Ch11 Energy Metabolism and Blood Health


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  • Typo on page 426 should be “insulates” not insulate
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  • Typo on page 426 should be “insulates” not insulate
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  • Ch11 Energy Metabolism and Blood Health

    1. 1. Chapter 11 Nutrients Involved with Energy Metabolism and Blood Health Lecture and Animation PowerPoint Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. To run the animations you must be in Slideshow View . Use the buttons on the animation to play, pause, and turn audio/text on or off. Please Note : Once you have used any of the animation controls , you must click in the white background before advancing to the next slide.
    2. 2. Nutrients Involved in Energy Metabolism & Blood Health: Lecture Overview <ul><li>B vitamins: </li></ul><ul><ul><li>Role in energy metabolism </li></ul></ul><ul><ul><li>Intakes in N. America </li></ul></ul><ul><li>Preserving vitamin content of foods </li></ul><ul><li>Energy Metabolism: </li></ul><ul><ul><li>Thiamin (B 1 ) </li></ul></ul><ul><ul><li>Riboflavin (B 2 ) </li></ul></ul><ul><ul><li>Niacin (B 3 ) </li></ul></ul><ul><ul><li>Pantothenic Acid (B 5 ) </li></ul></ul><ul><ul><li>Biotin (B 7 ) </li></ul></ul><ul><ul><li>Pyridoxine (B 6 ) </li></ul></ul><ul><li>Blood Health: </li></ul><ul><ul><li>Vitamin K </li></ul></ul><ul><ul><li>Anemias </li></ul></ul><ul><ul><li>Folate (B 9 ) </li></ul></ul><ul><ul><li>B 12 </li></ul></ul><ul><ul><li>Iron (Fe) </li></ul></ul><ul><ul><li>Copper (Cu) </li></ul></ul>
    3. 3. B Vitamins: Coenzymes <ul><li>B vitamins function as coenzymes </li></ul><ul><li>Coenzymes help unlock energy from macronutrients </li></ul><ul><li>After eating, B vitamins breakdown from coenzyme form -> free vitamins </li></ul><ul><li>Relatively bioavailable: 50-90% absorption </li></ul><ul><li>Coenzymes resynthesized in cells </li></ul><ul><li>Your body makes all the coenzymes it needs from vitamin precursors </li></ul>
    4. 4.
    5. 5.
    6. 6. B Vitamin Intakes <ul><li>Plentiful in diets containing variety of foods </li></ul><ul><li>Refined grain supply is fortified with B vits </li></ul><ul><li>Water soluble = very little storage in body </li></ul>
    7. 7.
    8. 8.
    9. 9. Thiamin: Functions <ul><li>Helps release energy from carbohydrate </li></ul><ul><li>First B-vitamin discovered </li></ul><ul><li>Important in ATP-producing pathways </li></ul>
    10. 10. Thiamin Deficiency: Beriberi <ul><li>Symptoms: </li></ul><ul><ul><li>Weakness </li></ul></ul><ul><ul><li>Loss of appetite </li></ul></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Tingling </li></ul></ul><ul><ul><li>Loss of muscle coordination </li></ul></ul><ul><ul><li>Deep muscle pain </li></ul></ul><ul><ul><li>Enlarged heart </li></ul></ul><ul><ul><li>Edema </li></ul></ul><ul><li>Occurs when glucose can ’t be metabolized to yield energy </li></ul><ul><li>Found in areas where refined grains predominate (ex: white vs. brown rice) </li></ul><ul><li>Refining grains -> ↓ thiamin content unless it is enriched </li></ul>
    11. 11. Thiamin: Nutrient Needs <ul><li>RDA: 1.1-1.2 mg/day </li></ul><ul><li>DV on food labels based on 1.5 mg/day </li></ul><ul><li>Men: exceed RDA by 50% or more </li></ul><ul><li>Women: just meet RDA </li></ul>
    12. 12. Thiamin: Dietary Sources <ul><li>Pork products </li></ul><ul><li>Whole grains & wheat germ </li></ul><ul><li>Ready-to-eat breakfast cereals </li></ul><ul><li>Refined grains </li></ul><ul><li>Green beans, milk, orange juice, organ meats, peanuts, dried beans, seeds </li></ul>
    13. 13.
