Kekurangan mikronutrien

1. VITAMIN AND MINERAL
S DEFICIENCY
dr. Indrawati, Sp.GK

2. VITAMIN

3. Vitamins
•Organic
•Essential
•Required in tiny amount to perform specific functions tha
t :
- promote growth
- reproduction
- maintenance of health and life
•Vital to life ( vita amine )

4. The vitamins differs from macro
nutrients
• Structure
- individual units, not linked
• Function
- do not yield usable energy
• Food content and requirement
- are measured in µg or mg
Similar to the energy-yielding nutrients, though, in that t
hey are vital to life, organic, and available from foods.

5. Availability
• Quantity provided by a food
- tables of food composition
• Bioavailability
- efficiency
- previous nutrient intake and nutrition status
- other foods consumed at the same time
- method of food preparation (raw, cooked, or processed)
- source (synthetic, fortified, or natural)
Some of the vitamins are available from foods in inactive forms k
nown as precursors or provitamins

6. Water soluble vitamins
Absorption Directly into the blood
Transport Travel freely into the blood
Storage Circulate freely in water-filled parts of the body
Excretion Kidney detect and remove excess in urine
Toxicity Possible to reach toxic levels when consumed from suppl
ements
Requirements Needed in frequent doses

7. Fat soluble vitamins
Absorption First into the lymph, the blood
Transport Many require protein carriers
Storage Stored in the cells associated with fat
Excretion Less readily excreted, tend to remain in fat-storage sites
Toxicity Likely to reach toxic level when consumed from supplements
Requirements Needed in periodic doses (perhaps weeks or even months)

8. Vitamin A: retinol
• Can only be found intact in animal s
ources
• In its natural form, it is alcohol kno
wn as retinol
• Provitamin : caroten stored in the li
ver
• retinol + opsin (protein) = rhodopsi
n (vision)
• Function: affect vision, bone growt
h, reproduction, cell division, immu
nity, and healthy surface linings of t
he respiratory tract and mucous m
embranes.
• deficiency = improper growth, xero
phthalmia, follicular keratosis

9. Vitamin D : cholecalciferol
• Vitamin D found as ergocalciferol (
D2) and cholecalciferol (D3)
• Both activated in plants/animal ski
n by UV radiation (‘conditional vita
mine’)
• D3 primarily used as precursor for c
alcium regulation
• Deficiency : bone deformation (rick
ets)
• An excess of vitamin D can lead to
hypervitaminosis resulting in renal
failure, weight loss, and calcificatio
n of soft tissues in the body

10. Rickets

11. Vitamin E: tocopherol
•active form is alpha tocopherol
•good antioxidant (protects unsaturated fatty acid compon
ent of cell membranes from free-radical attack)
•smokers are especially likely to develop vit E deficiency, als
o result of genetic abnormality of lipoprotein synthesis
•the primary def. symptoms is nervous system damage. Im
mune function also reduced
•deficiency leads to fragile red blood cells
•effects of overdosing: diarrhea, nausea, headaches, fatigue

12. Vitamin K: menadione
•Originally identified as a fat-soluble factor required for normal
blood clotting
•menadione is the most active form
•actually works by activating blood-clotting proteins
•Defic. occurs when a person takes antibiotic (certain type), or
has impaired fat absorption
•Also occur in newborn, typically low birth weight

13. Water SolubleVitamins
• These are vitamins that are also ne
eded in small amounts due to their
role in enzymatic reactions in the c
ells
• After being ingested, they undergo
chemical modifications which conv
ert them into enzymes
• Taking larger doses of these vitami
ns is pointless because they are not
stored in the body; they are excrete
d out in the urine

14. Thiamin B1
• Chief function : Part of co E TPP (Th
iamin Pyrophosphate) in the metab
olism of CHO
• Deficiency : manifest chiefly as neu
romuscular disorders
• Symptoms : Beri-beri, enlarged hea
rt, cardiac failure, weakness, apath
y, poor short term memory, anorexi
a, weight loss
• Wernicke-Korsakoff syndrome (alco
holism)

