Micronutrients & Water-Soluble Vitamins PDF

MICRONUTRIENTS NCM 105: NUTRITION AND DIET THERAPY WENDY JOIE S. OFONG, RN, LPT MICRONUTRIENTS Small molecule groups that are needed by the body to maintain normal physiologic functioning MINERALS VITAMINS MAJOR...

MICRONUTRIENTS NCM 105: NUTRITION AND DIET THERAPY WENDY JOIE S. OFONG, RN, LPT MICRONUTRIENTS Small molecule groups that are needed by the body to maintain normal physiologic functioning MINERALS VITAMINS MAJOR WATER SOLUBLE MINOR (TRACE) FAT-SOLUBLE Concept Properties of Micronutrients BIOAVAILABILITY PRECURSORS ORGANIC/INORGANIC NATURE SOLUBILITY TOXICITY OVERLOAD SYNDROME GENETIC ERRORS IN METABOLISM BIOAVAILABILITY Refers to the amount of a nutrient that the body can use that is of good quality BIOAVAILABILITY Factors that influence bioavailability Increased bioavailability Decreased bioavailability ❖Efficiency of digestion ❖Source of nutrient ❖Adequate nutrition status ❖Method of food preparation ❖Quality of nutrient ❖Foods that interfere with absorbed absorption (binders) are taken at the same time PRECURSORS Refer to the “inactive forms” or starting points from which other substances develop ORGANIC AND INORGANIC NATURE Are descriptions about whether micronutrients can be altered or destroyed during the handling or preparation process as a result of their chemical composition SOLUBILITY Refers to the degree to which a substance can dissolve in a water or fat medium TOXICITY Refers to an excess of a substance that can cause harm or damage due to accumulation in the body Serum levels of minerals and vitamins can be measured and toxic levels can be denoted OVERLOAD SYNDROME Refers to minerals that can either be taken in or produced by the body leading to toxic levels of sodium, potassium, calcium and iron GENETIC ERRORS IN METABOLISM Processes whereby there is insufficient production, absorption, or excretion of substances resulting in clinical deficiency states (too little) or excess states (too much) VITAMINS VITAMINS WATER SOLUBLE VITAMINS  WATER SOLUBLE VITAMINS Vitamin B Vitamin C  WATER SOLUBLE VITAMINS Vitamin B Function as coenzymes throughout the body in a series of chemical reactions and binding sites Involved in metabolism of all macronutrients  WATER SOLUBLE VITAMINS Vitamin B Function as coenzymes throughout the body in a series of chemical reactions and binding sites Involved in metabolism of all macronutrients  WATER SOLUBLE VITAMINS Vitamin B Vitamin B1 - Thiamin Roles Coenzyme in CHO metabolism  WATER SOLUBLE VITAMINS Vitamin B Vitamin B1 - Thiamin Dietary sources Pork, wheat germ,, black eyed peas Fortified cereals and enriched grains Handling and preparation losses can occur during grain processing or during heating process  WATER SOLUBLE VITAMINS Vitamin B Vitamin B1 - Thiamin Ingestion of foods containing antithiamin factors (certain fish, tea, coffee, blueberries and cabbage) in large quantities can decrease absorption and leat to deficiency symptoms  WATER SOLUBLE VITAMINS Vitamin B Vitamin B1 - Thiamin Recommendations in the diet: RDA for adult male 1.2 mg/day RDA for adult female 1.1 mg/day  WATER SOLUBLE VITAMINS Vitamin B Vitamin B1 - Thiamin Deficiency Excess Beriberi Headache, Wernicke-Korsakoff irritability, insomnia syndrome Tachycardia and weakness  WATER SOLUBLE VITAMINS Vitamin B Vitamin B1 Deficiency Beriberi Neurological deficits (disorientation, short-term memory loss, jerky eye movements, staggered gait and weakness) that can lead to cardiac failure  WATER SOLUBLE VITAMINS Vitamin B Vitamin B1 Deficiency Wernicke-Korsakoff syndrome Clinical state of encephalopathy seen in clients with alcoholism, noted by the presence of mental changes, psychosis and coma  WATER SOLUBLE VITAMINS Vitamin B Vitamin B2 - Riboflavin Roles Coenzyme in protein and energy metabolism and conversion of other vitamins into active forms (B6, niacin, folate and K) Thyroid adrenal hormone controls the