Obesity is a highly prevalent health problem in the United States [55, 56]. Obesity adversely affects all elements of the atherogenic cardiovascular risk profile, including blood lipids, hypertension, glucose tolerance, left ventricular hypertrophy, and plasma fibrinogen [55-57]. Existing elements of insulin resistance, obesity, hypertension, lipid disturbances, and glucose intolerance have been characterized by the term Syndrome X [55-57]. Theoretical considerations suggest that insulin resistance may be a primary factor that plays a causative role in the induction of both obesity and diabetes [55, 56]. Atherogenic risk factors associated with obesity and Syndrome X contribute independently to the development of atherosclerotic disease, and risk of a cardiovascular event also increases sharply [55, 56]. Metabolic problems such as obesity, unhealthy lipid profiles, and glucose intolerance become more common with advancing age . Suboptimal chromium intake, a common prevalence in the US and Western cultures, can also contribute to these metabolic disorders .
Studies have shown that chromium is efficacious in maintaining proper carbohydrate and lipid metabolism in both humans and animals. Trivalent chromium's insulin signaling potential has demonstrated its effects on body composition, including reducing fat mass and increasing lean body mass. Previous studies have focused on the use of the dietary chromium, niacin-bound chromium, due to its increased absorption and retention .
Clinical studies have shown that chromium supplementation on overweight people induced loss of fat mass and/or increased lean body mass. Crawford et al. in 1999 demonstrated that supplementation of 600 ^g of elemental chromium as niacin-bound chromium per day over a period of 2 months by African-American women with a moderate diet and exercise regimen influences weight loss and body composition . In a randomized, double-blind, placebo-controlled, crossover study, 20 overweight African-American women received placebo tid during the control period and 200 ^g niacin-bound chromium tid during the verum period and engaged in a modest diet-exercise regimen for 2 months. Group 1 subjects (n = 10) received placebo first then chromium, while Group 2 subjects (n = 10) received niacin-bound chromium first and placebo later. Body weights and blood chemistries were measured by routine clinical methodology. Fat and nonfat body masses were estimated using bioelectrical impedance (electrolipography) . In women receiving niacin-bound chromium after the placebo period (Group 1), body weight loss was essentially the same; but fat loss was significantly greater, and non-fat body mass loss was significantly less with chromium intake. There was a significantly greater loss of fat in the placebo period compared to the verum period in the Group 2 women who received chromium first. In both groups, blood chemistries were not affected by intake of chromium for 2 months. Results confirmed that niacin-bound chromium given to African-American women in conjunction with moderate diet and exercise caused a significant loss of fat and sparing muscle compared to placebo .
Grant et al. in 1997 studied the effects of chromium supplementation (400 ^g elemental chromium/day), as niacin-bound chromium or chromium picolinate, with or without exercise training in young, obese women . Results demonstrated that exercise training combined with niacin-bound chromium supplementation resulted in significant weight loss and lowered the insulin response to an oral glucose load. Chromium picolinate supplementation resulted in significant weight gain. Furthermore, results suggested that exercise training with niacin-bound chromium supplementation is beneficial for weight loss and lower the risk of diabetes .
Combinations of niacin-bound chromium along with other natural ingredients such as Maitake mushroom, Garcinia cambogia extract, and Gymnema sylvestre extract have also been evaluated [44, 59, 60]. Studies have demonstrated Garcinia cambogia-derived (-)-hydroxycitric acid (HCA) has been shown to reduce appetite, improve serum lipid profiles, and enhance fat oxidation and decrease body weight without stimulating the central nervous system, while Gymnema sylvestre extract has been shown to regulate weight loss and blood sugar levels [59, 60]. In a study using a combination of niacin-bound chromium, Maitake mushroom, and HCA, results demonstrated that diabetic Zucker fatty rats had a lower maintenance of body weight compared to control animals . Four groups of eight aged rats were gavaged daily with niacin-bound chromium (40 ^g elemental chromium/day), Maitake mushroom (100mg/day), and 60% (-)-hydroxycitric acid (HCA-SX, 200 mg/day) from Garcinia cambogia, while control group received only water. The doses of each treatment were doubled during 4-6 weeks. Animals consuming niacin-bound chromium lost approximately 9 g body weight per rat, while rats consuming Maitake mushroom lost 16 g body weight per rat. However, rats receiving HCA-SX simulated the pattern in the control group because these animals lost approximately 46 g body weight per rat .
