7 Nutritional Disorders

Nutrient and Energy Requirements in Humans

Recommended dietary allowance (RDA)
1. Optimal dietary intake of nutrients that under ordinary conditions will keep the general population
in good health
2. Varies with se! age! "ody weight! diet! and physiologic status
Nutrient and Energy Requirements in Humans
Recommended dietary allowance (RDA)
1. Optimal dietary intake of nutrients that under ordinary conditions will keep the general population
in good health
2. Varies with se! age! "ody weight! diet! and physiologic status
Recommended dietary allowance (RDA)
1. Optimal dietary intake of nutrients that under ordinary conditions will keep the general population
in good health
2. Varies with se! age! "ody weight! diet! and physiologic status
Daily energy ependiture (D##)
1. $actors influencing D##
a. %asal meta"olic rate (%&R)
". 'hermic effect of food
c. (hysical acti)ity
2. %asal meta"olic rate (%&R)
a. Accounts for *+, of D##
". #nergy consumption in)ol)ed in normal "ody functions
#amples-cardiac function! maintaining ion pumps
c. %ody weight is the most important factor determining %&R.
d. 'hyroid function alters the %&R.
%&R is increased or decreased in hyperthyroidism and hypothyroidism!
respecti)ely.
.. 'hermic effect of foods
o #nergy used in digestion! a"sorption! and distri"ution of nutrients
2. Degree of physical acti)ity
o Varies with the le)el of physical acti)ity
Dietary Fuels
/ar"ohydrates
1. 0lucose
a. 1tored primarily as glycogen in li)er and muscle
". R%/s use only glucose for energy.
c. /omplete oidation produces 2kcal3g.
2. #n4ymatic digestion
a. %egins in the mouth (amylase)
". (ancreatic amylase
5n chronic pancreatitis! car"ohydrates are not mala"sor"ed due to predigestion
"y sali)ary amylase.
c. %rush "order intestinal en4ymes (disaccharidases)
ii 6ydroly4e lactose! maltose! and sucrose
iii Disaccharidases produce glucose! galactose! and fructose.
/ar"ohydrates
1. 0lucose
a. 1tored primarily as glycogen in li)er and muscle
". R%/s use only glucose for energy.
c. /omplete oidation produces 2kcal3g.
2. #n4ymatic digestion
a. %egins in the mouth (amylase)
". (ancreatic amylase
5n chronic pancreatitis! car"ohydrates are not mala"sor"ed due to predigestion
"y sali)ary amylase.
c. %rush "order intestinal en4ymes (disaccharidases)
ii 6ydroly4e lactose! maltose! and sucrose
iii Disaccharidases produce glucose! galactose! and fructose
(roteins
page 121
page 122
1. Amino acids are su"strates for gluconeogenesis
2. Digestion
a. %egins in the stomach (pepsin and acid)
". (ancreatic proteases (e.g.! trypsin) and peptidases release amino acids.
.. /omplete oidation produces 2kcal3g.
$ats
1. 'riglycerides
a. &a7or dietary lipids
". &a7or source of energy for cells except R%/s and "rain
2. #ssential fatty acids
a. 8inolenic acid is cardioprotecti)e.
". 8inoleic acid is re9uired for synthesis of arachidonic acid.
c. Deficiency of essential fatty acids
i. 1caly dermatitis
ii. (oor wound healing! hair loss
.. Digestion of dietary triglyceride
a. Occurs primarily in the small intestine
i. 6ydroly4ed "y pancreatic lipase
ii. %ile salts3acid re9uired for rea"sorption
iii. (ackaged into chylomicrons! which enter the "lood
". /omplete oidation produces :kcal3g.
Protein-Energy Malnutrition (PEM)
;washiorkor
1. (athogenesis
a. 5nade9uate protein intake
". Ade9uate caloric intake consisting mainly of car"ohydrates
c. (rotein in li)er and other organs (i.e.! )isceral protein) is decreased.
d. &uscle protein (i.e.! somatic protein) is relati)ely unchanged.
