Welcome to Seminar on Iron Meera Kaur, PhD,

Welcome to Seminar on Iron Meera Kaur, PhD,

Welcome to Seminar on Iron Meera Kaur, PhD, RD Assistant Professor Department of Family Medicine Faculty of Medicine [email protected] http://home.cc.umanitoba.ca/~kaur Outline

Learning Objectives Introduction Physiochemical Properties Functions Food Sources Absorption Recommended Dietary Allowances Deficiency Toxicity Conclusions Questions and Answers 2 3 Learning Objectives

Physicochemical properties Biological functions Metabolism Food sources and Dietary Reference Intakes Deficiency and toxicity The global scenarios 4 Introduction Iron, one of the most abundant metal on earth, is found in every living cell Total body content of iron is 5g About 2/3rd of iron in the body is found in

hemoglobin (Hb) 5 Physiochemical Properties Pure iron is lustrous, silvery and easily rusts in damp air Solid at 200C Melting point: 15350C or 27950F Conducts heat and electricity and forms positive ions in its chemical reactions Pure iron is fairly soft and can easily be shaped and formed when hot Soluble in low pH (acid medium) 6 Functions of Iron... Iron plays important role in

Immune function Cognitive development Temperature regulation Work performance Other physiological functions of iron are 7 Functions of iron... Iron is important constituent of body protein hemoglobin gives ability to carry O2 from lung to all tissues assists in the transport of CO2 back to lungs for expiration

How O2 carrying capacity of blood is regulated? When the O2 carrying capacity of blood is declined, kidney produces a hormoneErythropoietin, which targets bone marrow to produce more red blood cells (RBC) and stimulates RBC release from the bone marrow 8 Functions of iron... Iron is important constituent of body protein myoglobin provides Oxygen to skeletal and heart muscle Acts as a cofactor for many biological reactions Cytochrome: in Electron transport chain helps transport electron to molecular O2 Cytochrome P-450: Oxidative degradation of drugs Mitochondria: helps conversion of citrate to isocitrate,

the first step of energy production in the body Functions of iron...(cofactor) 9 works with other enzymes to synthesize collagen, neurotransmitters(dopamine,epinephrine,nonepinephrine, serotonin) and eicosanoid Iron works through life cycles 10 Food Sources Two forms of dietary iron: Heme and Nonheme Heme: Food from animal origin (meat, fish, poultry etc.) absorbed better than the nonheme iron

Nonheme: grains and food from vegetable origin (cereal, legumes, vegetables, molasses, blackstrap etc.) most dietary iron is nonheme iron that are bound to some other organic constituent of the food. Cooking tends to break these interactions and increase iron availability. Please refer to the handout for food sources of heme and nonheme iron Absorptions Body uses variety of mechanisms to absorb and distribute iron in the body Heme iron absorbs directly into the absorptive cell Intestinal mucosal cells in the duodenum and upper jejunum absorb the iron. Heme iron is better absorbed than non heme iron Low pH enhances iron absorption Phytates, tannins and antacids block iron absorption. No physiologic mechanism for excretion of excess iron from the body other than blood loss (i.e., pregnancy, menstruation

or other bleeding.) Mucosal block and hemosiderin will prevent iron toxicity. 11 Factors affecting iron Absorption Increases Absorption Gastric acid, Low pH Heme form of iron High body demand Low body stores Meat Protein Factor

Vitamin C Decreases absorption Phytic acid (dietary fiber) Oxalic acid (leafy veg) Polyphenol (tea, coffee) Full body stores of iron Excess of Zn, Mn, Ca Reduced gastric acid output Some antacids

12 Absorptions Stomach Fe+++ Fe++ 13 Cell membrane of brush border Small Intestine (Duodenum and Jejunum) Mucus membrane

Liver Ceruloplasmi n Stored as Iron + Transferrin Ferritin Brush border of Absorptive cells Fe+++ Fe +++ + MBP MBP Blood Iron+ Apoferritin

