Micronutrients Sources and functions

Micronutrients and diseases

(1)Deficiencies of vitamins and minerals may be caused by disease states such as malabsorption.
(2)Both deficiency and excess of vitamins and minerals can cause disease. (e.g., vitamin A intoxication and liver disease).

(3)Vitamins and minerals in high doses may be used as drugs (e.g., niacin for hypercholesterolemia).
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Body stores of vitamins and minerals

1. Vitamin B12 and vitamin A stores are large, and an adult may not become deficient for years. 2. Folate and thiamine may become depleted within weeks when eating a deficient diet. 3. Therapeutic modalities can deplete essential nutrients from the body; e.g., hemodialysis removes water-soluble vitamins, which must be replaced by supplementation.
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Micronutrients and diseases

Nutrient Thiamine Clinical Finding Beriberi: neuropathy, muscle weakness and wasting, cardiomegaly, edema, ophthalmoplegia, confabulation Magenta tongue, angular stomatitis, seborrhea, cheilosis Pellagra: pigmented rash of sunexposed areas, bright red tongue, diarrhea, apathy, memory loss, disorientation Minimum level Contributing Factors to Deficiency <0.3 mg/1000 Alcoholism, chronic kcal diuretic use, hyperemesis <0.6 mg

Riboflavin

Niacin

<9.0 niacin equivalents

Alcoholism, vitamin B6 deficiency, riboflavin deficiency, tryptophan deficiency Jwar eating

Alcoholism, isoniazid

Vitamin B6

Seborrhea, glossitis, convulsions, <0.2 mg neuropathy, depression, confusion, microcytic anemia Folate Megaloblastic anemia, atrophic <100 g/d glossitis, depression, Reference: Harrisons Text book of medicine, 17th Ed.

Alcoholism
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Micronutrients and diseases

Nutrient Clinical Finding Min level Factors ppt Deficiency Vitamin Megaloblastic anemia, loss of vibratory and <1.0 g/d Gastric atrophy B12 position sense, abnormal gait, dementia, (pernicious anemia),, impotence, loss of bladder and bowel strict vegetarianism, acid control, homocysteine, methylmalonic aid reducing drugs (e.g., H2 blockers) Vitamin C Scurvy: petechiae, ecchymosis, coiled hairs, <10 mg/d Smoking, alcoholism inflamed and bleeding gums, joint effusion, poor wound healing, fatigue Vitamin A Xerophthalmia, nightblindness, Bitot's spots, follicular hyperkeratosis, impaired embryonic development, immune dysfunction Rickets: skeletal deformation, rachitic rosary, bowed legs; osteomalacia <300 g/d Fat malabsorption, infection, measles, alcoholism, proteinenergy malnutrition

Vitamin D

<2.0 g/d Aging, lack of sunlight , fat malabsorption, deeply pigmented skin Vitamin E Peripheral neuropathy, spinocerebellar NA Fat malabsorption, or ataxia, skeletal muscle atrophy, retinopathy genetic abnormalities Vitamin K Elevated prothrombin time, bleeding Reference: Harrisons Text book of medicine, 17th Ed. <10 g/d Fat malabsorption, liver disease, antibiotic use5

Micronutrients and diseases

Element Boron Deficiency No biologic function determined Reduced bone mass, osteoporosis Toxicity Tolerable Intake Developmental defects, 20 mg/d male sterility, testicular (extrapolated from atrophy animal data) Renal insufficiency nephrolithiasis, impaired iron absorption 2500 mg/d (milkalkalai)

Calcium

Copper

Anemia, growth --, defective pigmentation of hair, hypothermia, degenerative changes in aortic elastin, osteopenia, mental deterioration Impaired glucose tolerance

Nausea, vomiting, 10 mg/d (liver diarrhea, hepatic toxicity) failure, tremor, mental deterioration, hemolytic anemia, renal dysfunction Occupational: renal failure, dermatitis, pulmonary cancer NA

Chromium

Fluoride

Increased dental caries

Dental and skeletal 10 mg/d (fluorosis) fluorosis, osteosclerosis 6

Reference: Harrisons Text book of medicine, 17th Ed.

Micronutrients and diseases

Micronutrient Deficiency (Element) Iodine Thyroid enlargement, Decreased T4, cretinism Tolerable Intake Thyroid dysfunction, acne-like 1100 g/d eruptions (thyroid dysfunction) Iron Muscle abnormalities, Gastrointestinal effects 45 mg/d of kilonychia, pica, anemia, work (nausea, vomiting, diarrhea, elemental iron performance, impaired constipation), iron overload (GI side effects) cognitive development, with organ damage, acute premature labor, perinatal systemic toxicity maternal mortality Manganese Impaired growth and skeletal General: Neurotoxicity, 11 mg/d development, reproduction, Parkinson-like symptoms (neurotoxicity) lipid and carbohydrate Occupational: Encephalitis-like metabolism; upper body rash syndrome, Parkinson-like syndrome, psychosis, pneumoconiosis Molybdenum Severe neurologic Reproductive and fetal 2 mg/d abnormalities abnormalities extrapolated Reference: Harrisons Text book of medicine, 17th Ed.
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Toxicity

