Victor Tambunan

Fiastuti Witjaksono
Erwin Christianto
Department of Nutrition
Faculty of Medicine
Universitas Indonesia
References
Mahan LK, Escott-Stump S. Food & Diet Therapy
12th ed., 2008
Gropper SS, et al. Advanced Nutrition and
Human Metabolism 4th ed., 2005
Shils ME, et al. Modern Nutrition in Health
and Disease 10th ed., 2006
Bowman BA, Russell RM. Present Knowledge in
Nutrition 9th ed., 2006

2
3
 Organic substances
Needed in small amounts
Function in specific metabolic processes
Maintain health & secure growth
Should come from diet (plants & animals)

5
 Natural vs. Synthetic Vitamins

Chemically identical

Bioavailability same

Bioavailability:
the degree to which a substance becomes
available to the target tissue
6
Megadoses Vitamin

a dose at least 10 times greater than

the recommended intake

Seldom obtained from food alone

Readily available in pills

7
 Fat soluble:
Vitamins A, D, E, and K

Water soluble:
Vitamins B group and C

8
 Fat Soluble Water Soluble

Soluble in fat Soluble in water

Excess intake need to be Minimal storage of dietary
stored excesses
Excreted in urine & bile Excreted in urine
(little)
Deficiency symptoms
Deficiency symptoms often develop rapidly
slow to develop
Must be supply in diet
Not absolutely necessary every day
in diet every day
Do not have precursor
Have precursor
9
 THIAMIN
Functions
Thiamin pyrophosphate (thiamin
diphosphate, cocarboxylase):
coenzyme in energy metabolism &
transketolation (HMP shunt)

Involve in the production & release of

acetylcholine
10
 Glucose

TPP NADH + H+
NAD+
FAD
Piruvate acetyl-CoA
CoA CO2
Oxidative decarboxylation

TPP: thiamin pyrophosphate Citric acid

FAD: flavin adenine dinucleotide cycle
NAD: niacin adenine dinucleotide

Oxidation of glucose 11
Deficiency symptoms

Wet beri-beri: edema, cor bovinum

Dry beri-beri: paresthesia
Infantile beri-beri: 25 months of age
Cerebral:
in alcoholism
Wernicke-Korsakoff syndrome
12
Food Sources

Organ meats (liver, kidney, etc.)

Legumes
Whole-grain and enriched cereals &
breads
Wheat germ
Potatoes

13
 RIBOFLAVIN
Functions
Part of two coenzymes:
Flavin mono-nucleotide (FMN)
Flavin adenine dinucleotide (FAD)

Coenzyme in energy production from

oxidation of glucose, fatty acids, and
amino acids
14
Fatty acyl-CoA
FAD
FADH2

NAD
NAD + H+

acetyl-CoA

Citric acid
cycle FAD: flavin adenine dinucleotide
NAD: niacin adenine dinucleotide
15
Deficiency

Stomatitis angularis
Seborrheic dermatitis
Cheilosis
Glossitis (magenta tongue)

16
Food Sources

Milk and dairy foods

Organ meats
Green leafy vegetables
Eggs
Enriched cereals and breads

17
 NIACIN
Nicotinic acid, nicotinamide
Can be synthesised from tryptophan

Function
Coenzymes:
NADH, NADPH in carbohydrates, fatty
acids, and amino acids metabolism

18
Deficiency

Pellagra ---- 4 Ds (diarrhea, dermatitis,

dementia, and death)
Tremors
Sore tongue (beef tongue)
Low blood or urine nicotinamide

19
Food Sources

Fish Many grains

Liver Peanuts
Meat Legumes
Poultry
Milk
Eggs

20
 VITAMIN B6
Forms: pyridoxine, pyridoxal, pyridoxamine

Functions
Coenzyme pyridoxal phosphate (PLP)
in amino acid metabolism (transamination)

Synthesis of neurotransmitters:
Serotonin Norepinephrine
Epinephrine g-amino butyric acid (GABA)

Synthesis of heme
21
 a-keto acid 1 Amino acid 2

PLP

Amino acid 1 a-keto acid 2

PLP: pyridoxal phosphate

Transamination
22
Deficiency symptoms

Deficiency may be precipitated by medications

e. g. antituberculosis drug, isoniazid (INH)

Anemia
Impaired cell-mediated immunity
Niacin deficiency
Glossitis, cheilosis, stomatitis
Seborrheic dermatitis
PLP <<
Tryptophan Niacin
23
Food Sources

Chicken
Liver
Fish
Egg yolks
Whole grain cereals
Potato
Banana

24
 FOLIC ACID

Functions
Biosynthesis of purine & pyrimidine
Synthesis of the amino acids
methionine, histidine, and serine
Formation of heme
Catabolism of histidine
25
Deficiency symptoms

Megaloblastic anemia
Glossitis
GI disturbances
General weakness
Neural tube defects (NTD)

