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Vitamin d


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  • First time a letter was used to designate a specific vitamin
  • Transcript

    • 2. VITAMIN A
    • 3. Discovery
      • Ancient Greece
        • Night blindness was cured by ingestion of cooked liver or topical application of juice from cooked liver to the eyes
      • Vitamin A itself was not discover until the early part of twentieth century
    • 4.
      • McCollum and Davis, Osborne and Mendel (1913)
        • Extracted accessory food factor from butterfat by the use of ether
        • Fat-soluble
        • Addition of butterfat to diet of animals ameliorated xeropthalmia
          • An abnormal dryness of cornea and membrane of the eyes
    • 5.
      • McCollum and Davis
        • Named it fat-soluble A
      • C.E. Bloch
        • Addition of milk product to children’s diet could cure their xeropthalmia
      • Animal-feeding experiments
        • Only certain types of fats have this curative ability
          • None in vegetable oil but present in butterfat, cod liver oil, and ether extract of egg yolk
    • 6.
      • Fat-soluble A
        • Specific active principle in fats responsible for maintaining healthy eyes
      • Vitamin A
        • In 1920, fat-soluble was dropped and the factor was simply called Vitamin A
    • 7.
      • Plant pigment carotene
        • In 1920, its relationship to vitamin A was first demonstrated
        • In 1957, it was proved that carotene is a precursor of vitamin A and converted in the body
      • Vitamin A includes:
        • Retinol (vitamin A alcohol)
        • Retinal (vitamin A aldehyde)
        • Retinoic Acid (vitamin A acid)
    • 8. Vitamin A
      • Pale yellow, almost colorless
      • Soluble in fat or fat solvents
      • Insoluble in water
      • High degree of unsaturation
        • It can be destroyed by oxidation when fats or oils become rancid
        • Vitamin E or storage in cool, dry place will prevent oxidation and rancidity
    • 9. General Sources
        • Preformed vitamin A found in animal foods
          • Dairy foods and fish liver oils
        • Precursor carotene (provitamin A)
          • Plant foods with deep yellow or deep green pigment
          • The deeper the yellow or green, the more carotene
          • Chlorophyll (green pigment of plant) does not have any vitamin A activity
    • 10. 2 Forms of Vitamin A
      • Vitamin A1
        • Found in liver and body fat of fish and other foods of animal origin
          • Liver, milk, butter and egg yolk
      • Vitamin A2
        • Found in fresh-water fish
    • 11. Carotene
      • Found in orange-yellow and dark green fruits and vegetables
      • Three types are known: alpha- , beta-, gamma-
        • Beta-carotene is the most important
          • it has the highest vit. A activity and is the most plentiful
      • The fourth is cryptoxanthin
    • 12. Absorption of Vitamin A
      • Fat, bile salts and pancreatic juices – essential for complete absorption of vitamin A
          • Sprue and celiac disease can cause vitamin A deficiency because it interferes with fat metabolism
          • Diarrhea or excessive intake of mineral oil may interfere with absorption
    • 13. Utilization of Vitamin A
      • Conversion of absorbed carotene to retinol
        • Half of the biological activity is lost
        • Only 1/3 of carotene is available, therefore its utilization efficiency is only 1/6 of vitamin A
        • Vitamin A equivalent of carotene
          • Milligrams of carotene multiplied by 0.167 factor
    • 14. Storage of Vitamin A
      • Stored in the liver
        • Enough to meet vitamin A requirement for many months
        • Deficiency in vitamin A signs and symptoms develop very slowly
        • Cirrhosis of liver markedly reduces vitamin A storage
    • 15. Functions
      • Formation of visual purple for maintenance of retina
      • Control of the differentiation of epithelium in mucus-secreting structures
      • Promotion of bone remodeling
      • Promotion of normal reproduction in rats
      • Activation of cell membrane systems such as the E.R. and plasma membrane
      • Promotion of health of the oral structures
    • 16. Formation of Visual Purple
      • George Wald – Nobel Prize in medicine, 1967
        • Discovered the biochemical role of vitamin A in the retina
      • Human retina contains rods and cones
          • Photoreceptor systems
      • Rods contain visual purple pigment rhodopsin
          • Sensitive to light of low intensity
    • 17.
