PowerPoint Presentation

Manifestations of Calcium Malnutrition

Ken-Won MillerHoward UniversityNutrition Care Management 1Dr. Castor

This presentation will focus mainly on the role of calcium intake and the manifestations of calcium deficiencies.

Introduction

Nutrients are essential and all play a key role to survival of the human organism. WaterEnergy yielding nutrientsCarbohydrates, Protein, Lipids (Fat)Vitamins (organic)Fat soluble, Water solubleMinerals (inorganic)Macro, TraceNutrients

MineralsMacro-mineralsCalciumPhosphorusMagnesium SodiumPotassiumChlorideSulfur

Trace minerals. ManganeseCopperIodineZincCobalt Fluoride Selenium

Calcium is the most abundant mineral in the bodyThis mineral is naturally found in foods, added to some, available as a dietary supplement, and present in some medicines Most of the bodys calcium is found in bones and teeth.Estimated to be 99% of calcium in the bodyApprox 1.5-2% of the body weightAn adequate intake helps grow a healthy skeleton in early life and minimize bone loss later in lifeWhat is Calcium

Calcium salts form crystals called hydroxyapatite on a matrix of the protein collagen.Mineralization of calcium, phosphorus, and other minerals crystallize and harden the bones.The bones gain strength and rigidity as they harden.Calcium in Bones

Bones are not like solid rockBones gain and lose minerals continuously in an ongoing process of remodeling.The balance between bone resorption and deposition changes with aging.The lack of homeostasis can lead to manifestations of clinical problems and cause a disease state.Calcium in Bones

%1 of the bodys calcium circulates in the fluid as ionized calcium that is vital to life.The serum calcium is highly regulated and doesnt fluctuate with variations in dietary intakesCalcium also activates a protein called calmodulinCalmodulin (a inactive protein) is activated by calciumIt then becomes a messenger that tells other proteins what to do and serves as an interpreter for hormone and nerve mediated messages arriving at cellsCalcium in Body Fluids

vascular contraction and vasodilatationmuscle functionnerve transmissionintracellular signalinghormonal secretionRole in maintaining normal blood pressureCalcium in Body Fluids

Table 1: Recommended Dietary Allowances (RDAs) for Calcium [1]AgeMaleFemalePregnantLactating06 months*200 mg200 mg712 months*260 mg260 mg13 years700 mg700 mg48 years1,000 mg1,000 mg913 years1,300 mg1,300 mg1418 years1,300 mg1,300 mg1,300 mg1,300 mg1950 years1,000 mg1,000 mg1,000 mg1,000 mg5170 years1,000 mg1,200 mg71+ years1,200 mg1,200 mg

Recommended Dietary Allowance (RDA): RDAs for the amounts of calcium required for bone health and to maintain adequate rates of calcium retention in healthy people.

Calcium is found in a variety of foods.Dairy FoodsMilk, yogurt, and cheese are the most popular choice in the US.Leafy GreensKale, broccoli, and Chinese cabbage are vegetable sourceFishCanned sardines and salmonMost grains (such as breads, pastas, and unfortified cereals), while not rich in calcium, add significant amounts of calcium to the diet because people eat them often in large amounts.Fortified foods Breakfast cereals, fruit juices, soy(Silk) and rice beverages, and tofu. Foods that Contain Calcium

The two main forms of calcium in supplements are carbonate and citrateCalcium carbonate is found in some over-the-counter antacid products, such as Tums and Rolaids.

Medicines that Contain Calcium

Homeostasis of calcium is one of the bodys most important priorities.Bone tissue is used as a reservoir and a source of calcium, to maintain constant concentrations of calcium in muscles, blood, and intercellular fluids. Vitamin D and other hormones play a essential role as well in balancing levelsThree organs play a key role in calcium levelsThe intestinesBonesKidneys

Calcium Balance

Parathormone (Parathyroid hormone)A hormone from the parathyroid glands that regulates blood calcium by raising it when levels fall too lowCalcitoninA hormone from the thyroid gland that regulates blood calcium by lowering it when levels rise too highCalcium Balance

Calcium is absorbed by all parts of the small intestineTwo mechanisms of absorptionActive transport and passive diffusionIt is best absorbed in an acidic mediumLactose and vitamin D enhances calcium absorptionThe efficiency of absorption decreases as calcium intake increases Absorption of Calcium

