1. Minerals and trace elements
Dr K N Prasad MD., DNB.
Community Medicine

2. Seven Food Substances Dietary Fibre Minerals Water Food Substances
Vitamins
Proteins
Carbohydrates
Fats

3. Minerals 50 chemical elements are identified
Important for Growth, Development , regulation of vital functions
Major : calcium, Phosphorous, Sodium, Potassium, Magnesium
Minor: Required less than a few milligram per day. Ex. Iron, Iodine, Fluorine, Zinc, Copper, Cobalt, Chromium, Manganese, Molybdenum, Selenium, Nickel, Tin, Silicon, Vanadium

4. Trace elements
A naturally occurring, homogeneous, inorganic substance required in humans in amounts less than 100 mg/day
Bioavailability of minerals are low in vegetarian diet.
Excess amounts are injurious to health

5. Iron Requirement : Adult human body contains 3-4 Gm
60-70% is present in Blood and rest in storage form.
Each Gm of Hb contains 3.34mg of Iron.
Requirement :
1 mg per day for Male
2.5 mg for Females
3.5 mg for Females in Physiological stress conditions

6. Functions of iron
Iron is a part of all cells and has many different functions
Hb Carries of oxygen to the tissues
Brain development along with Folic acid
Myoglobin Facilitates oxygen use and storage in muscles
An integral part of enzyme reactions in various tissues ( Cyotchromes, Catalases, etc)
Regulation of Body temperature
Catecholamine metabolism
Susceptibility to infection

7. Sources of iron Haem Iron: Non Haem Iron:
Liver, meat, poultry, Fish
Non Haem Iron:
Cereals, GLV, Legumes,, Nuts, Oil seeds, Dried Fruits, Jaggery
Factors interfere in absorption are enzymes in the food – Phytates, Oxalates, Phosphates, Dietary fibres
Ascorbic acid is the most potent enhancer iron

8. Public Health problem
Categorized as one of the top ten most serious health problems in the modern world (WHO)
As many as 4-5 billion people (66-80% of population) may be iron deficient
2 billion people (>30% of population) are anemic
Iron deficiency in young children is the rule rather than the exception (from 45 to 70 percent prevalence
Anemia is a fact of life for almost 500 million of women of childbearing age(~40% of 15 to 40 y old females in developing world)
More than 1,000 severely anemic young women die every week in the perinatal period because of inadequate iron status

9. Iron loss Storage In adults – 1 mg per day
Menstruating women – 2 mg per day
Hemorrhages are common causes
IUCD may loss result in blood loss
Storage
Stored in Liver, Spleen, Bone marrow, Kidneys

10. Iron Deficiency Occurs in 3 stages:
First Stage: Decreased storage without any other detectable abnormalities
Second Stage: stores are exhausted, serum Ferritin level decreases.
Third Stage: Decrease in Hemoglobin percentage
Functional disturbances: decrease in resistance to infection, increase morbidity & mortality, decreased work performances, impaired cell mediated immunity

11. Iron Signs of iron deficiency anemia include: Fatigue Headache
Exertional dyspnoea
Cardiovascular stress
Poor tolerance to heavy blood loss

12. Evaluation of iron status
Hemoglobin Concentration: relative index of iron deficiency. ( early Anemia if Hb is g% & marked anemia Hb is < 10g%).
Serum Iron concentration: useful index ( Normal 0.8 to 1.8mg /L)
Serum Ferritin level: Gold standard & sensitive tool for evaluation and reflects the size of the iron status ( < 10Micrgms/L)
Serum Transferrin Saturation: 16% - 30%

13. Correction of Iron Deficiency
Oral iron supplements
mg elemental iron daily
Higher doses are of no benefit
Ferrous sulphate 65mg/tab
Pregnant women- 100mg/tablet (+ folic acid)