      • When light strikes retina, rhodopsin is split into
        • Opsin – protein component
        • Retinal – prosthetic group
      • Visual purple becomes visual yellow in this process
      • This causes a nervous excitation to the optic nerve which allows transmission of images to the brain
    • 18.
      • Retinal is reduced to retinol in this process
      • Most of the retinol is oxidized back to retinal
      • In the dark, retinal combines with opsin to form rhodopsin
          • Loss of degradation products will require new supplies of Vitamin A.
    • 19. Vitamin A Deficiency: Vision
      • Ability to reproduce rhodopsin is reduced
      • Faulty adaptation of eyes to the dark or night blindness
    • 20. Vitamin A Deficiency and Cancer
      • Deficiency of vitamin A may lead to cellular changes which is similar to those that occur when a normal cell is transformed into a precancerous cell
    • 21. Maintenance of Epithelial Cells and Tissues
      • Presence of vitamin A allows certain cells of the epithelium that resemble a cube to form mucus-secreting cells
      • Absence of vitamin A will cause the mucus-secreting cell to degenerate
        • Produces keratin instead of mucus
      • Vitamin A produces glycoprotein
          • Substance from which mucus is made
    • 22.
      • Without vitamin A:
        • Scleral and corneal epithelia of the eye becomes keratinized
        • Normal mucosal surfaces of the conjunctiva become dry and granular
        • Severe secondary infection may occur
          • Pus is exuded and the eye will hemorrhage
      • Bitot’s spots – keratin debris accumulated in whitish plaques
    • 23.
      • Keratinization and thickening of corneal epithelium causes xeropthalmia
          • Impairs vision
      • Keratomalacia – softening of cornea leading to deformation and destruction
    • 24.
      • In the absence of vitamin A:
        • Ciliated columnar epithelium of the respiratory tract is replaced by non-ciliated stratified squamous epithelium
        • Impairment of normal defensive function of the mucosa
        • Keratin formation may act as a foreign body
          • Produces irritation and infection
    • 25.
      • Follicular hyperkeratosis – rough sandpaper like skin and numerous papules caused by the plugging of hair shafts and sebaceous gland ducts
    • 26. Promotion of Bone Remodeling
      • Vitamin A deficiency is accompanied by cessation of bone growth
      • Intramembranous bone formation is normal but bone remodeling sequences become abnormal and stop
          • Failure of conversion of osteoblasts to osteoclasts
      • Thickening of the bone is present when there is vitamin A deficiency
    • 27.
      • Thickening of the skull or vertebral column may cause compression of nerve tissue resulting to nerve lesion
      • Excess of vitamin A causes resorption of cartilage and old bone
    • 28. Promotion of Normal Reproduction in Rats
      • In the absence of vitamin A:
        • Failure in spermatogenesis occurs in the male
        • Fetal resorption occurs in the female
    • 29. Activation of Cell Membranes
      • Vitamin A ensures the normal structure and function of the cell membranes
      • Severe vitamin A deficiency can cause abnormalities in RNA metabolism and protein synthesis
    • 30. Vitamin A Deficiency: Oral Structures
      • Periodontium
          • Produces hyperkeratosis and hyperplasia of gingival tissue
          • Tendency of periodontal pocket formation due to proliferation of basal cells of gingival epithelium and decreased cellular infiltrate of the lamina propria
    • 31.
      • Teeth
        • In rodents,
          • Growth of incisor teeth is slowed down or completely stopped
          • Enamel formation is affected due to disturbance in differentiation and function of ameloblasts
          • Hypoplastic (incompletely developed) chalky white incisors plus a loss of the usual orange pigment
          • Disorders of the labial and lingual odontoblasts produce regular labial dentin with interglobular spaces and thin, atubular lingual dentin
          • Crowding of teeth, stunting and thickening of tooth roots can also be present
    • 32.
