Micronutrients

• Substances that are essential for the growth of a living organism

  • Support coenzyme and cofactor production (vitamins and minerals)

  • dietary reference intake (DRIs)

• DRIs: A set of scientifically developed reference values for nutrients

  • They are standards for the general population:
    The DRIs aren't meant for people with acute or chronic disease or those who may be malnourished or nutrient deficient.

  • They refer to average daily nutrient intake over time: Some variation in nutrient intakes from day to day is expected. The DRI values represent long-term average intake.

  • They are set based on a variety of health indicators and outcomes:

    • The specific indicator used as the basis of each DRI value varies according to the nutrient and the type of value.

• Vitamins: organic substances required in the diet in small amounts for the maintenance of normal
  metabolic integrity

  • deficiency cured by restoring physiologic levels of deficient vitamin

  • deficiency diagnosed by signs, symptoms,
    laboratory tests

  • Fat-Soluble Vitamins

    • Absorbed with dietary fats

    • Stored in the body

    • Deficiency develops after several months of reduced intake.

    • Toxicity is possible with excess ingestion

    • Includes vitamins A, D, E, and K

Fat-soluble Vitamins

• Vitamin A

  • Family of compounds called retinoic acids

  • Exists in two forms: provitamin A carotenoids and preformed vitamin A

  • Needed for vision, growth, bone formation, reproduction, immune system function, skin health

  • Provitamin A carotenoids are found in green, leafy vegetables, sweet potatoes; carrots

  • Preformed vitamin A found in the liver, kidney, egg yolk, butter

  • Indicated in vitamin A deficiency, treatment of cataracts, reduction of HIV complications, measles, and malaria

  • Signs of toxicity include nausea, vomiting, vertigo, blurry vision, hair loss, headache, irritability, skin peeling, bone and liver problems.

  • Teratogenic and can lead to spontaneous abortions and fetal malformations

  • Topical vitamin A, also known as tretinoin, is
    sold by prescription under the names Retin-A,
    Stieva-a. This medication is used for a variety of dermatologic issues including acne, fine wrinkles, hyper-pigmentation, and skin
    roughness

• Vitamin D

  • Also called calciferol

  • Exists as two forms: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3)

  • Maintains calcium and phosphate levels; plays a role in insulin resistance, obesity, metabolic syndrome, various cancers

  • Ergocalciferol is human-made and added to foods.

  • Cholecalciferol is synthesized in the skin and is found in fatty fish, fish liver oil, egg yolks.

  • Indicated in the treatment of rickets and
    osteomalacia

  • Signs of toxicity include high blood calcium levels, kidney stones, nausea, vomiting, thirst, increased urination, muscle weakness, bone pain

• VItamine E

  • Also called tocopherol

  • Thought to work as an antioxidant

  • Tocopherol found in oils; meat; eggs; green
    leafy vegetables

  • Alpha-tocopherol found in olive oil,
    sunflower oil

  • Gamma-tocopherol found in soybean oil,
    corn oil

  • Used for vitamin E deficiency,  macular degeneration, Alzheimer’s disease, risk reduction for cancer and dementia, immune system function, diabetic retinopathy, cardiovascular disease

  • Signs of toxicity include bleeding or stroke with very high doses.

• Vitamine K

  • Exists as two forms:  phylloquinone and phytonadione

  • Coenzyme for production of blood-clotting factors and for bone metabolism

  • Found in green, leafy vegetables; plant oils; margarine

  • Indicated in vitamin K deficiency, reversal of warfarin effects

  • Signs of toxicity include anemia and jaundice.

  • Patients who are taking warfarin, or other common anticoagulants, should be instructed to monitor their intake of foods rich in vitamin K. These foods include green, leafy vegetables (broccoli, spinach, cabbage, turnip greens, parsley, lettuce, kale, and endive) as well as blueberries, blackberries, and avocados. Most patients can consume these foods as long as they keep their intake consistent.

