DEFICIENCY OF VITAMINS AND

MINERALS

Iron-Deficiency

Vitamin B12 Deficiency

Folate Deficiency

Calcium

Vitamin D
 Definition

ANEMIA

Anemia is a condition characterized by a

decrease in the amount of hemoglobin, also
affecting, often the size and number of
erythrocytes.

Anemia can be caused by bleeding, genetic

alterations, chronic diseases and toxic factors.
However, a high percentage of anemia are caused by
POOR DIETS.
 Anemia

Numerous studies show a high prevalence of anemia,

particularly iron deficiency in different groups such as

infants, children and adolescents, women of

childbearing age, pregnant women and the elderly.

The deficiencies of folate and / or vitamin B12 are

also responsible for the problem quite often.

 Anemia

Types of anemia:

Depending on the size of erythrocytes:

microcytic: small red blood cells (iron

deficiency)

macrocytic: large, immature red blood cells

(vitamin B12 and folic acid deficiency)

normocytic: red blood cells of equal size

(vitamin E deficiency)
 Anemia

Measurements of Anemia
Hemoglobin = grams of hemoglobin per 100 mL of whole
blood (g/dL)
Women: <12.0
Men: < 13.5
Hematocrit = percent of a sample of whole blood occupied
by intact red blood cells
Women: < 36
Men: <41
MCV = Mean corpuscular volume
If > 100 Macrocytic anemia
If 80 100 Normocytic anemia
If < 80 Microcytic anemia
 Iron deficiency anemia

IRON DEFICIENCY

Iron deficiency anemia is characterized by:

production of small erythrocytes (microcytic

anemia)

decreased levels of hemoglobin (hypochromic

anemia)

Occurs when losses or requirements exceed the

supply of iron that diet provides.
 Iron deficiency anemia

Iron deficieny anemia can be caused by:

Decreased iron available, not covering the normal

requirements (vegetarian diets, ...)

High iron requirements during the first years of life,

adolescence, pregnancy and lactation

Blood loss through excessive menstrual losses or

other various causes like bleeding (peptic ulcers, stomach
cancer, ...)
 Iron deficiency anemia

Symptoms of Anemia

Fatigue, dizziness and heart failure

Paleness of skin and mucous

Angular stomatitis

Edema (severe chronic cases)

Symptoms appears when hemoglobin 8g /dL

 Iron deficiency anemia

Nutritional Therapy:

Food sources and bioavailability:

 Iron deficiency anemia

Nutritional Therapy:
Enhancers of non heme iron absorption:
vitamin C (it can improve iron absorption)
other organic acids: citric, malic, tartaric and lactic
meat, fish and poultry

Inhibitors of iron absorption from non-heme:

phytic acid (legumes and rice)
polyphenols (fruits, vegetables, coffee and tea)
soy protein
some minerals: zinc, manganese, copper, calcium, copper

Iron supplements: oral iron salts (ferrous salts)

Fortification of foods: cereals, milk,...
 Vitamin B12 and Folic acid deficiencies

VIT B12 AND FOLIC ACID DEFICIENCIES

Megaloblastic anemia:
It is a macrocytic anemia that results from inhibition of DNA
synthesis in the production of red blood cells. This is due to
the deficiency of vitamin B12 and / or folic acid

Pernicious anemia:
It is a type of megaloblastic anemia caused by vitamin B12
deficiency due to a defect in absorption. The lack of intrinsic
factor is a major trigger
 Megaloblastic anemia

Vitamin B12 is important

for:
- metabolism
- formation of red blood
cells
- maintenance of the
central nervous system
(brain and spinal cord)
 Megaloblastic anemia

BIOCHEMISTRY OF VITAMIN B12

Degradation of odd chain

Important for DNA
fatty acids
synthesis, nervous tissue
and fat metabolism in the
liver
 Megaloblastic anemia

DNA synthesis & vitamin B12 and folate

the methylfolate trap

The methionine synthase reaction

 Megaloblastic anemia

Dietary vitamin B12 and acid folic

Vitamin B12 deficiency is

usually due to a deficiency of a
factor necessary for B12
absorption while a folic acid
deficiency is usually due to an
inadequate dietary intake.
Absorption and metabolism of
vitamin B12:
It is found in meats, eggs,
dairy products and liver
It is absorbed via a binding
protein called intrinsic factor (IF)
 Megaloblastic anemia

Dietary vitamin B12 and acid folic

Humans need 3-5 ug of vitamin B12 per day. Since

70% of dietary B12 is absorbed, the diet needs to
contain 5-7 ug/day.
Folic acid:

It is found in most of the foods,

including eggs, milk, yeast and liver
It is abundant in green leafy
vegetables
It is destroyed by heat
Its absorption occurs in the small
intestine
 Megaloblastic anemia

Vitamin B12 deficiency is caused by:

Reduced intake
Gastric disorders
Gastric atrophy prevents the separation
of the vitamin from food proteins to which
is attached
There is not produced the intrinsic
factor (IF)
Intestinal disorders such as
malabsorption
Other disorders associated with
transport, metabolism, interactions with
some drugs
 Megaloblastic anemia

Folate deficiency is caused by:

Reduced intake

High requirements during pregnancy, lactation,

Decreased absorption (malabsorption)

Increased excretion

Metabolic degradation
 Megaloblastic anemia

Clinical features:

Anemia is slow to
develop
Fatigue
Weakness
Yellow color
Weight loss
Glossitis
 Megaloblastic anemia

Treatment of megaloblastic anemia:

B12 deficiency
Vitamin therapy
Intramuscular or subcutaneous
injections for pernicious anemia to
bypass absorption through the gut.

