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In: defintin
In, ne f the mst abndant metas n Eath, is essentia t mst ife fms and t nma hman physigy. In is an intega pat f many pteins and enzymes that maintain gd heath. In hmans, in is an essentia mpnent f pteins invved in xygen tanspt. It is as essentia f the egatin f e gwth and diffeentiatin. A defiieny f in imits xygen deivey t es, esting in fatige, p wk pefmane, and deeased immnity . n the the hand, exess amnts f in an est in txiity and even death
Amst tw-thids f in in the bdy is fnd in hemgbin, the ptein in ed bd es that aies xygen t tisses. Smae amnts f in ae fnd in mygbin, a ptein that heps sppy xygen t mse, and in enzymes that assist bihemia eatins. In is as fnd in pteins that ste in f fte needs and that tanspt in in bd. In stes ae egated by intestina in absptin
Fds pvide in
Thee ae tw fms f dietay in: heme and nnheme. Heme in is deived fm hemgbin, the ptein in ed bd es that deives xygen t es. Heme in is fnd in anima fds that iginay ntained hemgbin, sh as ed meats, fish, and pty. In in pant fds sh as entis and beans is aanged in a hemia stte aed nnheme in. This is the fm f in added t in-enihed and in-ftified fds. Heme in is absbed bette than nnheme in, bt mst dietay in is nnheme in.
Fats affets in absptin
In absptin efes t the amnt f dietay in that the bdy btains and ses fm fd. Heathy adts absb abt 10% t 15% f dietay in, bt individa absptin is infened by sevea fats.
Stage eves f in have the geatest infene n in absptin. In absptin ineases when bdy stes ae w. When in stes ae high, absptin deeases t hep ptet against txi effets f in vead. In absptin is as infened by the type f dietay in nsmed. Absptin f heme in fm meat pteins is effiient. Absptin f heme in anges fm 15% t 35%, and is nt signifianty affeted by diet. In ntast, 2% t 20% f nnheme in in pant fds sh as ie, maize, bak beans, sybeans and wheat is absbed. Nnheme in absptin is signifianty infened by vais fd mpnents.
Meat pteins and vitamin wi impve the absptin f nnheme in. Tannins (fnd in tea), aim, pyphens, and phytates (fnd in egmes and whe gains) an deease absptin f nnheme in. Sme pteins fnd in sybeans as inhibit nnheme in absptin. It is mst imptant t inde fds that enhane nnheme in absptin when daiy in intake is ess than emmended, when in sses ae high (whih may with heavy mensta sses), when in eqiements ae high (as in pegnany), and when ny vegetaian nnheme ses f in ae nsmed.
emmended intake f in
emmendatins f in ae pvided in the Dietay efeene Intakes (DIs) deveped by the Institte f Mediine f the Natina Aademy f Sienes. Dietay efeene Intakes is the genea tem f a set f efeene vaes sed f panning and assessing ntient intake f heathy pepe. Thee imptant types f efeene vaes inded in the DIs ae emmended Dietay Awanes (DA), Adeqate Intakes (AI), and Teabe ppe Intake eves (). The DA emmends the aveage daiy intake that is sffiient t meet the ntient eqiements f neay a (97-98%) heathy individas in eah age and gende gp. An AI is set when thee is insffiient sientifi data avaiabe t estabish a DA. AIs meet exeed the amnt needed t maintain a ntitina state f adeqay in neay a membes f a speifi age and gende gp. The , n the the hand, is the maximm daiy intake nikey t est in advese heath effets.
Heathy f tem infants ae bn with a sppy f in that asts f 4 t 6 mnths. Thee is nt engh evidene avaiabe t estabish a DA f in f infants fm bith thgh 6 mnths f age. emmended in intake f this age gp is based n an Adeqate Intake (AI) that efets the aveage in intake f heathy infants fed beast mik..
In in hman beast mik is we absbed by infants. It is estimated that infants an se geate than 50% f the in in beast mik as mpaed t ess than 12% f the in in infant fma. The amnt f in in w's mik is w, and infants py absb it. Feeding w's mik t infants as may est in gastintestina beeding. F these easns, w's mik shd nt be fed t infants nti they ae at east 1 yea d. The Ameian Aademy f Pediatis (AAP) emmends that infants be exsivey beast fed f the fist six mnths f ife. Gada intdtin f in-enihed sid fds shd mpement beast mik fm 7 t 12 mnths f age. Infants weaned fm beast mik befe 12 mnths f age shd eeive in-ftified infant fma. Infant fmas that ntain fm 4 t 12 miigams f in pe ite ae nsideed in-ftified.
Data fm the Natina Heath and Ntitin Examinatin Svey (NHANES) desibe dietay intake f Ameians 2 mnths f age and de. NHANES (1988-94) data sggest that maes f a aia and ethni gps nsme emmended amnts f in. Hweve, in intakes ae geneay w in femaes f hidbeaing age and yng hiden.
eseahes as examine speifi gps within the NHANES ppatin. F exampe, eseahes have mpaed dietay intakes f adts wh nside themseves t be fd insffiient (and theefe have imited aess t ntitinay adeqate fds) t thse wh ae fd sffiient (and have easy aess t fd). de adts fm fd insffiient famiies had signifianty we intakes f in than de adts wh ae fd sffiient. In ne svey, twenty peent f adts age 20 t 59 and 13.6% f adts age 60 and de fm fd insffiient famiies nsmed ess than 50% f the DA f in, as mpaed t 13% f adts age 20 t 50 and 2.5% f adts age 60 and de fm fd sffiient famiies.
