3. Enrichment Act of 1941
and 1998
Many nutrients lost through milling
process of grains
Grain/cereal products are enriched
Thiamin, riboflavin, niacin, folate, iron
Whole grains contain original nutrients
Enriched grains still deficient in B-6,
magnesium and zinc
5. Deficiency of Thiamin
Occurs where polished rice is the only
staple
Chronic alcoholics
Little stored in body, so alcoholic binge of 1-
2 weeks may result in deficiency
Pernicious vomiting or diarrhea
• Wernicke-Korsikof f Syndrome
– Wernicke encephalopathy
• Korsakoff’s psychosis
• Result of thiamine deficiency caused by alcoholism
6. Beriberi (I can’t I can’t)
Weakness, nerve degeneration, irritability,
poor arm/leg coordination, loss of nerve
transmission
Edema, enlarged heart, heart failure
Symptoms due to poor metabolism of
glucose
Depression and weakness can be seen
after only 10 days on a thiamin-free diet
8. Food Sources of Thiamin
Green beans, milk, orange juice, organ
meats, peanuts, dried beans and seed
Enriched breads and grains/ whole grains
Thiaminase found in
raw fish Destroys thiamin
9. RDA For Thiamin
1.1 mg/day for women
1.2 mg/day for men
Surplus is rapidly lost in urine; non
toxic; no Upper Level
10. Riboflavin (B2)
Riboflavin is a critical component of
flavin mononucleotide (FMN) & flavin
dinucleotide (FAD) which participate in
redox reactions
12. Food Sources of
Riboflavin
Milk/products
Enriched grains
Ready to eat cereals
Liver
Vegetables (asparagus,
broccoli, greens)
Sensitive to uv radiation
(sunlight)
Stored in paper, opaque plastic containers
13. RDA for Riboflavin
1.1 mg/day for women
1.3 mg/day for men
Average intake is above RDA
Toxicity not documented
No upper level
14. Niacin (B3)
Nicotinic acid and nicotinamide
Essential component of NAD & NADP
which play central roles in cellular
intermediate metabolism.
Synthetic pathways require niacin, especially
fatty acid synthesis
15. Deficiency of Niacin:
3 Ds Pellagra
Dermatitis - which most often occurs in
sun exposed areas of face and upper
extremity
Dementia - results from neuronal
degeneration in the brain and spinal
column
Diarrhea - is associated with edema and
inflammation of the intestinal submucosa.
Poor appetite, weight loss, weakness
17. Food Sources of Niacin
Enriched grains, ready to eat cereals
Beef, chicken, turkey, fish
peanuts
Heat stable; little cooking
loss
18. RDA for Niacin
14 (mg) NE/day for women
16 (mg) NE/day for men
Upper Level is 35 mg
Other names
Nicotinic acid, Nicotinamide,
Niacinamide,Vitamin B3
Precursor: dietary tryptophan(60mg=1mg)
Toxicity S/S: headache, itching, flushing,
liver and GI damage
19. Pantothenic Acid/ Vit B5
Part of Coenzyme-A
Essential for metabolism of CHO, fat,
protein
Deficiency rare
No known toxicity
20. Food Sources of
Pantothenic acid
“From every side”
Meat
Milk
Mushroom
Liver
Peanut
Eggs
Adequate Intake= 5 mg/day
Daily Value 10 mg
Average intake meets AI
21. Biotin
Free and bound form
Metabolism of CHO and fat
Assists the addition of CO2 to other
compounds
Synthesis of glucose, fatty acids, DNA
Help break down certain amino acids
22. Biotin Deficiency
Raw egg whites avidin bind biotin →
deficiency
Requires large amount
Scaly inflamed skin, tongue, and lip
changes
Poor appetite, nausea, vomiting
Anemia
Muscle pain and weakness
Poor growth
23. Food Sources of Biotin
