NUTR 6104 and NUTR 6106 - Advanced Normal Nutrition: Macro and

Micronutrients
Learning Outcome 2- Comprehend the interrelationship among macro- and
micronutrient intakes as they impact human health in normal and disease
states.
The interrelationship among macro- and micronutrient intakes is only
one of the components of the graduate program that helped prepare us for
our career in dietetics. In my case, I am still learning everyday about the
interrelationships between macro and micronutrients. I am using graded
work form these classes as artifacts, but my rotations have also allowed me
to apply what I have learned in the classroom, adding to my competence.
People have different learning styles, mine is hands on not memorization.
Through this reflection, I will use both what I have learned from the Macro
and Micronutrient classes as well as knowledge I have gained from
supervised practice to describe how these assignments helped me gain
insight into the learning outcome of understanding interrelationship between
macro and micronutrients.
Firstly, carbohydrates are an essential macronutrient found in foods
that are made up of starch and sugars. This macronutrient is comprised of
Carbon, Hydrogen, and Oxygen containing molecules- which are broken
down to their simplest forms to be used by cells to produce energy for the
body. Through this process-in a healthy state, glycolysis occurs, and
micronutrients are used as cofactors and coenzymes for the metabolic
reactions that turn the carbohydrates into ATP for energy. A good example of
the interrelationship of carbohydrates and micronutrients in a disease state
is when people are dealing with disordered eating. Among a myriad of other
symptoms, the lethargic feeling one experiences may possibly be due to the
lack of an adequate amount of B vitamins. B vitamins, such as niacin, are
largely responsible for the breakdown of carbohydrates, to in turn produce
energy. So, though the patient may be eating carbohydrates, if they are not
eating an appropriate amount of foods that are abundant in niacin, such as
animal proteins, they will not have the cofactor to efficiently turn those
carbohydrates into energy.
Protein is another macronutrient that has significant micronutrient
interactions. Proteins are comprised of amino acids linked together to form
muscles, as well as make enzymes, hormones, transporters, DNA strands and
antibodies for immunity. In a healthy person, the body breaks down the
proteins they eat to their simplest form and reformulates them into the
proteins their cells need as needed. Proteins cannot be stored in the body
like carbohydrates and fat can. Rather, proteins are a use it or lose it

macronutrient. If we need the protein for any of the functions listed above,
our body will use it, but if we eat more than what our body needs, the body
will dispose of the nitrogen and repurpose the rest of the structure into fat.
One function of micronutrients that are especially important in the
bodies usage of proteins is in the production of hemoglobin, the protein in
red blood cells. A healthy person carries thousands of these hemoglobin
proteins through the body. The micronutrient iron is the heme portion of
that protein, which is acquired from eating proteins in the diet. As these iron
containing, hemoglobin rich, red blood cells reach the lungs, oxygen is picked
up and binds to the heme iron. Then, the oxygen can be transported on the
heme to all the cells in the body for the work of cellular respiration (making
of ATP in the cells for the cells ability to live). In the case of iron deficiency
anemia, the lack of iron causes a lack of oxygen loaded red blood cells. The
major symptoms are extreme lethargy, shortness of breath, poor appetite,
nerve damage, and many more complications. Along with a diagnosis of iron
deficiency anemia, hypochromic anemia can occur with a diet lacking in
vitamin C. The artifact I have included from Advanced Normal NutritionMicronutrients is a case study on the effects of scurvy, or vitamin C
deficiency. We were given this assignment to think critically about how
micronutrients are vital to overall nutrition status. In this case study, I
expand upon the role of vitamin C and its role as a cofactor in many
functions of the body, including iron status. Vitamin C keeps iron in its active
ferrous form. Without vitamin C accomplishing this, the body cannot release
the stored form of iron that it contains, causing a patient to become anemic
due to lower amounts of heme iron loaded erythrocytes. This assignment
helped me to be more aware of how micronutrients play an important part in
the utilization of macronutrients in the body. Through my awareness and
knowledge of this interrelationship, I will be able to provide medical nutrition
therapy (MNT) in the setting of both clinical MNT and individual MNT
counseling.
The last macronutrient that is found in our diet is fat or lipids. Lipids
are used by the body for energy, though not as readily as carbohydrates, and
they are stored in fat cells if consumed in greater amounts than the body
needs for its normal function. Fat we ingest is broken down during digestion
to its simplest form, and most fat travels through the portal vein and is
delivered to the liver for recomposition into cholesterol and to cells for
storage. The absorption of fat soluble vitamins A, D, E, and K depends on fat
for absorption. Fat cannot be fully metabolized without a working gallbladder.
If your gallbladder is diseased with a cancer or is insufficient for any number
of reasons, you may not produce enough bile to break down fat adequately
for absorption, reducing the absorption of fat soluble vitamins as well. The

addition of lipase capsules to the diet can increase the absorption of fat and
in turn will increase the absorption of those important fat soluble vitamins. A
deficiency in vitamin A can lead to blindness, deficiency of vitamin D can
lead to low calcium levels and osteoporosis, low levels of vitamin E will lead
to lower immunity and higher susceptibility to infection due to increased
levels of ROS (reactive oxygen species), and vitamin K deficiency can cause
difficulty in blood clotting.
The artifact I have attached from Advanced Normal NutritionMacronutrients is a power point that reviews interesting research article
results concerning n3 and n6 Polyunsaturated fats (PUFAs) and their effect
on inflammation. As we learned in this class, the effects of n3 and n6 can
have anti-inflammatory as well as inflammatory effects in the body,
depending on the ratio and the sources of these PUFAs. In this study, the
participants who ate a high n3 diet had higher measures of the CRP
inflammatory marker. The participants with higher Total PUFA and n6 PUFA
intake actually had lower measures of CRP. The conclusion of the study
indicated many previous research results showing lower inflammation with
high n3 PUFA diets were done in Japan, where there was a high intake of fatty
fish, and in the current study the most prevalent source of the n3 PUFAs
were from butter. Many of the participants in this study did not eat fish at
all, which may indicate why the high intake of n3 did NOT have an antiinflammatory effect. I learned through this assignment that critically
reviewing research and reading multiple articles is essential to
understanding and making nutrition recommendations.
The interrelationship between macronutrients and micronutrients and
their impact on both healthy individuals as well as those in different disease
states will be crucial in my position as a registered dietitian. I have seen
through my rotations, my patients outcome depends on my knowledge and
skillset as a trained dietitian. I will be able to effectively care for patients if I
can convey the principles of macro and micronutrient interrelationships to
them in a simple way that they can understand. If I can master this skill, I
will be satisfied that I have fulfilled this learning outcome! Until then, I will
do my best to always provide sound, evidence based recommendations
concerning all things nutrition, and most definitely macro and micronutrient
interrelationships.