In intake is negativey infened by w ntient density fds, whih ae high in aies bt w in vitamins and mineas. Sga sweetened sdas and mst dessets ae exampes f w ntient density fds, as ae snak fds sh as ptat hips. Amng amst 5,000 hiden and adesents between the ages f 8 and 18 wh wee sveyed, w ntient density fds ntibted amst 30% f daiy ai intake, with sweetenes and dessets jinty anting f amst 25% f ai intake. Thse hiden and adesents wh nsmed fewe "w ntient density" fds wee me ikey t nsme emmended amnts f in.
Data fm The ntining Svey f Fd Intakes by Individas (SFII1994-6 and 1998) was sed t examine the effet f maj fd and beveage ses f added sgas n mintient intake f .S. hiden aged 6 t 17 yeas. eseahes fnd that nsmptin f pesweetened eeas, whih ae ftified with in, ineased the ikeihd f meeting emmendatins f in intake. n the the hand, as intake f sga-sweetened beveages, sgas, sweets, and sweetened gains ineased, hiden wee ess ikey t nsme emmended amnts f in.
In defiieny
The Wd Heath ganizatin nsides in defiieny the nmbe ne ntitina disde in the wd. As many as 80% f the wd's ppatin may be in defiient, whie 30% may have in defiieny anemia.
In defiieny deveps gaday and say begins with a negative in baane, when in intake des nt meet the daiy need f dietay in. This negative baane initiay depetes the stage fm f in whie the bd hemgbin eve, a make f in stats, emains nma. In defiieny anemia is an advaned stage f in depetin. It s when stage sites f in ae defiient and bd eves f in annt meet daiy needs. Bd hemgbin eves ae bew nma with in defiieny anemia.
In defiieny anemia an be assiated with w dietay intake f in, inadeqate absptin f in, exessive bd ss. Wmen f hidbeaing age, pegnant wmen, petem and w bith weight infants, de infants and tddes, and teenage gis ae at geatest isk f deveping in defiieny anemia bease they have the geatest need f in. Wmen with heavy mensta sses an se a signifiant amnt f in and ae at nsideabe isk f in defiieny. Adt men and pst-menpasa wmen se vey itte in, and have a w isk f in defiieny.
Individas with kidney faie, espeiay thse being teated with diaysis, ae at high isk f deveping in defiieny anemia. This is bease thei kidneys annt eate engh eythpietin, a hmne needed t make ed bd es. Bth in and eythpietin an be st ding kidney diaysis. Individas wh eeive tine diaysis teatments say need exta in and syntheti eythpietin t pevent in defiieny.
Vitamin A heps mbiize in fm its stage sites, s a defiieny f vitamin A imits the bdy's abiity t se sted in. This ests in an "appaent" in defiieny bease hemgbin eves ae w even thgh the bdy an maintain nma amnts f sted in. Whie nmmn in the .S., this pbem is seen in deveping nties whee vitamin A defiieny ften s.
hni maabsptin an ntibte t in depetin and defiieny by imiting dietay in absptin by ntibting t intestina bd ss. Mst in is absbed in the sma intestines. Gastintestina disdes that est in infammatin f the sma intestine may est in diahea, p absptin f dietay in, and in depetin.
Signs f in defiieny anemia inde:
feeing tied and weak
deeased wk and sh pefmane
sw gnitive and sia devepment ding hidhd
diffity maintaining bdy tempeate
deeased immne fntin, whih ineases sseptibiity t infetin
gssitis (an infamed tnge)
Eating nnntitive sbstanes sh as dit and ay, ften efeed t as pia gephagia, is smetimes seen in pesns with in defiieny. Thee is disageement abt the ase f this assiatin. Sme eseahes beieve that these eating abnmaities may est in an in defiieny. the eseahes beieve that in defiieny may smehw inease the ikeihd f these eating pbems.
Pepe with hni infetis, infammaty, maignant disdes sh as athitis and ane may beme anemi. Hweve, the anemia that s with infammaty disdes diffes fm in defiieny anemia and may nt espnd t in sppements. eseah sggests that infammatin may ve-ativate a ptein invved in in metabism. This ptein may inhibit in absptin and ede the amnt f in iating in bd, esting in anemia.
Wh may need exta in t pevent a defiieny?.steps
Thee gps f pepe ae mst ikey t benefit fm in sppements: pepe with a geate need f in, individas wh tend t se me in, and pepe wh d nt absb in nmay. These individas inde:
pegnant wmen
petem and w bith weight infants
de infants and tddes
teenage gis
wmen f hidbeaing age, espeiay thse with heavy mensta sses
pepe with ena faie, espeiay thse ndeging tine diaysis
pepe with gastintestina disdes wh d nt absb in nmay
eia Disease and hn's Syndme ae assiated with gastintestina maabsptin and may impai in absptin. In sppementatin may be needed if these nditins est in in defiieny anemia.
Wmen taking a ntaeptives may expeiene ess beeding ding thei peids and have a we isk f deveping an in defiieny. Wmen wh se an intateine devie (ID) t pevent pegnany may expeiene me beeding and have a geate isk f deveping an in defiieny. If abaty tests indiate in defiieny anemia, in sppements may be emmended.
Tta dietay in intake in vegetaian diets may meet emmended eves; hweve that in is ess avaiabe f absptin than in diets that inde meat. Vegetaians wh exde a anima pdts fm thei diet may need amst twie as mh dietay in eah day as nn-vegetaians bease f the we intestina absptin f nnheme in in pant fds. Vegetaians shd nside nsming nnheme in ses tgethe with a gd se f vitamin , sh as its fits, t impve the absptin f nnheme in.
Thee ae many ases f anemia, inding in defiieny. Thee ae as sevea ptentia ases f in defiieny. Afte a thgh evaatin, physiians an diagnse the ase f anemia and pesibe the apppiate teatment.
