Dr. Suppasin Soontrapa Department of Orthopedics Khon Kaen University, Khon Kaen, Thailand

1. Trace elements Dr. Suppasin Soontrapa Department of Orthopedics Khon Kaen University, Khon Kaen, Thailand

2. *Ref: ค่าสารอาหารที่แนะนำให้บริโภคประจำวันสำหรับคนไทยอายุตั้งแต่ 6 ปีขึ้นไป (Thai Recommended Daily Intakes– Thai RDI) จัดทำโดย คณะอนุกรรมการพิจารณาการแสดงคุณค่าทางโภชนาการบนฉลากของอาหาร 2538

3. Magnesium

5. Magnesium Elemental Composition of the Human Body • Magnesium is found in small amount in the human body (http://ods.od.nih.gov/factsheets/magnesium.asp#h2)

6. Magnesium • Approximately 50% of total body magnesium is found in bone. • The other half is found predominantly inside cells of body tissues and organs. • Only 1% of magnesium is found in blood (http://ods.od.nih.gov/factsheets/magnesium.asp#h2)

7. The function of Magnesium • Magnesium has positive charge • Magnesium has many necessary function in cells • Co-factor in many basic cellular function especially in process of energy production • Magnesium is needed for more than 300 biochemical reactions in the body

8. The function of Magnesium • regulate blood sugar levels • promotes normal blood pressure • to be involved in energy metabolism and protein synthesis • Maintain normal muscle and nerve function • keeps heart rhythm steady • supports a healthy immune system • keeps bones strong.

9. Magnesium • Magnesium is absorbed in the small intestines. • Magnesium is excreted through the kidneys

10. Sources of Magnesium • Green vegetables • spinach are good sources of magnesium because the center of the chlorophyll molecule (which gives green vegetables their color) contains magnesium. • Some legumes (beans and peas), nuts and seeds • whole grains, unrefined grains are also good sources of magnesium

11. DRIs (Dietary Reference Intakes) • Recommended Dietary Allowances (RDA) • Adequate Intakes (AI) • Tolerable Upper Intake Levels (UL).

12. DRIs (Dietary Reference Intakes) • Recommended Dietary Allowances (RDA) • The RDA recommends the average daily intake that is sufficient to meet the nutrient requirements of nearly all (97-98%) healthy individuals in each age and gender group

13. DRIs (Dietary Reference Intakes) • Adequate Intakes (AI) • An AI is set when there is insufficient scientific data available to establish a RDA for specific age/gender groups. • AIs meet or exceed the amount needed to maintain a nutritional state of adequacy in nearly all members of a specific age and gender group

14. DRIs (Dietary Reference Intakes) • Tolerable Upper Intake Levels (UL) • UL is the maximum daily intake unlikely to result in adverse health effects.

15. Recommended Dietary Allowances (RDAs) for magnesium for children and adults

16. Causes of Magnesium Deficiency • Magnesium is absorbed in the intestines and then transported through the blood to cells and tissues. • Approximately one-third to one-half of dietary magnesium is absorbed into the body • Gastrointestinal disorders impair absorption • Crohn's disease can limit the body's ability to absorb magnesium. • Chronic or excessive vomiting and diarrhea may also result in magnesium depletion

17. signs and symptoms of magnesium deficiency • loss of appetite, nausea, vomiting, fatigue, and weakness. • As magnesium deficiency worsens, • numbness, tingling, muscle contractions and cramps, seizures, personality changes, abnormal heart rhythms, and coronary spasms can occur • Severe magnesium deficiency can result in low levels of calcium in the blood (hypocalcemia). • Magnesium deficiency is also associated with low levels of potassium in the blood (hypokalemia)

18. Who may need extra magnesium? • specific health problem • poorly-controlled diabetes • persons with alcoholism • condition limits magnesium absorption • Individuals with chronic malabsorptive problems such as • Crohn's disease, gluten sensitive enteropathy, regional enteritis, and intestinal surgery may lose magnesium through diarrhea and fat malabsorption

19. Who may need extra magnesium? • Older adults are at increased risk for magnesium deficiency. • The 1999-2000 and 1988-94 National Health and Nutrition Examination Surveys suggest that older adults have lower dietary intakes of magnesium than younger adults • Ford ES and Mokdad AH. Dietary magnesium intake in a national sample of U.S. adults. J Nutr. 2003;133:2879-82. • Bialostosky K, et al., Dietary intake of macronutrients, micronutrients and other dietary constituents: United States 1988-94. Vital Heath Stat. 11(245) ed: National Center for Health Statistics, 2002:168.

20. Magnesium and osteoporosis • Bone health is supported by many factors • most notably calcium and vitamin D • some evidence suggests that magnesium deficiency may be an additional risk factor for postmenopausal osteoporosis • Several human studies have suggested that magnesium supplementation may improve bone mineral density Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D and Fluoride. NationalAcademy Press. Washington, DC, 1999

21. Magnesium and osteoporosis • magnesium deficiency alters calcium metabolism and the hormones that regulate calcium1 • In a study of older adults, a greater magnesium intake maintained bone mineral density to a greater degree than a lower magnesium intake2 • Elisaf M, Milionis H, Siamopoulos K. Hypomagnesemic hypokalemia and hypocalcemia: Clinical and laboratory characteristics. Mineral Electrolyte Metab 1997;23:105-12. • Tucker KL, Hannan MT, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr 1999;69(4):727-36.

22. Conclusion • Magnesium is very important in older adults to maintain many functions • Magnesium deficiency usually found in poor controlled DM, alcoholism, chronic malabsorptive problems,ect. • magnesium supplementation may improve bone mineral density and prevent osteoporosis

23. Conclusion • Calvin-plus contain Magnesium 40 mg (~10% of RDA)

24. Copper

26. What is copper? • copper is a trace mineral that plays an important role in our metabolism, it allows many critical enzymes to function properly. • the total amount of copper in the body is only 75-100 mg • Copper stored primarily in the liver,with lesser amounts found in the brain, heart, kidney, and muscles

27. The function of copper? • Copper is an essential component of many enzymes. • Copper plays a role in a wide range of physiological processes including • iron utilization, • elimination of free radicals, • development of bone and connective tissue, • production of the skin and hair pigment called melanin.

28. Iron Utilization • Approximately 90% of the copper in the blood is incorporated into a compound called ceruloplasmin, which is a transport protein responsible for carrying copper to tissues that need the mineral. • ceruloplasmin also acts as an enzyme, catalyzing the oxidation of iron.

29. Iron Utilization • The oxidation of iron by ceruloplasmin is necessary for iron to be bound to its transport protein (called transferrin) so that it can be carried to tissues where it is needed. • Iron deficiency anemias may be a symptom of copper deficiency.

30. Elimination of Free Radicals • Superoxide dismutase (SOD) is a copper-dependent enzyme that catalyzes the removal of superoxide radicals from the body. • Superoxide radicals are generated • during normal metabolism • white blood cells attack invading bacteria and viruses (a process called phagocytosis). • If not eliminated quickly, superoxide radicals cause damage to cell membranes

31. Elimination of Free Radicals • When copper is not present in sufficient quantities, the activity of superoxide dismutase is diminished • The damage to cell membranes caused by superoxide radicals is increased

32. Development of Bone & Connective Tissue • Copper is also a component of lysyl oxidase, an enzyme that participates in the synthesis of collagen and elastin

33. Melanin Production • Tyrosinase, a copper-containing enzyme, converts tyrosine to melanin, which is the pigment that gives hair and skin its color.

34. The symptoms of copper deficiency • iron deficiency anemia • ruptured blood vessels • osteoporosis • elevated LDL cholesterol and reduced HDL cholesterol levels • increased susceptibility to infections due to poor immune function • loss of pigment in the hair and skin • weakness, fatigue, breathing difficulties

35. The risk factors of copper deficiency ? • most Americans consume less than recommended amounts of copper in their diet • Certain medical conditions result in decreased absorption of copper and may increase the risk of developing a copper deficiency • chronic diarrhea • celiac sprue • Crohn's disease

36. The risk factors of copper deficiency ? • copper requires sufficient stomach acid for absorption, so if you consume antacids regularly you may increase your risk of developing a copper deficiency.

37. RDAsof Copper • Boys & girls 9-13 years: 700 mg • Boys & girls 14-18 years: 890 mg • Men & women 19-70 years: 900 mg • Men & women>70 years: 900 mg • Pregnant & women 14-50 years: 1000 mg • Lactating women 14-50 years: 1300 mg

38. Conclusion • Copper have many functions in man • Most US people consume less amounts of copper than recommended • Copper in calvin plus = 1 mg can supplement adequate amount of copper per day

