Chapter 51 Micronutrient Mineral Deficiencies

Micronutrients include vitamins ( Chapters 45–50) and trace elements. By definition, a trace element is <0.01% of the body weight. Trace elements have a variety of essential functions (see Table 51-1 on the Nelson Textbook of Pediatrics website at www.expertconsult.com). With the exception of iron deficiency, trace element deficiency (see Table 51-1) is uncommon in developed countries, but some deficiencies (iodine, zinc, selenium) are important public health problems in a number of developing countries. Because of low nutritional requirements and plentiful supply, deficiencies of some of the trace elements are extremely rare in humans and typically occur in patients receiving unusual diets or prolonged total parenteral nutrition without adequate delivery of a specific trace element. They can also occur in children with short bowel or malabsorption. Excess intake of trace elements (see Table 51-1) is uncommon, but it can result from environmental exposure or overuse of supplements.

Table 51-1 TRACE ELEMENTS

For a number of reasons, children are especially susceptible to trace element deficiency. First, growth creates an increased demand for most trace elements. Second, some organs are more likely to sustain permanent damage due to trace element deficiency during childhood. The developing brain is particularly vulnerable to the consequences of certain deficiency states (iron, iodide). Similarly, adequate fluoride is most critical for dental health during childhood. Third, children, especially in the developing world, are more prone to gastrointestinal disorders that can cause trace element deficiencies due to malabsorption.

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