15. Riboflavin: B2
• Chief function: part of FMN (flavin
mononucleotide), FAD (Flavin ade
nine dinucleotide) used in energy m
etabolism
• Riboflavin co E have redox reaction
function
• Deficiency : manifested chiefly as d
ermal and neural disorders
• Symptoms : sore throat, cracks and
redness at corners of mouth, painful
, smooth, purplish red tongue

16. Riboflavin deficiency
 lesions of the margin of the lips (ch
eilosis) and corners of the mouth (ang
ular stomatitis)
 painful desquamation of the tongue,
so that it is red, dry and atrophic (mag
enta tongue)
 sebhorroeic dermatitis, with filiform
excrescences.
Deficiency is widespread; rarely fatal because there is efficient re
utilization of riboflavin released in catabolism of enzymes
Riboflavin functions as a redox coenzyme
in all energy-yielding pathways


17. Niacin
• forms: niacin, nicotinic acid, nicoti
namide
• the co E form : niacin, NAD and NA
DP are active participants in redox r
eactions.
• sources: rice polishings, yeast, rice
bran
• tryptophan can be converted to nia
cin in the body.
• deficiencies: pelagra, dermatitis, a
nemia, skin lesions, sunburning

18. Pellagra – the niacin deficiency disease
Sunburn-like dermatitis in areas exposed to sunlight


19. Niacin deficiency (pellagra) before and a
fter therapy

20. Pyridoxine (B6)
•The metabolically active form of B6 is pyridoxal phosphate,
which functions as a co E for reactions involving amino acids
•Required for synthesis and breakdown of amino acids
•Found in fish, meat, poultry, leafy green vegetables
•RDA: ~2.0 mg/day
•Deficiency: rare, nervousness/muscular weakness
•Overdose: if 50-100 times the RDA are taken
•peripheral neuropathy in young women has been seen

21. Pantothenic Acid
•Essential for the normal metabolism of fats and carbohydrat
es
•Abundant in meat, poultry, whole grain cereals and legumes
•RDA: 4-7 mg/day
•Deficiency: rare, except in alcoholics, leads to gastrointestin
al, neuromotor, and cardiovascular disorders
•Gets converted to CoA in the body (the functional form); als
o important in fatty acid metabolism

22. Biotin
•Involved in carboxylation/decarboxylation reactions in th
e metabolism of fats, carbs, and protein
•Sources: liver, egg yolks, cheese, peanuts, bacteria in the
intestines
•Deficiency: rare, dermatitis, loss of appetite/nausea, musc
le pain, elevated blood cholesterol
•Birth defect : labioplatoschisis, short limbs, etc.

23. Folic Acid
•Recently shown as very i
mportant for pregnant fe
males to avoid birth defec
ts
•function: synthesis of pur
ines, pyrimidines, nucleic
acids
•deficiencies: anemia, larg
e erythrocytes, Neural Tu
be Defect (NTD).

24. Folic acid
N
CH2
HN
N
N
N
C N
O
CH
CH2
COOH
CH2
C
(Glu)n
O
OH
H
H H
tetrahydrofolate (THF)
H
Dietary deficiency not uncommon
Megaloblastic anaemia
– release into the circulation of immature red cell precursors
– folate has a major rôle in DNA synthesis


25. Cyanocobalamine
•Last of 15 vitamins to be iden
tified
•chemically complex, cobalt n
ucleus
•function: coenzyme in metab
olic reactions, maturation of e
rythrocytes, uracil->thymine
•deficiency: pernicious anemi
a, nerve disorders

26. B vitamins-in CHO metabolism concert

27. Ascorbic Acid: C
• function: antioxidant, stress reduce
r, bone calcification, iron metab, tyr
osine metab, blood clotting
• Important for growth/repair of con
nective tissue, teeth, bones, and ca
rtilage
• Promotes wound healing, enhance
s absorption of iron, helps synthesi
ze several hormones
• deficiency: stomatitis, scorbut, slo
w woun healing
• toxicity: nausea, diarrhea kidney st
one