2. /linical findings left)
a. (itting edema and ascites
/aused "y hypoal"uminemia and loss of plasma oncotic pressure
". $atty li)er
ii /aused "y decreased synthesis of apolipoproteins
iii Apolipoprotein %-1++ is re9uired for secretion and assem"ly of )ery low density
lipoproteins (V8D8s) in the li)er.
". Diarrhea
/aused "y loss of the "rush "order en4ymes and parasitic infections
". Anemia and defects in cell-mediated immunity (/&5)
;washiorkor
1. (athogenesis
a. 5nade9uate protein intake
". Ade9uate caloric intake consisting mainly of car"ohydrates
c. (rotein in li)er and other organs (i.e.! )isceral protein) is decreased.
d. &uscle protein (i.e.! somatic protein) is relati)ely unchanged.
2. /linical findings
a. (itting edema and ascites
/aused "y hypoal"uminemia and loss of plasma oncotic pressure
". $atty li)er
ii /aused "y decreased synthesis of apolipoproteins
iii Apolipoprotein %-1++ is re9uired for secretion and assem"ly of )ery low density
lipoproteins (V8D8s) in the li)er.
". Diarrhea
/aused "y loss of the "rush "order en4ymes and parasitic infections
". Anemia and defects in cell-mediated immunity (/&5)
&arasmus
1. (athogenesis
a. Dietary deficiency of "oth protein and calories
". Decrease in somatic protein
2. /linical findings
a. #treme muscle wasting (<"roomstick etremities<)
i. %reakdown of muscle protein for energy
ii. 8oss of su"cutaneous fat
". 0rowth retardation! anemia! defects in /&5
Eating Disorders and Obesity
Anoreia ner)osa
1. (athogenesis
a. 1elf-induced star)ation leading to (#&
". Distorted "ody image
2. /linical findings
a. 1econdary amenorrhea
i. Decreased gonadotropin-releasing hormone
/aused "y loss of "ody fat and weight
ii. Decreased serum gonadotropins produces hypoestrinism.
". Osteoporosis
i. /aused "y hypoestrinism
ii. Decreased osteo"lastic acti)ity and increased osteoclastic acti)ity
c. 5ncreased lanugo (fine! downy hair)
d. 5ncreased hormones associated with stress (e.g.! cortisol! growth hormone)
Anoreia ner)osa
1. (athogenesis
a. 1elf-induced star)ation leading to (#&
". Distorted "ody image
2. /linical findings
a. 1econdary amenorrhea
i. Decreased gonadotropin-releasing hormone
/aused "y loss of "ody fat and weight
ii. Decreased serum gonadotropins produces hypoestrinism.
". Osteoporosis
i. /aused "y hypoestrinism
ii. Decreased osteo"lastic acti)ity and increased osteoclastic acti)ity
c. 5ncreased lanugo (fine! downy hair)
d. 5ncreased hormones associated with stress (e.g.! cortisol! growth hormone)
%ulimia ner)osa
page 12.
page 122
1. (athogenesis
o %inging with self-induced )omiting
2. /linical findings
a. /omplications of )omiting
i. Acid in7ury to tooth enamel
ii. 6ypokalemia and meta"olic alkalosis
b. Ventricular arrhythmia is the most common cause of death.
O"esity
page 122
page 12=
1. %ody mass inde (%&5) .+kg3m
2
(normal> 1?.=-22.:kg3m
2
)
a. %&5 @ weight (kg)3height (m
2
)
". Other factors than "ody weight
i. #cess fat in the waist and flanks is more important than an ecess in the thighs
and "uttocks.
ii. #cess )isceral fat in the a"dominal ca)ity has greater significance than ecess
su"cutaneous fat.
2. (athogenesis
a. 0enetic factors account for =+, to ?+, of cases.
#amples-defects in the leptin gene! syndrome A (o"esity! hypertension!
dia"etes)
". Ac9uired causes
i. #ndocrine disorders-hypothyroidism! /ushing syndrome
ii. 6ypothalamic lesions! menopause
". 8eptin
i. 6ormone is secreted "y adipose tissue that maintains energy "alance.
ii. 8eptin increases when adipose stores are ade9uate.