Micronutrients and diseases

Tolerable Intake Selenium Cardiomyopathy, heart failure, General: nausea, vomiting, 400 g/d (hair, striated muscle degeneration abnormal nails & Hair,& skin, nail changes) neuropathy, lassitude, garlic odor to breath, Occupational: liver & lung problems. Phosphorous Rickets , muscle weakness, Hyperphosphatemia 4000 mg/d rhabdomyolysis, paresthesia, ataxia, seizure, confusion, heart failure, hemolysis, acidosis Zinc dermatitis, diarrhea, immune General: Reduced copper 40 mg/d dysfunction, failure to thrive, absorption, gastritis, gonadal atrophy, sweating, fever, nausea, vomiting Occupational: pulmonary fibrosis Reference: Harrisons Text book of medicine, 17th Ed.
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Element

Deficiency

Toxicity

 Flavonoids constitute a large family of polyphenols (that contribute to the aroma, taste, and color of fruits and vegetables). Major groups of dietary flavonoids include anthocyanidins in berries; catechins in green tea and chocolate; flavonols (e.g., quercitin) in broccoli, onion, and the skins of grapes and apples; and isoflavones (e.g., genistein) in legumes. The dietary intake of flavonoids is estimated to be between 10 and 100 mg/d,

Functions: antioxidant activity & cell signaling.

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Physical Findings of Nutritional Deficiencies

Hair, Nails
Clinical Findings Possible Deficiency Possible Excess

Corkscrew hairs and Vitamin C coiled hairs Easily pluckable hair Protein Flag sign (transverse Protein de-pigmentation of hair) Sparse hair Protein, biotin, zinc Vitamin A Transverse ridging of Protein nails

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Physical Findings of Nutritional Deficiencies

Skin
Clinical Findings in Skin
Cellophane appearance Cracking (flaky paint or crazy pavement dermatosis) Follicular hyperkeratosis

Possible Deficiency
Protein Protein

Possible Excess

Vitamins A, C Vitamin C
Vitamins C, K Niacin Protein, vitamin C, zinc Vitamin A, essential fatty acids, biotin Vitamin A

Petechiae (especially perifollicular) Purpura

Pigmentation, scaling of sunexposed areas Poor wound healing, decubitus ulcers Scaling

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Physical Findings of Nutritional Deficiencies

Neurological
Clinical Findings Possible Deficiency
Thiamine (Korsakoff psychosis) Vitamin A Niacin, vitamin B12, folate Vitamin A Thiamine, phosphorus

Possible Excess

Confabulation, disorientation Drowsiness, lethargy, vomiting Dementia Headache Ophthalmoplegia

Peripheral neuropathy (e.g., Thiamine, pyridoxine, vitamin Pyridoxine weakness, paresthesias, ataxia, B12 foot drop, and decreased tendon reflexes, fine tactile sense, vibratory sense, and position sense) Tetany Calcium, magnesium
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Iron
The total body iron is regulated by degree of absorpion in intestine . Various dietary factors affect the absorption: inhibited by phytates, phosphates etc. The dietary iron is in ferric form while it is ferrous form that is needed for absorption. Ascorbic acid and Ferric reductase helps to convert the form in the stomach with the help of gastric secretions. . Almost all iron is absorbed in duodenum ( ~ 5 % of the amount ingested) Divalent Metal transporter-1 ( DMT-1) transports ferrous form in duodenum.
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Vitamin D Fat soluble vitamins are poorly absorbed in absence of Bile salts or pancreatic lipase. Vitamin D binds to transfer protein in circulation. Ergocalciferol (Vitamin D2) is available in vegetable sources. Cholecalciferol (Vitamin D3) is available in animal sources. Dietary vitamin D is not necessary for avoiding Vitamin D deficiency. Sun ultraviolet rays cannot penetrate skin pigments. 1-25-hydroxycholecalciferol is active form of vitamin D.

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The food pyramid

Its a guide that helps us choose healthy foods. It tells us all the food groups our bodies need and how many servings of each group we need. Each group on the Pyramid contains certain nutrients. If we eat foods from each group well be sure to get all the nutrients we need.
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The food pyramid

The Food Guide Pyramid is a graphical representation to better understand how to eat healthy. A balanced diet is one that includes all the food groups of the food pyramid. The pyramid is based on the best available scientific facts concerning links between diet and good health There are now two food pyramids...
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Old food pyramid

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New food pyramid The New Food Pyramid is a tool to educate people to eat a more balanced diet from a greater variety of food portions without counting calories. This include six groups ( earlier 4) and expanded number of servings (to meet the calorie needs of most people)

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Whats In
FRUITS AND VEGETABLES: Five servings of fruits and vegetables a daythe old recommendationare no longer enough to maintain good nutrition and prevent disease. The new goal is nine servings a day: four half-cup servings of fruit per day and five of vegetables or legumes, such as beans, peas and lentils. WHOLE GRAINS: Look for whole kernels of wheat or other grains in your bread and cereals. Whole-grain goods are packed with more nutrients than white bread, cakes or muffins made from refined flours. EXERCISE: Get up and get moving! The new guidelines say people should exercise for at least 30 minutes most days of the week.

What to Avoid
SODIUM: The recommended a target for salt intake: no more than 1 teaspoon of salt a day. Too much salt can cause high blood pressure. FATS: Fat should make up 35% or less of your daily calorie intake. Try to avoid eating trans fats (found in processed foods). These types of fat are often listed as partially hydrogenated oils in the list of ingredients. SUGAR: Its hard to remove sugar from your diet, but you can certainly cut down the amount you eat. Coke is loaded with sugar. Opt for low-fat milk, water, or any other beverage thats low in sugar.
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