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Calcium

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http://gizi.undip.ac.

id/fillah_dieny/

Fillah Fithra Dieny,SGz,MSi Program Studi Gizi FK UNDIP

INTRODUCTION
Ca is the most abundant divalent cation

of the human body, representing about 1,55-2% of total body weight/between 1000-1400 g in 70 kg. 99% in the bones and teeth (integral part) hidroksiapatit (3Ca3 (PO4)2Ca(OH2)) The other 1% of bodys calcium is distributed between extracellular fluids and various soft tissues (performs a variety of regulatory functions). as a Ca bank

FUNCTIONS
Structural component of bones and teeth
Ca
Ca

Muscle contraction Transmission of nerve impulses - Enzymes and hormones activation Blood clotting

Ca

Ca

Ca

Bone development and maintenance


Bone contain osteoblasts and osteoclasts Osteoblast : Pembentukan tulang, Osteoclast : Resorpsi tulang Osteoblast secrete a collagen matrix, which form the support

structures of the bone. They mature osteocytes and then secrete bone mineral, which cause bone mineralization.
Osteoclast continually break down bone in areas where bone is not

neededOsteoclast help to maintain normal blood Ca levels when Ca intake is low. Bone turnover (bone remodelling) represent a cycle of bone break down by osteoclasts, followed by bone rebuilding by osteoblasts. More bone being build in areas put under high stress.

vc
Most bone is built from infancy through the late

adolescent. In children and adolescents skeletal turnover is such that bone formation exceeds bone resorption (positive Ca balance). Bone loss begins in mid adulthood and increased significantly at menopause in women. In men bone loss is slow and steady from around age 30.

Bone Remodellingvideo
1. memeprbaiki kerusakan tulang slm digunakan Mengatur sirkulasi Ca n mineral lainny u/ memenuhi kebutuhan Respon thd aktivitasfisik/olahraga

stress beban akan merangsang tulang baru

Bone Remodeling Cycle


Never ending home repair project
Bone lining cells Bone Osteoclasts

Resorption by osteoclasts

Osteoblasts

Ca in bones
Ca salts form crystals (hydroxyapatite)

on a matrix of the collagen During mineralization give strength and rigidity to the maturing bones Types : cortical and trabecular (spongy) bones Cadangan Ca disimpan pd bag ujung tulang panjang dalam bentuk kristal (trabekula) dan dapat dimobilisasi untuk memenuhi kebutuhan yg meningkat. Trabecular bone has a faster turnover rate than cortical bone

After mid-30s, you begin to slowly lose bone mass. Women lose bone mass faster after menopause,

but it happens to men too. Bones can weaken early in life without a healthy diet and the right kinds of physical activity.

Blood clotting
Ca ions participate in in several reactions in the

cascade that leads to the formation of fibrin, the main protein component of blood clot. For example in the conversion of prothrombin to thrombin.

Mechanism of Blood clotting

Muscle contraction
When a skeletal muscle is stimulated by a nerve impulse from the brain, Ca ions are released from intracellular stores within the muscle cells.
The increased Ca ions permits the contractile proteins to slide along each other, leads to muscle contraction. To allow for subsequent relaxation, Ca ions are returned to intracellular stores, and the contractile proteins slide appart.

Mechanism Of Muscle Contraction

Kontraksi otot merupakan impuls syaraf yg

diangkut oleh serabut urat syaraf. Diperkirakan stimulasi kimia dari ujung syaraf ke tenunan otot menyebabkan terjadinya kontraksi lepasnya ion-ion kalsium menstimulasi enzim ATP dlm myosin, yg mengakibatkan pecahnya ATP menghasilkan energi&terbentuknya ikatan silang myosin&aktinaktomiosinkontraksi

Transmission of nerve impulse


When a nerve impulse reaches its target

site , the impulse is transmitted across the junction between the nerve and its target cell, called synapse
The arrival of the impulse at the target site

stimulates an influx of Ca ions into the nerve from the extra-cellular medium.
The rise in intra-cellular Ca ions then

triggers the release of neurotransmitters from synaptic vesicles, which are responsible for storing the neurotransmitter until needed. The released neurotransmitter then carries the impulse across the synapse to the target cells.

Ca in cell metabolism
Ca ions help regulate metabolism in

the cell by participating in the calmodulin system.


When Ca enters a cell and binds to

the protein calmodulin, the resulting protein-calcium complex can regulate the activity of various enzymes, including one that breaks down glycogen to many units of glucose 1-phosphate.