    14. 14. Riboflavin (Vitamin B 2 ): Functions <ul><li>Riboflavin coenzymes participate in energy-yielding pathways (ex: fatty acid breakdown) </li></ul><ul><li>Assists some vitamin & mineral metabolism </li></ul><ul><li>Antioxidant role: supports glutathione peroxidase enzyme </li></ul>
    15. 15. Riboflavin Deficiency: Ariboflavinosis <ul><li>Inflammation of the mouth and tongue </li></ul><ul><li>Dermatitis </li></ul><ul><li>Cracking on tongue & corners of mouth (cheilosis) </li></ul><ul><li>Eye disorders </li></ul><ul><li>Sensitivity to sun </li></ul><ul><li>Confusion </li></ul><ul><li>Occur jointly with deficiencies of niacin, thiamin & vitamin B 6 </li></ul>
    16. 16. Riboflavin Deficiency: Ariboflavinosis
    17. 17. Riboflavin: Excess <ul><li>No UL </li></ul><ul><li>No evidence of toxicity from megadosing </li></ul><ul><li>Riboflavin supplementation can -> bright yellow urine </li></ul><ul><ul><li>Name riboflavin derived from Latin “flavus” – meaning yellow </li></ul></ul>
    18. 18. Riboflavin: Nutrient Needs <ul><li>RDA: 1.1-1.3 mg/day </li></ul><ul><li>DV on food labels is 1.7 mg/day </li></ul><ul><li>Average intakes slightly > than RDA </li></ul><ul><li>Alcoholics at ↑ risk for deficiency because of ↓ nutrient-dense diets </li></ul>
    19. 19. Riboflavin: Dietary Sources <ul><li>Ready to eat breakfast cereals </li></ul><ul><li>Dairy foods </li></ul><ul><li>Enriched grains </li></ul><ul><li>Meat </li></ul><ul><li>Eggs </li></ul><ul><li>Asparagus, broccoli & greens (ex: spinach) </li></ul><ul><li>Easily destroyed by light; opaque milk containers </li></ul>
    20. 20.
    21. 21. Niacin (Vitamin B 3 ): Functions <ul><li>Functions as nicotinic acid or nicotinamide </li></ul><ul><li>Coenzyme niacin form used in many cellular pathways </li></ul><ul><li>Energy being used = niacin coenzyme being used </li></ul><ul><li>Fatty acid synthesis require niacin coenzymed </li></ul><ul><li>Involved as coenzyme in 200+ reactions </li></ul>
    22. 22. Niacin Deficiency: Pellagra <ul><li>Means rough or scaly skin </li></ul><ul><li>Symptoms characterized by “4 D’s”: </li></ul><ul><ul><li>Dermatitis </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul><ul><ul><li>Dementia </li></ul></ul><ul><ul><li>Death </li></ul></ul><ul><li>Occurs most commonly in alcoholics </li></ul>
    23. 23. Niacin: Excess <ul><li>UL is 35 mg/day nicotinic acid form </li></ul><ul><li>Megadosing nicotinic acid is used supplementally for ↑ blood lipids </li></ul><ul><li>Long term can -> GI tract & liver damage </li></ul><ul><li>Niacin flush: </li></ul><ul><ul><li>Usually when intakes > 100 mg/day </li></ul></ul><ul><ul><li>Headache, itching, ↑ blood flow to skin -> flushing </li></ul></ul>
    24. 24. Niacin: Nutrient Needs <ul><li>Adult RDA: 14-16 mg/day </li></ul><ul><li>RDA expressed in Niacin Equivalents (NE) </li></ul><ul><li>DV on food labels is 20 mg </li></ul><ul><li>Average American intake doubles RDA </li></ul>
    25. 25. Niacin: Dietary Sources <ul><li>Heat stable: little lost in cooking </li></ul><ul><li>Can synthesize from tryptophan: </li></ul><ul><ul><li>60 mg tryptophan can -> 1 mg tryptophan </li></ul></ul><ul><li>Found in foods: </li></ul><ul><ul><li>Poultry, fish, tuna & beef </li></ul></ul><ul><ul><li>Peanuts </li></ul></ul><ul><ul><li>Ready-to-eat cereals </li></ul></ul><ul><ul><li>Asparagus </li></ul></ul><ul><ul><li>Coffee & tea </li></ul></ul>
    26. 26.
    27. 27. Pantothenic Acid (Vitamin B 5 ) <ul><li>Coenzyme in chemical reactions </li></ul><ul><li>Widespread in foods: deficiency is rare but can occur in alcoholics </li></ul><ul><li>Toxicity unknown: no UL </li></ul><ul><li>Sunflower seeds, mushrooms, peanuts, eggs, milk, meat, vegetables </li></ul><ul><li>AI: 5 mg/day for adults </li></ul><ul><li>DV based on 10 mg/day </li></ul>
    28. 28.
