Intake deficiency

Apart from a low dietary intake, deficiencies of trace elements may arise from defects in absorption or utilization. Trace element absorption can be greatly influenced by other dietary components both organic, such as phytates, and inorganic, such as metals. Only those elements which are of practical importance will be discussed. 

Causes of Osteoporosis Dietary Deficiencies of Calcium Dietary Imbalances of Calcium and Phosphorus High Protein Intakes Deficiencies of Vitamin D Stresses... 

Phenylpyruvic acid can cause mental retardation m infants who are deficient m the enzymes necessary to convert l phenylalanine to l tyrosine This disorder is called phenylketonuria, or PKU disease PKU disease can be detected by a simple test rou tmely administered to newborns It cannot be cured but is controlled by restricting the dietary intake of l phenylalanine In practice this means avoiding foods such as meat that are rich m l phenylalanine... 

It is difficult to define the normal range of iodine intake in humans, and despite efforts to provide iodine supplementation in many geographic areas of the world, endemic iodine deficiency and attendant goiter remain a world health problem (147). Exposure to excess iodine may sometimes lead to the development of thyroid disease. This unusual type of iodide-induced goiter has been found, for example, in 10% of the population of a Japanese island where fishermen and their families consume large quantities of an iodine-rich seaweed and have an iodine intake as high as 200 mg/d (148). 

Sulfur. Sulfur is present in every cell in the body, primarily in proteins containing the amino acids methionine, cystine, and cysteine. Inorganic sulfates and sulfides occur in small amounts relative to total body sulfur, but the compounds that contain them are important to metaboHsm (45,46). Sulfur intake is thought to be adequate if protein intake is adequate and sulfur deficiency has not been reported. Common food sources rich in sulfur are Hsted in Table 6. 

Magnesium ion is essential for normal Ca " and K" metaboHsm. In acute experimental magnesium deficiency in humans, hypocalcemia occurs despite adequate calcium intake and absorption and despite normal renal and parathyroid functions. Negative K" balance is also observed. AH biochemical and clinical abnormaHties disappear upon restoration of adequate amounts of magnesium to the diet (64). 

Tin. The widespread use of caimed foods results in a daily intake of tin that is ca 1—17 mg for an adult male (154). At this level it has not been shown to be toxic. Some grains also contain tin. Too much tin can adversely affect 2inc balance and iron metaboHsm. EssentiaUty has not been confirmed for humans. It has been shown for the rat. An enhanced growth rate results from tin supplementation of low tin diets (85). Animals on deficient diets exhibit poor growth and decreased feed efficiency (155). 

Vanadium. Vanadium is essential in rats and chicks (85,156). Estimated human intake is less than 4 mg/d. In animals, deficiency results in impaired growth, reproduction, and Hpid metaboHsm (157), and altered thyroid peroxidase activities (112). The levels of coen2yme A and coen2yme Q q in rats are reduced and monoamine oxidase activity is increased when rats are given excess vanadium (157). Vanadium may play a role in the regulation of (NaK)—ATPase, phosphoryl transferases, adenylate cyclase, and protein kinases (112). 

Iodized Salt. Iodized table salt has been used to provide supplemental iodine to the U.S. population since 1924, when producers, in cooperation with the Michigan State Medical Society (24), began a voluntary program of salt iodization in Michigan that ultimately led to the elimination of iodine deficiency in the United States. More than 50% of the table salt sold in the United States is iodized. Potassium iodide in table salt at levels of 0.006% to 0.01% KI is one of two sources of iodine for food-grade salt approved by the U.S. Food and Dmg Administration. The other, cuprous iodide, is not used by U.S. salt producers. Iodine may be added to a food so that the daily intake does not exceed 225 p.g for adults and children over four years of age. Potassium iodide is unstable under conditions of extreme moisture and temperature, particularly in an acid environment. Sodium carbonate or sodium bicarbonate is added to increase alkalinity, and sodium thiosulfate or dextrose is added to stabilize potassium iodide. Without a stabilizer, potassium iodide is oxidized to iodine and lost by volatilization from the product. Potassium iodate, far more stable than potassium iodide, is widely used in other parts of the world, but is not approved for use in the United States. 

The Sugars Task Force s Select Committee on Nutrition and Human Needs recommended a daily consumption of sugars at 10% of total calories, which approximates current (11%) daily intake levels in the United States. At this level, sucrose does contribute to the development of dental caries however, no firm evidence exists that it causes dietary imbalances or deficiencies of vitamins (qv), minerals, or trace nutrients (62). 

Ascorbic acid is very soluble in water and mainly excreted in the urine. No ascorbic acid is excreted during vitamin C deficiency. A minimum amount is lost in the feces, even after intake of gram dosages (154). 

