Lecture 1: Dietary Reference Intake (DRI) – reference values of nutrient intakes for healthy populations, used for planning

and assessment diets. Estimated

Average Requirement (EAR) – median value: level of nutrient estimated to meet the requirement of 50% of the people within a life stage and gender group.
Requirement to prevent disease and deficiency; used to set the RDAs. Recommended Dietary Allowance (RDA) – daily dietary intake that’s enough to meet the
nutrient requirements of 97.5% of people in a life stage and gender group (EAR + 2SD). Adequate Intake (AI) – expected to exceed the average requirement and
covers needs of 98% of people, when not enough info to have an EAR. Tolerable Upper Intake Levels (UL) - the highest level of a nutrient intake on a daily
basis that’s likely to have no risks of adverse effects for people. Critical Assessment of a Journal Article- does the study address an important scientific issue or
one of clinical or public health relevance? Does the study add anything new? What is the research question being asked (is it clear? Does the study test a stated
hypothesis?)? Was the study designed to address the specific research question or is it an exploratory analysis (was the study one in line with the original
protocol)? Was the study design appropriate for the research question? Does the study design address key sources of bias? Were the statistical analyses performed
correctly? Do the authors fairly consider their findings in relation to the larger literature? Do the data justify the conclusion? Are there conflicts of interest?
(Accuracy and precision also).
Lecture 2: White flour fortification in 1998 to prevent NTDs in women who didn’t know they were yet pregnant, also for cleft lip/palate. Inside the cell, folate is
polyglutamated to trap it to act as a coenzyme. SNP MTHFRC667T alanine for valine, lower enzyme activity. Most is reabsorbed. Microcytic hypochromic anema
– iron deficiency, magaloblastic anemia – folate/b12 deficiency. Low prevalence of inadequacy in kids, so little benefit from supplements (male adults too). Issue
with UL intakes for those with supplements. High levels of FA during pregnancy can affect insulin resistance in kids, might also cause carcinogenesis.
Lecture 3: Cyanocobalamin and hydroxocolbalmin are synthetic forms. B12 circulates in blood as methylcobalamin (80%) and bound to transporter proteins (R
proteins). High FA could mask b12 deficiency. Theres no association between elevated HC and onset of dementia.
Lecture 4: animal sources have both heme(efficient absorption) and non heme iron, plant sources only have nonheme iron. Free iron can cause oxidative damage
so must be bound by transferrin/stored as ferritin in body. Regulation by cellular iron regulatory proteins and by hepcidin signaling- released when levels are high,
and traps fe in enterocytes to be sloughed off (dec absorp/incr loss). Low fe levels cause dec translation of ferritin and incr translation of transferrin receptor.
Nutrient Sources Absorption E/I Function Assessment Recommendations Info
Folate White Proximal 1/3 Purine Plasma f [], Consume FA Circulates in NTDs:
bread, pasta of SI via pyrimidine RBC f [], supplement (400ug) + serum in improper
GCPII, PCFT, synthesis; AA plasma HC, MV if you are going to CH3folate form; closure of the
RDC, colon metab; megaloblastic be pregnancy, or are or 2/3s in plasma is NT during 3rd
(Slow) remethyl of anemia lactating, nutrition bound to albumin and 4th weeks
HC to education, fortification, and a2 of gestation:
methionine follow CFGHE, higher macroglobulin spina bifida,
levels if needed anencephaly
Vitamin Meat, Released from Remethyl of Serum b12, Those over 51yo should NO can increase Stored for
B12 poultry, food by acid, HC-> plasma HC, have b12 fortified foods HC, cause m years, 50% in
fish, binds R methionine, methylmaloni or have supplement anemia, liver. B12 []
shellfish, protein, from meth c acid in urine neuropathy. in breast milk
eggs, milk released in SI, synthetase; or blood, Prevalence of reflects
binds IF, conversion megaloblastic inadequacy is maternal
binds R on methylmolany anemia, underestimated. status.
enterocytes- lcoA to holotranscoba Fat soluble
endocytosis succinalcoA lamin
Iron Liver, fish, Heme into E: sugar, Hemoglobin, 1-plasma Nonbreast fed babies on Hemochromatosis
cereal,lentils enterocytes by acids, myoglobin, ferritin when formula, fortified -chronic iron
, spinach heme carrier meat, cytochromes, iron stores pablum cereal (cow overload, genetic-
1, hydrolyzed poultry, enzymes, pro- diminish 2- milk is poor source), decreased
to release Fe2. fish, oxidant, transport decr, 20mg MV for hepcidin
Nonheme mucin, peroxidases 3-anemia; pregnancy, vegans have synthesis, body
release fe2/3 I:polyphe MCV(size), higher needs, and those cant sense iron
and reduced to nols, MHC(av Hg who donate blood and levels to decr
fe2 at BB, oxalate, content), intense physical activity absorption.
absorbed phytate, MCHC,
DMT1 antacids hypochromic,
microcytic
