Lectures Notes In Medical Biochemistry & Nutrition PDF 2022-2023

‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪-1-‬‬ ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ...

‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪-1-‬‬ ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Items Page  Introduction 1- 7  Carbohydrates 8-18  Quiz 1 19  Lipids 2022/2023 2022/2023 20- 32 2022/2023  Quiz 2 33  Proteins 34- 45  Vitamins 46- 57  Minerals 58- 69 30511211602499 30511211602499 30511211602499 -2- ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪-3-‬‬  Medical Biochemistry & Nutrition ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ 1.Biochemistry Biochemistry is the science concerned with the various molecules that occur in living cells and organisms and their chemical reactions. The main components of living organism are: 1. Water 2. Organic compounds  Carbohydrates and their derivatives. 2022/2023 Lipids and their derivatives.2022/2023 2022/2023  Protein and amino acids. 3.Inorganic constituents (Minerals)  Bulk or main elements: that includes seven principal mineral elements: calcium, phosphorus, sodium, potassium, chlorine, iron and sulphur.  Trace elements: that includes iodine, copper, zinc, cobalt, selenium and manganese, which are needed in micro amounts. Water Water constitutes about 70% of the30511211602499 30511211602499 body weight of adults. 30511211602499 Biochemical importance of water: 1- It acts as an excellent solvent inside the body. 2- It is very important for regulation of body temperature. 3- It is suitable medium for the different metabolic pathways. 4- Many waste products are excreted as soluble form in water. -4-  5- It enters in the processes of digestion of foods by digestive enzymes. Severe dehydration is dangerous hence; death happens if about ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ 20 % of the body water is lost. 2022/2023 2022/2023 2022/2023 Maintenance of water balance  For the body to remain in water balance: Water gain should be equal to water loss. Water gain Water loss  Water and other fluids taken  Urine: about 1 liter/day. (about 1200 ml/day)  Faeces (stool), about 100  Water of foods ml/day. (about 100 ml/day). 30511211602499  Sweat and expired air: 30511211602499 600- 30511211602499  Metabolic water 1000 ml/day. (about 500 ml/day), produced from metabolic processes.  If water gain exceeds water loss, this leads to overhydration and oedema.  If water loss exceeds water gain, this leads to dehydration. -5-  2. Nutrition Nutrition is the science dealing with nutrient composition, ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ eating habits and nutritional status. Nutrients types: 1. Macronutrients are those nutrients that provide energy. They include Carbohydrates, lipids and proteins. Energy is expressed as calorie or kilocalories (kcal). 2. Micronutrients are nutrients that are required in small quantities for survival. They include vitamins and minerals 2022/2023 2022/2023 2022/2023 Nutrients requirements:  Age: nutrients requirements vary from infancy to adulthood. For example, adults require about 0.8 gram of protein per kg body weight, whereas infants need over 2.0 grams per kg body weight per day.  Sex: nutrients requirements for men are approximately 20% Greater than those for women. This is due to the larger body mass of men. The iron requirement is an exception, because women must replace iron lost during menstruation. 30511211602499 30511211602499 30511211602499  Other factors: a) Pregnant and lactating women: need about 20-30% of most nutrients above normal individuals. b) Patients with injury or illness: show also an increased requirement for some nutrients. -6-  Adequacy of diet: Adequate diet should be balanced in verities and amounts and designed to maintain optimal health and to prevent chronic ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ diseases. Balanced (Adequate) diet should contains:  Water: The most critical component of the diet.  Energy: Supplied by utilization of carbohydrates, lipids and proteins in variable proportions.  Amino acids: a) Essential amino acids that cannot be formed in the body so it must be supplied in diet. b) Non-essential amino acids are needed by the body but they 2022/2023 2022/2023 2022/2023 can be formed in the body.  Fatty acids: Essential fatty acids that cannot be formed in the body so it must be supplied in diet.  Vitamins: a) Water soluble vitamins: Vitamin C and Vitamin B complex b) Fat soluble vitamins: vitamin A, vitamin D, vitamin K& vitamin E.  Minerals: a) Bulk or main elements: that includes seven principal mineral elements. b) Trace elements: which are needed 30511211602499 in micro amounts 30511211602499 30511211602499  Fibers: Required for optimal health. -7- ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪-8-‬‬  Carbohydrates ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Definition:  Carbohydrates are organic compounds which contain carbon, hydrogen and oxygen. H and O are being in the same proportion as in water. Classification of carbohydrates: Carbohydrates are classified into three classes:  Monosaccharaides: They are the simplest unit of carbohydrate, contain one sugar unit  Oligosaccharides contain 2-10 sugar units  Polysaccharides contain More than 2022/2023 2022/2023 10 Sugar units 2022/2023 Monosaccharaides  Definition: They are the simplest carbohydrates, contains only one sugar unit.  Classification: Monosaccharaides are classified according to the number of carbon atoms present: 1) Trioses: Monosaccharaides which 30511211602499 contain three carbon atoms. 