Mineral-Associated Disorders😍

Metal cofactor Enzymes

Calcium

• Richest grain:
• Ragi

• Sources: Milk, eggs, fish, meat

• Used as an important weaning food

• Metabolism requires: Vitamin D

Iodine

Cretinism

• Condition with irreversible intellectual abnormalities.

Endemic Cretinism

• Cause: Nutritional deficiency of iodine

• Types:
• Neurological cretinism
• Features: Strabismus, spastic diplegias
• Myxedematous cretinism

National Iodine Deficiency Disorder Control Programme (NIDDCP)

• 1962: National goitre control programme

• 1992: NIDDCP

• Organization: At district level.

• Target: Goitre rate <5% in children.

Strategy

• Iodization of salt: Potassium iodate used
• Not potassium Iodide
• Ensured by salt commissioner under:
• Ministry of Commerce & Industry.
• Headquarters in Jaipur, Rajasthan.
• Levels
• At production: >30 ppm.
• At Consumer: >15 ppm.

Programme Indicators

Iron Metabolism (for IDA):

• Absorption: Duodenum.

• Dietary Fe3+ → Fe2+ (by Cytochrome B Reductase) for absorption.

• Fe2+ into duodenal cells via DMT1 (Divalent Metal Transporter).

• Fe2+ → Fe3+ (by Hephaestin and Ceruloplasmin) inside cell.

• Fe3+ out of duodenal cells via Ferroportin.

• Transport: Transferrin bound Fe3+ (Normal Saturation: 33%).

• Storage: Ferritin.

• Regulated by Hepcidin.

Absorption

• Ferric iron (Ingested) → Ferrous iron (Absorbed).
• FerrUs → comes to us

• Activated by: Vitamin C

• Inhibited by: Phytates, tannin, oxalates, fiber, calcium.

• "I'm Iron. My religion was 3."
• This refers to Fe³⁺ 

• "I need to go to a country, but I can only do so by crossing another country which told me 'Do CHange' your religion."
• Do CHange → Duodenal Cytochrome B (Duodenal Cyto B)
• Duodenal Cytochrome B reduces Fe³⁺ to Fe²⁺.

• I gave into 'demand’
• demand → DMT1 (Divalent Metal Transporter 1)
• DMT1 transports the non-heme Fe²⁺ (ferrous iron) into the enterocyte.

• "I changed to religion 2 and entered."
• This represents Fe²⁺ (ferrous iron), the form that enters the cell via DMT1.

• "And then escaped by a ferri."
• ferri → Ferroportin 1
• Ferroportin 1 transports iron out of the enterocyte, across the basolateral membrane.

• “Sid tried to kill me when I was on Ferri
• Hepcidin inhibits Ferroportin

• "Hamza/Hafsa helped me change my religion back to 3."
• Hamza/Hafsa → Hephaestin
• Hephaestin oxidizes Fe²⁺ back to Fe³⁺ at the basolateral membrane, before it enters circulation.

Disorders

Mineral Iron

Sources

• Heme:
• Animal source (20 - 40% bioavailability).

• Non-Heme:
• Plant source (6 - 9% bioavailability):
• Pumpkin seeds (Rich).
• Pista.
• Dates.
• Green leafy vegetables.
• Poor man’s source: Jaggery
• Note: Iron in jaggery due to iron vessel used for production.

• Pregnancy:
• Iron cannot be fully supplemented by diet alone
• Supplementation required regardless of Hb or socioeconomic status

• Mass prophylaxis:
• Use Tablet ferrous sulphate
• (Us Ate)
• Withhold in:
• Acute illness (fever, pneumonia, diarrhea)
• Known thalassemia major
• History of repeated blood transfusion

• Always continue iron for 3 months after Hb normalizes
• To replenish iron stores

WHO Anemia Definition (Hemoglobin Levels):

• Best for epidemiological surveys

• Insensitive for early nutrient depletion

• Levels:
• Healthy Adult Male: <13 g/dL
• Healthy Adult Female: <12 g/dL
• Pregnant Woman: <11 g/dL
• CKD Patient: <10 g/dL
• Children 6 months—5 years: Hb <11 g/dl
• Children 6-14 years: Hb <12 g/dl