  • Dietary Sources for Vitamin K

    • Green, leafy vegetables

      • spinach

      • broccoli

      • brussel sprouts

      • cabbage

    • Plant oils

    • Margarin

MIcroNutrients

• Vitamins

  • Water-soluble vitamins

    • Easily excreted from the body in the urine

    • Toxicity difficult to achieve

    • Includes the B vitamins: B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folate or folic acid), and B12 (cyanocobalamin)

    • Also includes vitamin C

Water Soluble Vitamins

• B1

  • Also called thiamine

  • Coenzyme involved in carbohydrate metabolism and plays a role in nerve impulse propagation

  • Found in yeast, legumes, pork, rice, cereals

  • Indicated in vitamin B1 deficiency, Wernicke-Korsakoff syndrome, beriberi

  • Wernicke – Korsakoff Syndrome - a neurodegenerative disorder that is caused by a severe thiamine (vitamin B1) deficiency. Parts of the brain may be damaged as a result of this deficiency, causing increased difficulty with memory, movement, vision and coordination

• B2

  • Also called riboflavin

  • Coenzyme involved in tissue respiration and normal cell metabolism

  • Found in cereal, green vegetables, milk, some meats

  • Also made in the intestines by bacteria

  • Indicated in vitamin B2 deficiency and used in higher doses to reduce migraine headaches

• B₃

  • Also called niacin

  • Exists as two forms: nicotinic acid and nicotinamide

  • Essential for reactions that produce ATP; helps regulate production and activity of cholesterol

  • Found in yeast, peanuts, peas, beans, whole grain, potatoes, lean meats

  • Indicated for treatment of dyslipidemia, medication-related vitamin B3 deficiency, pellagra (skin condition)

  • flushing occurs with B₃

• B6

  • Also called pantothenic acid

  • Precursor to coenzyme A, which has a role in the synthesis of vitamins A and D, cholesterol, steroids, heme, fatty acids, amino acids, proteins

  • Found in whole grains, potatoes, chicken, beef, egg yolk, liver, kidney, broccoli, milk, walnuts

  • Also produced in the colon by bacteria

  • Indicated in vitamin B5 deficiency

• B8

  • Commonly referred to as pyridoxine

  • Exists as multiple forms: pyridoxine, pyridoxal, pyridoxamine

  • in the body to the coenzymes responsible for amino acid metabolism

  • Pyridoxine and pyridoxamine found in vegetables, whole grains, nuts.

  • Pyridoxal found in animal foods.

  • Indicated in vitamin B6 deficiency, some types of anemia, certain seizure disorders, nerve damage in patients with history of alcoholism, patients taking isoniConverted azid for tuberculosis

• B7

  • Also called biotin

  • Plays a role in many processes including cell replication

  • Found in peanuts; green, leafy vegetables; liver; egg yolk; soybeans; yeast

  • Indicated for vitamin B7 deficiency

• B8

  • Commonly referred to as folic acid or folate

  • Plays a major role in intracellular metabolism and the breakdown of homocysteine; involved in the production of the neurotransmitter serotonin

  • Found in green, leafy vegetables; fruits; cereals; grains; red meat

  • ATP = adenosine triphosphate

    Pellegra - caused by a lack of the vitamin niacin (vitamin B3). Symptoms include inflamed skin, diarrhea, dementia, and sores in the mouth. Areas of the skin exposed to either sunlight or friction are typically affected first. Over time affected skin may become darker, stiffen, peel, or bleed

  • Indicated for folic acid deficiency; during pregnancy to reduce risk of neurologic birth defects; in end-stage kidney disease to reduce homocysteine levels; and in chronic fatigue syndrome, depression, and vitiligo

• B12

  • Commonly called cyanocobalamin

  • Coenzyme necessary for cell production, normal growth, RBC production

  • Found in fish, milk, bread, meats

  • Intrinsic factor, produced by the stomach, required for absorption of oral form

  Indicated in vitamin B12 deficiency, pernicious anemia, end-stage renal disease

• Vitamin C

  • Also called ascorbic acid

  • Role in immune system function and antioxidant

  • Found in citrus fruits, tomatoes, potatoes, Brussels sprouts, cauliflower, broccoli, strawberries, blueberries, cabbage, spinach

  • Indicated in scurvy, macular degeneration, seasonal allergies, improved iron absorption, protein metabolism in premature infants

  • Used for prevention of the common cold, cancer, atherosclerosis, sunburn

Micronutrients

• Trace Mineral

  • A metallic substance found in minimal amounts in the body

  • Significant roles in cell structure and required for physiologic functions

  • Present in food and produced by the body

  • Deficiency diagnosed with signs, symptoms, laboratory tests

• Chromium

  • Helps regulate glucose tolerance and insulin levels

  • Found in grains, cereals, fruits, vegetables, processed meats

  • Indicated in chromium deficiency; used to improve glucose tolerance in diabetes

  • Signs of toxicity include skin or nasal lesions, skin rash, lung cancer.