30511211602499 30511211602499 2) Tetroses: Monosaccharaides which contain four carbon atoms. 3) Pentoses: Monosaccharaides which contain five carbon atoms. 4) Hexoses: Monosaccharaides which contain six carbon atoms e.g. Glucose, Fructose, Galactose & Mannose. -9-  Biochemical importance of hexoses: 1) Glucose: Glucose is the sugar of grape. It is the sugar of blood. It is the principle sugar that is utilized by the tissues ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ giving CO2, H2O and energy. Glucose is stored in the body as glycogen. 2) Fructose: It present in fruit juices and honey, Fructose is the sugar of fetal blood& seminal fluid. 3) Galactose: is present in combination with glucose in milk sugar (Lactose). 4) Mannose: occurs in Mucoproteins Oligosaccharides These 2022/2023sugars are formed by condensation 2022/2023 of two to ten molecules 2022/2023 of monosaccharaides - Disaccharides are the most important group. Disaccharides They are formed by condensation of 2 monosaccharaides. Structure Importance Lactose 1 Galactose + 1Glucose Milk Sugar Sucrose 1Glucose + 1 Fructose Cane sugar, beet sugar or table sugar 30511211602499 30511211602499 30511211602499 Maltose 1Glucose + 1 Glucose produced during digestion of cooked starch by salivary amylase - 10 -  Polysaccharides They are composed of a great number of monosaccharide units (more than 10 sugar units) attached together ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ A-Homopolysaccharides B-Heteropolysaccharides Contain only one type of sugar Contain different Sugars Examples: starch, glycogen, Examples: gums, pectin and cellulose, dextrins, dextrans, mucopolysaccharides and agar-agar A- Homopolysaccharides: 2022/2023 2022/2023 2022/2023 These are polysaccharides contain similar sugar units. 1) Starch : - Starch is the main carbohydrate of food. - It is the main storage from of carbohydrates in plants. - It exists in cereals (e.g. rice, barley, maize and wheat) and in roots and tubers (e.g. potatoes and sweat potatoes). Starch never present in animals. - Starch granule is formed of : 30511211602499 a-Amylose: This forms the inner layer of granule. 30511211602499 30511211602499 It is formed of straight chain of glucose units attached together. b- Amylopectin: This forms the outer layer of the granule. It is formed of branched chains of glucose units - 11 - ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ 2) Glycogen: - Glycogen is the main storage from of carbohydrates in animals (Sometimes called animal starch). - It is stored in liver and muscles. It is formed of branched chains of glucose units - Differences between liver & muscle glycogen: 2022/2023 2022/2023 2022/2023 Liver glycogen Muscle glycogen Amount 120 grams 350 grams Function General store of glucose Private store of energy for all body cells for muscles only Sources Glucose, hexoses and Blood glucose only Glucogenic amino acids Fate Blood glucose Lactic acid In starvation It is broken rapidly to No affected 30511211602499 glucose 30511211602499 30511211602499 Muscular No affected Consumes muscle exercise glycogen. - 12 - ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ 3) Cellulose: - Cellulose constitutes the walls of plant cells. - Cellulose is not digested - However cellulose is important in our diet for preventing constipation i.e. increases the bulk of the stools so stimulates the large intestine contraction for act of defecation. 2022/2023 2022/2023 2022/2023 4) Dextrins: - They are produced during enzymatic hydrolysis of starch by salivary amylase or pancreatic amylase enzymes. - They include amylodextrin , erythrodextrin and achrodextrin. 5) Dextrans: - It used as plasma substitute to increase blood volume after severe hemorrhage. 6) Agar-agar: - Agar agar is a polysaccharide formed 30511211602499 of galactose. 30511211602499 30511211602499 - It is prepared from sea weeds. - It is use as a culture medium for growing of bacteria in bacteriological studies. B- Heteropolysaccharides These are polysaccharides contain different sugar units. - 13 -  1) Gums: - Gums are heteropolysaccharides derived from plants - They consist of a mixture of hexoses, pentoses & sugar ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ acids 2) Pectins: - Pectins are heteropolysaccharides occurred in fruits - They are responsible for the gelling properties of jams. - They are used in the treatment of infantile diarrhea. 3) Mucopolysaccharides - They enter in the structure of most tissues and are not oxidized to give energy. 2022/2023 2022/2023 2022/2023 - The most important members are: *Mucoitin sulphate * Chondritin sulphate * Hyaluronic acid * Heparin Normal Blood Glucose Levels Fasting blood level Range from 65 -110 mg/dl Two hours after meal Range from 100-140 mg/dl Metabolic abnormalities of glucose level 30511211602499 30511211602499 30511211602499 Hypoglycemia Definition: Blood glucose level equal to or less than 65 mg/dl. Hypoglycemia is a medical emergency because the central nervous system (CNS) has an absolute requirement for a continuous supply of glucose to serve as fuel for energy metabolism. - 14 -  Effect of hypoglycemia: A. Hypoglycemia causes cerebral dysfunction (as brain and nervous tissue are dependent on glucose as a source of energy). ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ B. If hypoglycemia is severe and prolonged, it causes coma (hypoglycemic coma) and then death. Symptoms of hypoglycemia: A. Adrenergic symptoms (that is, symptoms mediated by elevated epinephrine) anxiety, palpitation, tremors and sweating and hunger. B. Symptoms due to impaired glucose supply to the brain Impairment of brain functions as 2022/2023 2022/2023 headache, confusion, slurred 2022/2023 speech, coma and death. Causes of hypoglycemia: 1- Insulin-induced hypoglycemia: Hypoglycemia occurs in patients with diabetes receiving insulin treatment without eating. 