Micro-nutrients and theirs Roles in Metabolism

For 1st Year HUMAN NUTRITION Students(Msc)

Melese.S(Chem,B.Pharm,Msc , Ass.professor )
Jimma University ,Institute of Health
Faculty of Public Health, Nutrition & Dietetics Department
10/23/2023
January 2,2021 1
 MINERALS

10/23/2023 Melese.S 2
 Goals and Objectives
1. Describe the concept of essential mineral
elements and how their content in the
body is regulated.

MICRONUTRIENTS 2. Describe the factors influencing intestinal

mineral absorption.
3. Describe the cellular mechanism of iron
absorption and its regulation.
4. Describe the consequences of iron
deficiency and abnormal increased
absorption.

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 Mineral metabolism

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 Functions of Minerals
 Some participate with enzymes in
metabolic processes (cofactors, e.g. Mg,
Mn, Cu, Zn, K)
 Some have structural functions (Ca, P in
bone; S in keratin)
 Acid-base and water balance (Na, K, Cl)
 Nerve & muscle function (Ca, Na, K)
 Unique functions: hemoglobin (Fe),
Vitamin B12 (Co), thyroxine (I).

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Classification
 Macro or Major  Micro or Trace minerals
minerals (body needs relatively
 Sodium (Na), less)
potassium (K),  Manganese(Mg),
magnesium (Mg), iron(Fe), cobalt(Co),
calcium (Ca), chromium(Cr),
phosphorus (P), molybdenum(Mo),
copper(Cu), zinc(Zn),
sulfur (S), chloride
fluoride(F), iodine(I),
(Cl) selenium(Se)
 Present in body  Present in body tissues
tissues at at concentrations <50
concentrations >50 mg/kg
mg/kg  requirement of these is
 requirement of these ﹤100 mg/d
is >100 mg/d
10/23/2023 Melese.S 6
 Nutritionally Important Minerals
Macro Trace
Element g/kg Element mg/kg
Ca 15 Fe 20-50
P 10 Zn 10-50
K 2 Cu 1-5
Na 1.6 Mo 1-4
Cl 1.1 Se 1-2
S 1.5 I 0.3-0.6
Mg 0.4 Mn 0.2-0.5
10/23/2023 Co
Melese.S 0.02-0.1 7
Minerals in Foods
 Found in all food groups.
 More reliably found in
animal products.
 Often other substances in
Oxalate foods decrease absorption
(bioavailability) of minerals
 Oxalate, found in spinach,
prevents absorption of most
calcium in spinach.
 Phytate, form of phosphorous
in most plants makes it poorly
available
Phytate
10/23/2023 Melese.S 8
 Factors Affecting Requirements
 Physiological state/level of production
 Interactions with other minerals

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 Mineral Pyramid

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 MACRO-MINERALS
(Principal elements)

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 Minerals are classified into two major groups (macro

minerals and micro minerals).

Macro Minerals (Principal

Elements)
These are minerals that are
Required in relatively larger amounts > 100
mg/day or are found in the body in amounts >
5grams.

They are: - Calcium (Ca), Phosphorus (P),

Sulphur (S), magnesium (Mg), Sodium (Na),
chloride (Cl2), and Potassium (K).
10/23/2023 Melese.S 12
 Calcium (Ca)
Calcium is the most abundant mineral in the
human body.
The bones maintain over 99% of the body's
calcium.
2% of body weight

1% in body fluids

Plasma (Extracellular fluid)

2.25 – 2.75 mmol/l
Cell (Intracellular fluid)
10-8 – 10-7 mol/l = 10-5 – 10-4 mmol/l

10/23/2023 Melese.S 13
 Calcium (Ca)
 Most abundant
mineral in animal
tissues
 99% Ca in skeleton
 1% Present in:
 Blood & other tissues
 Lots of functions
 Bone structure
 Nerve function
 Blood clotting
 Muscle contraction
 Cellular metabolism
10/23/2023 Melese.S 14
 Functions
 This vital mineral is required for the formation and
maintenance of bones and teeth (Maintains bone density and
strength)
 Calcium also assists in enzyme actions involving:
 Muscle contraction
 Neurotransmitter release
 “second messenger”
 Regulation of heart beat
 Blood clotting
 Blood pressure regulation
 Is used as an antidote to magnesium poisoning

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 The homeostasis of calcium in blood and intracellular
fluid represents an intricate biological control
mechanism.
The blood calcium level depends on a balance between
 Bone resorption,
 Intestinal absorption and
 Renal tubular re-absorption, on the one hand, and
 Calcium lost by skeletal formation as well as renal and intestinal
excretion
 Usually 20–30% of ingested calcium is absorbed.
It is absorbed mainly in the duodenum in an acid medium; its absorption is much reduced
in the lower part of the intestinal tract. However, absorption of calcium is not limited to
the small intestine.

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 Calcium and its significance in
the bone metabolism

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 Bones – reservoir of calcium
 99% of skeletal calcium forms stable bone (not
exchangeable with the Ca in extracellular fluid)
 1% is in the form of releasable pool of Ca
 Balance of deposition and resorption
 Osteoblasts – bone-forming cells responsible for
bone deposition
 Secrete type I collagen
 Differentiate into osteosytes
 Osteoclasts – “bone-eating” cells that resorb the
previously formed bone

10/23/2023 Melese.S 20
 Calcium homeostasis
storage kidney
bone

calcium deposition Blood

Ca++
calcium resorption
1000 g
Ca++
stored in
bone

intake Ca++ Ca++

absorbed into excretion lost in urine
blood
Calcium in
the diet
calcium lost in feces

10/23/2023
small intestine
Melese.S 21
 Calcium cycling in bone tissue
 Bone formation
 Osteoblasts
 Synthesize a collagen matrix that holds
Calcium Phospate in crystallized form
 Once surrounded by bone, become
osteocyte
 Bone resorption
 Osteoclasts
 Have lysosomes that
 Change local pH, causing Ca++ and
phosphate to dissolve from crystals
into extracellular fluids

10/23/2023 Melese.S 22
 Changes in vitamine D
plasma level
Hypovitaminosis
 RICKETS (rachitis)– children
 OSTEOMALACIA - adults

 Attention! – Osteoporosis is decrease of bone

mass (matrix and minerals)

Hypervitaminosis
 Tissue and organs calcification
 Lost of body weight
 Kidney function failure

10/23/2023 Melese.S 23
 Calcium absorption
The first Saturable, requiring energy and a calcium-
binding protein (calbindin).
 This process is regulated by vitamin D (Calcitriol), namely 1,25-
(OH) 2-D, largely in the proximal intestine.
 The vitamin D-dependent calcium transport system is stimulated
when dietary calcium is low and when its requirement is high, such
as during growth, pregnancy and lactation.

Second
Calcium absorption occurs throughout the small intestine but
mostly in the jejunum and ileum.
This is a non-saturable process, which is independent of
nutritional and physiological regulation; increased absorption via this
mechanism becomes possible when there is increased intake of the
mineral
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 Deficiency
Adult deficiency leads to
 Osteomalacia (softening of bones).
Muscle spasms and cramps, high blood
pressure, osteoporosis
 Muscle contractions
 Convulsive seizures
 Muscle cramps
 Low backache
In children, calcium deficiency is
associated with rickets, bone deformities,
and growth retardation.
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Genu valgum Genu Bowing of long bones in
varum legs
Rachitic Deformities

10/23/2023 Melese.S 30
 Risk Factors For
Osteoporosis

Low calcium intake

Decreased mobility
Steroid therapy
Osteogenesis imperfecta
Cushing's syndrome
Smoking, alcohol

Osteoporosis: is a decrease
in bone quantity (mass) per unit volume.