Causes

• Dietary, blood loss (trauma, PUD, colon cancer, menorrhagia)

• Hookworm infection

Approach to anemia in children:

Iron Deficiency Anemia

• Most common cause of nutritional disorders in the world

• Most common cause of anemia in the world

• Vitamin C helps in the absorption of iron

• Associated with celiac disease

Selenium

• Daily requirement: 50–60 mcg/day

• Functions as an important antioxidant

• Selenocysteine:
• 21st amino acid
• Coded by UGA (Stop codon)
• Formed by co-translational modification
• Serine → Selenocysteine
• Found in:
• Glutathione peroxidase
• Protects against oxidative stress
• Thioredoxin reductase
• Redox balance in cells
• Glycine Reductase
• Deiodinase
• Thyroid hormone conversion: T4 → T3
• Selenoprotein P
• Transports selenium in plasma
• NOT GLUTATHIONE REDUCTASE (Dep on Vit B2)
• ”Mneumonic: Selena’s sister serena from UGAnda“
• "Selena glue thinnu diarrhea aayi"

• Pyrrolysine:
• 22nd Amino acid
• Coded by UAG
• From Lysine

• Both 21 22 due to cotranslational modification

Disorders

National Program for Prevention and Control of Fluorosis

• Normal fluoride level in drinking water: 0.5–0.8 mg/L

• Fluorine is called a "Double-edged sword"

Disorders

Dental Fluorosis

• Fluoride in water is >1.5 mg/L

• Manifestation: Mottling of upper incisors

Dental Caries

• Fluoride in water is <0.5 mg/L

• Due to fluoride deficiency

Genu Valgum (Knock-knee syndrome)

 

 

 

• Cause: Excess fluorine

 

 

 

Crippling Fluorosis

• Occurs when fluoride in water is >10 mg/L

Nalgonda Technique

• Purpose: Defluoridation of water (removes excess fluoride)

• Method:
• Addition of: (LAB)

Component	Function
Lime	• Precipitation of fluoride • Form dense floc
Alum	• Coagulant • + H2O ⇒ AlOH adsorbs fluoride ions
Bleaching powder / Sodium hypochlorite	• Disinfects

• to fix vaishna’s teeth → Put Lime and bleaching powder in Aluminium pathram

• Developed by: NEERI Institute, Nagpur
• National Environmental Engineering Research Institute

• Zinc deficiency → ↓ Retinol dehydrogenase → Visual disturbance

• Sources: Breast milk (picolinic acid aids absorption)

• Function:
• Essential for 100+ enzyme activities.
• 2nd most common trace element in body after Iron
• Important in forming zinc fingers (transcription factor motif) → part of gene transcription
• Major antioxidant → part of SOD

Disorders

• WHO dose in diarrhea:
• <6 months: 10 mg/day × 14 days
• >6 months: 20 mg/day × 14 days

• Deficiency causes:
• Diarrhoea
• Delayed wound healing
• Hypogonadism
• Male hypogonadism and sexual dysfunction
• Suppressed immunity
• Dysgeusia (altered taste), anosmia (loss of smell)
• Predispose to alcoholic cirrhosis.

Acrodermatitis Enteropathica

 

 

 

• Autosomal Recessive

• Daily requirement: 5–10 mg/day

Types of Zinc Deficiency

1. Congenital:
• Autosomal recessive (Zip4 transporter protein deficiency).
• After 6 months / weaning (maternal milk aids zinc absorption)

2. Acquired: Chronic alcoholics

Main Features (DDA Mnemonic)

• Dermatitis
• acral, periorificial
• Presents with extensive inflammatory rashes
• oral cavity,
• genital region.
• Rash distribution:
• Cheeks
• Mouth
• Anal region

• Diarrhoea

• Alopecia

• Mnemonic: Z → vayil kude keri appi pokunnath

Treatment:

• Zinc supplementation

• Zinc deficiency → ↓ Retinol dehydrogenase → Visual disturbance