Download Iron

Dr Ali Soroush
Head of Department of Sports Medicine and Rehabilitation
Chairman of Imam Reza Hospital
MINERALS AND TRACE ELEMENTS
• Are inorganic substances that are essential for the normal
function and development of body cell and systems
• They make up approximately 3% of total body-weight
Functions of mineral in the body
• Formation and maintenance of strength and Rigidity of bone and
teeth
• Regulation of fluid balance
• Regulation of acid /base balance
• Components of enzymes and hormones and , as such , essential
for energy metabolism and functioning of the immune system
• Transmission of action potential along nerves
• Contraction of muscle fibres.
Essential minerals and trace elements
minerals
trace elements
Calcium
Iron
manganese
phosphorus
Fluoride
chromium
Potassium
Copper
selenium
Sodium
Zinc
molybdenum
Chlorine
Iodine
magnesium
Cobalt
Reference nutrient intakes, sources and effects of incorrect intakes
UK RNI*/day
Dietary sources
Calcium
Dairy product
Phosphorous
Dairy product
Functions
bone and teeth formation
Muscle contraction
Nerve transmission
Blood clotting
700mg
Deficiency symptoms
Toxicity symptoms
Rickets
Osteoporosis
Convulsion
Stunted growth
bone and teeth formation
ACID –BASE BALANCE
Deminerilisation of bone
Low blood Ca levels
550mg
Meat and fish
Iron
Meat, dried fruit , green
vegetables fortified cereals
Component of haemoglobin
Pallor
Tiredness
Breathlessness
Reduced resistance to
infection
Cirrhosis of liver
Iodine
Seafish and shellfish , milk
some vegetables
Iodised salt
Component of thyroid
hormones , controls
metabolic rate
Enlarged thyroid
Foetal abnormality
Retarded growth
Hyperthyroid
Flourine
Seafood , tea, drinking water
Helps prevent caries
Increased frequency of
dental caries
Tooth mottling
Skeletal changes
Sodium
Cheese preserved foods
Pre-prepared foods added to
cooking
Acid-base and fluid balance
Nerve transmission
Muscle contraction
Muscular fatigue , nausea
Reduced appetite
Hypertension vomiting
8.7 mg male
14.8 female
140 µg
50 µg
1600 mg
RNI: Reference Nutrient Intake*
Reference nutrient intakes, sources and effects of incorrect intakes (2)
UK RNI*/day
Dietary sources
Functions
Deficiency
symptoms
Toxicity symptoms
Potassium
Fruit , vegetables
Acid-base and fluid balance ,
nerve transmission, muscle
contraction
Muscle weakness, confusion,
cardiac arrest
irregular heart rate
Mg
Wholegrain cereals, green
vegetables , nuts
Protein and DNA synthesis,
bone development
Neuro muscular dysfunction
Hypertension
Copper
Meat , shellfish , vegetables
Enzymefunction lon
absorption
Reduced resistance to
infection
--------
Zinc
Meat , eggs , ,pulses ,
wholehrain cereals
Enzyme function , immune
system
Skin lesions , growth failure
, reduced immunity
Diarrhea , nausea
3500 mg
300 mg
1.2 mg
9.5 mg
RNI: Reference Nutrient Intake*
Calcium (Ca)
•
•
•
•
Greatest amount in the body
The body of a well-nourished adult contains 1-1.5 kg ca
99% of total content is deposit in bones and teeth,
1% in blood and body fluids
Functions
Bone structure
Nerve function
Blood clotting
Muscle contraction
Cellular metabolism
Functions of Ca
• Deposits of Ca in the original soft matrix give bones their
necessary rigidity.
• In the case and resistance to decay.
• The small amount of Ca remaining in the tissue fluids
plays a part in controlling the action of nerves.
• Ca also has a role in the clotting of blood.
Absorption of calcium:
–
Mechanism
predominantly in the jejunum but also in the
ileum and colon.
Simple diffusion
An active transport involving Ca pump
Absorption factors
Absorption increased by
Body need
Vitamin D
Fat
Lactose
Amino acid
Arginine
Absorption decreased by:
Vitamin D deficiency
Calcium-phosphorus imbalance
Coca
spinach
Food Sources:
Best sources:
Milk and milk product;
Good sources:
Beans, vegetables, fish,
cabbage,broccoli.
Ca content of some dairy products and white bread
•
•
•
•
500 ml milk contains approximately 500 mg Ca
30 g cheddar cheese contains 240 mg Ca
125 g pot low-fat yoghurt contains 200mg Ca
Two thick slices white bread contains 74 mg Ca
Ca Deficiency
Calcium may be lacking in the body if absorptions is
impaired as in the:
• Malabsorption syndrome
• Vitamin D deficiency
• Dietary deficiency of Ca in girls age 15-18 y
Dietary requirement
• During Pregnancy(no extra Ca is required because increase
absorption)
• During lactation (550mg per/day)
• Throughout childhood and adolescence
Calcium and Osteoporosis
•
Bone growth is greatest during “linear growth”
– Peaks out at around age 35
Ca
• Lose of cortical bone occurs at a rate 35% per
year in males and in females prior to the
menopause . The rate in a females for 5 years
after menopause.
