Micronutrients Deficiency Dr Khawla Belhoul Director Thalassemia Center 2532008

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Micronutrients DeficiencyDr Khawla
BelhoulDirector Thalassemia Center25/3/2008
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• Talking about micronutrient deficiency in 15
  minutes is not easy
• Let us see how can we make the coming 15 min
  enjoyable and useful to you
• Every body knows that Micronutrient deficiencies
  are widespread in developing countries.

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Malnutrition and Obesity are not a Paradox
Only one suffers from hunger, but both are
subject to malnutrition
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• Nutritional needs during childhood
• and adolescence are increased

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• Many children and adolescents receive a higher
  proportion of energy from fat

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Importance of minerals and vitamins
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Vitamins

• Essential organic substances
• Needed in minute amounts
• Activate highly specific metabolic functions in
  the body
• Usually do not become part of the product they
  create

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Vitamins

• Body only requires a very small amount of each.
• A well balanced diet will provide plenty of
  vitamins!

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Fat Soluble

• Stored in liver and adipose
• Body has no way of removing them until used.
• They dissolve in fat and not water.
• We do not need to get a supply of them everyday.
• Vitamins A,D,E, K

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Water Soluble

• Not stored in tissues
• Excess voided in urines.
• we need to get a new supply of them every day.
• Vitamin C, B1 (thiamine), B2 (niacin), B6
  (pyridoxine), B12 (cobalt), folic acid, biotin.

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Vitamin A

• Essential for normal growth, integrity of the
  skin, and bone development.
• Lack of Vitamin A can lead to infection
• Deficiency can also cause night blindness.
• Vitamin A is found in butter, butterfat in milk,
  egg yolk, some fruits (prunes, pineapples,
  oranges, limes, and cantaloupe), green leafy
  vegetables and carrots.

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Vitamin B Complexes

• Vitamin B1 (thiamine) affects growth, appetite,
  and carbohydrate metabolism. Alcoholics can be
  especially deficient. B1 is found in whole
  grains, nuts, egg yolk, fruits, and most
  vegetables.
• Vitamin B2 (riboflavin) affects growth and
  cellular metabolism (the ability of the cell to
  take in food, make energy and discard waste).
  Found in liver, meat, poultry, eggs, milk, and
  green vegetables.
• Vitamin B6 (niacin) deficiency in will cause
  pellagra, which is associated with the "four
  D's" dermatitis, diarrhea, dementia, and death.
  Found in liver, meat, poultry, and green
  vegetables.
• Vitamin B12 (biotin, folic acid, and
  cyanocobalamin) is found in leafy green
  vegetables, organ meats, lean beef and veal, and
  wheat cereals. A deficiency will result in
  pernicious anemia and neurological problems,
  including numbness and weakness.

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Other Vitamins

• Vitamin C (ascorbic acid)
• Necessary for the formation of connective tissue
  between cells as well as maintenance of the
  "cement" that secures cells to membranes. A
  deficiency will lead to scurvy (shallow
  complexion, loss of energy, pain in legs and
  joints, bleeding gums, and muscle pain). Vitamin
  C is found in raw cabbage, carrots, orange juice,
  lettuce, celery, onions, tomatoes, and all citrus
  fruits.
• Vitamin D
• Necessary for the development of bones and teeth,
  a deficiency can lead to rickets and tooth decay.
  It is essential in the metabolism of calcium and
  phosphorus, two of the most important
  constituents of bone and teeth. Vitamin D is
  manufactured in the skin with exposure to
  sunlight, and is also found in milk, cod liver
  oil, salmon, egg yolk, and butter fat.
• Vitamin E
• Defence against oxidative damage by free
  radicals. Although the exact function of this
  vitamin is not clearly understood, it is
  essential to humans and has been related to the
  healing of scars. A deficiency is extremely rare,
  as Vitamin E is found in many foods.
• Vitamin K
• Essential for blood clotting, Vitamin K is found
  in fats, oats, wheat, rye, and alfalfa.

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Minerals

• "co-factors of enzymes" , enzymes would not exist
  or function without minerals.
• Vitamins cannot function without minerals.
• There are fourteen trace minerals necessary for
  survival, a few of which are
• Iron
• Chromium
• Copper
• Fluorine
• Manganese
• Selenium
• Zinc

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Iron in Nature
Iron is among the most abundant minerals on
earth.
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HB IN IDA
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Groups at Risk

• Infants
• Under 5 children
• Children of school age
• Women of child bearing age

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Etiology

• Inadequate intake of iron of food, which
  enhances iron absorption.
• High intake of inhibitors of iron absorption
• Hookworm infestation.
• Blood loss (heavy menses use of aspirin
  NSAID).
• High fertility rate in womem.
• Low iron stores in newborns.

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Dietary Iron

• There are 2 types of iron in the diet haem iron
  and non-haem iron
• Haem iron is present in Hb containing animal food
  like meat, liver spleen
• Non-haem iron is obtained from cereals,
  vegetables beans
• Milk is a poor source of iron.

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Iron Absorption

• Haem iron is not affected by ingestion of
• other food items.
• It has constant absorption rate of 20-30
• The haem molecule is absorbed intact and the iron
  is released in the mucosal cells.

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Iron Absorption

• The absorption of non-haem iron varies greatly
  from 2 to 100 because it is strongly influenced
  by
• The iron status of the body
• The solubility of iron salts
• Integrity of gut mucosa
• Presence of absorption inhibitors or facilitators

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Inhibitors of Iron Absorption

• Oxalates in spinach
• Phytates in whole grains, cereals like wheat,
  rice, maize barely. Legumes like soya beans,
  black beans peas.
• Beverages like tea, coffee, cocoa and wine.
• A single cup of tea taken with meal reduces iron
  absorption by up to 11.