conversion to the coenzyme forms  WATER SOLUBLE VITAMINS Vitamin B Vitamin B2 - Riboflavin Dietary Sources Organ meats, milk, legumes and vegetables Found in whole or enriched grain products Handling and preparation losses occurs because of light sensitivity; most products are packaged in cardboard or other opaque containers  WATER SOLUBLE VITAMINS Vitamin B Vitamin B2 - Riboflavin Recommendations: RDA for adult male is 1.3 mg/day RDA for adult female is 1.1 mg/day  WATER SOLUBLE VITAMINS Vitamin B Vitamin B2 - Riboflavin Deficiency Excess Ariboflavinosis Yellow-orange Oral lesions discoloration of urine Eye problems  WATER SOLUBLE VITAMINS Vitamin B Vitamin B2 Deficiency Ariboflavinosis Refers to a clinical deficiency state that affects the skin, eyes, mouth, and tongue and results in the development of a normocytic anemia  WATER SOLUBLE VITAMINS Vitamin B Vitamin B2 Deficiency Oral lesions such as cheilosis (cracks at the corners of the mouth) and eye problems (photophobia, tearing, and burning)  WATER SOLUBLE VITAMINS Vitamin B Vitamin B2 Deficiency Drug interactions are seen with chlorpromazine (Thorazine), imipramine, amitriptyline and can interfere conversion of the vitamin to its active form  WATER SOLUBLE VITAMINS Vitamin B Vitamin B3 - Niacin Roles Functions as part of respiratory enzymes and is involved in energy expenditure Precursor to niacin is tryptophan (60 mg of dietary tryptophan = 1 mg of niacin) Cholesterol lowering properties and causes peripheral vasodilation  WATER SOLUBLE VITAMINS Vitamin B Vitamin B3 - Niacin Dietary sources: Found in meat, peanuts legumes and coffee The inclusion of large amounts of corn in the diet interferes with dietary conversion of tryptophan to niacin (corn is high in amino acid leucine which interferes with tryptophan conversion  WATER SOLUBLE VITAMINS Vitamin B Vitamin B3 - Niacin Recommendations: Male daily requirement is 16 NE (niacin equivalents) Female daily requirement is 14 NE  WATER SOLUBLE VITAMINS Vitamin B Vitamin B3 - Niacin Deficiency: Excess: Pellagra Increased Drug interactions histamine levels Carcinoid Increased uric syndrome acid levels Hartnup disease Aggravation of Peptic ulcer disease  WATER SOLUBLE VITAMINS Vitamin B Vitamin B3 Deficiency Pellagra Clinical deficiency state characterized by the three Ds: dermatitis, diarrhea, and dementia  WATER SOLUBLE VITAMINS Vitamin B Vitamin B3 Deficiency Drug interactions are seen with isoniazid, and hydralazine that can lead to clinical deficiency states  WATER SOLUBLE VITAMINS Vitamin B Vitamin B3 Deficiency Carcinoid syndrome can exist when serum blood tryptophan levels are low due to increased serotonin synthesis from tumors  WATER SOLUBLE VITAMINS Vitamin B Vitamin B3 Deficiency Hartnup disease Rare genetic disorder that is characterized by decreased absorption of tryptophan with similar symptoms to those of pellagra  WATER SOLUBLE VITAMINS Vitamin B Biotin Roles Coenzyme in metabolism that functions in the tricarboxylic cycle for release of energy Involved in gluconeogenesis  WATER SOLUBLE VITAMINS Vitamin B Biotin Dietary sources: Liver, kidney, meat, tomatoes, and egg yolk Handling and preparation losses are seen with heat  WATER SOLUBLE VITAMINS Vitamin B Biotin Recommendations Allowable intake: 30 ug/day for both male and female  WATER SOLUBLE VITAMINS Vitamin B Biotin Deficiency Excess Large number of No toxic effects eggwhites in the diet reported Px with No UL has been Phenylketonuria indicated Long term TPN Protein energy malnutrition Biotindase deficiency  WATER SOLUBLE VITAMINS Vitamin B Biotin Deficiency Phenylketonuria Leads to functional biotin deficiency because high phenylalanine levels inhibit enzyme activity  WATER SOLUBLE VITAMINS Vitamin B Biotin Deficiency Biotindase deficiency Genetic disorder that leads to clinical deficiency state resulting in delayed development, seizures, and rashes, fatal without biotin correction  WATER SOLUBLE