Micronutrient Reference Table_2021.pdf

Micronutrient Deficiency Reference Table Fat-Soluble Vitamins Vitamin A Function • • • • • • • • Source • Deficiency • • • • • • • Excess • • Carotenoids are Vit A precursors Synthesized by plants Antioxidant Interacts with: Vitamins E and K, as well as, iron and zinc Eye health and night vi...

Micronutrient Deficiency Reference Table Fat-Soluble Vitamins Vitamin A Function • • • • • • • • Source • Deficiency • • • • • • • Excess • • Carotenoids are Vit A precursors Synthesized by plants Antioxidant Interacts with: Vitamins E and K, as well as, iron and zinc Eye health and night vision. Cell proliferation, growth and differentiation Supports reproduction in males and females. Supports both osteoblasts and osteoclasts in bone development. Vitamin D • • • • • Orange and dark green vegetables: sweet potatoes, carrots, green leafy vegetables. Eggs Liver Dairy Night blindness/xerophthalmia • Drying of the conjunctiva & cornea • Bitot's spots • Dry skin, flaky dermatitis & follicular hyperplasia. Acute: nausea, vomiting, dizziness and headache Chronic: changes in the skin, hair loss, conjunctivitis and anorexia. • • • • • • Vitamin E Vitamin K • • • • • • Antioxidant Synthesized by plants Maintains membrane integrity Prevents oxidation/peroxidation Cholesterol metabolism Interacts with: Selenium, Vitamin C, and Sulfur-containing amino acids (Cysteine and Methionine) • • • Blood-clotting Vitamin K- Carboxylation Bone and Teeth integrity • • • • • Plant-based oils nuts and seeds cereal grains legumes fatty cuts of meat • • • • Can be synthesized by the microbiome Dark green vegetables Pumpkin, Beans, peas and legumes Rickets in children Osteomalacia in adults Myalgia • • • • Peripheral neuropathy Ataxia retinopathy (such as seen in infants) Impaired immune response • • • Increased prothrombin time Bleeding/hemorrhage Reduce bone mineralization Results from supplemental sources Hypercalcemia Calcification of soft tissues hyperphosphatemia, hypertension nausea renal dysfunction • • Least toxic of the fat-soluble vitamins Increased bleeding from impaired coagulation GI distress Physical weakness or fatigue • Excess dietary intake and excess synthesis of Vitamin K demonstrate no symptoms Toxicity has been observed in infants supplemented with Vitamin K which resulted in hemolytic anemia and hyperbilirubinemia.. Bone health Calcium & Phosphorus metabolism Steroid hormone Gene expression Cellular differentiation • • • Micronutrient Deficiency Reference Table Thiamin (B1) Riboflavin (B2) Niacin (B3) Pantothenic Acid (B5) Pyridoxine (B6) Biotin (B7) Folate (B9) B12 (Cobalamin) Vitamin C (Ascorbic Acid) •In TPP, cofactor for dehydrogenase rxns: Alphaketoglutarate DH (TCA), Pyruvate dehydrogenase (links glycolysis to TCA), Transketolase (HMP shunt), branched-chain ketoacid DH **Think ATP • prosthetic group of flavoproteins (FAD, FMN), used as cofactors in redox rxns (succinate DH in TCA) •Constituent of NAD+, NADP+ (used in redox reactions) •Derived from tryptophan •Synthesis requires B2 and B6 **NAD derived from Niacin (B3=3ATP) • protein modification • FA, phospholipid, cholesterol, & steroid hormone synthesis • essential component of CoA and fatty acid synthase •converted to pyridoxal phosphate (PLP), a cofactor used in transamination (ALT, AST) decarboxylation rxns, glycogen phosphorylase •synthesis of neurotransmitters • homocysteine  cysteine • glycogen storage •cofactor for bicarbonate-dependent carboxylation rxns (add 1 C) -Pyruvate carboxylase: acetyl CoA(2C)pyruvate (3C) -Acetyl CoA carboxylase: acetyl CoA (2C) malonyl CoA -Propionyl CoA carboxylase: propionyl CoA(3C) methylmalonyl CoA (4C) • DNA synthesis • converted to tetrahydrofolate (THF), a coenzyme for 1C transfer/ methylation •important for synthesis of nitrogenous bases in DNA and RNA •absorption: jejunum • small reserve pool stored primarily in the liver • antioxidant • regenerates vit E • formation of bones & teeth •facilitates iron absorption by reducing it to Fe2+ •necessary for hydroxylation of proline and lysine in collagen synthesis •necessary for dopamineNE • beef • poultry/eggs • whole/Fortified grains • sweet potatoes • legumes • yogurt • chicken • meat, poultry, fish • corn • bananas • potatoes & sweet potatoes Deficiency •Impaired glucose •Cheilosis •Glossitis • slowed growth • breakdownATP depletion (inflammation of lips, fatigue/depression • damages cerebral • Weight loss worsened by glucose scaling, and fissures at & peripheral • anemia • Severe infusion; highly aerobic corners of mouth) • loss of hair color neurons deficiency tissues (brain, heart) •Corneal vascularization Pellagra: • confusion • infertility affected first • edema, dermatitis, • Diarrhea • cheilosis • weakened •High serum [Lactic Acid] angular stomatitis, • Dermatitis (Casal immune responses • depression • Dry BerIBerI: anemia necklace) • microcytic •Dermatitis polyneuritis, symmetrical • impairs niacin, B6, & • Depression anemia •Enteritis muscle wasting, neuropathy, folate function • Dementia • glossitis •Alopecia confusion, dementia • may result from • Death •convulsions, •Adrenal • Wet Beriberi: high output cancer, diabetes, CVD hyperirritability, •Hyperpigmentation insufficiency heart failure (dilated peripheral of sun exposed arms cardiomyopathy), edema neuropathy • Vit B6 can • muscle weakness •sideroblastic potentiate a niacin •Wernicke-Korsakoff: anemias due to deficiency confusion, ophthalmoplegia, impaired Hb ataxia (classic triad) + synthesis and Fe confabulation, personality excess change, memory loss (permanent). Damage to medial dorasal nuclus of thalamus, mammillary bodies • seen w/ alcohol abuse • possibly caused by hyperemesis • intestinal flora • cauliflower • soybeans • mushrooms • eggs • rare: only in people with biotinidase defect •dermatitis •alopecia •enteritis • green leafy vegetables • OJ, citrus • legumes • fortified grains • macrocytic, megaloblastic anemia • hypersegmented PMNs •glossitis •NO NEURO (as opposed to B12) Labs: • ↑ [homocysteine] (risk factor for CV dz) •normal methylmalonate • neural tube defects in fetus • DNA synthesis • homocysteine  methionine • cofactor for methionine synthase & Lmethylmalonyl CoA mutase •synthesized by microorganisms •very large reserve pool (several years) stored in liver • small daily turnover rate •reabsorbed with enterohepatic cycle so deficiency-may take 2-5 years in adults to manifest • Meat, poultry, fish • milk • dairy • eggs Excess • no adverse Function •not stored to large extent and has relatively fast turnover rate, so need continuous supply Source • pork, meat substitutes • peas • enriched grains • no adverse **FAD and FMN are derived from riboflavin **B2=2 ATP • milk • eggs • broccoli • no adverse • facial flushing • no adverse (induced by prostaglandin) • GI problems • liver dysfunction • glucose intolerance • ocular effects •hyperglycemia •hyperuricemia • sensory neuropathy •Caused by antibiotic use or excessive injestion of raw egg whites (Avidin in egg whites avidly binds biotin) • may mask B12 deficiency • fruits •vegetables Scurvy •swollen gums •bruising • petechiae •perifollicular and subperiosteal hemorrhages •hemarthrosis •anemia • poor wound healing • bleeding gums • cork-screw body hair •deficiency caused by • fatigue, pain, death malabsorption, lack of •weakened immune intrinsic factor (pernicious system anemia), absence of terminal ileum, insuffient **Vitamin C deficiency intake (veganism) causes sCurvy due to a Collagen synthesis defect • macrocytic, megaloblastic anemia • hypersegmented PMNs • paresthesias/ neuropathy Labs: • ↑ [homocysteine] •↑[methylmalonate] • neural tube defects in fetus • depression, confusion, dementia • no adverse • osmotic diarrhea • GI problems • kidney stones (oxalate) Micronutrient Deficiency Reference Table Minerals Function Iron Copper Zinc Calcium Selenium Phosphate Potassium Magnesium Sodium Chromium • O2 transport • respiration • free radical defense • hormone synthesis • metabolism of aas, lipids, alcohol, vitamin A, & sulfate • enzyme cofactor (cytochrome