2- Fasting hypoglycemia: Often seen in patients with liver damage. Hyperglycemia Definition: 30511211602499 It is the rise of blood30511211602499 glucose level above normal 30511211602499 average level. Causes of hyperglycemia: 1- Diabetes mellitus 2- Sever stress 3- Patient receiving intravenous fluid containing glucose. - 15 -  Diabetes Mellitus Definition: Diabetes mellitus characterized by hyperglycemia that is caused by ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ a relative or absolute deficiency of insulin. Biochemical disturbances in diabetes mellitus:  Polyphagia (Excessive eating)  Glycosuria (Glucose appears in urine) & polyuria (Frequent urination)  Polydepsia (thirst sensation)  Muscle wasting  Repeated infection  Loss of weight 2022/2023 2022/2023 2022/2023  Poor wound healing  Hyperlipidemia gives atherosclerosis Change in blood glucose level in diabetes mellitus Fasting blood glucose Two hours postprandial Normal 65 -110 mg/dl 100-140 mg/dl Impaired glucose 30511211602499 110- 126 mg/dl 140- 200 mg/dl 30511211602499 30511211602499 utilization Diabetes Mellitus 126 mg/dl 200 mg/dl Types of diabetes: It can be classified into two groups: Type 1 and Type 2 Diabetes - 16 -   Type 1 Diabetes  The disease is characterized by an absolute deficiency of insulin caused by an autoimmune attack on the cells of the ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ pancreas.  This destruction requires a stimulus from the environment (such as a viral infection).  Type 1 diabetics must take exogenous insulin to control hyperglycemia  Type 2 Diabetes  It has a strong genetic component.  Results from a combination of insulin resistance and dysfunctional cells.  Insulin resistance is the decreased 2022/2023 2022/2023 ability of receptors2022/2023 in target tissues to respond properly to normal circulating level of insulin. Obesity is the most common cause of insulin resistance.  The long-standing elevation blood glucose causes the chronic complications in the form of atherosclerosis, retinopathy, nephropathy, and neuropathy.  Available treatments (diet, exercise, oral hypoglycemic drugs & insulin) Complications of Diabetes Mellitus 30511211602499 30511211602499 30511211602499 Acute complications: diabetic ketoacidosis, hyperosmolar hyperglycemic coma, and hypoglycemia Chronic complications: atherosclerosis, retinopathy, nephropathy and neuropathy. - 17 -  Type 1 Diabetes Type 2 Diabetes Prevalence 10–20% of diabetics 80–90% of diabetics ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Age of onset It often begins in It often begins after age 35 childhood (Young). (Old). Genetic Moderate Very strong predisposition Nutritional status Frequently thin Most patients with this at onset of type of diabetes are obese diabetes Defect or β- cell destruction leading Insulin resistance with 2022/2023 2022/2023 2022/2023 deficiency to absolute insulin relative insulin deficiency deficiency Treatment with Necessary Not required insulin Treatment with No response Responsive oral hypoglycemic drugs 30511211602499 30511211602499 30511211602499 - 18 - ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪- 19 -‬‬ ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪- 20 -‬‬  Lipids ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Definition: These are organic compounds insoluble in water and soluble in fat solvents (e.g. ether, benzene, alcohol). Biochemical importance of lipids: * In diet: 1. Fats are the richest source of energy. 2. Fats provide the body with the essential fatty acids. 3. Fats provide the body the fat-soluble vitamins. 2022/2023 2022/2023 2022/2023 * In the body: 1. Fat in the adipose tissue is an important storage form of energy (one-gram fat produces about 9 Kilocalories). 2. Fat supports some important internal organs e.g. kidney. 3. Fat provides the body with 7-dehydrocholesterol which is converted into vitamin D3 by exposure of skin to U.V light of sun. 30511211602499 4. Fat acts as heat insulator for 30511211602499 30511211602499 protection the body against loss of heat. 5. Fat act as electrical insulator allowing nerve impulses propagation. 6. Fat enters in the structure of cell membranes. - 21 -  Body fats ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Tissue fat Depot fat It is constant It is variable Not affected by starvation. Affected by starvation. Never oxidized to give energy. Oxidized to give energy It is present in every cell and in Fats which are stored in the body cell membrane. in the adipose tissues.  Under the skin. 2022/2023  Around 2022/2023 the important organs 2022/2023 such as kidney. It is composed from: cholesterol, - Adipose tissues have a white phospholipids and small amount color of triglycerides It is composed of triglycerides mainly and small amount of cholesterol and phospholipids. N.B: Sources of depot fat:  Absorbed fat (From diet). 30511211602499 30511211602499 30511211602499  From carbohydrate by a process known as lipogenesis. - 22 -  Fatty acids Definition: Fatty acids are monocarboxylic acids. (R-COOH) ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Classification:  Depending on the Chain Length Short Chain Fatty Acid (C2–C6) Medium 2022/2023 Chain Fatty Acid (C8–C14)2022/2023 2022/2023 Long Chain Fatty Acid (≥ C16).  