39. Zinc

40. Zinc: What is it? • Zinc is an essential mineral that is found in almost every cell. • It stimulates the activity of approximately 100 enzymes, which are substances that promote biochemical reactions in the body, including alkaline phosphatase1-2 • Zinc supports a healthy immune system3-4 1. Sandstead HH. 1994;124:322-327. 2. Institute of Medicine. National Academy Press. Washington, DC, 2001. 3. Solomons NW. Nutr Rev 1998;56:27-28. 4. Prasad AS. Zinc: An overview. Nutrition 1995;11:93-99

41. Zinc: What is it? • Zinc is needed for wound healing1 • maintain your sense of taste and smell2 • Zinc is needed for DNA synthesis3 • Zinc also supports normal growth and development during pregnancy, childhood, and adolescence4,5 1. Heyneman CA. Ann Pharmacother 1996;30:186-187. 2. Prasad AS, et al. Proc Assoc Am Physicians 1997;109:68-77. 3. Institute of Medicine. National Academy Press. Washington, DC, 2001. 4. Simmer K and Thompson RP. Acta Paediatr Scand Suppl 1985;319:158-163. 5. Fabris N and Mocchegiani E. Aging (Milano) 1995;7:77-93.

42. What foods provide zinc? • Zinc is found in a wide variety of foods1 • Oysters contain more zinc per serving than any other food, • Red meat and poultry provide the majority of zinc in the American diet. • Other good food sources include beans, nuts, certain seafood, whole grains, fortified breakfast cereals, and dairy products1-2 • Institute of Medicine. National Academy Press. Washington, DC, 2001. • U.S. Department of Agriculture, Agricultural Research Service. 2001. Nutrient Data Laboratory Home Page, http://www.nal.usda.gov/fnic/foodcomp Search the database online.

43. The 2001 RDAs for zinc for infants 7 through 12 months, children and adults in mg per day Institute of Medicine. National Academy Press. Washington, DC, 2001

44. Inadequate intake of zinc • Low zinc status has been observed in 30% to 50% of alcoholics. • Alcohol decreases the absorption of zinc and increases loss of zinc in urine. • Many alcoholics do not eat an acceptable variety or amount of food, so their dietary intake of zinc may be inadequate1-3 • Institute of Medicine. National Academy Press. Washington, DC, 2001 • Menzano E and Carlen PL. Alcohol Clin Exp Res 1994;18:895-901 • Navarro S, et al., Pancreas 1994;9:270-274.

45. Inadequate intake of zinc • Individuals who have had gastrointestinal surgery • Digestive disorders that result in malabsorption • including sprue • Crohn’s disease • short bowel syndrome1-3 • These patients may benefit from zinc supplementation • Institute of Medicine. National Academy Press. Washington, DC, 2001 • Hambidge KM, In: Mills CF, ed. Zinc in Human Biology, New York: Springer-Verlag 1989 Pp 281-296. • Naber TH, et al., Scand J Gastroenterol 1998;33:514-523.

46. Signs of zinc deficiency • growth retardation • hair loss • diarrhea • delayed sexual maturation • impotence • eye and skin lesions • loss of appetite Institute of Medicine. National Academy Press. Washington, DC, 2001.

47. Signs of zinc deficiency • weight loss • delayed healing of wounds • taste abnormalities • mental lethargy1-5 • Hambidge KM, In: Zinc in Human Biology, 1989 Pp 281-296. • King JC and Keen CL. In: Modern Nutrition in Health and Disease, 1999, Pp223-239. • Krasovec M and Frenk E. Dermatology 1996;193:361-363. • Ploysangam A, et al., J Trop Pediatr 1997;43:192-198. • Nishi Y. J Am Coll Nutr 1996;15:340-344.

48. Who may need extra zinc? • There is no single laboratory test that adequately measures zinc nutritional status1-2 • risk factors of zinc deficiency1 • inadequate caloric intake • alcoholism • digestive diseases • Institute of Medicine. National Academy Press. Washington, DC, 2001. • Van Wouwe JP. Clinical and laboratory assessment of zinc deficiency in Dutch children. A review. Biol Trace Elem Res 1995;49:211-225.

49. Who may need extra zinc? • Vegetarians may need as much as 50% more zinc than non-vegetarians because of the lower absorption of zinc from plant foods • it is very important for vegetarians to include good sources of zinc in their diet1-2 • Institute of Medicine. National Academy Press. Washington, DC, 2001. • Gibson RS. Content and bioavailability of trace elements in vegetarian diets. Am J Clin Nutr 1994;59:1223S-1232S.

50. Conclusion • Zinc is an essential mineral for many function including bone growth • Many people consume inadequate zinc especially vegetarians • Zinc in calvin plus = 7.5 mg can supply about 50% of daily requirement of zinc