Beruflich Dokumente
Kultur Dokumente
Mikro Mineral
1
Mikromineral
Elemen yang tersusun sekitar 0.8% (0.01
– 0.00001%) dari berat badan tubuh,
diperlukan dalam jumlah sedikit tetapi
esensial untuk seluruh proses
metabolisme tubuh.
2
Peranan mikronutrien dalam metabolisme
Respirasi di mitokondria
& sintesa ATP
Immune function: Komponen Hb, mioglobin,
chemotaxis, phagocytosis sitokrom (P450, a,b,c)
of neutrophils and Sitokrom oxidase
monocytes Enzymes involved in DNA,
cytotoxic lymphocyte and
RNA and protein synthesis
NK cell activity
Bone formation and
Neuromuscular, muscle,
cardiovascular function,
Micronutrien mineralization
Synaptic transmission Zn, Cu, Se, Fe, Antioxidant defence
proteins, hormons Cu/Zn SOD, GSH-peroxidase
I... DNA repair enzyme
Components of metallothioneins
Detoxyfication of heavy
metals and xenobiotics Involved in food catabolizm
Thyroid function:
Thioredoxin reductase
Iodothyronine Lowe NM et al. 2002,
deiodinase Erickson KL et al. 2000, Ames BN Mutat
3
Res 2001, Hartwig A. Mutat Res 2001
Miconutrient
Optimum intake dapat bervariasi, tergantung:
– Umur
– Jenis kelamin
– Faktor genetik
– Kondisi kesehatan
– Influences by other aspects of diet, dietary practices
– Geographic differences (mineral content in soil, water etc.)
Recommended intake established for general
healthy population
– The Recommended Daily Allowances (RDA) have been set at
levels that prevent deficiency for 95% healthy people
– Dietary Reference Intake (DRI)/ Estimated Average
Requirement (EAR)– nutrient intake meeting requirement
levels for 50% of the healthy subjects
4
National recommended nutrient intakes for
the elderly
High levels of
Micronutrients Presence of chronic
medication use: reason for diseases affected
mineral-drug different absorption and
interaction needs bioavailability
in the elderly
8
Selenium and cancer deaths
adjusted odds ratio (Kornitzer M. Eur J Clin Nutr 2004)
-10
-20
-30
-37
-40
-44
-50 -50
-60 -61
-65
-70
Total ca Total ca Lung ca Prostatae ca Colorectal ca
mortality incidence incidence incidence incidence
10
Minerals significance
Serum Se inversly correlated with
homocysteine concentration
(Gonzales S et al. 2004)
Low serum selenium – enhanced production
of TXA2, decreased production of PGI2
(Alissa EM et al. 2003)
14
Requirements for trace elements
in the elderly
Copper - prooxidant
Zinc – impaired immune function,
decreased bioavailability of Fe, Cu
(Chandra RK 1992, 2004, Nakamura et al. 1987)
Selenium – oxidative damage
Iron excess lead to DNA oxidative
damage, carcinogenesis (Nelson 1994) and
heart disease (Ascherio et al. 1994), Alzheimer
disease (Smith et al. 1997), low Cu and Zn
status
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Micronutrient deficiency in elderly -
summary.
Susceptibility due to a triad:
ageing/chronic conditions &medications/environment
Impairs:
– Immune system (increased incidence of infections!)
– Oxidative defense (promote chronic diseases)
– WELL-BEING (unfavourable)
Warrants actions
– Reference for dietary intake in elderly to be established
– Education to increase awareness (patient/family/physician)
– Proper intake/elderly at risk.
Supplementation indicated ONLY in deficient patients
(improved immune defense, reduced risk of age-
related diseases). EXCESS has deleterious effect. (like
elsewhere in life). 17
18
Micronutrients in the elderly
Relationship between age and micronutrient status:
– Iron
• Fe requirement in older subjects is lower, Fe deficiency is rare
(Richard MJ 1999)
• 4-year follow-up in group of healthy elderly in France – average Fe
intake higher than recommended (Nicolas AS et al. 2000).
– Zinc
• inverse correlation between plasma Zn and age (Hercberg et al.
1991)
• Zinc deficits are more related to hospitalization and chronic
diseases than to age; Zn – 38% below RDI (Schmuck et al. 1996)
– Copper
• Status not modified by aging process (Richard MJ 1999)
– Selenium
• Status not modified by aging till age of 75 y. then lowered (Neve
1989, Olivieri 1994)
19
Selenium and cardiovascular diseases
Suggested threshold effect < 45 µg/l – assotiation
between serum Se and cardiovascular diseases
Data from studies inconsistent:
– Salonen et al. 1982 -Se<45 µg/l - RR 2.9 from CHD, 2.1 from MI
– Miettinen et al. 1983 - Se 50-105 µg/l - no sigificant risk
– Virtamo et al. 1985 - Se< 45 µg/l – RR 1.4 from CHD, from
cerebrovascular diseases
– Ringstad et al. 1986 -Se 59 – 197 µg/l – no sigificant risk
– Kok et al. 1987 -Se< 105 µg/l - RR 1.1 from CHD, – stroke
– Suadiciani et al. 1992 - Se< 79 µg/l RR 1.6 from CHD
– Salvini et al. 1995 - Se>80 µg/l - no sigificant risk
– Kardinnal et al. 1997 - Se toenail 0.55ug/gm RR 0.63 from MI
20
Multinutrient supplementation - 1 year
(Chandra RK Lancet 1992, 340,1124
p = 0.002
days 50 48
45
40 p = 0.004
35 32
30
25 23 supplemented
20 18 controls
15
10
5
0
days of infection days with antibiotics
21
Estimates of the percentage of individuals who do not
consume 100% of the dietary reference intake of Mg
and the recommended daily allowance for Zn
90%
80%
70%
60%
50% 50-59
40% 60-69
>70
30%
20%
10%
0%
Men Women Men Woman
Magnesium Zinc
Adapted from the US Department of Agriculture Continuing Survey of
Food Intakes by Individuals 22
Trace element intakes in polish free-living
and hospitalized elderly
Minerals Women In Men In
hospital hospital
mg/d RDI Mean % RDI Mean RDI Mean % RDI Mean
23
Gabrowska E. 2004