Micronutrient Supplementation in Adult Nutrition Therapy: Practical Considerations

Abstract

Preexisting micronutrient (vitamins and trace elements) deficiencies are often present in hospitalized patients. Deficiencies occur due to inadequate or inappropriate administration, increased or altered requirements, and increased losses, affecting various biochemical processes and resulting in organ dysfunction, poor wound healing, and altered immune status with deleterious sequelae. Guidelines for the 13 essential vitamins and 10 essential trace elements have been established. These recommendations, however, are applicable to healthy adults and not to critically ill patients, in whom decreased serum levels may indicate actual deficiencies or a deficiency due to redistribution. Benefits of supplementation over and above the daily requirements, which may not result in increased serum levels, are also unclear and may, in fact, be detrimental. Vitamin requirements are increased in disease states, but a similar recommendation for trace elements has not been initiated except for selenium (Se) and zinc (Zn). In practice, a multivitamin preparation and a multiple trace element admixture (containing Zn, Se, copper, chromium, and manganese) are added to parenteral nutrition formulations. Most enteral nutrition preparations also contain adequate amounts of vitamins and trace elements, although bioavailability may be an issue. Detailed information about individual micronutrient use specifically in hospitalized adult patients receiving nutrition therapy will be discussed, emphasizing the practical and clinical aspects. Clinicians are encouraged to think of micronutrients not as nutritional supplements alone but also as therapeutic agents and nutraceuticals.

Dosing and Monitoring of Trace Elements in Long‐Term Home Parenteral Nutrition Patients

“…maintenance dosing guidelines, about 38% of serum selenium concentrations were below normal in SBS and non-SBS patients alike. Although a minimum selenium dose of 50 mcg/d and a usual dose of 60 mcg/d have been recommended in PN, 15,17 our data show that even a higher parenteral selenium dose of about 70 mcg/d achieved normal serum selenium concentrations in only about 60% of cases. Higher maintenance selenium doses of 60-100 mcg/d have been actually suggested for adult home PN patients, and patients with selenium depletion may require even higher doses.…”

“…17,29 The majority (92.6%) of manganese doses far exceeded the upper limit of A.S.P.E.N. supplementation guidelines.…”

Physicochemical and sensory characteristics of snack bars added of jerivá flour (Syagrus romanzoffiana)

“…Copper, manganese and iron levels significantly increased when the bars were supplemented with 10%, 15% or 20% of jerivá flour. Micronutrients are compounds necessary for proper physiological condition of the body which can be orally administered in enteral or parenteral diet, and are required to maintain a proper balance of nutrients (Davidi et al, 2011;Sriram & Lonchyna, 2009). Because minerals cannot be synthesized, they should be supplied from food, and considering the mineral deficiencies worldwide, the bars developed with jerivá flour can be considered as viable alternatives for mineral intake.…”

Trace Elements in Critical Illness

“…However, these measures are of limited significance to reflect accurate trace element status in critical illness. Measuring serum levels of trace elements is difficult and requires careful collection techniques, using special trace elementfree tubes [3]. Previous balance studies have demonstrated the unreliability of serum trace element levels [4].…”

“…Iron plays a central role in oxygen transport as the key component of the heme molecule and also other oxygen-carrying proteins including heme enzymes, myoglobin, and cytochrome a-a 3 . As a constituent of the functional groups of many enzymes operating in the Krebs cycle, it is essential for energy metabolism.…”