29. Mineral
Major minerals :
Essential mineral nutrients need in the human body
in amounts larger than 100 mg. Sometimes called m
acrominerals (sodium, potasium, clorida, magnesiu
m, fosfor, calcium)
Trace mineral :
Essential mineral nutrients need in the human body
in amounts less than 100 mg. Sometimes called mic
rominerals (zinc, iodine, fe, cu, fluoride)

30. Characteristics
 Inorganic,
 Found in every living cell
 Optimal intake (essential, but can also be toxic)
 Bioavailibility
 Amplification of action
 Interaction

31. Functions
Found in every living cell
Important constituents of essential molecules
Cofactors in numerous enzymatic reactions
Serve in the maintenance of pH, osmotic pressure, nerve conductance, mu
scle contraction,blood clotting, energy production, and in almost of every a
spect of life.

32. Food sources
The trace mineral contents of food depend on soil a
nd water composition and on how foods are proces
sed.
Furthermore, many factors in the diet and within th
e body affect the mineral’s bioavailability
Bioavailability refers to the rate at and the extent to
which a nutrient is absorbed and used

33. Bioavalibility
Defined as the percent of the consumed mineral that
enters via the intestinal absorptive cells and is used fo
r its intended purpose.
Bioavailibility includes not only how much of a consu
med minerals enters the body, but also how much is r
etained and available for use.

34. Deficiencies
Severe deficiencies of the better-known minerals are e
asy to recognize.
Mild deficiencies are easy to overlook
In general, the most common result of a deficiency is
failure of children to grow and thrive.

35. Toxicities
Some of the trace minerals are toxic at intakes not
far above the estimated requirements.
Thus it is important not to habitually exceed the u
pper level of recommended intakes

36. Interaction
Interactions among the trace minerals are common and ofte
n lead to nutrient imbalances.
An excess of one may cause a deficiency of another.
A deficiency of one may open the way for another to cause a
toxic reaction.
A deficiency of one may exacerbate the problems associated
with the deficiency of another.
Interlocking gear system

37. Mineral antagonisms

38. Vitamin & Mineral interactions

39. Iron (Fe)
Functions
a key attribute of iron is i
ts ability to take up and re
lease oxygen atoms and ele
ctrons. This allows it to pa
rticipate in carrying oxyge
n in the blood and transfer
ring electrons in the electr
on transport chain of the c
ell mitochondria
•Carrier of oxygen in the blood
(Hb).
•Storage of oxygen in muscle (
myoglobin)
•Involved in electron transport
chain and production of ATP (
cytochromes)

40. Sources
• Heme iron
- animal ( ± 30%)
• Non Heme iron
- vegetable, legumes etc.

41. •Terdapat dlm bentuk Fe (II) atau (Fe(III)  di dlm tubuh dite
mukan berasosiasi dgn protein. Di dalam tubuh tersimpan dl
m jumlah besar dalam protein  ferritin
•Dlm btuk bebas di dalam tubuh : konsentrasi sgt rendah. Kar
ena
• Ion Ferri tidak larut dalam air
• Mungkin ion ferro toksik bagi sel dpt bereaksi dg hidrogen peroksida
 radikal hidroksil
HOOH HO- + HO.
•Makanan biasa mengandung Fe (III)  tapi untuk mudah dis
erap harus dlm bentuk Fe (II)
•Reduksi Fe (III) menjadi Fe (II)  dgn askorbat (vit C) atau dg
n suksinat
Fe2+ Fe3+

42. Absorption
iron status regulated through absorption
Increase
- Acid in stomach
- Heme iron
- High body demand
- Low body stores of iron
- Meat protein factors (MPF)
- Vit C (converts ferri to ferro)
Decrease
- Phytic acid (dietary fibre)
- Oxalic acid
- Polyphenols (tea, coffee)
- Full body stores of iron
- Excess of other minerals (Zn, Mn,
Ca)
- Reduction in stomach acid
- Antacid

43. Transport
- Transferrin is a protein that transports iron in the blood
- When iron stores are adequate all iron binding sites are saturated
-Transferrin can be used as an indicator of overload or deficiency
- Almost all cells in the body have transferrin receptor (TfR)
- Serum soluble Tfr (sTfR) is a good indicator of deficiency.