C oxidase & superoxide dismutase • iron metabolism • catecholamine formation • collagen & elastin • ETC • oxidative phosphorylation • chicken • chocolate • beans • instant cereal • immune health • wound healing • intestinal folate absorption • protects against oxidative stress • modulates insulin activity • growth & cell division • DNA & RNA synthesis • metabolism of carbs, proteins, lipids • milk • meat • yogurt • beans • hormone signaling • neurotransmission • muscle contraction • regulation of cell growth & differentiation • blood clotting • absorption depends on Vit D • defense against oxidative stress (glutathione peroxidase) • regulation of thyroid hormone • reg. of redox status of vit. C • energy metabolism & storage • buffer • constituent anion in bones & teeth • intracellular cation • acid-base balance • membrane transport & polarization • neuromuscular & cardiac fxn • energy metabolism • protective against high BP • helps maintain normal BP • needed for all rxns using or producing ATP • ECF volume • electrochemical gradient w/ K+ (nerve signals, muscle) • co-transport of substances into cells (glucose, aas) • binds nuclear DNA, ↑ # of initiation sites for RNA synthesis • dairy, milk, yogurt, cheese • calcium-fortified juice • cereal • tofu • cabbage, kale • broccoli At risk: • avoid dairy (lactose intolerance, allergies, veganism) • high oxalate & phosphate consumption can greatly reduce uptake • Low bone density • Parasthesia • seafood • meat • grains • nuts • protein-rich foods • processed cheese • soda • fruits & vegs • fresh meats • milk • whole grains • legumes • nuts • dark green vegs • some fruits • processed foods • smoked, cured, pickled foods • condiments • nuts • whole grains • yeast • cheese • rare • Keshan dz (cardiomyopathy in China) • more common in elderly • factor contributing to refeeding syndrome • rare (prolonged N/V, diarrhea) • diuretics • muscle cramps • heartbeat irregulatiry • confusion • loss of appetite • ↑ BP • ↑ insulin resistance • atherosclerosis • arrhythmia • bone mineral loss • usually elderly • rare (profuse, prolonged sweating or diarrhea) • impaired carb utilization • ↑ insulin resistance • hair & nail brittleness & loss • GI disturbances • skin rash • fatigue • irritability • nervous system abnormalities • more often problem than too little • reduces intestinal Ca2+ absorption • promotes Ca2+ mobilization from bone • ↑ renal Ca2+ loss • occurs w/ kidney problems • cardiac arrest • osmotic diarrhea • HTN • free radical formation Source 100% non-heme iron: • fortified grains • legumes • broccoli 40% heme iron: • meat Deficiency • microcytic anemia • ↑ CA risk • delayed grown & brain development • Dyspnea • Angular stomatitis • Glossitis • alter nail & hair • impair immune function • impairs brain function, vascular & bone integrity, & metabolic control • Anemia • Pancytopenia • Fatigue • Dyspnea • Changes in gait • Peripheral neuropathy, Parasthesias • growth retardation • delayed wound healing • immune dysfunction • skin lesions • anemia • cognitive impairment • delayed sexual maturation • hypogonadism • impaired taste • ↓ appetite Excess • discolor skin • cirrhosis • Hepatosplenomegaly • cardiomyopathy • liver damage • DNA damage • rare • interferes w/ copper & iron absorption • GI irritation • vomiting • anemia • CNS disturbances • overdose of iron supplements is leading cause of poisoning in children • • • • Most minerals and trace elements are stored extensively, some in bone (calcium, magnesium, phosphate), and some as part of metalloproteins (iron, copper, zinc, iodine, selenium, molybdenum) Iron, copper and selenium are potentially toxic when long-term intakes even moderately exceed needs; excess of most others cause milder, but still significant, adverse effects Other minerals and trace elements: chromium, electrolytes, fluoride, iodine, magnesium, manganese, molybdenum Because an excess of most, if not all, minerals & trace elements causes significant to severe toxic effects, supplement use requires particular caution