Decreases food intake
5ncreases energy ependiture (stimulates B-oidation of fatty acids)
iii. 8eptin decreases when adipose stores are inade9uate.
5ncreases food intake
Decreases energy ependiture (inhi"its B-oidation of fatty acids)
i). O"esity may "e due to se)eral factors>
Resistance to leptin effects
&utations resulting in inhi"ition of leptin release
.. /linical findings
Table 7-! "lini#al Findings $sso#iated %it& Obesity
"lini#al Finding "omments
/ancer 5ncreased incidence of estrogen-related cancers (e.g.! endometrial! "reast) "ecause of
increased aromati4ation of androgens to estrogens in adipose tissue
/holelithiasis 5ncreased incidence of cholecystitis and cholesterol stonesC "ile is supersaturated with
cholesterol
Dia"etes mellitus! type 2 5ncreased adipose down-regulates insulin receptor synthesis
6yperinsulinemia increases adipose stores
Deight reduction up-regulates insulin receptor synthesis
6epatomegaly $atty change accompanied "y li)er cell in7ury and repair "y fi"rosis
6ypertension 6yperinsulinemia increases sodium retention! leading to increase in plasma )olume
8eft )entricular hypertrophy and stroke complicate hypertension
6ypertriglyceridemia 6ypertriglyceridemia decreases serum high-density lipoprotein le)els! increasing risk of
coronary artery disease
5ncreased low-density
lipoprotein le)els
6ypercholesterolemia predisposes to coronary artery disease
O"structi)e sleep apnea Deight of adipose tissue compresses upper airways causing respiratory acidosis and
hypoemia
(otential for de)eloping cor pulmonale (pulmonary hypertension and right )entricular
hypertrophy)
Osteoarthritis Degenerati)e arthritis in weight-"earing 7oints (e.g.! femoral heads)
Fat-'oluble (itamins
Vitamins A! D! #! and ; are fat solu"le.
Vitamin
A
An ecess of B-carotenes in the diet causes the skin to turn yellow! "ut unlike in
7aundice! the sclera remains white. B-/arotenes also ha)e antioidant acti)ity
(neutrali4e free radicals).
1. Retinol
a. Deri)ed from dietary B-carotenes and retinol esters
". &ain transport and storage form of )itamin A
2. Retinal
a. (roduct of the oidation of retinol
". /omponent of the )isual pigment rhodopsin
.. $unctions of )itamin A
a. Eormal )ision in reduced light
". (otentiating differentiation of mucus-secreting epithelium
c. 1timulating the immune system
d. 0rowth and reproduction
2. /linical uses of )itamin A
a. 'reatment of acne (e.g.! isotretinoin)
". 'reatment of acute promyelocytic leukemia
=. /auses of deficiency
a. Diets lacking sufficient yellow and green )egeta"les
". $at mala"sorption (e.g.! celiac disease)
*. /auses of toicity
a. /onsumption of polar "ear li)er
". &egadoses of )itamin A
c. 'reatment with isotretinoin
F. /linical findings in )itamin A deficiency and toicity
Table 7-)! Fat-'oluble (itamins* "lini#al Findings in De+i#ien#y and To,i#ity
(itaminE++e#ts o+ De+i#ien#y E++e#ts o+ To,i#ity
A 5mpaired night )ision! "lindness (s9uamous metaplasia
of corneal epithelium)
$ollicular hyperkeratosis (loss of se"aceous gland
function)! pneumonia! growth retardation! renal calculi
(apilledema and sei4ures (due to an increase in
intracranial pressure)! hepatitis! "one pain (due to
periosteal proliferation)
D (athologic fractures! ecess osteoid! "ow legs
/hildren> ricketsC craniota"es (soft skull "ones)C rachitic
rosary (defecti)e minerali4ation and o)ergrowth of
epiphyseal cartilage in ri"s)
Adults> osteomalacia
/ontinuous muscle contraction (tetany)
6ypercalcemia with metastatic calcification! renal
calculi
# 6emolytic anemia (damage to R%/ mem"rane)
(eripheral neuropathy! degeneration of posterior
column (poor 7oint sensation) and spinocere"ellar tract
(ataia)
Decreased synthesis of )itamin ;-dependent
procoagulant factorsC synergistic effect with warfarin
anticoagulation
; Eew"orns> hemorrhagic disease of new"orn (/E1
"leeding! ecchymoses)
Adults> gastrointestinal "leeding! ecchymosesC
prolonged prothrom"in time and partial throm"oplastin
time
6emolytic anemia and 7aundice in new"orns if
mother recei)es ecess )itamin ;
/E1! central ner)ous system.
