Vitamins And Minerals Part 1 PDF 2024-2025 University of Baghdad

University of Baghdad College of Medicine 2024-2025 Title: vitamins and mineral part 1 Grade: Third Grade Module: Nutrition, Water & Electrolytes Imbalance Module (NT) Speaker: Ola Hussein Jasim Date: 30-9-2024 ...

University of Baghdad College of Medicine 2024-2025 Title: vitamins and mineral part 1 Grade: Third Grade Module: Nutrition, Water & Electrolytes Imbalance Module (NT) Speaker: Ola Hussein Jasim Date: 30-9-2024  University of Baghdad/ College of Medicine 2022-2023 by the of this lecture you will able to: 1. Define hidden hunger. 2. Memorize sign and symptom of vitamin A deficiency. 3. State ways to prevent and control of vitamin A deficiency. 4. Identify the causes of vitamin D deficiency. 5. State ways to prevent and control vitamin D deficiency.  University of Baghdad/ College of Medicine 2022-2023 Hidden hunger: The term “hidden hunger” is used to describe vitamin and mineral deficiency that resulting in health impacts may not always be obviously visible. Micronutrient malnutrition has been associated with metabolic disorders; reduced immune, endocrine, and cognitive function; delayed or inadequate physical development. may also be an underlying cause of chronic disease.  University of Baghdad/ College of Medicine 2022-2023 The term was coined by WHO in 1986 and refers to the problems associated with the deficiency of 3 essential micronutrients: Iron. Vitamin A. Iodine. Vitamin D Vitamin A consists of: University of Baghdad/ College of Medicine 2022-2023 Retinoids (pre-formed vitamin/active form): Found only in animal based foods such as eggs, fatty fish, dairy products and organ meat(beef liver, lamb liver ,chicken liver),fish liver oil(richest natural source of retinol). Can be used by the body right away. About 90 % of ingested preformed vitamin A is absorbed. 5  University of Baghdad/ College of Medicine 2022-2023 Carotenoids/ β - carotene (pro-vitamin A): Found in plant based foods: Red and orange fruits and vegetables (carrot, mango, melon, apricot and sweet potato…) Dark green leafy vegetables (spinach, lettuce, green collard…) the absorption efficiency of pro-vitamin A carotenoids varies widely depending on the type of plant source and the fat content of the accompanying meal. Main Functions: University of Baghdad/ College of Medicine 2022-2023 Vitamin A is essential for vision (especially in dark adaptation). Maintaining the integrity and normal functioning of glandular and epithelial tissues which lines the intestinal, respiratory and urinary tracts as well as skin and eyes. Support growth (skeletal growth) and reproduction. Retinol and retinoic acid function as steroid hormones. Essential for maintenance of proper immune system. Carotenoids function as antioxidants and reduce the risk of cancer. VAD: WHO defines it as “tissue concentration of vitamin A low University of Baghdad/ College of Medicine 2022-2023 enough to have adverse health consequences even if there is no evidence of clinical xerophthalmia”. VAD epidemiology: Leading cause of preventable blindness in children. Major cause of controllable public health and nutrition problem. According to WHO statistics an estimated 250 million preschool children are vitamin A deficient. an estimated 250000 to 500000 vitamin A deficient children become blind every year, half of them dying within 12 months of losing their sight.  RDA of vitamin A University of Baghdad/ College of Medicine 2022-2023 Groups Retinol RAE(microgram)/ day  Adults:  infants (0-6 months)  400  men: ≥ 19 years  900  infants (7-12 months)  500  women: : ≥ 19  700 years  children(1- 3 years)  300  Pregnancy:  children (4-8 years)  400  14 -18 years.  750  Adolescents:  19 -50 years.  770  boys:  9- 13 years  Lactation:  600  14 -18 years  14 -18 years.  1200  900  girls:  19 – 50 years.  