1. TRACE ELEMENTS Nutrition Department Faculty of Medicine University of North Sumatera

2. IRON; FERRUM (Fe) A component RBC’s in hemoglobin formation A component of muscles in the form of myoglobin Stored and transported through ferritin, transferrin and pretransferrin Heme is the iron haloding part of the Hb molucule and found in animal sources Nonheme usually found in plant sources

3. Dietary sources of Fe MFP factor Eating vitamin C at the same time helps to promote Fe absorption High Ca intake promotes the absorption A decrease in stomach acid, phytates, oxalates, tannins and minerals excesses (Cu, Zn and Mg) can lead to decreased absorption

4. Deficiency state ▫Nutritional anemia – Iron Deficiency Anemia present with fatigue, weakness, headache, pallor, temperature intolerance and behavior change ▫Pica ▫At risk population include females due to menses and pregnant female due to dilutional anemia of pregnancy

5. IODINE (I) An important component of the thyroid hormones (T3, T4 and TSH) Needed for growth and development, reproduction and balance of metabolic rate and temperature in the body RDA is 150 µg for adult males and females

6. Dietary sources Found in saltwater fish and shellfish Found in iodized salt (fortified) in bread and milk Broccoli, brussel sprout, cabbage and cauliflower act as goitrogen or thyroid antagonist in the body

7. Iodium deficiency

8. Excess intake Lead to goiter development Hyperthyroidism → increase metabolic rate, promote weight loss and lead to intolerance to head and tachycardia Accidental exposure during pregnancy can lead to teratogenic effect

9. COPPER; CUPRUM (Cu) A cofactor in Hb, blood clotting and collagen formation Participates in iron metabolism Participates as an antioxidant with Zn to help support immune system Found in organ meat, seafood, nuts, seeds, legumes and whole grain product

10. Deficiency state of Cu RARE, associated with increased Zn, Fe, Ca, Mn, phytates, antacids, vitamin C, diets high in fructose and TPN solutions Anemia Skeletal demineralization, decreased pigments in skin and kinky hair

11. ZINC; ZINKUM (Zn) Participating in DNA and RNA synthesis and heme formation for the protein Hb Carbohydrates metabolism (insulin) and release of energy and in essential fatty acid metabolism Activation vitamin A and attaches albumin and transferrin for transport in the body Immune response by stabilizing cell membranes and preventing the damage of free radicals An important coenzyme

12. Intake of Zn Shellfish (oysters and crabmeat), red meat (beef sirloin), poultry, wheat germ, green peas, yogurt and whole grain products Caffeine, oxalic acid, fiber, phytic acid, tea, increase Fe and folate lead to decrease in Zn absorption

13. RDA ▫   15 mg/day ▫   12 mg/day Clients at risk include pregnant adolescents, vegetarians, the elderly, low income clients prone to malnutrition, people who in stress states (myocardial infarction, burn), Crohn’s disease and lymphoma

14. SELENIUM An antioxidant (part of enzyme glutathione peroxidase) and with vitamin E provides a synergistic effects to increase immune activity Involved in iodine metabolism Found in seafood, liver, meats, green vegetables and dairy products RDA for adults : 55 µg/day

15. MANGANESE (Mn) A cofactor in energy metabolism and bone formation The liver and pancreas have the highest content in the body Found in wheat bran, legumes, cereal grains, green leafy vegetables, coffee and tea

16. Mn deficiency Clients who have diabetes, PEM and epilepsy Clinical manifestation include weight loss, nausea, vomiting, diarrhea, change in hair color and increased cholesterol level Decreased absorption of Mn ▫Phytic and oxalic acid ▫High intake of Ca, Mg and Fe ▫Use of antacids and tetracyclines

17. FLUORIDE; FLUOR Part of dental structure in the formation of tooth enamel, teeth and bones Helps to strengthen resistance to bacterial acid in the body Ca, phosphorus and fluoride is subtance that make bone and teeth stronger Found in fluoridated water

18. Recommendation in the diet (AI) ▫   3,8 mg/day ▫   3.1 mg/day Deficiency ▫Tooth decay and increased dental caries Excessive intake

19. CHROMIUM (Cr) CHO metabolism (enhance the action of insulin) Lipid metabolism Participates in RNA and DNA A cofactor in fat and cholesterol metabolism

20. Dietary sources of Cr Found in spices (thyme and black pepper), brewes yeast, broccoli, unrefined foods and meat, liver, fats and vegetables oil Vitamin C increased absorption Antacids and phytates decrease absorption

21. MOLYBDENUM A cofactor in protein synthesis Found in the liver, kidneys, bone and adrenals glands Dietary sources in organ meats, legumes, grains and milk

22. - A metallic transition element - A part of vitamin B12 - Function : -An essential cofactor ~ regulation of translation - A constituent of an oxygen sensor

23. A strict vegetarian : Fe, Ca (soybean milk fortified with Ca, orange juice with added Ca) Live inland, away from the ocean A man and a woman Pregnant and Breast Feeding (Ca, P, Mg,Fe, Zn and Selenium) Menopause