1

MICRO-NUTRIENTS
The VITAMINS AND MINERALS
January 20th 2015
Salome A. Rebello

VITAMINS
2

Organic substance (contain the elements hydrogen

and carbon)
Needed by the body in small amounts
Inadequate intake results in deficiencies
Excessive intake can lead to toxicity in some cases
Two major types

Fat

Soluble: A, D, E and K
Water Soluble : B, C and choline

FAT and WATER SOLUBLE VITAMINS

FAT SOLUBLE VITAMINS

WATER SOLUBLE VITAMINS

Characteristics

Soluble in lipids

Soluble in water

Found in

Fatty or oily foods

Foods having a high water content

Absorption

Requires bile.
Absorbed in the small intestine along
with fats (chylomicrons)

Absorbed in the small intestine

Storage

Adipose tissue or liver

Generally not stored *

* Exceptions: B6 (muscle) and B12 (liver)

Excreted

Low excretion, some level of

excretion via bile *
* Exception: vitamin K (urine + bile)

Generally via urine

Toxicities

Sometimes observed with excessive

dietary intakes, possible with high
supplement use

Rare, may be possible with mega-doses

via supplements

Cooking losses

Generally low. Cooking increases the

availability of some of these vitamins

Susceptible to losses while cooking

VITAMIN A
Retinoids and Pro-vitamin A Carotenoids

VITAMIN A
5

Preformed : Retinoids

Retinol, (alcohol form)

Retinal, (aldehyde form)

Retinoic acid, (acid form)

BETA-CAROTENE

Reversible
RETINOL

Pro-vitamin A: Some
carotenoids
Of 600 carotenoids, three can
be converted to Vitamin A
(retinoids)

RETINAL

Irreversible

Alpha carotene
Beta carotene
Beta cryptoxanthin

Others carotenoids do not

have vitamin A activity in
humans

Lycopene
Leutin

RETINOIC ACID

Retinoids can exist as cis or trans

forms

-ionone ring

polyunsaturated tail
polar endgroup
alcohol group

= vitamin A
aldehyde group

acid group

Slide courtesy of Dr. Silke Vogel

Provitamin A carotenoids

-ionone ring

Slide courtesy of Dr. Silke Vogel

Food Sources and Absorption

RETINOIDS

70-90% absorbed
Mal absorption

CAROTENOIDS

15-50% absorbed

Protein deficiency
Fat malabsorption
Diahorrea or
intestinal infections

CARROTS
MANGO

MILK
LIVER

EGGS

FISH OILS
DAIRY PRODUCTS
FORTIFIED FOODS
SUPPLEMENTS

FISH

GREEN LEAFY
VEGETABLES

VITAMIN A UNITS
9

RETINOL ACTIVITY EQUIVALENTS (RAE)

1g RAE = 1g retinol
1g RAE = 2g all-trans--carotene from
supplements
1g RAE = 12g of all-trans--carotene from
food
1g RAE = 24g -carotene or -cryptoxanthin
from food
1 g retinol = 3.3 international units

Functions of Vitamin A- VISION

10

Human Nutrition, 2nd Ed, Mary Barasi, 2003

Night Blindness

2003 Wadsworth, a division of Thomson Learning, Inc. Thomson Learning is a trademark used herein under license.

DARK ADAPTATION TEST: Speed at which we get

accustomed to seeing in the dark measure of vitamin A
status
Sufferers should anoint their eyeballs with the stuff
dripping from a liver whilst roasting, preferably of a hegoat, or failing that of a she-goat; and as well they should
eat some of the liver itself. Aulus Cornelius Celsus, 30 AD
11

Aulus Cornelius Celsus

Image courtesy of Dr. Silke Vogel

FUNCTIONS OF VITAMIN-A: VISION

12

Mediated primarily by retinoic acid

Helps in cellular differentiation (determines ability to secrete mucus)
Maintain the integrity of the cell
Deficiency Dry eyes (xerophthalmia)

Bitots spots
Dry, "foamy," silver-gray
deposits appear on the
delicate membranes
covering the whites of the
eyes.

