chap 8 10 11 12 13 14 15

1. CHAPTER 8 Food Sources
VIT E and K only
VITAMIN E Seed oils = major source
wheat germ oil
One of the most misused and controversial nutrients vegetable oils
because of many erroneous claims for its healing nuts and seeds
powers in variety of ailments whole grains
egg yolk
Discovery leafy green vegetables
1922- female rats and male rats were sterile unless Toxicity
lettuce wheat germ and dried alfalfa were added to
their diet large doses may increase time required for blood
1924- called this fertility vitamin, vitamin E coagulation
1936 - vitamin E was isolated from wheat germ oil and symptoms:
called it alpha tocopherolgreek of child-birth and to o headache
carry o fatigue
o weakness
Absorption and metabolism o blurred vision
o temporary nausea
Best absorbed on the presence of fat o flatulence
Conditions that interfere with fat absorption: o diarrhea
o Bilary tract disease
o Pancreatic insufficiency VITAMIN K
o Excessive mineral oil digestion
Intestinal absorption is between 20-30% 1931 – chickens were protected from bleeding when
Vitamin enters lymph unchanged they were fed fish meal that was not extracted with
Attaches to lipoproteins as they are being transported ether
to bloodstream and become tocopherol 1935 – found that VitK was essential for blood
Stored in: coagulation
o Adipose tissue
o Muscle Chemistry
o Liver
Derivative of 2-methyl-1,4-napthoquinone
(in smaller amounts): K1& K2
o Natural forms
o Heart o Yellowish ols
o Uterus o Unstable in UV light
o Testes o Easily destroyed by strong acids and
o Adrenals alkalis
o K1 – occurs in green plants
Function o K2 - produced by bacterial synthesis in
intestine
Antioxidant- limits free-radical chain reactions o K3 – menadione; synthetic form of VitK
Protect body cells from lipid peroxidation
Make cell membranes more stable Absorption
Prevents fat from becoming rancid
Requires bile and pancreatic juice
**vitE requirement is proportional to the amount and the Can also be synthesized by bacteria in GI tract in
degree of unsaturation of polyunsaturated fatty acid in diet jejunum and ileum
= less polyunsaturated fat, less vitE required
Function
Deficiency
Aids in blood clotting (main function)
Rare Assist in Ca+ absorption
If present, due to congenital or malabsorption disease Lowers risk of kidney stones
Anemia - For premature infants born w/ inadequate
reserve of vitE
Deficiency
Treatment
Rare
30-100mg daily may be prescreibed Only occurs in individuals with GI disorders
Minor symptoms such as mausea and intestinal **breastfed infants have VitK due to immaturity
distress appears when ingesting 300IU per day of liver and thus newborn babies are given Vit K
suppelements and aor the mother is requested to

2. eat recommended amount of green leafy • Fluoride content of teeth increases rapidly during
vegetables daily early mineralization periods and continues to
increase with age, but at a slower rate.
Food Sources • Metabolism - Distribution
• Found in both extracellular and intracellular fluids of
Spinach soft tissues but at very low concentrations.
Broccoli • Found in saliva, 0.01 ppm.
Cabbage – Play a part in maintenance of fluoride
Lettuce concentrations in the outer layer of tooth
Vegetable oils enamel.
• Metabolism - Excretion
CHAPTER 9 • Principal route of excretion is urine (90 – 95%).
• FLUORIDE AND THEIR ROLE IN DENTAL CARIES • Remaining 5 – 10% in the feces.
PREVENTION • Outstanding characteristic of fluoride excretion is its
• Fluoride speed.
• Compound form of fluorine. – Reabsorption of fluoride from urine is less
– A trace element, halogen. efficient.
– Very reactive gas.  Effective mechanisms for
– Not found in free elemental form in maintaining low concentrations
nature. of fluoride in the soft tissues
• Major source is from water – artesian wells. and plasma.
• Found in soils rich in fluorspar, cryolite, and other  Metabolism - Excretion
minerals.  Directly related to the degree of
• Fluoride active bone growth.
• Also found in plants, food, and human – calcified  Fluoride excretion is lower
structures (teeth and skeleton). when a child is growing rapidly
• Nutrient beneficial to dental health. and is actively depositing bone
• Dietary sources - drinking water material than in adults with a
• Waterborne fluorides are the most important source mature bone structure and fully
of flouride for humans. mineralized teeth.
• Modern diets as a source of flouride. • About half of the ingested fluoride is excreted in the
– Use of fluoridated water in preparation of urine each day.
processed foods and beverages. • Metabolism - storage
• For temperate climates • Deposited in calcified structures.
– Optimal fluoride level: 1 ppm of fluoride. • Skeletons of older persons contain more fluoride than
• Dietary sources - drinking water those of younger ones.
• For infants and young children – Amount of fluoride in bone gradually
– Intake of 2 – 4 glasses of water: 0.5 – 1 mg increases with age – greatest during active
of fluoride. growth years.
• For older children, adolescents and adults • Metabolism - storage
– Intake of 6 – 8 glasses of water: 1.5 – 2 mg • Factors that attract fluoride to bones:
of fluoride. – Presence of an active growth area at the
• Ingestion of fluoride greater than optimal levels in ends of long bones.
drinking water (2 ppm) cause fluorosis. – Small size of the bone crystals.
– Dietary sources - foods – Close contact between bones and the
• Fluoride in foods by adults blood supply
– Nonfluoridated communities: 1 mg/day. • Metabolism - storage
– Fluoridated communities: 2 – 3 mg/day. • Deposited in the enamel through diffusion.
• Not known to be a significant factor in fluorosis – Carious enamel may take up 10 times more
(mottled enamel). fluoride than adjacent healthy enamel to
• Small amounts: fruits, vegetables, cereals. inhibit expansion of carious lesion.
• Rich amounts: seafoods and tea leaves. • Dentin may contain even more fluoride.
– Dietary sources - foods – Chemically similar to bone
• Metabolism - absorption – Highest concentration found adjacent to
• Major site of absorption: stomach. pulp: close to blood supply.
• Studies with animals suggest intestinal absorption • Relative safety
also occurs. • Low and moderate intake results to:
• Soluble fluoride in drinking water is completely – Skeletal fluorosis
absorbed, whereas 50 – 80% of the fluoride in foods is – Mottled enamel
absorbed. – Osteosclerosis (hardening of bone)
• Metabolism - Distribution – Exostoses (bony projections)
• Teeth and skeleton have the highest concentrations – Calcification of ligaments
of fluoride. • High intake may result to death.
