Dr Ali SoroushHead of Department of Sports Medicine and RehabilitationChairman of Imam Reza Hospital

• Are inorganic substances that are essential for the normal function and development of body cell and systems

• They make up approximately 3% of total body-weight

MINERALS AND TRACE ELEMENTS

Functions of mineral in the body

• Formation and maintenance of strength and Rigidity of bone and teeth

• Regulation of fluid balance• Regulation of acid /base balance• Components of enzymes and hormones and , as such ,

essential for energy metabolism and functioning of the immune system

• Transmission of action potential along nerves• Contraction of muscle fibres.

Essential minerals and trace elements

mineralstrace elements

CalciumIron manganese

phosphorusFluoride chromium

PotassiumCopper selenium

SodiumZinc molybdenum

ChlorineIodine

magnesiumCobalt

UK RNI*/dayDietary sourcesFunctions Deficiency symptoms

Toxicity symptoms

Calcium700mg

Dairy product bone and teeth formation

Muscle contractionNerve transmission Blood clotting

Rickets Osteoporosis ConvulsionStunted growth

Phosphorous550mg

Dairy product

Meat and fish

bone and teeth formation ACID –BASE BALANCE

Deminerilisation of bone Low blood Ca levels

Iron 8.7 mg male14.8 female

Meat, dried fruit , green vegetables fortified cereals

Component of haemoglobin

PallorTiredness BreathlessnessReduced resistance to infection

Cirrhosis of liver

Iodine 140 µg

Seafish and shellfish , milk some vegetables Iodised salt

Component of thyroid hormones , controls metabolic rate

Enlarged thyroidFoetal abnormalityRetarded growth

Hyperthyroid

Flourine50 µg

Seafood , tea, drinking water

Helps prevent caries Increased frequency of dental caries

Tooth mottlingSkeletal changes

Sodium1600 mg

Cheese preserved foods Pre-prepared foods added to cooking

Acid-base and fluid balanceNerve transmission Muscle contraction

Muscular fatigue , nauseaReduced appetite

Hypertension vomiting

Reference nutrient intakes, sources and effects of incorrect intakes

RNI: Reference Nutrient Intake*

UK RNI*/dayDietary sourcesFunctions Deficiency symptoms

Toxicity symptoms

Potassium3500 mg

Fruit , vegetablesAcid-base and fluid balance , nerve transmission, muscle contraction

Muscle weakness, confusion, cardiac arrest

irregular heart rate

Mg 300 mg

Wholegrain cereals, green vegetables , nuts

Protein and DNA synthesis, bone development

Neuro muscular dysfunction

Hypertension

Copper1.2 mg

Meat , shellfish , vegetables

Enzymefunction lon absorption

Reduced resistance to infection

--------

Zinc9.5 mg

Meat , eggs , ,pulses , wholehrain cereals

Enzyme function , immune system

Skin lesions , growth failure , reduced immunity

Diarrhea , nausea

Reference nutrient intakes, sources and effects of incorrect intakes (2)

RNI: Reference Nutrient Intake*

Calcium (Ca)

• Greatest amount in the body

• The body of a well-nourished adult contains 1-1.5 kg ca

• 99% of total content is deposit in bones and teeth,

• 1% in blood and body fluids

Functions

Bone structureNerve functionBlood clottingMuscle contractionCellular metabolism

Functions of Ca

• Deposits of Ca in the original soft matrix give bones their necessary rigidity.

• In the case and resistance to decay.• The small amount of Ca remaining in the tissue fluids

plays a part in controlling the action of nerves.• Ca also has a role in the clotting of blood.

Absorption of calcium:

– predominantly in the jejunum but also in the ileum and colon.

MechanismSimple diffusion

An active transport involving Ca pump

Absorption factors

Absorption increased by

Body needVitamin DFatLactose Amino acidArginine

Absorption decreased by:

Vitamin D deficiencyCalcium-phosphorus

imbalanceCocaspinach

Food Sources :

Best sources: Milk and milk product; Good sources: Beans, vegetables, fish, cabbage,broccoli.

Ca content of some dairy products and white bread

• 500 ml milk contains approximately 500 mg Ca• 30 g cheddar cheese contains 240 mg Ca• 125 g pot low-fat yoghurt contains 200mg Ca• Two thick slices white bread contains 74 mg Ca

Ca Deficiency

Calcium may be lacking in the body if absorptions is impaired as in the:

• Malabsorption syndrome• Vitamin D deficiency• Dietary deficiency of Ca in girls age 15-18 y

Dietary requirement

• During Pregnancy(no extra Ca is required because increase absorption)

• During lactation (550mg per/day)• Throughout childhood and adolescence

Calcium and Osteoporosis

• Bone growth is greatest during “linear growth”– Peaks out at around age 35

• Lose of cortical bone occurs at a rate 35% per year in males and in females prior to the menopause . The rate in a females for 5 years after menopause.

