Horm Metab Res 2018; 50(03): 193-200
DOI: 10.1055/s-0044-101835
© Georg Thieme Verlag KG Stuttgart · New York

The Effects of Supplementation with Chromium on Insulin Resistance Indices in Women with Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Javad Heshmati
1   Songhor Healthcare Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
Reza Omani-Samani
2   Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
Samira Vesali
2   Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
Saman Maroufizadeh
2   Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
Mahroo Rezaeinejad
3   Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
Maryam Razavi
4   Pregnancy Health Research Center, Department of Obstetrics and Gynecology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
Mahdi Sepidarkish
2   Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
› Author Affiliations
Further Information

Publication History

received 22 August 2017

accepted 24 January 2018

Publication Date:
09 March 2018 (online)


Recently, the effects of nutritional supplementation on improvement or prevention of polycystic ovary syndrome (PCOS) have been considered. Several studies have been carried out on the effect of chromium supplementation in improving PCOS patients. This study aimed to summarize the available findings regarding the effect of chromium on improving the polycystic ovary syndrome. The review includes randomized controlled trials (RCTs) comparing chromium treatment with placebo or other treatments in women with PCOS. Women with PCOS diagnosed according to the ESHRE/ASRM or NIH criteria in reproductive age were eligible. Electronic searches using the MeSH terms were conducted in the following databases: Medline, Embase, Scopus, Web of Science, and The Cochrane Library. Effects were measured as weighted mean difference (WMD) and 95% confidence intervals (CI) for studies of PCOS and control subjects were calculated by using random-effects model. The initial search yielded potentially 100 relevant articles of randomized clinical trials on dietary chromium supplements: 16 from Pubmed, 36 from Embase, 29 from Scopus, and 19 from Web of Science. After studying these publications, 5 were potentially eligible and retrieved in full text. The five studies included in the meta-analysis reported data on 137 women with PCOS and 131 controls. A meta-analysis of 5 studies showed a non-significant difference in fasting insulin between chromium, and placebo or other treatment (mean difference (MD): –1.14; (95% CI: –4.11 to 1.83, p=0.45). We retrieved two randomized controlled trials, in which Quantitative Insulin Sensitivity Check Index (QUICKI) was compared between chromium, and placebo or other treatment in 156 women with PCOS. Meta-analysis of two RCTs showed no significant difference in QUICKI score between chromium and placebo (MD: 0.01; 95% CI: –0.01 to 0.04, p=0.34). Two randomized controlled trials compared Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) between chromium, and placebo or other treatment in 81 women with PCOS. After combining the data, there was a significantly lower HOMA-IR in the chromium group (MD: –1.68; 95% CI: –2.42 to –0.94, p<0.001). One RCT reported a significant difference in Homeostatic Model Assessment-beta-cell function (HOMA-B) between chromium and placebo groups (–15.5±32.3 vs. +13.6±23.1, p<0.001). No significant effect of chromium on fasting insulin and QUICKI score was found in women with PCOS. Chromium supplementation significantly improved HOMA-IR and HOMA-B among patients with diabetes. The magnitude of the effect is small, and the clinical relevance is uncertain. Future trials in well characterized studies that address the limitations in the current evidence are needed before definitive claims can be made about the effect of chromium supplementation.

