Nutrient Deficiencies

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Nutrient Deficiencies

• Roberta Anding, MS,RD/LD,CSSD, CDE
• Baylor College of Medicine

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Goals and Objectives

• List common nutrient deficiencies
• Identify vulnerable nutrients in adolescents
• Describe physical findings associated with
  nutrient deficiencies

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Nutrient Deficiencies

• Macronutrients
• Calories
• Carbohydrate
• Protein
• Fat
• Micronutrients
• Vitamins/Minerals

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Macronutrients

• Calories
• Marasmus
• Anorexia nervosa
• Preservation of serum proteins

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Protein

• Hypoalbuminemic malnutrition
• Kwashiorkor
• Stressed starvation
• Alteration in fuel utilization
• Characterized by
• Low serum protein
• Edema
• Weight gain

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At risk

• Water soluble vitamins
• Malabsorption
• Dietary restriction
• Chronic dieting
• Anorexia nervosa
• Food group restrictions
• Medications

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B Vitamins

• In general, are cofactors of metabolism
• Many forms of Vitamin B
• Alcohol can increase risk of deficiency

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Vitamin B12

• Food source- animal only
• Vegans
• Bariatric surgery
• Metformin use

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Niacin

• Good for lowering cholesterol
• Causes vessel dilation
• Sources protein containing foods and fortified
  cereals
• Alcoholics are at increased risk of deficiencies
• Main deficiency is pellagra

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Vitamin B6 - Pyridoxine

• Food source- Bananas, protein containing foods,
  fortified cereals
• Cofactor of amino group transfer
• Water soluble and is not stored

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Thiamine

• Food source- Pork and fortified cereals
• Necessary for metabolism of carbohydrate
• Deficiency known as Beriberi

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Riboflavin

• Food source - Cows milk and fortified cereals
• Deficiency can cause cracks and fissures at
  corners of mouth (cheilosis)

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Vitamin C deficiency

• Deficiency disease-scurvy
• Infants feed surrogate formulas
• Secondary iron deficiency anemia

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Folic acid

• Food sources include fortified breakfast
  cereals/green leafy vegetable
• Need for one carbon transfer and cell
  development-prevention of neural tube defects
• Macrocytic anemia-mean corpuscular volume
• Sexually active-folic acid supplements

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Folic acid fortification

• US Public Health Service/FDA increased folic acid
  level of foods in 1998
• Mean intake increased approximately 100 ug per
  day
• Less than 50 of women age 15-44 reach 400 ug of
  folic acid/day
• Approximately 30 of minority women reach this
  goal

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Vitamin A

• Precursor - carotenoids
• Sources Carrots and other yellow and green
  vegetables and fruits
• Needed for normal vision and healthy epitheliol
  cells
• Anti-cancer activities found in this group

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Vitamin A

• Deficiency keratinization of skin and eyes.
• Avtive/preformed VA can be toxic and large
  amounts can cause birth defects

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Vitamin D

• Deficiency emerging as the newest public health
  concern
• Decreased absorption and activity can occur with
  anticonvulsants, bile acid sequestrants mineral
  oil, cimetidine neomycin
• Intake has decreased from the 1950
• Increased use of sunscreen

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Vitamin D

• Works synergistically to promote bone mineral
  density
• Approximately 10 of calcium absorbed with
  vitamin D deficiency
• Needed for normal cell differentiation
• Multiple sclerosis
• Type 1 diabetes
• Breast cancer

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Vitamin D deficiency

• Decreased bone mineral density
• Rickets
• Traditional deficiency

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Vitamin E

• Family of compounds known as Tocopherols
• Primary role is anti-oxidant
• Sources nuts, oils, seeds
• Natural version better than synthetic

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Vitamin K

• Needed for blood clotting
• Also plays integral role in bone growth
• Sources intestinal bacteria accounts for 75 of
  requirements.
• Other sources include broccoli, cabbage, green
  leafy vegetables.

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Vitamin K deficiency

• Can be caused by taking antibiotics
• Babies are given injection of VK at birth because
  of sterile intestine
• Symptoms
• Bruising easily
• Slow clotting

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Calcium

• Bone mineral density
• Study of adolescent twins
• One twin received 1000 mg calcium
• One received placebo
• Significant difference in BMD over 12 months
• Data suggests that calcium deficiency is a
  primary cause of decreased BMD

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Calcium

• Deficiency can be caused by
• Inadequate dairy intake
• Alternative is calcium fortified juice
• Calcium competes with iron zinc and magnesium
• Calcium depletion may occur with chronic use of
  corticosteroids and laxatives

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Iron

• Common mineral deficiency
• Males and females

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Iron deficiency in adolescents

• Data from NHANES III indicates that the
  prevalence of iron deficiency anemia is 7.9 in
  Non Hispanic whites
• Prevalence in Mexican Americans is 17.4 with an
  unclear etiology
• Data is less clear in African Americans

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Magnesium

• Cofactor for most enzymes (ATP)
• Central molecule of chlorophyll
• Sources Green leafy vegetables and chocolate
• Alcohol and multiple medications can cause Mg
  mal-absorption
• Too much Mg can have diarrhetic effect

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Sodium Potassium

• Sodium linked to hypertension
• Na can cause fluid retention
• Avg Houstonian consumes 8 g Na/day (16 X
  requirement)
• Higher Potassium diet can be used to control
  blood pressure
• K found exclusively in fruits and vegetables

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Sodium Potassium

• The more processed the food, the lower the K
  content, and the higher the Na content.

VS
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Chromium

• Part of glucose tolerant factor
• Brewers yeast is best source

Selenium

• Primary role is as anti-oxidant
• Involved in enzyme metabolism
• Body guard Vitamin E

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Zinc

• Deficiency and toxicity appear similar
• Both affect immune system
• Source same as iron (red meat)

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Summary

• Nutrient deficiencies involve both macronutrients
  and vitamins and minerals
• Increased growth and development in adolescents
  increase demand
• Promoting a healthy diet and responsible
  supplementation crosses all disciplines