26
Food Sources

Asparagus Liver
Spinach Kidney
Wheat germ
Yeast
Legumes
Nuts

27
 VITAMIN B12
Functions
DNA synthesis
Growth & cell division
Coenzyme: homocysteine methionine
Metabolism of propionate, amino acids,
and single carbon (C)

28
FH4: tetrahydrofolate
SAM: S-adenosyl methionine
CH3: methyl
PLP: pyridoxal phosphate

Metabolism of homocysteine 29
Deficiency

Can develop in vegans (true vegetarians)

Pernicious anemia
Enlarge bone marrow cells (megaloblastic)
Neurologic disorders
Hyperhomocysteinemia
coronary heart disease risk
30
Food Sources

Liver
Kidney
Milk & dairy foods
Meat
Eggs

31
32
 MINERAL
Inorganic substances, essential
Vital to maintain life, growth, & reproduction
Balance among them is crucial for health
Ash constituents when food is burned
4% of human body, includes 60 minerals
Exist as free ion or bound

33
 Macronutrient minerals (major
minerals):
required in the diet in relatively large
amounts
Micronutrient minerals (trace
elements):
required in relatively small amounts
34
Minerals essential for human nutrition
Major minerals Trace elements

Calcium (Ca) Iron (Fe)

Phosphorous (P) Zinc (Zn)
Potassium (K) Copper (Cu)
Sulfur (S) Iodine (I)
Sodium (Na) Selenium (Se)
Chloride (Cl) Manganese (Mn)
Magnesium (Mg) Chromium (Cr)
Molybdenum (Mo)
Cobalt (Co)
35
 General Functions

1. Components of essential body compounds

2. Cofactors in biological reactions
3. Facilitation of absorption, digestion, & transport
4. Maintenance of acid-base balance
5. Maintenance of water balance
6. Transmission of nerve impulses
7. Regulation of muscle contraction
36
37
The most abundant mineral in the body

Functions
Bone & tooth formation
Growth
Blood clotting
Influences many biochemical reactions

38
Functions (cont.)
Second messenger in signal transductions
Ca2+ is an integral part of the signaling systems
facilatated by calmodulin
Calmodulin:
an intracellular calcium-dependent regulatory
protein (Ca2+ receptor protein)

Ca is required for nerve transmission & regulation

of heart muscle function

39
Food Sources

Milk and milk products

Sardines
Clams
Oysters
Green leafy vegetables
Tofu

40
Functions
Mineralisation of bones & teeth
Energy released in CHOs, fats & proteins
oxidation adenosine triphosphate (ATP)
Integral part of DNA & RNA
Component of essential body compounds:
coenzyme thiamin pyrophosphate (TPP)
41
Food Sources
In general, good food sources of protein are also
good sources of P
Meat
Poultry
Fish
Eggs
Milk & milk products
Cereals
Legumes
Nuts
42
Major cation of intracellular fluid
Functions
Required:
For cell growth
In biochemical reactions, esp. those involved
in the release of energy from food
In the synthesis of glycogen & protein
43
Food Sources

Fruits (especially banana)

Milk
Meat
Cereals
Vegetables
Legumes

44
Functions
Stabilise the structure of ATP in ATP-dependent
enzyme reactions
Cofactor for >300 enzymes involved in the
metabolism of food components & synthesis of
metabolic products:
e.g. - Synthesis of fatty acids & proteins
- Phosphorylation of glucose
Muscle relaxation
45
 HEXOKINASE
GLUCOKINASE

Mg2+
Glucose Glucose 6-phosphate
ATP ADP

Phosphorylation of glucose
46
Food Sources

Nuts
Legumes
Cereals
Dark green vegetables
Milk
Tofu

47
48
Functional Iron Nonfunctional Iron
Hemoglobin Iron storage compounds
Myoglobin within the liver, spleen, &
bone marrow:
Heme enzymes
Ferritin
Nonheme enzymes
Hemosiderin
Transferrin

49
Functions

Oxygen transport
Cofactor of enzymes:
Involved in energy release during nutrients oxidation
Conversion of b-carotene retinol
Synthesis of purine, carnitine, collagen,
neurotransmitters dopamine, serotonin, & norepinephrine

Formation of erythrocytes

50
Citric acid cycle
(Krebs cycle)

51
 Deficiencies
Anemia
Low productivity
Low cognitive function
Prone to infection
Body temperature regulation is disturbed

Excess
Hemosiderosis (liver)
Hemochromatosis (other tissues)
52
 Heme iron Nonheme iron
Iron that is combined Iron that is not bound within
within heme groups the structure of heme
Largely derived from Found predominantly in
hemoglobin & myoglobin plant foods
molecules within foods of Absorbed only 5%
animal origin
Absorbed 25% of dietary
iron

