Nhng iu cn bit v vin km (Zn)

L-vn-Nhn Km l g ? Km l mt kim loi thit yu tm thy trong hu ht cc t bo. C th cha khong 2 n 3 g km tm thy trong xng, rng, tc, da. gan, c bp, bch cu v tinh hon. Mt phn ba (1/3) km trong huyt tng gn lng lo vi albumin, trong khi 2/3 gn cht vi globulin. Km kch thch hot ng ca khong 100 enzym, l nhng cht xc tc phn ng sinh ha trong c th. Km h tr mt h thng min nhim lnh mnh, cn thit cho vt thng lnh li, gip bo v v gic v khu gic v cn thit cho s tng hp DNA. Km cng h tr cho vic tng trng v pht trin bnh thng thai nhi trong bng m, thi k u th, v thiu nin. Thc n no cung cp km? Km tm thy trong nhiu loi thc n. Con ho (oyster) cha km nhiu nht trong mi phn n, nhng cc ging cng h nh nghu, s c hn c th cng cha nhiu km m cha ai nghin cu. Tht v tht g cng cung cp nhiu km. Nhng ngun thc n khc l u, qu hch (nut), mt s hi sn, ht ng cc cha ch bin, hay thc n cereals c gia tng cht b dng (fortified) v thc n bin ch t sa. Km c hp th nhiu hn trong ch dinh dng giu m ng vt hn l m thc vt. Cht phytates trong bnh m lm bng la m nguyn ht, cereals, rau qu c th gim hp th km. RDA l g? RDA l t vit tt ca Recommended Dietary Allowance l lng yu t nn dng hng ngy, chng ta thng thy t ny sau lng chai thuc a sinh t v khong cht sn xut ti Hoa-k. Lng km khuyn nn dng hng ngy cho tr em t 7 thng n 3 tui l 3mg v nhiu nht l cho cc b m ang cho con b 14mg mi ngy. Lc no c th thiu km? Hu ht trng hp thiu km xy ra khi lng km tiu th cha hay hp th km, khi tng tht thot km khi c th, hay khi nhu cu c th v cht km gia tng. Du hiu v triu chng thiu km gm ln chm, rng tc, tiu chy, c quan sinh dc trng thnh chm v bt lc, thng tn da v mt v n mt ngon. Cng c bng c l st cn, vt thng chm lnh, v gic bt thng v chng ng lm do no b c th xy ra. Trng hp thiu km trm trng c bo co nhm ngi ln Iran. Nhng nam thiu nin ny n mt lng ln t st, chm ln v chm pht trin c quan sinh dc, thiu mu, gim nng tuyn sinh dc, ln gan v l lch, da th v tr no l . Sau khi cha tr bng thc n cn i cha lng km trong 1 nm, lng c quan sinh dc mc ra, kch thc c quan sinh dc ln bnh thng, b cao pht trin v da tr nn bnh thng. Chng thiu mu p ng vi cht b dng st. Mt s ngi x gan b thiu km do khng gi c km. Du hiu sinh ha i km vi thiu km gm gim mc km trong huyt thanh (< 70 mcg/dl hay <10.7 micromol/L), gim alkaline phosphatase, alcohol dehydrogenase trong vng mc (khng thy ban m) gim testosterone trong huyt tng v hng chc nng hot ng ca t bo lymph T, gim tng hp cht to keo (collagen) t vt thng khng lin c v gim hot ng ca RNA polymerase trong nhiu m. V phn ln nhng triu chng trn c th xy ra nhiu bnh khc, ng vi kt lun ngi bnh thiu km khi thy nhng triu chng trn. iu quan trng l nn tham kho bc s v cc triu chng bnh c chm sc thch hp. Ai cn thm km?

