Micronutrient vitamin and mineral

Dr. Joko wahyu Wibowo,MKes

Micronutrients and Macronutrients

Micronutrients are substances required in very small amounts (mg or g) and that mainly function as co-factors of enzymes ( < 0.005% body weight). Examples include: 1. Vitamins 2. Trace minerals (Fe, Cu, F, Zn, I, Se, Mn, Mo, Cr, Co and B). Macronutrients are chemical substances that are required in relatively large amounts (> 0.005% body weight). Examples include proteins, fats, carbohydrates and minerals (Na, Mg, K, Ca, P, S, and Cl).
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Minerals
Mineral What the mineral does Fluid and electrolyte balance, supports muscle contraction and nerve impulse transmissions Maintains fluid and electrolyte balance, aids in digestion Maintains fluid and electrolyte balance, cell integrity, muscle contractions and nerve impulse transmission Formation of bones and teeth, supports blood clotting Food sources salt, soy sauce, bread, milk, meats

Sodium Chloride Potassium Calcium

salt, soy sauce, milk, eggs, meats potatoes, vegetables, banana, strawberries, cod, milk milk, yogurt, cheddar cheese, Swiss cheese, tofu, sardines, green beans, spinach, broccoli all animal foods (meats, fish, poultry, eggs, milk) Green vegetables, tomato juice, beans, cashews, halibut spinach, broccoli, green beans, tomato juice, beef liver

Phosphorus Formation of cells, bones and teeth,

maintains acid-base balance

Magnesium Supports bone mineralization, protein

building, muscular contraction, nerve impulse transmission, immunity

Iron

Part of the protein hemoglobin (carries oxygen throughout body's cells)

Minerals
Mineral Zinc Function
Enzymes production of genetic material/proteins, vitamin A transport, wound healing, sperm production and the normal development of the fetus Antioxidant, works with vitamin E to protect body from oxidation Thyroid hormones regulate growth, development and metabolic rate Absorption/utilization of iron, formation of hemoglobin , enzymes

Food sources
Green vegetables, tomato juice ,lentils, oysters, shrimp, crab, meats yoghurt, cheese seafood, meats and grains salt, seafood, bread, milk, cheese meats, water

Selenium Iodine Copper

Manganese
Fluoride Chromium

Facilitates many cell processes

formation of bones and teeth, helps to make teeth resistant to decay

widespread in foods
fluoridated drinking water, tea, seafood

Associated with insulin and is required for vegetable oils, liver, whole the release of energy from glucose grains, cheese, nuts legumes, organ meats 4

Molybdenum Facilitates many cell processes

Vitamin Characteristics
Each vitamin has one or more specific purposes. Vitamins are essential to life processes. Vitamins are generally used by the body with very minimal changes Vitamins are usually required in only small amounts Most vitamins cannot be synthesized by the body directly
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Important Vitamins
Vitamin A
Retinol

Function
Supports vision, skin, bone and tooth growth, immunity and reproduction Collagen synthesis, amino acid metabolism, helps iron absorption, antioxidant Promotes bone mineralization New cell synthesis, Breaking down fatty acids / amino acids, nerve cell maintenance Antioxidant, regulation of oxidation reactions, supports cell membrane stabilization

Source
mango, broccoli, butternut squash, carrots, tomato juice, sweet potatoes, pumpkin, beef liver Fruits and vegetables

C
Ascorbic Acid

D B12 E

Self-synthesis milk, egg yolk, liver, fatty fish Meats, poultry, fish, shellfish, milk, eggs

Shrimp, cod, wheat germ, tofu, polyunsaturated vegetable oils, sweet potatoes, Liver, leafy green vegetables, spinach, broccoli, cabbage, 6

Synthesis of blood-clotting proteins, regulates blood calcium

Classification of Vitamins
Vitamins can be classified as either Water soluble Fat soluble. Water soluble vitamins are generally involved in the cellular metabolism of energy supplying nutrients. Fat soluble vitamins often have very specialized functions
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Classification of Vitamins
Vitamins can be classified as either Water soluble Fat soluble. Water soluble vitamins are generally involved in the cellular metabolism of energy supplying nutrients. Fat soluble vitamins often have very specialized functions
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Water Soluble Vitamins

Water soluble vitamins usually contain hydrogen attached to electronegative atoms such as oxygen or nitrogen. They easily form hydrogen bonds with water molecules. Water soluble vitamins do not accumulate in the body, so regular supplies are necessary

Fat Soluble Vitamins

Fat soluble vitamins have long nonpolar hydrocarbon chains or rings. Common fat soluble vitamins include

A, D, E, F K.