10/23/2023 Melese.S 31
 Lab Tests to Detect Deficiency:
24-hour urine collection to measure calcium
levels

Imaging procedures to scan for bone

density (more reliable than above tests)

For rickets bon X-ray shows a porotic bone,

fraying and cupping of the long bones.
10/23/2023 Melese.S 32
 Age RDA
AGE RDA
0-6 months 360mg
6-12 months 540mg
1-10 years 800mg
11-18 years 1000mg
18+ 800mg
Pregnant +400mg
Lactating +400mg

10/23/2023 Melese.S 33
Dietary requirements
 Dietary requirements:
 Adult : 800 mg/day;
 Women during pregnancy, lactation and post-
menopause: 1.5 g/day;
 Children (1-18 yrs): 0.8-1.2 g/ day;
 Infants: (< 1 year): 300-500 mg /day
 Food Sources:
 Best sources: milk and milk product;
 Good sources: beans, leafy vegetables, fish,
cabbage, egg yolk.

10/23/2023 Melese.S 34
 Food Sources
• Milk products (milk, Cheese, butter,
yogurt)
• Finger millets (‘Dagusa”)
• Almonds
• Molasses
• Salmon,
• Sardines, Shrimp
• Soybeans products (Tofu)
• Spinach
10/23/2023 Melese.S 35
 Factor promoting Ca absorption
1. Vit.D induce the synthesis of Ca binding protein in
the intestinal epithelial cells and promotes Ca
absorption.
2. Parathyroid hormone (PTH) enhances Ca absorption
through the increased synthesis of calcitriol.
3. Acidity (low pH) is more favorable for Ca absorption.
4. Lactose promotes calcium uptake by intestinal cell.
5. Lysine and arginine facilitate Ca absorption.

10/23/2023 Melese.S 36
 Factor inhibiting Ca absorption
1. Phytates and oxalates form insoluble salts and
interfere with Ca absorption.
2. The high content of dietary phosphate results in the
formation of insoluble Ca phosphate and prevent Ca
uptake.
 Dietary ratio of Ca : P ---1:1 to 2:1--- is ideal for Ca absorption.

3. The free fatty acids are react with Ca to form

insoluble Ca soaps.
4. The alkaline condition (high pH) is unfavorable for
Ca absorption.
5. High content of dietary fiber interferes with Ca
absorption.
6. Low estrogen levels (postmenopausal women)
10/23/2023 Melese.S 37
 Calcium Deficiencies -Rickets

weakness and deformity of the bones that occurs from

vitamin D deficiency or dietary deficiency of Ca and P
in a growing person or animal.
10/23/2023 Melese.S 38
 Calcium Deficiencies -Osteoporosis

progressive loss of bone density, thinning of bone tissue

and increased vulnerability to fractures in the elderly
people of both sexes.
10/23/2023 Melese.S 39
 Calcium and Osteoporosis
• Bone growth is greatest during “linear growth”
– Peaks out at around age 30

 Around age 40,

bone breakdown
exceeds
formation.
 By age 65, some
women have lost
50% of bone
mass.

10/23/2023 Melese.S 40
Prevention is the Key

 Maintain adequate
calcium and vitamin D
intake —many
recommend
supplements?
 Perform weight-bearing
exercise.
 Take estrogen
supplements to
postmenopausal?
10/23/2023 Melese.S 41
 Calcium Toxicity
 Deposition in soft tissue

 Impaired kidney function

 Interference of other nutrient

absorption
 Iron & zinc

10/23/2023 Melese.S 42
 Phosphorous (P)

 80% of P occurs in combination with

Ca in the bone and teeth.
 About 10% is found in muscles and
blood in association with proteins,
carbohydrate and lipids.
 The remaining 10% is widely
distributed in various chemical
compounds.

10/23/2023 Melese.S 43
 Functions of Phosphorus
 Essential for the development of
bones and teeth
 Phospholipids, Phosphoproteins
 Component of:
 DNA & RNA
 ATP, NAD+, NADP+
 Energy metabolism: ATP, GTP
 Maintenance of blood pH: phosphate
buffer system
10/23/2023 Melese.S 44
Dietary requirements
 The recommended dietary allowance (RDA)
of phosphate is based on the intake of
calcium.
 For adult, the ratio of Ca:P of 1:1 is
recommended (800mg/day);
 For infant, however, the ratio is around 2:1,
which is ratio found in human milk.
 Sources:
 milk, cereals, leafy vegetable, meat, eggs.

10/23/2023 Melese.S 45
 Absorption and Excretion
Absorption:
Phosphate absorption occur from jejunum
1. Calcitriol promotes phosphate uptake along with
calcium.
2. absorption of P and Ca is optimum when the
dietary Ca:P is 1:2-2:1.
3. acidity favors while phytate decreases phosphate
uptake by intestinal cells.
Excretion:
About 500 mg phosphate is excreted in urine per day.
The reabsorption of phosphate by renal tubules is
inhibited by PTH.
10/23/2023 Melese.S 46
 Importance of Ca:P ratio
 The ratio of plasma Ca:P is important for
calcification of bones.
 The product of Ca×P (in mg/dl) in child is around
50 and in adults around 40. This product is less
than 30 in rickets.

 Phosphorus Deficiency
 Rickets, osteomalacia, osteoporosis

10/23/2023 Melese.S 47
 Factors affecting Calcium Absorption

Increased by: Decreased by:

o Body needs—growth, o Vitamin D deficiency

pregnancy, lactation o Gastrointestinal problems
o Vitamin D o Hypochlorhydria (low
o Milk lactose stomach acid)
o Acid environment— o Stress
hydrochloric acid, citric acid, o Lack of exercise
ascorbic acid (vitamin C) o Oxalic acid foods (beet
o Increased protein intake greens, chard, spinach,
Increased fat intake rhubarb, cocoa)
o Exercise o Phytic acid foods (whole
o Phosphorus balance grains)
o High phosphorus intake
(forms precipitation/insoluble
complex)
10/23/2023 Melese.S 48
 Phosphorus(P)
 Total body phosphorus is about
800 g.
 80% in the skeleton and 20% in
other tissues and body fluids.
 Phosphorus is present in every cell
of the body.

10/23/2023 Melese.S 49
 Phosphorus…
Functions
1. Formation of bones and teeth.
2. Formation of nucleic acids and nucleotides.
e.g. ATP, ADP and cAMP.
3. Formation of phospholipids,
phosphoproteins, hexose, pentose and triose
phosphates.
4. Formation of many coenzymes as TPP, CoA-
SH, NAD, NADP, FMN, FAD, UDP-G and
pyridoxal phosphate.
5. Formation of buffers.
10/23/2023 Melese.S 50
 Absorption of Phosphorus
 Phosphorus is absorbed from the intestine in
the form of phosphates.
 Only about 70% of food phosphates are
absorbed.
 Factors which help the absorption of calcium
will secondarily help the absorption of
phosphate as unabsorbed calcium inhibits the
absorption of phosphate.
 The best Ca/P ratio for the proper absorption
of both calcium and phosphate is 1:1 (1:2 to
2:1).
10/23/2023 Melese.S 51
 Factors affecting plasma inorganic phosphate
I. Renal function: Renal failure → failure of
excretion in urine → ↑ plasma inorganic
phosphate.
II. Parathyroid hormone: It inhibits renal
tubular reabsorption of phosphate → ↑
phosphate excretion in urine → ↓ plasma
phosphate.
III. Vitamin D: Plasma inorganic phosphate
decreases in rickets.