    29. 29. Biotin (Vitamin B 7 ) <ul><li>As coenzyme: aids in chemical reactions </li></ul><ul><li>Egg yolks, peanut butter, cheese </li></ul><ul><li>AI: 30 mcg/day for adults </li></ul><ul><li>Food supply gives 40-60 mcg/day average </li></ul><ul><li>DV on food & supplement labels: 300 mcg </li></ul><ul><li>No UL; relatively nontoxic </li></ul>
    30. 30. Biotin (Vitamin B 7 ) <ul><li>Intestinal bacteria can synthesize biotin – makes deficiency rare </li></ul><ul><li>Deficiency: scaly skin inflammation, changes in tongue & lips, ↓ appetite, N/V, anemia, depression, muscle pain, weakness, poor growth </li></ul><ul><li>Raw egg whites bind biotin and ↓ its absorption; ↑↑ raw egg white intake can -> biotin deficiency </li></ul>
    31. 31.
    32. 32. Vitamin B 6 (Pyridoxine): Functions <ul><li>Coenzyme in many metabolic reactions </li></ul><ul><li>Acts as coenzyme in 100+ amino acid and protein reactions </li></ul><ul><li>Synthesizes neurotransmitters </li></ul><ul><li>Converts tryptophan -> niacin </li></ul><ul><li>Breaks down stored glycogen -> glucose </li></ul><ul><li>Synthesizes hemoglobin and WBC </li></ul><ul><li>Aids in homocysteine metabolism </li></ul>
    33. 33. Vitamin B 6 (Pyridoxine): Deficiency <ul><li>Widespread symptoms: depression, vomiting, skin disorders, nerve problems, impaired immunity </li></ul><ul><li>B 6 helps synthesize heme portion of hemoglobin: </li></ul><ul><ul><li>B 6 deficiency -> small RBCs with ↓ hemoglobin concentration (microcytic hypochromic anemia) </li></ul></ul><ul><ul><li>Cell can ’t produce ATP when aerobic metabolism limited </li></ul></ul>
    34. 34. Vitamin B 6 (Pyridoxine): Excess <ul><li>UL: 1000 mg/day </li></ul><ul><li>Excess -> nerve damage </li></ul><ul><li>2-6 g/day X 2 or more months -> irreversible nerve damage </li></ul><ul><li>Symptoms: gait abnormality, tingling in extremities, numbness </li></ul>
    35. 35. Vitamin B 6 (Pyridoxine): Nutrient Needs <ul><li>Adult RDA: 1.3-1.7 mg/day </li></ul><ul><li>DV on food labels: 2 mg </li></ul><ul><li>Average adult intake is > RDA </li></ul><ul><li>Athletes ’ needs > than sedentary adults </li></ul><ul><ul><li>↑ needs required by ↑ processing of protein and glycogen </li></ul></ul>
    36. 36. Vitamin B 6 (Pyridoxine): Dietary Sources <ul><li>Animal products </li></ul><ul><li>Fortified ready-to-eat breakfast cereals </li></ul><ul><li>Potatoes, spinach, bananas, cantaloupe </li></ul><ul><li>B 6 in animal foods and fortified foods is better absorbed than B 6 from plant foods </li></ul>
    37. 37.
    38. 38.
    39. 39. RBC Overview <ul><li>Erythropoiesis: formation of RBCs </li></ul><ul><li>RBC functions </li></ul><ul><ul><li>Primary: carry O 2 from lungs -> tissues </li></ul></ul><ul><ul><li>Secondary: carry CO 2 from tissues -> lungs </li></ul></ul><ul><li>Hemoglobin: large iron-containing protein </li></ul><ul><ul><li>Iron in Hgb binds & carries 4 molecules of O 2 </li></ul></ul>
    40. 40. Anemia <ul><li>Inadequate healthy RBCs -> anemia </li></ul><ul><li>Anemia can be caused by: </li></ul><ul><ul><li>↓ RBC production or ↓ Hgb production in RBCs </li></ul></ul><ul><ul><li>Loss or destruction of blood </li></ul></ul><ul><li>Symptoms result from inadequate O 2 -> organs </li></ul><ul><li>Normal RBCs: normocytic & normochromic </li></ul><ul><li>Nutrient deficiencies -> changes in RBC size and color </li></ul>
    41. 41. Vitamins & Minerals Involved in Blood Health <ul><li>Vitamin K (Quinone) </li></ul><ul><li>Folate (B 9 ) </li></ul><ul><li>B 12 </li></ul><ul><li>Iron (Fe) </li></ul><ul><li>Copper (Cu) </li></ul>
    42. 42. Vitamin K (Quinone): Functions <ul><li>Can be synthesized by colonic bacteria </li></ul><ul><li>Blood clotting: </li></ul><ul><ul><li>Activates prothrombin -> thrombin </li></ul></ul><ul><ul><li>Converts soluble fibrinogin -> insoluble fibrinogin </li></ul></ul>
    43. 43.