Keratomalacia
Cornea becomes soft, leading to
infection, rupture, perforation, resulting
in blindness.

Vitamin A: Other functions

13

Preventions infection
Maintains cellular integrity of the gastrointestinal tract and lungs
Prevents bacteria from translocating
Also may be involved in improving immunity
Maintains healthy skin Dry skin (follicular hyperkeratosis)
Promotes normal growth in children

Recommended Dietary Allowances

(RDAs)
700 mcg for females
900 mcg for males
Follicular hyperkeratosis

IMPLICATIONS OF VITAMIN A DEFICIENCY

Clinical vitamin-A deficiency in pre-school children (1995-2005)

14

An estimated 250 000 to 500 000 vitamin A-deficient children become blind
every year, half of them dying within 12 months of losing their sight.
Source: http://www.who.int/nutrition/topics/vad/en/ http://whqlibdoc.who.int/publications/
2009/9789241598019_eng.pdf

Vitamin A toxicity
15

Acute

Chronic

Repeated intake of 10 times the recommended amount

Skin disorders, liver damage, double vision, coma

Teratogenic : causing birth defects

1 or a few large doses (100 times recommended amount)

GI upset, headache, blurred vision

Extremely important for pregnant women

Avoid large intake of liver, vitamin-A supplements, topical application of
vitamin-A creams

Only results from excessive intake of retinoids

Carotenoids from foods do not cause toxicity

Can result in yellowing of the skin

Upper limit: 3000 mcg of retinoids

Hypercarotenemia

16

VITAMIN D

Sources of vitamin D
17

Produced by the
body

Food sources
Vitamin D2

Sunshine
(UV-B)

7-dehydrocholesterol
(skin)

MILK

EGGS

OILY FISH
Vitamin D3
MUSHROOMS
Absorption: About 50%

LIVER
FISH OILS
DAIRY PRODUCTS
FORTIFIED FOODS
SUPPLEMENTS

Metabolism and function of vitamin D

Vitamin D2
(ergocalciferol)
Plant food sources/
supplements

Vitamin D3
Sunshine
supplements
Animal food
sources

Low plasma
calcium levels

Increase in
Parathyroid
(PTH) levels
18

RDA: 600 international units

Gastrointestinal
tract
Increases calcium
absorption from
food

Bone
Releases calcium and
phosphorus from
bones
Kidneys
Increases calcium reabsoprtion from urine

Maintain
normal
plasma
Ca levels

DEFICIENCY
19

Osteomalacia (Adults)
Inadequate mineralization of the
bone tissue soft bones
Bone/muscle pain, bowing of the
spine
Measuring risk
Based on serum 25 (OH) D concentrations
Sufficient: More than 50 nanomolar
(nM)
Clinical deficiency: Less than 25 nM
Rickets/osteomalacia: Less than 15 nM

Rickets (children): bow legs, curved

spines, bone pain, beaded thorax
Source: van Schoor, Worldwide Vitamin D status (25) 2011, 671-680, Best Practice & Research Clinical Endocrinology & Metabolism

Other potential health consequences of Vitamin D deficiency

20

Source: Holick, M. F. (2011) Health benefits of vitamin D and sunlight: a Dbate

Nat. Rev. Endocrinol. doi:10.1038/nrendo.2010.234

Prevalence of deficiency is high in Asia and Middle East

NORMAL LEVELS
50 nM

..Toxicity: Deposition of Ca in soft tissue

21

Upper Limit: 4000 IU

Source: van Schoor, Worldwide Vitamin D status (25) 2011, 671-680, Best Practice & Research Clinical Endocrinology & Metabolism

At risk groups
22

Obese
Breast-fed infants beyond 6 months

Breast fed infants are often given vitamin D supplements

Dark-skinned individuals
Reduced exposure to sunlight
Pollution
Elderly
High degree of covering
Increase sunscreen use
Less outdoor activity

