Vitamins and Minerals

Vitamins

essential, organic, and noncaloric

Vitamins help other nutrients in digestion, absorption, and metabolism

Vitamin precursors→ become something else

fat and water soluble

absortption

Blood→ Bs and C

Lymph→ ADEK

Fat soluble vitamins

ADEK

food sources→ fat and oils

storage is for weeks

Toxicity can occur w/ build up

DO not need to be consumed every day

deficiencies can occur from diet, inestinal conditions, liver issues,

Vitamin A

precursor provitamin for beta carotene ( plant derived)

there are three active forms in the body

retinol- stored in the liver converted to retinal and retinoic acid

Food source→ liver

Eye sight

process of light perception through the retina

maitain a healthy cornea

Rhodopsin molecule ( retinal)

color blindness - photopsins coded on X chromsome

Night blindness

deficiency in retinal

Xerophthalmia and blindness- permenent

Keratinization- accumulates in the eye and skin

Xerosis- drying and thickening of the skin and conjunctiva

Gene regulation ( delayed growth and eye development)

Retinoic acid

cell differentation

vulnerable to infection

Immune function

can be impaced if malnurised and infection

reproduction and growth

spermatogenesis and fetal growth ( retinol)

Bone and teeth

Deficiency around the world

Toxicity

supplement and fortified foods

symptoms→ many

high risk groups pregnant women and children

food sources liver and fish oil

Beta carotene

plant based foods

colorful food groups

reduces the risk of macular degredation

dietary antioxidant

if not converted efficently can lead to toxicity

Vitamin D

not an essential nutrient

body can synthesis all it needs using sunlight

estimate deficiency prevalance- low dietary intake

clacium regulation

acts at 3 locationd to raise calcium levels

other roles

hormones

acts at the genetic level

Deficiency → Rickets in children

Osteomalacia

recommendation- supplements for the elderly

osteoporosis- weak and brittle bones

groups of concen- vegetarians, milk, allergies, Lactose intolerance, an northern zones

too much vitamin D can lead to danger to soft tissues most potential toxic vitamin

can increase blood calcium concentration and cause hyperclacemia

kidney and heart failure- nerve and muscle are less excitable

risk with high dose supplements

Vitamin D from sunlight

UV

cholesterol compound

role of the liver and kidneys

skin pigments

dark skin up to 3 hours

lighter skin 5 minutes

Recommendations

steadt throughout life

food sources

milk and fortified products

Vitmain E

Tocopherols

Roles

reproduction

Antioxidant

  • Inflammation free radicals

Deficiency

symptoms→ muscle weakness, impaired vision or speech

premature babies - hemolytic anemia

toxicity rare

Symptoms include prolonged blood clotting w/certian medications

tolerable UL 1000 mg/day

recommended 15 mg a day

smokers need higher intakes

can be destroyed be heat and oxygen

Vitamin K

blood clotting

bone protein → osteocalcin

deficiency most commonly seen with infants

toxicity can occur from prolonged doses

Juandice- bilirubin release

rapid weight loss

requirements

men 120 ug a day

women 90 ug a day

sources food and intestional bacteria

Vitamin K deficiency

Necessary for the synthesis and regulation of prothrombin and factors II, V II, IX, X, and Protein C

Water soluble Vitmains

dissolve in water

absorption is easy

transport

excretion out of the body is easy

Vitamin C ( asorbic acid)

exs. Red peppers, OJ, and Strawberries

Roles

connective tissue

collagen

carnitine

Antioxidant

protects iron from oxidation

Deficieny

scury

  • gums corrode, teeth fall out

  • smokers need more

Toxicity

safe doses 10 mg and 2000 mg

Recommendations 90 mg men 75 mg women

tobacco use add 35 mg

pysical stressors

infections, burns, fever, toxic heavy metals, and some medications

can be destroyed by heat and oxygen

Immune boosting

The B vitamins

function as a part of coenzymes

combines with enzymes and activates it

coenzyme shape - determination of function

Roles in

Helps the body use the energy-yeilding nutrient for energy

Cell multiplication B9 or folate and B12

deficiences

every cell is affected

Symptoms- nuasea, exhuastion, irritability, depression, muscle pain, immune impairment, heart issues, and skin problems'