Vitamin D
page 12F
page 12?
1. &eta"olism
a. (reformed )itamin D in the diet consists of cholecalciferol (fish) and ergocalciferol
(plants).
". #ndogenous synthesis of )itamin D in the skin occurs "y photocon)ersion of F-
dehydrocholesterol )ia sunlight.
c. Rea"sorption occurs in the small intestine.
d. 8i)er hydroylation to 2=-hydroy)itamin D (2=-O6-D) occurs in the cytochrome (-2=+
system.
e. ;idney hydroylation "y 1-G-hydroylase produces 1!2=-(O6)2-D (acti)e form of )itamin
D).
f. Vitamin D increases rea"sorption of calcium and phosphorus from the intestine and
calcium from the distal renal tu"ules.
2. $unctions
a. &aintenance of serum calcium and phosphorus
". Re9uired for minerali4ation of epiphyseal cartilage and osteoid matri
i. Receptor located on osteo"lasts
ii. 1timulates release of alkaline phosphatase
iii. Alkaline phosphatase dephosphorylates pyrophosphate! which normally inhi"its
"one minerali4ation
c. 1timulates macrophage stem cell con)ersion into osteoclasts
.. /auses of deficiency
a. Renal failure
Decrease in 1-G-hydroylation
". 5nade9uate eposure to sunlight
Decreased synthesis from F-dehydrocholesterol
c. $at mala"sorption
Decreased rea"sorption of )itamin D
d. /hronic li)er disease
Decreased synthesis of 2=-(O6)-D
e. #n4yme induction of the cytochrome (-2=+ en4yme system (e.g.! alcohol)
5ncreased meta"olism of precursors of 2=-(O6)-D
ii &egadoses may cause toicity.
ii /linical findings in )itamin D deficiency and toicity (see
Vitamin #
1. 1er)es as an antioidant
a. (rotects cell mem"ranes from lipid peroidation from free radicals
". (re)ents oidation of low-density lipoprotein
2. Deficiency is uncommon
a. $at mala"sorption in children with cystic fi"rosis
". A"etalipoproteinemia
.. &egadoses may cause toicity.
4. /linical findings in )itamin # deficiency and toicity
Vitamin ;
1. Deri)ed from endogenous "acteria and green )egeta"les
2. Acti)ated "y the li)er microsomal en4yme epoide reductase
o Anticoagulant effect of coumarin deri)ati)es results from the inhi"ition of epoide
reductase.
.. $unction
a. H-/ar"oylates glutamate residues in )itamin ;-dependent procoagulants
i. (rocoagulants include factors 55 (prothrom"in)! V55! 5A! A! protein /! and protein 1.
ii. (rocoagulants are nonfunctional.
b. H-/ar"oylation allows )itamin ;-dependent procoagulants to "ind to calcium in fi"rin clot
formation.
2. /auses of deficiency
a. Ise of "road-spectrum anti"iotics
Destroy "acterial synthesis of )itamin ;
ii Eew"orns
i. 8ack "acterial coloni4ation of the "owel
ii. &ust recei)e )itamin ; at "irth
(re)ents hemorrhagic disease of the new"orn
%reast milk is deficient in )itamin ;.
b. /oumarin deri)ati)es
5nhi"it epoide reductase acti)ation of )itamin ;
ii $at mala"sorption
Decreased intestinal rea"sorption of )itamin ;
2. 'oicity caused "y ecessi)e intake of )itamin ; is uncommon.