Absorptive cells Mucosal Block Endocytosis Receptor cell Reduces iron toxicity Lysosome Free iron Binds iron Hemosiderin

Various sites If excess iron 14 Recommended Dietary Allowances(mg/d) Age Males Females Pregnancy Lactation 0 to 6 months 0.27* 0.27* (* Adequate intake)

7 to 12 months 11 11 N/A N/A 1 to 3 years 7 7 N/A

N/A 4 to 8 years 10 10 N/A N/A 9 to 13 years 8 8 N/A

N/A 14 to 18 years 11 15 27 10 19 to 50 years 8 18

27 9 51+ years 8 8 N/A N/A Deficiency 15 WHO considers iron deficiency to be the number

one nutritional disorder in the world Eighty per cent of the world population may be iron deficient, while 30% may have Iron Deficiency Anaemia (IDA)-- also known as hypochromic microcytic anaemia IDA can be detected by measuring hematocrit the % of blood volume occupied by RBC (normal: <34-37%) and the Hemoglobin in blood (<10-11%) DeficiencyIDA IDA Associated with Low dietary intake Inadequate absorption Excess blood loss

Vitamin A deficiency (helps mobilize Fe from the storage site), especially common in the developing countries Chronic malabsorptions such as inflammatory bowel diseases 16 17 Deficiency Who are at risk for developing IDA?

Women of childbearing age Pregnant women Low birth weight infants Older infants and toddlers Teenage girls Individuals with kidney failure (on Dialysis) because failing kidneys cannot produce enough erythropoietin to make RBC in the blood Intestinal worm infestation (hook worm etc.) YYY 18 Deficiency Symptoms Symptoms of IDA

Lack of energy or tiredness Extreme fatigue and feeling of weakness Pale skin Light headedness, headache Pale skin on the lining of the eyes, the inner mouth and the nails Rapid and forceful heartbeat Low blood pressure with position change from sitting to standing up YYY Deficiency Symptoms 19

Symptoms of IDA Finger nails that become thin, brittle and white may grow abnormally with a spoon-shaped appearance Tongue may become sore, smooth and reddened Decrease in appetite Shortness of breath during exercise Decreased immune function and increased vulnerability to infection A strong desire to eat nonfoods such as ice, paint or dirt (a condition called Pica) Disturbed sleep and abdominal pain Deficiency (blood picture) 20 These red cells are hypochromic and microcytic due to iron deficiency

21 Deficiency Symptoms YYY Deficiency Symptoms 22 23 Deficiency Symptoms 24 Mary - a case study

ary, a 14 year old girl, was feeling tired all the time. She had brittle nails and sore tongue as well. She went to her physician. Her physician ordered some blood test. After a week her physician called her back to clinic and prescribed Iron tablet for her. He also advised Mary to eat foods rich in vitamin C. . 1. Why Mary was feeling tired? . 2. Why Marys doctor Prescribed Iron tablets? . 3. Why Marys doctor advised her to eat foods rich in vitamin C? 25 Toxicity/Overload Two kinds Hemochromatosis Genetic disorder. Causes liver, heart and other organ

damage. Absorbs iron three times more than normal. Common treatments are blood donation and drugs that bind iron. Common amongst Asian/ Asian Islanders Hemosiderosis Accumulation of hemosiderin (insoluble storage iron due to frequent blood transfusion or long-term consumption of large amount of iron. Can affect lung, liver, heart and other vital organs Conclusions Iron -- an important trace mineral is needed by everybody throughout the life cycles Is absorbed in the duodenum and jejunum is part of hemoglobin and myoglobin that carry oxygen throughout the body. carries many other important physiological functions is stored in liver, spleen and other tissues and it is an essential part of many of body's proteins and enzymes.

deficiency of which causes Iron Deficiency Anaemia one of the most common nutritional disorders around the globe. that our body cannot excrete if overloaded and results in hemochromatosis and hemosiderosis. YYY 26 27 Thank you for attending the class Any question?

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