1300  9- 13 years  14 -18 years  600  700  Risk Factors University of Baghdad/ College of Medicine 2022-2023 Low vitamin A diet. Suboptimal breastfeeding and weaning practices: Inadequate breastfeeding practices, including premature cessation of breastfeeding. Infants who are exclusively breastfed by mothers with insufficient vitamin A intake or those not receiving adequate complementary foods rich in vitamin A are at risk of deficiency. Poverty, overcrowding house, poor environmental sanitation and low educational status.  University of Baghdad/ College of Medicine 2022-2023 Infections (mainly measles). Protein energy malnutrition(PEM). Health conditions that affect the liver. Malabsorption issues. Vegetarians. Prolonged dietary deprivation. Chronic alcohol consumption. Signs and symptoms of vitamin A deficiency: University of Baghdad/ College of Medicine 2022-2023 1.Ocular (specific): Ocular manifestations are the most common ones. Xerophthalmia: it refer to all the ocular manifestation of VAD, it is a serious nutritional disorder leading to preventable blindness.  University of Baghdad/ College of Medicine 2022-2023 A. Night blindness: First symptom. Inability to see in dim light (due to impaired dark adaptation). Can be diagnosed by mother: when in the evening child strikes against a stone while play and fall down Unable to see the content of food plate. In dimly classroom cannot see board. Reversible with vitamin A.  University of Baghdad/ College of Medicine 2022-2023 B.Conjunctival xerosis: First clinical sign. Cornea and tissue of eye become dry, wrinkled (vertically folded) and thickened. C. Bitot’s spot: University of Baghdad/ College of Medicine 2022-2023 Triangular pearly white to yellowish foamy spots on bulbar conjunctiva on either side of cornea. Usually bilateral. Diagnostic in young children but in older children and adult it is often an inactive sequelae of earlier disease. D. Corneal Xerosis: University of Baghdad/ College of Medicine 2022-2023 cornea appears dry and dull Very serious condition, may progress to corneal ulceration. Ulcer may heal leaving a scar behind which affect vision. E. Keratomalascia: University of Baghdad/ College of Medicine 2022-2023 Liquefaction of cornea. A grave medical emergency (the process is rapid one). The cornea is soft and may burst open Vision is lost permanently. 2.Extra ocular (non specific): University of Baghdad/ College of Medicine 2022-2023 Follicular hyperkeratosis, dry brittle hair and nails, acne. Loss of appetite, weight loss, Increased risk of anemia, fatigue. Growth retardation, Low immunity and increased vulnerability to infection, Increased risk of certain cancers. Prevalence criteria for defining vitamin A deficiency University of Baghdad/ College of Medicine 2022-2023 of public health significance indicators Degree of severity Mild moderate severe Night blindness at 27-71 months < 0% to >1% ≥ 1% to < 5% ≥ 5% Night blindness in pregnant women ≥ 5% Serum retinol < 70 micro mol/l in ≥ 2% to >10% ≥ 10% to < 20% ≥ 20% preschool children* Serum retinol < 70 micro mol/l in ≥ 2% to >10% ≥ 10% to < 20% ≥ 20% pregnant women Breast milk retinol < 1.05 micro 30ng/ml  University of Baghdad/ College of Medicine 2022-2023 Obese children and adults; those on medications that affect vitamin D given at least two to three times more vitamin D for their age group to satisfy their body’s requirement. Special consideration should be given to preterm babies.  University of Baghdad/ College of Medicine 2022-2023 Monitoring of S.25-OH vitamin D: For all patients, serum 25-OH vitamin D levels should be monitored during or shortly after vitamin D supplementation therapy. In practice, it’s recommended to check 25-OH vitamin D levels in such patients after two to three months of vitamin D supplementation therapy, then as needed thereafter, depending on the adequacy of the patient's intake and adherence to maintenance supplements.  University of Baghdad/ College of Medicine 2022-2023 in summery: 1. VAD is Leading cause of preventable blindness in children. 2. Vitamin A supplementation program in Iraq. 3. Vitamin D is a sun shin vitamin functions like hormone and every single cell in the body has a receptor for it. 4. Vitamin D supplementation and monitoring. University of Baghdad/ College of Medicine 2022-2023