Isolated deficiences are rare- red and swollen tongue

  • usually multiple nutrients

B1→ Thiamine

B2→ Riboflavin

B3→ Niacin

B5→ Pantothenic acid

B6→ Pyridoxine

B7→ Biotin

B9→ Folic aicd

B12→ cyancobalamin

Thaimine B1

Energ metabolism of all cells ( sugar and aas)

Nerve cell membranes ( mylein)

Deficiency

Beri-Beri “ i cannot”

forms dry and wet

alchol abuse

DRI recommendation

men 1.1 mg

women 1.2 mg

Riboflavin B2

role in energy metabolism of all cells ( niacin, B6, and folate)

Deficiencies similar to thiamin deficinecy

DIetary sources

DRI 1.1-1.3 mg

Destruction of B2

Uv light

irradiation

heat stable

Niacin B3

Participates in energy metbolism and can be made from tryptophan

deficeincy

pellagra

  • diarrhea, dermatitis, dementia, and death

can happen form too much corn or ETOH

toxicitity can cause liver tox

used in the past to improve blood lipids

increase hdl and decrease ldl

Recommendations 14-16 mg a day

Folate B9

DNA synthesis and cell division ( specifically hematopioetuc cells)

deficiency from diet or GI disorfers

outcomes of deficiency

anemia, diminished immunity, and abnormal digestive function

cancer risk breast and prostate

inx with medications

antacids and aspirin cna interfer with absorption

Birth defects

neural tube defects

Tox

Ul= 1000 ug a day

may mask B 12 deficiency

recommendations 400 ug a day

food sources

dried folage

Raw or lightly cooked vegtables

Vitmain b12

2.4 ug a day

maintian sheath around the nerve fiber

Deficiency

anemia

absorption→ intrinsic factor made by the parietal cells

Vitamin B6

partipates in over 100 rxns

tox rare

intake recommendation 1.3 mg a day

Biotin ( panthenoic acid) b7

important for energy metabolism

Bitotin 30 mg a day

cofactor for enzymes carbohydates fat and protein metabolism

gene expression

No UL

patothenoic acid 5 mg a day b5

key for coenzyme a

non- B vitamins

choline→ conditioning essential

widely supplied by protien- rich foods

Non vitamins

carnitine Insitol

Lipoacid

other substances PABA

Major Minerals

Clacium, Phosphorus, Potassium, sulfur, Sodium, chloride, and magnesium

Trace- Iron and Zinc

Calcium

most abundant

DRI 1000 mg a day

99% stored in the bones

  • in constant flux

teeth discolored in deficiency

Bone is formed from hydroxyaptite invade collagen

teeth → dentin and enamel

In body fluids

1 % in the blood

roles muscle contration , neurotransmitter release, and wound healing

blood calcium is tightly controlled

calcitionin decreases calcium in the blood

and parathyroid hormone increses calcium in the blood

calcium can potentially reduce HTN and modulates SM

Calcium balance

skeleton serves as a calcium bank

bone density

intestines and kidneys assist w/calcium balance

clasium absorption 25-30% of what is ingested

increses in times of need - infants and growth

times of increased absorption when calcium is low

Bone loss

Inevitable consequnces of aging

peak bone density 25-30 yrs

Low calcium intake is associated with diseases, bone loss, HTN, and colon cancer

Milk and milk products good source

Types of calcium supplements

calcium carbonate US

calcoum phospahte EU

Trabecular bone → tapped when blood calcium is low

cortiol bone outer

Bone loss you will see Dowager’s hump

fractures commonly seen are hip and wrist fratures

Calcium and Vitamin D

bone strength later in life

  • important to build bone when you are young

Protein

may reduce bone density when consumed at high levels

Sodium and soft drinks

increase sodium intake w high urinary ca 2+

vitamin k helps with one bone protein

Diagnosis - DEXA scan

drug therapy - fosamax and estrogen replacement therapy

down signs of ert are increased risk of HA, stroke, breast cancer, and BCs

Phosphorus 2nd most abundant mineral

majority found in the bones and teeth

roles in body buffers, DNA, RNA, metabolism, phospholipids, assist enzymes, vitamins