• Ca supplementation without the addition of oestrogen can not prevent Osteoporosis.

Ca

Phosphorous (P)

• Second largest amount in the body • 80% of P occurs in combination with Ca in the

bone and teeth. • 20% ECF

Functions of Phosphorus

• Essential for the development of bones and teeth

• Phospholipids, Phosphoprotieon• Energy metabolism• Maintenance of blood pH: phosphate buffer

system

P Absorption

• PTH absorption of P

• phosphate is based on the intake of calcium.(the ratio of Ca:P of 1:1)

• Sources: –milk, fish, vegetable, meat, eggs

Phosphorus Deficiency

• Patients with renal diseases.• Patients receiving TPN• Alcoholic

Iron

The function of Iron in the body are as follows:Iron is necessary for the formation of HbHb Carries of oxygen to the tissues and carbon dioxide between the lungs Part of the protein myoglobin in musclesIron is found in the muscle pigment myoglobinIt is also an important constituent of many enzyme systems

Iron

Iron absorption

Not all the Iron in the diet is absorbed If the diet contains adequate amounts meat and

ascorbic acid it is usual only 15% of dietary iron to be absorbed

Iron absorption occurs in the duodenum and jejunum

Sources of iron

Two types of iron are found in foods: Meat and meat products contain haem iron (i.e.the iron in hemoglobin) Fruit and vegetables contain iron as ferric complexes

Heme and Nonheme Iron in Foods

Iron Deficiency

Groups of the population who may suffer from iron deficiency are those with:

Increased needs: pregnant women, Infants, toddlers, andAdolescentsHigh losses: Mensturating womenPoor or reduced absorption: Elderly people, Vegetarians

Iron absorption mechanisms in the upper small intestine (McGeown 1999)

High Iron Intakes

Haemochromatosis:Is an inherited condition in which iron absorption is inappropriately high and results in an accumulation of iron in the tissuesIron poisoning:

It does occur in children and adults

Iodine

The trace element iodine is a constituent of thyroxine (T4)

and triiodothyronine (T3) These hormones control the rate of tissue activity,

metabolic rate, integrity of connective tissue They are also necessary for the development of the

foetal nervous system during the first trimester of pregnancy

They are vital for normal and physical mental development

Dietary Sources Iodine

Vegetables Sea fish

Cretinism

A deficiency in the mother’s diet during early pregnancy results in cretinism, a syndrome of mental

retardation and dwarfism

Goitrogens

Some foods have been found to contain substances which interfere with the uptake of iodine by thyroid gland such as sweet potato

• Cabbage and turnip contain goitrogenic cyanoglucosides

• Cassava, maize, sweet potato and lima beans• Water may have goitrogenic properties when

contaminated with faeces• Calcium, fluoride, manganese and magnesiumions

present in hard water are also goitrogenic

Goiter

• If sufficient Iodine is not available for formation T3 &T4 , the thyroid gland enlarges in an effort to maintain normal out put of hormones ,and gives rise to swelling of neck.

Iodine Deficiency

• Iodine Deficiency is prevalent in communities where dietary intake is low or insufficient or combination with a diet containing goitrogens.

Goiter

• Endemic (commonl found) in parts of S. America and India

• Sporadic cases in U.S.

Fluorine

• Principally in matrix of bone and teeth.• This mineral is present in water and tea• Amount normal Fluorine is present in water to extent

of 1 part per million

• Deficiency symptoms– Susceptibility to tooth decay

• Toxicity symptoms– Fluorosis (pitting and discoloration of teeth)

Fluorine Deficiency

Sodium

Sodium is found principally in the blood plasma and the fluid surrounding the tissues.

Na+ are important in maintaining and influencing osmotic balance between cells and the interstitial fluid

Distribution is mediated by the Na+/K+-ATPase pump Na+ are important in neuron (brain and nerve) function

– action potential

Sodium dietary sources

• Common salt • Fish • Milk• Egg• Fruit & vegetables• cheese

• Sodium losses occur through urine and sweat (symptoms: excessive fatigue and muscle cramp)

• Shifts in sodium balance result in expansion or contraction of ECF

•Too low, ADH / aldosterone secreted•Too high, Atrial natriuretic peptide (ANP)• secreted

• Normally , the sodium content of the body is maintained by the kidneys at an almost constant level.

• Changes in the sodium concentration in the ECF are compensated for by changes in the ECF volume.