Cauliflower, yolk, liver,
peanuts, cheese
Intestinal synthesis of
biotin
24. Biotin Needs
Adequate Intake is 30 ug/day for adults
Deficiency rare
No Upper Level for biotin
Relatively nontoxic
25. Pyridoxine (B6)
Coenzyme
Activate enzymes needed for
metabolism of CHO, fat , protein
Synthesize nonessential amino acid via
transamination
Synthesize neurotransmitters
Synthesize hemoglobin and WBC
27. Food Sources of Vitamin
B-6
Well absorbed
• Meat, fish, poultry
• Enriched cereals
• Potatoes
• Milk
Less well absorbed
• Fruits and vegetables:
Banana, spinach
Heat and alkaline sensitive
28. B6 Toxicity
Nerve damage
Difficulty walking
Numbness in hands/feet
Can lead to irreversible nerve damage
with > 200 mg/day
Upper Level set at 100 mg/day
29. RDA for Vitamin B-6
1.3 mg/day for adults
1.7 mg/day for men over 50
1.5 mg/day for women over 50
Average intake is more than the RDA
Athletes may need more
Alcohol destroys vitamin B6
30. Folate
Part of coenzymes THF
(tetrahydrofolate) and DHF
(dihydrofolate) used in DNA synthesis
and therefore important in new cell
formation-Anticancer drug methotrexate
Homocysteine metabolism
Neurotransmitter formation
31. Deficiency of Folate
Similar signs and symptoms of vitamin
B-12 deficiency
Anemia
Pregnant women
Alcoholics
Megaloblastic Anemia
33. Food Sources of Folate
Liver
Fortified breakfast cereals
Grains, legumes
Foliage vegetables
Susceptible to heat,
oxidation, ultraviolet light
Synthetic form better
absorbed
34. RDA for Folate
400 ug/day for adults
(600 ug/day for pregnant women)
Excess can mask vitamin B-12
deficiency
Upper Level set at 1 mg
35. Cobalamin/Vitamin B-12
Synthesized by bacteria, fungi, and
other lower organisms
Role in folate metabolism
Maintenance of the myelin sheaths
RBC formation
Part of coenzymes methylcobalamin
and deoxyadenosylcobalamin used in
new cell synthesis
36. Absorption requires
HCl
Pepsin
Intrinsic factor
Difficult for vegetarians to obtain
Pernicious anemia
Nerve degeneration, weakness
Tingling/numbness in the extremities (parasthesia)
Paralysis and death
Looks like folate deficiency
Usually (95%) due to decreased absorption
ability
37. Vitamin B12 deficiency
Diagnosis: Schilling test
Treatment: 1000mg Vitamin B12 IM
daily for two weeks and monthly injections
for life
High Risk: African Americans, northern
Europeans, elderly
38. Food Sources of Vitamin
B-12 and algae
Synthesized by bacteria, fungi
Animal products, meat
Seafood
Eggs
Milk
39. RDA for Vitamin B-12
2.4 ug/ day for adults and elderly
adults
B-12 stored in the liver
Non-toxic (no Upper Level)
40. Vitamin C
Synthesized by most animals (not by
humans)
Decrease absorption with high intakes
Excess excreted
41. Functions of Vitamin C
Reducing agent (antioxidant)
Iron absorption (enhances)
Synthesis of collagen
Immune functions
Wound healing
42. Antioxidant
Can donate and accept hydrogen
atoms readily
Water-soluble
Needs are higher for smokers
May prevent certain cancers
(esophageal, oral, stomach cancer,
cardiovascular disease, cataracts)
43. Vitamin C Deficiency:
History of Scurvy
Sailors on long sea voyages suffered horribly
from scurvy
On Vasco da Gama's voyage to the East Indies
in 1497, 100 out of 160 men were lost from the
disease.
44. Scurvy in the British
James Lind
Royal Navy
published his
Treatise on the
Scurvy in 1754.
Lime juice was
made mandatory
on British Navy
sailing ships 40
years later
45. Deficiency of Vitamin C
Scurvy
Deficient diet for 20-40 days
Fatigue, pinpoint hemorrhages
Bleeding gums and joints. Hemorrhages
Associated with poverty; macrobiotic diet
Rebound Scurvy
Suddenhalt to high levels of vitamin C
supplements
50. Choline
Newest essential nutrient
Grouped with B group vitamins
All tissues contain choline
Precursor for acetylcholine
(neurotransmitter)and
phospholipids
Some role in homocysteine
metabolism
51. Food Sources of Choline
Widely distributed
Milk
Liver
Eggs
Peanuts
Lecithin added to food
Deficiency rare
53. Copper
Metabolism
• Copper circulates bound to ceruloplasmin
• Excretion occurs via transport of copper into bile
and elimination in feces
54. cofactor for many cuproenzymes including:
•Cu, Zn-superoxide dismutase (antioxidant)
•Cytochrome C oxidase (ATP synthesis, neurologic
function)
•Ceruloplasmin (6 atoms per molecule)
•Lysyl oxidase (cross links and stabilizes connective
tissue proteins)
•Tyrosinase (melanin synthesis)
55. Copper Physiology/Deficiency
• Acquired deficiency is rare
• Manifestations:
Hypochromic microcytic anemia
Neutropenia
Hypopigmentation of hair and skin
Structural abnormalities in connective tissue
Fetal and neonatal deprivation leads to neurologic
dysfunction
Reduced levels of circulating copper and ceruloplasmin
59. Iodine
-body normally has 20-30 mg of iodine
and more than 75% is in the thyroid
gland
-the rest is in the mammary gland,
gastric mucosa, and blood
-it’s only function is related to thyroid
hormone
61. Deficiency
-goiter—enlargement of the thyroid
gland
goitrogens -cabbage, turnips, peanuts,
soybeans
-deficiency may be absolute—in areas
of deficiency, or relative—adolescence,
pregnancy, lactation
-goiters are more prevalent in women
and with increased age
62. Endemic Cretinism
severe deficiency during
gestation and early
postnatal growth:
cretinism
(mental deficiency, spastic
diplegia, quadriplegia,
deaf mutism, dysarthria,
shuffling gait, short
stature, hypothyroidism)
64. Iodine Excess and Toxicity
Humans are remarkably tolerant to high
iodine intakes
In iodine deficiency, repletion must be
done slowly to prevent hyperthyroidism
65. Goiter
Endemic to parts of
S. America and India
Sporadic cases in U.S.
Selenium deficiency
(needed to convert T4 to T3)
66. Goiter -
Complications
Usually asymptomatic
Acute pain from thyroidal
hemorrhage
Dysphagia
Dyspnea
67. Chromium
Regulation of glucose metabolism as a
component of glucose tolerance factor
(GTF).
GTF increases effect of insulin (by facilitating
its binding to cell receptor site).
Chromium regulates plasma lipoprotein
concentration.
Reduces serum cholesterol and serum
triglycerides.
Both chromium and Fe are carried by Tf,
however albumin can also assume this role
72. Selenium
-glutathione peroxidase
• --overlaps with vit E for antioxidant
effects
• Iodothyronine 5’- deiodinase
• Thioredoxin reductase
• Epidemiologic evidence indicates low intakes of
Se are associated with higher risk of prostate
cancer
73. Food Sources
Food content tends to follow Se content of soil –
richest food sources are organ meats and sea foods,
followed by cereals and grains, dairy products, fruits
and vegetables
• Requirements determined based on serum glutathione
peroxidase activity
74. Selenium Deficiency Diseases
•Human deficiency is rare except in areas with low Se
content in soil
Keshan disease occurs in Keshan China: endemic
cardiomyopathy and muscle weakness (due to oxidized lipids)
Aggressive supplementation has eliminated disease
•Iatrogenic deficiency
TPN without supplemental Se
75. Selenium Toxicity
Acute-cardiorespiratory collapse
(gram amounts)
Chronic (selenosis) -changes in
nail structure and loss of hair
(intakes ~6x UL)
76. Molybdenum
-relationship with copper and sulfate
-cofactor of many enzymes involved in
the catabolism of sulfur AA, purines and
pyridines
-Toxicity: gout-like syndrome,
reproductive SE’s
-Deficiency: increased risk with co-
existing copper deficiency, TPN
77. Manganese
•High concentration of Mn2+ is present in mitochondria
• Functions as a necessary factor for activation of
glycosyltransferases (enzymes responsible for the
synthesis of oligosaccharides, glycoproteins,
proteoglycans.