Zinc Red meats, Carrier I: phytic Role in Hard to Cold severity not Acrodermatitis Low levels of
seafood, mediated/dif( acid, metalloenzym measure, affected by zn, but decr Enteropathica- inadequacy in
pork, dairy, ZIP4 on BB) oxalic es, growth serum/plasma duration of symptoms mutations in kids, and
whole acid, (transcription) Zn, and duration with SCL39A4 gene adults
grains (bran folate, , cell rep, metallothionei >75mg/day. Too much coding Zn
and germ) iron, Ca bone n [], urine/hair impairs immune transporter, ZIP4
E:acid formation, zn, zn-dep system. Lozenges have
skin, enzyme 14mg of zn (4 exceeds
immunity, activity UL)
Copper Organ meat, Reduced to E: aa, Enzymatic Serum/plasma Menkes disease:x Wilsons
shellfish, cu1, Ctr1 BB acids, reactions /RBC Cu, linked, high cell disease:
nuts, seeds transp, I:phytate, superoxide cu [], vascular and defect in
zn, fe dismutase, neuro issues, ATP7b
ATP7a excretion
mechanism
Iodine Soil, marine 90% absorbed Use for Urine iodine Table salt must be Goiter-def, Def is
origin, in stomach making excretion, iodized cretinism- def in increasing
dairy, salt thyroid thyroid size, fetus from from fast
hormones serum TSH [] mothers def foods,
(neurological) watching
sodium intake
Fluoride Fluoridated Passive dif, Osteoblast Monitor with Use pea size toothpaste Chronic toxicity is 1.5mg/L in
water, proliferation, urine and for children, don’t fluorosis Canada is
 grains, fish, bone mineral plasma, but swallow toothpaste. (dental/skeletal) safe.
tea, deposit, acid not body Prevents cavities and Municipality
toothpaste resistance, status improves dental health resp to add to
cavity resis, water.
Vitamin C Citrus fruits, Ascorbate- Metalloenzym Plasma vit C, Survey-def, Low
strawberries SVCT1 e redox state, vit c in WBCs bleeding gums, inadequacy in
carrier, microsomal loose teeth, kids, higher
dehydroascorb xenobiotic bruising, in adults, low
ate-GLUT1/3 metabolism, Water soluble levels above
transporters antioxidant UL
activity
Vitamin D Milk, rice, Micelles and Serum Ca Serum 25 Oh If shadow is taller than Osteoporosis; 25OHD3
fatty fish, chylomicrons homeostasis vit D you are tall, you cannot high inadequacy liver,
eggs, organ (calcitriol, make vitD. Supplement in kids, rickets in 1,25OH2D3
meats, intestine, breast fed infants, adults kids, osteomalacia kidneys
kidney, over 50 others with in adults (+PTH, -Ca, -
bones); impaired absorption. P)
calcitonin dec Avoid tanning beds,
serum Ca unless UVB rays
Calcium Milk, Carrier Oxalates, Bone Serum PPIs given at lowest Rickets, increased Low
cheese, ice mediated phytate, mineralization calcium(horm dose for short time risk of inadequacy in
cream, transport divalent ,coagulation, ones), ionized osteoporosis, kids, older
salmon, kale cations contraction, et Ca, protein hypertension, women high
bound Ca, colon cancer,
DXA obesity
Phosphorus everywhere Pi passive dif E: vitD I: Bone mineral, Serum Def is rare
or ATPase Ca, Mg, DNA P/urinary P
Phytate backbone, excretion
metabolism
Magnesium Greens, TRPM6 E:vitD, Surface bone, Serum [], Gitelman-bartter Kids don’t
nuts, transporter, protein, crystal lattice, RBC [], renal 104 syndrome, have
bananas diff carbs, enzymatic excretion hypomagnesemia inadequacy,
I:fiber, reactions, before and with def inc in adults
phytics ATP after Mg load
Vitamin K Phylloquino Through Blood Prothrombin Routine Fat soluble,
nes (plants), micelles, coagulation, time, under supplementation of all
oils passive diff bone proteins carboxylation newborns, those with
of proteins prolonged antibiotics
use, fat malapsorption
Vitamin A Liver, dairy, Micelle, 2 Vision, Eye Def-night Low
eggs, oils, retinals, gene exp, examinations, blindness, bitots prevalence of
tuna; proA- CRBPIIretinol cellular conjuctival spots, inadequacy,
yellow, , diff, impression keratinization; diet is low in
orange red “”retinylpalmi growth, cytology, hypervitaminosis vitamin
F&V tate, rep, bone plasma retinol A,
chylomicrons metab; [], relative hypercarotenemia,
antioxidan dose response
test
Vitamin E Plant foods, Passive diff, Antioxida Plasma Rare deficiencies,
oils, whole chylomicrons nt, heart vitamin E, rare toxicity
grains disease, erythrocyte
cancer, hemolysis test
eye health
Selenium Selenomethi Aa transport, antioxidan Blood and Keshan disease- selenosis -
onine, selenate via t, plasma [], [] def toxicity
selenite, active Na hormone of (cardiomyopathy),
selenite, transport, synthesis selenoproteins kashin-becks
meat, fish selenite via , urinary [] disease
passive diff (osteoarthropathy)
Sodium Table salt, BBM na/gluc, Osmotic 24 hour Keep na intakes below
water Na/Cl transp balance, urinary 2300mg (9-50yo); those
nerve sodium older no higher than the
transmissi excretion AI. Issue with
on, level hypertension; reduce Na
contractio intake and processed
n, Bp regu foods
Potassium Bananas, Plasma K [] Hypokalemia,
mango, hyperkalemia
greens, nuts
Chloride Table salt Hcl Issue with hypertension
synthesis

Ex: iron 14mg DV, 2% %DV, 18mg RDA; 14*0.02 = 0.28mg; 0.28/18mg = 1.5% RDA