10/23/2023 Melese.S 52
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 Deficiency
• Decreased appetite
• Demineralization of bones and teeth
• Cold hands and feet Sore breasts
• Night sweats
• Faint/rapid pulse
• Continuous diarrhea
• Constipation
• Cramps
• Colic
• Depression

10/23/2023 Melese.S 54
 Age RDA
0-6 months 300mg
6-12 months 500mg
1-10 years 800mg
11-18 years 1,000mg
18+ years 1,000mg
Pregnant 1200mg
Lactating 1200mg

10/23/2023 Melese.S 55
 Function
Potassium (k)
• Promotes regular heartbeat.
• Promotes normal muscle contraction.
• Regulates transfer of nutrients to cells.
• Maintains water balance in body tissues
and cells.
• Potassium is the predominant positive
electrolyte in body cells and controls acid-
base balance.
10/23/2023 Melese.S 56
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 Deficiency
 Hypokalemia
Weakness( paralysis )
Low blood pressure
Life-threatening, irregular or rapid heartbeat
that can lead to cardiac arrest and death

Special Consideration
Potassium supplements for those who take loop
diuretics

10/23/2023 Melese.S 58
 Food Sources

Banana

Pineapple

Recommended Daily Allowance

(RDA):
No RDA has been established
A total daily intake of 40 to 150 milliequivalents
per day is recommended.

10/23/2023 Melese.S 59
 Function Sodium (NA)
As an electrolyte, sodium is present in all body cells
and renders the following functions:

• Its most important function is to regulate the

balance of water inside and outside cells.
• Plays a crucial role in maintaining blood
pressure.
• Aids muscle contraction and nerve
transmission.
• Regulates body's acid-base balance.
10/23/2023 Melese.S 60
 Deficiency

Muscle and stomach cramps

Nausea
Fatigue
Mental apathy
Muscle twitching and cramping (usually in
legs)
Appetite loss

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 No RDA has been established. Estimated safe
intake given below.

Estimated Safe
Age: Intake:
0-6 months 0.115-0.35g
6-12 months 0.25-0.75g
1-3 years 0.325-0.975g
4-6 years 0.45-1.35g
7-10 years 0.60-1.80g
11-17 years 0.90-2.270g
18+ years
10/23/2023 Melese.S
1.10-3.30g 64
 Food Sources

• Table salt (chief source of sodium)

• Tomatoes
• Beef, dried and fresh
• Green beans
• Margarine
• Milk
• Sardines
• Bread
• Butter

10/23/2023 Melese.S 65
 Chloride (Cl2)

Function

Regulates body's electrolyte balance.

 Regulates body's acid-base balance.
Chloride is a constituent of acid in the stomach
(hydrochloric acid).

Food Sources
Salt substitutes (potassium chloride)
Sea salt
Table salt (sodium chloride)
Found in combination with
10/23/2023 other molecules
Melese.S 66
 Healthy people do not have to make any
special efforts to maintain sufficient
chloride.
Eating a balanced diet supplies all daily
needs.
Extremely ill patients, with acid-base
imbalance, require hospitalisation,
frequent laboratory studies and skilful
professional care.

10/23/2023 Melese.S 67
 Deficiency may be caused due to:
Continuous vomiting
Intentional neglect of Chloride in infant formula
preparations, infant develops metabolic alkalosis,
hypovolemia and significant urinary loss

It manifests by:
Upsets balance of acids and bases in body fluids
(rare)
Nausea
Vomiting
Confusion
Weakness
Coma
10/23/2023 Melese.S 68
10/23/2023 Melese.S 69
 Recommended Daily Allowance (RDA):
Estimate of adequate daily intake by the Food and
Nutrition Board of the National Research Council,
1989.

AGE RDA
0-6 months 0.275-0.7g
6-12 months 0.4-1.2g
1-3 years 0.5-1.5g
7-10 years 0.93-2.78g
11-17 years 1.4- 4.2g
18+ years 1.75-5.1g
10/23/2023 Melese.S 70
 Magnesium
• Nearly 99% of the total body magnesium is located in bone or the
intracellular space.
• Second plentiful cation of the extracellular fluids.
• Mg is a cofactor of all enzymes involved in phosphate transfer
2+

reactions utilizing ATP and other nucleotide triphosphates as

substrate.
• Required for the structural integrity of numerous intracellular
proteins and nucleic acids.
• A substrate or cofactor for important enzymes such as adenosine
triphosphatase, guanosine triphosphatase, phospholipase C,
adenylate cyclase, and guanylate cyclase.
• A required cofactor for the activity of over 300 other enzymes.
• A regulator of ion channels; an important intracellular signaling
molecule.
• A modulator of oxidative phosphorylation.

Mg2+ is chelated between the beta and gamma

phosphates, diminishes the dense anionic
10/23/2023 character of ATP Melese.S 71
 Magnesium (Mg)
Functions
Activates essential enzymes.
Aids bone growth and strengthens tooth
enamel.
Aids function of nerves and muscles,
including regulation of normal heart
rhythm.
Works as laxative in large doses.
Acts as antacid in small doses.
 Prevents high blood pressure(pre-
eclampsia)
 Alleviates cramps associated with
premenstrual syndrome.
10/23/2023 Melese.S 72
 As nature’s physiological calcium
blocker, magnesium improves vision in
persons with glaucoma

The mineral may also prevent kidney

stones by increasing the solubility of
calcium in urine, thereby preventing stone
formation (This effect is even stronger in
combination with vitamin B-6).

Deficiency during pregnancy may lead to

pre-eclampsia, pre-term delivery, and
fetal growth
10/23/2023 Melese.S 73
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 Deficiency Symptoms
Muscle contractions
Convulsions
Confusion and delirium
Irritability
Nervousness
Skin problems
Hardening of soft tissues
Increased blood pressure (Pre-eclampsia
in pregnant women)
10/23/2023 Melese.S 75
 RDA
300-400 mg/day

Food sources
Soya bean, Wheat germ, nuts, beans,
oats, barley, banana, green leafy
vegetables, milk

10/23/2023 Melese.S 76
 MICROMINERALS
(Trace elements)

10/23/2023 Melese.S 77
 Micro Minerals (Trace Elements)

These are minerals that are:

Required in relatively larger amounts <100

mg/day or are found in the body in amounts <
5grams.

They are: - Iodine (I), Iron(Fe), Zinc(Zn),

Fluorine(F), Manganes(Mn), Selenium(S),
Cobalt, Nickel

10/23/2023 Melese.S 78
 Iron
 The total content of iron in an adult
body is 3-5 g.
1. About 70%: in the erythrocytes of blood
as a constituent of Hb.
2. At least 5%: in Mb of muscle.
3. Heme is the most predominant iron
containing substance: e.g. Hb, Mb,
cytochromes.
4. Non-heme iron: e.g. transferrin, ferritin.

10/23/2023 Melese.S 79
 Iron
Major function of Fe – oxygen transport by hemoglobin.
Fe2+ and Fe3+ are highly insoluble – special transporter
systems are required.
Food Fe is predominantly in Fe3+, tightly bound to organic
molecules.

Apoferritin assimilates up to 4 300 Fe molecules to form

Fe storage protein – ferritin.

In the retikuloendothelial system ferritin provides an

available storage form for iron.