Des pegnany inease the need f in?..k
Ntient eqiements inease ding pegnany t sppt feta gwth and matena heath. In eqiements f pegnant wmen ae appximatey dbe that f nn-pegnant wmen bease f ineased bd vme ding pegnany, ineased needs f the fets, and bd sses that ding deivey. If in intake des nt meet ineased eqiements, in defiieny anemia an . In defiieny anemia f pegnany is espnsibe f signifiant mbidity, sh as pemate deiveies and giving bith t infants with w bith weight.
w eves f hemgbin and hematit may indiate in defiieny. Hemgbin is the ptein in ed bd es that aies xygen t tisses. Hematit is the pptin f whe bd that is made p f ed bd es. Ntitinists estimate that ve haf f pegnant wmen in the wd may have hemgbin eves nsistent with in defiieny. In the .S., the entes f Disease nt (D) estimated that 12% f a wmen age 12 t 49 yeas wee in defiient in 1999-2000. When bken dwn by gps, 10% f nn-Hispani white wmen, 22% f Mexian-Ameian wmen, and 19% f nn-Hispani bak wmen wee in defiient. Pevaene f in defiieny anemia amng we inme pegnant wmen has emained the same, at abt 30%, sine the 1980s.
The DA f in f pegnant wmen ineases t 27 mg pe day. nftnatey, data fm the 1988-94 NHANES svey sggested that the median in intake amng pegnant wmen was appximatey 15 mg pe day. When median in intake is ess than the DA, me than haf f the gp nsmes ess in than is emmended eah day.
Sevea maj heath ganizatins emmend in sppementatin ding pegnany t hep pegnant wmen meet thei in eqiements. The D emmends tine w-dse in sppementatin (30 mgday) f a pegnant wmen, beginning at the fist penata visit. When a w hemgbin hematit is nfimed by epeat testing, the D emmends age dses f sppementa in. The Institte f Mediine f the Natina Aademy f Sienes as sppts in sppementatin ding pegnany. bstetiians ften mnit the need f in sppementatin ding pegnany and pvide individaized emmendatins t pegnant wmen.
Sme fats abt in sppements:
In sppementatin is indiated when diet ane annt este defiient in eves t nma within an aeptabe timefame. Sppements ae espeiay imptant when an individa is expeiening inia symptms f in defiieny anemia. The gas f pviding a in sppements ae t sppy sffiient in t este nma stage eves f in and t epenish hemgbin defiits. When hemgbin eves ae bew nma, physiians ften mease sem feitin, the stage fm f in. A sem feitin eve ess than eqa t 15 migams pe ite nfims in defiieny anemia in wmen, and sggests a pssibe need f in sppementatin.
Sppementa in is avaiabe in tw fms: fes and fei. Fes in sats (fes fmaate, fes sfate, and fes gnate) ae the best absbed fms f in sppements. Eementa in is the amnt f in in a sppement that is avaiabe f absptin. Fige 1 ists the peent eementa in in these sppements.
The amnt f in absbed deeases with ineasing dses. F this easn, it is emmended that mst pepe take thei pesibed daiy in sppement in tw thee eqay spaed dses. F adts wh ae nt pegnant, the D emmends taking 50 mg t 60 mg f a eementa in (the appximate amnt f eementa in in ne 300 mg tabet f fes sfate) twie daiy f thee mnths f the theapeti teatment f in defiieny anemia. Hweve, physiians evaate eah pesn individay, and pesibe ading t individa needs.
Theapeti dses f in sppements, whih ae pesibed f in defiieny anemia, may ase gastintestina side effets sh as nasea, vmiting, nstipatin, diahea, dak ed sts, and abdmina distess. Stating with haf the emmended dse and gaday ineasing t the f dse wi hep minimize these side effets. Taking the sppement in divided dses and with fd as may hep imit these symptms. In fm entei ated deayed-eease pepaatins may have fewe side effets, bt is nt as we absbed and nt say emmended.
Physiians mnit the effetiveness f in sppements by measing abaty indies, inding etiyte nt (eves f newy fmed ed bd es), hemgbin eves, and feitin eves. In the pesene f anemia, etiyte nts wi begin t ise afte a few days f sppementatin. Hemgbin say ineases within 2 t 3 weeks f stating in sppementatin.
In ae sitatins paentea in (pvided by injetin I.V.) is eqied. Dts wi aefy manage the administatin f paentea in.
Wh shd be atis abt taking in sppements?.
In defiieny is nmmn amng adt men and pstmenpasa wmen. These individas shd ny take in sppements when pesibed by a physiian bease f thei geate isk f in vead. In vead is a nditin in whih exess in is fnd in the bd and sted in gans sh as the ive and heat. In vead is assiated with sevea geneti diseases inding hemhmatsis, whih affets appximatey 1 in 250 individas f nthen Epean desent. Individas with hemhmatsis absb in vey effiienty, whih an est in a bid p f exess in and an ase gan damage sh as ihsis f the ive and heat faie. Hemhmatsis is ften nt diagnsed nti exess in stes have damaged an gan. In sppementatin may aeeate the effets f hemhmatsis, an imptant easn why adt men and pstmenpasa wmen wh ae nt in defiient shd avid in sppements. Individas with bd disdes that eqie feqent bd tansfsins ae as at isk f in vead and ae say advised t avid in sppements.
What ae sme ent isses and ntvesies abt in?.
In and heat disease:
Bease knwn isk fats annt expain a ases f heat disease, eseahes ntine t k f new ases. Sme evidene sggests that in an stimate the ativity f fee adias. Fee adias ae nata by-pdts f xygen metabism that ae assiated with hni diseases, inding adivasa disease. Fee adias may infame and damage nay ateies, the bd vesses that sppy the heat mse. This infammatin may ntibte t the devepment f athesesis, a nditin haateized by patia mpete bkage f ne me nay ateies. the eseahes sggest that in may ntibte t the xidatin f D ("bad") heste, hanging it t a fm that is me damaging t nay ateies.
