Elsevier

Molecular Aspects of Medicine

Volume 26, Issues 4–5, August–October 2005, Pages 353-362
Molecular Aspects of Medicine

Review
Nutritional aspects of manganese homeostasis

https://doi.org/10.1016/j.mam.2005.07.003Get rights and content

Abstract

Manganese (Mn) is an essential mineral. It is present in virtually all diets at low concentrations. The principal route of intake for Mn is via food consumption, but in occupational cohorts, inhalation exposure may also occur (this subject will not be dealt with in this review). Humans maintain stable tissue levels of Mn. This is achieved via tight homeostatic control of both absorption and excretion. Nevertheless, it is well established that exposure to high oral, parenteral or ambient air concentrations of Mn can result in elevations in tissue Mn levels. Excessive Mn accumulation in the central nervous system (CNS) is an established clinical entity, referred to as manganism. It resembles idiopathic Parkinson’s disease (IPD) in its clinical features, resulting in adverse neurological effects both in laboratory animals and humans. This review focuses on an area that to date has received little consideration, namely the potential exposure of parenterally fed neonates to exceedingly high Mn concentrations in parenteral nutrition solutions, potentially increasing their risk for Mn-induced adverse health sequelae. The review will consider (1) the essentiality of Mn; (2) the concentration ranges, means and variation of Mn in various foods and infant formulas; (3) the absorption, distribution, and elimination of Mn after oral exposure and (4) the factors that raise a theoretical concern that neonates receiving total parenteral nutrition (TPN) are exposed to excessive dietary Mn.

Section snippets

The essentiality of manganese

Manganese (Mn) is an essential trace metal that is found in all tissues and is required for normal amino acid, lipid, protein, and carbohydrate metabolism. Mn-dependent enzyme families include oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. Manganese metalloenzymes include arginase, glutamine synthetase, phosphoenolpyruvate decarboxylase, and Mn superoxide dismutase (Mn-SOD). Mn is involved in the function of numerous organ systems. It is needed for normal immune

The concentration ranges, means and variation of manganese in various foods and infant formulas

Diet represents the major source of human Mn intake. In the general population, enteral intake of this essential metal is <5 mg Mn/kg (with a range of 0.9–10 mg Mn/day; Agency for Toxic Substances and Drug Registry, 2000). Major sources of dietary Mn include grain, rice, and nuts (∼30 mg Mn/kg). Another source rich in Mn content is tea (with Mn levels of 0.4–1.3 mg/cup; Agency for Toxic Substances and Drug Registry, 2000). Dietary supplements are also fortified with Mn, and some contain levels as

The absorption, distribution, and elimination of oral manganese

Approximately 1–5% of ingested Mn is normally absorbed (Davis et al., 1993). In adults the net gastrointestinal absorption (mean ± SD) of radiolabeled 54Mn from a meal containing 1 mg Mn is 1.35 ± 0.51 and 3.55 ± 2.11% for adult men and women, respectively (Finley et al., 1994). The mean (±SD) retention 10 days after ingestion of 0.3 mg Mn was estimated at 5.0 ± 3.1% in young adult women (Davidsson et al., 1988). Gender differences for Mn absorption have been noted, men absorbing significantly less Mn

Factors that raise a theoretical concern that neonates receiving total parenteral nutrition (TPN) are exposed to excessive dietary manganese

It is very common for premature or critically ill infants to be nourished parenterally. Parenteral nutrition solutions contain variable quantities of Mn as a contaminant (Kurkus et al., 1984, Hambidge et al., 1989, Wilson et al., 1992). Wilson et al. (1992) reported that the Mn content of TPN solutions in the absence of trace element supplementation was 7.3 μg/l (range 5.6–8.9 μg/l; Table 2).

It is standard clinical practice to supplement infants receiving parenteral nutrition with a neonatal

Acknowledgement

This review was supported in part by funds from the National Institute of Environmental Health and Safety (NIEHS) ES 10563 to MA.

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