Apotransferrin (apoTf) – protein, that can bind 2 atoms

of Fe to form transferrin, Fe carrier in plasma.
10/23/2023 Melese.S 80
 Iron
Function
Hemoglobin and myoglobin formation
Immunity (enhancing neutrophil function)
Cognitive development
Metabolic efficiency
Enhances Physical growth of children

10/23/2023 Melese.S 81
Functions
 O2 and CO2 transport via
hemoglobin
 Thus, necessary for ATP
production!
 Essential component of
many enzymes
 Immune function
 Brain function
 Iron deficiency/toxicity
thought to slow mental
development in kids.
10/23/2023 Melese.S 82
Role of Liver in Regulating Iron Absorption
1. Liver is main storage site for excess iron CAUSES OF IRON
2. Hepcidin is an antimicrobial peptide secreted by DEFICIENCY
hepatocytes which it acts as an inhibitor of iron 1. Dietary deficiency
absorption by the gut and release from
macrophages. 2. Excess phytate or oxylate in
3. Production of hepcidin is decreased by iron diet
deficiency and increased with iron loading and 3. Gastric achlorhydria
inflammation
4. Hepacidin interacts directly with ferroportin leading 4. Hookworm infestation
to its degradation. This leads to decreased iron 5. Excessive bleeding
absorption and release

ORGANISMAL IRON HOMEOSTASIS

CONSEQUENCES OF IRON
DEFICIENCY
1. Anemia (microcytic, hypochromic)
2. Poor growth in children
3. Impaired energy metabolism
Source Undetermined

Ferroportin functions as a hepcidin-regulated valve

to control the efflux of recycled, dietary and stored
iron. In turn hepcidin levels are controlled by body
iron10/23/2023
stores and are also increased by inflammation. Melese.S 83
Page 7 Page 8
 Iron Mechanism in cognition
 Iron in oligodendrocytes is required for proper
myelination of the neurons used in sensory systems
(visual, auditory) and learning and interacting behaviors
(Lozoff & Black,2004).
 Dopaminergic neurotransmitter systems related to behavioral
development (eg, inhibition, affect, attention processing, and
extraneous motor movements) are sensitive to changes in
iron status.
 Iron is also a cofactor for enzymes that synthesize
neurotransmitters such as tryptophan hydroxylase
(serotonin) and tyrosine hydroxylase (norepinephrine,
dopamine) (Beard, 2003).

 Iron deficiency has been linked to changes in neuronal

metabolism in the hippocampus and prefrontal projections
where memory processing
10/23/2023
occurs (deUngria et al 200).
Melese.S 84
 Regulation of Iron absorption
 Regulation of iron uptake by enterocytes
and release of iron stores from
macrophages and hepatocytes is mediated
by the hormone hepcidin, and its effect on
ferroportin.
 Hepcidin decreases serum iron by
decreasing iron absorption and preventing
macrophages from releasing iron (causing
iron sequestration). Hepcidin is regulated
by iron levels and erythropoiesis.
10/23/2023 Melese.S 85
 Iron regulation

10/23/2023 Melese.S 86
 Iron absorption
 Iron is mainly absorbed in the stomach and
duodenum.
 mostly found in the food in ferric form (Fe3+), bound to
protein or organic acid.
 In the acid medium provided by gastric HCl, the Fe3+ is
released from food.
 Reducing substances such as ascorbate (Vitamin C) and
cystein reduces ferric form (Fe3+) to ferrous form (Fe2+).
 Iron in ferrous form (Fe2+) is soluble and readily absorbed.
 How much do we absorb?
 We absorb iron from the diet only when we need it
 In normal people, about 10% of dietary iron is usually
absorbed.
 Those with LOW stomach acid secretions absorb less.
10/23/2023 Melese.S 87
 Factors enhancing and inhibiting
absorption of non-hem iron.

Enhancers Inhibitors
Vitamin c Phytates
Amino acids Tanins
High altitude Polyphenoles
Hydrochloric acid Heavy metals
Fermentation Fibers
Alcohol Low altitude
Deficient stores Replete stores
Achlorhydria
10/23/2023 Melese.S 88
 Iron storage
 Iron can be stored by ferritin (a protein) or
hemosiderin
 Stored in liver, bone marrow (why here?),
intestinal mucosa, and spleen
 A apoferritin molecule can combine with 4,000

atoms of iron.

10/23/2023 Ferritin Melese.S

Ferritin 89
 Iron transport in the plasma
 The iron enters the plasma in ferrous state
(Fe2+), then oxidized to ferric form (Fe3+) by a
copper-containing protein, ceruplasmin.
 Fe3+ binds with a specific iron binding protein,
namely transferrin. Each transferrin molecule
can bind two atoms of ferric iron.

Transferrin
10/23/2023 Melese.S 90
 Increased iron will upregulate hepcidin
which then decreases iron and vice
versa.

 Active erythropoiesis inhibits hepcidin

(allowing iron to be absorbed/released for
hemoglobin synthesis).
 Hepcidin is increased by inflammatory
cytokines, particularly IL-6, and reduces
available iron during inflammatory
processes
10/23/2023 Melese.S 92
10/23/2023 Melese.S 93
 Deficiency
Global problem affecting more than two billion people

In almost all developing countries, between one third and

one half of the female and child population are anemic.

Among pregnant women and children 1-5 five years of age

in developing countries, anemia prevalence is
estimated to be 50-60%.

In sub-Saharan Africa the prevalence rate for pregnant

women is 50%

 while that for non-pregnant women is 40%.

 In Ethiopia, 44% of children and 17 percent of women are

anemic (DHS,2011)

10/23/2023 Melese.S 94
10/23/2023 Melese.S 95
 Normal Blood Film

10/23/2023 Melese.S 96
 MICROCYTES

10/23/2023 Melese.S 97
 HYPOCHROMIA

10/23/2023 Melese.S 98
10/23/2023 Melese.S 99
Altitude Correction Hemoglobin (WHO, 2011)

10/23/2023 Melese.S 100

 Signs and symptoms
Listlessness
Light headedness
Heart palpitations upon exertion
Fatigue
Irritability
Paleness of skin
Cracking of lips and tongue
General feeling of poor health
Pica (Geophargia during pregnancy)

10/23/2023 Melese.S 101

 Consequences
In adults, anemia with a hemoglobin concentration
of less than 11g/dl leads to
Reduced physical work capacity
Reduced mental (cognitive) performance-Poor
attention span and learning ability in children
Low tolerance to infections
Poor physical growth.
Premature birth, inter-uterine retardation, and low
birth weight
When the hemoglobin concentration level falls
below 4 g/dl it may result in death from anemic
heart failure.
10/23/2023 Melese.S 102
 Risk factors for anemia
Parasitic infection Hook worm, malaria,
Schistosomiasis, heavy load of Trichuris or
Ascaris)
Cereal based monotonous diet

10/23/2023 Melese.S 103

 Population at Risk
Low birth weight infants

Children aged 6-59 months

Adolescent girls and boys(10-19 years)

Pregnant and lactating women

 People living with HIV and AIDS

10/23/2023 Melese.S 104

 Intervention
Supplementation of iron and folic acid
Treatment of severe anemia
Deworming
Bed net distribution
 Dietary diversification – increased production
and consumption of locally available iron rich
foods
Dietary modification -Fortification of foods with
iron Supplementation of iron and folic acid

10/23/2023 Melese.S 105

10/23/2023 Melese.S 106
 Universal Supplementation for Pregnant and Lactating
Women

10/23/2023 Melese.S 107

 In areas where anemia prevalence in young children is 40% or
more, delivery of iron supplements should continue through the
second year of life, to adolescent girls
Iron and Folic Acid Doses For Universal Supplementation for Children and
Adolescents

10/23/2023 Melese.S 108

 Therapeutic doses

10/23/2023 Melese.S 109

 (Deworming)

10/23/2023 Melese.S 110

10/23/2023 Melese.S 111
 Age RDA
0-6 months 5mg
6-12 months 10mg
1-3 years 10mg
4-6 years 10mg
7-10 years 10mg

MALES

11-18 years 12mg

19+ years 10mg

FEMALES

11-50 years 15mg

51+ years 10mg
Pregnant 30mg
Lactating 15mg
10/23/2023 Melese.S 112
 Iron Pyramid

10/23/2023 Melese.S 113

 Food Sources Animal Source
o Bread, enriched Egg yolk, meat, chicken, fish
o Cheese, cheddar
o Garbanzo beans
(chickpeas)
o Lentils
o Molasses, black-strap
o Mussels
o Pumpkin seeds
o Seaweed
o Walnuts
o Wheat germ
o Whole-grain products
10/23/2023 Melese.S 114
 Iodine

Functions
• Iodine is a trace element that combines with the amino acid,
tyrosine, to form the thyroid hormone(T3 and T4) and is
necessary for normal thyroid function.