As fa bak as the 1980s, sme eseahes sggested that the ega mensta ss f in, athe than a ptetive effet fm estgen, d bette expain the we inidene f heat disease seen in pe-menpasa wmen. Afte menpase, a wman's isk f deveping nay heat disease ineases ang with he in stes. eseahes have as bseved we ates f heat disease in ppatins with we in stes, sh as thse in deveping nties. In thse gegaphi aeas, we in stes ae attibted t w meat (and in) intake, high fibe diets that inhibit in absptin, and gastintestina (GI) bd (and in) ss de t paasiti infetins.
In the 1980s, eseahes inked high in stes with ineased isk f heat attaks in Finnish men. Hweve, me eent stdies have nt sppted sh an assiatin.
ne way f testing an assiatin between in stes and nay heat disease is t mpae eves f feitin, the stage fm f in, t the degee f athesesis in nay ateies. In ne stdy, eseahes examined the eatinship between feitin eves and athesesis in 100 men and wmen efeed f adia examinatin. In this ppatin, highe feitin eves wee nt assiated with an ineased degee f athesesis, as meased by angigaphy. nay angigaphy is a tehniqe sed t estimate the degee f bkage in nay ateies. In a diffeent stdy, eseahes fnd that feitin eves wee highe in mae patients diagnsed with nay atey disease. They did nt find any assiatin between feitin eves and isk f nay disease in wmen.
A send way t test this assiatin is t examine ates f nay disease in pepe wh feqenty dnate bd. If exess in stes ntibte t heat disease, feqent bd dnatin d ptentiay we heat disease ates bease f the in ss assiated with bd dnatin. ve 2,000 men ve age 39 and wmen ve age 50 wh dnated bd between 1988 and 1990 wee sveyed 10 yeas ate t mpae ates f adia events t feqeny f bd dnatin. adia events wee defined as (1) ene f an ate myadia infatin (heat attak), (2) ndeging angipasty, a media pede that pens a bked nay atey; (3) ndeging bypass gafting, a sgia pede that epaes bked nay ateies with heathy bd vesses. eseahes fnd that feqent dns, wh dnated me than 1 nit f whe bd eah yea between 1988 and 1990, wee ess ikey t expeiene adia events than asa dns (thse wh ny dnated a singe nit in that 3-yea peid). eseahes nded that feqent and ng-tem bd dnatin may deease the isk f adia events.
nfiting ests, and diffeent methds t mease in stes, make it diffit t eah a fina nsin n this isse. Hweve, eseahes knw that it is feasibe t deease in stes in heathy individa thgh phebtmy (bd etting dnatin). sing phebtmy, eseahes hpe t ean me abt in eves and adivasa disease.
In and intense exeise:
Many men and wmen wh engage in ega, intense exeise sh as jgging, mpetitive swimming, and ying have magina inadeqate in stats. Pssibe expanatins inde ineased gastintestina bd ss afte nning and a geate tnve f ed bd es. As, ed bd es within the ft an pte whie nning. F these easns, the need f in may be 30% geate in thse wh engage in ega intense exeise.
Thee gps f athetes may be at geatest isk f in depetin and defiieny: femae athetes, distane nnes, and vegetaian athetes. It is patiay imptant f membes f these gps t nsme emmended amnts f in and t pay attentin t dietay fats that enhane in absptin. If apppiate ntitin inteventin des nt pmte nma in stats, in sppementatin may be indiated. In ne stdy f femae swimmes, eseahes fnd that sppementatin with 125 miigams (mg) f fes sfate pe day pevented in depetin. These swimmes maintained adeqate in stes, and did nt expeiene the gastintestina side effets ften seen with highe dses f in sppementatin.
In and minea inteatins
Sme eseahes have aised nens abt inteatins between in, zin, and aim. When in and zin sppements ae given tgethe in a wate stin and witht fd, geate dses f in may deease zin absptin. Hweve, the effet f sppementa in n zin absptin des nt appea t be signifiant when sppements ae nsmed with fd. Thee is evidene that aim fm sppements and daiy fds may inhibit in absptin, bt it has been vey diffit t distingish between the effets f aim n in absptin vess the inhibity fats sh as phytate.
What is the isk f in txiity?.
Thee is nsideabe ptentia f in txiity bease vey itte in is exeted fm the bdy. Ths, in an amate in bdy tisses and gans when nma stage sites ae f. F exampe, pepe with hemahmatsis ae at isk f deveping in txiity bease f thei high in stes.
In hiden, death has ed fm ingesting 200 mg f in. It is imptant t keep in sppements tighty apped and away fm hiden's eah. Any time exessive in intake is sspeted, immediatey a y physiian Pisn nt ente, visit y a emegeny m. Dses f in pesibed f in defiieny anemia in adts ae assiated with nstipatin, nasea, vmiting, and diahea, espeiay when the sppements ae taken n an empty stmah.
In 2001, the Institte f Mediine f the Natina Aademy f Sienes set a teabe ppe intake eve () f in f heathy pepe. Thee may be times when a physiian pesibes an intake highe than the ppe imit, sh as when individas with in defiieny anemia need highe dses t epenish thei in stes.
Seeting a heathf diet
As the 2000 Dietay Gideines f Ameians states, "Diffeent fds ntain diffeent ntients and the heathf sbstanes. N singe fd an sppy a the ntients in the amnts y need". Beef and tkey ae gd ses f heme in whie beans and entis ae high in nnheme in. In additin, many fds, sh as eady-t-eat eeas, ae ftified with in. It is imptant f anyne wh is nsideing taking an in sppement t fist nside whethe thei needs ae being met by nata dietay ses f heme and nnheme in and fds ftified with in, and t disss thei ptentia need f in sppements with thei physiian.