15. Iodine Requirement per day is 150 micrograms Essential Micronutrient
Body normally has mg of iodine and more than 75% is in the thyroid gland,
rest is in the mammary gland, gastric mucosa, and blood
it’s only function is related to thyroid Hormone
Required for synthesis of thyroid hormone
Thyroxin (T4) – 4 atoms of iodine per molecule
Triiodothyronine (T3) – 3 atoms of iodine per molecule
Requirement per day is 150 micrograms

16. Iodine
Food Sources – 90% intake
Foods of marine origin (seaweed), processed foods, iodized salt
Fresh Water – small & Variable
Small amounts in Milk, meat, Vegetables, Cereals etc.
Goitrogens occurring naturally in foods can cause goiter by blocking absorption or utilization of iodine (cabbage, turnips, peanuts, soybeans)

17. Iodine - Absorption and Excretion
Iodine is absorbed in the form of iodide
occurs both as free and protein-bound iodine in circulation
iodine is stored in the thyroid where it is used for the synthesis of T3 and T4
hormone is degraded in target cells and in the liver and the iodine is conserved if needed
excretion is primarily via urine
small amounts from bile are excreted in the feces

18. Iodine - deficiency Goitre—enlargement of the thyroid gland
deficiency may be absolute—in areas of deficiency,
or relative—adolescence, pregnancy, lactation
goiters are more prevalent in women and with increased age
Iodine deficiency is the world’s most prevalent cause of brain damage
Serious iodine deficiency during pregnancy may result in stillbirths, abortions and cretinism
the less visible, more pervasive form of iron & iodine deficiency that lowers intellectual performance at home and school may have far greater global and economic impact

20. Public Health problem of Iodine
By the year 2000,
Global prevalence of iodine deficiency from 30% to <15%
Adding iodine to 2/3 of the world’s household salt
70 million newborns protected in some Degree
Every year, 50 million children are born without the protection that iodine offers to the growing brain and body
About 18 million of those will suffer some significant degree of mental impairment
Iodine deficiency remains the single greatest cause of mental retardation
The one third of the world’s people without protection by iodized salt are the most marginalized populations –economically, culturally and geographically
Sustainability is another battle: salt iodization is slipping back in several countries

21. Epidemiological assessment
Prevalence of Goitre
Prevalence of Cretinism
Urinary iodine excretion
Prevalence of Neurological hypothyroidism
Thyroid Function tests
Neonatal Hypothyroidism is a sensitive indicator of environmental iodine deficiency
Serum T4 is more sensitive indicator among adults

23. Fluorine Source: It is found in combined forms
96% of fluorides in the body found in bone and teeth.
An essential for normal mineralisation of bones and formation of dental enamel
Source:
Drinking water : Fluorine in the drinking water is 0.5 mg per ltr. Excess of fl > 3mg causes flourosis.
Foods: Sea fish, cheese, Tea
It is a two edged sword ( deficiency or excess)

24. Zinc Functions are Food sources :
Adult body contains 1.4 to 2.3 gms of Zinc
Plasma level- 96Microgm per 100 ml ( adults), 89 Microgram per 100 ml (children)
Functions are
Active role in metabolism of glucose and proteins
Synthesis of insulin by pancreas
Immunity functions
Food sources :
meat, milk, fish
Plant sources have low bioavailability

25. Zinc
On of the ten biggest factors contributing to burden of disease in developing countries
Zinc interventions could reduce child deaths globally by 63%
South East Asia and Sub-Saharan Africa highest risk of zinc deficiency:
Inadequate intake – 1/3 of the population
Stunting – 40% of pre-school children
Zinc used as a (part of) curative intervention for severe malnutrition and diarrhoea

26. Zinc deficiency Requirement is 15mg for men Growth failure
Sexual infantilism in adolescents, loss of taste, delayed wound healing, decrease in immunosynthesis.
Spontaneous abortions, stillbirths, congenital malformations, anencephaly
LBW, Intra Uterine deaths, premature labour.
Requirement is 15mg for men
12 mg for women, 10mg for children

27. Thought for the day An advice is like snow, the softer it falls,
the deeper it penetrates
and the longer it dwells.

28. Thank you