Malabsorption syndromes: Celiac disease

Liver or Kidney disease

23

VITAMIN E

Food Sources
24

2 forms of vitamin E
Tocopherols alpha, beta, gamma, delta isomers
Tocotrienols - alpha, beta, gamma, delta isomers
alpha tocopherol is most biologically active

PLANT SOURCES

ANIMAL SOURCES
Not as rich as plant sources
Poultry
Fish
Eggs

Peanuts

Vegetable Oils
Almonds

Avocado

Absorption: About 20-50 %

Functions of vitamin E
25

Very important anti-oxidant

Normal metabolism, pollution,

exercise, smoking
Free radicals: Molecules that
have an unpaired electron,
very reactive

Vitamin E

Damage cell membranes,

and cell components
including DNA

Vitamin C

Vitamin E donates an electron to

the free radical
Vitamin E gets oxidized in this
process
Vitamin C and Selenium help to
regenerate Vitamin E

Oxidized
Vitamin E

RDA: 15 mg

Oxidized LDLatherosclerosis- heart disease

Damaged DNA - Cancer

Deficiency and Toxicities

26

Deficiency is rare in humans

Red

cell hemolysis (breakdown)

Neurological symptoms

At-risk of deficiency
Fat

malabsorption
Smokers
Preterm infants (low stores)

Toxicity
Uncommon

(can be excreted via bile)

Prevent vitamin K clotting action
Upper Limit: 1000 mg

Vitamin E and chronic disease

27

Data from clinical studies do not support a

protective effect of Vitamin E intake on
Cancer
Heart

disease

Along with other antioxidants, zinc, and copper

vitamin E may slow the progression of an eye
disease (Age-related macular degeneration) in
people with early-stage disease.
Source: http://ods.od.nih.gov/factsheets/VitaminE-HealthProfessional/

28

VITAMIN K

Food sources
29

Phylloquinones (plant sources)

Menaquinones (animal sources)

Milk
Green leafy vegetables
Liver

Menadione:
synthetic form
(water soluble)

Green peas
Vegetable Oils

Gut Bacteria (10%)

Absorption is about 40-80%

Functions
30

Important for the function of gla proteins

Blood clotting
n Synthesis

of blood clotting factors

Bone mineralization
n Osteocalcin

which is needed for calcium deposition in the

bone
Adequate Intake (day): 90 microgram for women, 120 microgram for men

Deficiency
31

Deficiency can occur in newborns : increased risk of bleeding

Rare in older children and adults

Low levels in human milk

Low gastrointestinal production of menaquinones
Given vitamin K at birth
Can occur with fat malabsorption
Can occur with prolonged antibiotic use

Megadoses of vitamin A and vitamin E can interfere with vitamin

K action

TOXICITY
Natural forms : Unlikely (low storage, excreted in the urine and bile)
Menadione injections: Can cause jaundice in newborns and death has been
reported. In the US vitamin K injections as phylloquinone have been administered.
Upper Limit : None set

32

WATER SOLUBLE VITAMINS

B-complex and vitamin C

B-Complex Vitamins
33

Group of 8 vitamins

ENERGY METABOLISM
Thiamin (B1)
Riboflavin (B2)
Niacin (B3)
Panthothenic Acid
Biotin

AMINO ACID
METABOLISM/ RED
BLOOD CELL SYNTHESIS
Folate
Pyridoxine (B6)
Cobalamine (B12)

34

B complex vitamins in Energy

Metabolism

Slide courtesy : Prof Silke Vogel

35

Whole grains are an important source

of B vitamins
Grain milling
results in loss of
B vitamins and
other nutrients
which are
present in the
germ and bran
layer

Thiamin
36

Food sources: varied including whole and enriched grains ,

beans, peanuts, mushrooms.