مع تحيات أبو وسام
In, ne f the mst abndant metas n Eath, is essentia t mst ife fms and t nma hman physigy. In is an intega pat f many pteins and enzymes that maintain gd heath. In hmans, in is an essentia mpnent f pteins invved in xygen tanspt. It is as essentia f the egatin f e gwth and diffeentiatin. A defiieny f in imits xygen deivey t es, esting in fatige, p wk pefmane, and deeased immnity . n the the hand, exess amnts f in an est in txiity and even death
Amst tw-thids f in in the bdy is fnd in hemgbin, the ptein in ed bd es that aies xygen t tisses. Smae amnts f in ae fnd in mygbin, a ptein that heps sppy xygen t mse, and in enzymes that assist bihemia eatins. In is as fnd in pteins that ste in f fte needs and that tanspt in in bd. In stes ae egated by intestina in absptin
Fds pvide in
Thee ae tw fms f dietay in: heme and nnheme. Heme in is deived fm hemgbin, the ptein in ed bd es that deives xygen t es. Heme in is fnd in anima fds that iginay ntained hemgbin, sh as ed meats, fish, and pty. In in pant fds sh as entis and beans is aanged in a hemia stte aed nnheme in. This is the fm f in added t in-enihed and in-ftified fds. Heme in is absbed bette than nnheme in, bt mst dietay in is nnheme in.
Fats affets in absptin
In absptin efes t the amnt f dietay in that the bdy btains and ses fm fd. Heathy adts absb abt 10% t 15% f dietay in, bt individa absptin is infened by sevea fats.
Stage eves f in have the geatest infene n in absptin. In absptin ineases when bdy stes ae w. When in stes ae high, absptin deeases t hep ptet against txi effets f in vead. In absptin is as infened by the type f dietay in nsmed. Absptin f heme in fm meat pteins is effiient. Absptin f heme in anges fm 15% t 35%, and is nt signifianty affeted by diet. In ntast, 2% t 20% f nnheme in in pant fds sh as ie, maize, bak beans, sybeans and wheat is absbed. Nnheme in absptin is signifianty infened by vais fd mpnents.
Meat pteins and vitamin wi impve the absptin f nnheme in. Tannins (fnd in tea), aim, pyphens, and phytates (fnd in egmes and whe gains) an deease absptin f nnheme in. Sme pteins fnd in sybeans as inhibit nnheme in absptin. It is mst imptant t inde fds that enhane nnheme in absptin when daiy in intake is ess than emmended, when in sses ae high (whih may with heavy mensta sses), when in eqiements ae high (as in pegnany), and when ny vegetaian nnheme ses f in ae nsmed.
emmended intake f in
emmendatins f in ae pvided in the Dietay efeene Intakes (DIs) deveped by the Institte f Mediine f the Natina Aademy f Sienes. Dietay efeene Intakes is the genea tem f a set f efeene vaes sed f panning and assessing ntient intake f heathy pepe. Thee imptant types f efeene vaes inded in the DIs ae emmended Dietay Awanes (DA), Adeqate Intakes (AI), and Teabe ppe Intake eves (). The DA emmends the aveage daiy intake that is sffiient t meet the ntient eqiements f neay a (97-98%) heathy individas in eah age and gende gp. An AI is set when thee is insffiient sientifi data avaiabe t estabish a DA. AIs meet exeed the amnt needed t maintain a ntitina state f adeqay in neay a membes f a speifi age and gende gp. The , n the the hand, is the maximm daiy intake nikey t est in advese heath effets.
Heathy f tem infants ae bn with a sppy f in that asts f 4 t 6 mnths. Thee is nt engh evidene avaiabe t estabish a DA f in f infants fm bith thgh 6 mnths f age. emmended in intake f this age gp is based n an Adeqate Intake (AI) that efets the aveage in intake f heathy infants fed beast mik..
In in hman beast mik is we absbed by infants. It is estimated that infants an se geate than 50% f the in in beast mik as mpaed t ess than 12% f the in in infant fma. The amnt f in in w's mik is w, and infants py absb it. Feeding w's mik t infants as may est in gastintestina beeding. F these easns, w's mik shd nt be fed t infants nti they ae at east 1 yea d. The Ameian Aademy f Pediatis (AAP) emmends that infants be exsivey beast fed f the fist six mnths f ife. Gada intdtin f in-enihed sid fds shd mpement beast mik fm 7 t 12 mnths f age. Infants weaned fm beast mik befe 12 mnths f age shd eeive in-ftified infant fma. Infant fmas that ntain fm 4 t 12 miigams f in pe ite ae nsideed in-ftified.
Data fm the Natina Heath and Ntitin Examinatin Svey (NHANES) desibe dietay intake f Ameians 2 mnths f age and de. NHANES (1988-94) data sggest that maes f a aia and ethni gps nsme emmended amnts f in. Hweve, in intakes ae geneay w in femaes f hidbeaing age and yng hiden.
eseahes as examine speifi gps within the NHANES ppatin. F exampe, eseahes have mpaed dietay intakes f adts wh nside themseves t be fd insffiient (and theefe have imited aess t ntitinay adeqate fds) t thse wh ae fd sffiient (and have easy aess t fd). de adts fm fd insffiient famiies had signifianty we intakes f in than de adts wh ae fd sffiient. In ne svey, twenty peent f adts age 20 t 59 and 13.6% f adts age 60 and de fm fd insffiient famiies nsmed ess than 50% f the DA f in, as mpaed t 13% f adts age 20 t 50 and 2.5% f adts age 60 and de fm fd sffiient famiies.