In a similar study, the effect of niacin-bound chromium in combination with HCA-SX and a standardized Gymnema sylvestre extract on weight loss was evaluated in moderately obese subjects . A randomized, double-blind, placebo-controlled human study was conducted in 60 moderately obese subjects (aged 21-50 years, BMI > 26 kg/m2) for 8 weeks. One group was administered a combination of 4 mg niacin-bound chromium, 4667 mg HCA-SX, and 400 mg Gymnema sylvestre extract, while another group was given placebo daily in three equally divided doses 30-60 minutes before meals. All subjects received a 2000 kcal diet/day and participated in supervised walking program. At the end of 8 weeks, body weight and BMI decreased by 5-6%. Food intake, as well as total cholesterol, LDL, triglycerides, and serum leptin levels were significantly reduced, while HDL levels and excretion of urinary fat metabolites increased . In another related study, 30 moderately obese subjects received the same combination of niacin-bound chromium, Gymnema sylvestra extract, and HCA or placebo daily in three equally divided doses 30-60 minutes before each meal for 8 weeks . Subjects also received 2000 kcal diet/day and underwent a 30 minute/day supervised walking program, 5 days/week as in the previous study. Results demonstrated that at the end of 8 weeks, chromium combination supplemented group reduced body weight and BMI by 7.8 and 7.9%, respectively. Food intake was reduced by 14.1%. Total cholesterol, LDL, and triglyceride levels were reduced by 9.1, 17.9, and 18.1%, respectively, while HDL and serotonin levels increased by 20.7 and 50%, respectively. Serum leptin levels decreased by 40.5% and enhanced excretion of urinary fat metabolites increased by 146-281%. Placebo reduced body weight and BMI by only 1.6 and 1.7%, respectively, food intake was increased by 2.8%, and LDL, triglycerides, and total cholesterol decreased by 0.8, 0.2, and 0.8%, respectively. HDL were reduced by 4.1% while serum leptin levels were increased by 0.3%, and excretion of urinary fat metabolites did not change in MDA, ACT, and FA, and marginally increased in the case of ACON .
In similar studies on moderately obese women participating in a 12-week exercise program, the effect of chromium picolinate supplementation on body composition, resting metabolic rate, and selected biochemical parameters in moderately obese women was investigated. In a double-blind study, 44 women (aged 27-51 years) received either 400 ^g/day of elemental chromium as chromium picolinate or a placebo and participated in a supervised weight-training and walking program 2 days per week for 12 weeks. Body composition and resting metabolic rate were measured at baseline, 6 and 12 weeks. Body composition and resting metabolic rate were not significantly changed by chromium picolinate supplementation. Overall results demonstrated that 12 weeks of chromium picolinate supplementation (400 ^g elemental chromium/day) did not significantly affect body composition, resting metabolic rate, plasma glucose, serum insulin, plasma glucagon, serum C-peptide, and serum lipid concentrations in moderately obese women placed on an exercise program .
Further research using chromium picolinate demonstrated its effects on body composition in athletes. In a double-blind study, the effects of daily chromium supplementation (200 ^g elemental chromium as chromium picolinate) were investigated in football players during spring training for 9 weeks . Subjects receiving chromium picolinate demonstrated urinary chromium losses five times greater than those in the placebo group. Chromium picolinate supplementation was ineffective in bringing about changes in body composition or strength during a program of intensive weight-lifting training . In another double-blind, randomized, placebo-controlled study, the effects of 14 week of chromium picolinate supplementation during preseason resistance and conditioning program on body composition and neuromuscular performance in NCAA Division I wrestlers were assessed . Twenty wrestlers from the University of Oklahoma was assigned to either a treatment group (n = 7; 20.4 years ± 0.1) receiving 200 ^g elemental chromium as chromium picolinate daily, a placebo group (n = 7; 19.9 years ± 0.2), or a control group (n = 6; 20.2 years ± 0.1) using a stratified random sampling technique based on weight classification. Body composition, neuromuscular performance, metabolic performance, and serum insulin and glucose were measured before and immediately following the supplementation and training period . Repeated measures ANOVA indicated no significant changes in body composition for any of the groups. Aerobic power increased significantly (p < 0.002) in all groups, independent of supplementation. These results demonstrated that chromium picolinate supplementation coupled with a typical preseason training program did not enhance body composition or performance variables beyond improvements seen with training alone .
In another double-blind, placebo-controlled study, the efficacy of chromium picol-inate as a fat-reduction aid for obese individuals enrolled in a physical exercise program was investigated for 16 weeks . Participants were healthy, active-duty, Navy personnel (79 men, 16 women) who exceeded the Navy's percent body fat standards of 22% fat for men, 30% for women. Mean age was 30.3 years, and comparisons between the subjects who completed the study (n = 95) and dropouts (n = 109) revealed no significant differences in demographics or baseline percent body fat. The physical conditioning programs met a minimum of three times per week for at least 30 minutes of aerobic exercise. Subjects were given either 400 ^g elemental chromium as chromium picolinate or a placebo per day . At the end of 16 weeks, the group as a whole had lost a small amount of weight and body fat. However, the chromium picolinate supplemented group failed to show a significantly greater reduction in either percent body fat or body weight, or a greater increase in lean body mass than did the placebo group .
In a recent study, Livolsi et al. in 2001 examined the effect of chromium picolinate supplementation on muscular strength, body composition, and urinary excretion in women softball athletes . Fifteen women softball athletes were randomly divided into two groups, the chromium picolinate (500 ^g elemental chromium/day) treatment group (n = 8) and the placebo control group (n = 7). Results demonstrated that no significant (p < 0.05) differences in muscular strength or body composition were found after 6 weeks of resistance training. In addition, chromium excretion (^g per every 24 hours) was examined and increased significantly with the treatment group after the 6-week period .
In a longitudinal, double-blind, randomly assigned intervention study in 33 female obese subjects for 16 months with supplementation of 200 ^g elemental chromium as chromium picolinate along with a very low energy diet (VLED) during the first 2 months, results show that chromium picolinate intake did not result in significant changes in blood parameters and body composition .
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