• Thyroid hormone accelerates cellular reactions, increases

oxygen consumption and basal metabolic rate,
influences growth and development, energy
metabolism, differentiation and protein synthesis.

• Ocean water, like seafood, is high in iodine content.

• Goiter is more common in geographic areas that are inland

and where iodine is not added to the soil through seepage of
ocean water and ocean winds.

10/23/2023 Melese.S 115

 Deficiency
• Iodine deficiency disorder refers to medical
conditions ranging from simple goiter to
deafness, mutism, squint and profound metal
retardation called cretinism.

• Globally, 30 % of the world’s population is

affected by IDD and more than 150 million
people are affected in Africa alone.
• In Ethiopia,
• 38% of under five years old children have goiter
and 35% of their biological mothers have goiters

10/23/2023 Melese.S 116

 Risk factors
• Living in mountainous areas
• Not eating sea foods
• Eating large amounts of raw food that
can cause thyroid goiter (goiterogens),
such as spinach, lettuce, turnips, beets,
rutabagas, kale are also at risk of
developing iodine deficiency.

10/23/2023 Melese.S 117

 Clinical Manifestations
Fetus and Infants
• Depressed growth
• Delayed sexual development
• Mental retardation and learning disability
• Deafness and akinetic mutism
• Abortion and still birth
Adult deficiencies:
• Goiter
• Symptoms of low-thyroid-hormone level (children and adults):
• Listlessness
• Sluggish behavior
Beasts of burden
• Poor reproduction (abortion, still birth)
• Weakness

10/23/2023 Melese.S 118

10/23/2023 Melese.S 119
 Endemic Goitor
An area is said to be endemic if 10% or more of
child population has goiter.
Classification of Endemia of Iodine deficiency disorders by
Severeity

Grades of severity of iodine

deficiency disorders
Mild Moderate Severe
IDD IDD IDD
1. Prevalence of goiter (total) 5-19% 20-29% >=30%
2. Cretinism 0 0 0-5
3. Median Urine iodine ug/d 3.5-5 2-3.4 0-1.9
4. Prevalence of neonatal TSH >
<1% 1-5% >5%
50 ug/d
10/23/2023 Melese.S 120
 Intervention
1. Supply iodized salt for the whole
family
• The Quality and Standards Authority of Ethiopia, has set the
iodine level to be 60-80 PPM as potassium iodate, after
making allowance for losses of iodine during storage and
distribution.

In Ethiopia, an iodine content of 80 – 100 PPM is required as

KIO3 at the port of entry or at the packaging factory to satisfy the
recommended daily requirement of 150µg of iodine per a
person to prevent IDD

10/23/2023 Melese.S 121

  Universal salt iodization (USI) is the most widely practiced
intervention in eliminating iodine deficiency disorders (IDDs).

 Salt iodine testing is an important process indicator for

monitoring progress towards USI.

 Although considerable success in eliminating or reducing

endemic goiter has been achieved through national salt
iodization programs and mandatory iodization programs of
household salt, IDD remains a problem

 Consumption of iodized salt by the family can be communicated

through the seven contacts of women and children with the
health services, (ANC, delivery, PNC/FP visit, immunization
visits, well baby and growth monitoring and promotion visits
and sick child visits.
10/23/2023 Melese.S 122
 Choice of intervention methods
Severity
of IDD
Iodized salt at the concentration of 10-25
Mild IDD mg/kg. It may disappear with socioeconomic
development
Can be controlled with iodinated salt at the
concentration of 25 to 40mg/kg if the salt
can be produced and effectively distributed.
Moderate Otherwise iodized oil ether orally or by
IDD injection should be used through the primary
health care system contacts

Iodized oil either by injection or orally for

Severe the prevention and control of central nervous
IDD system defects
10/23/2023 Source: Shils OS, Modern nutrition in Health and Diseases Vol II: 261.
Melese.S 123
 2. Supplementation of Iodine Capsules
• As a short-term strategy in highly endemic areas,
Lipiodol (iodized oil capsules), should be
distributed on a one - time basis to individuals.

• This will cover the recipients for one to two

years until salt iodization processes are in place.

Dosages are:
- 1 Capsule (200mg) for pregnant women and
children under 5

- 2 Capsules(400mg) for women of reproductive

age and children 5 to14 years of age
10/23/2023 Melese.S 124
 3. Increased consumption of sea food
and decrease consumption of goitrogens

10/23/2023 Melese.S 125

 RDA

Age RDA
0-6 months 40mcg
6-12 months 50mcg
1-3 years 70mcg
4-6 years 90mcg
7-10 years 120mcg
11+ years 150mcg
Pregnant 375mcg
Lactating 200mcg

10/23/2023 Melese.S 126

 Food sources
Drinking water
Sea foods
Foods grown on iodine containing soil.

10/23/2023 Melese.S 127

 Selenium
Function
Selenium functions as a cofactor in enzyme systems,
exerting effects similar to the free radical fighting action
of Vitamin E.
Anti Oxidant: This trace mineral works with Vitamin E to
enhance immunity and create enzymes, which protect the
body from harmful peroxide

Selenium has been shown to be protective against

oesophageal, stomach, colon, and rectal cancers.

Selenium supplementation increases glutathione

peroxidase activity

Enhances iodine up take from food

10/23/2023 Melese.S 128

 Deficiency

Selenium deficiency in the soil and water has

resulted in selenium responsive cardiomyopathy
and myocardial deaths in humans Keshan's
disease, a fatal heart disease

Keshin beck disease- Osteoarthropathy of large

joints

Cataracts

Muscular dystrophy

Goiter…

* Geochemical deficiency
10/23/2023 Melese.S 129
 Estimated Safe
Age:
Intake:
0-6 months 10mcg
6-12 months 15mcg
Females
1-3 years 20mcg
11-14
4-6 years 20mcg 45mcg
years
7-10 years 30mcg
15-18
Males 50mcg
years
11-14 years 40mcg
19+ 55mcg
15-18 years 50mcg
19+ 70mcg
Pregnant 65mcg
10/23/2023 Melese.S 130
Lactating 75mcg
 Food Sources
Liver Egg yolk
Barley
Milk Garlic
Bran
Mushroom Kidney
Broccoli
s Brazil nuts
Brown rice
Oats Wheat germ
Cabbage
Onions Whole-grain
Celery
Orange products
Chicken
juice
Cucumbers
Seafood
Tuna
Turnips

10/23/2023 Melese.S 131

 Fluoride
Fluoride is any combination of elements containing the
fluoride ion.
In its elemental form, fluorine is a pale yellow, highly toxic
and corrosive gas
Drinking water
containing optimum levels of fluoride
(0.5–1.5 mg/l) confers protection against dental
caries without causing fluorosis depending on
tenperature
 The WHO has set the guideline value at 1.5 mg/l of fluoride, but
mild forms of dental fluorosis begin to occur at lower levels.
 Above 1.5 mg/l, prolonged intake of fluoride can cause dental
fluorosis;
 3–6 mg/l, skeletal fluorosis;
 more than 6 mg/l, crippling skeletal fluorosis
10/23/2023 Melese.S 132
10/23/2023 Melese.S 133
 In Ethiopia,
Fluoride concentrations above 1.5 mg/l
have been reported from all parts of
Ethiopia, but the highest levels were found
in the Rift Valley, the lowland area with the
most recent volcanic activity in the
country.