recommendations- 700 mg a day

def unlikely

excess in blood- HD and kidney stones

food sources diary, meat, and legumes

Potassium 3rd most abundant

principal pos ion inside of the cells

roles

  • fluid and electrolyte balance

  • cell intergrity

  • heart beat

Deficiency

most likely seen in alcholics

dehydration can lead to decreased potassium

tox- lethal injection

DRI 4,700 mg a day

exs. Oj, butternut squash, lima, beans, wild Salmon, baked potatom and avocado

Sodium 5th most abundant

over consumed

Roles

major part of electrolyte balance

acid-base balance

deficiency - drinking too much water

diuretics, diarrhea, dehydration, Drains

recommendations

1500 mg a day

2300 mg UL

Blood pressure

increased sodium intake with HTN, HD, and Stroke

pre-HTN 121-139/81-89 mmHg

DASH

Controlling salt intakes

cut down on processes foods and fast foods

read nutrition lables

chloride and sulfate

chloride is crucial for fluid balance

hydrochloric acid

salt

sulfate

roles of methinoine and cysteine

No recommended intakes

Deficiences are unknown

Magnesium- least abundant

102 in the body

dietary 300-400 mg

half is in the bones

works with calcium

def rare seen with alcholism

tox rare can be fatal

trace minerals less than 30 mg

Iron

every living cell contains iron

2 proteins

hemoglobin

myoglobin

roles carry oxygen

Roles

make new cells, aas, hormones, neurotransmitters, enzymes, and metabolism

Iron stores

from RBCs recycled and sotres in BM

special proteins and transport and storage - transferrin

Iron Def

anemia

mental symptoms

adults- impaired energy

children- irratable , loss of focus

Pica- consuming chalk, clay, soil

causes of anemia

inadequate iron intake- high cal, carb diet, blood loss

most susceptible

infants, toddlers, adolescents, and the obese

Recommendations 18 mg for woman and 8 mg for men

Zinc

works with proteins

roles protect against ROS, heme production, and gout

excess zinc HD and anemia

DRI 11mg men and 8 mg women

copper

helps to form hemoglobin- iron metabolism

Def rare- linked to CVD

Tox 10 mg a day

Iodine- body work is done by ionic form iodine

roles - hormone thyroxine

def and tox goiter can occur

can result from congenital idoine def syndrome- infant

intelligence and growth effectd

tox 1,100 ug

idoized salt

Enteral Nutrition

tube feeding delivers liquid formula directly to GI tract

  • Transnasal- nasogastric, nasoduodenal, nasojejunal

Enterostomies- gastrostomy, jejunostomy

candidate for tube feedings

  • swallowing disorders

  • imparied motility in the upper GI tract

  • GI obstructions

  • Intestional sugeries

  • Mechanical ventilation

Enteral formulas

standard ( polymeric)

  • contain intact proteins w/ balances amounts of macronutrients to meet nutrient needs

  • Delivery option- intermittent, bolus, or continous

Elemental

  • requires less digestion

  • may provide protein as aas and fat from medium chain triglycerides

Specialized

  • designed for a variety of clinical conditions or disease states

  • more expensive and contraversial as there are no clinical trials

Modular

  • provide specific nutrient needs an or comboinations of nutrients

Paraenteral Nutrition

primary reason

  • patient is unable to digest or absorb nutrients

Select access site

  • peripheral veins

  • central veins

Use of peripheral veins

  • rotation of venous access sites

    • not possible if too weak

Concern for phlebitis

used most often for short term nutrition

support 7 to 10 days

Use of central veins

larger BV
Nutrient concentration does not need to be limited

  • provide all total nutrients

  • used for both long/short term nutrition support

Selenium - antioxidant and part of some proteins ( Glutathine peroxidase)

RDA: 55 to 70 ug

Relationship w/chronic diseases

  • cancer risk is reduced

Def- muscle weakness and HD
Tox can be from supplements

Sources- meat, shellfish, and brazil nuts

Fluoride

def tooth decay

other trace minerals

chromium - carbs and lipds

metabolism- insulin

molybdenum- help facilitate the breakdown of certain metal containing proteins

Maganese - cofactor in enzyme

Boron- enzymes

Cobalt- found in b12

Nickel- cofactor

Energy balance and healthy body weight

hunger

  • response to physiological need

    • chemical messengers

Hypothalamus

  • Ghrelin

    • opposes WL and activates appetite

Appetite

can occure without hunger

drugs an depressants and cultrual habits can impact

Statiation and Satiety

  • hormone and sensory nerve messenger

  • satiation- fullness during a meal

leptin- adikine hormone that supresses appetite