– Due to the affinity of fluoride to calcium. – Mottled enamel (Endemic Dental Fluoride)
– Cementum, bone, dentin, and enamel. • White or brown spotty staining of tooth enamel.
– May be due to food, debris, or plaque.

3. • Sometimes will have horizontal striations. – Fluoride supplementation at birth gives
• Enamel is deficient in: some protection against caries to the
– Number of cells producing enamel causes deciduous teeth.
pitting (hypoplasia). – No fluoride supplements must be given to
– Hypocalcification causes chalkiness. infants less than 6 months of age (
• Mottled enamel (Endemic Dental Fluoride) exception of infants consuming milk)
• Occurs only in teeth that are being formed. • Fluoride and dental caries
– When exposed to high concentrations of • Fluoride Rinses
fluoride, opaque spots will develop on the – 3 years is necessary to achieve the
enamel. maximum benefit from a rinse program.
• High intake of fluoride results to mottled enamel. – Effective in children with a higher caries
– Protection of fluoride is decreased by baseline than low caries baseline.
severe fluorosis. 1. The lower the incidence of
• Mottled enamel (Endemic Dental Fluoride) caries, the more limited the
• Fluoride and dental caries effect of each preventive
• Communal Water Fluoridation measure.
– Most effective, practical, feasible and – Fluoride and dental caries
economical public health measure for • Sustained Release Delivery Systems
preventing caries. – Advantages: lower required dosage,
– Greatest resistance to caries and greatest reduced toxicity, release constant level of
amount of fluoride deposition are acquired fluoride, better use of fluoride and better
by starting the intake as early as possible patient compliance.
and using it continuously. – Clinical studies showed exposure to low
• Fluoride and dental caries levels of fluoride is more effective in
– Other factors to the decline of caries: decreasing the incidence of caries.
1. Greater dental health – Fluoride and dental caries
awareness. – Useful in children who tend to get caries
2. Expansion in dental resources. easily, xerostomia, adults with rampant
3. Application of preventive root or coronal caries.
dentistry. • Fluoride and dental caries
– Fluoride and dental caries • Fluoridated Milk
• School Water Fluoridation – Milk is used as an instrument for fluoride
– Fluoridated with levels of three to seven administration.
times the optimum for communal water – Fluoridated milk was found to be as
fluoridation resulting to reduction in caries effective as fluoridated water in reducing
incidence. dental caries.
• Fluoride and dental caries – Fluoride and dental caries
• Fluoride Tablets • Fluoridated Salt
– Ingestion daily beginning at 5 – 9 years: – Use salt as a vehicle for fluoride in the diet.
permanent teeth can still be significantly – Salt is about 2/3 as effective as the water.
protected from caries. – Mechanisms of anticaries action of fluoride
• Fluoride and dental caries 1. Increase in the enamel’s resistance to acid solubility
– Lozenge is much preferred than tablets or − Enamel formed has more perfect and
drops. larger crystals, less soluble in acid, and less
1. Dissolves slowly, produces both likely to develop caries.
topical and systemic effects.  Fluoride favors formation of
– Advantage: specific and precise dosage fluorapatite, a more acid –
– Disadvantage: assurance of continuous resistant apatite than
daily ingestion and cost is greater. hydroxyapatite.
1. Fluoride and dental caries − Mechanisms of anticaries action of fluoride
• Prenatal Fluoride Supplement 2. Remineralization
– Fluorides supplements are not − Greater concentration of fluoride released
recommended for adults, especially from the dissolved enamel or already
pregnant women, for reducing dental present on the plaque, the more will
caries. remineralization be favored and carious
1. The concentration of fluoride process be slowed.
that reaches the fetus is − Use of topical fluoride raises the fluoride
generally lower than that in the level of tooth surface and underlying
maternal blood. tissues to a level expected to protect
2. Infants exposed will have higher against caries.
plasma, skeletal and developing − Mechanisms of anticaries action of fluoride
enamel fluoride levels. 3. Antibacterial effects of fluoride
• Fluoride and dental caries − Inhibition of enzymes essential to cell
• Fluoride Supplements (Infants and Children) metabolism and growth.
− Lower the surface energy of the tooth.
− Can strip off bacteria from hydroxyapatite.

4.  Fluoride can bind more  Deficiency in Vit. D- decreased calcium
effectively to positively charged absorption
areas on the apatite crystal than 4) Lactose
can the bacteria.  The disaccharide lactose found
• Dental benefits in milk promotes calcium
• Fluorosis of the deciduous teeth is rarely seen and is absorption.
not a problem.  Lactose in ileum change the
• First 2 to 3 years of life are the most critical period for intestinal bacteria lowering the
the development of mottled enamel on the pH thus increase calcium
permanent anterior teeth and for this reason only. absorption
– 0.25 mg/day is prescribed from birth until 6) Citric acid
2 years of age. 6) Its low pH promotes calcium
• Dental benefits absorption
– 0.5 mg/day from 2 to 3 years of age. 7) Oxalic and phytic acid
– 1.0 mg/day from 3 until 13 years of age. 8) Intake of foods rich in oxalic
• Use of fluoridated water or fluoride supplements as such as spinach and phytic acids
early as 1 year of age enhance the formation of the found in cereal grain and meal
relatively caries – resistant fluorapatite in the enamel flour causes formation of
surface. insoluble complexes (calcium
Thank you  salts) within intestinal lumen
that leads to increased calcium
absorption.
CHAPTER 10 7) Fat
6) Decreased fat, bile or salts
 The Macrominerals: produces insoluble calcium thus
Calcium, Phosphorus increase calcium absorption.
and Magnesium 7) Emotional reactions
 Their Role in the Health of the Body and Especialy the 8) Stress may cause hormonal
Oral Cavity changes that affects calcium
 metabolism
11) Exercise
Calcium  Weight-bearing exercise helps
maintain calcium in bone.