In the early 1970s, 124 analyses of Rift

Valley lake water showed that 67 (54%)
had fluoride concentrations above 2 mg/l
and 38 (31%) had levels above 8
mg/l; 35% of the 152 community
water sources tested in the Rift Valley
had concentrationsMelese.S
10/23/2023 of 5 mg/l and 134
 Dental
Fluorosis

10/23/2023 Melese.S 135

 Mild/Moderate
Mild David Kenedy DDS

Severe Hardy Limeback, DDS severe

http://www.fluoridealert.org/health/teeth/
10/23/2023 Melese.S 136
 Mechanism of fluorosis
 Fluorosis occurs when fluoride interacts with
mineralizing tissues, causing alterations in the
mineralization process.
 In dental enamel, fluorosis causes subsurface
hypomineralizations or porosity, which extend
toward the dentinal-enamel junction as severity
increases.
 This subsurface porosity is most likely caused by a
delay in the hydrolysis and removal of enamel
proteins, particularly amelogenins, as the
enamel matures.
 This delay could be due to the direct effect of
fluoride on the ameloblasts or to an interaction of
fluoride with the proteins or proteinases in the
mineralizing matrixMelese.S
10/23/2023
. 137
 The specific mechanisms by which fluoride causes
the changes leading to enamel fluorosis are not
well defined; though the early-maturation
stage of enamel formation appears to be
particularly sensitive to fluoride exposure.
 The risk of enamel fluorosis is lowest when
exposure takes place only during the secretory
stage, but highest when
 exposure occurs in both secretory and
maturation stages.
 The incidence of dental fluorosis is best correlated
with the total cumulative fluoride exposure to the
developing dentition.
10/23/2023 Melese.S 138
 The aim of artificial fluoridation of drinking water in some
Western World countries as a public health measure is the
prevention of dental caries

Intervention options
 bone-meal and bone-char methods reduce fluoride
concentrations efficiently from 6 mg/l to 0.1 mg/l, but
they are not acceptable to the general population due to the
unacceptable taste of the treated water and to Moslems for
religious reasons.
 The use of lateritic clay, which in its preheated form
reduces fluoride at high levels (>7 mg/l) to below 1 mg/l
.
 The seeds of Moringa oleifera, has been shown to reduce
in the laboratory fluoride levels from 20 mg/l to less than
1 mg/l at low cost

10/23/2023 Melese.S 139

 Age
RDAs Estimated Safe Intake

0-6 months 0.1-0.5mg/day

6-12 months 0.20-1.0mg/day

1-3 years 0.5-1.5mg/day

4-6 years 1.0-2.5mg/day

7-10 years 1.5-2.5mg/day

11+ years 1.5-4.0mg/day

10/23/2023 Melese.S 140

 Food Sources
Apples
Calves' liver Pecans
Cod Seaweed
Eggs Spinach
Kidneys Whole grains
Salmon, canned
Sardines, canned
Tea

10/23/2023 Melese.S 141

 Zinc
• Zinc is in every cell of the body and is a
part of over 200 enzymes.
• Essential for the maintenance of vision,
taste and smell, this mineral is also
necessary for immune function, protein
synthesis, and cell growth.
• Zinc has been used successfully in the
treatment of rheumatoid arthritis, acne,
and macular (eye) degeneration and
wound healing.
10/23/2023 Melese.S 142
 Functions
Functions as antioxidant.
Promotes normal growth and development.
Immunity (decreases the severity of diarrhea in
children(
Promotes normal fetal growth.
Helps synthesize DNA and RNA.
Promotes cell division, cell repair, cell growth.
Maintains normal level of vitamin A in blood.

10/23/2023 Melese.S 143

10/23/2023 Melese.S 144

The zinc in whole grain products
and plant proteins is more difficult
for the body to absorb. The enzymatic
action of yeast in leavened whole
grain breads improves absorption.
Shellfish, beef, and other red
meats are rich sources of
zinc. Nuts and legumes are
relatively good plant sources
of zinc.

Oysters 6 medium (cooked) 76.3mg

Beef 3 ounces (cooked) 6.0mg
Turkey (dark meat) 3 ounces (cooked) 3.8mg
Milk 1 cup (8 ounces) 1.8mg
Beans, baked
10/23/2023 1/2 cup 1.8mg Melese.S 145
 Adolescents 14-18 years 11mg/day for males 9 mg/day for females
Adults 19 years and older 11mg/day for males 8mg/day for females
The symptoms of severe zinc
deficiency include the slowing or
cessation of growth and
development, delayed sexual
maturation, characteristic skin
rashes, chronic and severe diarrhea,
immune system deficiencies,
impaired wound healing, diminished
appetite, impaired taste sensation,
night blindness, swelling and
clouding of the corneas,
and behavioral disturbances.
Overdoses of zinc have occurred as a result of the consumption of
food or beverages from galvanized containers. Signs of acute zinc
toxicity are abdominal pain, diarrhea, nausea, and vomiting. Single
doses of 225 to 450 mg of zinc usually induce vomiting. Long-term
10/23/2023 Melese.S 146
excesses of zinc result in copper deficiencies.
 Deficiency
 Signs
 Growth retardation
 Delayed sexual
maturation & impotence
 Impaired testicular
development
 Hypogonadism &
hypospermia
 Alopecia
 Acroorifical skin lesions
 Other, glossitis, alopecia &
nail dystrophy
 Immune deficiencies
 Behavioral changes
10/23/2023
 More signs
 Night blindness
 Impaired taste
acuity(hypoguesia)
 Delayed healing of
wounds, burns,
decubitus ulcers
 Impaired appetite &
food intake
 Eye lesions including
photophobia & lack of
dark adaptation
Melese.S 147
10/23/2023 Melese.S 148
10/23/2023 Melese.S 149
 Deficiency …

Acro dermatitis
enterohepatica

10/23/2023 Melese.S 150

 151

Zinc Deficiency
Low birth weight, preterm deliveries, spontaneous abortions
Melese.S & congenital malformations 10/23/2023
 current WHO recommendation on zinc
supplementation

Health workers should provide children

 with 20 mg per day of zinc supplementation for
10–14 days during diarrheal attacks.

(10 mg per day for infants under six months old)

during diarrheal attacks.

10/23/2023 Melese.S 152

 Mechanisms for the effect on diarrhea
 The vast majority of data derive from in-
vitro studies using intestinal cell lines or
from animal model.
 The positive action by zinc in acute
diarrhea derives from:
-regulation of intestinal fluid transport,
-mucosal integrity,
-immunity,
-gene expression, and
-oxidative stress.
10/23/2023 Melese.S 153
 Age: RDA:
0-6 months 5mg
6-12 months 5mg
1-10 years 10mg

Males:

11+ years 15mg

Females:

11+ years 12mg

Pregnant 15mg

Lactating:

1st 6 mos. 19mg

2nd 6 mos. 16mg
10/23/2023 Melese.S 154
 Food Sources
Zinc is found in many foods. However the
rich sources are

Red meat- the more dark red the color of

the meat the more the zinc content is.