• Copper

  • Catalyst and coenzyme for chemical reactions in the body

  • Found in vegetables, grains, seeds, meat, fish, poultry

  • Indicated in copper deficiency

  • Signs of toxicity include diarrhea, vomiting, metallic taste in mouth, cirrhosis.

• Iodine

  • Used in the body to make thyroid hormones

  • Found in seafood and seaweed; added to salt in developed countries

  • Indicated in iodine deficiency, treatment of some thyroid conditions, radiation emergencies in which radioactive iodides have been used

  • Signs of toxicity include metallic taste in mouth, sore teeth and gums, irritation of the mouth and throat, toxic thyroid, upset stomach, diarrhea, weight loss, tachycardia, muscle weakness, fever, infertility.

• Iron

  • A cofactor for neurotransmitter production; part of the functional groups of many enzymes; involved in production of RBCs

  • Found in red meat, poultry, fish, whole-grain cereals, spinach, walnuts, green peas

  • Indicated in anemia of chronic disease, iron-deficiency anemia

  • Signs of toxicity include hemochromatosis, cirrhosis, heart problems, pancreatic damage, changes in skin pigmentation

  • Iron supplements can be given orally and intravenously.  Many, but not all, brand names of iron supplements contain the elemental abbreviation for iron: Fe  Ferrous Sulfate, Ferrous Gluconate, Ferrous Fumarate are examples.

  • Table 1 lists the current iron RDAs for nonvegetarians. The RDAs for vegetarians are 1.8 times higher than for people who eat meat. This is because heme iron from meat is more bioavailable than nonheme iron from plant-based foods, and meat, poultry, and seafood increase the absorption of nonheme iron.

  • should be taken on an empty stomach

  • to avoid stomach irritation, recommended to be taken with meals.

  • cereals, milk, tea, and coffee may decrease iron absorption.

• interferes with the absorption of antibiotics such as tetracyclines and fluoroquinolones, other supplements containing iron supplements and other antibiotics

  • should be taken at least 2 hours apart.

• Manganese

  • A cofactor in many metabolic or enzymatic reactions in the body

  • Found in nuts; legumes; seeds; tea; whole grains; green, leafy vegetables

  • Indicated for manganese deficiency

  • Signs of toxicity include change in gait, loss of balance, irritability, hallucinations, changes in libido.

  • Risks for toxicity include exposure to manganese aerosols or dust and consumption of well water with high manganese concentrations.

• Selenium

  • incorporated into amino acids and plays a role in multiple biologic functions

  • Found in seafood, kidney, liver, some grains and seeds

  • Indicated in selenium deficiency

  • Signs of toxicity include nausea, vomiting, hair and nail loss, tooth decay, skin lesions, irritability, fatigue, and peripheral neuropathy.

• Zinc

  • A cofactor in the synthesis of DNA and protein; role in immune function, wound healing, blood clotting, reproduction, growth

  • Found in nuts, legumes, meat, seafood, dairy products, whole grains

  • Used to treat zinc deficiency, boost immune function, aid wound healing, treat Wilson’s disease, reduce the severity and length of the common cold

  • Signs of toxicity include upset stomach, nausea, dizziness, and decreased HDL cholesterol levels.
    

Macronutrients

• Macronutrients: Substances consumed in larger quantities than micronutrients

• Carbohydrates

  • Sugars or starches

  • Provide energy

  • No specific daily allowance recommended

  • Rated based on their glycemic index, or food’s effect on an individual’s glucose level

Recommended Percentage of Total Daily Calories

• Carbohydrates

• 45%–65%

• Proteins

• 10%–35%

• Fats

• 20%–35%