Vitamins & Minerals PDF

VITAMINS & MINERALS Micronutrient Deficiency in the Philippines 2013 National Nutrition Survey Iron, iodine, Vitamin A and folic acid The 2008 NNS reported that among Filipino women, there was a low one-day consumption of foods such as legumes, fruits and vegetables which are natural sour...

VITAMINS & MINERALS Micronutrient Deficiency in the Philippines 2013 National Nutrition Survey Iron, iodine, Vitamin A and folic acid The 2008 NNS reported that among Filipino women, there was a low one-day consumption of foods such as legumes, fruits and vegetables which are natural sources of folic acid. Concern: Data is now more than a decade old MICRONUTRIENT GAP STUDY 2023 In children ages 6 – 23 months, micronutrient gaps identified are Vitamin A, iron, calcium & zinc. Questions When is the best time to take vitamins? Which vitamin is best taken with food? Is there a difference between men’s multivitamins and women’s multivitamins? Which is the best type of multivitamin? Which statement is TRUE regarding intake of multivitamin supplement? Reduces the risk for heart disease Reduces risk of Reduces the risk for deaths in heart certain types of attack survivors cancers Reduces risk of repeat heart attacks in heart attack survivors Methods of Biochemical Assessment Static measurement Measures specific nutrient concentration in body fluids & other biological samples (hair, skin, nails, etc.) Functional measurement Tests the physiologic role of a specific nutrient within a certain metabolic process or reaction (abnormal metabolic products, etc.) Nutrition Care Process Model  DOH Administrative Order No. 2019-0033: Guidelines for the Implementation of Nutrition Care Process in Hospitals Sample Nutrition Care Algorithm Nutrition-Focused Physical Exam (NFPE): Skin Nutrition-Focused Physical Exam (NFPE): Nails Nutrition-Focused Physical Exam (NFPE): Hair Which micronutrient deficiency leads to anemia? A. Iron B. Vitamin A C. Vitamin C D. Vitamin E E. Zinc What is your diagnosis? What is your diagnosis? What is your diagnosis? What is your diagnosis? What is your diagnosis? What does a nootropic do? A. Appetite stimulant B. Cognitive enhancer C. Mood stabilizer D. Muscle relaxant Which is the best type of calcium supplement? Which is the best type of iron supplement? Have you taken niacinamide recently? Energy drinks and liquid death Vitamin A Vitamin A Vitamin A Static Measurement Functional Measurement Serum retinol Conjunctival impression Retinol binding protein cytology Breastmilk retinol Anemia Retinol dose response Vitamin D Vitamin D Vitamin D metabolism Vitamin D Static Measurement Calcitriol Serum 25- Active metabolite in liver & hydroxycholecalciferol kidney Serum 1,25- Reduces its own synthesis by dihydroxycholecalciferol inducing 24-hydroxylase & repressing 1-hydroxylase in the kidney Functional Measurement Increases intestinal absorption Parathyroid Hormone of calcium Reduces excretion of calcium Mobilizes bone mineral Vitamin D Deficiency Vitamin D toxicity Susceptibility to Vitamin D toxicity leads to: Contraction of blood vessels High blood pressure Calcinosis (calcification of soft tissues Does excessive exposure to sunlight lead to Vitamin D toxicity? Vitamin E Static Measurement Serum alpha-tocopherol Tissue tocopherol Functional Measurement Erythrocyte hemolysis test Erythrocyte malondialdehyde ratio Vitamin E No precise metabolic function Major lipid-soluble antioxidant in cell membranes & plasma lipoproteins Reacts with lipid peroxide radicals to form tocopheroxyl radicals that are unreactive and form nonradical compounds The tocopheroxyl radical can be reduced back to tocopherol by reacting with Vitamin C from plasma Premature infants with inadequate reserves have abnormally fragile RBC membranes → hemolytic anemia Vitamin K Static Measurement Phylloquinone or menaquinone measurement Functional Measurement Prothrombin Time  Vitamin K in synthesis of carboxyglutamate Vitamin K Prothrombin, Factors VII, IX and X, and Proteins S & C contain 4-6 gamma carboxyglutamate residues → chelates calcium →blood clotting proteins can bind to cell membranes Preprothrombin – abnormal precursor of prothrombin secreted in Vitamin K deficiency or in the presence of warfarin Should a patient on warfarin need to avoid foods rich in Vitamin K? WATER SOLUBLE VITAMINS Function mainly as enzyme cofactors Deficiency of a single vitamin is rare Labile metabolic stores → toxicities are rare  Myer’s Cocktail https://hydramed.com/iv- therapy/myers-cocktail- max Reading (In Between) the Labels Vitamin C Static Measurement Roles of Vitamin C Serum ascorbic acid Antioxidant Leukocyte ascorbic acid Coenzyme in hydroxylation Urinary excretion of ascorbic reactions (bile acid, collagen & acid catecholamine synthesis) & tyrosine degradation Reducing agent Functional Measurement None commonly used Vitamin C as Coenzyme for Hydroxylases Dopamine Beta-hydroxylase → copper containing enzyme involved in the synthesis of catecholamines Proline & lysine hydroxylases → iron-containing enzymes required for postsynthetic modification of procollagen to collagen