Fohc acid is safe, even at levels of daily oral supplementation up to 5—10 mg (97). Gastrointestinal upset and an altered sleep pattern have been reported at 15 mg/day (98). A high intake of foHc acid can mask the clinical signs of pernicious anemia which results from vitamin deficiency and recurrence of epilepsy in epileptics treated with dmgs with antifolate activity (99). The acute toxicity (LD q) is approximately 500 and 600 mg per kg body weight for rats and mice, respectively (100). 

The RDA for niacin is based on the concept that niacin coen2ymes participate in respiratory en2yme function and 6.6 niacin equivalents (NE) are needed per intake of 239 kj (1000 kcal). One NE is equivalent to 1 mg of niacin. Signs of niacin deficiency have been observed when less than 4.9 NE/239 kj or less than 8.8 NE per day were consumed. Dietary tryptophan is a rich source of niacin and the average diet in the United States contains 500—1000 mg of tryptophan. In addition, the average diet contains approximately 8—17 mg of niacin. In total, these two quantities total 16—34 NE daily. Table 5 Hsts the RDA and U.S. RDA for niacin (69). 

Thiamine requirements vary and, with a lack of significant storage capabiHty, a constant intake is needed or deficiency can occur relatively quickly. Human recommended daily allowances (RDAs) in the United States ate based on calorie intake at the level of 0.50 mg/4184 kj (1000 kcal) for healthy individuals (Table 2). As Httle as 0.15—0.20 mg/4184 kJ will prevent deficiency signs but 0.35—0.40 mg/4184 kJ are requited to maintain near normal urinary excretion levels and associated enzyme activities. Pregnant and lactating women requite higher levels of supplementation. Other countries have set different recommended levels (1,37,38). 

Vitamin Deficiency. Vitamin deficiency is uncommon in normal adults. However, when it does occur, it can be serious, particularly in pregnant women. Some vitamin deficiency can occur because of a large reduction of fat intake, which decreases absorption. Strict vegetarians also risk reduced vitamin intake. Premature infants and elderly people who are exposed to minimal sunlight and consume Htde vitamin also have a reduced capacity to metabolize and can develop vitamin deficiency. 

Owing to the ubiquitous natural occurrence of vitamin K and its production by intestinal bacteria, vitamin K deficiencies are rare. However, they can be caused by certain antibiotics (qv) coupled with a reduced dietary intake. Newborn infants who do not possess the necessary intestinal bacterial population are at danger for vitamin K deficiency. As a result, vitamin K injections are routinely given to the newborn. 

About 50% of copper in food is absorbed, usually under equitibrium conditions, and stored in the tiver and muscles. Excretion is mainly via the bile, and only a few percent of the absorbed amount is found in urine. The excretion of copper from the human body is influenced by molybdenum. A low molybdenum concentration in the diet causes a low excretion of copper, and a high intake results in a considerable increase in copper excretion (68). This copper—molybdenum relationship appears to correlate with copper deficiency symptoms in cattle. It has been suggested that, at the pH of the intestine, copper and molybdate ions react to form biologically unavailable copper molybdate (69). 

Oral calcium has long been used for the treatment of osteoporosis, both in the form of dietary and pharmacological supplements. In patients with calcium deficiency, oral calcium at doses of 1000-1500 mg/day corrects a negative calcium balance and suppresses PTH secretion. Sufficient calcium intake is most important for the acciual of peak bone mass in the young, but is also considered the basis of most anti-osteoporotic regimens. In the elderly, supplementation with oral calcium and vitamin D reduces the risk of hip fracture by about 30 4-0%. 

Glucose- 6-phosphate dehydrogenase Low or absent enzyme activity in about 10% of African populations. Hemolysis following intake of a number of drugs which have electrophilic reactive metabolites, but also, carriers of this enzyme deficiency have a partial protection from malaria. 

Due to bleeding risk, individuals on anticoagulant therapy or individuals who are vitamin K-deficient should not take vitamin E supplementation without close medical supervision. Absent of that, vitamin E is a well-tolerated relatively non-toxic nutrient. A tolerable upper intake level of 1,000 mg daily of a-tocopherol of any form (equivalent to 1,500 IU of RRR a-tocopherol or 1,100 IU of all-rac-a-tocopherol) would be, according to the Food and Nutrition Board of the Institute of Medicine, the highest dose unlikely to result in haemorrhage in almost all adults. 

A deficiency of this vitamin caused by a low dietary intake of vitamin B12 is rare because the vitamin is found in meats, milk, eggs, and cheese. The body is also able to store this vitamin a deficiency, for any reason, will not occur for 5 to 6 years. 

D Deficient Fluid Volume related to inadequate fluid intake, need to inotease dose of drug, failure to recognize symptoms of dehydration (diabetes insipidus)... 

The historic Maya diet is protein-deficient, and it was long assumed that prehispanic meat intake was also low (Morley 1946 25 Behar 1968), although... 

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