Some foods (fish/shell fish) contain thiamin antagonist destroyed

by cooking

Major Function

As thiamin pyrophosphate (TPP) needed for the metabolism of

carbohydrate and amino acids
Glucose

Thiamin pyrophosphate
(TPP)
Panthothenic Acid (CoA)
Niacin (NAD)
Riboflavin (FAD)

Pyruvate
Decarboxylation
Acetyl Co A
RDA: 1.1 mg for women, and 1.2 for men

Thiamin Deficiency
37

Beri Beri
Some signs can develop only 14 days on a thiamin-free diet
Dry : Primarily neurological symptoms

Peripheral neuropathy, edema, weight loss, poor memory, confusion

Wet: Also includes cardiovascular symptoms

Heart enlargement

Wernicke-Korsakoff (Cerebral Beri Beri)

Vision problems (double vision), impaired mental function
Seen in alcoholics
Alcohol decreases thiamin absorption
Alcohol increases thiamin urinary excretion
Alcoholics typically have a poor diet
Toxicity : Not observed, no Upper Limit

38

http://eresources.nlb.gov.sg/newspapers/Digitised/Article/straitstimes19050414.2.67.aspx

Riboflavin (yellow vitamin)

39

Milk

Eggs

RDA: 1.1 mg for women, 1.3 for

men
Toxicity : Not observed, no Upper
Limit

Meats

Green leafy vegetables

Riboflavin
40

As part of the 2 important co-factors participates in a large number

of oxidation-reduction reactions

Flavin mononucleotide (FMN)

Flavin adenine dinucleotide (FAD)

Some pathways include

Macronutrient metabolism: Krebs cycle, fatty acid beta-oxidation

Folate metabolism
Antioxidant function

Deficiency : Mouth, skin and red blood cells

Glossitis: Painful inflamed tongue,

smooth texture

Angular stomatitis : Inflammation

at the corners of the mouth

Niacin
41

SOURCES
Obtained from the diet
Poultry,

Made from the amino acid trypytophan

60

fish, meat, enriched cereal products, coffee

mg of tryptophan -> 1 mg niacin

FUNCTION

Part of NAD and NADP participates in a wide variety of

oxidation-reduction reaction
carbohydrate, protein and fat metabolism
Fatty acid synthesis
Alcohol metabolism

Niacin Deficiency
42

PELLAGRA (pelle , skin; agra, rough)

4 Ds
Dermatitis
Diahorrea
Dementia
Death
- RDA: 14 mg for women, 16 mg for men
Casals necklace : Rough red
rash that appears on areas
exposed to sunlight

- Upper limit : 35 mg/d (supplements /

fortified foods)
flushing observed at very high doses

43

Emergence of Pellagra as a public

health problem
Explorers took it back to Europe (1700s)
-Corn was not treated with lime
- Major component of the diet
-Seen in poor peasants
Casal (1771) : the color of the skin becomes red,

Used by South Americans

-Treat it with lime (alkaline
solution of calcium
hydroxide)
- Culinary advantages
Can be ground into a flour
and made into a dough
- Nutritional advantages
Releases niacin for
absorption

the skin becomes dry,..the affected skin falls in white scales

just like bran, ..becomes repulsively disfigured,..the disease
rages recurrently till at length the skin, becomes wrinkled,
thickened and full of fissures. Then for the first time the
patients begin to have trouble in the head, fear, sadness
wakefulness, and vertigo, mental stupor,..fluxes from the
bowels and sometimes to suffer from mania, then the
strength of the body begins to fail, they begin to lose
motion,..to emaciate in the highest degree, to be seized
with a colliquative diahorrea most resistant to all remedies
and consumed with a ghastly wasting they approach the
last extremity

Possible treatment was only identified in the mid 1900s

Vitamin B6 (Pyridoxine)
44

PYRIDOXINE

Plant Foods
Whole

grains
Carrots, spinach,
potatoes and bananas

PYRIDOXAL AND PYRIDOXAMINE

Animal Food
Stored

in muscle tissue of
animals
May be better absorbed
Meat, fish and poultry

Vitamin B6 : Functions
45

Functions: Involved in multiple reactions including

Synthesis of porphyrin (haem)
Synthesis of neurotransmitters (dopamine, serotonin)
Synthesis of non-essential amino acids
Metabolism of fatty acids
Utilization of glycogen in the liver
RDA: 1.3 mg (males), 1.2 mg (females)

