Trace Elements in Human Nutrition and Health
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Trace elements in human nutrition and health World Health Organization Geneva 1996 WHO Library Cataloguing in Publication Data Trace elements in human nutrition and health. 1.Trace elements - metabolism 2.Trace elements - standards 3.Nutrition 4.Nutritional requirements ISBN 92 4 156173 4 (NLM Classification: QU 130) The World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or ~nfull. Applications and enquiries should be addressed to the Office of Publications, World Health Organization, Geneva, Switzerland, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. @ World Health Organization 1996 Publications of the World Health Organlzatlon enjoy copyright protection In accordance wlth the provisions of Protocol 2 of the Universal Copyright Convention All rlghts reserved The designations employed and the presentation of the materlal ~nthls publlcatlon do not imply the expression of any oplnlon whatsoever on the part of the Secretariat of the World Health Organlzatlon concernlng the legal status of any country territory, clty or area or of its authorities, or concernlng the delim~tatlonof ~tsfrontiers or boundaries The mention of speclflc companies or of certaln manufacturers' products does not Imply that they are endorsed or recommended by the World Health Organlzatlon In preference to others of a s~mllarnature that are not ment~onedErrors and omlsslons excepted the names of proprietary products are dist~ngulshedby lnltlal capltal letters The contributors alone are responsible for the views expressed in th~spublication TYPESET IN INDIA PRINTED IN BELGIUM Contents Preface xv Abbreviations used in the text xvii Technical note xviii 1. Introduction 1 1 .l Background 1.2 Structure and content of the report References 5 2. Trace-element requirements and safe ranges of population mean intakes 2.1 Definitions 7 2.1 .l Definitions relating to the needs of individuals 8 2.1.2 Definitions relating to population group mean intakes I0 2.2 Derivation of estimates 12 2.3 Application and interpretation of requirement estimates 15 2.3.1 Prescriptive application-food and nutrition planning 15 2.3.2 Diagnostic application-assessment of observed intakes 17 References 2 0 3. Trace-element bioavailability and interactions 2 2 3.1 Physiological variables influencing trace-element utilization 2 3 3.1 .l Age-related changes 2 3 3.1.2 Influence of trace-element intake and status 2 5 TRACE ELEMENTS IN HUMAN NUTRITION AND HEALTH 3.2 Metabolic and functional aspects of bioavailability 3.2.1 Multielement interactions ~nvolvingiron 3.2.2 Tissue anabolism/catabolism and utilization of tissue zlnc 3.2.3 Selenium status and iodine utilization 3.2.4 Other functional interactions 3 3 lnteractions limiting element mobility 3.3.1 Interactions involving dietary phvtate and other inositol phosphates 3.3.2 Influence of phytate/protein interactions on zinc availability 3.3.3 lnteractions of phytate with other metals 3.3.4 Iron-related antagonistic interactions 3.3.5 Other factors influencing element mobility and utilization 3.3.6 Other extrinsic variables influencing bioavailabil~ty 3.4 Conclusions and nutritional implications 3.4.1 Copper 3.4.2 lodine 3.4.3 Lead and cadmium 3.4.4 Selenium 3.4.5 Zinc References A. Essential trace elements 47 4. iodine 4 1 Introduction 4.2 Iodine-deficiency disorders 4.2.1 Goitre 4.2.2 Fetal iodine deficiency 4.2.3 Neonatal iodine deficiency 4.2.4 lodine deficiency in children 4.2.5 lodine deficiency in adults 4.2.6 lodine deficiency in animals 4 3 Epidemiology and control of iodine-deficiency disorders 4.4 Assessment of status CONTENTS 4.5 Intake, absorption and bioavailability 4 6 Requirements 4.7 Correction of Iodine deficiency 4.7.1 Iodized salt 4.7.2 lod~nesupplements for animals 4.7.3 lodized oil by injection 4.7.4 Iodized oil by mouth 4.7.5 Indications for different methods of iodine supplementation 4.8 Toxicity and hyperthyroidism 4.8.1 Toxicity 4.8.2 Iodine-induced hyperthyroidism 4.8.3 Safe upper limits of intake 4 9 Recommendations for future research and other activities 67 References 68 5. Zinc 5.1 Biochemical function 5.2 Deficiency and toxicity 5.2 7 Deficiency 5.2.2 Toxicity Epidemiology of deficiency Assessment of status Metabolism Absorption and bioavailability Dietary sources and intake Physiological requirements 5.8.1 Adults 5.8.2 Infants, children and adolescents 5.8.3 Tissue growth 5.8.4 Pregnancy 5.8.5 Lactation Dietary requirements 5.9.1 Bioavailability of dietary zinc 5.9.2 Infants consuming maternal milk or formula feeds 5.9.3 Estimation of individual requirements 5.9.4 Estimation of population requirements TRACE ELEMENTS IN HUMAN NUTRITION AND HEALTH 5.9.5 Implications