        • In humans,
          • Teeth are less sensitive to deficiencies
          • No absolute correlation between vitamin A deficiency and dental caries or enamel hypoplasia
          • Deficiency in vitamin A should probably be very severe which is rare
    • 33.
      • Salivary glands
          • Atrophy of salivary glands
          • Reduced salivary flow
          • Increases caries
    • 34.
      • Oral Mucous Membranes
          • Epithelial metaplasia – reversible change wherein one cell type is replaced by another
          • Hyperkeratinization
          • Leukoplakia – thickened white patches on mucous membranes
    • 35.
      • Cleft Lip and Palate
          • Deficiency or high doses of vitamin A induces cleft lip and palate
    • 36. Recommended Dietary Allowance
      • 1 retinol equivalent = 1 µg of retinol or 0.6 µg of beta-carotene
      • 1 international unit (IU) = 0.3 µg of retinol or 0.6 µg of beta-carotene
      • Adult man => 1000 RE or 5000 IU
      • Adult woman => 800 RE or 4000 IU
    • 37. Food Sources
      • Preformed Vitamin A (available only in animal products)
        • Liver
        • Kidney
        • Cream
        • Butter
        • Egg yolk
    • 38.
      • Major Dietary Plant Source
        • Carrots
        • Sweet potatoes
        • Squash
        • Apricots
        • Spinach
        • Collards
        • Brocolli
        • Cabbage
        • Dark leafy greens
    • 39.
      • Processing and cooking cause little loss of vitamin A because of water insolubility
      • Pureeing, mashing or cutting increases availability of carotenes due to rupture of cell walls
    • 40. Therapy
      • Mild Vitamin A deficiency
          • Oral administration of 30,000 IU of vitamin A daily
          • Toxic if taken for more than a month
      • Advanced cases of epithelial metaplasia in adults with xeropthalmia and skin disorders such as keratomalacia
          • Initial dose 500,000 IU in the first few days
          • Reduced to half by the next few days and reduced to ¼ by the middle of second week
          • Third week, dosage = 30,000 IU
    • 41.
      • Parenteral (by injection) aqueous dispersion of vitamin A can be used when initially combined with a fatty acid. Oral administration of cod liver oil (30 ml = 25,000 IU) may then be used.
      • Supportive therapy consisting of high-protein and high-calorie diet rich in sources of vitamin A and carotene is recommended
    • 42. Toxicity: Hypervitaminosis
      • Vitamin A has a potential for toxicity because it is stored in the body
      • Chronic hypervitaminosis in adults has occurred when they are given 100,000 to 150,000 IU (20 to 30 times the RDA)
      • Misinformed people
    • 43.
      • Causes anorexia, irritability, loss of weight, tenderness over long bones, enlarged spleen and liver
      • Vitamin A concentration in serum = 0.1mg/ml
      • Effective therapy: stop administration of Vitamin A
    • 44. Hypercarotenemia
      • Serum carotene level = 250 µg/ml
      • Produces yellow orange discoloration of skin and oral mucosa but not jaundiced eyes
      • Caused by excessive ingestion of carrots in various forms, especially in juices
      • Not harmful
      • Therapy: stop carotene ingestion
    • 45. VITAMIN D
    • 46. Vitamin D (Discovery)
        • Sir Edward Mellanby (1918)
          • Rickets(softening of bones in children) in puppies is a nutritional deficiency that was curable by the administration of cod liver oil(contains Vit. A and Vit D).
        • (1922) researchers found that heated and aereated cod liver oil would not cure xerophthalmia(medical condition in which the eye fails to produce tears) in experimental animals.
          • Vitamin A is destroyed
    • 47. Vitamin D (Discovery)
          • Animals are cured when they were fed with diets containing abnormal calcium to phosphorus ratio(Vitamin D).
          • It is called vitamin D because it is the fourth vitamin to be discovered.
          • After discovering vitamin D, many researchers studied the relationship of ultraviolet light to the formation of vit. D in animals and food.