Vitamin B6: Deficiency

46

Anemia
Neuromuscular problems

Infants

: convulsions
Irritability, fatigue, muscle weakness, headache

Often co-exists with deficiencies of other vitamins

Riboflavin

deficiency : angular stomatitis

Niacin deficiency : dermatitis
RISK GROUPS
Poor nutrition intake
Increased demand (pregnancy, women on oral contraceptives)

Vitamin B6 Excess
47

Upper Limit
100

mg/day

Long term intake of > 200 mg per day

Neurological

effects such as walking difficulties and

hand/foot numbness

Folate
48

Natural folates (generally polyglutamate form)

Green

leafy vegetables

Liver
n Monoglutamate

form better absorbed

Needs zinc, inhibited by alcohol

About 50 % absorbed

Synthetic folate (folic acid)

Supplements

Fortification
About 85 % absorbed

Name is derived from folium which means leaf

in Latin

Functions of folate
49

Participates in one-carbon transfer

Synthesis
n Needed

of purines and pyrimidines

for DNA synthesis

Conversion of amino acids

Conversion of homocysteine to methionine

RDA: 400 mcg/day

Folate and B12, interrelationship

50

Folate deficiency, vulnerable groups

51

Blood Cells

Red

blood cells: Macrocytic anemia

White blood cells: lower immunity

Gastrointestinal cells
Diahorrea and constipation

Vulnerable Groups
Pregnant women
Increased needs
Premature infants
Elderly
Alcoholics
Reduced folate absorption

Folate Toxicity: Can potentially mask vitamin B12

deficiency
Upper limit: 1000 mcg per day

Folate and neural tube defects (NTDs)

52

Neural tube is the precursor to the brain and spinal cord in the developing fetus

Defects in events that occur in the 21-28th day of pregnancy lead to neural tube defects

About 1 in every 1000 pregnancies

Folic acid deficiency in the mother increases the risk of NTDs in her child (studies in the 1990s)

Fortification of flour in the US, estimated provision of 200 mcg/day (1998)

Reduced incidence of NTDS in the US by 23-27% (2003-2005)

In addition women of child bearing age are advised to take a 400 mcg from supplements or fortified
foods

Anencephaly:
Baby usually dies in utero or
shortly after birth

Spina Bifida : Physical and neuriological defects

http://www.cdc.gov/ncbddd/birthdefects/anencephaly.html#ref, http://www.cdc.gov/ncbddd/spinabifida/data.html

Vitamin B12
53

Group of compounds
Has cobalt in the center
Dietary Sources
Only animal foods
Liver, fish, meat, eggs and milk
Absorption of dietary B12 requires intrinsic factor (IF) produced
by cells in the stomach

Absorption occurs in the small intestine

Up to 80% can be absorbed

RDA: 2.4 mcg per day

Toxicity: No known adverse effects
No upper limit

Vitamin B12 : Function and deficiency

54
Secondary folate deficiency and its
consequences
(Megalobastic Anemia)
In the event that there is B12
deficiency due to lack of intrinsic
factor production , the anemia is
termed as Pernicious Anemia

Neurological effects: Damage of the myelin sheaths

Causes for B12 deficiency

Inadequate intake
vegans and strict vegetarians
infants of vegan mothers

Inadequate absorption
malabsorption in pernicious anemia: autoimmune disease where parietal cells
are destroyed-- IF production diminshed
atrophic gastritis: loss or inflammation of gastric cells- IF decreased
gastrectomy: Intrinsic factor affected
achlorhydria (decreased HCL release): B12 cannot be efficiently released from
food matrix
decreased absorptive surface of the ileum - ileal resection, celiac sprue, ileitis

55

Slide : courtsey Dr. Silke Vogel

Vitamin C : Food Sources and Functions

56

Sources

Fruits: Guava, Indian gooseberry (amla), mango, citrus fruits ,

papaya, strawberries
Vegetables: cauliflowers, broccoli, green peppers, potatoes

Very sensitive to cooking losses

Air, light, heat or alkali (soda bicarbonate)

