water soluble Vitamins and minerals - Dr.Parvathy

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water soluble Vitamins and minerals - Dr.Parvathy

  1. 1. The Water SolubleVitamins & Traceelements Dr.Parvathy Dept. of Pathology
  2. 2. B Complex Primary FunctionsEnergy metabolism Thiamin (B-1), Riboflavin (B-2), Niacin (B- 3), Pyridoxine (B-6), Biotin, Pantothenic AcidRed blood cell synthesis Folate, B12Homocysteine metabolism Folate, B12, B6
  3. 3. Enrichment Act of 1941 and 1998Many nutrients lost through millingprocess of grainsGrain/cereal products are enrichedThiamin, riboflavin, niacin, folate, ironWhole grains contain original nutrientsEnriched grains still deficient in B-6,magnesium and zinc
  4. 4. Thiamin (B1)Thiamine Functions:Synthesis of ATPCo-factor in pentose phosphate pathwayMaintains neural membranes and conduction
  5. 5. Deficiency of Thiamin Occurs where polished rice is the only staple Chronic alcoholicsLittle stored in body, so alcoholic binge of 1- 2 weeks may result in deficiency Pernicious vomiting or diarrhea• Wernicke-Korsikof f Syndrome – Wernicke encephalopathy• Korsakoff’s psychosis• Result of thiamine deficiency caused by alcoholism
  6. 6. Beriberi (I can’t I can’t) Weakness, nerve degeneration, irritability, poor arm/leg coordination, loss of nerve transmission Edema, enlarged heart, heart failure Symptoms due to poor metabolism of glucose Depression and weakness can be seen after only 10 days on a thiamin-free diet
  7. 7. Wet and Dry BeriBeri
  8. 8. Food Sources of Thiamin Green beans, milk, orange juice, organ meats, peanuts, dried beans and seed Enriched breads and grains/ whole grains Thiaminase found inraw fish Destroys thiamin
  9. 9. RDA For Thiamin1.1 mg/day for women1.2 mg/day for menSurplus is rapidly lost in urine; nontoxic; no Upper Level
  10. 10. Riboflavin (B2)Riboflavin is a critical component offlavin mononucleotide (FMN) & flavindinucleotide (FAD) which participate inredox reactions
  11. 11. Ariboflavinosis
  12. 12. Food Sources of Riboflavin Milk/products Enriched grains Ready to eat cereals Liver Vegetables (asparagus, broccoli, greens) Sensitive to uv radiation(sunlight) Stored in paper, opaque plastic containers
  13. 13. RDA for Riboflavin1.1 mg/day for women1.3 mg/day for menAverage intake is above RDAToxicity not documentedNo upper level
  14. 14. Niacin (B3)Nicotinic acid and nicotinamide Essential component of NAD & NADPwhich play central roles in cellularintermediate metabolism.Synthetic pathways require niacin, especiallyfatty acid synthesis
  15. 15. Deficiency of Niacin:3 Ds PellagraDermatitis - which most often occurs insun exposed areas of face and upperextremityDementia - results from neuronaldegeneration in the brain and spinalcolumnDiarrhea - is associated with edema andinflammation of the intestinal submucosa.Poor appetite, weight loss, weakness
  16. 16. Pellagra
  17. 17. Food Sources of Niacin Enriched grains, ready to eat cereals Beef, chicken, turkey, fish peanuts Heat stable; little cookingloss
  18. 18. RDA for Niacin 14 (mg) NE/day for women 16 (mg) NE/day for men Upper Level is 35 mgOther names Nicotinic acid, Nicotinamide, Niacinamide,Vitamin B3 Precursor: dietary tryptophan(60mg=1mg) Toxicity S/S: headache, itching, flushing, liver and GI damage
  19. 19. Pantothenic Acid/ Vit B5Part of Coenzyme-AEssential for metabolism of CHO, fat,proteinDeficiency rareNo known toxicity
  20. 20. Food Sources of Pantothenic acid“From every side”MeatMilkMushroomLiverPeanutEggsAdequate Intake= 5 mg/dayDaily Value 10 mgAverage intake meets AI
  21. 21. BiotinFree and bound formMetabolism of CHO and fatAssists the addition of CO2 to othercompoundsSynthesis of glucose, fatty acids, DNAHelp break down certain amino acids
  22. 22. Biotin DeficiencyRaw egg whites avidin bind biotin →deficiencyRequires large amountScaly inflamed skin, tongue, and lipchangesPoor appetite, nausea, vomitingAnemiaMuscle pain and weaknessPoor growth
  23. 23. Food Sources of Biotin Cauliflower, yolk, liver, peanuts, cheese Intestinal synthesis ofbiotin
  24. 24. Biotin NeedsAdequate Intake is 30 ug/day for adultsDeficiency rareNo Upper Level for biotinRelatively nontoxic
  25. 25. Pyridoxine (B6) Coenzyme Activate enzymes needed formetabolism of CHO, fat , protein Synthesize nonessential amino acid viatransamination Synthesize neurotransmitters Synthesize hemoglobin and WBC
  26. 26. Pyridoxine/B6 DeficiencyWidespread symptoms• Depression• Vomiting• Scaly dermatitis• Nerve irritation• Impaired immune system
  27. 27. Food Sources of Vitamin B-6Well absorbed• Meat, fish, poultry• Enriched cereals• Potatoes• MilkLess well absorbed• Fruits and vegetables:Banana, spinachHeat and alkaline sensitive
  28. 28. B6 ToxicityNerve damageDifficulty walkingNumbness in hands/feetCan lead to irreversible nerve damagewith > 200 mg/dayUpper Level set at 100 mg/day
  29. 29. RDA for Vitamin B-61.3 mg/day for adults1.7 mg/day for men over 501.5 mg/day for women over 50Average intake is more than the RDAAthletes may need moreAlcohol destroys vitamin B6
  30. 30. Folate Part of coenzymes THF (tetrahydrofolate) and DHF (dihydrofolate) used in DNA synthesis and therefore important in new cell formation-Anticancer drug methotrexate Homocysteine metabolism Neurotransmitter formation
  31. 31. Deficiency of FolateSimilar signs and symptoms of vitaminB-12 deficiencyAnemiaPregnant womenAlcoholicsMegaloblastic Anemia
  32. 32. Neural Tube Defects
  33. 33. Food Sources of Folate Liver Fortified breakfast cereals Grains, legumes Foliage vegetables Susceptible to heat,oxidation, ultraviolet light Synthetic form betterabsorbed
  34. 34. RDA for Folate400 ug/day for adults(600 ug/day for pregnant women)Excess can mask vitamin B-12deficiencyUpper Level set at 1 mg
  35. 35. Cobalamin/Vitamin B-12 Synthesized by bacteria, fungi, andother lower organisms Role in folate metabolism Maintenance of the myelin sheaths RBC formation Part of coenzymes methylcobalaminand deoxyadenosylcobalamin used innew cell synthesis
  36. 36. Absorption requires HCl Pepsin Intrinsic factor Difficult for vegetarians to obtain Pernicious anemia  Nerve degeneration, weakness  Tingling/numbness in the extremities (parasthesia)  Paralysis and death  Looks like folate deficiency Usually (95%) due to decreased absorptionability
  37. 37. Vitamin B12 deficiencyDiagnosis: Schilling testTreatment: 1000mg Vitamin B12 IMdaily for two weeks and monthly injectionsfor lifeHigh Risk: African Americans, northernEuropeans, elderly
  38. 38. Food Sources of Vitamin B-12 and algaeSynthesized by bacteria, fungiAnimal products, meatSeafoodEggsMilk
  39. 39. RDA for Vitamin B-122.4 ug/ day for adults and elderlyadultsB-12 stored in the liverNon-toxic (no Upper Level)
  40. 40. Vitamin CSynthesized by most animals (not byhumans)Decrease absorption with high intakesExcess excreted
  41. 41. Functions of Vitamin CReducing agent (antioxidant)Iron absorption (enhances)Synthesis of collagenImmune functionsWound healing
  42. 42. AntioxidantCan donate and accept hydrogenatoms readilyWater-solubleNeeds are higher for smokersMay prevent certain cancers(esophageal, oral, stomach cancer,cardiovascular disease, cataracts)
  43. 43. Vitamin C Deficiency: History of ScurvySailors on long sea voyages suffered horriblyfrom scurvyOn Vasco da Gamas voyage to the East Indiesin 1497, 100 out of 160 men were lost from thedisease.
  44. 44. Scurvy in the BritishJames Lind Royal Navypublished hisTreatise on theScurvy in 1754.Lime juice wasmade mandatoryon British Navysailing ships 40years later
  45. 45. Deficiency of Vitamin C Scurvy  Deficient diet for 20-40 days  Fatigue, pinpoint hemorrhages  Bleeding gums and joints. Hemorrhages  Associated with poverty; macrobiotic diet Rebound Scurvy  Suddenhalt to high levels of vitamin C supplements
  46. 46. ScurvyScorbutic Rosary Follicular Hemorrhages
  47. 47. Food Sources of Vitamin CCitrus fruit Easily lost throughPotato cookingGreen pepper Sensitive to heatCauliflowerBroccoliStrawberrySpinach
  48. 48. RDA for Vitamin C90 mg/day for male adults75 mg/day for female adults+35 mg/day for smokersUpper Level is 2 g/day
  49. 49. Vitamin C ExcessHemochromatosisOxalate kidney stonesErodes tooth enamel
  50. 50. CholineNewest essential nutrientGrouped with B group vitaminsAll tissues contain cholinePrecursor for acetylcholine(neurotransmitter)andphospholipidsSome role in homocysteinemetabolism
  51. 51. Food Sources of CholineWidely distributedMilkLiverEggsPeanutsLecithin added to foodDeficiency rare
  52. 52. Trace Elements Essential Trace Elements: iron, zinc, copper, cobalt, chromium, fluorine, iodine, manganese,molybdenum and selenium Probably essential: nickel, tin, vanadium, silicon, boron
  53. 53. Copper Metabolism• Copper circulates bound to ceruloplasmin• Excretion occurs via transport of copper into bile and elimination in feces
  54. 54. cofactor for many cuproenzymes including:•Cu, Zn-superoxide dismutase (antioxidant)•Cytochrome C oxidase (ATP synthesis, neurologicfunction)•Ceruloplasmin (6 atoms per molecule)•Lysyl oxidase (cross links and stabilizes connectivetissue proteins)•Tyrosinase (melanin synthesis)
  55. 55. Copper Physiology/Deficiency• Acquired deficiency is rare• Manifestations: Hypochromic microcytic anemia Neutropenia Hypopigmentation of hair and skin Structural abnormalities in connective tissue Fetal and neonatal deprivation leads to neurologic dysfunction Reduced levels of circulating copper and ceruloplasmin
  56. 56. Food Sources organ meats, seafood, nuts, seeds, cereals, whole grains, cocoaInborn Errors of Copper Metabolism: Wilson’s Disease (Hepatolenticular Degeneration) Menkes Kinky Hair Syndrome
  57. 57. Pili torti (Menkes Disease)
  58. 58. Iodine-body normally has 20-30 mg of iodineand more than 75% is in the thyroidgland-the rest is in the mammary gland,gastric mucosa, and blood-it’s only function is related to thyroidhormone
  59. 59. Food Sourcesfoods of marine origin (seaweed),processed foods, iodized salt
  60. 60. Deficiency-goiter—enlargement of the thyroidglandgoitrogens -cabbage, turnips, peanuts,soybeans-deficiency may be absolute—in areasof deficiency, or relative—adolescence,pregnancy, lactation-goiters are more prevalent in womenand with increased age
  61. 61. Endemic Cretinism severe deficiency during gestation and early postnatal growth: cretinism(mental deficiency, spastic diplegia, quadriplegia, deaf mutism, dysarthria, shuffling gait, short stature, hypothyroidism)
  62. 62. Iodine deficiency is the most common nutrient deficiency in the world!
  63. 63. Iodine Excess and ToxicityHumans are remarkably tolerant to highiodine intakesIn iodine deficiency, repletion must bedone slowly to prevent hyperthyroidism
  64. 64. Goiter Endemic to parts ofS. America and India Sporadic cases in U.S. Selenium deficiency(needed to convert T4 to T3)
  65. 65. Goiter - ComplicationsUsually asymptomaticAcute pain from thyroidalhemorrhageDysphagiaDyspnea
  66. 66. ChromiumRegulation of glucose metabolism as acomponent of glucose tolerance factor(GTF).GTF increases effect of insulin (by facilitatingits binding to cell receptor site).Chromium regulates plasma lipoproteinconcentration.Reduces serum cholesterol and serumtriglycerides. Both chromium and Fe are carried by Tf,however albumin can also assume this role
  67. 67. Food Sourcesbread, meats, poultry, fish, beer
  68. 68. Deficiencyaltered CHO metabolism, impaired glucosetolerance, glycosuria, fasting hyperglycemia,increased insulin levels and decreased insulinbinding to receptors-impaired growth, peripheral neuropathy,negative nitrogen balance Toxicitychronic renal failure
  69. 69. Cobalt-most stored with vitamin B12-component of B12—cobalamin-essential for maturation of RBC’s andnormal function of all cells