In intake is negativey infened by w ntient density fds, whih ae high in aies bt w in vitamins and mineas. Sga sweetened sdas and mst dessets ae exampes f w ntient density fds, as ae snak fds sh as ptat hips. Amng amst 5,000 hiden and adesents between the ages f 8 and 18 wh wee sveyed, w ntient density fds ntibted amst 30% f daiy ai intake, with sweetenes and dessets jinty anting f amst 25% f ai intake. Thse hiden and adesents wh nsmed fewe "w ntient density" fds wee me ikey t nsme emmended amnts f in.
Data fm The ntining Svey f Fd Intakes by Individas (SFII1994-6 and 1998) was sed t examine the effet f maj fd and beveage ses f added sgas n mintient intake f .S. hiden aged 6 t 17 yeas. eseahes fnd that nsmptin f pesweetened eeas, whih ae ftified with in, ineased the ikeihd f meeting emmendatins f in intake. n the the hand, as intake f sga-sweetened beveages, sgas, sweets, and sweetened gains ineased, hiden wee ess ikey t nsme emmended amnts f in.
In defiieny
The Wd Heath ganizatin nsides in defiieny the nmbe ne ntitina disde in the wd. As many as 80% f the wd's ppatin may be in defiient, whie 30% may have in defiieny anemia.
In defiieny deveps gaday and say begins with a negative in baane, when in intake des nt meet the daiy need f dietay in. This negative baane initiay depetes the stage fm f in whie the bd hemgbin eve, a make f in stats, emains nma. In defiieny anemia is an advaned stage f in depetin. It s when stage sites f in ae defiient and bd eves f in annt meet daiy needs. Bd hemgbin eves ae bew nma with in defiieny anemia.
In defiieny anemia an be assiated with w dietay intake f in, inadeqate absptin f in, exessive bd ss. Wmen f hidbeaing age, pegnant wmen, petem and w bith weight infants, de infants and tddes, and teenage gis ae at geatest isk f deveping in defiieny anemia bease they have the geatest need f in. Wmen with heavy mensta sses an se a signifiant amnt f in and ae at nsideabe isk f in defiieny. Adt men and pst-menpasa wmen se vey itte in, and have a w isk f in defiieny.
Individas with kidney faie, espeiay thse being teated with diaysis, ae at high isk f deveping in defiieny anemia. This is bease thei kidneys annt eate engh eythpietin, a hmne needed t make ed bd es. Bth in and eythpietin an be st ding kidney diaysis. Individas wh eeive tine diaysis teatments say need exta in and syntheti eythpietin t pevent in defiieny.
Vitamin A heps mbiize in fm its stage sites, s a defiieny f vitamin A imits the bdy's abiity t se sted in. This ests in an "appaent" in defiieny bease hemgbin eves ae w even thgh the bdy an maintain nma amnts f sted in. Whie nmmn in the .S., this pbem is seen in deveping nties whee vitamin A defiieny ften s.
hni maabsptin an ntibte t in depetin and defiieny by imiting dietay in absptin by ntibting t intestina bd ss. Mst in is absbed in the sma intestines. Gastintestina disdes that est in infammatin f the sma intestine may est in diahea, p absptin f dietay in, and in depetin.
Signs f in defiieny anemia inde:
feeing tied and weak
deeased wk and sh pefmane
sw gnitive and sia devepment ding hidhd
diffity maintaining bdy tempeate
deeased immne fntin, whih ineases sseptibiity t infetin
gssitis (an infamed tnge)
Eating nnntitive sbstanes sh as dit and ay, ften efeed t as pia gephagia, is smetimes seen in pesns with in defiieny. Thee is disageement abt the ase f this assiatin. Sme eseahes beieve that these eating abnmaities may est in an in defiieny. the eseahes beieve that in defiieny may smehw inease the ikeihd f these eating pbems.
Pepe with hni infetis, infammaty, maignant disdes sh as athitis and ane may beme anemi. Hweve, the anemia that s with infammaty disdes diffes fm in defiieny anemia and may nt espnd t in sppements. eseah sggests that infammatin may ve-ativate a ptein invved in in metabism. This ptein may inhibit in absptin and ede the amnt f in iating in bd, esting in anemia.
Wh may need exta in t pevent a defiieny?.steps
Thee gps f pepe ae mst ikey t benefit fm in sppements: pepe with a geate need f in, individas wh tend t se me in, and pepe wh d nt absb in nmay. These individas inde:
pegnant wmen
petem and w bith weight infants
de infants and tddes
teenage gis
wmen f hidbeaing age, espeiay thse with heavy mensta sses
pepe with ena faie, espeiay thse ndeging tine diaysis
pepe with gastintestina disdes wh d nt absb in nmay
eia Disease and hn's Syndme ae assiated with gastintestina maabsptin and may impai in absptin. In sppementatin may be needed if these nditins est in in defiieny anemia.
Wmen taking a ntaeptives may expeiene ess beeding ding thei peids and have a we isk f deveping an in defiieny. Wmen wh se an intateine devie (ID) t pevent pegnany may expeiene me beeding and have a geate isk f deveping an in defiieny. If abaty tests indiate in defiieny anemia, in sppements may be emmended.
Tta dietay in intake in vegetaian diets may meet emmended eves; hweve that in is ess avaiabe f absptin than in diets that inde meat. Vegetaians wh exde a anima pdts fm thei diet may need amst twie as mh dietay in eah day as nn-vegetaians bease f the we intestina absptin f nnheme in in pant fds. Vegetaians shd nside nsming nnheme in ses tgethe with a gd se f vitamin , sh as its fits, t impve the absptin f nnheme in.
Thee ae many ases f anemia, inding in defiieny. Thee ae as sevea ptentia ases f in defiieny. Afte a thgh evaatin, physiians an diagnse the ase f anemia and pesibe the apppiate teatment.