and limitations of requirement estimates 94 5.10 Upper limits of intakes 5.1 1 Recommendations for future studies References 101 6. Selenium 105 6.1 Biochemical function 6.2 Deficiency and toxicity 6.2.1 Deficiency 6.2.2 Toxicity 6.3 Epidemiology of deficiency and toxicity 108 6.4 Assessment of status 109 6.5 Absorption and bioavailability 109 6.6 Dietary intake 110 6 7 Requirements and safe range of population mean intakes 112 6.7.1 Requirements of adults, adolescents and infants 112 6.7.2 Pregnancy and lactation 114 6.8 Tolerance of high dietary intakes 6.9 Recommendations for future studies References 120 7. Copper 123 7.1 Tissue distribution 7.2 Biochemical function 7.3 Symptoms of deficiency and toxicity 7.3.1 Deficiency 7.3.2 Toxicity 7.4 Epidemiology of deficiency 127 7.5 Dietary intake and bioavailability 127 7.6 Requirements and safe ranges of population mean intakes 130 7.6.1 Adult basal requirement 1 30 7.6.2 Adult normative requirement 132 7.6.3 Minimum population mean intakes 133 7.6.4 Requirements of infants 133 CONTENTS 7.6.5 Basal and normative requirements of children and adolescents 7.6.6 Requirements for pregnancy and lactation 7.6.7 Safe upper limits of population mean intakes 7.6.8 Comparison of reference values with dietary intakes 7.7 Recommendations for future studies References 8. Molybdenum 8.1 Biochemical function 8.2 Deficiency and toxicity 8.2.1 Deficiency 8.2.2 Toxicity (molybdenosis) 8.3 Epidemiology of deficiency and toxicity 8.3.1 Cancer 8.3.2 Dental caries 8.3.3 Keshan disease 8.4 Absorption and bioavailability 8.5 Dietary intake 8.5.1 Infants and children 8.5.2 Adolescents and adults 8.5.3 Tissue status 8.6 Requirements 8.7 Safe population mean intake References 9. Chromium Biochemical function Deficiency and toxicity Epidemiology of deficiency and toxicity Assessment of status Absorption and bioavailability Dietary intake Safe range of population mean intakes Recommendations for future studies References TRACE ELEMENTS IN HUMAN NUTRITION AND HEALTH B. Trace elements that are probably essential 10. Manganese Biochemical function Deficiency and toxicity Epidemiology of deficiency and toxicity Assessment of status Absorption and bioavailability Dietary intake Requirement and tolerable intakes Recommendations for future studies References 11. Silicon References 12. Nickel 12.1 Biochemical functron 12.2 Deficiency and toxicity 12.3 Epidemiology of deficiency and toxiclty 12.4 Assessment of status 12.5 Absorption and bioavailability 12.6 Dietary intake 12.7 Requirement and tolerable intakes References 13. Boron Biochemical function Deficiency and toxicity Epidemiology of defrciency and toxicity Assessment of status Absorption and bioava~lability Dietary intake Safe range of population mean intakes Recommendations for future studies References CONTENTS 14. Vanadium 14.1 Biochemical function 14.2 Deficiency and toxic~ty 14.3 Epidemiology of deficiency and toxicity 14.4 Assessment of status 14.5 Absorption and bioavailability 14.6 Dietary intake 14.7 Requ~rementand tolerable intakes References C. Potentially toxic elements, some possibly with essential functions 15. Fluoride 15.1 Absorption 15.2 Biochemical function 15.3 Tissue fluoride 15.4 Balance studies 15.5 Toxicity 15.5.1 Interactions with calcium 15.6 Intake 15.6 1 Infants 15 6.2 Children and adults 15.7 Safe levels 15.8 Recommendations for future studies References 16. Lead, cadmium and mercury 16.1 Variables influencing tolerance 16.1.l Stage of physiological development 16.1.2 Nutrition 16.1.3 Liquid diets 16.1.4 Other variables 16.2 Entry into food chains TRACE ELEMENTS IN HUMAN NUTRITION AND HEALTH 16.3 Toxicity of lead 16.3.1 Neurological, neurobehavioural and developmental effects in children 16.3.2 Haematological effects 1 6.3.3 Renal effects 1 6.3.4 Effect on blood pressure 16.3.5 Other effects 16.3.6 Biochemical signs of intoxication 16.3.7 Maximum tolerable intakes 16.4- Toxicity of cadmium 16.4.1 Kidney damage 16.4.2 Skeletal damage 16.4.3 Pulmonary damage 16.4.4 Biochemical signs of intoxication 16.4.5 Maximum tolerable intakes 16.5 Toxicity of mercury 16.5.1 Signs of intoxication 16.5.2 Maximum tolerable intakes 16.6 Possible essentiality of lead and cadmium 16.6.1 Lead 16.6.2 Cadmium References 17. Arsenic References 18. Aluminium References 19. Lithium References 20. Tin 20.1 Biochemical function 20.2 Claimed deficiency and toxicity 20.3 Epidemiology of deficiency and toxicity 20.4 Assessment of status CONTENTS 20.5 Absorpt~onand bioavailability 20.6 Dietary intake 20.7 Requirement and tolerable intakes References D. Conduct and interpretation of trace-element investigations 21. Analytical methodology 21 .l Biomedical specimens 21 .l .l Sample quality 21 .l .2 Presampling factors