Folate deficiency
Vitamin therapy
 Osteoporosis

CALCIUM AND VITAMIN D

Osteoporosis is a condition where bones become thin
and their strength is reduced; this makes them more
likely to break. It affects both men and women but is
most common in women who have gone through the
menopause.
 Osteoporosis

Osteoporosis Epidemic
Osteoporosis is a serious, worldwide,
and growing health problem.
More than 75 million people in Japan,
Europe and the U.S. have
osteoporosis.
 Osteoporosis

Osteoporosis Incidence

50% over 80 years have osteoporosis

30- 50% lifetime osteoporosis risk for

women
Osteoporosis is diagnosed by
checking the bone mineral
density (BMD) on a DEXA scan

The World Health Organization

defines osteoporosis as having
a T score of less than -2.5.
 Osteoporosis

Breaking a bone is a serious complication of

osteoporosis, especially when youre older.

Broken bones due to osteoporosis are most

likely to occur in the hip, spine and wrist, but
other bones can break too.

National Osteoporosis Foundation, 2002.

Available at: http://www.nof.org
 Bone Basics

The bones are made up of three major components that

make them both flexible and strong:
__________, a protein that gives bones a flexible
framework
____________________ that make bones hard and
strong
___________________ that remove and replace
weakened sections of bone

Ca Ca
 Bone Basics

Explain the graph

 Risc Factors

Uncontrollable Risk Factors

Being over age 50
Being Female
Menopause
Family History
Low Body Weight/Being Small and Thin.
Broken Bones or Height Loss
 Risc Factors

Controllable Risk Factors

 Risc Factors

Controllable Risk Factors

Not getting enough calcium and vitamin D
Getting too much protein, sodium and caffeine
Having an inactive lifestyle
Smoking Modifiable Risk
Drinking too much alcohol Factors

Losing weight

There are also medications

and diseases that can cause
bone loss and increase your risk
of osteoporosis.
 Risc Factors

How we weaken our bones

Caffeine- Increased urinary Ca

excretion for 1-3 hrs
Alcohol- Decreases osteoblast activity
Sodium- >2 g/d increases Ca excretion
Tobacco- increases Ca excretion
Inadequate Ca and/or Vit D
Inadequate exercise
 Prevention

Preventing Osteoporosis

Pay attention to your modifiable risk factors

mainly what you put in your mouth!
Anyone not taking in adequate dietary Calcium
and Vitamin D should get supplements
Dairy
Fortified juice or soy milk
Adequate calcium intake
Lowers risk of kidney stone
 Prevention

Calcium Recommended Intake

 Prevention

Calcium supplements

Preparation % Elemental Solubility

Calcium
Calcium 40% Insoluble
carbonate (take with food)
Calcium citrate 21% Soluble

Calcium lactate 13% Soluble

Calcium 9% Soluble
gluconate
 Prevention

Vitamin D

The body needs vitamin

D to absorb calcium.
It leads to insufficient
calcium absorption from the
diet. In this situation, the
body must take calcium
from its stores in the
skeleton. Requirements increase
with age
10g/day <70 years
15g/day >70 years
 Prevention

Exercise
Back strengthening exercise lead to
fewer vertebral fractures over 10 years
1.6% in exercising group
4.3% in control group
Sinaki M, et al. Bone 2002;30:836-841
Increased spine BMD over 9 months
3.5% vs. 1.5%
Villareal DT, et al. JAGS 2003;51(7):985-90
Kemmler W, et al. Arch Int Med 2004;164(10):1084-91
 Activity

1. Explain the different types of anemia. What are the main

differences?
2. Complete the following table

CAUSES SYMPTOMS TREATMENTS

Iron-
Deficiency

Vitamin B12
Deficiency

Folate
Deficiency

Calcium

Vitamin D
 Activity

3. Choose from the list enhancers of non heme and heme iron
absorption:
Legumes
Fruits
Tea
Soy protein
Cola
Fish
Meat
Coffee
 Activity

4. Explain the differences between megaloblastic anemia and

pernicious anemia
5. The bones are made up of three major components that make
them both flexible and strong. Please complete the slide in the
presentation:
- living bone cells
- calcium-phosphate mineral complexes
- collagen
7. Explain the peak bone mass graph (see slide )
8. Write some recommendations for the ostoporosis prevention
based on the pictures: