IRON IN HEALTH AND DISEASE

3. IRON IN HEALTH AND DISEASE

4. Iron • Iodide • Chromium • Copper • Selenium • Manganese • Molybdenum • Zinc Major Functions of each mineral

5. Surah 57. Al-Hadid (The Iron) Aya: 25

6. Surah 57. Al-Hadid (The Iron) Aya: 25

7. IRON • Called by Egyptians as “Heavenly metal”. • Quran also describes it as a means of power. • One of the most plentiful elements on earth. • 5% of earth crust, still its deficiency a common health problem • Used as medicine around 1500 B.C. for the treatment of parasitic infection and a variety of other ailments.

8. IRON • 18th Century: presence was demonstrated in animal tissues and blood. • 20th Century: Much learnt about iron & its interaction with other elements.

9. Distribution Daily Requirements Dietary sources Important functions Absorption & Metabolism Deficiency diseases Learning Objectives

10. IRON ( Al-Hadeed)FeSura No. 57Aya No. 25

11. At. No. 26 IRON At. Mass 56

12. DISTRIBUTION • 4 grams of Fe ,on an average in human body • 3 grams in active or functional form and • 1 gram in storage or transport form.

13. Distribution of Iron in human body • Hemoglobin 66% • Myoglobin 03% • Other body cells 05% • Enzymes 01% • Ferritin (store) 25%

14. Recommended Dietary Allowance Infants 0 – 0.5 = 10 mg 0.5 – 1.0 = 15 mg Children 1 – 3 = 15 mg 4 – 6 = 10 mg 7 – 10 = 10 mg

15. Iron RDA

16. Major Dietary sources • Red meat, Liver and Eggs • green vegetables and , cereals • Apple, nuts, peaches, dry fruit and Spices • Iron from cooking utensils, made of iron

17. FUNCTIONS • Essential elements in the daily diet. • Vital role in O2 transport and energy production. • Exclusively involved in the uptake and release of O2 at cellular level.

18. FUNCTIONS • Active part is mostly in Porphyrin and forms an integral part of Hb and Myoglobin, • In RBCs enzymes cytochrome, oxidase, catalase and peroxidases .

19. FUNCTIONS • Shuttles O2 from lungs to all other tissues and • CO2 back from tissues to lungs. • Ability of Hb molecule to take up O2 and release CO2, is dependent on presence of Fe in Hb. • Without Fe, the Hb. molecule cannot perform this function. • The cytochrome enzyme system functions in energy production.

20. FUNCTIONS • Myoglobin works on similar principle but performs in muscles only.

21. Absorption and Metabolism

22. METABOLISM • Fe++ is absorbed from intestinal lumen into the cells of intestinal mucosa. • Here Fe++ is oxidized to Fe+++ • Combines with proteins Apoferritin. • Iron – protein complex, Ferritin and stored.

23. EXCRETION • Iron is unique among mineral elements. • There is no physiologic mechanism for regulating its increase or decrease excretion. • Balance is mainly controlled at the site of intestinal absorption.

25. Absorption is influenced by the amount already present in the diet / food that increase or decrease the availability of iron for absorption.

26. Iron Absorption • Primary regulator of iron homeostasis • 1-50% of iron is absorbed. • If body needs more iron, it increases amount of “transferrin” an iron carrying protein. • Iron can also be stored in another protein called “ferritin”

28. Absorption • Heme iron is better absorbed than non heme iron • During states of iron balance, about 10% of dietary iron is absorbed • Figure can increase by 2 or 3 times, during periods of iron deficiency

29. METABOLISM • When iron is needed by the body, Ferritin gives up its iron to the blood stream. • Fe+++ iron is reduced within the mucosal cell to Fe++ form and released. • The apoferritin in the mucosal cell can then combine with dietary iron absorbed in the intestine. • If all the mucosal cells are saturated, no further absorption.

30. METABOLISM • Most of iron in blood stream is utilized by bone marrow to synthesize Hb. • Some is used by other tissue in the formation of enzyme

31. Factors affecting Iron Absorption Absorbed through intestinal mucosa, only when needed No excessive storage. Ferrous (Fe++) is better absorbed than Fe+++ (Ferric) Better absorbed in Acidic medium, by virtue of conversion of ferric to ferrous state.

32. ABSORPTION OF IRON Enterocyte Gut Fe+++ Ferritin Fe++ Tf-Fe+++ Fe++ Fe++ Haem Tf

33. IRON PART 2

34. BODY IRON CYCLING

35. Absorption • Absorption increase with need: • Period of rapid growth in infancy. • Childhood and adolescence • During pregnancy, • As a result of blood loss and • At high attitude.

36. Factors • Absorption is more efficient in presence of Vit C, sulfhydral and other reducing substances • Vitamin C and fructose forms soluble complexes with iron and therefore better absorbed.

37. High fiber in diet – decrease iron absorption • Tea can also inhibit the absorption of non heme iron • Phosphate, Oxalates, Phytates forms insoluble complexes with iron, preventing absorption.

38. IRON DEFICIENCY Hypo chromic anemia: • No of RBCs are either normal or reduced • Amount of circulating Hb is reduced • In each RBC the Hb. content fall • Hb low, oxygen carrying capacity is reduced

39. IRON REQUIREMENTS • Due to efficient conservation and reutilization in the body daily physiologic requirement is small. • Healthy man loses about 1 mg/day iron, while women lose about 1.5 mg/day • 10% of average available dietary iron is absorbed which comes to 10 mg/day required for men and 18 mg/day required for women

40. IRON REQUIREMENTS • Pregnancy increase iron daily need by 3.5 mg/day • To be taken as iron supplement and not diet 30 – 60 mg/day • Lactation iron losses are 0.5 – 1.0 mg/day • Continuous Supplementation needed for 2 – 3 month after delivery

41. IRON DEFICIENCY Commonest cause of anaemia worldwide Cause of chronic ill health May indicate the presence of important underlying disease eg. blood loss from tumour

42. CLINICAL FEATURES (Symptoms) • Dizziness • Headache • Weakness • Fatigue

43. CLINICAL FEATURES (signs) Pallor glossitis angular cheilosis and koilonychia. Koilonychia Glossitis

44. CLINICAL FEATURES OF IRON DEFICIENCY Angular Cheilosis or Stomatitis

45. Hypochromic microcytic red cells

46. Poor diet Chronic blood loss or both Intestinal parasite Bleeding Hemorrhoids Peptic Ulcer Heavy menstrual losses Closed space pregnancy Insufficient proteins Insufficient calories B – vitamins. / Ascorbic acid Iron deficiency develops

47. Common situation where Iron Intake is inadequate. • During infancy: • Low iron content of milk • Fe stores at birth which are usually sufficient only for first 6 months. • During rapid growth in child hood and adolescences: • Because of the need of expanding iron stores.

48. Common situation where Iron Intake is inadequate. • During reproductive period: Menstrual losses • During pregnancy, because of increased: • Maternal blood volume • Demands of the fetus and placenta • Blood losses during child birth.

49. Iron overload Total amount of Fe in body can be increased by • Excessive intake. • Abnormalities in iron absorption. • Parenteral administration of iron. Overload iron by food alone  very difficult because of intestinal mucosal absorption.

50. Toxic intakes of iron reported in children and adults ingesting medicine iron supplements. • Lethal dose for Young Child = 3 grams Adult = 200 – 250 mg/kg BW. • Overload can also be caused by defect in intestinal mucosa. (Hemochromatosis) Deposition of iron in the parenchymal cells of the liver.