Heme iron has higher bioavailability than nonheme iron

53
Food Sources

Liver
Meat
Egg yolk
Legumes
Dark green vegetables
Shrimp
Oysters

Milk & milk products are devoid of iron

54
Functions
Catalytic functions:
required for the biological function of >300 enzymes
(zinc metalloenzymes) e.g. RNA polymerases, alkaline
phosphatase, & carbonic anhydrase

Normal growth, reproduction, & immune system

Taste buds healthy appetite
Involved in stabilisation of protein & nucleic acid
structure
55
 Antioxidant: constituent of superoxide dismutase (SOD)
SOD
O2 -
H2O2
(superoxide) (peroxide)

Structural functions:
in structural zinc sites, or zinc fingers,
Zn2+ is coordinated by 4 amino acid side chains.
Linking of zinc fingers to corresponding sites on DNA
initiates the transcription process
& gene expression

C, Cys: cysteine
H, His: histidine
56
Deficiencies
Growth retardation Delayed wound healing
Delayed sexual maturation Immune deficiencies
Hypogonadism Impaired taste
& hypospermia (hypogeusia)
Skin lesions

Patients with type 1 & 2 diabetes:

hyperzincuria
tends to with the severity of the disease

57
Food Sources

Oysters & shellfish

Fish
Meat
Liver
Legumes
Milk
Wheat bran
58
Functions
Roles in mitochondrial in energy production
involve in Cu-containing electron transport
protein
Part of Cu-containing enzyme SOD
Promotes synthesis of melanin & catecholamines
Cu in ceruloplasmin role in oxidising iron
Synthesis of collagen & elastin
59
Respiratory chain components in mitochondria
60
Deficiency
Anemia
Neutropenia
Skeletal demineralisation
Hair & skin depigmentation
Failure of erythropoiesis
Menkes syndrome (kinky-hair syndrome): hereditary.
Affected infants: retarded growth, defective hair
keratinisation & pigmentation, hypothermia,
degenerative changes in aortic elastin, &
progressive mental deterioration

61
Food Sources

Shellfish
Liver, kidney
Meats
Chocolate
Nuts
Cereal grains
Dried legumes
Dried fruits

Cows milk: poor source of Cu

62
Functions
Synthesis of triiodothyronine (T3) & thyroxine (T4)
Conversion of T4 T3, catalysed by Se-containing
5-deiodinases
The metabolic action is through T3 in tissues
Thyroid hormones promote synthesis of enzymes & other
proteins to metabolic activity in tissues
Thyroid hormones is essential for proper maturation of
the central nervous system (CNS)
63
Deficiencies

Fetal & infant mortality

Neurologic deficit
Cretinism: mental retardation, hearing & speech loss,
short stature, and spasticity
Intellectual impairment low IQ
Reproductive damage
Hypothyroidism
Goiter enlargement of thyroid gland
Less energetic & inefficient
64
Food Sources

Iodized table salt

Seafoods: clams, lobsters, oysters,
sardines & other saltwater fish

The iodine content of cows milk & eggs is

determined by the iodides in the diet of the animal

The iodides content in of vegetables varies according

to the iodine content of the soil

65
Functions
Antioxidant: integral part of glutathione
peroxidase (GSHPx) break down H2O2

Constituent of the enzyme 5-deiodinases which

convert T4 (thyroxine) T3 (triiodothyronine)

T3 is the active thyroid hormone

66
 GSSG 2H20

Se Glutathione
peroxidase

2GSH H202

GSH: reduced glutathione

GSSG: oxidised glutathione

Enzymatic reaction catalysed by Se-containing

enzyme, glutathione peroxidase (GSHPx)
67
 Deficiency

Keshan disease
cardiomyopathy in children

Kashin-Beck disease
preadolescent or adolescent osteoarthritis

68
Food Sources
Brazil nuts
Seafood
Kidney
Liver
Meat
Poultry
Grains
Selenium content in food depends on Se content
in the soil & water
69
Functions
Component of many enzymes, including:
Enzyme in energy release metabolism
Mitochondrial SOD
Enzymes in CHO & lipid metabolism

Mn is associated with:
Formation of connective & skeletal tissues
Growth & reproduction
70
Citric acid cycle
(Krebs cycle)

71
Food Sources

Blueberries
Whole grains
Legumes
Nuts
Tea
Fruit

72
Functions
Potentiates insulin action influences
CHO, lipid, & protein metabolism

Deficiency
Insulin resistance & a few lipid abnormalities
73
Food Sources

Brewers yeast
Broccoli
Oyster
Liver
Potatoes
Whole grains
Chicken
Bran

74
Glucose Fatty acids Amino acids
Niacin Riboflavin Vitamin B6
Potassium Niacin Magnesium
Magnesium Sulfur Potassium
Magnesium

Citric acid cycle

Niacin Manganese
Thiamin Iron
Riboflavin Magnesium
Copper

CO2 + H2O + Energy

75
Recommended Dietary Allowances
(RDA)

Indonesian RDA:
Angka Kecukupan Gizi (AKG) 2004

76
081310733442
dr.erwin.christianto@gmail.com