 Storage
 Functions  calcium and phosphorus are stored in the trabeculae
 Provides rigidity and strength to the bones and teeth but can be withdrawn out when it is needed in the
 Functions (cont…) blood
 Serum calcium performs specific functions:  The blood and tissue calcium serve as reserves
 Contraction and relaxation of heart muscle.  The degree of bone development amount of calcium
 Helps in blood clotting deposited in are directly related to the amount of the
 Low blood calcium will increase the irritability of calcium available from the diet.
nervous tissue and may cause tetany.  Excretion
 Activate enzymes such as pancreatic lipase and  Out of the 100og dietary intake of calcium, 700 – 800g
alkaline phosphatase. are excreted in feces but it could be less than that
 Activates rennin which causes curding of milk when the dietary intake is low.
during its digestion  During lactation, mother loses 150 -300mg of calcium
 Necessary for the release of NTs daily but normally, it is not affected because of
(neurotransmitters) human adaptability.
 Regulates transport of ions across cell  Excess calcium from the bone are excreted in the
membranes urine
 Absorption  Unimportant daily lost of 15mg of calcium through
 Active process perspiration
 Reqiures Vitamin D and calcium-binding protein  Regulation of calcium balance
 20-30% of calcium is absorbed and the rest are  Calcium in serum is regulated by the:
excreted in the feces, urine and perspiration.  Parathormone (PTH)
 Factors affecting absorption of Calcium  Calcitonin
1. Needs of the body  -serum calcium rises, PTH is
 Growing child, pregnant, a person healing from inhibited
a bone fracture- increased calcium absorption  -serum calcium falls, secretion
2. Gastric acidity of PTH increases
 Acidity in the stomach converts the  -serum calcium rises, calcitonin
insoluble calcium salts into more soluble increases
types  Role of Bone, Kidney, and Intestine
3. Hormonal influences  Kidney can resorb calcium
 Parathormone and cacitonin  Intestine - acidity
 Vitamin D

5.  Bone – activity of the osteoblast and Depression
osteoclast. How? Tremors
 Vitamin D Convulsions
 Necessary for normal intestinal absorption Chronic Renal Failure:
of calcium and helps maintain bone cells, Definition:
thus regulating serum calcium and serum Slow loss of kidney function over time
phosphate levels. Signs & Symptoms:
 Recommended Dietary Allowance and Sources Appetite loss
 Avrage adult- 800mg Nausea
 Infants- 360-450mg Headache
 1-10 yrs.old – 800mg Weight loss
 11-18 yrs.old- 1200mg Chronic Alcoholism
 During lactation- 1200mg Definition:
 *all daily Primary disease with genetic, psychosocial, and environmental
 Sources factors influencing its development and manifestations
 Cheddar cheese – highest level of calcium Signs & Symptoms:
 Best sources are hard cheese, milk, and dark green Neglecting responsibilities due to drinking
leafy vegetables (the darker the green, the more Tolerance (over time, one needs more and more alcohol to feel
calcium), the same effects): 1st major warning sign of alcoholism
 Good sources are ice cream, blackstrap molasses, Withdrawal (body is used to alcohol and experiences withdrawal
broccoli, baked beans, dried legumes, and dried figs. symptoms if it’s taken away): 2nd major warning sign of
 Fair sources are cottage cheese, string breans, alcoholism
parsnips, lima beans lettuce and other sald greens, Anxiety
eggs and bread. Depression
 Calcium supplements Irritability and so on.
 Calcium carbonate or oyster shell calcium is Acute Diarrhea
frequently recommended for persons who cannot eat Definition:
dairy products. Abrupt onset of abnormally high fluid content in the stool
 When children refuse to drink milk, it should be Signs & Symptoms:
incorporated either in fluid or powder form in soups, Watery stool
gravies, casseroles, or baked goods. Abdominal pain
Fever
Macromolecule: Magnesium dehydration
Should be provided in the foods that we eat every day Chronic malabsorption syndrome
Third most abundant mineral in teeth Definition:
One of the major cations in plant & animal tissue Alteration in the ability of the intestine to absorb nutrients
Essential ion (enzymatic reactions & protein synthesis) adequately into the bloodstream
Found mostly in bones and muscles, cell types and body fluids Signs & Symptoms:
Human body = 20 to 35 mg of Mg Diarrhea
Essential constituent of bone & soft tissues Bloating
Functions: Flatulence
Regulate body’s nerves &muscles Weight loss
Plays a role in protein synthesis cramping
Activator of numerous coenzymes (carboxylase and co-A) Hypomagnesemia
Helps in catalyzing the transport of phosphate groups Definition:
Binds mRNA Low levels of Magnesium in the blood
Important in synthesis & degradation of DNA Often leads to hypocalcemia (inhibition of parathyroid hormone;
Critical for normal metabolism& function of the organism does not resolve until the magnesium deficiency has been
Absorption & Excretion corrected)
1/3 is absorbed and utilized in the body Signs & Symptoms:
High intake of other macromolecule (Ca, P, lactose) will interfere Muscle Weakness
with Mg absorption Convulsions
Stored in bone---little excretion through the intestine Fatigue
Mg is lost via urine &feces Sources
Maintenance of the normal level of Mg in the blood depends on Mustard greens
a balance between absorption and renal excretion of sodium. Whole grains
Magnesium Deficiency Nuts
Conditions: Soybeans
Chronic malabsoprtion syndrome Green leafy veggies
Acute diarrhea Dietary allowance
Chronic renal failure Male: 350 mg
Chronic alcoholism Females: 300 mg
Symptoms: Thank you and have a good day. 