VITAMINS Vitamin B Vitamin B5 -Panthothenic acid Roles Coenzyme in metabolism that functions in the tricarboxylic cycle for release of energy Involved in gluconeogenesis  WATER SOLUBLE VITAMINS Vitamin B Vitamin B5 -Panthothenic acid Roles Coenzyme in the formation of coenzyme A Involved in fat, cholesterol and heme formation and amino acid activation  WATER SOLUBLE VITAMINS Vitamin B Vitamin B5 -Panthothenic acid Dietary Sources Found in whole grain cereals and legumes Animal tissues Handling and preparation losses are seen with heat and acid conditions  WATER SOLUBLE VITAMINS Vitamin B Vitamin B5 -Panthothenic acid Recommendations No established RDA AI is 5 mg/day for both male and female  WATER SOLUBLE VITAMINS Vitamin B Vitamin B5 -Panthothenic acid Deficiency Deficiency Fatigue, paresthesias, Fatigue, paresthesias, weakness, and leg weakness, and leg cramps cramps Neurological Neurological manifestations manifestations (restlessness and (restlessness and irritability) irritability) Burning feet syndrom Burning feet syndrome  WATER SOLUBLE VITAMINS Vitamin B Vitamin B5 -Panthothenic acid Deficiency Excess Fatigue, paresthesias, Diarrhea can occur with weakness, and leg excess levels of this cramps vitamin Neurological manifestations Fluid retention can (restlessness and occur with excess levels irritability) of this vitamin Burning feet syndrome  WATER SOLUBLE VITAMINS Vitamin B Vitamin B5 Deficiency Burning feet syndrome Seen in malnourished clients  WATER SOLUBLE VITAMINS Vitamin B Vitamin B6 -Pyridoxine Roles Coenzyme in amino acid, lipid and protein metabolism (gluconeogenesis), erythrocyte function, modulation of hormones Made by intestinal bacteria in the body  WATER SOLUBLE VITAMINS Vitamin B Vitamin B6 -Pyridoxine Dietary sources Pork, organ meat, whole grains, wheat germ, fortified cereals Handling and preparation losses are seen with heat and storage (low bioavailability)  WATER SOLUBLE VITAMINS Vitamin B Vitamin B6 -Pyridoxine Recommendations RDA for male and female clients up to age 50 is 1.3 mg/day Male above 50: 1.7 mg/day Female above 50: 1.5 mg/day  WATER SOLUBLE VITAMINS Vitamin B Vitamin B6 -Pyridoxine Deficiency states Clients taking oral contraceptives, Clinical deficiency symptoms as vitamin antagonist and clients with neurological deficits (depression, alcoholism confusion, headache, fatigue, nerve Drug interactions with INH, damage) and dermatologic lesions (scaly hydralazine, dopamine and dermatitis) and microcytic anemia penicillamine (vitamin antagonists) Peripheral Neuropathy Deficiency usually exists with other B Increase in serum homocysteine vitamin deficiencies levels (cardiac disease)  WATER SOLUBLE VITAMINS Vitamin B Vitamin B6 -Pyridoxine Excess states Imposed peripheral neuropathy in high doses (2-6 g/day) UL of 100 mg/day to prevent nerve impairment  WATER SOLUBLE VITAMINS Vitamin B Folic Acid Roles Used in the synthesis of DNA and helps convert Vit.B12 to a coenzyme form in the body Growth and development of RBCs Increased need is seen during pre pregnancy and antenatal periods for its effect on preventing neural tube defects and allowing normal spinal cord development Folic acid in the body goes through the enterohepatic circulation to be regulated Vitamin C enhances folic acid conversion in the body  WATER SOLUBLE VITAMINS Vitamin B Folic Acid Dietary Sources Orange juice, liver, green leafy vegetables and fruit Enriched breads and cereals with fortification lead to improved bioavailability Handling and preparation losses are seen with exposure to heat and light  WATER SOLUBLE VITAMINS Vitamin B Folic Acid Recommendations RDA for male and female clients is 400 ug/day measured in DFEs (dietary folate equivalents) Increased folic acid is needed up to 400 ug/day during pregnancy and lactation  WATER SOLUBLE VITAMINS Vitamin B Folic Acid Deficiency Excess Neural tube defects Drug interaction with Nutritional anemia: megaloblastic phenytoin