AIMST MBBS Micronutrients PDF

AIMST UNIVERSITY FACULTY OF MEDICINE Bachelor of Medicine and Bachelor of Surgery (MBBS) INTRODUCTION TO BASIC SCIENCES L49 IMPORTANCE OF MICRONUTRIENTS IN HUMAN HEALTH 10 20. 9. 2023 Prof. Dr. Abd. Rahman Md. Said AIMST University Faculty of Medicine, MBBS 1 Learning Objectives • • • • • Upo...

AIMST UNIVERSITY FACULTY OF MEDICINE Bachelor of Medicine and Bachelor of Surgery (MBBS) INTRODUCTION TO BASIC SCIENCES L49 IMPORTANCE OF MICRONUTRIENTS IN HUMAN HEALTH 10 20. 9. 2023 Prof. Dr. Abd. Rahman Md. Said AIMST University Faculty of Medicine, MBBS 1 Learning Objectives • • • • • Upon completion of this lesson, students will be able to: List micronutrients essential to humans. Explain how specific micronutrients function . List reasons why vitamins and minerals are critical to a healthy diet. Associate deficiency of a micronutrient with a specific outcome. Identify various micronutrient deficiencies by examining and analysing symptoms. 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 2 1. 2. 3. 4. 5. Learning outcomes At the end of this session the student would be able to: Define 'micronutrient' and explain the types and benefits of micronutrients. list examples of micronutrients and their classification. Explain micronutrient functions at physiologic and organ/system levels and comment on how functions relate to development, health and prevention of chronic disease. Describe manifestations of micronutrient deficiency and excess that could compromise health of specific conditions such as pregnancy, lactation, and older age. Summarize risks for micronutrient deficiency or excess, and identify risks that are common to multiple micronutrients vs. those that are unique to single micronutrients. . Loading… 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 3 ↑ 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 4 Loading… Micronutrients includes: • vitamins water- and fat-soluble vitamins • minerals macrominerals and trace minerals. 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 5 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 6 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 7 Vitamin A • Pro-vitamin (beta carotene) converted to Pre-formed vitamin (retinol) in the intestinal mucosa. Many of the functions are hormones-like (interact with DNA). • Vitamin A has several functions: • Precursor of rhodopsin, needed for vision lights. • Maintaining healthy immune system • Regulates growth and development, especially skeletal growth. • Protect against some epithelial cancers (eg. bronchial cancers). • Assists in maintaining healthy skin and the linings and coverings of tissues • Necessary for maintaining integrity and normal function of glandular and epithelial tissue which lines intestinal , respiratory and urinary tracts as well as the skin and eyes. 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 8 • • • • • Vitamin A Deficiency led to: Nightblindness; Conjunctival xerosis; Bigot's spots; Corneal xerosis; Keratomalacia Common sign of vitamin A deficiency is xerophthalmia - the inability to see in low light, and it can lead to blindness if untreated. A long-term deficiency of vitamin A can lead to a higher risk of respiratory diseases and infections. It can also cause anemia, increase risk for hip fracture in postmenopausal women, lung cancer, cardiovascular mortality. Excessive vitamin A supplementation can cause: severe headache, blurred vision, nausea, dizziness, muscle aches, and problems with coordination. Excessive Vitamin A while pregnant, it can cause birth defects including abnormal eyes, skull, lungs, and heart. 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 9 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 10 Loading… 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 11 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 12 Functions of vitamin D • Intestine: Promotes intestinal absorption of calcium and phosphorus • Bone: Stimulates normal mineralization, Enhances bone reabsorption, Affects collagen maturation • Kidney: Increases tubular reabsorption of phosphate • Vitamin D and calcium are essential for bone metabolism and maintaining bone health. • Essential for fracture healing process, bone remodelling and skeletal integrity. Deficiencies can contribute to complications and traumatic bone loss. • Deficiency of vitamin D leads to Rickets and Osteomalacia • Vitamin D is required for muscle, nerve and immune system functions. 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 13 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 14 Vitamin E Consists of a group of eight compounds: α-, β-, γ-, δ-tocopherols and α-, β-, γ-, δ-tocotrienols; synthesised from homogenestic acid. 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 15 Vitamin E Functions • Vitamin E is an essential lipid-soluble antioxidant. • Antioxidant efficacy of δ- and γ-tocopherol are more potent than αtocopherol. • Assists immune function and acts as an antioxidant protects against cellular damage. • The antioxidant properties are exerted through its phenolic hydroxyl group, which donates hydrogen to peroxyl radicals, resulting in the formation of stable lipid species. • γ-tocopherol trap membrane-soluble electrophilic NO and other mutagens, inhibiting damage by rNOS. • Play important roles in cellular signalling. • regulates signal transduction cascades at the mRNA and miRNA level. 