.. /linical findings in )itamin ; deficiency and toicity
-ater-'oluble (itamins
'hiamine ()itamin %
1
)
Table 7-.! -ater-'oluble (itamins* "lini#al Findings in De+i#ien#y
(itamin E++e#ts o+ De+i#ien#y
'hiamine
()itamin %1)
Dry "eri"eri> peripheral neuropathy (demyelination)
DernickeJs syndrome> ataia! confusion! nystagmus! mamillary "ody hemorrhage
;orsakoffJs syndrome> antegrade or retrograde amnesiaC demyelination in lim"ic system
Det "eri"eri> congesti)e cardiomyopathy with "i)entricular failure
Ri"ofla)in
()itamin %2)
/orneal neo)asculari4ation! glossitis! cheilosis (cracked lips)! angular stomatitis (fissuring at angles
of mouth)
Eiacin ()itamin
%.)
(ellagra> diarrhea! dermatitis (hyperpigmentation in sun-eposed areas)! dementia
(yridoine
()itamin %*)
1idero"lastic anemia (microcytic anemia with ringed sidero"lasts)! con)ulsions! peripheral
neuropathy
/o"alamin
()itamin %12)
&egalo"lastic anemia! neurologic disease (posterior column and lateral corticospinal tract
demyelination)! glossitis
$olic acid &egalo"lastic anemia! with no neurologic disease (unlike )itamin %12)! glossitis
%iotin Dermatitis! alopecia! lactic acidosis
Ascor"ic acid
()itamin /)
Deak capillaries and )enules! skin ecchymoses! perifollicular hemorrhage (ring of hemorrhage
around hair follicles)! hemarthrosis! "leeding gums! anemia (com"ined iron and folate deficiency)
8oosened teeth! glossitis! poor wound healing
1. $unction
a. /ofactor in "iochemical reactions that produce adenosine triphosphate (A'()
". #ample-pyru)ate dehydrogenase-cataly4ed con)ersion of pyru)ate to acetyl /oA
2. /auses of deficiency
a. /hronic alcoholism (in the Inited 1tates)
". Diet of nonenriched rice (in de)eloping countries)
.. /linical findings in thiamine deficiency
o 1igns and symptoms mainly result from A'( deficiency.
'hiamine ()itamin %
1
)
Table 7-.! -ater-'oluble (itamins* "lini#al Findings in De+i#ien#y
(itamin E++e#ts o+ De+i#ien#y
'hiamine
()itamin %1)
Dry "eri"eri> peripheral neuropathy (demyelination)
DernickeJs syndrome> ataia! confusion! nystagmus! mamillary "ody hemorrhage
;orsakoffJs syndrome> antegrade or retrograde amnesiaC demyelination in lim"ic system
Det "eri"eri> congesti)e cardiomyopathy with "i)entricular failure
Ri"ofla)in
()itamin %2)
/orneal neo)asculari4ation! glossitis! cheilosis (cracked lips)! angular stomatitis (fissuring at angles
of mouth)
Eiacin ()itamin
%.)
(ellagra> diarrhea! dermatitis (hyperpigmentation in sun-eposed areas)! dementia
(yridoine
()itamin %*)
1idero"lastic anemia (microcytic anemia with ringed sidero"lasts)! con)ulsions! peripheral
neuropathy
/o"alamin
()itamin %12)
&egalo"lastic anemia! neurologic disease (posterior column and lateral corticospinal tract
demyelination)! glossitis
$olic acid &egalo"lastic anemia! with no neurologic disease (unlike )itamin %12)! glossitis
%iotin Dermatitis! alopecia! lactic acidosis
Ascor"ic acid
()itamin /)
Deak capillaries and )enules! skin ecchymoses! perifollicular hemorrhage (ring of hemorrhage
around hair follicles)! hemarthrosis! "leeding gums! anemia (com"ined iron and folate deficiency)
8oosened teeth! glossitis! poor wound healing
1. $unction
a. /ofactor in "iochemical reactions that produce adenosine triphosphate (A'()
". #ample-pyru)ate dehydrogenase-cataly4ed con)ersion of pyru)ate to acetyl /oA
2. /auses of deficiency
a. /hronic alcoholism (in the Inited 1tates)
". Diet of nonenriched rice (in de)eloping countries)
.. /linical findings in thiamine deficiency
o 1igns and symptoms mainly result from A'( deficiency.