It is also found in other foods of animal

and plant origin.

10/23/2023 Melese.S 155

 Copper
• Cu is an essential nutrient.
• Rapid growth increases Cu demands in infancy.
• The adult body contains approximately 100 mg of copper
– the highest concentrations are in liver, kidney, and
hearth.

• The absorption in gastrointestinal tract requires a specific

mechanism - metal binding protein
metallothionein (Cu2+ ions are highly insoluble).
• Ceruloplasmin (CP) is a glycoprotein, copper-
dependent ferroxidase (95% of the total copper in human
plasma), oxidizes Fe2+ to Fe3+ in gastrointestinal iron
absorption mechanism. Melese.S
10/23/2023 156
 Copper
Functions
Promotes normal red blood cell formation.
Acts as a catalyst in storage and release of iron to form
hemoglobin for red blood cells.
Assists in production of several enzymes involved in respiration.
Promotes connective tissue formation and central nervous system
function.
Copper is an essential component of : Lysyl oxidase is responsible for
the cross linking of collagen and elastic. Superoxide dismutase (SOD) is the
antioxidant in charge of breaking down the superoxide free radical.
Copper intake should be based on zinc intake. A zinc to copper ratio of
10:1 is advised.
10/23/2023 Melese.S 157
1. Copper bracelets used to be a popular folk remedy for
arthritis.
2. Copper absorbed through the skin gets into the circulatory
system very efficiently.
3. The "patients" were getting an average of 13 milligrams of
copper a month through the skin, or roughly the
recommended daily intake of copper.
4. Studies conducted in Australia have provided evidence that
copper bracelets can reduce inflammation due to arthritis.

10/23/2023 Melese.S 158

 Copper metabolism
Model of Cu uptake and metabolism in hepatocytes:
Cu cross the plasma membrane through Ctrl1 (copper transporter1) or DMT1
(divalent metal transporter1) to the trans Golgi network (TGN) by chaperone Hah1.
Chaperone protein Ccs delivers Cu to cytosolic Cu/Zn SOD. Cox17 delivers Cu to
mitochondria for cytochrome c oxidase.

10/23/2023 Melese.S Carrol et159

all, 2004)
 Copper metabolism
• Cu is an essential cofactor in a number of critical
enzymes in metabolism:
superoxide dismutase (Cu/Zn-SOD)
cytochrome c oxidase (COX)
tyrosinase
monoamino oxidase
lysyloxidase

• Cu metabolism is altered in inflammation, infection,

an cancer.
• In infection, Cu is essential for production of Ile-2
by activated lymphocytes.
• In cancer, plasma CP is positively correlated with
disease stage.
10/23/2023 Melese.S 160
 Copper (Cu) is an essential trace element for humans and animals. In
the body, copper shifts between the cuprous (Cu1+) and cupric (Cu2+)
forms, though the majority of the body's copper is in the Cu2+ form.
The ability of copper to easily accept and donate electrons explains
its important role in oxidation-reduction (redox) reactions and in
scavenging free radicals.
Copper is a critical
functional component of a
number of essential
enzymes. One of these
enzymes helps maintain the
integrity of connective tissue
in the heart and blood
vessels and also plays a role
in bone formation. Others Dark chocolate
help metabolize iron and has high levels
contribute to the correct of dietary
functioning of the brain and copper.161
10/23/2023 Melese.S
nervous system.
 Remember this slide and
how antioxidants work?

This is a free Now that the radical

This is the antioxidant.
radical with one has two electrons, he
He prevents the free
unpaired electron. is no longer free to do
radical from continuing
He is destroying his destruction, by harm.
fat and some giving him an extra More free radicals may
proteins, and electron to hold onto. be created as a result
accelerating aging of tobacco, alcohol,
COPPER EASILY FINDS
in a process called stress, lack of sleep,
FREE RADICALS AND
oxidation… while poor diet, and
DONATES
trying to find a pollution.
ELECTRONS!
second electron.
10/23/2023 Melese.S 162
 Copper is found in a wide
variety of foods.
It is most plentiful in organ meats, shellfish, nuts, and seeds. Wheat
bran cereals and whole grain products are also good sources.

10/23/2023 Melese.S 163

 The tolerable upper intake level (UL) of copper is:
Adolescents 14-18 years 8,000 mcg/day
Adults 19 years and older 10,000 mcg/day 900 mcg is the RDA
Copper deficiency may present itself
as a form of anemia or in abnormally
low numbers of white blood cells,
accompanied by increased
susceptibility to infection; low body
temperature, bone fractures and
osteoporosis, irregular heartbeat,
loss of skin pigment, and thyroid
disorders.
Copper overdose has occurred through the
contamination of beverages by long-term
storage in copper-containing containers or
water standing in copper pipes. Symptoms of
acute copper toxicity include abdominal pain,
nausea, vomiting, and diarrhea. Of more concern
from a nutritional standpoint is the possibility of
liver damage resulting from long-term exposure
10/23/2023 164
to lower doses of copper.Melese.S
Deficiency Symptoms
Anemia

Low white blood cell count associated with reduced resistance to

infection

Faulty Collagen Formation

Bone demineralization

Increased LDL cholesterol and decreased HDL cholesterol

Brain impairment
10/23/2023 Melese.S 165
Age Estimated Safe Intake
0-6 months 0.5-0.7mg Food Sources
6-12 months 0.7-1.0mg Oysters and other
shellfish, whole grains,
1-3 years 1.0-1.5mg
beans, nuts, potatoes,
4-6 years 1.5-2.0mg and organ meats
(kidneys, liver) are
7-10 years 2.0-2.5mg
good sources of copper
11+ years 2.0-3.0mg
10/23/2023 Melese.S 166
 Manganese (Mn) is a mineral found in large
quantities in both plant and animal matter, but It aids in the
only trace amounts can be found in human formation of
tissue. Manganese is predominantly stored in connective tissue,
the bones, liver, kidney, and pancreas. bones, blood-
clotting factors, and
sex hormones and
plays a role in fat
and carbohydrate
metabolism, calcium
absorption, and
blood sugar
regulation.
Manganese is also
necessary for
normal brain and
nerve function. Like
copper, it is an
10/23/2023 Melese.S
antioxidant. 167
 Whole grains are a major source of dietary manganese. Refined
grains provide only half the amount of manganese as whole grains.
Other rich dietary sources of manganese include nuts and seeds,
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legumes, pineapples, and green or black teas.
Melese.S 168
 The adequate intake (AI) for manganese is 2.3 mg/day
for adult men and 1.8 mg/day for adult women.
Manganese rarely causes side effects
when taken orally, but there are
numerous symptoms when
manganese is ‘inhaled’ (such as by
industrial workers or miners or taken
intravenously, such as loss of
appetite, headaches, leg cramps,
muscle rigidity, tremors, convulsions,
extreme irritability, acts of violence,
and hallucinations. Low levels of manganese in the body
can contribute to infertility, bone malformation,
weakness, and seizures. Since calcium,
phosphorous, and manganese work closely
together in the body, dietary requirements of
manganese may increase as calcium and
Malformation
10/23/2023 at end of bone phosphorous
Melese.S
consumption increases. 169
Fluorine (F) occurs naturally as the negatively charged ion, fluoride(F-).
Fluoride is considered a trace element because only small amounts are
present in the body (about 2.6 grams in adults), and because the daily
requirement for maintaining dental health is only a few milligrams a
day. About 95% of the total body fluoride is found in bones and teeth.
Although humans do not require fluoride for growth or to sustain life,
its role in the prevention of tooth decay is well established. Fluoride
hardens tooth enamel and stabilizes bone mineral.
Fluoride is absorbed in
the stomach and small
intestine. Once in the
blood stream it rapidly
enters mineralized
tissue (bones and
developing teeth). At
usual intake levels,
fluoride does not
accumulate in soft
tissue.
10/23/2023 Melese.S 170
 The major source of
dietary fluoride in the
U.S. diet is drinking
water. Most home
water filters do not
remove fluoride,
however most bottled
water is low in
fluoride.
Fluoridated
toothpastes also add
fluoride to the body.