Function
Ascorbate

The hydrogen released from ascorbate is used in a wide

variety of reactions including reduction of vitamin E
Can also act directly as an anti-oxidant

Dehydroascorbate

NADH, NADPH can act as hydrogen donors to

regenerate ascorbate

Vitamin C: Function
57

Function
Hydroxylation reactions
Collagen

synthesis
Use of fatty acids for generating energy
Synthesis of norepinephrine
Synthesis of brain peptide

Helps in iron absorption

RDA: 75 mg for women; 90 mg for men
Toxicity
q Cramps, diahorrea, increases risk of kidney stones

q Upper

limit: 2 grams per day

Vitamin C Deficiency : Scurvy

58

Gums: spongy, bleeding

Skin: pinpoint
hemorrages

Progressive
weakness
Muscle /bone
pain
Delayed wound
healing
Subcutaneous
bleeding

Death due to pnuemonia and cardiac failure

Vitamin C Deficiency: Scurvy

On

Dr. James
Lind

59

the 20th of May 1747, I selected twelve patients in the

scurvy, on board the Salisbury at sea. Their cases were as similar
as I could have them. They all in general had putrid gums, the
spots and lassitude, with weakness of the knees. They lay together
in one place, being a proper apartment for the sick in the forehold; and had one diet common to all, viz. water gruel sweetened
with sugar in the morning; fresh mutton-broth often times for
dinner; at other times light puddings, boiled biscuit with sugar, etc.,
and for supper, barley and raisins, rice and currants, sago and
wine or the like. Two were ordered each a quart of cyder a day.
Two others took twenty-five drops of elixir vitriol three times a
day Two others took two spoonfuls of vinegar three times a
day Two of the worst patients were put on a course of seawater Two others had each two oranges and one lemon given
them every day The two remaining patients, took an
electary recommended by a hospital surgeon The consequence
was, that the most sudden and visible good effects were
perceived from the use of oranges and lemons; one of those who
had taken them, being at the end of six days fit for duty The
other was the best recovered of any in his condition; and was
appointed to attend the rest of the sick. Next to the oranges, I
thought the cyder had the best effects
Source: http://fn.bmj.com/content/76/1/F64.full

60

MINERALS

Minerals
61

Present in the human

body

Structural: As a part of
biological components
n Hemoglobin
n Bone
n Thyroid

hormones

Ionized

forms involved in
various cellular processes
n Ca

ions, K(potassium) ions

n Signaling, muscle
contractions

Other features of minerals

62

Absorption and availability

Some minerals (Ca, Fe, Zn) may be present in foods
attached to other compounds (such as phytates) which
limit their availability
Large amounts of some minerals (e.g. Ca) may inhibit
absorption of others (e.g. Fe)
Generally resistant to cooking losses

Excretion
Urine

or bile

Other features of minerals

63

MACROMINERALS
Require more than 100 mg per day
Examples: Ca, P (phosphorus), S (sulphur), Na (sodium) , K (potassium), Mg (magnesium) ,
Cl (chloride)
TRACE MINERALS
Require less than 100 mg per day
Examples: Fe (iron), Zn (Zinc), Cu (copper), Mn (Manganese), I (iodine), F( fluorine)

TOXIC MINERALS
No known requirements : Lead, Mercury
Difficult to excrete, may accumulate in the body

Calcium : Sources
64

Milk and its products

Tofu, fortified soy milk
Green leafy vegetables
Small fish

Dietary Calcium Intake in Singaporean Adults

RDA: 1000 mg/d

Source: Singapore National Nutrition Survey, 2010

Calcium : absorption and excretion

65

Only about 30 % of Ca is absorbed

Absorption Enhancers:
Vitamin D synthesis of Ca binding protein which increase intestinal absorption
Lactose maintains solubility, facilitating absorption
Acidity maintain solubility, facilitating absorption
Absorption Inhibitors
Phytates which form insoluble complexes with Ca
Oxalates (spinach, chocolate, tea, strawberries) form insoluble complexes
Calcium Excretion
Urine ( typically 97 % re-absorbed by the kidney tubule)
n Increased by high Ca intake, high protein intake, high sodium intake
n Decreased by high potassium , phosphorus intake and by active vitamin D
Fecal losses
n Un-absorbed from the diet
n Via sloughing off intestinal cells
n Digestive secretions