Ri"ofla)in ()itamin %
2
)
1. Acti)e forms include fla)in adenine dinucleotide ($AD) and fla)in mononucleotide ($&E).
2. Deficiency is caused "y se)ere malnourishment.
.. /linical findings in ri"ofla)in deficiency
Eiacin ()itamin %
.
! nicotinic acid)
page 12:
page 1.+
1. $unctions
a. Acti)e forms of niacin
i. Oidi4ed nicotinamide adenine dinucleotide (EAD
K
)
ii. Oidi4ed nicotinamide adenine dinucleotide phosphate (EAD(
K
)
". EAD
K
and EAD(
K
are cofactors in oidation-reduction reactions.
2. /auses of deficiency (pellagra)
a. Diets deficient in niacin
". Deficiency of tryptophan
i. 'ryptophan is used to synthesi4e niacin
ii. /auses of tryptophan deficiency
Diets deficient in tryptophan
6artnup disease
5n"orn error of meta"olism with ina"ility to rea"sor" tryptophan in
the small "owel and kidneys
/arcinoid syndrome
'ryptophan is used up in synthesi4ing serotonin.
.. /linical findings in niacin deficiency (see
2. #cessi)e intake of niacin
a. 8eads to flushing caused "y )asodilation
Ad)erse effect of nicotinic acid! a lipid-lowering drug
". 5ntrahepatic cholestasis
(yridoine ()itamin %
*
)
1. $unctions
o Re9uired for transamination! heme synthesis! and neurotransmitter synthesis
2. /auses of deficiency
a. 5sonia4id (used in treating tu"erculosis)
b. 0oat milk! chronic alcoholism
2. /linical findings in pyridoine deficiency
/o"alamin ()itamin %
12
) (see
1. (resent only in animal products (eggs! meat! dairy products)
2. Re9uires intrinsic factor for rea"sorption in the terminal ileum
.. $unctions
a. DEA synthesis
". (ropionate (odd-chain fatty acid) meta"olism
2. /auses of deficiency
a. 1trict )egan diet
". (ernicious anemia
c. 'erminal ileal disease (e.g.! /rohnJs disease)! "acterial o)ergrowth
5. /linical findings in )itamin %12 deficiency
$olic acid
page 1.+
page 1.1
1. (resent in most foods
2. $unction
o DEA synthesis
.. /auses of deficiency
a. Dietary deficiency
#lderly indi)iduals! goat milk
b. Drugs
Alcohol! methotreate! phenytoin! oral contracepti)es! trimethoprim! =-fluorouracil
c. &ala"sorption! o)erutili4ation (e.g.! pregnancy)
2. /linical findings in folic acid deficiency
%iotin
1. $unction
a. /ofactor in car"oylase reactions
". #ample-pyru)ate car"oylase-cataly4ed con)ersion of pyru)ate to oaloacetate
2. /auses of deficiency
a. #ating raw eggs (a)idin "inds "iotin)
". 'aking anti"iotics
.. /linical findings in "iotin deficiency
Ascor"ic acid ()itamin /)
1. $unctions
a. 6ydroylation of lysine and proline residues in collagen synthesis
i. Deficiency leads to collagen with reduced tensile strength.
ii. 6ydroylation sites are anchors for cross-linking of G-chains.