Rich sources of fluoride include tea, which concentrates fluoride in its

leaves, and marine fish that are consumed with their bones (e.g.,
sardines). Foods made with mechanically separated (boned) chicken,
such as canned meats, hot dogs, and infant foods, also add fluoride to
the diet. In addition, certain fruit juices, particularly grape juices, often
10/23/2023
have relatively high Melese.S
fluoride concentrations. 171
Adolescents 14-18 years 3.0 mg/day males 3.0 mg/day females
Adults 19 years and older 4.0 mg/day males 3.0 mg/day females
In humans, the only clear effect of inadequate fluoride intake is an
increased risk of dental caries (tooth decay) for individuals of all
ages.
Researchers estimate
that children under 6
years of age ingest an
average of 0.3 mg of
fluoride from
fluoridated toothpaste
with each brushing.

Children under the age of 6 years who ingest more than 2 or 3 times
the recommended fluoride intake are at increased risk of a white
speckling or mottling of the permanent teeth, known as dental
10/23/2023 fluorosis.
Melese.S 172
 Chromium (Cr) is an
essential mineral that
The dietary form of chromium is not made by the
is known as trivalent body and must be
chromium, or chromium III. obtained from the
Chromium is important in the diet.
metabolism of fats and
carbohydrates . Chromium
stimulates fatty acid and
cholesterol synthesis, which
are important for brain
function and other body
processes. Chromium
appears to enhance the action
of insulin.

Non-dietary chromium is known as The pancreas produces the

hexavalent chromium (VI), used for industrial
hormone insulin, which
purposes. It is a strong skin irritant and is
recognized as a carcinogen (causes cancer)
acts like a key…unlocking
when inhaled. cells and allowing them to
10/23/2023 Melese.S 173
absorb glucose.
 Processed meats, whole grain products, ready-to-eat bran
cereals, green beans, broccoli, and spices are relatively rich in
chromium. Foods high in simple sugars, such as sucrose and
fructose, are not only low in chromium but have been found to
promote chromium loss

10/23/2023 Melese.S 174

AI levels:
Adolescents 14-18 yrs 35 mcg/day for males 24 mcg/day for females
Adults 19 to 50 years 35 mcg/day for males 25 mcg/day for females

No adverse effects have been

convincingly associated with
excess intake of chromium (III) from
food or supplements

Chromium supplements
have been promoted as a
way to build muscle and
lose weight. There is no
scientific evidence to
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support this.
Melese.S 175
 Selenium (Se) is required for the functioning of several selenium-
dependent enzymes called selenoproteins. These selenoproteins are
antioxidant enzymes, which play a role in preventing cell damage.
Selenium appears to
stimulate antibodies after
you receive a vaccination.
It also may help protect
the body from the
poisonous effects of
heavy metals and other
harmful substances.
After a calf was fed a
selenium-deficient diet, it
died of a heart attack.
This cross-section of its
heart shows a white area
or dead tissue in the
10/23/2023 Melese.S center. 176
Plant foods, such as vegetables, are the most common dietary
sources of selenium. How much selenium is the vegetables you eat
depends on how much of the mineral was in the soil where the plants
grew. Fish, shellfish, red meat, grains, eggs, chicken, liver, and garlic
are all good sources of selenium. Meats produced from animals that
ate grains or plants found in selenium-rich soil have higher levels of
selenium.

Brewer's yeast, used in the production of

beer and wine, is a good source of
10/23/2023 Melese.S 177
selenium…but can cause bloating.
 The UL (upper tolerable level) of selenium is 400 mcg/day for
adolescents and adults.
Too much selenium in the blood can cause a
condition called selenosis. Selenosis can
cause loss of hair, nail brittleness, nausea,
irritability, fatigue, and mild nerve damage.
Other symptoms may include
gastrointestinal disturbances, skin rashes, a
garlic breath odor, fatigue, irritability, and
nervous system abnormalities.
Selenium deficiency is rare in people in the
United States. However, selenium deficiency
may occur when a person is fed through a vein
(IV line) for long periods of time. Keshan
disease is caused by a deficiency of selenium,
leading to an abnormality of the heart muscle.
Kashin-Beck disease, which results in joint and
bone disease, is also linked to selenium
10/23/2023 Melese.S
deficiencies. 178
Molybdenum (Mo) is an essential trace element for virtually all life
forms. It functions as a cofactor for a number of enzymes that
catalyze important chemical reactions in the carbon, nitrogen and
sulfur cycles.

Enzymes are catalysts.

An enzyme has a protein

nt
po n
component and a non-

m tei
ne
co Pro
protein component… a Non-protein
cofactor. Molybdenum cofactor
is a cofactor.

This leg bone of a sheep

shows painful, bony knobs
caused by an excess of
dietary molybdenum.
10/23/2023 Melese.S 179
Legumes, such as beans, lentils, and peas, are the richest sources of
molybdenum. Grain products and nuts are considered good sources,
while animal products, fruits, and many vegetables are generally low
in molybdenum. Because the molybdenum content of plants depends
on the soil molybdenum content and other environmental conditions,
the molybdenum content ofMelese.S
10/23/2023
foods can vary considerably. 180
 Adolescents 14-18 years 43 mcg/day for males and females
Adults 19 years and older 45 mcg/day for males and females
Deficiencies are rare, especially considering
that the average dietary intake of molybdenum
in the U.S. averages 76 mcg/day for women
and 109 mcg/day for men.
Patients fed strictly
through IV’s and
deprived of
selenium
developed rapid
heart and Extreme overdose:
respiratory rates, acute psychosis with
headache, night hallucinations,
blindness, and seizures, and other
ultimately became neurologic
comatose. symptoms; gout-like
10/23/2023 Melese.S symptoms 181
 Cobalt (Co) is a naturally occurring
element in the earth’s crust. It is a
very small part of our environment
and very small amounts are needed
for good health. Cobalt is a
component of Vitamin B12.

As a component of Vitamin
B12, cobalt helps red blood
cell production, nervous
system function, sperm
production, normal growth
and the proper function of
the immune system. It has
also been shown to improve
memory and concentration.

10/23/2023 Melese.S 182

Industrial sources of cobalt in:
Chemistry/crystal sets
Magnets
Dyes and pigments (Cobalt Blue)
Alloys
Batteries
Dietary sources of cobalt are the
Drill bits and machine tools
same as vitamin B12, such as foods
Tires
of animal origin or fermented foods
where the bacteria produce the
vitamin. Organ meats are the best
source of vitamin B12 (liver, kidney,
heart, and pancreas), followed by
clams, oysters, extra-lean beef,
seafood, eggs, milk and yogurt,
chicken, cheese, and miso.

Miso is a fermented soy product with the consistency of peanut

butter. It has a strong, savory flavor and is often used in Japanese
10/23/2023 Melese.S 183
soups and sauces.
Major Minerals

Copyright © 2016 by Elsevier Inc. All

rights reserved. 184
 Thank you!
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10/23/2023 Melese.S 185