According to Saturation (presence of double bonds) into: 1) Saturated fatty acids: They contain no double bonds. As: Plamitic acid (16C) Stearic acid (18C) 2) Unsaturated fatty acids: They contain double bonds and are classified into 2 groups:  Monounsaturated fatty acids: 30511211602499 which contain only 30511211602499 30511211602499 one double bond. As: Palmitoleic acid (16C) Oleic acid (18C) Contain one double bonds between C 9−10  Polyunsaturated fatty acids: they contain more than one double bond. As: Linoleic acid: (18C) contains two double bonds between - 23 -  C9−10 and C12−13 Linolenic acid: (18C) contains three double bonds between C9−10&C12−13&C15−16 ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ 2022/2023 2022/2023 2022/2023  According nutritional value into: 1. Essential fatty acids They are considering as essential as the human body cannot synthesize them, accordingly they must be taken in the diet. They include all polyunsaturated fatty acids Sources: Plant oils e.g. corn oil, soya bean oil, sunflower, 30511211602499 30511211602499 30511211602499 Fish oils: shark liver oils 2. Nonessential fatty acids: These are fatty acids which can be synthesized in the body. Thus they are not necessary to be obtained from the diet. - 24 -  They include all saturated and monounsaturated fatty acids. ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Classification: Lipids Simple lipids Conjugated lipids Derived lipids Phospholipids Fatty Acids Neutral fat waxes Glycolipids Fat soluble vitamins Lipoproteins Steroids 2022/2023 2022/2023 2022/2023 Liquids Solids Oils Fats Simple lipids A- Neutral Fats (Triglycerides) These are esters of fatty acids with glycerol. 30511211602499 30511211602499 30511211602499 B- Waxes - Esters of fatty acids with higher alcohols other than glycerol. - Their importance is: manufacture of lubricants, polishes, ointments and cosmetics. - 25 -  Conjugated or Compound lipids Conjugated lipids ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Phospholipids Glycolipids Lipoproteins A) Phospholipids Definition These conjugated lipids contain phosphate group. They include:  Phosphatidic acid,  Lecithin,  Cephalin,  Lipositols and 2022/2023 2022/2023 2022/2023  sphingomyelin. Importance of phospholipids: 1) Phospholipids are present in cell membrane. 2) The brain and nerves are very rich in cephalin and sphingomyelin. 3) Phospholipids in bile make cholesterol soluble; their deficiency leads to formation of cholesterol gallstones. 4) Phospholipids are necessary for transport of fat from the liver to the subcutaneous stores and their deficiency lead to accumulation of 30511211602499 30511211602499 fat in the hepatic cells,30511211602499 a condition called fatty liver. B- Glycolipids – They are present mainly in the brain tissue. – They contain carbohydrate part. - 26 -  C- Lipoproteins Definition they are conjugated lipids in which the lipid part (e.g. ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ cholesterol, phospholipids or triglycerides) combines with protein part Four major groups (types) of liporoteins are identified: 1) Chylomicrons 2) Very low density lipoproteins (VLDL) 3) Low density lipoproteins (LDL) 4) High density lipoproteins (HDL) Importance 2022/2023 of plasma lipoproteins:2022/2023 2022/2023 Blood lipids are water insoluble substance, thus cannot be transported in the plasma, they are conjugated with proteins to form lipoproteins which become water soluble substances and can be transported in the plasma. 30511211602499 30511211602499 30511211602499 - 27 -  Lipoproteins and atherosclerosis: - LDL represent the transport of cholesterol to the tissues while HDL represent the removal of cholesterol from ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ tissues - Increased LDL level is associated with atherosclerosis and coronary heart disease. - Increased HDL level in blood represents the protection from atherosclerosis and coronary heart disease. LDL - Thus ratio is used in prediction of atherosclerosis HDL and coronary heart disease. 2022/2023 2022/2023 2022/2023 30511211602499 30511211602499 30511211602499 - 28 -  LDL HDL Low Density Lipoproteins High Density Lipoproteins ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Bad cholesterol carrier Good cholesterol carrier Low protein to phospholipid ratio High protein to phospholipid ratio It transports cholesterol & It transports cholesterol & phospholipids from liver to cells. phospholipids from cells back to liver. Normal blood level of lipids:  Cholesterol (140 – 200 mg %)  Triglycerides (50 – 160 mg %)  Phospholipids (150 – 200 mg %)  HDL (>35 mg %) 2022/2023 2022/2023 2022/2023  LDL (40 is class III or morbid or very severe obesity. Causes of obesity: 1. High caloric intake: The major cause of weight gain is the consumption of excess calories due to bad eating habits and environmental factors. 2. Endocrine diseases as hypothyrodism 2022/2023 2022/2023or Cushing'sdisease 2022/2023 3. Genetic causes Effects of obesity: 1. In most common type of obesity,the number of fat cells of the body does not increase. They get larger with triglycerides. 2. If obesity develops before puberty, increase in the number of fat cells occur. 3. Obesity is a risk factor for developmentof: a) Diabetes mellitus. 30511211602499 30511211602499 30511211602499 b) Hypertension. c) Osteoarthritis. d) Gallstone. e) Cardiovascular diseases. Treatment of obesity: 1. Dietary changes - 31 -  2. Exercise and activity 3. Behavior change 4. Prescription weight-loss medications ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ 5. Weight-loss surgery 2022/2023 2022/2023 2022/2023 30511211602499 30511211602499 30511211602499 - 32 - ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪- 33 -‬‬ ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪- 34 -‬‬  Proteins Definition: ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Proteins are high molecular weight organic substances containing carbon, hydrogen, sulphur and nitrogen. Proteins are formed of chains of - amino acids united together by peptide linkage. Nitrogen forms 16% of the protein molecule. Biochemical importance of proteins: 1. Proteins are necessary for health, growth and replacement of tissues. 