Dietary surveys indicate that many people do not meet the Adequate Intake for calcium, especially womenConsuming foods to maintain adequate vitamin D status improve absorption

Dietary inadequacy is not likely if protein and calcium intake are adequateStimulants in coffee and tea can discreetly increase calcium excretion and reduce absorption in the GI tractPhytic acid found in whole-grain breads can decrease availabilityLikelihood of Deficiency

The normal levels for ionized (free) Ca2+4.64-5.28 mg/dLThe normal levels for total serum Ca2+ (bound and unbound)8.6-10 mg/dLStatus is related to many factors, including vit D, vit K, phosphate, parathyroid function, and medicationsLab Values for Nutritional Assessment

Hypercalcemia (High Calcium Levels)Associated with endocrine disorders, malignancy, and hypervitaminosis DHypocalcemia (Low Calcium Levels)Associated with Vit D deficiency and inadequate hepatic or renal activation of Vit D, hypoparathyroidism, magnesium deficiency, renal failure, and nephrotic syndromeLab Values for Nutritional Assessment

HypoparathyroidismHypoparathyroidism is the result of a decrease in production of parathyroid hormones by the parathyroid glands located behind the thyroid glands in the neck.

Usually occurs after a surgery where the parathyroid glands are removed.

The result is a low level of calcium in the blood or hypocalcemia.

Dual-Energy X-ray absorptiometry (DXA) is thought to be one of the best tools for assessing bone mineral densityVery important in early detection, treatment, and monitoring of osteoporosisPreferred approach for measuring BMDMeasures bone mineral content at axial and appendicular sitesMonitors changes over timeLow radiation exposureSuperior quality control proceduresComputerized tomography (CT) scans measure variances in tissue density. This method is less precise and accurate than DXAAssessment Tools

Disease in which the bones become porous and fragile due to a loss of mineralsBone strength is a function of two factorsBone mineral density and bone qualityBMD is determined by peak bone mass and BQ relates to bone architecture, bone turnover, mineralization, and the accumulation of damage to the bonePeak in bone mass= late 20s early 30s

Osteoporosis (Adult Bone Loss)

Primary-not related to other diseaseMostly seen in middle aged females and older men/femalesMales have greater bone massSecondary-identifiable cause other than age or menopause is presentCushings syndrome, myeloma, hyperthyroidism, amenorrhea, medicines( thiazide diuretics and heparin)

Classification

OsteoporosisLeads to a greater risk of fractures Fractures in the hip, vertebrae, pelvis, humerus, distal forearmFemales more likely to have fractures

Maintain a balance diet rich in calcium and vitamin D.Participate in regular, weight-bearing exercise.Practice a healthy lifestyle with no smoking or excessive alcohol intakeTalk to health care professional about bone healthIf indicated, obtain bone mineral density testing and take medication, if appropriateFive Steps to Optimize Bone Health

Calcium is the most abundant mineral in the body and is mostly found in bones and teeth.%1 of the bodys calcium circulates in the fluid as ionized calcium that is vital to life and homeostasis Many people become deficient in calcium especially those suffering from illness and the elderlyIt is important for dietitians to thoroughly evaluate patients for calcium defiency and provide nutritional intervention if needed.

In conclusion

Chung M, Balk EM, Brendel M, et al. Vitamin D and Calcium: A Systematic Review of Health Outcomes. Rockville (MD): Agency for Healthcare Research and Quality (US); 2009 Aug. (Evidence Reports/Technology Assessments, No. 183.) 1, Introduction. Available from: http://www.ncbi.nlm.nih.gov/books/NBK32605/

National Institutes of Health. Optimal calcium intake. NIH Consensus Statement: 1994;12:1-31. [PubMed abstract]

2 Overview of Calcium." Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011.

Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA. Clarification of DRIs for calcium and vitamin D across age groups. J Am Diet Assoc. 2011 Oct;111(10):1467. [PubMed abstract]

U.S. Department of Agriculture, Agricultural Research Service. 2011. USDA National Nutrient Database for Standard Reference, Release 24. Nutrient Data Laboratory Home Page,http://www.ars.usda.gov/ba/bhnrc/ndl.

References