Hin nay cha c mt xt nghim n thun no o lng km trong dinh dng. Nu bc s nghi ng thiu km s xem li cc yu t nguy him nh n cha s calori cn thit, nghin ru, bnh tiu ha v triu chng nh chm ln trong giai on thiu nhi v thiu nin khi xc nh ngi bnh c can km khng. Nhng ngi n chay thng cn thm 50% lng km ngi khng n chay v hp th km km hn thc n ngun thc vt, do ngi n chay nn chn nhng thc n c lng km tt. B m thiu km s lm cho thai nhi chm pht trin. Dng km h tr c th lm tng tc ln mt s tr em chm ln nh hay va phi v ng thi thiu km. Sa ngi khng cung cp lng km cn thit cho tr em t 7 n 12 thng, v vy tr em b sa m phi n thm thc n cha km hay dng sa bt c cha km. Bc s nhi khoa c th khuyn dng thm km trong trng hp ny. B sa m cng lm cn ngun d tr km b m v nhu cu tng ln khi cho con b. Cc b m cho con b nn chn thc n giu cht km v cc b ang mang thai nn theo li khuyn bc s dng thm sinh t v khong cht cn thit. Theo mt nghin cu ng trn American Journal of Clinical Nutrition s thng 5/04, mc km b m thp c th nh hng n xng ca hi nhi. Nghin cu ny thc hin Peru l quc gia thng gp bnh thiu km. H nghin cu 242 ph n mang thai, mt na dng vitamin c cha km v na kia dng vitamin khng c km. Thai nhi ca nhng b m c ung thm cht km xng pht trin hn vng chu v xng i hn l thai nhi ca cc b m khng ung km. H dng k thut siu m kim sot. Tnh trng thiu km thy 30% n 50% ngi ung ru. Ru lm gim hp th km v tng that thot km trong nc tiu. Ngoi ra, nhiu ngi nghin ru khng n nhiu loi thc n khc nhau, nn lng km a vo c th c th khng . Tiu chy cng lm mt km. Ngi no b m ct rut hay d dy hay c bnh ng tiu ha lm km hp th nh bnh sprue (vim rut lot ming), bnh Crohn v hi chng ngn rut d b thiu km. Ngi b tiu chy kinh nin cn bo m dng lng km cn thit t ngun thc n hay cht h tr dinh dng. Bc s s nh gi xem c nn dng thm cht h tr dinh dng cp thm km nu thc n khng . Km, nhim trng v lnh vt thng H min nhim b tc dng nghch c khi thiu km mc va phi. Thiu km trm trng s n p h min nhim. Km cn thit cho s pht trin v hot ng ca t bo lymph T, mt loi bch cu gip chng nhim trng. Khi dng thm cht h tr km cho ngi thiu km, s t bo lymph T lu thng trong mu gia tng v kh nng chng nhim trng ci thin. Cc nghin cu cho thy tr em ngho v thiu dinh dng n-, Phi chu, Nam M v ng nam b tiu chy nhim trng trong mt thi gian ngn hn sau khi dng cht h tr km. Lng km dng trong nghin cu ny t 4 mg n 40 mg mi ngy v c cung cp nhiu dng mui (zinc acetate, zinc gluconat v zinc sulfat). Thuc bi dng km thng c cho gip tr lot ngoi da, nhng khng tng tc lnh vt trong khi mc km trong c th mc bnh thng. Km v bnh cm mo Dng km cha bnh cm mo to ra kt qu nghch nhau v mc trm trng v thi gian mc bnh. Mt nghin cu trn 100 nhn vin Cleveland Clinic cho thy vin km ngm gim thi gian b cm xung mt na, mc du khng thy khc bit gia thi gian b st v mc c bp b au nhc. Nhng nh nghin cu khc quan st tc dng ca vin km ln thi gian b cm v mc trm trng ca bnh cm trn 400 bnh nhn c chn theo li tnh c. Trong nghin cu u tin, h dng 1 siu vi gy ra triu chng cm lnh. Thi gian bnh ngn hn mt cch ng k nhm dng vin ngm Zn gluconat (hm lng 13.3 mg km), nhng khng thay i nhm dng Zn acetate hm lng 5 n 11.5 mg km. C 2 dng bo ch u khng