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 16 Vitamin K metabolism • Involved in energy metabolism; in vitamin K-dependent enzymes; required for blood clotting; proper bone development; • Deficiency caused by liver, pancreatic disease, celiac disease, malabsorption condition and bleeding disorders. • Signs and symptoms include nosebleeds, easy bruising, broken blood vessels, bleeding gums, and heavy menstrual bleeding in women. • Warfarin action is affected by Vitamin K intake, by competitively inhibits the epoxide reductase. • Prothrombin needed for blood clotting is vitamin K-dependent. • Osteocalcin requires vitamin K to produce healthy bone tissue. 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 17 Vitamin K1,K2,K3 Cofactor for prothrombin synthesis. Required for generation of clotting factors. Deficiency led to hypoprothrombinemia and deficiency in Factor VII resulting in hemorrhagic disease in newborn. Vitamin K1,K2,K3 Cheese 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 18 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 19 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 20 The water-soluble vitamins are not stored in body and get flushed out with urine when consumed in excess. Each has a unique role, act as coenzymes in many metabolic reactions. They are essential for every aspect of brain and energy metabolism. 20. 9. 2023 Water-Soluble Vitamins AIMST University Faculty of Medicine, MBBS 21 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 22 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 23 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 24 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 25 Vitamins B Complex Family 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 26 B Vitamin Function Deficiency: Signs and Symptoms Thiamine Coenzyme: for energy metabolism, synthesis of ribose for nucleotides and ATP. Beriberi: fatigue, confusion, movement impairment, swelling, heart failure B2 Riboflavin Coenzyme: assists in glucose, fat and carbohydrate metabolism, electron carrier, other B vitamins are dependent on Ariboflavinosis: dry scaly skin, mouth inflammation and sores, sore throat, itchy eyes, light sensitivity B3 Niacin Coenzyme: assists in glucose, fat, and protein metabolism, electron carrier Pellagra: diarrhea, dermatitis, dementia, death B5 Pantothen ic Acid Coenzyme: assists in glucose, fat, and protein metabolism, cholesterol, and neurotransmitter synthesis Muscle numbness and pain, fatigue, irritability B6 Pyroxidin e Coenzyme; assists in amino-acid synthesis, glycogenolysis, neurotransmitter and hemoglobin synthesis Muscle weakness, dermatitis, mouth sores, fatigue, confusion B7 Biotin Coenzyme; assists in glucose, fat, and protein metabolism, amino-acid synthesis Muscle weakness, dermatitis, fatigue, hair loss B1 B9 B12 Folate Cobalami n9. 2023 20. Coenzyme; amino acid synthesis, RNA, DNA, and red blood cell synthesis Coenzyme; fat and protein catabolism, folate function, RBC &AIMST DNA synthesis University Faculty of Medicine, MBBS Diarrhea, mouth sores, confusion, anemia, neural-tube defects Muscle weakness, sore tongue, anemia, nerve damage, neural-tube defects 27 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 28 Loading… 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 29 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 30 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 31 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 32 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 33 -B 9 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 34 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 35 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 36 Macrominerals Macromineral s Functions Calcium Necessary for proper structure and function of bones and teeth. Assists in muscle function and blood vessel contraction Phosphorus Part of bone and cell membrane structure Magnesium Assists with over 300 enzyme reactions, including regulation of blood pressure. Sodium Electrolyte that aids fluid balance and maintenance of blood pressure. Chloride Often found in combination with sodium. Helps maintain fluid balance and is used to make digestive juices Potassium Electrolyte that maintains fluid status in cells and helps with nerve transmission and muscle function. Sulphur Part of every living tissue and contained in the amino acids methionine and cysteine. 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 37 Micromineral s Functions Trace Minerals Iron Helps provide oxygen to muscles and assists in the creation of certain hormones. Manganese Assists in carbohydrate, amino acid and cholesterol metabolism Copper Required for connective tissue formation, as well as normal brain and nervous system function. Zinc Necessary for normal growth, immune function and wound healing. Iodine Assists in thyroid regulation. Fluoride Necessary for the development of bones and teeth. Selenium Important for thyroid health, reproduction and defense against oxidative damage. 