2022/2023 2022/2023 2022/2023 2. Proteins provide the body with the essential amino acids that cannot be formed inside the body. 3. Proteins are the major source for nitrogen, sulphur and phosphorus. 4. Protein foods are also rich in some members of water soluble vitamins. 5. Some amino acids as glycine and glutamate act as neurotransmitters. 30511211602499 30511211602499 30511211602499 Amino Acids - Amino acids are organic acids which contain both  Acidic carboxyl group ( -COOH)  Basic amino group (-NH2). - 35 - ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ - Over 300 amino acids occur in nature; only 20 amino acids enter in protein structure. Classifications of amino acids: 1) Chemical classification 2) Their content of amino and carboxyl groups. 2022/2023 3) Metabolic classification. 2022/2023 2022/2023 4) Nutritional classification. Metabolic classification:  ketogenic amino acids Amino acid that gives ketone bodies e.g. Leucine  Glucogenic amino acids Amino acid that gives glucose e.g.30511211602499 30511211602499 Alanine 30511211602499  Mixed amino acids Amino acid that gives both glucose and ketone bodies e.g. Tyrosine - 36 -  Nutritional classification:  Essential amino acids: ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬  These amino acids called essential because they cannot be formed in the body so they must be supplied in diet.  They are 10 amino acids: 1) Valine. 6) Phenyl alanine. 2) Leucine. 7) Tryptophan. 3) Isoleucine. 8) Histidine 4) Methionine. 9) Arginine. 5) Threonine. 10) Lysine. 2022/2023 2022/2023 2022/2023  Non- essential amino acids:  These amino acids can be synthesized are in the body.  They include: 1) Glycine. 6) Asparagine. 2) Alanine. 7) Glutamic Acid. 3) Serine. 8) Glutamine. 4) Cysteine. 9) Tyrosine 30511211602499 5) Aspartic Acid. 10)30511211602499 Proline 30511211602499 - 37 -  Peptide linkage ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ - Peptide bond is a covalent bond formed between the carboxyl group of one amino acids and the amino group of its next amino acid with removal of one H2O molecule. 2022/2023 2022/2023 2022/2023 Levels of protein structure - Protein is formed of a large number of L- amino acids connected together by peptide bonds. 30511211602499 30511211602499 30511211602499 - Each protein is folded in a specific manner to give three dimensional shape of the protein. - Protein folding is essential for its biological function. - 38 -  1) The primary structure: - Which refer to the number, type and sequence of the amino ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ acids in the polypeptide chain. - The amino acids sequence must be written from the Amino- terminus to the Carboxyl-terminus. - Some diseases e.g. sickle-cell anemia can result from a change in a single amino acid in the polypeptide chain. 2022/2023 2022/2023 2022/2023 2) The secondary structure: Coiling of the polypeptide chain taking different forms: a) The -helix: - The polypeptide chain is folded in the form of a right handed helix. - Stabilized by hydrogen bonds between 30511211602499 30511211602499-CO group of one 30511211602499 amino acid and -NH group of the fourth amino acid below. b) The - pleated sheet: - In - pleated sheet the polypeptide chain is folded to form zigzag like shape. - 39 -  - Stabilized by hydrogen bonds between -CO of one strand, -NH group of the opposite peptide bond. ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ 3) The tertiary structure: Polypeptide chain is more folded to form a compact tightly folded structure forming globular protein. 2022/2023 2022/2023 2022/2023 4) The quaternary structure: It is the arrangement of multiple subunits of a protein. 30511211602499 30511211602499 30511211602499 (Hemoglobin) - 40 - ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪- 41 -‬‬  Classification of proteins ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Simple proteins Conjugated proteins Derived proteins Albumin Phosphoproteins Hydrolytic Globulins Glycoproteins products of protein Scleroproteins Lipoproteins by Histones Chromoproteins acids, alkali and Gliadins Nucleoproteins proteolytic enzymes 2022/2023 2022/2023 2022/2023 Albumin and globulins  Coagulation: Both are coagulated by heat.  Biological value: Both are proteins of high biological value i.e. contain all essential amino acids and easily digested.  Sources: Both are almost present in the same sources: blood, Milk and egg. 30511211602499 30511211602499 30511211602499 The differences between them can be shown in the following table: - 42 - ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Denaturation of proteins Definition: - Change in the physical, chemical 2022/2023 2022/2023 and biological2022/2023 properties of proteins from the native (natural) state without destruction of peptide bonds. - It involves unfolding and loss of secondary, tertiary and quaternary structures of the protein molecule. - Denaturation is an irreversible reaction Causes: Denaturation 30511211602499 can be produced by: 30511211602499 30511211602499 1) Physical agents like: heat, X-rays, UV rays, atomic radiations, high pressure, and strong shaking. 