nh hng n mc trm trng ca bnh trong 3 ngy u iu tr. Trong nghin cu th hai, quan st tc dng vin km ln thi gian v mc trm trng ca bnh cm t nhin, khng thy khc bit gia ngi dng vin km v ngi dng gi dc (vin ng). Nhng nghin cu mi nay ngh tc dng ca km c th c nh hng do cng thc bo ch c bit cung ng ion km cho mng nhy ming. Cn thm nhng nghin cu khc xem cng thc bo ch c tc dng no ln chng cm mo khng. Khi dng km di dng bm vo mi hay ngm km, mc ch khng phi tng mc km trong c th, nhng can thip vo tc dng ca siu vi sau cung hng hay trong mi. Ngi ta thy ch c Zn acetate hay Zn gluconat dng chng siu vi. Mt s cht ph gia trong vin ngm nh tng v ngt hay tng mi thm c th ngn cn tc dng chng siu vi ca km. Dextrose, ng, mannitol v sorbitol dng c, nhng khng nn dng acid citric v tartaric. Tc dng ca glycin trong vin ngm cng khng r rng. Tc dng chng siu vi c th gia tng khi phi hp vi cc cht chng oxyt ha. Km v hp th st Bnh thiu mu do thiu st ngy nay c xem l mt vn nghim trng ca ngnh y t cng cng. Chng trnh tng thm cht dinh dng st c pht trin nga chng thiu st, v ci thin c mc st hng triu ph n, hi nhi v tr em. Mt s nh nghin cu t vn tng cng st c nh hng n hp th cc cht dinh dng khc khng, trong c c nguyn t km. Thc n tng thm st khng nh hng hp th km. Tuy nhin nu st lng ln c th lm gim hp th km k c dung dch st. Dng thuc bi dng st gia cc ba n s gim thiu tc dng hp th km. Km v th gic: Cc nh khoa hc bit rng km gi mt vai tr quan trng trong hot ng bnh thng ca rhodopsin, mt protein trong mt lin quan n chng vim vng mc sc t (retinitis pigmentosa), mt bnh di truyn c th a n m mt. Nu khng gn vo km, rhodopsin rt khng bn, l c im ca chng vim vng mc sc t. Bc s John Hwa i hc y khoa Hanover, New Hamshire gii thch. Do nng km trong vng mc c th quan trng trong iu tr chng vim vng mc sc t. (Theo bo Ha sinh hc ngy 20 thng 8 nm 2004)) Nu km d tha th s nguy him cho sc kho ra sao ? Nhim c km thy dng cp v mn tnh. Dng 150mg n 450mg mi ngy thng kt hp vi tnh trng nguyn t ng (Cu) thp trong c th, thay i chc nng ca st, suy gim h min nhim, gim mc cholesterol tt HDL. Mt bo co cho bit ngi bnh nn ma d di sau khi nut 4 gam Zn gluconat (570 mg nguyn t km). Nm 2001, vin khoa hc quc gia Hoa-k a ra liu ti a c th c th chu ng c khng thy phn ng nghch gi l mc cao (Upper levels vit tt l UL). Mc cao ny khng p dng cho ngi ung vin km do bc s iu tr mt chng bnh no v c bc s theo di. Nhim c km thng do n ung thc n chua ng trong nhng bnh cha bng tn (m km). Sau y l mc cao cho hi nhi, tr em v ngi ln: Tui 0 n 6 thng 7 n 12 thng Tr em 4 mg 5 mg Nam hay n C thai hay cho b

1 n 3 tui 4 n 8 tui 9 n 13 tui 14 n 18 tui 19 tui tr ln

7 mg 12 mg 23 mg 34 mg 40 mg

34 mg 40 mg

Mt s kinh nghim lm sng cha c chng minh bng nghin cu: Mt bc s chuyn vin dinh dng vin dinh dng lm sng Saigon k cho chng ti mt s kinh nghim dng km cha lnh mt s bnh m cha c nghin cu no cp n nhng trng hp ny, th d: ng ch cho chng ti lp da chai di bn chn c th do thiu km gy ra; mt s tr em bing n hay n n khng hc c, sau khi dng thm vin km, em b n ung bnh thng tr li hay i hc c ngay c mt s trng hp ging nh ri lon tm thn hay b chng panic, i khi vin km cng gip tr li trng thi bnh thng. Vin km gip gim nn ma nhng ph n c thai. Dng mui km v liu lng: Km c th dng mui v c hay hu c, nhng mui c phn t lng thp thng cho mt t l km cao v c th gy cm gic bun nn, do nn chn dng c phn t ln nh km gluconat. V nhu cu ti a l 14 mg mi ngy, nn trong vin a sinh t v khong cht nh vin Centrum, hm lng km 15 mg cung ng cho nhu cu hng ngy khi cn ung thm. Trng hp ung cha bnh, liu ti a km nguyn t l 40 mg t ta c th suy on lng mui km nh Zn gluconat hay Zn acetate l bao nhiu. Nn hi ngi c s hm lng km trn chai thuc l km nguyn t hay mui km, v nn dng vin c hm lng thp khong 30 mg v trong mt thi gian ngn.

Ti liu tham kho:

1/ 2/ 3/ 4/ 5/ 6/ Vin y t quc gia Hoa-k The Merck Manual Ohio State University Human nutrition Mayo clinics American Journal of Nutrition 05/04. Journal of Biological Chemistry, August 20, 2004