Supplementary Material

  • References

  • 1 Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H. Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria. Hum Reprod 2012; 27: 3067-3073
  • 2 Ollila M-ME, Piltonen T, Puukka K, Ruokonen A, Järvelin M-R, Tapanainen JS, Franks S, Morin-Papunen L. Weight gain and dyslipidemia in early adulthood associate with polycystic ovary syndrome: prospective cohort study. J Clin Endocrinol Metab 2015; 101: 739-747
  • 3 Joham AE, Teede HJ, Ranasinha S, Zoungas S, Boyle J. Prevalence of infertility and use of fertility treatment in women with polycystic ovary syndrome: data from a large community-based cohort study. J Women Health 2015; 24: 299-307
  • 4 Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol 2013; 6: 1-13
  • 5 Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013; 98: 4565-4592
  • 6 Mendoza N, Cancelo M. Diabetes mellitus and polycystic ovary syndrome: implications for diet and nutrition. Handbook of diet and nutrition in the menstrual cycle, periconception and fertility. Wageningen: Academic Publishers; 2014: 114-123
  • 7 Rondanelli M, Perna S, Faliva M, Monteferrario F, Repaci E, Allieri F. Focus on metabolic and nutritional correlates of polycystic ovary syndrome and update on nutritional management of these critical phenomena. Arch Gynecol Obstet 2014; 290: 1079-1092
  • 8 Facchinetti F, Bizzarri M, Benvenga S, D’Anna R, Lanzone A, Soulage C, Di Renzo GC, Hod M, Cavalli P, Chiu TT, Kamenov ZA, Bevilacqua A, Carlomagno G, Gerli S, Oliva MM, Devroey P. Results from the International Consensus Conference on Myo-inositol and d-chiro-inositol in Obstetrics and Gynecology: The link between metabolic syndrome and PCOS. Eur J Obst Gynecol Reprod Biol 2015; 195: 72-76
  • 9 Moghetti P. Insulin resistance and polycystic ovary syndrome. Curr Pharm Design 2016; 22: 5526-5534
  • 10 Geller DH, Pacaud D, Gordon CM, Misra M. State of the art review: emerging therapies: the use of insulin sensitizers in the treatment of adolescents with polycystic ovary syndrome (PCOS). Int J Pediatr Endocrinol 2011; 2011:: 9
  • 11 Hua Y, Clark S, Ren J, Sreejayan N. Molecular mechanisms of chromium in alleviating insulin resistance. J Nutr Biochem 2012; 23: 313-319
  • 12 Wang ZQ, Cefalu WT. Current concepts about chromium supplementation in type 2 diabetes and insulin resistance. Curr Diabetes Rep 2010; 10: 145-151
  • 13 Amr N, Abdel-Rahim HE. The effect of chromium supplementation on polycystic ovary syndrome in adolescents. J Pediatr Adolesc Gynecol 2015; 28: 114-118
  • 14 Fazelian S, Rouhani MH, Bank SS, Amani R. Chromium supplementation and polycystic ovary syndrome: A Systematic Review and Meta-Analysis. J Trace Elem Med Biol 2017; 42: 92-96
  • 15 Fauser BCJM, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, Carmina E, Chang J, Yildiz BO, Laven JS, Boivin J, Petraglia F, Wijeyeratne CN, Norman RJ, Dunaif A, Franks S, Wild RA, Dumesic D, Barnhart K. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): The Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 2012; 97: 28-38.e25
  • 16 Ashoush S, Abou Gamrah A, Bayoumy H, Othman N. Chromium picolinate reduces insulin resistance in polycystic ovary syndrome: Randomized controlled trial. J Obstet Gynaecol Res 2016; 42: 279-285
  • 17 Jamilian M, Asemi Z. Chromium supplementation and the effects on metabolic status in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. Ann Nutr Metab 2015; 67: 42-48
  • 18 Lucidi RS, Thyer AC, Easton CA, Holden AEC, Schenken RS, Brzyski RG. Effect of chromium supplementation on insulin resistance and ovarian and menstrual cyclicity in women with polycystic ovary syndrome. Fertil Steril 2005; 84: 1755-1777
  • 19 Amooee S, Parsanezhad ME, Shirazi MR, Alborzi S, Samsami A. Metformin versus chromium picolinate in clomiphene citrate-resistant patients with PCOs: A double-blind randomized clinical trial. Iran J Reprod Med 2013; 11: 611
  • 20 Fogle RH, Baker MB, Patel SK, Korst LM, Stanczyk FZ, Sokol RZ. A prospective, randomized clinical trial comparing chromium picolinate to metformin for the treatment of insulin resistance in obese, hispanic women with polycystic ovarian syndrome. Fertil Steril 2007; 88: S181
  • 21 Rotterdam E. Group A-SPCW. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod (Oxford, England) 2004; 19: 41
  • 22 Stearns DM. Is chromium a trace essential metal?. BioFactors 2000; 11: 149-162
  • 23 Hummel M, Standl E, Schnell O. Chromium in metabolic and cardiovascular disease. Hormone and metabolic research 2007; 39: 743-751
  • 24 Chen Y-L, Lin J-D, Hsia T-L, Mao FC, Hsu C-H, Pei D. The effect of chromium on inflammatory markers, 1st and 2nd phase insulin secretion in type 2 diabetes. Eur J Nutr 2014; 53: 127-133
  • 25 Whitfield P, Parry-Strong A, Walsh E, Weatherall M, Krebs JD. The effect of a cinnamon-, chromium-and magnesium-formulated honey on glycaemic control, weight loss and lipid parameters in type 2 diabetes: An open-label cross-over randomised controlled trial. Eur J Nutr 2016; 55: 1123-1131
  • 26 Cefalu WT, Wang ZQ, Zhang XH, Baldor LC, Russell JC. Oral chromium picolinate improves carbohydrate and lipid metabolism and enhances skeletal muscle Glut-4 translocation in obese, hyperinsulinemic (JCR-LA corpulent) rats. J Nutr 2002; 132: 1107-1114
  • 27 Dong F, Kandadi MR, Ren J, Sreejayan N. Chromium (D-phenylalanine) 3 supplementation alters glucose disposal, insulin signaling, and glucose transporter-4 membrane translocation in insulin-resistant mice. J Nutr 2008; 138: 1846-1851
  • 28 Qiao W, Peng Z, Wang Z, Wei J, Zhou A. Chromium improves glucose uptake and metabolism through upregulating the mRNA levels of IR, GLUT4, GS, and UCP3 in skeletal muscle cells. Biol Trace Elem Res 2009; 131: 133-142
  • 29 Chen G, Liu P, Pattar GR, Tackett L, Bhonagiri P, Strawbridge AB, Elmendorf JS. Chromium activates glucose transporter 4 trafficking and enhances insulin-stimulated glucose transport in 3T3-L1 adipocytes via a cholesterol-dependent mechanism. Mol Endocrinol 2006; 20: 857-870
  • 30 Wang ZQ, Zhang XH, Russell JC, Hulver M, Cefalu WT. Chromium picolinate enhances skeletal muscle cellular insulin signaling in vivo in obese, insulin-resistant JCR: LA-cp rats. J Nutr 2006; 136: 415-420