Proline hydroxylase is required in osteocalcin formation & C1q component of complement Vitamin C as Coenzyme for Hydroxylases Aspartate hydroxylase required for synthesis of the precursor of Protein C Trimethyllysine & gamma butyrobetaine hydroxylases are required for the synthesis of carnitine  Static Measurement Erythrocyte or whole blood thiamine Urinary excretion of thiamine Vitamin B1 Thiamine load test (Thiamine) Functional Measurement Erythrocyte transketolase activity coefficient Thiamine diphosphate Coenzyme for oxidative Coenzyme for transketolase in decarboxylation reactions: the pentose phosphate Pyruvate dehydrogenase pathway Alpha keto glutarate Phosphorylates and activates dehydrogenase a chloride channel in the nerve Branched chain keto acid membrane dehydrogenase in the metabolism of leucine, isoleucine & valine Thiamine Deficiency: Beriberi Beriberi (peripheral neuritis) Shoshin beriberi Wernicke encephalopathy & Korsakoff psychosis Pyruvate dehydrogenase deficiency → lactic acidosis Vitamin B2 (Riboflavin) Static Measurement FMN & FAD are its active Blood riboflavin coenzyme forms that Urinary excretion of riboflavin participate in many redox Riboflavin load test reactions Deficiency is widespread but Functional Measurement not fatal → cheilosis, desquamation & inflammation Erythrocyte glutathione reductase activity coefficient of the tongue, seborrheic dermatitis Vitamin B3 (Niacin) Static Measurement Not strictly a vitamin since it Blood niacin can be synthesized from Urinary N-methyl nicotinamide & tryptophan N-methyl-2-pyridine 60 mg of Tryptophan = 1 mg of Niacin load test niacin Functional Measurement NAD & NADP None Treatment for hyperlipidemia → causes flushing Vitamin B6 (Pyridoxine) Active coenzyme is pyridoxal 5 phosphate important in amino acid metabolism (transamination) and decarboxylation 80% of total body Vit B6 is pyridoxal phosphate in muscle, associated with glycogen phosphorylase Toxicity may cause neuropathy Vitamin B6 (Pyridoxine) Static Measurement Functional Measurement Plasma pyridoxal-5-phosphate Erythrocyte aminotransferase Urinary Vitamin B6 stimulation activity coefficient Urinary 4-pyridoxic acid Tryptophan load test Methionine load test Vitamin B9 (Folate) Static Measurement Functional Measurement Red blood cell indices Serum homocysteine Serum folate Erythrocyte folate Neutrophil lobe count Histidine load test  Folic acid supplements reduce the risk of neural tube defects Vitamin B 9 (Folate) Vitamin B12 (Cobalamin) Static measurement Functional measurement Serum Vitamin B12 Serum methylmalonic acid Erythrocyte Vitamin B12 Urinary methylmalonic acid Serum holotranscobalamin II Deoxyuridine suppression test Serum homocysteine Vitamin B 12 (Cobalamin) Synthesized only by microorganisms (found only in foods of animal origin) Vegetarians need to take Vitamin B12 supplements Vitamin B 12 Deficiency & the Folate Trap Methylmalonyl CoA mutase and methionine synthase are vitamin B12 dependent enzymes Methylmalonyl CoA undergoes a Vitamin B12-dependent rearrangement to Succinyl CoA Vitamin B12 absorption failure leads to pernicious anemia Macrominerals & Trace Elements Macrominerals Required by adults in amounts > 100 mg/day Trace elements Required by adults in amounts between 1-100 mg/day Ultratrace elements Required by adults in amounts < 1 mg/day  Hemoglobin, Serum ferritin hematocrit Transferrin Red cell indices saturation Iron UIBC Serum iron, (unsaturated serum iron-binding transferrin capacity) TIBC (total iron-binding capacity) Iron Body Iron Compartments & Testing Parameters https://www.sciencedirect.com/scie nce/article/pii/S152168962300054X Zinc Static measurement Functional measurement Serum zinc Delta-aminolevulinic acid Urinary zinc dehydratase Hair zinc Angiotensin-1 Cu-Zn-SOD Iodine Static measurement Functional measurement Urinary iodine excretion Serum thyroxine & Serum thyroglobulin triiodothyronine (T4 & T3) Serum thyroid stimulating hormone (TSH) Selenium Static measurement Functional measurement Plasma or whole blood selenium Glutathione peroxidase activity Hair selenium Nail selenium Calcium Serum Total calcium Ionized calcium  https://ellischiropracticofpuyallup.com /let-food-be-thy-medicine/ http://en.people.cn/n3/2024/1126/c900 00-20246761.html References 1. Gibson, RS (2005). Principles of Nutritional Assessment, 3 rd edition. Oxford University Press. https://nutritionalassessment.org/#1.3 2. FRAX. Fracture Risk Assessment Tool. https://frax.shef.ac.uk/FRAX/tool.aspx?country=33 3. Rusch, et.al. Diagnosing iron deficiency: Controversies & novel metrics. In Best Practice & Research Clinical Anesthesiology. Volume 7, Issue 4, December 2023, pp. 451-467 References 4. Fairfield, KM, et.al. Dec. 2024. Vitamin intake & disease prevention. UpToDate. https://www.uptodate.com/contents/vitamin-intake-and-disease- prevention?search=multivitamin%20supplementation&source=sea rch_result&selectedTitle=1%7E150&usage_type=default&display_r ank=1#H2134522100 5. Abbott Nutrition Health Institute Malnutrition Handout. https://static.abbottnutrition.com/cms-prod/anhi- 2017.org/img/MSLMalnutritionHandout.pdf