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Fat Soluble Vitamins

Fat soluble vitamins usually accumulate in tissues and are not leached out quickly. Unlike water soluble vitamins, an excess of a fat soluble vitamin can be just as harmful as a deficiency

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Vitamin C- Sources
Vitamin C is found in many fresh fruits and vegetables. It contains several polar groups, making it very water soluble. Cooking vegetables in water tends to leach the vitamin from the food. Cooked foods also contain less vitamin C, since it is also easily oxidized and hence destroyed in the cooking process.

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Vitamin Functions
Involved in the biosynthesis of the protein, collagen, found in connective tissues such as cartilage, ligaments, and tendons Aid in healing wounds and helping to prevent bacterial infections. Massive doses of vitamin C have often been thought to help in the prevention of the common cold, There is NO reliable evidence to show that this is true

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Vitamin C Deficiencies
Scurvy or Scorbutus. Symptoms include
1. swollen legs, 2. rotting gums, 3. and bloody lesions. Common among sailors in the 18th and 19th centuries who spent a long time at sea without fresh fruits and vegetables

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Vitamin A
Vitamin A is also known as retinol

The long chain hydrocarbon structure of vitamin A means that the vitamin is essentially non-polar. Hence it is fat soluble rather than water soluble.

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Vitamin A Sources

Commonly found in cod liver oil, green vegetables, and fruit. Carrots indirectly serve as a source of vitamin A since they contain b carotene which the body readily converts to vitamin A

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Vitamin A Functions
Vitamin A is fat soluble. It is not readily broken down by cooking. Role in aiding in night vision. Retinol is oxidized to retinal, which combines with the protein opsin to form rhodopsin. Rhodopsin is the active agent which converts light signals to electrical impulses that the optic nerve transmits to the brain

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Prevalence of Vitamin A
Around the world 250 million children vitamin A deficient (serum retinol <0.70 mol/l) 3 million children have xerophthalmia (dry eyes) Areas with high rates of night blindness in children also have high rates of night blindness in mothers

Vitamin A Deficiencies
A deficiency in vitamin A results in night blindness. The most serious deficiency results in a condition known as Xeropthalmia, a severe form of conjunctivitius or blindness.

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Vitamin A deficiency: consequences

Night blindness - ancient Egypt, Greek and Assyrian medical literature Early deaths High rates of respiratory and diarrheal diseases Affects immunocompetence Cured with animal and fish liver or plants with green and yellow pigments

Risk factors for VAD

Age Diet Disease Seasonality Culture Clustering

Illness related indicators for 6-71 month old children

Indicator Immunization Measles case fatality rate (1) Diarrhea disease (2) Fever rates Worm infections (3)
<50% fully imm.

> 1% > 20% > 20% > 50%

Dietary modification for VAD

Ex. Where food sources of vitamin A are underutilized:

Thailand: VAD in preschool

children, pre-clinical levels, Animal foods expensive Fruits are seasonal Ivy gourd-underutilized, low esteem

Fortification of VAD
EX. Guatemala; sugar fortification Low serum retinol levels Low dietary intake of vitamin A Sugar usually refined Sugar consumed within a narrow range of daily intake across age groups In 1970, sugar was fortified with vitamin A, program very successful (Arroyave, 1979
PAHO publication)

Vitamin A deficiency summary

Vitamin A deficiency is highly prevalent It has severe consequences especially in the young Supplementation, fortification and

dietary changes have all been used successfully to reduce its prevalence The cost of the programs is not high if integrated into existing child care services

Vitamin D - Sources

Vitamin D is commonly found in fish liver oil as well as egg yokes. Unlike other vitamins, the body synthesizes vitamin D in the skin through the action of ultraviolet light on 7-dehydrochlosterol

Like vitamin A, the long chain Hydrocarbon structure makes vitamin D fat soluble

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Vitamin D Functions

Vitamin D is an important regulator of calcium metabolism. It is involved in the uptake of calcium and phosphate ions from food into the body. It is necessary for the proper formation of bone structures and teeth.