". Antioidant acti)ity
Regenerates )itamin # and reduces oidation of low-density lipoprotein
". (re)ents nitrosylation
i. 5nhi"its amides from com"ining with nitrites present in food preser)ati)es
ii. Eitrosamines and nitrosamides are carcinogens implicated in stomach cancer.
". Reduces nonheme iron (K. )alence) from plants to the ferrous (K2 )alence) state for
rea"sorption in the duodenum
Deficiency may produce iron deficiency (microcytic anemia).
". ;eeps tetrahydrofolate ($62) in its reduced form
Deficiency may produce folate deficiency (macrocytic anemia).
c. /ofactor in the con)ersion of dopamine to norepinephrine in catecholamine synthesis
ii /auses of deficiency
a. Diets lacking fruits and )egeta"les
". /igarette smoking
ii /linical findings in )itamin / deficiency (scur)y)
ii #cess intake (hyper)itaminosis /) may lead to the formation of renal calculi composed of uric
acid.
Tra#e Elements
'race elements are micronutrients that are re9uired in the normal diet.
Linc
page 1.1
page 1.2
1. $unctions
a. /ofactor for metalloen4ymes (e.g.! collagenase in wound remodeling)
". 0rowth and spermatogenesis in children
2. /auses of 4inc deficiency
a. Alcoholism! dia"etes mellitus! chronic diarrhea
". Acrodermatitis enteropathica
i. Autosomal recessi)e disease
ii. Dermatitis! growth retardation! decreased spermatogenesis! poor wound healing
.. /linical findings in 4inc deficiency
Table 7-/! Tra#e Metals* "lini#al Findings in De+i#ien#y
Tra#e Metal E++e#ts o+ De+i#ien#y
/hromium &eta"olic> impaired glucose tolerance! peripheral neuropathy
/opper %lood> microcytic anemia (cofactor in ferroidase)
Vessels> aortic dissection (weak elastic tissue)
&eta"olic> poor wound healing (cofactor in lysyl oidase)
$luoride 'eeth> dental caries
5odide 'hyroid> thyroid enlargement (goiter)! hypothyroidism
1elenium &uscle> muscle pain and weakness! dilated (congesti)e) cardiomyopathy
Linc &eta"olic> poor wound healing (cofactor in collagenase)
&outh> dysgeusia (cannot taste)! anosmia (cannot smell)! perioral rash
/hildren> hypogonadism! growth retardation
/opper
page 1.2
page 1..
1. $unctions as a cofactor>
a. $erroidase ("inds iron to transferrin)
". 8ysyl oidase (cross-linking of collagen and elastic tissue)
c. 'yrosinase (melanin synthesis)
2. /opper deficiency
o &ost often due to total parenteral nutrition ('(E)
2. /linical findings in copper deficiency
3. /opper ecess! DilsonJs disease>
a. Autosomal recessi)e disease
". Defect in eliminating copper into "ile
c. Defect in synthesi4ing ceruloplasmin ("inding protein for copper)
d. /hronic li)er disease! ;ayser-$leischer ring in cornea! "asal ganglia degeneration
5odine
1. $unction
o 1ynthesis of thyroid hormone
2. 5odine deficiency
o &ost often due to inade9uate intake of iodi4ed ta"le salt
.. /linical findings in iodide deficiency
/hromium
1. $unctions
a. /omponent of glucose tolerance factor (maintains a normal glucose)
". /ofactor for insulin that facilitates "inding of glucose to adipose and muscle
2. /hromium deficiency
o &ost often due to '(E
2. /linical findings in chromium deficiency
1elenium
1. /omponent of glutathione peroidase
o Antioidant that con)erts peroide to water using reduced glutathione (016)
2. 1elenium deficiency
o &ost often due to '(E
.. /linical findings in selenium deficiency
$luoride
1. $unction
o /omponent of calcium hydroyapatite in "one and teeth
2. $luoride deficiency
o &ost often due to inade9uate intake of fluoridated water
.. $luoride ecess
a. /halky deposits on the teeth
b. /alcification of ligaments
c. 5ncreased risk for "one fractures
2. /linical findings in fluoride deficiency