UPSC MainsMEDICAL-SCIENCE-PAPER-I201110 Marks
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Q5.

Give the role of a micronutrient as a component of 'glucose tolerance factor'. What is its RDA and deficiency manifestation ?

How to Approach

This question requires a focused answer on the role of a specific micronutrient in glucose tolerance, its recommended daily allowance (RDA), and the consequences of its deficiency. The approach should be to first identify the micronutrient, then detail its mechanism as a component of the Glucose Tolerance Factor (GTF), followed by its RDA and finally, the manifestations of its deficiency. A structured answer covering these aspects will demonstrate a comprehensive understanding of the topic.

Model Answer

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Introduction

Glucose tolerance, the body’s ability to regulate blood glucose levels, is a complex process reliant on various factors, including insulin and a chromium-containing complex known as the Glucose Tolerance Factor (GTF). GTF enhances insulin’s action, facilitating glucose uptake by cells. Micronutrient deficiencies can significantly impair glucose metabolism, leading to conditions like insulin resistance and diabetes. This answer will focus on chromium, its role as a crucial component of GTF, its RDA, and the clinical manifestations arising from its deficiency.

Chromium and the Glucose Tolerance Factor

The micronutrient central to the Glucose Tolerance Factor is Chromium. Chromium exists in several forms, with trivalent chromium [Cr(III)] being the biologically active form. GTF isn't a single molecule but a complex containing Cr(III), nicotinic acid (vitamin B3), glycine, cysteine, and glutamic acid. The exact structure of GTF remains debated, but its function is well-established.

Mechanism of Action

Chromium, as part of GTF, potentiates insulin signaling. It achieves this through several proposed mechanisms:

  • Insulin Receptor Binding: GTF enhances the binding of insulin to its receptors on cell membranes, increasing insulin sensitivity.
  • Insulin Receptor Kinase Activation: It promotes the activation of insulin receptor kinase, a crucial step in insulin signaling.
  • GLUT4 Translocation: GTF facilitates the translocation of GLUT4 glucose transporters to the cell membrane, increasing glucose uptake into cells, particularly muscle and adipose tissue.
  • Glycogen Synthesis: Chromium may also enhance glycogen synthesis, the process of storing glucose as glycogen in the liver and muscles.

Recommended Daily Allowance (RDA) of Chromium

The RDA for chromium varies based on age, sex, and physiological state. According to the National Institutes of Health (NIH) (as of my knowledge cutoff in 2021), the Adequate Intake (AI) levels are:

Age Group AI (µg/day)
Adult Men (19-50 years) 35
Adult Women (19-50 years) 25
Pregnant Women 30
Lactating Women 45

These are AI levels as an RDA hasn’t been definitively established. Chromium absorption is generally poor, estimated to be between 0.4% and 2%.

Deficiency Manifestations

Chromium deficiency is relatively uncommon in developed countries due to its widespread presence in food. However, certain populations, such as those with poor dietary intake, individuals with gastrointestinal disorders affecting absorption, or those receiving long-term parenteral nutrition, are at higher risk. Manifestations of chromium deficiency include:

  • Impaired Glucose Tolerance: This is the hallmark of chromium deficiency, leading to elevated blood glucose levels and insulin resistance.
  • Hyperlipidemia: Increased levels of cholesterol and triglycerides in the blood.
  • Increased Insulin Resistance: Cells become less responsive to insulin, requiring higher insulin levels to maintain normal blood glucose.
  • Weight Gain: Impaired glucose metabolism can contribute to weight gain and difficulty losing weight.
  • Neurological Symptoms: In severe cases, neurological symptoms like irritability, depression, and cognitive impairment have been reported.

It's important to note that diagnosing chromium deficiency can be challenging as there are no reliable biomarkers. Clinical assessment and response to chromium supplementation are often used to confirm the diagnosis.

Conclusion

Chromium plays a vital role as a component of the Glucose Tolerance Factor, enhancing insulin sensitivity and facilitating glucose metabolism. While deficiency is uncommon, it can lead to impaired glucose tolerance, hyperlipidemia, and other metabolic disturbances. Maintaining adequate chromium intake through a balanced diet is crucial for optimal glucose control and overall health. Further research is needed to fully elucidate the complex mechanisms of chromium action and establish definitive RDAs.

Answer Length

This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.

Additional Resources

Key Definitions

Glucose Tolerance Factor (GTF)
A biologically active chromium-containing complex that enhances the action of insulin, facilitating glucose uptake by cells.
Insulin Resistance
A condition in which cells become less responsive to the effects of insulin, requiring higher insulin levels to maintain normal blood glucose levels.

Key Statistics

Chromium absorption rate is estimated to be between 0.4% and 2%.

Source: National Institutes of Health (NIH), 2021 (knowledge cutoff)

Approximately 9.6% of the US adult population had diabetes in 2019.

Source: Centers for Disease Control and Prevention (CDC), 2019 (knowledge cutoff)

Examples

Total Parenteral Nutrition (TPN)

Patients receiving long-term TPN, which bypasses the normal digestive process, are at risk of chromium deficiency as TPN solutions may not contain sufficient chromium. This can lead to hyperglycemia and insulin resistance in these patients.

Frequently Asked Questions

Can chromium supplementation improve blood sugar control in individuals with type 2 diabetes?

Some studies suggest that chromium supplementation may modestly improve blood sugar control in individuals with type 2 diabetes, particularly those with chromium deficiency. However, the evidence is mixed, and chromium supplementation should not be considered a replacement for conventional diabetes management strategies.

Topics Covered

BiochemistryNutritionMicronutrientsGlucose MetabolismDiabetes