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Prevention of IDA

• Dietary modification
• Food fortification
• Iron supplementation

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Promoters of Iron Absorption

• Foods containing ascorbic acid like citrus
  fruits, broccoli
• Foods containing muscle protein enhance iron
  absorption due to the effect of cysteine
  containing peptides released from partially
  digested meat.

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Iron Absorption

• Some fruits inhibit the absorption of iron
  although they are rich in ascorbic acid because
  of their high phenol content e.g strawberry,
  banana and melon.

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What Should You Do ?

• Include iron enhancers in your diet.
• meat, poultry, fish,
• foods rich in vitamin C (oranges, grapefruit,
  strawberries, and cantaloupe
• Read nutrition labels, remember that they may
  state the iron content of a food, but not the
  amount of iron actually absorbed by your body.

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Consequences of Iron Deficiency

• Increase maternal fetal mortality.
• Increase risk of premature delivery and LBW.
• Learning disabilities delayed psychomotor
  development.
• Reduced work capacity.
• Impaired immunity (high risk of infection).
• Inability to maintain body temperature.
• Associated risk of lead poisoning because of
  pica.

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Vitamin D
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Functions

• Calcium metabolism vitamin D enhances ca
  absorption in the gut renal tubules.

• Cell differentiation particularly of collagen
  skin epithelium

• Immunity important for Cell Mediated Immunity
  coordination of the immune response.

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Vitamin D deficiency

• Rickets in small children.
• Osteomalacia
• Osteoporosis
• Increasing the risk of cancer, heart disease and
  autoimmune diseases

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Sources of Vitamin D

• Sunlight is the most important source
• Fish liver oil
• Fish sea food (herring salmon)
• Eggs
• Plants do not contain vitamin D3

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Vitamin D Status of Arab Mothers
Arab women, have very low serum 25-OHD
Concentrations compared with white women.
JOURNAL OF ARAB NEONATOLOGY FORUMVol 3 Issue 3,
December 2006 Vol 1 Issue 1, 2004 
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Do We Have A Problem ?

• In Saudi Arabia
• In UAE
• 33 United Arab Emirates (UAE) and 25 non-Gulf
  Arab volunteer women and 17 female Europeans
  residents in the UAE
• 158 healthy UAE women volunteers
• low serum 25-OHD concentrations have been
  reported in Lebanese volunteer women aged 30-50
• Arab women living in Europe have been shown to
  have low serum concentrations of 25-OHD

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Causes of vitamin D deficiency among Arab women
and infants

• Decrease in the endogenous production of vitamin.
  
• Serum 25-OHD concentrations were negatively
  correlated with wearing a veil.
• Less time spent in the sun
• In adequate intake
• High parity was found to be associated with
  hypovitaminosis D.
• less efficient synthesis of vitamin D among some
  dark-skinned Arab women
• prolonged breast feeding without vitamin D
  supplementation.
• Avoidance of sun exposure due a general belief
  spread that exposure to sun damages the skin and
  speed up skin aging .

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Effects Of Maternal Vitamin D Deficiency During
Pregnancy

• Decreased fetal growth
• Tooth enamel hypoplasia
• Poor fetal bone mineralization and congenital
  rickets.
• Neonatal hypocalcemic seizure
• Poor linear growth
• Rickets

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Factors Contributing To The Continuing High
Prevalence Of Hypovitaminosis D In Arab Women And
Infants

• lack of awareness of the magnitude of the
  problem.
• Physicians fail to prescribe vitamin D
  supplementation to breastfeeding infants whose
  mothers are at risk
• The continuing womens lifestyles

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Prevention of vitamin D deficiency in mothers and
Infants

• Exposure of the face and hands for 30 minutes
  three times a week in adults and 6 or 2
  hours/week in infants during late morning or late
  afternoon may be sufficient to produce adequate
  vitamin D stores.

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Prevention of vitamin D deficiency in mothers and
Infants

• Public health campaigns to improve the Vitamin D
  status in the community and for changes in
  lifestyle
• Vitamin D supplementation, will be the choice
  until modifications in lifestyle can be achieved
  to improve endogenous vitamin d synthesis.
• Fortification of dairy products, juice and
  cereals.

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Free Radicals ?

• A molecule with an odd, unpaired electron
• Very unstable and very reactive
• Attack the nearest stable molecule, "stealing"
  its electron.
• The "attacked" molecule loses its electron,
• The attacked molecule becomes a free radical
  itself
• A chain reaction begins
• Reactions cascade
• Disruption of a living cell.

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Free Radicals ?

• Some free radicals arise normally during
  metabolism.
• Sometimes the immune system purposefully create
  them to neutralize viruses and bacteria.
• Environmental factors such as pollution,
  radiation, cigarette smoke, sunlight,
  environmental chemicals, exposure of metals, and
  biological materials (including food), can start
  free radicals formation.
• Normally, the body can handle free radicals

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Free Radicals ?

• Free radicals may damage cell membranes, or
  change chemicals in the body into carcinogens.
• May also increase oxidation of LDL-C ? CAD

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What is an Antioxidant

• Counteract the effects of free radicals
• Antioxidants donate extra electrons to stop free
  radical Chain reactions

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Antioxidants
Free Radicls
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How Antioxidants May Prevent Against Free Radical
Damage

• Vitamin E ? The most abundant fat-soluble
  antioxidant in the body.
• Vitamin C The most abundant water-soluble
  antioxidant in the body.

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Warning

• More is not always better.
• The long-term effect of large doses of these
  nutrients has not been proven.

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• The Lesson is 
• Eat Your Fruits and Vegetables!
• Eat a balanced diet consisting of 5-8 servings of
  fruits and vegetables per day
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Thank you for listening,Hearing me out.Healthy
food and sunshine are needed, no doubt