Sources

Skim Milk Whole Milk Yogurt Oysters Cheddar Chesee Spinach Broccoli White Bread Egg

123 mg/100 g 119 120 45 728 135 48 125 50

illustrates serving sizes of various calcium-rich foods that contain

the equivalent amount of calcium as one glass (8 fl. oz) of skim milk. a wide variety of foods can be consumed each day to contribute to adequate calcium intakes. When you are selecting foods that are good sources of calcium, it is important to remember that we do not absorb 100% of the calcium contained in our foods

Bioavailability of Ca from selected foods


> 50% absorbed
cauliflower, broccoli, cafortified foods and beverages

30% absorbed
milk, Ca-fortified soy milk, cheese, yogurt

20% absorbed
almonds, sesame seeds, beans

< 5 % absorbed
spinach

Absorption
Kalsium yang diabsorpsi tergantung pada jenis makanan, kombinasi diet, dan status fisiologis seseorang (jenis kelamin, umur,keadaan hamil/menyusui/menopause) Absorpsi Ca meningkat pd masa pertumbuhan,

kehamilan,menyusui, Def.Ca, Aktivitas fisik yg meningkatkan densitas tulang) Occurs primarily in the upper part of the small intestine because Ca requires a pH < 6 to stay in solution in an ionic state.

Depends on the active vit D.(1,25D(OH)D3)


Human absorb about 25% ca in the food,

however, when the body needs extra Ca absorption might reach as high as 60%. Older people < young people Absorpsi Ca dilakukan scr aktif dan absorpsi pasif Pd keadaan N:30-50% kalsium yang dikonsumsi diabsorpsi Pada wanita postmenopause, absorpsi kalsium menurun

Ca absorption
Enhancer

- Stomach acid - Vit D (helps to make Ca binding protein) - Lactose - Growth hormones - Fat

Inhibitor

- high P intakes - high phosphor intake - high fiber diet ( phytate, oxalate) - alcohol - caffeine - Stress, - excessive divalent cations (Fe, Zn, Mg)

Each cell has a critical need for calcium, obtaining it from the blood stream. This critical need is probably the reason humans have such excellent hormonal systems to control blood calcium. Normal blood Ca can be maintained despite an inadequate Ca intake, as much is stored in bones. Bila kadar dalam darah kurang akan menimbulkan masalah.

Transport, Storage, and Excretion

Ca Homeostatis

ANGKA KECUKUPAN KALSIUM YG DIANJURKAN


Bayi
Anak-anak Remaja

300-400 mg
500 mg 600-700 mg

Dewasa
Ibu Hamil & menyusui

500-800 mg
+ 400 mg

PENYEBAB HOMEOSTATIS Ca TERGANGGU


Penurunan Efisiensi Absorpsi Usus
Defisiensi vitamin D Peningkatan PTH Penurunan calcitonin Defisiensi Ca Defisiensi Estrogen

NIH Consensus Conference


Birth 6 months 400 mg/day

6-12 months
1-5 years 6-10 years

600 mg/day
800 mg/day 800-1200 mg/day

Adolescent,young adult
Females age 25-50 Postmenopouse HRT Postmenopouse tnp HRT Males age 25-65 After age 65,males n females

1200-1500 mg/day
1000 mg/day 1000 mg/day

1500 mg/day
1000 mg/day 1500 mg/day

KEKURANGAN N KELEBIHAN
Kekurangan :

1.Osteoporosis 2.Osteomalasia 3.Tetani 4. Bradycardia 5. Heart Block 6. Ricketsia Kelebihan 1. Batu Ginjal 2. Pengapuran berbagai organ (otot,sendi) 3. Anemia 5. Ulcus Peptic

OSTEOPOROSIS
Silent Killer Penyakit metabolik tulang yg ditandai dengan penurunan massa tulang progresifkecenderungan menglami fraktur Tulang selalu mengalami proses pembentukan dan resorpsi scr terus menerus dan seimbang. Resorpsi>pembentukanosteoporosis Berkurangnya ketebalan kortek dan berkurangnya jumlah/ukuran trabekula Tulang belakang, pergelangan tangan (laki-laki), tulang panggul (wanita)

osteoporosis

Ca loss is the effect, not the cause

Osteoporosis: Definition
A skeletal disorder characterized by compromised bone

strength predisposing to an increased risk of fracture.


Normal Bone Osteoporotic Bone

Osteoporosis Prevention, Diagnosis, and Therapy. NIH Consensus Statement 2000 March 27-29; 17(1): 1-36. Dempster, DW, et al., JBMR 2000; 15 (1): 20.

World Health Organization (WHO) Osteoporosis Guidelines

T-Score
WHO, Guidelines for Preclinical Evaluation and Clinical Trials in Osteoporosis, 1998.

Established Risk Factors for Osteoporosis


Genetic
Female White or Asian races Thin or low peak bone

Lifestyle

mass Family history of fractures

cigarette Smoking Excessive alcohol use physical inactivity Excessive stress

Medical
Menopause Menstrual dysfunction or

Nutritional
inadequate calcium inadequateVitamin D excessive coffee

early menopause Glucocorticoid, thyroid use Hormonal status (low estrogen/testorone

Thank You

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