44. Storage
 Ferritin is the primary store of iron
 Iron not taken up by transferrin is stored as ferritin in
the intestinal wall (short term store)
also stored in the liver and spleen as ferritin
 Hemosiderin is a stable iron-protein compound in the
liver that stores iron when iron exceeds the storage
capacity of ferritin.

45. Deficiency and excess
Deficiency
IDA – high prevalence
Reduced cognitive functionin
g
Reduce capacity for physical
work
Increased maternal mortalit
y
Excess
Haemochromatosis – genetic
disorders
Fe deposits cause cell damag
e in pancreas, liver and heart
Leads to diabetes, liver and
heart failure

46. Iodine in human body
•Usual intake of healthy person 100 to 200 µg/day, mostly from iodized salt
•Rapidly absorbed from GI tract
•Fasting plasma concentration are about 1µg/L.
•80% Iodide ingested and absorbed is trapped by the thyroid gland through
an ATP-dependent iodide pump
•Thyroid gland (15 to 20 g) contains 80% of the body’s iodine pool (15 mg)
•The primary function of Iodine in the body is to provide a substrate for the
synthesis of the thyroid hormones, which are crucial for normal growth and
development

47. GAKY= Iodine deficiency disorders
Adalah sekumpulan gejala yang timbul karena tubuh
seseorang kekurangan unsur yodium secara terus me
nerus dalam jangka waktu yang cukup lama
Goiter/gondok Cretinism

48. Spektrum GAKY
Ibu hamil : keguguran
Janin : lahir mati cacat bawaan
kematian perinatal kematian bayi
kretin neurologi kretin myxedematosa
Neonatus : gondok neonatus
hipotiroidi neonatus
Anak dan remaja : gondok
ggn pertumbuhan fisik dan mental
hipotiroidi juvenile
Dewasa : gondok
gangguan fungsi mental
hipotroidi

49. Calcium
• The most abundant mineral in the body
• The fifth most abundant elemen in the body
• 99% in the bones and teeth
- as an integral part of bone structure
- as a ‘Ca bank’

50. Physiological function
•Structural component of bones and teeth
- hydroxyapatite
- will maintain calcemia at bone’s expense
•Role in biochemical reactions
- muscle contraction
- blood clotting
- enzymes and hormones activation
- transmission of nerve impulses

51. Sources
• Milk and milk product
• Sardines
• Oysters
• Cauliflowers
• Brocolli
• Legumes
• Dried fruits
• Ca carbonate (40%)
• Ca citrate ( 21%)
• Ca phosphate (8%)

52. Ca absorption
•Enhancer
- Stomach acid
- Vit D (helps to make Ca binding protein)
- Lactose
- Growth hormones
•Inhibitor
- high Phosfor intakes
- high fiber diet ( phytate, oxalate)

53. Hypocalcemia
• Increased in membrane excitability ( hypocalcemic tetany).
• Cardiac depression
- hypototension
- bradycardia
- heart block

54. Osteoporosis: Definition
•A skeletal disorder characterized by compromised bone strengt
h predisposing to an increased risk of fracture.
Osteoporosis Prevention, Diagnosis, and Therapy. NIH Consensus Statement 2000 March 27-29; 17(1): 1-36.
Dempster, DW, et al., JBMR 2000; 15 (1): 20.
Normal Bone Osteoporotic Bone

55. osteoporosis
Ca loss is the effect, not the cause

56. THANKYOU