Hyperexcitability
Behavioral disturbances  Toxicity
Weakness  Hypercalcemia (excess calcium in the blood)

6.  Hypercalcinuria (excess calcium in the urine) -dietary calcium and vitamin D
 Kidney stones (result in high levels of calcium in the  Osteoporosis
serum and urine calcification of soft tissues)  Abnormal organic matrix formation
 Hyperparathyroidism  Due to:
 PHOSPHORUS -deficiencies of calcium and estrogen
 One of the most essential elements of the body  Results in:
 Available in all foods of plant and animal origin -decreased ossification (forming activity)
 Second most abundant mineral in body, after calcium -mineral composition of bone remains normal
 >600 g of phosphorus in the normal human body, 80-  Clinical Manifestations:
90% combined with calcium to form bones and teeth -hip and back pain
 Absorption and Metabolism -decreased height
 Dietary phosphorus intake : 1.5 g/day -tendency to bone fracture
 Phosphorus balance is regulated by the metabolic  Treatment
and hormonal factors vitamin D, calcitonin, -estrogens, protein, calcium, vitamin D and fluoride
parathyroid hormone
 Amount of phosphorus in the body is controlled by  FACTORS INDICATE GREATER RISK OF OSTEOPOROSIS
excretion in the urine rather than by absorption  Heredity
 Function  Smoking
 Major functions:  Alcohol
-formation of bone and tooth mineral  Coffee(5 or more cups daily)
-production and transfer of high-energy phosphates  Low calcium intake
 Plays a role in absorption and transport of nutrients  Certain levels of hormones, PTH, calcitonin, estrogen,
 Regulates the acid-base balances androgen, insulin, growth hormone, throid hormones,
 Plays an important role in cell protein synthesis (part protein
of the nucleic acids DNA and RNA, the substances that  Drugs like phenytoin (anticonvulsant) and
control heredity) phenobarbital
 Buffers in blood and tissue (chemicals that prevent  Clinical diagnosis
change in the concentration of other chemicals)  Osteoporosis occurs most commonly in older people,
 Attachment of phosphate to the matrix of bone and >60 age
teeth is one of the initial steps in their mineralization  Osteoporotic individuals tends to have a lower intake
 Failure of bone calcification results from a lack of and a higher urinary excretion of calcium than normal
phosphorus as often as from a lack of calcium persobs
 Increase in serum alkaline phosphatase is associated  Loss of height because of shortening of the trunk and
with poor bone calcification as seen in rickets collapsed of the vertebrae
(vitamin D deficency disease resulting in bone  Therapy
deformities) and osteomalacia (softening of the bone  Ingestion of high calcium diets , estrogen, fluoride,
in adults) calcitonin, PTH, active form of vitamin D
 Recommended Dietary Allowances and Sources  Estrogen and diet: reduces vertebral, hip and forearm
 Intakes of 800 to 1200 mg of phosphorus daily are fractures
recommended  Fluoride: large doses of fluoride can stimulate bone
 Animal foods rich in protein are also rich in formation
phosphorus (meat, fish, poultry, eggs and milk)  Calcitonin: can increase bone mass
 Nuts, legumes and whole-grain cereals are also good  PTH increases with age, also found to increase bone
sources of phosphorus mass
* Excess dietary phosphorus in animals will increase
bone loss and bone porosity (significantly decrease bone mineral CHAPTER 11
and cause calcification of the kidney, tendons, heart and thoracic
aorta) • FLUORIDE AND THEIR ROLE IN DENTAL CARIES
 Osteoporosis PREVENTION
 A condition in which the rate of bone resorption is • Fluoride
greater than the rate of bone formation, resulting in • Compound form of fluorine.
decreased bone density and a reduction in the total – A trace element, halogen.
bone mass – Very reactive gas.
 Caused by deficiencies of calcium and estrogen – Not found in free elemental form in
hormone nature.
 Osteomalacia • Major source is from water – artesian wells.
 Abnormal bone calcification • Found in soils rich in fluorspar, cryolite, and other
 Due to: minerals.
- deficiency of Vitamin D, Calcium and phosphates • Fluoride
 Results in: • Also found in plants, food, and human – calcified
- excessive uncalcified osteiod structures (teeth and skeleton).
-Abnormal bone mineral composition • Nutrient beneficial to dental health.
 Clinical Manifestations: • Dietary sources - drinking water
-weakness • Waterborne fluorides are the most important source
-aching of flouride for humans.
 Treatment • Modern diets as a source of flouride.

7. – Use of fluoridated water in preparation of • Metabolism - storage
processed foods and beverages. • Deposited in calcified structures.
• For temperate climates • Skeletons of older persons contain more fluoride than
– Optimal fluoride level: 1 ppm of fluoride. those of younger ones.
• Dietary sources - drinking water – Amount of fluoride in bone gradually
• For infants and young children increases with age – greatest during active
– Intake of 2 – 4 glasses of water: 0.5 – 1 mg growth years.
of fluoride. • Metabolism - storage
• For older children, adolescents and adults • Factors that attract fluoride to bones:
– Intake of 6 – 8 glasses of water: 1.5 – 2 mg – Presence of an active growth area at the
of fluoride. ends of long bones.
• Ingestion of fluoride greater than optimal levels in – Small size of the bone crystals.
drinking water (2 ppm) cause fluorosis. – Close contact between bones and the
– Dietary sources - foods blood supply
• Fluoride in foods by adults • Metabolism - storage
– Nonfluoridated communities: 1 mg/day. • Deposited in the enamel through diffusion.
– Fluoridated communities: 2 – 3 mg/day. – Carious enamel may take up 10 times more
• Not known to be a significant factor in fluorosis fluoride than adjacent healthy enamel to
(mottled enamel). inhibit expansion of carious lesion.
• Small amounts: fruits, vegetables, cereals. • Dentin may contain even more fluoride.
• Rich amounts: seafoods and tea leaves. – Chemically similar to bone
– Dietary sources - foods – Highest concentration found adjacent to
• Metabolism - absorption pulp: close to blood supply.
• Major site of absorption: stomach. • Relative safety
• Studies with animals suggest intestinal absorption • Low and moderate intake results to:
also occurs. – Skeletal fluorosis
• Soluble fluoride in drinking water is completely – Mottled enamel
absorbed, whereas 50 – 80% of the fluoride in foods is – Osteosclerosis (hardening of bone)
absorbed. – Exostoses (bony projections)
• Metabolism - Distribution – Calcification of ligaments
• Teeth and skeleton have the highest concentrations • High intake may result to death.
of fluoride. – Mottled enamel (Endemic Dental Fluoride)
– Due to the affinity of fluoride to calcium. • White or brown spotty staining of tooth enamel.
– Cementum, bone, dentin, and enamel. – May be due to food, debris, or plaque.
• Fluoride content of teeth increases rapidly during • Sometimes will have horizontal striations.
early mineralization periods and continues to • Enamel is deficient in:
increase with age, but at a slower rate. – Number of cells producing enamel causes
• Metabolism - Distribution pitting (hypoplasia).
• Found in both extracellular and intracellular fluids of – Hypocalcification causes chalkiness.
soft tissues but at very low concentrations. • Mottled enamel (Endemic Dental Fluoride)
• Found in saliva, 0.01 ppm. • Occurs only in teeth that are being formed.
– Play a part in maintenance of fluoride – When exposed to high concentrations of
concentrations in the outer layer of tooth fluoride, opaque spots will develop on the
enamel. enamel.
• Metabolism - Excretion • High intake of fluoride results to mottled enamel.