Calcium metabolism and action

Normal plasma
Ca Levels

1, 25 (OH)2 D

Blood clotting
Nerve transmission
Muscle contraction

Thyroid

Kidney
Low
plasma
Ca levels

66

Calcitonin

High
plasma
Ca levels
Skeletal Health : maintain
integrity
Bones act as a Ca depot

Calcium Deficiency
67

Calcium deficiency
Blood

levels are very closely regulated

Low blood levels (hypocalcemia) occurs under medial
conditions such as kidney failure or abuse of diuretics
n Numbness

and tingling in the fingers, muscle cramps,

convulsions, lethargy, poor appetite, and abnormal heart
rhythms

Required for bone mineralization

Long

term deficiency can result in low bone mass

(osteopenia) and osteoporosis

Osteoporosis
68

Osteoporosis porous bones

Micronutrients
Calcium, Vitamin D, Vitamin K, Vitamin C
Weight bearing exercise
Low body weight resulting in lack of
menstrual cycles in young adult females
Alcohol and smoking: reduce bone accretion

Loss of bone mineral, fragile bones, prone

to fractures
Supplementation with calcium plus vitamin D has been shown to be
effective in reducing fractures and falls in institutionalized older adults

Calcium and Health

69

May be associated with lower risk of colon cancer

Supplemental Ca may be associated with higher risk of
prostate cancer -> mixed evidence
Supplemental Ca (>1500-2000 mg/d) may increase
the risk of kidney stones
Some evidence to suggest lower blood pressure with
high Ca intakes particularly in hypertensive persons
Mixed evidence for supplemental Ca increasing risk of
cardiovascular disease
Upper Limit: 2500 mg
Source: http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

Iron : Sources
70

Non-haem iron (inorganic iron), Ferric form

Present in Plant foods

Less bio-available (generally less than 10%)
n
n
n

Converted to ferrous form (soluble) prior to

absorption
Enhanced by vitamin-C , gastric acid
Reduced by phytates, polyphenols (tea,
coffee), oxalic acid, Ca and Zn

Legumes, Green vegetables, cereals

(fortified)

Haem iron (organic iron), Ferrous form

Present in Animal foods

More bio-available (20-25 % absorbed)
Liver, meat, fish

Recycling of iron
from hemoglobin
in the body

Iron absorption, excretion and losses

71

Absorption is highly regulated by iron stores in the body

Gastrointestinal muscosal cells act as block Mucosal Block

High iron stores: iron can be trapped inside the mucosal cell by ferritin
Iron is lost when the cells are shed
Very little free iron is available in the body

Low body iron stores: 35-40% absorbed

High body iron stores: 5 % absorbed

Free iron can form free-radicals that can increase oxidative stress
Stored as ferritin and hemosiderin (liver, bone marrow and spleen)

Iron losses
Small obligatory losses (loss of skin, mucosal cells)
Premenopausal adult women, menstrual losses
Pathological conditions
n Ulcers
n Stomach cancers

Iron : Function
72

Hemoglobin: Oxygen carrier in the blood

Myoglobin: Oxgen carrier in muscle
Production of cytochromes

Drug

and alcohol metabolism

Immune function
Production

of lymphocytes
RDA: 8 mg for males,
and 18 mg for females

Iron deficiency: Microcytic anemia

73

Lower number of red blood cells (RBCs)

RBCs contain less hemoglobin
(hypochromic)
Smaller RBCs (microcytic)
Symptoms
Fatigues, loss of appetite, brittle nails,
may impair future learning ability(infants),
depressed immunity
Microcytic , hypochromic anemia
Iron deficiency anemia is a major public health problem:
At risk : premature infants, young children, menstruating women, vegetarians, blood
donors (> 2-4 times each year)
Picture Source: http://www.dnwalcker.com/Laboratory2.html

