UPSC MainsMEDICAL-SCIENCE-PAPER-I20155 Marks
Q12.

Chromium as a trace element

How to Approach

This question requires a detailed understanding of chromium's biochemical role, nutritional importance, deficiency manifestations, and potential toxicity. The answer should be structured to cover these aspects systematically. Begin with defining chromium and its forms, then elaborate on its functions, dietary sources, deficiency symptoms, and finally, its toxicity. Mention relevant biochemical pathways and clinical conditions. A concise and focused approach is crucial, given the limited marks.

Model Answer

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Introduction

Chromium is a trace mineral essential for human health, existing in several oxidation states, with trivalent chromium (Cr(III)) being the biologically relevant form. While required in very small amounts, it plays a crucial role in carbohydrate, fat, and protein metabolism. Its discovery dates back to 1797, but its biological significance was recognized much later in the 1950s with the identification of a chromium-containing factor necessary for glucose tolerance. Understanding chromium’s role is vital in addressing metabolic disorders and maintaining overall nutritional well-being.

Chromium: Biochemical Role and Forms

Chromium primarily exists in the diet as Cr(III), which is relatively non-toxic and readily absorbed. Hexavalent chromium (Cr(VI)), however, is toxic and found in industrial settings. Within the body, Cr(III) forms a complex with nicotinic acid (niacin) to create chromodulin, also known as glucose tolerance factor (GTF). This complex enhances insulin signaling.

Functions of Chromium

  • Glucose Metabolism: Chromodulin potentiates insulin action by increasing the number of insulin receptors or improving their affinity for insulin. This facilitates glucose uptake by cells, improving glucose tolerance.
  • Lipid Metabolism: Chromium may influence lipid metabolism by affecting enzymes involved in fatty acid synthesis and cholesterol metabolism.
  • Protein Metabolism: Some studies suggest chromium can enhance protein synthesis and reduce muscle breakdown.
  • Gene Expression: Chromium picolinate has been shown to influence gene expression related to carbohydrate and lipid metabolism.

Dietary Sources of Chromium

Chromium is found in various foods, but its concentration is often low and varies depending on soil content. Good sources include:

  • Broccoli
  • Grape juice
  • Whole grains (wheat germ, whole wheat bread)
  • Brewer’s yeast
  • Meat (beef, poultry)
  • Potatoes

Food processing can reduce chromium content. The bioavailability of chromium is also relatively low, typically ranging from 0.4% to 2%.

Chromium Deficiency

Chromium deficiency is relatively rare, but can occur in individuals with poor dietary intake, those receiving long-term parenteral nutrition, or those with certain medical conditions. Symptoms of chromium deficiency include:

  • Impaired glucose tolerance
  • Increased insulin resistance
  • Elevated blood lipids (cholesterol and triglycerides)
  • Neurological symptoms (rare)

Individuals with diabetes, particularly those with poorly controlled blood sugar, may be at higher risk of chromium deficiency.

Chromium Toxicity

While Cr(III) is relatively non-toxic, excessive intake of chromium, particularly in the form of Cr(VI), can lead to toxicity. Cr(VI) is a known carcinogen and can cause:

  • Skin irritation and ulcers
  • Kidney damage
  • Liver damage
  • Respiratory problems

Occupational exposure to Cr(VI) in industries like leather tanning and metal plating poses the greatest risk. The tolerable upper intake level (UL) for chromium is 1000 µg/day (as Cr(III)).

Clinical Significance & Supplementation

Chromium supplementation is sometimes used in the management of type 2 diabetes and insulin resistance, although evidence of its efficacy is mixed. Some studies have shown modest improvements in glycemic control with chromium picolinate supplementation, while others have found no significant benefit. It's crucial to note that supplementation should be undertaken under medical supervision.

Conclusion

Chromium, though a trace element, is vital for maintaining metabolic health, particularly in glucose and lipid metabolism. While deficiency is uncommon, it can exacerbate insulin resistance and contribute to metabolic dysfunction. Conversely, exposure to Cr(VI) poses significant health risks. Further research is needed to fully elucidate the optimal intake and therapeutic potential of chromium, and to understand individual variations in chromium metabolism and requirements.

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

Chromodulin
A biologically active chromium(III)-nicotinic acid complex that enhances insulin signaling and glucose metabolism. It is also known as Glucose Tolerance Factor (GTF).
Bioavailability
The proportion of a nutrient that is absorbed from the diet and utilized by the body. Chromium has relatively low bioavailability, meaning only a small percentage of ingested chromium is actually absorbed.

Key Statistics

The average daily chromium intake in the US is estimated to be between 25-35 µg, significantly lower than the Adequate Intake (AI) of 25-35 µg for adults (as of 2001, National Institutes of Health).

Source: National Institutes of Health, Office of Dietary Supplements

Studies suggest that approximately 1-2% of ingested chromium is absorbed by the human body, with the absorption rate influenced by factors like chromium form, dietary composition, and individual physiological factors. (Knowledge cutoff 2023)

Source: Anderson RA. Chromium as an essential nutrient for humans. *Advances in Nutrition*. 2015;6(5):693-702.

Examples

Chromium and Diabetes

A randomized controlled trial published in the *Diabetes Care* journal (2006) showed that chromium picolinate supplementation (1000 µg/day) improved HbA1c levels in patients with type 2 diabetes, suggesting a potential role in glycemic control. However, subsequent studies have yielded inconsistent results.

Frequently Asked Questions

Is chromium supplementation safe for everyone?

Chromium supplementation is generally considered safe for most people when taken within the recommended upper limit. However, individuals with kidney or liver disease, those taking certain medications (like insulin or diabetes drugs), and pregnant or breastfeeding women should consult a healthcare professional before taking chromium supplements.

Topics Covered

BiochemistryNutritionTrace ElementsChromiumMetabolism