• Principal route of excretion is urine (90 – 95%). – Protection of fluoride is decreased by
• Remaining 5 – 10% in the feces. severe fluorosis.
• Outstanding characteristic of fluoride excretion is its • Mottled enamel (Endemic Dental Fluoride)
speed. • Fluoride and dental caries
– Reabsorption of fluoride from urine is less • Communal Water Fluoridation
efficient. – Most effective, practical, feasible and
 Effective mechanisms for economical public health measure for
maintaining low concentrations preventing caries.
of fluoride in the soft tissues – Greatest resistance to caries and greatest
and plasma. amount of fluoride deposition are acquired
 Metabolism - Excretion by starting the intake as early as possible
 Directly related to the degree of and using it continuously.
active bone growth. • Fluoride and dental caries
 Fluoride excretion is lower – Other factors to the decline of caries:
when a child is growing rapidly 1. Greater dental health
and is actively depositing bone awareness.
material than in adults with a 2. Expansion in dental resources.
mature bone structure and fully 3. Application of preventive
mineralized teeth. dentistry.
• About half of the ingested fluoride is excreted in the – Fluoride and dental caries
urine each day. • School Water Fluoridation

8. – Fluoridated with levels of three to seven – Fluoridated milk was found to be as
times the optimum for communal water effective as fluoridated water in reducing
fluoridation resulting to reduction in caries dental caries.
incidence. – Fluoride and dental caries
• Fluoride and dental caries • Fluoridated Salt
• Fluoride Tablets – Use salt as a vehicle for fluoride in the diet.
– Ingestion daily beginning at 5 – 9 years: – Salt is about 2/3 as effective as the water.
permanent teeth can still be significantly – Mechanisms of anticaries action of fluoride
protected from caries. 1. Increase in the enamel’s resistance to acid solubility
• Fluoride and dental caries − Enamel formed has more perfect and
– Lozenge is much preferred than tablets or larger crystals, less soluble in acid, and less
drops. likely to develop caries.
1. Dissolves slowly, produces both  Fluoride favors formation of
topical and systemic effects. fluorapatite, a more acid –
– Advantage: specific and precise dosage resistant apatite than
– Disadvantage: assurance of continuous hydroxyapatite.
daily ingestion and cost is greater. − Mechanisms of anticaries action of fluoride
1. Fluoride and dental caries 2. Remineralization
• Prenatal Fluoride Supplement − Greater concentration of fluoride released
– Fluorides supplements are not from the dissolved enamel or already
recommended for adults, especially present on the plaque, the more will
pregnant women, for reducing dental remineralization be favored and carious
caries. process be slowed.
1. The concentration of fluoride − Use of topical fluoride raises the fluoride
that reaches the fetus is level of tooth surface and underlying
generally lower than that in the tissues to a level expected to protect
maternal blood. against caries.
2. Infants exposed will have higher − Mechanisms of anticaries action of fluoride
plasma, skeletal and developing 3. Antibacterial effects of fluoride
enamel fluoride levels. − Inhibition of enzymes essential to cell
• Fluoride and dental caries metabolism and growth.
• Fluoride Supplements (Infants and Children) − Lower the surface energy of the tooth.
– Fluoride supplementation at birth gives − Can strip off bacteria from hydroxyapatite.
some protection against caries to the  Fluoride can bind more
deciduous teeth. effectively to positively charged
– No fluoride supplements must be given to areas on the apatite crystal than
infants less than 6 months of age ( can the bacteria.
exception of infants consuming milk) • Dental benefits
• Fluoride and dental caries • Fluorosis of the deciduous teeth is rarely seen and is
• Fluoride Rinses not a problem.
– 3 years is necessary to achieve the • First 2 to 3 years of life are the most critical period for
maximum benefit from a rinse program. the development of mottled enamel on the
– Effective in children with a higher caries permanent anterior teeth and for this reason only.
baseline than low caries baseline. – 0.25 mg/day is prescribed from birth until
1. The lower the incidence of 2 years of age.
caries, the more limited the • Dental benefits
effect of each preventive – 0.5 mg/day from 2 to 3 years of age.
measure. – 1.0 mg/day from 3 until 13 years of age.
– Fluoride and dental caries • Use of fluoridated water or fluoride supplements as
• Sustained Release Delivery Systems early as 1 year of age enhance the formation of the
– Advantages: lower required dosage, relatively caries – resistant fluorapatite in the enamel
reduced toxicity, release constant level of surface.
fluoride, better use of fluoride and better Thank you 
patient compliance.
– Clinical studies showed exposure to low
levels of fluoride is more effective in CHAPTER 12
decreasing the incidence of caries.  Trace Minerals Other Than Fluorides
– Fluoride and dental caries  Essential Trace Minerals
– Useful in children who tend to get caries  Essential Trace Minerals
easily, xerostomia, adults with rampant  Trace elements or micro-minerals
root or coronal caries.  Inorganic nutrients required by humans in very small
• Fluoride and dental caries amountsfrom micrograms (o.oo1 mg) to no more than
• Fluoridated Milk a few mg - less than 100 mg/day
– Milk is used as an instrument for fluoride  Essential for humans with vital functions to avoid a
administration. deficiency disease.
 Mn, Mo, Se, Cr, Co – human enzymatic actions

9.  Fe, I, Zn – recommended daily allowances  If phytates (a salt of phosphoric acid ester) present in
 Cu, F – estimated safe ranges and adequate intake bran or food phosphates are ingested in excess, the
 Trace Elements: Modes of Action absorption of iron can be impaired.
 Act as catalysts either as  Absorption
 Metallo-enzymes  The Ferrous iron is initially taken up by the brush
 the trace element is an integral border of the intestinal wall, where it is passed into the
part of the enzyme molecule intestinal mucosal cells.
 Fe, Zn, Mo  In the mucosal cells, it can be either bound to:
 Cu – firmly bound and  Transferrin
incorporated in the protein  an iron-binding protein for
molecule of the enzyme transport of iron in blood
tyrosinase  And absorbed into the bloodstream or combined with
 Metal-enzymes another protein:
 the metal ion is loosely  Apoferritin
associated with the enzymes  This protein complex is known as ferritin (the storage
 Arginase form of iron), which remains within the cells and is
 Functions as constituents and activators of hormones released as needed.