Iron excess
74

Upper Limit for adults set at 45 mg /d

Acute toxicity
Consumption

of multi-nutrient supplements
Children are at risk of toxicity
n Diahorrea,

vomiting, nausea, can be fatal

Large iron stores

Hemochromatosis

: 1 in 200-300 people (genetic defect)

Over-supplementation or frequent blood transfusions
Iron is deposited in liver, heart and other organs
Liver damage, diabetes mellitus, cardiac failure, skin
discoloration
Upper limit : 45 mg

Iodine : Sources and Absorption

75

Goitrogens
Compounds found in raw
vegetables such as cauliflower,
broccoli, cabbage, soy,
peanuts, and strawberries
Reduce iodine absorption
Oceanic sources
Fish, sea food, seaweed
Dairy products
Cattle feed contain iodine
Sanitizing solutions contain iodine
Plants sources
Higher to areas near the sea
Iodized salts
1/2 tsp of salt meets iodine requirement

Reduce iodine use by the

thyroid gland

RDA: 150 micrograms

Iodine utilization
76

Iodide

Increases iodine
uptake by thyroid

Thyroid

Thyroid hormones are

involved in a variety of
metabolic processes
- Basal metabolic rate
- Bone growth
- Neural maturation

contains about 70-80% of the body's

iodine stores

Thyroid stimulating
hormone (TSH)

Iodine + tyrosine = Thyroid hormone

Brain

Iodine deficiency: cells of

the gland increase to
capture more iodine; gland
enlargement - GOITRE

Low blood thyroid

hormone levels

Source of images: Mayo foundation , The Guardian, World Journal of Endocrine Surgery, May-August 2010;2(2):103-104, http://
www.endocrinesurgery.net.au/goitre

Iodine deficiency
77

Signs/Symptoms
Increased sensitivity to cold
temperature
Fatigue
Joint or muscle pain
Paleness or dry skin
Sadness or depression
Weakness
Weight gain
Decreased taste and smell
Hoarseness
Puffy face, hands, and feet
Slow speech
Thickening of the skin
Thinning of eyebrows

Iodine inadequacy during pregnancy can

result in development abnormalities in the
newborn

Cretinism: dwarfism
severe neurological damage (deafmutism, spasticity, motor rigidity)

Image Source: http://prezi.com/t1pmzldh6w6y/cretenism

Iodine excess
78

Inhibits thyroid hormone synthesis and thereby

increases TSH stimulation, which can also produce
goiter
Thyroid inflammation and can increase the risk of
thyroid cancer
Upper limit: 1.1 mg

Public Health Significance of Iodine Nutrition

79

266 million children

and 2 billion
people worldwide
are at risk for iodine
deficiency

Source : http://www.who.int/vmnis/iodine/status/en/

Sodium: Sources
80

Packaged and
canned foods

Sauces

Preserved
foods

Taste (sodium
chloride, MSG)
Preservation
(sodium benzoate)
Leavening agent
(sodium bicarbonate)
Curing agents
(sodium nitrates)

Sodium absorption and excretion

81

Almost all is absorbed

Excretion via urine (primary), perspiration
Physiological requirement : 200 mg /day
Adequate Intake(day) : 1500 mg
Function

Glucose

absorption
Muscle contraction and nerve transmission
n Sodium-potassium

Maintains

gradient

water balance

Sodium deficiency
82

Rare
Diarrhea

/vomiting in children
Athletes who over-consume water

Symptoms
Headache,

nausea, muscle cramps

Can be fatal

Sodium excess
83

Adequate Intake : 1500 mg /day(< 51 year)

Upper Limit : 2300 mg /day (approximately 1 teaspoon of salt, 5 g)

-Increases risk of high blood

pressure, heart disease and
stroke
- Increases losses of Ca in
the urine
-May increase the risk of
stomach cancer

Sodium reduction initiatives in SE Asia

84

Batcagan-Abueg et al, Asia Pac J Clin Nutr 2013;22(4):490-504

85

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