2) Chemical agents like: acids, alkalies, high salt concentration and heavy metals. - 43 -  Effect of denaturation 1) Physical changes: ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ - Increased viscosity. - Decreased solubility. 2) Chemical changes: - Some chemical groups became exposed e.g.-SH groups. - Some linkages in the protein molecule are destroyed e.g. hydrogen bonds. 3) Biological changes: - Loss of the enzymatic activity of the denatured enzymes. - Loss of the hormonal activity2022/2023 2022/2023 of the denatured protein2022/2023 hormones. - Loss of antigenic activity if the denatured protein has antigenic activity. Nitrogen Balance It is the quantitative difference between the nitrogen intake and nitrogen loss. It is expressed in grams per day. 30511211602499 30511211602499 30511211602499 - 44 -  1) Nitrogen Equilibrium: Nitrogen intake is equal to nitrogen loss. ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ It occurs in healthy persons with balanced diet. Nitrogen intake: Nitrogen is taken in the form of dietary proteins. Every100 g protein contains 16 g nitrogen. Nitrogen loss in a-Urine: Nitrogen is excreted in urine in the form of e.g.: Urea - Creatinine - Uric acid - Ammonia b- Stool 2022/2023 2022/2023 2022/2023 c- Hair and nails d- Sweat 2) Positive Nitrogen Balance: Nitrogen intake is more than nitrogen loss It occurs in cases of Pregnancy, lactation, children during the period of growth. 30511211602499 30511211602499 30511211602499 3) Negative Nitrogen Balance: Nitrogen loss is more than nitrogen intake. It occurs in Cancer, hemorrhage and in cases of burns. - 45 - ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪- 46 -‬‬  Vitamins ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Definition: Vitamins are organic compounds that are needed in small amounts in the diet, but they are essential for life. o They do not enter into tissue structure. o They are not used for energy production. Classification of Vitamins: Vitamins can be classified according 2022/2023 to their solubility into:2022/2023 2022/2023 Fat soluble vitamins Water soluble vitamins They dissolve in fat and fat They do not dissolve in fat and fat solvents solvents They do not dissolve in water They dissolve in water Vitamin A, D, E and K. Vitamin C & B complex Vitamin A 30511211602499 30511211602499 30511211602499 Vitamin A is a derivative of Carotenes pigments "yellow and red". Sources of vitamin A: 1-Plants supply carotenes e.g. all pigmented vegetables and fruits as potatoes, carrots, tomatoes and leafy green vegetables. - 47 -  2-Animals supply vitamin A e.g. liver, milk, fish, eggs and Cod liver. ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Functions of vitamin A: 1- Essential for formation of photosensitive pigment called rhodopsin (visual purple) in the retina of the eye which is responsible for night vision. 2- Maintenance of health and smoothness of epithelial tissue and skin. 3- Essential for growth of bone and teeth formation. 2022/2023 4- Essential for normal function of adrenal cortex. 2022/2023 2022/2023 Vitamin A deficiency: Manifestation of deficiency: 1- Night blindness (Nyctalopia): Inability to see in a dim light. 2- Xero-ophthalmia: dryness and roughness of cornea. 3- Atrophy and keratinization of epithelial tissues. 4- Defective bone and teeth formation. 5- Abnormal cellular function of 30511211602499 adrenal cortex. 30511211602499 30511211602499 Vitamin D Sources of vitamin D: 1- Animal sources: - Sun light on skin. - 48 -  - Fish liver oil, egg, butter and milk. 2- Plant Sources. ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Plants contain pro-vitamin D and not the vitamin. Functions of vitamin D: Vitamin D plays vital role in control of calcium and phosphorus metabolism. 1-In the intestine: Active vitamin D increases the intestinal absorption of calcium and phosphorus. 2-In bone: it stimulates calcium and phosphorus deposition in bone. 3-In the kidney: It increases excretion2022/2023 2022/2023 of phosphate and decreases 2022/2023 calcium excretion in urine. 4-Action of the parathyroid hormone is produced only in the presence of adequate supply of vitamin D. Deficiency of vitamin D: 1- Metabolic manifestations;  Vitamin D deficiency decreases intestinal absorption of 30511211602499 calcium and increase its30511211602499 excretion in urine resulting in 30511211602499 decrease calcium level in blood.  In sever vitamin D deficiency, Tetany occur. 2- Bony manifestations; 1-Rickets in childhood: - 49 -   Delayed dentations, sitting, and walking and teeth formation. ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬  Diminished mineralization of bone results in softening and deformities of bone. 2-Osteomalacia in adults: Which occurs among poor women after repeated pregnancies and lactation Vitamin E 2022/2023 2022/2023 2022/2023 Sources of vitamin E 1- Plant Sources "rich sources": - Plant oils as cotton seed and corn oils. - Green leaves of vegetables. 1- Animal sources "poor sources" e.g. liver, egg yolk and meat. Functions of vitamin E: 1-30511211602499 It acts as antioxidant in the body. 30511211602499 30511211602499 2- It acts as anti-sterility factor in rats, There is no evidence that vitamin E acts in human as anti-sterility as it does in rats. Deficiency of vitamin E: 1- Hemolytic anemia lack of protection against peroxides. - 50 -  2- Sterility of rats and other experimental animals due to damage of the reproductive system. ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Vitamin K Sources of vitamin K: - Vitamin K1 is naturally occurring in plants e.g. spinach. - Vitamin K2 is a bacterial product. - Vitamin K3 is a synthetic vitamin K. Functions of vitamin K: 2022/2023 2022/2023 2022/2023 It is necessary for the formation of several factors needed for blood clotting as: * Prothrombin (Factor II). * Factor VII, IX and X. Deficiency of vitamin K:  Deficiency may occur in: 1. Infants due to sterility of their large intestine. 2. Inadequate absorption of the vitamin by intestine due to 30511211602499 30511211602499 30511211602499 absence of adequate amount of bile salts. 3. Long treatment with oral antibiotics, which inhibit the growth of bacteria in the large intestine.  Manifestation of vitamin K deficiency includes Impairment of blood clotting and prolonged coagulation time - 51 -  Water soluble vitamins ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ This group includes:- 1- Vitamin C. 2- Vitamin B-Complex. Vitamin C (L- Ascorbic acid) Sources of vitamin C: 1. Plants e.g. leafy vegetables, citreous fruits, tomatoes, green 2022/2023 2022/2023 2022/2023 and red peppers. 2. Animals e.g liver, milk and adrenals. Functions of vitamin C: 1-Vitamin C is important for collagen biosynthesis Collagen is the major fibrous element of skin, cartilage, bone and blood vessels. So vitamin C accelerates the healing of wounds and fractures of bones. 30511211602499 30511211602499 30511211602499 2- It helps the conversion of tryptophan to 5-Hydroxy -Tryptophan which is a reaction in the pathway of serotonin (Vasoconstrictor and stimulator of smooth muscle contraction). 3-It is present in a high concentration in adrenal cortex, so it may play a rule in the synthesis of hormones of the adrenal cortex. - 52 -  4- Vitamin C may acts as a general soluble antioxidant. ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ Deficiency of vitamin C: Deficiency of vitamin C leads to Scurvy which is a disease resulting from failure of collagen formation. It is characterized by: 1-Bleeding gums. 2. Loose and fracture of teeth. 3. Delayed healing of wounds and bony fractures. 4. Anemia due to inactivation of folic acid. 2022/2023 Vitamin B complex 2022/2023 2022/2023 Vitamin B complex includes the following members: 1- Vitamin B1 (Thiamin). 2- Vitamin B2 (Riboflavin) 3- Nicotinic acid (Niacin). 4- Lipoic acid. 5- Pantothenic acid. 6- Vitamin B6 (Pyridoxine) 7- Biotin. 30511211602499 30511211602499 30511211602499 8- Folic acid. 9- Vitamin B12 (Cyanocobalamine). - 53 -  Vitamin B1 Thiamine Functions of vitamin B1: ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ After absorption of the vitamin, it is actively phosphorylated to thiamine pyrophosphate (TPP) in the tissues which acts as a coenzyme in many reactions. Thiamine deficiency: Severe thiamine deficiency results in a disease called Beri Beri which is characterized by: 1- Peripheral polyneuritis. 2022/2023 2022/2023 2022/2023 2- Gastrointestinal troubles: as loss of appetite, constipation, nausea. 3-Cardiovascular manifestations: palpitation, dyspnea, cardiac enlargement "the usual cause of death is heart failure"  If oedema occurs the disease is wet beriberi,  While if no edema occurs the disease is dry beri beri. 30511211602499 Vitamin B2 (Riboflavin) 30511211602499 30511211602499 Functions of vitamin B2: After absorption of the vitamin it forms 2 important coenzymes  Flavin Mononucleot ide (FMN)  Flavin Adenine Dinucleotide (FAD). - 54 -  Deficiency of vitamin B2: 1. Lesions of the lips, fissures at the angle of the mouth ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ (cheilosis) and glossitis (inflamed tongue). 2. Localized seborrheic dermatitis of the face. Nicotinic acid (Niacin) Functions of nicotinic acid: In the body nicotinic acid enters in the formation of 2 coenzymes. 1- Nicotinamide Adenine Dinucleotide (NAD). 2022/2023 2022/2023 2022/2023 2- Nicotinamide Adenine Dinucleotide Phosphate (NADP). Deficiency of nicotinic acid:  In man a disease called Pellagra is produced.  It is manifested by (3D): 1-Dermatitis (skin is dry, scaly and brown). 2- Diarrhea. 3- Dementia (loss of mental power). 30511211602499 30511211602499 30511211602499 Vitamin B6 Functions of vitamin B6 : Pyridoxal phosphate "which is the active form of vitaminB6" acts as important coenzyme in amino acid metabolism. - 55 -  Deficiency of vitamin B6 : 1- Impaired growth due to disturbance in amino acids metabolism. ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ 2- Anaemia due to decreased synthesis of haemoglobin. 3- Convulsion in infants. Folic acid Functions of folic acid: Folic acid (Folate) must be reduced before it acts as a coenzyme to (H4 folate). 2022/2023 2022/2023 2022/2023 Deficiency of folic acid: 1- Decreased synthesis of neucleoproteins resulting in decreased growth and reproduction of cells. 2- Macrocytic anemia as it is essential of red blood cells. 3- Leuocopenia: as it is necessary for synthesis of leucocytes. Vitamin B12 (Cyanocobalamin) 30511211602499 30511211602499 30511211602499 Sources of vitamin B12: Milk, eggs and livers are good sources of vitamin B12, and it is synthesized by intestinal bacteria. - 56 -  Absorption of vitamin B12: B12 is absorbed from the ileum; the absorption depends on the ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ presence of: - Gastric HCL and - Intrinsic factor which is a normal constituent of gastric juice. Deficiency of vitamin B12: Deficiency of vitamin B12 leads to pernicious anemia which is characterized by: 1 - Macrocytic anemia. 