 Iodine: found in thyroid hormones  Control of iron absorption depends on the amount of
 Chromium: insulin activator iron deposited as ferritin in the mucosal cells
 Cobalt: acts as a structural center of vit.B12  Absorption
 Dietary Sources & Classification  2 most important factors determining the regulation of
 Good sources iron absorption:
 Meat  The state of iron stores in the body
 Fish  The state of RBC formation in the bone
 Natural plant foods marrow
 Grains  Absorption is increased in conditions that decrease
 Beans body iron
 Fruits  during growth or pregnancy when new
 Vegetables RBCs are being produced
 Consumption of processed foods REDUCES the intake  during anemia resulting from hemorrhage
of essential micronutrients, unless these foods are  Transport
fortified to conc’ns at least equal to those naturally  Transferrin
occurring in the product.  special carrier protein in the plasma
 2 categories: designed for binding and transporting iron.
 Those that have well-defined human  attach to the immature RBC and rapidly
requirements – Fe, Zn, I, Cu, F pass iron to them.
 Those that are integral constituents or  attaches to the liver cells and more slowly
activators of enzymes – Mn, Mo, Se, Cr, Co transfers iron to them
 Iron  responsible for recycling iron and
 Iron transporting it to the bone marrow by
 One of the most important minerals in nutrition production of new RBCs
 Involved in oxygen transport and cellular respiration  The normal plasma iron concentration= 100 µg per 100
(in hemoglobin) mL
 Serves as an oxygen reserve in muscles metabolism (in  The total iron-binding capacity (TIBC) of transferrin =
myoglobin) 330 µg/per 100 L
 Total quantity ofironin the body averages about 4g,  Transport
consisting of two major fractions:  A drop in the saturation of transferrin below 10-15%
 70% essential body iron indicates iron deficiency anemia
 hemoglobin, myoglobin, and  After 120 days, RBCs are destroyed by
intracellular enzymes such as reticuloendothelial cells (large phagocytic cell) and the
cytochrome released iron is taken up by the transferrin molecules.
 30% mobilizable iron reserves  Iron and Storage Overload
 ferritin&hemosiderin  Ferritin
 Physiological Functions  storage form of excess iron in the liver cells
 Absorption as when it is deposited there among all cells
 Transport of the body
 Absorption  also found in the cells of spleen and bone
 Humans have difficulty in efficient iron absorption. marrow
 Only 7-10% of iron in cereals and vegetables  Hemosiderin
 10-30% in animal protein and soybeans  an insoluble storage form of iron in the
 Iron is absorbed in the reduced ferrous state (divalent) body as when the amount of of iron in the
in the upper portion of the small intestine liver, spleen, and bone marrow EXCEEDS
 Ascorbic acid, citric acid, and amino acids the capacity of the cells to form ferritin.
 convert the less absorbable ferric (trivalent)  Hemochromatosis
iron present in foodsèmore phosphoric
absorbable ferrous form

10.  occurs when there is excessive  It leads to loss of efficiency and impaired general
levels of hemosiderin or iron health
overload.  Occurrences and Causes
 characterized by excess  Occurs most frequently in infants and children due to
deposition of iron in the tissues, undergoing rapid growth and having rapid RBC
especially in the liver, and by formation
skin pigmentation  Occurs in pregnant women due to the increasing
 Iron and Storage Overload demand of the growing fetus on the mother’s body
 Common causes of Hemochromatosis: iron
 Numerous transfusions in patients with  In adult males and postmenopausal women –
hemolytic anemia (separation of pathological blood loss
hemoglobin from red blood cells) anemias  In premenopausal women – menstruational blood loss
 Excessive iron intake from food cooked in  Bizarre food habits (avoidance of meat and vegetables)
iron vessels  Inadequate intake among the elderly due to poverty
 Drinking excessive amounts of cheap wines  Vomiting, diarrhea, and intestinal hypermotility
 Failure of the body to regulate absorption, increases iron loss.
as in alcoholics on low-protein diets and in  Clinical Manifestations
patients with hereditary hemochromatosis  Slow development; takes for months or years
 Recommended Dietary Allowances  Anemia
 Iron intake usually tends to be inadequate in the infant  Characterized by weakness, fatigue, pallor,
and child during the first 2 years. and numbness and tingling of the
 The recommended dietary allowance (RDA)=10-15 extremities
mg/day  Epithelial changes – early manifestations
 Males  Nail changes; dullness, brittleness
 11-18 yrs. old: 18 mg daily  Fingernails may be flat instead of convex;
 19 and older: 10 mg daily spoon-shaped appearance with longitudinal
 Females ridges (koilonychia)
 At childbearing age: 18 mg daily  Hair growth may be altered
 After menopause: 10 mg  Dysphagia (difficulty in swallowing) in severe cases
 The amount of iron expected from a normal diet is  Clinical manifestations: oral area
about 6 mg/1000 kcal  Glossitis
 Only 10% of iron from is food is absorbed, as this  Inflammation of the tongue
approx. replaces the 1 mg/day lost physiologically in a  Fissures (clefts or grooves) at the corners of the mouth
normal adult  The papillae of tongue are atrophied, giving a smooth,
 Food Sources shiny, red appearance to the tongue
 3 forms of iron in food  The clinical appearance of the tongue in iron deficiency
 Heme resembles that in vit.B complex deficiency
 Nonheme  Oral mucous membranes may be atrophied and ashen
 Additive iron gray
 Enriched white bread, rolls, and crackers are a major  More susceptible to carcinoma (cancer arising from
source of iron. epithelial cells)
 The amount of iron to be absorbed from the food  Plummer-Vinson syndrome
depends or on the bodily need for iron.  Combination of dysphagia, koilonychia,
 The greater the need, the greater the absorption angular stomatitis, and atrophic glossitis
 Heme  THERAPY
 form of iron in hemoglobin and in myoglobin that is  Administration of 200 mg of ferrous sulfate tablets 3x a
absorbed intact day (after each meal) as prescribed by a physician
 found in organ meats (liver, heart, kidney, spleen), red  Treatment should be continued for approximately 2
meats, veal, pork, poultry, fish, oysters, and clams, but months after the hemoglobin level has returned to
not milk or milk products normal.
 About 40% of iron in meat and fish is heme iron  ZINC
although only 1/3 can be absorbed by the body  Zinc
 Nonheme  Approx. 2-3 g of zinc in human body
 Accounts for the other 60% of iron in animal protein  Is concentrated in the eyes, liver, bones, prostate,
and all the iron in molasses, fruits (figs, dates), green prostatic secretions, and hair
veggies, dried beans, nuts, and grain products (wheat  In blood, 85% in RBCs, but each WBC has about 25x
germ) than each RBC.