• So is the ECF sodium concentration increases , more water is retained in the ECF to keep the constant concentration

The absorption of sodium and water are under the complex hormonal control of aldosterone and ACTH.Change of ECF volume are detected by pressure sensors in the circulation , which stimulate changes in sodium and water absorption in the kidneys

Sodium Absorption

• Muscle cramps• Excessive fatigue• Pathology • Prolonged Vomiting or Diarrhoea• Poor kidney function • Excessive sweating • Tissue damage

In the elderly , Na deficiency can lead to confusion

Signs & Symptoms of decrease in sodium

• There is much conflicting evidence about the links between hypertension and dietary sodium intake

• High alcohol intake , smoking , high salt intake and obesity contribute to rise in blood pressure

Dietary salt and hypertension

Potassium

K+ is the principal cation of the intracellular fluid. Potassium is present principally in body Excessive retention occurs in association with some

kidney disorders and also in Addison’s disease, and may cause cardiac arrest

Kidneys play important role to regulating the Potassium

Content in body. Over 90% K absorbed in proximal small intestinal.

Potassium sources

Fruit and vegetables are the major contributors of potassium to the diet, bananas and fruit juices being particularly rich sourcesCoffee is also a good source

Potassium and Blood Pressure

Increasing the dietary potassium intake has been shown to reduce blood pressure in normotensive and hypertensive individuals

Excessive retention

• Kidney disorders• Addison’ s disease• Cardiac arrest

Deficiency

• Prolonged Vomiting• Diarrhoea• Diuretic therapy

Potassium

Magnesium

Magnesium is a necessary for skeletal and maintaining electrical potenial across the membranes of nerves and

muscles.

Dietary sources

• Hard water • Green vegetable• Meat and meat product

Case Magnesium deficiency

StarvationAlcoholismProlonged Diarrhoea

Prolonged vomiting

Symptom of Magnesium deficiency

• Progressive muscle weaknss

• Failure to thrive• Neuromuscular

dysfunction• VF

Magnesium Deficiency

Copper

• Chief functions in the body– Necessary for absorption and use of iron in the

formation of hemoglobin– Part of several enzymes–

Copper Deficiency

Symptom Deficiency

– Defect hair pigmentation– Increased susceptibility to respiratory infection – Reduced immune response

Zinc

• 60% in skeletal muscle • 30%in bone • Part of many enzymes(metalloenzymes )• Needed for wound healing • Zinc Deficiency: impaired immune , Growth failure,

impaired healing • Zinc Toxicity: , copper deficiencies , nausea & vometing

Factors predisposing to Deficiency

• Lacking in diets • Parasites causing chronic blood loss• Excessive sweating• Malabasorption of food • Surgery • burns • Dietary sources : seafood ,meat, egg

Selenium

• acts with other antioxidants

• May be protective froms cancer

• Dietary sources:• Meats , fish

Chromium

• Increases action of insulin• Part of metabolism lipid• Dietary sources:• meats , nuts,

Molybendum

• Essential of some enzymes involved in the DNA metabolism

• Dietary sources:• Milk , liver

Cobalt

• Constituent with vitamin B12

• essential for maturation of RBC’s

• Dietary sources:• Meats ,milk

Choloride

• Balance Na & K in the cells and ECF

• Dietary sources• Salt

Aluminium

• Aluminium is found all plats animals

• Dietary sources• vegetable

Water

• Water constitutes about 65 - 70 % total body weight• Fluid balance between ECF & ICF • Products of digestion are absorbed in a fluid medium

and distributed in blood and lymph • Controlled body temperature• Excretion (lung , kidney ,..) • Involve chemical reaction

Water sources

• Water is a constituent of most food , even though they may be solid in consistency:

• Bread contains approximately 35% water• Fish 65%• Meat 50-70%• Vegetables and fruits 80-90%

Water balance

• Water is lost from the body in urine , faeces , sweat and expired air.

• The regulatory mechanisms in the kidneys result in a variable volume of urine being secreted-consequently a balance is maintained between intake and output of water

Requirement

• An average adult living in a temperate climate requires approximately 2500 ml of water daily.

• The actual amount that is ingested depends both on climate and habit :

• Drinks provide 1000-2500 ml.• Food provide 1000-1500 ml.• Metabolism provide 200-400ml.

Dehydration

• Means loss of water , but is often used as implying a loss of certain mineral elements also , particularly sodium.

• Loss of up to 5% of body-weight by dehydration results in thirst and discomfort.

• Loss of 6-10% results in dizziness , absence of saliva and inability to walk.

• Loss of 11-12% results in delirium , swollen tongue , inability to swallow and shrivelled skin

Total body fluidMale 60%

% Female 50