2022/2023 2022/2023 2022/2023 2- Nervous manifestation as: - Numbness and tingling of extremities. - Stiffness of arms and legs. 30511211602499 30511211602499 30511211602499 - 57 - ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪2022/2023‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪30511211602499‬‬ ‫‪- 58 -‬‬  Minerals ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬  Definition: They are inorganic compounds that are required for the body as one of the nutrients.  Classification: Minerals can be classified into:  Bulk or main elements: that includes seven principal mineral elements: calcium, phosphorus, sodium, potassium, chlorine, iron and sulphur. 2022/2023  Trace elements: that 2022/2023 includes iodine, copper,2022/2023 cobalt, selenium, manganese and zinc which are needed in micro amounts. Bulk elements 1. Calcium  Sources: 1. Milk and dairy products. 30511211602499 30511211602499 30511211602499 2. Beans, leafy vegetables and egg yolk.  Absorption: 1. Calcium is actively absorbed in the upper part of small intestines. 2. Factors affecting calcium absorption: - 59 - ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬  Distribution of body calcium: 1. Calcium is the most abundant mineral in the body. 2. 99% of calcium is present in bones and teeth. So, bones act a reservoir for calcium. 2022/2023 2022/2023 2022/2023 3. Only 1 % of calcium is distributed in plasma with a total level (9-11 mg/dl).  Plasma Calcium: 1. Plasma calcium level is about (9-11 mg/dl). 2. Plasma calcium is present in 2 forms: a. Ionized (50%): It is the active fraction and its deficiency causes tetany. 30511211602499 30511211602499 30511211602499 b. Non-ionized (50%): It is either diffusible (5%) that makes complexes with organic ions or non-diffusible (45%) which is protein bound. - 60 -  3. Factors affecting plasma calcium: a. Hormonal factors: ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ 1. Parathormone (PTH): It is secreted by parathyroid gland.  Increases calcium absorption  Increases calcium reabsorption from kidneys. 2. Calcitonin: It is secreted by thyroid gland  It decreases calcium levels by inhibition of calcium mobilization from bones and increasing its deposition in bones 2022/2023 2022/2023 2022/2023 b. Non-hormonal factors: 1. Solubility product: Ca/P ratio must be constant. Ca x P is 50 in children and it is 40 in adults. So, increase in phosphate blood level causes a decrease in calcium plasma level. 2. Vitamin D:  Increases calcium absorption form intestines  Increases calcium reabsorption for kidneys 30511211602499 30511211602499 30511211602499  Increases calcium mobilization from bones.  Daily requirements: 1. Adult: 0.8 g/day. 2. Children, pregnant and lactating women: 1.5 g/day. - 61 -   Functions of calcium: 1. Bone and teeth formation. ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ 2. Blood clotting. 3. It acts as muscular neurotransmitter. 4. It initiates and propagates muscle contraction.  Disorders of calcium metabolism: a. Hypocalcemia: Tetany and muscle convulsion. b. Hypercalcemia: It leads to stone formation, calcification and muscle paralysis. 2022/2023 2022/2023 2022/2023 2. Phosphorus  Sources: 1. It is present in all foods. 2. Milk and dairy products. 3. Food additives. 4. Fish, meat, liver and kidney. 5. Leafy vegetables and egg yolk. 30511211602499 30511211602499 30511211602499  Phosphorus absorption: a. It is absorbed in the upper part of the small intestines. b. Factors affecting phosphorus absorption: the same as calcium. - 62 -   Body phosphorus distribution: 1. The body contains about 700 g of phosphate. ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ 2. About 600 g is present in bone and teeth. 3. The rest 100 g is distributed among tissues.  Blood phosphorus: 1. Normal plasma level is 3-5 mg/dl. 2. Parathyroid hormone decreases the phosphorus blood level by stimulation of its excretion through kidneys. 3. Vitamin D increases phosphorus blood level by stimulation 2022/2023 2022/2023 2022/2023 of phosphorus absorption and increases bone resorption.  Functions of phosphate: 1. It enters in DNA structure. 2. Enters in the structure of phosphoproteins as casein. 3. Enters in the structure of active nucleotides that contain high energy phosphate bonds as ATP. 4. Formation of important coenzymes. 5. Formation of phospholipid. 30511211602499 30511211602499 30511211602499 6. Formation of phosphate buffer.  Daily requirements: a. Adults: 1.3 g/day. b. Pregnant and lactating women: 2 g/day. - 63 -  3. Sodium  Sources: The main source is table salt. ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬  Absorption: Occurs in small intestines.  Daily requirements: 5 gm are recommended per day for adults.  Distribution of body sodium: 1. About 1/3 is distributed in the skeleton. 2. 2/3 of sodium is present in the tissues and body fluids. Sodium is the main extracellular2022/2023 2022/2023 cation. 2022/2023  Functions of Sodium: 1. Maintenance of osmotic pressure and volume of plasma and extracellular fluids. 2. Transmission of nerve impulse. 3. Contraction of muscles. 30511211602499 Plasma sodium: 30511211602499 30511211602499 1. It is about 137-145 mmol/L. 2. Plasma level is regulated by the action of aldosterone and rennin- angiotensin system that increases sodium plasma level. - 64 -   Excretion of sodium: 95% in urine and sweat. ‫ﻋﻼﺀ ﺭﺍﺿﻰ ﻋﺒﺪ ﺍﻟﺤﻠﻴﻢ ﺣﺴﻦ ﺭﺍﺿﻰ‬ 3. Potassium  Sources: vegetables, fruits as banana and nuts.  Absorption and body distribution: 1. It is easily absorbed form the small intestines 2. Normal blood level is 20 mg% which is equal to 5 mmol/L. 3. Potassium plasma level is regulated 2022/2023 2022/2023 by the action 2022/2023 of aldosterone. 4. 2/3 of body potassium is present in the plasma and body fluids. 5. Potassium is the main intracellular cation.  Functions of potassium: 1. Maintenance of osmotic pressur