 Only 2-10% can be absorbed by the body  Functions
 Additive iron  An integral part of at least 70 enzymes that belong to
 found in both enriched and fortified products metallo-enzymes
 Iron Deficiency Anemia  Active component of carbonic anhydrase
 Occurs due to inadequate intake or excessive loss of  Essential for the transport of
iron or both. CO2 to the lungs
 Characterized by the production of small RBCs that are  Other enzymes with zinc content
deficient in hemoglobin.  Alcohol dehydrogenase
 The most common type of nutritional anemia  Lactate dehydrogenase

11.  Activates enzymes (carboxypeptidase and  Consuming excessive amounts of zinc may increase the
aminopeptidase) that function in the digestion of risk of cardiovascular disease due to:
proteins  Low HDL
 Is part of alkaline phosphatase − bone metabolism  High LDL
 Added to insulin to prolong the hypoglycemic effect  Common zinc level in popular vitamin/mineral
 It plays an essential role in RNA, DNA, and protein preparations is 15 mg (safe)
synthesis  Clinical Application
 Functions  Zinc sulfate supplements can decrease wound healing
 Essential for wound healing, tissue growth, and time significantly
prevention of dwarfism, production of hormones.  Zinc peroxide powder when used topically on acute
 Zinc inadequacy may play an important role in the gingival lesions in acute necrotizing gingivitis, the
reduced immune response in protein-calorie soreness disappears soon enough and the mouth
malnutrition restores to its normal healthy condition
 Used in the treatment of sickle-cell disease  SELENIUM
 Assist in restoring a missing sense of taste in some  Selenium
cases  Essential component of the enzyme that catalyzes
 Important for thymic hormone activity since its oxidation of glutathione which protects red blood cells
removal reduces hormone functions through destruction of hydrogen peroxide protecting
 Recommended Dietary Allowance hemoglobin from oxidative damage
 RDI: 15 mg a day  Extremely effective in reducing the prevalence of
 During pregnancy and lactation: 20-25 mg/day keshan disease, which is characterized by
 Infant at 6 mos. old: 3 mg/day abnormalities in the heart muscle.
 6 mos.-1 yr.: 5 mg/day  Estimated safe and recommended daily intake of
 1-10 yrs.: 10 mg/day selenium for adults is 0.05 to 0.2mg while for infants,
*These are relatively high values when considered in proportion children and adolescents is somewhat less.
to the amount of food eaten.  MOLYBDENUM
 Food Sources  Molybdenum
 Protein rich foods such as meat and fish  Part of the molecular structure of two enzymes:
 Oysters and herring as highest zinc content per ounce Xanthineoxidase and Aldehydeoxidase,
 Milk --- total dietary zinc intake Xanthineoxidase is responsible for the conversion of
**Grains contain dietary fiber and phytic acid, that can bind zinc, xanthine to uric acid.
inhibiting its absorption, but when used in making bread with  Daily intake is 0.15 to 0.5mg
yeast, it inactivates the phytates and the body now obtains more  CHROMIUM
of the zinc.  Chromium
 Deficiencies  Trivalent chromium is the biologically active form of
 Causes chromium
 Poor diet  Required for the maintenance of normal glucose and
 Excessive alcohol intake energy metabolism
 Liver disease  May act as cofactor in insulin and stimulates synthesis
 Chronic kidney disease of fatty acids and cholesterol in the liver
 Genetic disorders  Daily intake is 0.05 to 0.2mg
 Acrodermatitisenteropathica  COPPER
 A sever  Copper
gastrointestinal and  Functions :
cutaneous disease 1. Aids in synthesis of hemoglobin in the bone marrow
 May intensify the anemia of sickle-cell 2. Form and maintain compounds having enzymatic
disease activity
 Deficiencies 3. Influence the central nervous system physiology
 Clinical Manifestations 4. Aids in formation of pigments
 Retardation of both growth and sexual 5. Component of enzyme necessary for the oxidation of
development the amino acid tyrosine and vitamin C
 Poor appetite 6. May also have a role in the maintenance of the myelin
 Slow healing of wounds sheath around the nerve tissue
 Loss of sense of taste  Copper
 Progressive pustular dermatitis of the  Deficiency :
extremities, mouth, anus, and genital areas 1. Copper deficiency seen in australian lambs called
 Emotional irritability “swayback disease” characterized by demyelination
 Tremors and degeneration of motor nerves in CNS, its
 Loss of coordination prevented by giving copper supplements to
 In pregnancy ewes(female sheep) during pregnancy.