  70. 70. Deficiency -**macrocytic anemiaToxicity polycythemia -hyperplasia of BM -reticulocytosis -increased blood volume
  71. 71. Selenium -glutathione peroxidase• --overlaps with vit E for antioxidant effects• Iodothyronine 5’- deiodinase• Thioredoxin reductase• Epidemiologic evidence indicates low intakes of Se are associated with higher risk of prostate cancer
  72. 72. Food Sources Food content tends to follow Se content of soil – richest food sources are organ meats and sea foods, followed by cereals and grains, dairy products, fruits and vegetables• Requirements determined based on serum glutathione peroxidase activity
  73. 73. Selenium Deficiency Diseases•Human deficiency is rare except in areas with low Secontent in soil Keshan disease occurs in Keshan China: endemic cardiomyopathy and muscle weakness (due to oxidized lipids) Aggressive supplementation has eliminated disease•Iatrogenic deficiency TPN without supplemental Se
  74. 74. Selenium Toxicity Acute-cardiorespiratory collapse(gram amounts) Chronic (selenosis) -changes innail structure and loss of hair (intakes ~6x UL)
  75. 75. Molybdenum-relationship with copper and sulfate-cofactor of many enzymes involved inthe catabolism of sulfur AA, purines andpyridines-Toxicity: gout-like syndrome,reproductive SE’s-Deficiency: increased risk with co-existing copper deficiency, TPN
  76. 76. Manganese•High concentration of Mn2+ is present in mitochondria• Functions as a necessary factor for activation ofglycosyltransferases (enzymes responsible for thesynthesis of oligosaccharides, glycoproteins,proteoglycans.• Required for superoxid dismutase activity, foractivity of metalloenzymes: hydrolases kinases decarboxylases transferases.Deficiency of Mn extensively reduce glycoprotein andproteoglycan formation.
  77. 77. Iron Adult human body contains 3-4 Gm 60-70% is present in Blood and rest in storage form. Each Gm of Hb contains 3.34mg of Iron.Requirement : 1 mg per day for Male 2.5 mg for Females 3.5 mg for Females in Physiological stress conditions
  78. 78. Sources of iron Haem Iron:  Liver, meat, poultry, Fish Non Haem Iron:  Cereals, GLV, Legumes,, Nuts, Oil seeds, Dried Fruits, Jaggery Factors interfere in absorption are enzymes in the food – Phytates, Oxalates, Phosphates, Dietary fibres Ascorbic acid is the most potent enhancer iron
  79. 79. Iron Deficiency Occurs in 3 stages: First Stage: Decreased storage without any other detectable abnormalities Second Stage: stores are exhausted, serum Ferritin level decreases. Third Stage: Decrease in Hemoglobin percentage Functional disturbances: decrease in resistance to infection, increase morbidity & mortality, decreased work performances, impaired cell mediated immunity
  80. 80. Evaluation of iron1. status relative index of Hemoglobin Concentration: iron deficiency. ( early Anemia if Hb is 10- 11g% & marked anemia Hb is < 10g%).2. Serum Iron concentration: useful index ( Normal 0.8 to 1.8mg /L)3. Serum Ferritin level: Gold standard & sensitive tool for evaluation and reflects the size of the iron status ( < 10Micrgms/L)4. Serum Transferrin Saturation: 16% - 30%
  81. 81. Correction of Iron Deficiency Oral iron supplements 100-200 mg elemental iron daily Higher doses are of no benefit Ferrous sulphate 65mg/tab Pregnant women- 100mg/tablet(+ folic acid)
  82. 82. Fluorine It is found in combined forms 96% of fluorides in the body found in bone and teeth. An essential for normal mineralisation of bones and formation of dental enamelSource: Drinking water : Fluorine in the drinking water is 0.5 mg per ltr. Excess of fl > 3mg causes flourosis. Foods: Sea fish, cheese, Tea It is a two edged sword ( deficiency or excess)
  83. 83. Zinc Adult body contains 1.4 to 2.3 gms of Zinc Plasma level- 96Microgm per 100 ml ( adults), 89 Microgram per 100 ml (children) Functions are Active role in metabolism of glucose and proteins Synthesis of insulin by pancreas Immunity functions Food sources : meat, milk, fish Plant sources have low bioavailability
  84. 84. Zinc deficiency1. Growth failure2. Sexual infantilism in adolescents, loss of taste, delayed wound healing, decrease in immunosynthesis.3. Spontaneous abortions, stillbirths, congenital malformations, anencephaly4. LBW, Intra Uterine deaths, premature labour.5. Requirement is 15mg for men6. 12 mg for women, 10mg for children

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