Des pegnany inease the need f in?..k
Ntient eqiements inease ding pegnany t sppt feta gwth and matena heath. In eqiements f pegnant wmen ae appximatey dbe that f nn-pegnant wmen bease f ineased bd vme ding pegnany, ineased needs f the fets, and bd sses that ding deivey. If in intake des nt meet ineased eqiements, in defiieny anemia an . In defiieny anemia f pegnany is espnsibe f signifiant mbidity, sh as pemate deiveies and giving bith t infants with w bith weight.
w eves f hemgbin and hematit may indiate in defiieny. Hemgbin is the ptein in ed bd es that aies xygen t tisses. Hematit is the pptin f whe bd that is made p f ed bd es. Ntitinists estimate that ve haf f pegnant wmen in the wd may have hemgbin eves nsistent with in defiieny. In the .S., the entes f Disease nt (D) estimated that 12% f a wmen age 12 t 49 yeas wee in defiient in 1999-2000. When bken dwn by gps, 10% f nn-Hispani white wmen, 22% f Mexian-Ameian wmen, and 19% f nn-Hispani bak wmen wee in defiient. Pevaene f in defiieny anemia amng we inme pegnant wmen has emained the same, at abt 30%, sine the 1980s.
The DA f in f pegnant wmen ineases t 27 mg pe day. nftnatey, data fm the 1988-94 NHANES svey sggested that the median in intake amng pegnant wmen was appximatey 15 mg pe day. When median in intake is ess than the DA, me than haf f the gp nsmes ess in than is emmended eah day.
Sevea maj heath ganizatins emmend in sppementatin ding pegnany t hep pegnant wmen meet thei in eqiements. The D emmends tine w-dse in sppementatin (30 mgday) f a pegnant wmen, beginning at the fist penata visit. When a w hemgbin hematit is nfimed by epeat testing, the D emmends age dses f sppementa in. The Institte f Mediine f the Natina Aademy f Sienes as sppts in sppementatin ding pegnany. bstetiians ften mnit the need f in sppementatin ding pegnany and pvide individaized emmendatins t pegnant wmen.
Sme fats abt in sppements:
In sppementatin is indiated when diet ane annt este defiient in eves t nma within an aeptabe timefame. Sppements ae espeiay imptant when an individa is expeiening inia symptms f in defiieny anemia. The gas f pviding a in sppements ae t sppy sffiient in t este nma stage eves f in and t epenish hemgbin defiits. When hemgbin eves ae bew nma, physiians ften mease sem feitin, the stage fm f in. A sem feitin eve ess than eqa t 15 migams pe ite nfims in defiieny anemia in wmen, and sggests a pssibe need f in sppementatin.
Sppementa in is avaiabe in tw fms: fes and fei. Fes in sats (fes fmaate, fes sfate, and fes gnate) ae the best absbed fms f in sppements. Eementa in is the amnt f in in a sppement that is avaiabe f absptin. Fige 1 ists the peent eementa in in these sppements.
The amnt f in absbed deeases with ineasing dses. F this easn, it is emmended that mst pepe take thei pesibed daiy in sppement in tw thee eqay spaed dses. F adts wh ae nt pegnant, the D emmends taking 50 mg t 60 mg f a eementa in (the appximate amnt f eementa in in ne 300 mg tabet f fes sfate) twie daiy f thee mnths f the theapeti teatment f in defiieny anemia. Hweve, physiians evaate eah pesn individay, and pesibe ading t individa needs.
Theapeti dses f in sppements, whih ae pesibed f in defiieny anemia, may ase gastintestina side effets sh as nasea, vmiting, nstipatin, diahea, dak ed sts, and abdmina distess. Stating with haf the emmended dse and gaday ineasing t the f dse wi hep minimize these side effets. Taking the sppement in divided dses and with fd as may hep imit these symptms. In fm entei ated deayed-eease pepaatins may have fewe side effets, bt is nt as we absbed and nt say emmended.
Physiians mnit the effetiveness f in sppements by measing abaty indies, inding etiyte nt (eves f newy fmed ed bd es), hemgbin eves, and feitin eves. In the pesene f anemia, etiyte nts wi begin t ise afte a few days f sppementatin. Hemgbin say ineases within 2 t 3 weeks f stating in sppementatin.
In ae sitatins paentea in (pvided by injetin I.V.) is eqied. Dts wi aefy manage the administatin f paentea in.
Wh shd be atis abt taking in sppements?.
In defiieny is nmmn amng adt men and pstmenpasa wmen. These individas shd ny take in sppements when pesibed by a physiian bease f thei geate isk f in vead. In vead is a nditin in whih exess in is fnd in the bd and sted in gans sh as the ive and heat. In vead is assiated with sevea geneti diseases inding hemhmatsis, whih affets appximatey 1 in 250 individas f nthen Epean desent. Individas with hemhmatsis absb in vey effiienty, whih an est in a bid p f exess in and an ase gan damage sh as ihsis f the ive and heat faie. Hemhmatsis is ften nt diagnsed nti exess in stes have damaged an gan. In sppementatin may aeeate the effets f hemhmatsis, an imptant easn why adt men and pstmenpasa wmen wh ae nt in defiient shd avid in sppements. Individas with bd disdes that eqie feqent bd tansfsins ae as at isk f in vead and ae say advised t avid in sppements.
What ae sme ent isses and ntvesies abt in?.
In and heat disease:
Bease knwn isk fats annt expain a ases f heat disease, eseahes ntine t k f new ases. Sme evidene sggests that in an stimate the ativity f fee adias. Fee adias ae nata by-pdts f xygen metabism that ae assiated with hni diseases, inding adivasa disease. Fee adias may infame and damage nay ateies, the bd vesses that sppy the heat mse. This infammatin may ntibte t the devepment f athesesis, a nditin haateized by patia mpete bkage f ne me nay ateies. the eseahes sggest that in may ntibte t the xidatin f D ("bad") heste, hanging it t a fm that is me damaging t nay ateies.