anemia Malabsorptive states seen in celiac UL is 100 ug/day disease, Chron’s disease, ulcerative colitis and in clients with alcoholism Increased risk of cancer Deficiency exists in the presence of other B vitamin deficiencies  WATER SOLUBLE VITAMINS Vitamin B Folic Acid Deficiency Neural tube defects Associated with folic acid deficiency in pregnant women and result in spinal deformities of the fetus  WATER SOLUBLE VITAMINS Vitamin B Folic Acid Deficiency Megaloblastic anemia Large immature cells with a decreased oxygen-carrying capacity This can occur due to impaired DNA synthesis  WATER SOLUBLE VITAMINS Vitamin B Folic Acid Deficiency Aminosalicylic acid, Corticosteroids and oral phenytoin, sulfonamides and contraceptives lead to trimethoprim can lead to increased folic acid decreased absorption of folic requirements that can lead to acid deficiency  WATER SOLUBLE VITAMINS Vitamin B Folic Acid Deficiency AFP (Alpha feto protein) is used as a biochemical marker for correlation of presence of neural tube defects and certain cancers in the body  WATER SOLUBLE VITAMINS Vitamin B Vitamin B12 -cobalamin/cyanocobalamin Roles Coenzyme in the synthesis of hemoglobin, RBCs and DNA Intrinsic factor is secreted by the parietal cells in the stomach that allows the vitamin to be absorbed into the intestine Extrinsic factor is vitamin B12 itself  WATER SOLUBLE VITAMINS Vitamin B Vitamin B12 -cobalamin/cyanocobalamin Dietary Sources Found in animal sources such as eggs, milk, meat and cheese and fortified cereals Vegetarians need fortified sources Handling and preparation losses are seen with heat, light, air and vitamin C exposure  WATER SOLUBLE VITAMINS Vitamin B Vitamin B12 -cobalamin/cyanocobalamin Recommendation RDA for male and female clients is 2.4 u/day Increased needs are seen in growth states, renal and liver disease, hemorrhage and malignancy  WATER SOLUBLE VITAMINS Vitamin B Vitamin B12 -cobalamin/cyanocobalamin Deficiency Excess Pernicious anemia Acute liver diseae Leukocytosis Strict vegetarian diets Gastric surgery Symptoms: smooth beefy red tongue, fatigue, weakness, numbness, tingling, and neuro abnormalities that leads to neuropathy  WATER SOLUBLE VITAMINS Vitamin B Vitamin B12 -cobalamin/cyanocobalamin Pernicious anemia Due to deficiency of intrinsic factor Schilling Test 24 hour urine with radioisotope injection – can be used to check absorption and vitamin B12 levels in the body  WATER SOLUBLE VITAMINS Vitamin B Vitamin C  WATER SOLUBLE VITAMINS Vitamin C -Ascorbic acid Roles Antioxidant function Synthesis of neurotransmitters, hormones, and bile acids, metabolism of amino acids and breakdown of fatty acids Enhances folic acid conversion and iron absorption Structural component involved in collagen formation in the body  WATER SOLUBLE VITAMINS Vitamin C -Ascorbic acid Dietary sources Found in citrus fruits and green vegetables Potatoes are an excellent source of Vitamin C Handling and preparation losses are seen with heating, contact with cooking surfaces containing iron, alkaline solutions  WATER SOLUBLE VITAMINS Vitamin C -Ascorbic acid Recommendations RDA for males is 90 mg/day RDA for females is 75 mg/day Increased needs are seen in growth states  WATER SOLUBLE VITAMINS Vitamin C -Ascorbic acid Deficiency Scurvy Clients with chronic inflammatory diseases and cancers Mouth presentations (bleeding gums) Drug interactions (Aspirin, OTC meds) leads to decreased vitamin C levels  WATER SOLUBLE VITAMINS Vitamin C -Ascorbic acid Excess Clients with Hx of kidney stone formation should not increase Vitamin C Clients with Iron Overload syndromes Dental erosion Hx of clinical gout Sickle cell anemia Clients taking warfarin and heparin Toxicity: diarrhea, nausea, abdominal cramps, hot flashes, rashes headache  WATER SOLUBLE VITAMINS Vitamin C -Ascorbic acid Minimum of 10 mg/day is needed to prevent clinical symptoms of scurvy  WATER SOLUBLE VITAMINS Vitamin B Vitamin C