    44. 44. Vitamin K (Quinone): Deficiency <ul><li>In infants: </li></ul><ul><ul><li>Infant ’s gut at birth is sterile: GI tract doesn’t have bacteria </li></ul></ul><ul><ul><li>Can ’t synthesize vitamin K needed for clotting if infant injured or needs surgery </li></ul></ul><ul><ul><li>Vitamin K routinely administered by injection shortly after birth </li></ul></ul><ul><li>In adults: deficiency after long-term antibiotic use & when fat malabsorbed </li></ul>
    45. 45. Vitamin K (Quinone): Excess <ul><li>No reports of toxicity </li></ul><ul><li>No UL </li></ul>
    46. 46. Vitamin K (Quinone): Nutrient Needs <ul><li>AI: 90-120 mcg/day for adults </li></ul><ul><li>DV on food labels: 80 mcg </li></ul><ul><li>Elderly adults have ↓ vitamin K intake due to ↓ intake of vegetables </li></ul>
    47. 47. Vitamin K (Quinone): Dietary Sources <ul><li>Resistant to cooking losses </li></ul><ul><li>Absorption requires dietary fat & adequate pancreatic secretions </li></ul><ul><li>Food sources: Liver, Dark green leafy vegetables, Broccoli, Asparagus, Peas </li></ul><ul><li>Patients on Coumadin (warfarin) should keep dietary Vitamin K intake constant </li></ul>
    48. 48.
    49. 49. Folate (Vitamin B 9 ): Functions <ul><li>Cell division </li></ul><ul><li>As a coenzyme: supplies or accepts single carbon compounds </li></ul><ul><li>Helps form DNA </li></ul><ul><li>Helps metabolize amino acids & their derivatives (ex: homocysteine) </li></ul>
    50. 50. Folate (Vitamin B 9 ): Deficiency <ul><li>In early RBC synthesis: </li></ul><ul><ul><li>Immature cells can ’t divide because they can’t form new DNA </li></ul></ul><ul><ul><li>Cells grow larger because insufficient DNA for nuclei to divide </li></ul></ul><ul><ul><li>Large immature form: megaloblast </li></ul></ul><ul><ul><li>Folate deficiency -> megaloblastic anemia (aka macrocytic anemia) </li></ul></ul><ul><li>Symptoms: </li></ul><ul><ul><li>Tongue inflammation, diarrhea, poor growth, mental confusion, depression, nerve dysfunction </li></ul></ul>
    51. 51.
    52. 52. Folate (Vitamin B 9 ): Maternal Deficiency <ul><li>↓ folate levels in pregnant woman -> neural tube defects in fetus (ex: spina bifida) </li></ul><ul><li>Neural tubes close within first 28 days of pregnancy </li></ul><ul><li>Recommended that 6 weeks before pregnancy all women have 400 mcg/day </li></ul>
    53. 53. Folate (Vitamin B 9 ): Excess <ul><li>UL: 1 mg/day (1,000 mcg) </li></ul><ul><li>Large doses of folate can mask vitamin B 12 deficiency symptoms </li></ul>
    54. 54. Folate (Vitamin B 9 ): Nutrient Needs <ul><li>RDA: 400 mcg/day </li></ul><ul><li>Pregnancy RDA: 600 mcg/day </li></ul><ul><li>DV: based on 400 mcg/day </li></ul><ul><li>Very susceptible to heat: cooking destroys 50-90% folate </li></ul>
    55. 55. Folate (Vitamin B 9 ): Dietary Sources <ul><li>Green leafy vegetables </li></ul><ul><li>Orange juice </li></ul><ul><li>Dried beans </li></ul><ul><li>Fortified ready-to-eat breakfast cereals </li></ul><ul><li>Bread </li></ul><ul><li>Milk </li></ul>
    56. 56.
