MICRONUTRIENT DEFICIENCIES IN CHILDREN
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Our bodies need nutrients for proper growth and development. These nutrients may be divided into two main categories: macronutrients and micronutrients. Macronutrients include carbohydrates, fats, and proteins, while micronutrients are composed of vitamins and trace elements, such as iron and zinc. Any deficiency with trace elements or minerals can interfere not just with growth and development, but with maintaining the normal and necessary functions of other areas of the body as well.
Iron is necessary for proper function of certain enzymes, as well as the structure of hemoglobin and myoglobin. Inadequate levels of iron may lead to anemia, impairments in cognitive and psychomotor development, and problems with immunity. Iron deficiency is currently the most common micronutrient deficiency.
Iron is found in meat, poultry, fish, eggs and fortified breads and cereals. Adequate amounts of iron are found in breastmilk for the first 4 to 6 months of age. Adequate intake for 0-6 months old is 0.2 mg per day. The recommended dietary intake is as follows: 11 mg a day for 7-12 months, 9 mg a day for 1-3 years old, 10 mg a day for 4-8 years old, 8 mg a day for 9-13 years old, and 11-15 mg a day for 14-18 years old. Adolescent females have a higher iron requirement than males due to menstruation.
Zinc is an important component of growth and development. It is a catalyst for enzymes and is essential for expression of genes. A deficiency in this mineral may lead to impaired appetite, growth, and immunity. Symptoms include eye lesions, alopecia, dermatitis, diarrhea, and poor wound healing. Children may become prone to respiratory and gastrointestinal diseases or infections.
Zinc is readily available in meats, shellfish, legumes, cheese, and fortified cereals. Breastmilk also has sufficient amounts of zinc for the first 4-6 months of life. For children, the daily adequate intake is 2 mg for 0-6 months old. Recommended dietary intake is 3 mg daily for 7-12 months old, 3mg daily for 1-3 years old, 4 mg daily for 4-8 years old, 6 mg daily for 9-13 years old, and 7-13 mg daily for 14-18 years old.
Calcium is necessary for normal muscle contraction and nerve conduction. It is a component of bone and tooth formation, as well as the proper blood clotting process. It is stored in bones and teeth. Deficiency in calcium commonly leads to osteoporosis and bone fractures, while excess calcium can lead to kidney stone formation and renal insufficiency.
Sources of calcium are milk, cheese, yoghurt, cabbage, kale, broccoli, some nuts and legumes, and fortified breakfast cereals. Adequate intake for children 0-6 months old and 7-12 months old are 210 mg a day and 270 mg a day, respectively. The daily recommended intake are as follows: 500 mg for 1-3 years old, 700 mg for 4-8 years old, 1 gram for 9-11 years old, and 1.3 grams for 12-18 years old.
Potassium is an important electrolyte for proper nutrient and fluid absorption. This mineral helps maintain normal blood pressure, hydration status, and bone health. Inadequate intake may lead to body weakness, fatigue, constipation, increased blood pressure, increased risk of forming kidney stones, and even cardiac arrhythmias. On the other hand, excess potassium intake from oral supplements can cause sudden death so it is important to talk to a doctor before starting any supplements.
Some medications retain potassium in the body. Taking these medications alongside supplements or high amounts of potassium-rich foods should be avoided. Some of these drugs include potassium-sparing diuretics, ACE inhibitors and angiotensin receptor blockers.
This micronutrient may be found in fruits, leafy green and root vegetables, fruits from vines, beans and dairy products. Daily adequate intake is at least 400 mg for children 0-6 months, 700 mg for 7-12 months old, 2 grams for 1-3 years old, 2.3 grams for 4-8 years old, 2.5-3.0 grams for 9-13 years old, and 2.6-3.6 grams a day for 14-18 years old.
Sodium and Chloride
Sodium and chloride are micronutrients required for maintaining the body’s normal fluid volume and ensuring normal cell functions. These two minerals are commonly found together as “salt” (sodium chloride) and is also used to preserve food. Excess intake of salt can lead to hypertension and increased risk of cardiovascular disease and stroke.
Sodium chloride is found in processed foods, salted foods (bread, meat), butter and margarine. Daily adequate intake for children are as follows: 120 mg for 0-6 months old, 170 mg for 7-12 months old, 200-400 mg for 1-3 years old, 300-600 mg for 4-8 years old, 400-800 mg for 9-13 years old, and 460-920 mg for those 14-18 years of age.
Iodine is a trace element commonly incorporated in thyroid hormone. Hypothyroidism can ensue with insufficient intake. Symptoms include weakness, cold sensitivity, weight gain, constipation, neck swelling (called goiter), muscle pains and difficulties in physical and mental development. For pregnant women, miscarriages, fetal malformations, or stillbirth may occur. Infants with iodine deficiency may have intellectual disabilities, deaf mutism, cretinism, and dwarfism.
Common sources of iodine are found in seafood. Milk, cheese, and yogurt may also contain some iodine. Most commercially available table salt has been fortified with iodine. Naturally occurring substances called goitrogens may inhibit iodine from binding with the rest of the thyroid hormone. Examples of foods with goitrogens include sweet potato, maize, broccoli, cabbage and Brussel sprouts.