• Ca supplementation without the addition of
oestrogen can not prevent Osteoporosis.
Phosphorous (P)
• Second largest amount in the body
• 80% of P occurs in combination with Ca in the bone
and teeth.
• 20% ECF
Functions of Phosphorus
•
•
•
•
Essential for the development of bones and teeth
Phospholipids, Phosphoprotieon
Energy metabolism
Maintenance of blood pH: phosphate buffer system
P Absorption
• PTH absorption of P
• phosphate is based on the intake of calcium.(the ratio of Ca:P
of 1:1)
• Sources:
milk, fish, vegetable, meat, eggs –
Phosphorus Deficiency
• Patients with renal diseases.
• Patients receiving TPN
• Alcoholic
Iron
The function of Iron in the body are as follows:
Iron is necessary for the formation of Hb
Hb Carries of oxygen to the tissues and carbon dioxide between
the lungs
Part of the protein myoglobin in muscles
Iron is found in the muscle pigment myoglobin
It is also an important constituent of many enzyme systems
Iron
Iron absorption
 Not all the Iron in the diet is absorbed
 If the diet contains adequate amounts meat and ascorbic acid
it is usual only 15% of dietary iron to be absorbed
 Iron absorption occurs in the duodenum and jejunum
Sources of iron
Two types of iron are found in foods:
 Meat and meat products contain haem iron (i.e.the iron in
hemoglobin)
 Fruit and vegetables contain iron as ferric complexes
Heme and Nonheme Iron in Foods
Iron Deficiency
Groups of the population who may suffer from iron
deficiency are those with:
 Increased needs: pregnant women, Infants, toddlers, and
Adolescents
High losses: Mensturating women
Poor or reduced absorption: Elderly people, Vegetarians
Iron absorption mechanisms in the upper small intestine (McGeown 1999)
High Iron Intakes
Haemochromatosis:
Is an inherited condition in which iron absorption is inappropriately
high and results in an accumulation of iron in the tissues
Iron poisoning:
It does occur in children and adults
Iodine
 The trace element iodine is a constituent of thyroxine (T4)
and triiodothyronine (T3)
 These hormones control the rate of tissue activity, metabolic
rate, integrity of connective tissue
 They are also necessary for the development of the foetal
nervous system during the first trimester of pregnancy
 They are vital for normal and physical mental development
Dietary Sources Iodine
Vegetables
Sea fish
Cretinism
results A deficiency in the mother’s diet during early pregnancy
in cretinism, a syndrome of mental
retardation and dwarfism
Goitrogens
Some foods have been found to contain substances which
interfere with the uptake of iodine by thyroid gland such as
sweet potato
• Cabbage and turnip contain goitrogenic cyanoglucosides
• Cassava, maize, sweet potato and lima beans
• Water may have goitrogenic properties when contaminated with
faeces
• Calcium, fluoride, manganese and magnesiumions present in hard
water are also goitrogenic
Goiter
• If sufficient Iodine is not available for formation T3 &T4 ,
the thyroid gland enlarges in an effort to maintain normal out
put of hormones ,and gives rise to swelling of neck.
Iodine Deficiency
• Iodine Deficiency is prevalent in communities where dietary
intake is low or insufficient or combination with a diet
containing goitrogens.
Goiter
•
•
Endemic (commonl
found) in parts of
S. America and
India
Sporadic cases in
U.S.
Fluorine
• Principally in matrix of bone and teeth.
• This mineral is present in water and tea
• Amount normal Fluorine is present in water to extent of 1 part
per million
Fluorine Deficiency
• Deficiency symptoms
– Susceptibility to tooth decay
• Toxicity symptoms
– Fluorosis (pitting and discoloration of teeth)
Sodium
 Sodium is found principally in the blood plasma and the fluid
surrounding the tissues.
 Na+ are important in maintaining and influencing osmotic
balance between cells and the interstitial fluid
 Distribution is mediated by the Na+/K+-ATPase pump
 Na+ are important in neuron (brain and nerve) function – action
potential
Sodium dietary sources
•
•
•
•
•
•
Common salt
Fish
Milk
Egg
Fruit & vegetables
cheese
• Sodium losses occur through urine and sweat (symptoms:
excessive fatigue and muscle cramp)
• Shifts in sodium balance result in expansion or contraction of
ECF
• Too low, ADH / aldosterone secreted
• Too high, Atrial natriuretic peptide (ANP)
• secreted
• Normally , the sodium content of the body is maintained
by the kidneys at an almost constant level.
• Changes in the sodium concentration in the ECF are
compensated for by changes in the ECF volume.