As fa bak as the 1980s, sme eseahes sggested that the ega mensta ss f in, athe than a ptetive effet fm estgen, d bette expain the we inidene f heat disease seen in pe-menpasa wmen. Afte menpase, a wman's isk f deveping nay heat disease ineases ang with he in stes. eseahes have as bseved we ates f heat disease in ppatins with we in stes, sh as thse in deveping nties. In thse gegaphi aeas, we in stes ae attibted t w meat (and in) intake, high fibe diets that inhibit in absptin, and gastintestina (GI) bd (and in) ss de t paasiti infetins.
In the 1980s, eseahes inked high in stes with ineased isk f heat attaks in Finnish men. Hweve, me eent stdies have nt sppted sh an assiatin.
ne way f testing an assiatin between in stes and nay heat disease is t mpae eves f feitin, the stage fm f in, t the degee f athesesis in nay ateies. In ne stdy, eseahes examined the eatinship between feitin eves and athesesis in 100 men and wmen efeed f adia examinatin. In this ppatin, highe feitin eves wee nt assiated with an ineased degee f athesesis, as meased by angigaphy. nay angigaphy is a tehniqe sed t estimate the degee f bkage in nay ateies. In a diffeent stdy, eseahes fnd that feitin eves wee highe in mae patients diagnsed with nay atey disease. They did nt find any assiatin between feitin eves and isk f nay disease in wmen.
A send way t test this assiatin is t examine ates f nay disease in pepe wh feqenty dnate bd. If exess in stes ntibte t heat disease, feqent bd dnatin d ptentiay we heat disease ates bease f the in ss assiated with bd dnatin. ve 2,000 men ve age 39 and wmen ve age 50 wh dnated bd between 1988 and 1990 wee sveyed 10 yeas ate t mpae ates f adia events t feqeny f bd dnatin. adia events wee defined as (1) ene f an ate myadia infatin (heat attak), (2) ndeging angipasty, a media pede that pens a bked nay atey; (3) ndeging bypass gafting, a sgia pede that epaes bked nay ateies with heathy bd vesses. eseahes fnd that feqent dns, wh dnated me than 1 nit f whe bd eah yea between 1988 and 1990, wee ess ikey t expeiene adia events than asa dns (thse wh ny dnated a singe nit in that 3-yea peid). eseahes nded that feqent and ng-tem bd dnatin may deease the isk f adia events.
nfiting ests, and diffeent methds t mease in stes, make it diffit t eah a fina nsin n this isse. Hweve, eseahes knw that it is feasibe t deease in stes in heathy individa thgh phebtmy (bd etting dnatin). sing phebtmy, eseahes hpe t ean me abt in eves and adivasa disease.
In and intense exeise:
Many men and wmen wh engage in ega, intense exeise sh as jgging, mpetitive swimming, and ying have magina inadeqate in stats. Pssibe expanatins inde ineased gastintestina bd ss afte nning and a geate tnve f ed bd es. As, ed bd es within the ft an pte whie nning. F these easns, the need f in may be 30% geate in thse wh engage in ega intense exeise.
Thee gps f athetes may be at geatest isk f in depetin and defiieny: femae athetes, distane nnes, and vegetaian athetes. It is patiay imptant f membes f these gps t nsme emmended amnts f in and t pay attentin t dietay fats that enhane in absptin. If apppiate ntitin inteventin des nt pmte nma in stats, in sppementatin may be indiated. In ne stdy f femae swimmes, eseahes fnd that sppementatin with 125 miigams (mg) f fes sfate pe day pevented in depetin. These swimmes maintained adeqate in stes, and did nt expeiene the gastintestina side effets ften seen with highe dses f in sppementatin.
In and minea inteatins
Sme eseahes have aised nens abt inteatins between in, zin, and aim. When in and zin sppements ae given tgethe in a wate stin and witht fd, geate dses f in may deease zin absptin. Hweve, the effet f sppementa in n zin absptin des nt appea t be signifiant when sppements ae nsmed with fd. Thee is evidene that aim fm sppements and daiy fds may inhibit in absptin, bt it has been vey diffit t distingish between the effets f aim n in absptin vess the inhibity fats sh as phytate.
What is the isk f in txiity?.
Thee is nsideabe ptentia f in txiity bease vey itte in is exeted fm the bdy. Ths, in an amate in bdy tisses and gans when nma stage sites ae f. F exampe, pepe with hemahmatsis ae at isk f deveping in txiity bease f thei high in stes.
In hiden, death has ed fm ingesting 200 mg f in. It is imptant t keep in sppements tighty apped and away fm hiden's eah. Any time exessive in intake is sspeted, immediatey a y physiian Pisn nt ente, visit y a emegeny m. Dses f in pesibed f in defiieny anemia in adts ae assiated with nstipatin, nasea, vmiting, and diahea, espeiay when the sppements ae taken n an empty stmah.
In 2001, the Institte f Mediine f the Natina Aademy f Sienes set a teabe ppe intake eve () f in f heathy pepe. Thee may be times when a physiian pesibes an intake highe than the ppe imit, sh as when individas with in defiieny anemia need highe dses t epenish thei in stes.
Seeting a heathf diet
As the 2000 Dietay Gideines f Ameians states, "Diffeent fds ntain diffeent ntients and the heathf sbstanes. N singe fd an sppy a the ntients in the amnts y need". Beef and tkey ae gd ses f heme in whie beans and entis ae high in nnheme in. In additin, many fds, sh as eady-t-eat eeas, ae ftified with in. It is imptant f anyne wh is nsideing taking an in sppement t fist nside whethe thei needs ae being met by nata dietay ses f heme and nnheme in and fds ftified with in, and t disss thei ptentia need f in sppements with thei physiian.
مع تحيات أبو وسام
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