TRACE ELEMENTS

• Copper:

  • Present in 2 forms: Oxidised cupric (Cu2+) and reduced cuprous (Cu+)
  • Dietary sources include liver, shellfish, and whole-grain products
  • Bioavailability affected by antacid and iron
  • Major absorption in small intestine, bound to cerruloplasmin
  • Functions as a cofactor for metalloenzymes involved in redox reactions, ATP production, iron metabolism, neural function, antioxidant function, and connective tissue synthesis
  • Deficiency rare but can cause defective connective tissue, anaemia, and neural problems
  • Toxicity rare
• Selenium:

  • Dietary sources include nuts, seafood, meat, and garlic
  • Absorption is high and not regulated, used for protein synthesis
  • Functions as an antioxidant, immunity booster, and cancer prevention
  • Severe deficiency causes Keshan disease, affecting children and causing serious heart problems
• Chromium:

  • Found in a variety of foods depending on soil content
  • Bioavailability increased by Vitamin C and acidic medications, decreased by antacids
  • Functions in insulin hormone function and glucose homeostasis
  • Rare deficiency could cause a diabetic-like state, rare toxicity among industry workers
• Manganese:

  • Dietary sources include whole grains, pineapples, nuts, legumes, and dark green vegetables
  • Functions as a cofactor for metalloenzymes, glucose production, bone formation, and energy metabolism
  • Rare deficiency and toxicity, present in mining workers and patients with liver disease
• Molybdenum:

  • Dietary sources vary depending on soil content
  • Completely absorbed in the liver
  • Functions in redox reactions, metabolism of sulfur-containing amino acids and purines, and drug detoxification
  • Rare deficiency and toxicity
• Zinc:

  • Dietary sources include shellfish, meat, organ meats, dairy, legumes, and chocolate
  • Bioavailability influenced by various factors
  • Functions as a cofactor in enzymatic reactions, gene regulation, stabilizing cell membranes, and as an antioxidant
  • Rare deficiency, uncommon toxicity
• Fluoride:

  • Food sources include toothpaste or water additives
  • Functions in strengthening teeth and bones, decreasing bacterial acid production, and preventing tooth decay
  • Rare deficiency, severe toxicity may cause dental and skeletal fluorosis
• Iron:

  • Needed for oxygen and carbon dioxide transport, energy metabolism, removal of free radicals, and DNA synthesis
  • Dietary sources include heme and nonheme iron from a wide variety of foods
  • Bioavailability affected by iron compound, status, and other dietary components
  • Functions in oxygen transport, cellular energy metabolism, and storage
  • Iron balance influenced by bleeding, menstruation, growth, pregnancy, and lactation
  • Deficiency can lead to iron deficiency anaemia
• • Iron status determined by various indices including haemoglobin levels, serum ferritin, and transferrin saturation
  • Development of iron deficiency anaemia involves stages from normal iron to depleted iron stores and anaemia
  • Important to distinguish between iron deficiency anaemia and anaemia of chronic disease
• Anaemia of chronic disease (ACD) is the most common anaemia in hospitalised patients
• It is important to distinguish between Iron Deficiency Anaemia (IDA) and ACD
• Main differences between IDA and ACD:

  • Transferrin, ferritin, soluble transferrin receptor, ratio of soluble transferrin receptor to log ferritin, and cytokine levels
• For hemoglobin, the WHO cut-off for anemia is 120 g/L for females and 130 g/L for males (WHO 1994)
• Iron deficiency risk factors:

  • Elderly
  • Teenagers
  • Immigrants
  • 'Orang asli'
  • Widowers
  • Low Fe, heam Fe
  • Low Vit. C
  • Excess phytate
  • Excess tea/coffee (tannin)
  • Fad diets/ Vegetarianism
  • Poverty
  • Poor detention
  • Alcohol/drug abuse
  • Depression
  • GIT disease
• Iron deficiency anaemia:

  • Discuss IDA based on prevalence, blood picture and clinical sign, consequences, prevention, and treatment
• Prevalence of iron deficiency:

  • Commonest nutritional deficiency worldwide, affecting young children and women of reproductive age
  • Areas worst affected: sub-Saharan Africa, Asia, and the West Pacific
  • In women: 40% in Africa, 65% in South Asia
  • Associated with poverty in the USA and UK
• Consequences of iron deficiency anaemia:

  • Fatigue
  • Low productivity
  • Decreased physical activity
  • Impaired motor and language development
  • Increased risk of PEM
  • Infection at childbirth
  • Decreased body iron store
  • Maternal mortality
  • Increased fetal morbidity & mortality
  • Increased risk of low birth weight
  • Aggravates the effects of maternal blood loss
• Prevention of iron deficiency:

  • Fortification of staple foods is cost-effective
  • Iron salts listed as safe by the US FDA
  • Treatment usually involves oral iron supplements, with IV iron in clinical settings
• Iodine Deficiency Disorder (IDD):

  • Discuss IDD based on definition, indication, prevalence, cause and effects, treatment, and prevention
• Definition of IDD:

  • Partial or absolute failure to synthesize thyroid hormone
  • Most common cause of preventable mental retardation
  • Evident as 'endemic cretinism' with delayed development and growth failure
• Iodine:

  • Essential component of thyroid hormones
  • Regulates growth, reproduction, energy metabolism, immune system, and neural development
• Causes of IDD:

  • Environmental iodine deficiency
  • Goitrogens inhibiting iodine uptake
  • Poor dietary iodine intake
  • Disorders of the thyroid gland
• Effects of IDD:

  • Goiter, hypothyroidism, loss of energy
  • Miscarriages & stillbirths in pregnant mothers
  • Cretinism, impaired mental & physical development in children
  • Low productivity and higher demand for social services in society
• Prevention of IDD:

  • Iodine fortification of salt
  • Water iodination