
weeks.
HIV patients with HOMA gt 2.5 n59
Randomized
Chromium nicotinate (400 ug/d) (n29)
Placebo (di-calcium phosphate) (n30)
BACKGROUND
Body Composition
16 Weeks
Completed n25
Completed n25

• Role of Chromium (Cr) In Human Health
• Potentiates Insulin action
• Glucose tolerance factor (GTF)
• Lipid, Protein, Nucleic acid metabolism
• Body composition
• Low Chromium is Associated With Abnormal
  Glucose Tolerance And Lipid Abnormalities
• (Woolliscroft 1977 Hopkins 1968 Anderson 1987
  Riales 1981)
• Chromium Mode Of Action
• Increases insulin receptor number (Anderson
  1987)
• Activates receptor kinase (required for
  phosphorylation of b-subunits) (Davis 1997)
• Inhibits protein tyrosine phosphatase (Inhibits
  phosphorylation of b- subunits)
  (Imparl-Radosevich 1999)
• Increases phosphorylation of the b-subunits of
  insulin receptor and thus increases insulin
  sensitivity
• Why Study Chromium in HIV?
• Frequent manifestations associated with ART are
  similar to low Cr status ( Abnormal glucose
  tolerance, Increased circulating insulin,
  Abnormal lipid profile, Alteration in body
  composition)
• HIV infection is associated with low levels of
  several micronutrients (Allard 1998, Baum
  1995 Coodley 1991 Tang 1993 Abrams 1993)
• Low plasma chromium in HIV patients
• (Aghdassi et al, J Am Coll Nutr 2006)

P0.004
P0.003
P0.013
RESULTS
Medication profile, body weight, did not change
in the Cr-supplemented or the placebo group after
16 weeks. Results are reported as Mean SEM.
Comparison is done using paired t-test between
baseline and week 16 in each intervention group
Subjects Characteristics
Chromium
Placebo
P0.068
P0.05
Comparison is done using Un-paired t-test between
the chromium supplemented and the placebo group
CONCLUSION

• In HIV subjects with metabolic abnormalities
  chromium supplementation leads to
• ? insulin resistance
• ? blood TG
• ? total body fat mass
• ? trunk fat mass
• ? lean body mass
• The effects of supplementation on insulin
  resistance was much more pronounced in patients
• with higher baseline insulin level
• The effects on trunk fat mass was more
  pronounced in patients with BFR
• Simple measurements such as fasting blood
  insulin, waist and hip circumference should be
• included in the routine assessment of the
  patients with metabolic abnormalities

HYPOTHESIS In HIV-infected patients who have
metabolic abnormalities, chromium supplementation
improves insulin resistance and metabolic
parameters
Primary outcome Change in insulin
level Secondary outcomes Changes in blood
glycemia, HOMA, blood lipid profile and body
composition (by DEXA scan) HOMAhomeostasis
model assessment fasting blood glucose (mmol/L)
x fasting blood insulin (mU/L) / 22.5
Results are expressed as Mean SEM or as
proportion of patients. Comparison is done using
Chi-square test for proportions and un-paired
t-test for continuous variables. Plt0.05 is
considered statistically significant.