Daily adequate intake of iodine is 90 micrograms for 0-6 months old and 110 micrograms for 7-12 months old. Recommended daily dietary intake is 90 micrograms for 1-8 years old, 120 micrograms for 9-13 years old, and 150 micrograms for 14-18 years old.
Chromium is essential for carbohydrate, amino acid, and lipid metabolism; it helps activate insulin. When there are inadequate levels of chromium, one may experience peripheral neuropathy or problems due to poor glucose control, such as hyperglycemia and glycosuria (sugar in the urine).
This trace element is found in meats, fruits, vegetables, nuts, and grain products. For children, daily adequate intake is 0.2 micrograms for 0-6 months old, 5.5 micrograms for 7-12 months old, 11 micrograms for 1-3 years old, 15 micrograms for 4-8 years old, 21-25 micrograms for 9-13 years old, and 25-35 micrograms for 14-18 years old.
Copper is an enzyme cofactor involved in connective tissue and iron metabolism. Decreased copper levels in the body may lead to anemia, osteoporosis and depigmentation of the skin and hair. Menkes disease is a genetic disorder that leads to severe copper deficiency. On the other hand, excess copper deposition in the liver and brain is due to Wilson disease, another inherited disorder.
Sources of copper are liver, vegetables, grains, nuts, and legumes. For children, daily adequate intake is 0.2-0.22 mg for 0-12 months old, 0.7 mg for 1-3 years old, 1 mg for 4-8 years old, 1.1-1.3 mg for 9-13 years old, and 1.1-1.5 mg for 14-18 years old.
Fluoride is an essential micronutrient for dental health. Dental caries can develop due to decreased levels of this trace element, while dental fluorosis can occur with excess fluoride intake.
Most foods may contain low levels of fluoride. It is typically found in toothpaste and fluoridated water. Recommended daily intake is as follows: 0.5 mg for 7-12 months old, 0.6mg for 1-3 years old, and 1.1mg for 4-8 years old.
Manganese is a cofactor for bone formation, as well as for enzymes that are part of carbohydrate, cholesterol, and amino acid metabolism. Inadequate levels of manganese may lead to hypercholesterolemia and weight loss.
Sources of manganese include meat, vegetables, nuts, grains, and tea. Breast milk has low levels of this trace element. Daily adequate intake is 0.003 mg for 0-6 months, 0.6 mg for 7-12 months, 2 mg for 1-3 years old, 2.5 mg for 4-8 years old, 2.5-3.0 mg for 9-13 years old, and 3.0-3.5 mg for 14-18 years old.
Molybdenum is a cofactor for enzymes involved in metabolizing toxins and drugs. Low levels of molybdenum are rare. Some cases report that symptoms include increased heart rate and breathing, irritability and night blindness. Excess levels may lead to an increased risk for developing gout.
Molybdenum can be found in liver, grains, nuts, and legumes. Daily adequate intake is 2 micrograms for 0-6 months old, 3 micrograms for 7-12 months old, 17 micrograms for 1-3 years old, 22 micrograms for 4-8 years old, 34 micrograms for 9-13 years old, and 43 micrograms for 14-18 years old.
Selenium is another enzyme cofactor, specifically an antioxidant. A deficiency in this trace element can lead to Keshan disease (cardiomyopathy and heart failure) or Kashin-Beck disease (necrosis of joint cartilage). Too much selenium may lead to changes in brittle hair and nails, hair loss, garlic odor of the breath, metallic taste in the mouth, nausea, diarrhea and skin rashes.
This trace element can be found in meat, poultry, eggs, seafood, whole grains, and garlic. Recommended daily adequate intake are as follows: 12 micrograms for 0-6 months old, 15 micrograms for 7-12 months old, 25 micrograms for 1-3 years old, 30 micrograms for 4-8 years old, 50 micrograms for 9-13 years old, and 60-70 micrograms for 14-18 years old.
Although they are found in minimal amounts in the body, minerals and trace elements have a significant role to play in our body’s daily functions. These are essential components of our diet, as deficiencies in any micronutrient can lead to various diseases and illnesses. Fortunately, most minerals are commonly seen in fresh and healthy food sources.
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- Kliegman, R.M. et al. (2020). Part V Nutrition. Nelson Textbook of Pediatrics 21st edition. Elsevier.
- Nutrients. Nutrient Reference Values for Australia and New Zealand. Ministry of Health. Taken from: https://www.nrv.gov.au/nutrients
- Chromium (2021). National Institutes of Health Office of Dietary Supplements. Taken from: https://ods.od.nih.gov/factsheets/Chromium-HealthProfessional/
- Molybdenum (2021). National Institutes of Health Office of Dietary Supplements. Taken from: https://ods.od.nih.gov/factsheets/Molybdenum-HealthProfessional/
- Selenium (2021). National Institutes of Health Office of Dietary Supplements. Taken from: https://ods.od.nih.gov/factsheets/Selenium-HealthProfessional/
- Potassium (2021). National Institutes of Health Office of Dietary Supplements. Taken from: https://ods.od.nih.gov/factsheets/Potassium-HealthProfessional/
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