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Vitamin D

A serious deficiency in vitamin D results in a condition known as Ricketts. Ricketts is characterized by bone softening an malformation.

Child with Ricketts and two years after treatment

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Micronutrient Deficiencies
Vitamin Deficiency Diseases Retinol (Vitamin A) xerophthalmia / night blindness Ascorbic acid (Vitamin C) scurvy or scorbutus Calciferol (Vitamin D) rickets. Niacin (Vitamin B3) pellagra Thiamin (Vitamin B1) beriberi Mineral Deficiency Diseases Iron anemia Iodine goiter

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Macro-nutrient Deficiencies
Macronutrient deficiencies diseases in chlidren often result from a lack of protein
Kwashiorkor is a specific wasting away often occurring in infants at weaning. It results from a lack of protein in the diet
Marasmus is a wasting away of the body tissues from the lack Kwashiorkor of calories as well as protein in the diet. The child is fretful rather than apathetic and is skinny rather than swollen with edema.

Marasmus

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Iodine deficiency (ID)

Iodine must be obtained from the
environment Thyroid hormones, thyroxin and triiodothyronine (T4 &T3) contain 4 and 3 iodine atoms, respectively. Adults need 100-150 g/daily Children require less in total, but more per Kg body weight

Iodine deficiency: consequences

The following are affected by iodine deficiency: Thyroid size; enlargement (goiter) Mental and neuromotor abilities Reproductive results Physical growth

Consequences of ID

Neuromotor and cognitive impairment are the most important effects of ID Where ID is severe and mothers have severe ID, endemic cretinism is found results include:

cognitive impairment learning, speech deficits psychomotor problems

Reproductive effects

Rates of reproduction may be lower Fetal and postnatal survival lower Motor performance in childhood impaired

ID prevalence
assessment methods
Goiter rates (*)
Classification of goiters into grades 0, 1 and 2 ID suspected when >5% of school age children have grade 1 or 2 goiters

Urinary iodine (**)

Can define individual status Used to define population status Used to monitor interventions

Prevention of ID - fortification

Salt fortification

Unique in micronutrient supplementation

as no dietary changes required Fortified product more expensive

Social marketing to create demand Mass media campaigns Universal salt iodization is the goal Level of fortification 25-50 mg iodine/Kg

ID prevention-supplementation

Drops and tablets

Original study showing that iodine prevents

goiter used sodium iodide tablets given to school children twice per year Lugols solution also used in classrooms

Iodinated oil

Iodinated poppy seed oil - New Guinea Intra-muscular or oral routes Well accepted Costly due to delivery teams required

ID National Programs
Europe and North America Iodized salt universally available Mass media campaign Medical education Nutrition education Cooperation of industry Iodine deficiency nearly non existent

ID National Programs
Europe and North America Iodized salt universally available Mass media campaign Medical education Nutrition education Cooperation of industry Iodine deficiency nearly non existent

Iodine deficiency - summary

Iodine deficiency occurs in
geographic clusters It results in severe mental and physical disability It can be virtually eliminated by national supplementation programs Correction of ID should be performed with close monitoring to prevent adverse reactions

Nutritional Deficiencies
Proposed approaches to combating nutritional deficiencies world-wide include: Providing food rations that are composed of fresh and vitamin- and mineral-rich foods. Adding nutrients missing in commonly consumed foods. Genetic modification of food. Providing nutritional supplements. Providing selenium supplements to people eating foods grown in selenium-poor soil.

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