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 38 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 39 Iron • Iron is critical for motor and cognitive development. Children and pregnant women are especially vulnerable to the consequences of iron deficiency. • Iron deficiency is a leading cause of anemia which is defined as low hemoglobin concentration. Anemia affects 40% of children younger than 5 years of age and 30% of pregnant women globally. • Anemia during pregnancy increases the risk of death for the mother and low birth weight for the infant. Worldwide, maternal and neonatal deaths total between 2.5 million and 3.4 million each year. • Babies fed only breast milk, only formula, or a mix of breast milk and formula have different needs when it comes to iron. 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 40 Iron and Nutritional Anaemia • The most common nutritional cause of anaemia is iron deficiency, although deficiencies in folate, vitamins B12 and A are also important causes. • Iron deficiency anemia arises when the balance of iron intake, iron stores, and the body's loss of iron are insufficient to fully support production of erythrocytes. • Iron deficiency anemia rarely causes death, but the impact on human health is significant. • Iron proteins: superoxide dismutase, ribonucleotide reductase, ferritin), iron-sulfur proteins, aconitase and heme proteins (hemoglobin). 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 41 Iodine • Iodine is required during pregnancy and infancy for the infant’s healthy growth and cognitive development. • Globally an estimated 1.8 billion people have insufficient iodine intake. • Iodine content in most foods and beverages is low. • Fortifying salt with iodine is a successful intervention – about 86% of households worldwide consume iodized salt. The amount of iodine added to salt can be adjusted so that people maintain adequate iodine intake even if they consume less salt. • It is recommend that pregnant or breastfeeding women take a supplement every day containing 150 micrograms of iodine. • Women who are planning a pregnancy is recommended to consume a daily iodine supplement starting at least 3 months in advance of 20. 9. 2023 AIMST University Faculty of Medicine, MBBS pregnancy. 42 Zinc • Zinc promotes immune functions and helps people resist infectious diseases including diarrhea, pneumonia and malaria. Zinc is also needed for healthy pregnancies. • Globally, 17.3% of the population is at risk for zinc deficiency due to dietary inadequacy; up to 30% of people are at risk in some regions of the world. • Providing zinc supplements reduces the incidence of premature birth, decreases childhood diarrhea and respiratory infections, lowers the number of deaths from all causes, and increases growth and weight gain among infants and young children. • Providing zinc supplementation to children younger than 5 years appears to be a highly cost-effective intervention in low- and middle-income countries. 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 43 SUMMARY: FUNCTIONS OF SELECTED MICRONUTRIENTS Micronutrients Metabolic Functions Vitamin C as antioxidant and maintain immune system Vitamin B12 for proper nerve function and synthesis of Hb in blood. Vitamin A required for vision, immunity, and healthy skin Vitamin D calcidiol and calcitriol for bone osteoblastic activities ; healthy immune function Vitamin E an antioxidant and protect against cellular damage Vitamin K needed to form blood clots and to shuttle calcium into bone Iron/ Ferrum required for oxygen transport Calcium needed for muscle contraction and bone formation Magnesium regulates muscle contraction and nerve transmission; form teeth and bones and needed in over 300 metabolic reactions Potassium needed for muscle contraction, proper nerve conduction, and maintenance of fluid AIMST University Faculty of Medicine, MBBS 44 and electrolyte balance 20. 9. 2023 SUMMARY: DEFICIENCIES DISORDERS OF SELECTED VITAMINS 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 45 List of major disorders due deficiencies of essential minerals and vitamins: Vitamins / Minerals Deficiency Diseases A (Retinol) Night blindness B1 (Thiamine) Beri-beri B2 (Riboflavin) Retarded growth, bad skin B12 (Cyanocobalamin) Anaemia C (Ascorbic acid) Scurvy D (Calciferol) Rickets K (Phylloquinone) Excessive bleeding due to injury Types of Minerals Deficiency Diseases Calcium Brittle bones, excessive bleeding Phosphorus Bad teeth and bones Iron Anaemia Iodine Goitre, enlarged thyroid gland Copper Low appetite, retarded growth 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 46 THANK YOU References: 1. 2. 3. 4. 5. 6. Guyton and Hall. Textbook of Medical Physiology, 3th edition (2015). Elsevier Health Sciences. John P. Bilezikian, Robert Marcus, Michael A. Levine, Claudio Marcocci, Shonni J Silverberg and John T. Potts; The Parathyroids: Basic and Clinical Concepts (Third Edition) . ISBN: 9780-12-397166-1 Kraemer K, , Badham J, Christian P, Hyun Rah J, eds. Micronutrients; macro impact, the story of vitamins and a hungry world external icon. Sight and Life Press; 2015. World Health Organization. e-Library of evidence for nutrition actions external icon. Accessed June 18, 2021. Fairfield KM. Vitamin supplementation in disease prevention. Seres D, ed. Waltham, MA: UpToDate. http://www.uptodate.com. Accessed December 7, 2018: 2020. Nutr J. 2021; 20: 55. Published online 2021 Jun 15. doi: 10.1186/s12937-021-00708-2 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 47 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 48 20. 9. 2023 AIMST University Faculty of Medicine, MBBS 49