• Required for superoxid dismutase activity, for
activity of metalloenzymes:
hydrolases
kinases
decarboxylases
transferases.
Deficiency of Mn extensively reduce glycoprotein and
proteoglycan formation.
78. Iron
Adult human body contains 3-4 Gm
60-70% is present in Blood and rest in storage
form.
Each Gm of Hb contains 3.34mg of Iron.
Requirement :
1 mg per day for Male
2.5 mg for Females
3.5 mg for Females in Physiological stress
conditions
79. Sources of iron
Haem Iron:
Liver, meat, poultry, Fish
Non Haem Iron:
Cereals, GLV, Legumes,, Nuts, Oil seeds,
Dried Fruits, Jaggery
Factors interfere in absorption are
enzymes in the food – Phytates, Oxalates,
Phosphates, Dietary fibres
Ascorbic acid is the most potent enhancer
iron
80. Iron Deficiency
Occurs in 3 stages:
First Stage: Decreased storage without any
other detectable abnormalities
Second Stage: stores are exhausted, serum
Ferritin level decreases.
Third Stage: Decrease in Hemoglobin
percentage
Functional disturbances: decrease in
resistance to infection, increase morbidity &
mortality, decreased work performances,
impaired cell mediated immunity
81. Evaluation of iron
1.
status relative index of
Hemoglobin Concentration:
iron deficiency. ( early Anemia if Hb is 10-
11g% & marked anemia Hb is < 10g%).
2. Serum Iron concentration: useful index
( Normal 0.8 to 1.8mg /L)
3. Serum Ferritin level: Gold standard &
sensitive tool for evaluation and reflects the
size of the iron status ( < 10Micrgms/L)
4. Serum Transferrin Saturation: 16% - 30%
82.
83. Correction of Iron
Deficiency
Oral iron supplements
100-200 mg elemental iron daily
Higher doses are of no benefit
Ferrous sulphate 65mg/tab
Pregnant women- 100mg/tablet
(+ folic acid)
84. Fluorine
It is found in combined forms
96% of fluorides in the body found in bone and
teeth.
An essential for normal mineralisation of bones
and formation of dental enamel
Source:
Drinking water : Fluorine in the drinking water is
0.5 mg per ltr. Excess of fl > 3mg causes
flourosis.
Foods: Sea fish, cheese, Tea
It is a two edged sword ( deficiency or excess)
85.
86. Zinc
Adult body contains 1.4 to 2.3 gms of Zinc
Plasma level- 96Microgm per 100 ml ( adults), 89
Microgram per 100 ml (children)
Functions are
Active role in metabolism of glucose and proteins
Synthesis of insulin by pancreas
Immunity functions
Food sources :
meat, milk, fish
Plant sources have low bioavailability
87. Zinc deficiency
1. Growth failure
2. Sexual infantilism in adolescents, loss of taste,
delayed wound healing, decrease in
immunosynthesis.
3. Spontaneous abortions, stillbirths, congenital
malformations, anencephaly
4. LBW, Intra Uterine deaths, premature labour.
5. Requirement is 15mg for men
6. 12 mg for women, 10mg for children