    57. 57. Vitamin B 12 : Functions <ul><li>AKA cobalmin or cyanocobalmin </li></ul><ul><li>Functions in folate metabolism </li></ul><ul><li>Maintaining myelin sheath that insulates neurons from each other </li></ul><ul><li>Requires Intrinsic Factor (IF) for absorption </li></ul>
    58. 58. Vitamin B 12 : Deficiency <ul><li>Destruction of parts of myelin sheath </li></ul><ul><li>Neurological symptoms: </li></ul><ul><ul><li>Irregular muscle actions </li></ul></ul><ul><ul><li>Impaired reflexes </li></ul></ul><ul><ul><li>Eventual paralysis and perhaps, death </li></ul></ul><ul><li>Pernicious anemia: anemia from lack of B12 absorption (as opposed to inadequate folate absorption) </li></ul><ul><li>Vegans at risk for deficiency </li></ul>
    59. 59. Vitamin B 12 : Nutrient Needs <ul><li>Adult RDA: 2.4 mcg/day </li></ul><ul><li>DV on food labels & supplements: 6 mcg </li></ul><ul><li>Adults consume 2 X RDA on average/day </li></ul><ul><li>Elderly encouraged to have synthetic form because of ↓ IF production with ↑ age </li></ul>
    60. 60. Vitamin B 12 : Dietary Sources <ul><li>Concentrated sources found only in animal foods </li></ul><ul><li>Organ meats: liver, kidneys, heart </li></ul><ul><li>Meat, salmon, seafood </li></ul><ul><li>Ready-to-eat fortified breakfast cereals </li></ul><ul><li>Milk </li></ul><ul><li>Eggs </li></ul>
    61. 61.
    62. 62. Iron (Fe): Functions <ul><li>Iron is part of: </li></ul><ul><ul><li>Hemoglobin in RBCs </li></ul></ul><ul><ul><li>Myoglobin in WBCs </li></ul></ul><ul><li>Used as part of many enzymes, proteins </li></ul><ul><li>Needed for brain & immune function </li></ul><ul><li>Helps detoxify drugs in the liver </li></ul><ul><li>Contributes to bone health </li></ul>
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    64. 64. Iron (Fe): Deficiency <ul><li>Iron deficiency caused when: </li></ul><ul><ul><li>When hematocrit (% of RBCs) and hemoglobin concentration ↓ </li></ul></ul><ul><li>Iron deficiency anemia caused when: </li></ul><ul><ul><li>Hgb and Hct levels fall so low that O 2 carried in bloodstream is ↓ </li></ul></ul>
    65. 65. Iron (Fe): Iron Deficiency Anemia <ul><li>Stage 1: Depleted body stores but no physical symptoms </li></ul><ul><li>Stage 2: Depleted circulating iron and some physiological impairment </li></ul><ul><li>Stage 3: RBCs are small (microcytic) and pale (hypochromic) and ↓ in number </li></ul>
    66. 66. Iron (Fe): Iron Deficiency Anemia <ul><li>Most common micronutrient deficiency worldwide </li></ul><ul><li>Can be caused by: </li></ul><ul><ul><li>Growth & ↑ blood volume (ex: pregnancy) </li></ul></ul><ul><ul><li>Blood loss during menstruation </li></ul></ul><ul><ul><li>Blood loss from ulcers, colon cancer, hemorrhoid </li></ul></ul><ul><li>Symptoms: fatigue, pale skin, always cold, loss of appetite, ↓ work capacity </li></ul>
    67. 67. Iron (Fe): Excess <ul><li>UL: 45 mg/day </li></ul><ul><li>↑↑ iron can -> stomach irritation </li></ul><ul><li>Iron pills are common cause of iron toxicity in children who accidentally overdose </li></ul><ul><li>Vitamin C ↑ iron absorption: problematic in people with hemochromatosis </li></ul>
    68. 68. Iron (Fe): Nutrient Needs <ul><li>Male & menopausal female RDA: 8 mg/day </li></ul><ul><li>Female RDA: 18 mg/day for 18-50 y.o. </li></ul><ul><li>DV based on 18 mg/day </li></ul>
    69. 69. Iron (Fe): Dietary Sources <ul><li>Heme: </li></ul><ul><li>Meat </li></ul><ul><li>Fish </li></ul><ul><li>Poultry </li></ul><ul><li>Non-heme: </li></ul><ul><li>Fruits & vegetables </li></ul><ul><li>Fortified foods </li></ul><ul><li>Supplements </li></ul>
    70. 70.
    71. 71.
    72. 72. Copper (Cu) <ul><li>Component of blood </li></ul><ul><li>Needed by enzymes </li></ul><ul><li>Immune system function: blood clotting, blood lipoprotein metabolism </li></ul><ul><li>Sources: liver, legumes, seeds, whole grain breads and cereals, cocoa </li></ul><ul><li>RDA: 900 mcg/day for adults </li></ul><ul><li>UL: 10 mg/day </li></ul>