• So is the ECF sodium concentration increases , more
water is retained in the ECF to keep the constant
concentration
Sodium Absorption
The absorption of sodium and water are under the complex
hormonal control of aldosterone and ACTH.
Change of ECF volume are detected by pressure sensors in
the circulation , which stimulate changes in sodium and
water absorption in the kidneys
Signs & Symptoms of decrease in sodium
•
•
•
•
•
•
•
Muscle cramps
Excessive fatigue
Pathology
Prolonged Vomiting or Diarrhoea
Poor kidney function
Excessive sweating
Tissue damage
In the elderly , Na deficiency can lead to confusion
Dietary salt and hypertension
• There is much conflicting evidence about the links between
hypertension and dietary sodium intake
• High alcohol intake , smoking , high salt intake and obesity
contribute to rise in blood pressure
Potassium
 K+ is the principal cation of the intracellular fluid.
 Potassium is present principally in body
 Excessive retention occurs in association with some kidney
disorders and also in Addison’s disease, and may cause cardiac
arrest
 Kidneys play important role to regulating the Potassium
 Content in body.
 Over 90% K absorbed in proximal small intestinal.
Potassium sources
Fruit and vegetables are the major contributors of potassium to
the diet, bananas and fruit juices being particularly rich
sources
Coffee is also a good source
Potassium and Blood Pressure
Increasing the dietary potassium intake has been shown
to reduce blood pressure in normotensive and
hypertensive individuals
Potassium
Excessive retention
• Kidney disorders
• Addison’ s disease
• Cardiac arrest
Deficiency
• Prolonged Vomiting
• Diarrhoea
• Diuretic therapy
Magnesium
Magnesium is a necessary for skeletal and maintaining electrical
potenial across the membranes of nerves and muscles.
Dietary sources
• Hard water
• Green vegetable
• Meat and meat product
Magnesium Deficiency
Symptom of Magnesium
deficiency
Case Magnesium deficiency
Starvation
Alcoholism
Prolonged Diarrhoea
Prolonged vomiting
•
•
•
•
Progressive muscle weaknss
Failure to thrive
Neuromuscular dysfunction
VF
Copper
• Chief functions in the body
– Necessary for absorption and use of iron in the formation of
hemoglobin
– Part of several enzymes
–
Copper Deficiency
Symptom Deficiency
– Defect hair pigmentation
– Increased susceptibility to respiratory infection
– Reduced immune response
Zinc
•
•
•
•
•
60% in skeletal muscle
30%in bone
Part of many enzymes(metalloenzymes )
Needed for wound healing
Zinc Deficiency: impaired immune , Growth failure, impaired
healing
• Zinc Toxicity: , copper deficiencies , nausea & vometing
Factors predisposing to Deficiency
•
•
•
•
•
•
•
Lacking in diets
Parasites causing chronic blood loss
Excessive sweating
Malabasorption of food
Surgery
burns
Dietary sources : seafood ,meat, egg
Selenium
• acts with other antioxidants
• May be protective froms
cancer
• Dietary sources:
• Meats , fish
Chromium
•
•
•
•
Increases action of insulin
Part of metabolism lipid
Dietary sources:
meats , nuts,
Molybendum
• Essential of some enzymes
involved in the DNA
metabolism
• Dietary sources:
• Milk , liver
Cobalt
• Constituent with vitamin B12
• essential for maturation of
RBC’s
• Dietary sources:
• Meats ,milk
Choloride
• Balance Na & K in the
cells and ECF
• Dietary sources
• Salt
Aluminium
• Aluminium is found all
plats animals
• Dietary sources
• vegetable
Water
• Water constitutes about 65 - 70 % total body weight
• Fluid balance between ECF & ICF
• Products of digestion are absorbed in a fluid medium and
distributed in blood and lymph
• Controlled body temperature
• Excretion (lung , kidney ,..)
• Involve chemical reaction
Water sources
• Water is a constituent of most food , even though they
may be solid in consistency:
• Bread contains approximately 35% water
• Fish 65%
• Meat 50-70%
• Vegetables and fruits 80-90%
Water balance
• Water is lost from the body in urine , faeces , sweat and
expired air.
• The regulatory mechanisms in the kidneys result in a
variable volume of urine being secreted-consequently a
balance is maintained between intake and output of water
Requirement
• An average adult living in a temperate climate requires
approximately 2500 ml of water daily.
• The actual amount that is ingested depends both on
climate and habit :
• Drinks provide 1000-2500 ml.
• Food provide 1000-1500 ml.
• Metabolism provide 200-400ml.
Dehydration
• Means loss of water , but is often used as implying a loss
of certain mineral elements also , particularly sodium.
• Loss of up to 5% of body-weight by dehydration results
in thirst and discomfort.
• Loss of 6-10% results in dizziness , absence of saliva and
inability to walk.
• Loss of 11-12% results in delirium , swollen tongue ,
inability to swallow and shrivelled skin
Total body fluid
Male 60%
Female 50%