 Abnormal taste sensations 2. Found by clinicians that combined administration of
 Prolonged gestation copper and iron is more effective in treating
 Protracted labor hypochromic anemia than the administration of iron
 Increased risks to the fetus alone
 Supplementation  Copper
 Effects of excess :

12.  Accumulation of excess copper in body  Hypothyroidism
tissues, probably because of genetic  Cretinism and Myxedema are pathological conditions
absence of liver enzyme is called Wilson’s resulting from low thyroid activity
disease, characterized by neurological  Treatment is administration of thyroid hormone until
degeneration and cirrhotic liver changes. euthyroid(normal) state is achieved
 Reduction of dietary copper may be useful  If it affects a fetus prior to birth, cretinism develops
in treating this disease.  Hyperthyroidism
 Also be arrested by giving chelating agents  Excessive activity of thyroid gland brought by
like penicillamine to mobilize copper from deficiency of iodine producing an enlarged excretory
tissues and promote excretion in the urine. gland as a result of hyperplasia of the cells lining the
 Copper follicles along with increased colloidal material
 Excess copper concentrations found in human saliva  Produces hypermetabolic rate(increase pulse rate,
appear to inhibit acid production, although there is temperature and blood pressure, extreme
nothing conclusive to this theory. nervousness, irritability, increased sweating, dyspnea,
 Daily intake is 2 to 3mg weight loss and tiredness)
 COBALT  Patients with diffuse primary thyroid hyperplasia may
 Cobalt develop exopthalmos(abnormal protrusion of the
 Part of the vitamin B₁₂ molecule eyeball)
 May also be involved in the metabolism of sulfur  Oral Effects of Imbalance
containing amino acids  In severe hypothyroidism, jaws are small and rate of
 Inadequacies of cobalt will cause anemia tooth eruption is retarded
 Essential for adequate nutrition of sheep and cattle,  Hyperthyroid patients conceivably develop caries
deficiency will cause extreme emaciation and wasting. rapidly due to their increased need for calories and
 High dose of cobalt stimulates the bone marrow to possible use of excessive sugars
produce excessive numbers of red cells(polycythemia)  Effects on development of dental caries
and higher than normal hemoglobin level  Mineral Elements That May Inhibit or Promote Caries
 MANGANESE  5 Categories of Elements accdg. to their Cariogenicity
 Manganese (by Navia)
 Functions : 1. Caries-promoting: Selenium, Magnesium,
1. needed for normal bone structure Cadmium, Platinum, Lead, Silicon
2. For reproduction 2. Mildly cariostatic: Molybdenum, Strontium,
3. Normal functioning of CNS Calcium, Boron, Lithium, Gold
4. Important catalyst and component of many enzymes in 3. With doubtful effect on caries: Beryllium,
body, Enzymes involved in the synthesis of Cobalt, Manganese, Tin, Zinc, Bromine,
carbohydrates, those necessary for the protection of Iodine
cells from high levels of oxygen and enzymes necessary 4. Caries-inert: Barium, Aluminum, Nickel,
for mucopolysaccharide synthesis Iron, Palladium, Titanium
 Manganese 5. Strongly cariostatic: Fluorine, Phosphorus
 Effects of deficiency and excess :  Possible Mechanism of Trace Elements Action on
1. Manganese deficiency produces skeletal abnormalities Dental Caries
in animals  By altering the resistance of the tooth by modifying the
2. Excesses can produce profound neurological local environment at the plaque-tooth enamel
disturbances similar to those of Parkinson’s disease interface
 Manganese  By altering the size of enamel crystals available to acid
 Average adult estimated safe and adequate daily exposure; influencing enamel solubility
dietary intake appears to be between 2.5 to 5mg  Smaller crystals have a greater surface area (more
 IODINE exposed to acid solubility) than larger crystals in
 Iodine enamel rods of similar size
 One of the first trace elements recognized essential for  By influencing the microbial ecology of plaque to either
normal health inhibit or promote the growth of caries-producing
 Integral part of the hormones thyroxine and bacteria
triiodothyronine, functions to maintain the control of
the energy metabolism of the body. CHAPTER 13
 Most important in synthesis of thyroid hormone is the
ability of the thyroid gland to trap and oxidize iodine  Food Composition,
molecules into free iodine. Preparation,Processing,
 Effects of Imbalance Preservation, Fabrication, and Labeling
 Hypothyroidism  Food Composition
 Goiter, Thyroid gland enlargement  Food
 Develops swelling in the front of neck in the area of an edible substance made up of a variety of nutrients
hyoid bone that nourish the body
 Iodine deficiency Two Categories:
 Potassium iodide in small doses may completely a. Plant
eliminate goiter b. Animal
 Current level of enrichment furnishes 76 mg of iodine  Plant Foods
per g of salt

13.  where the food eaten by human beings,including  An incomplete protein unless combined with at least
meat, originates complementary protein such as corn or rice
 Basic requirement for human survival Peanut
 Three very good reasons why to increase intake of  Not a true nut but a beanlike legume,rich in oils and
plant foods: protein
› 1. more readily available  1 pound of peanut provides more protein(but
› 2. more economical incomplete) than a pound steak,more carbohydrate
› 3. more healthful than a pound of potatoes,approximately as much fat
 Cereals as pound of butter
 Derived from the seed of grasses  Double virtue
 Important cereal grains: 1. high in food value
› Corn 2. have long shelf-life
› Wheat Soybean
› Rice  Most important legume
› Barley  Dry,whole bean contains 40% protein and 20% fat
› Rye  Soy can be used as a flour in bread or as a breakfast
› Oats food
Corn  Fruits
 or maize,first grown by American Indians  Edible,more or less succulent,products of seed-
 most truly American cereal bearing plants
› Sweet corn › Fleshy fruits
 Developed by hybrid breeding  Have numbers of seeds in the
 High quality and suitable for center of their pulp such as
human consumption apples and pears
› Yellow corn › Stone fruits
rich in carotene (provitamin A), zein ( an incomplete  Contain a single
protein of low biological value), and starch stone or pit such as
Wheat peaches,cherries,
 is grown in temperate climates of countries and apricots
 contains gluten (a highly nutritious protein)  Fruit-vegetables
Rice › Known as vegetables but really are fruits
 Principal cereal food commodity of Asians such as tomatoes,peppers,okra,squash,
 Grown in moist tropical or semitropical climates and avocadoes
› Bran of the rice  Fruits like banana,fig,coconut,date and breadfruit
 removed by polishing or milling  Are staple articles of food for
to make the rich kernel more people of the tropics
palatable,lowered nutrional • Apple is the most popular fruit and next to it are the
value of rice citrus fruits—oranges, lemons,limes and grapefruit
 rich in thiamin(can be preserved  Fruits are good sources for:
only if the unhusked rice is › Vitamin C
parboiled) › Cellulose
Barley  Decreases the time of passage
 Hardy plant and is the oldest known cereal of waste products through the
 Used in soups and as flour for infants who may be large intestine
allergic to wheat › Pectin
 Used as malt and as food for livestock  Assists in formation of jelly
Rye › Fructose and glucose
 Grown in cold northern climates  Citrus fruits and peaches yield an alkaline ash(fully
 Used in making rye bread oxidized in the body)
Oats  Plums and cranberries yield an acid ash( used in
 Eaten mostly in the form of cooked oatmeal,contain conjunction with a low-calcium dieatary regimen to
slightly more protein,Ca,and fat than any other create a urinary environment less conducive to
cooked cereal formation of kidney stones
 Used mainly as food for livestock  Vegetables
 Legumes  May be any part of the plant, the leaf stalk,leaves or
 pods, the seed case of peas,beans, or lentils the roots.
 Have almost twice as much protein than cereal grains  Greatest part of it is water, therefore it is sensitive to
 used as meat substitute weather changes and tend to spoil quickly
› Dried peas › Vitamins most commonly found in
 22% protein because of their vegetables
low moisture content  Ascorbic acid,B complex
› Fresh peas or cooked dried ones vitamins,provitamin A
 6% to 8% protein › Minerals most commonly found in
 Average serving of legumes= 1/3 as much protein as vegetables
an average serving of meat  Calcium and Iron