    • 48. Vitamin D (Chemistry)
      • There are 3 types
        • Only 2 are of nutritional importance (Vit. D2 and D3)
          • Fat soluble and stable to cooking, processing, storage, and acids but sensitive to light.
    • 49. Vitamin D (Chemistry)
      • Vit. D2
        • Ergocalciferol
        • From provitamin ergosterol
          • Present in plants, especially in fungi and yeast.
        • Synthetic form produced by irradiating ergosterol with UV light.
        • 1 mg=40,000 IU (internation unit)
    • 50. Vitamin D (Chemistry)
      • Vit. D3
        • Cholecalciferol
        • Naturally occurring form of viamin D in animal tissues
          • Produced in the skin
        • Precursor-7-dehydrocalciferol
        • Occurs naturally but in small amounts in egg yolk, liver, fish, fortified milk(pasteurized milk enriched with one or more nutrients, usually vitamins A and D, that has been standardized at 400 International Units per quart (fortified vitamin D milk).)
    • 51. Vitamin D (Chemistry)
      • People derive most of their vit. D from the irradiation activity of the sunlight on oils in the skin.
      • D2 and D3 are equally potent as dietary supplement.
    • 52. Vitamin D (Absorption)
      • Absorbed in the intestinal tract
        • By the presence of bile salts and fats.
        • Transported into the lymph circulation via chylomicrons(particles of emulsified fat fount in the blood).
        • The ff can aversely affect vit. D absorption.
          • Pancreatitis, sprue (A chronic, chiefly tropical disease characterized by diarrhea, emaciation, and anemia, caused by defective absorption of nutrients from the intestinal tract), and malabsorption disorders.
    • 53. Vitamin D (Transport and Storage)
      • Carried by the blood to the liver.
      • Converted to calcitrol (active form of vit. D).
      • Found in skin and brain, with smaller quantities in the lungs, spleen, and bones.
    • 54. Vitamin D (Metabolism)
      • Deluca (1969) showed that vit. D must first be converted to atleast two biologically active metabolites before it can induce physiological changes.
    • 55. Vitamin D (Metabolism)
        • Vit. D is hydroxylated in the liver and intestine to form 25-hydroxyvitamin D3(25-hydroxycholecalciferol [25-Oh-D])
        • Carried to the kidney for further hydroxylation to form 1,25-dihydroxyvitamin (1,25 dihydroxycholecalciferol or calcitrol)
          • Regulated by circulating calcium, parathyroid hormone, and calcitonin.
    • 56. Vitamin D (Metabolism)
      • Calcitrol enters epithelial cells of small intestine and acts on nucleic acid.
        • Produces protein that binds calcium and promotes active transport of calcium across the intestinal walls into the circulation(ensures sufficient supply of calcium to the bones).
          • Increased conc. of calcium promotes deposition.
    • 57. Vitamin D (Function)
      • Functions both as a vitamin(present in food) and as a hormone (formed in skin and acts on distant target organs, specially the instestines and bones).
      • Promotes intestinal calcium and phosphate absorption.
        • Involved in formation and functioning of bones, teeth, nerves, and muscle.
    • 58. Vitamin D (Function)
      • In conjunction of the parathyroid gland. It maintains the proper levels of serum calcium, and phosphorus, which promotes the formation, calcification and repair of bones.
      • Stimulates renal tubular transport of calcium and phosphorus(Deluca).
      • Aids in the treatment of serious bones disease.
    • 59.  
    • 60. Vitamin D (Recommended Dietary Allowance)
      • 400IU(10ug)/day
        • Birth to 22 years of age
        • Due to bone formation and mineralization during active growth and development
      • 500IU/day
        • Pregnant and lactating
      • 300IU(7.5)/day
        • 19-22-year-old female(not pregnant)
      • Allowance of 200 IU of vitamin D is recommended for adult men and women
        • Maintain calcium
        • Reduce osteoporosis (past menopause)
    • 61. Vitamin D (Sources)
      • Sunlight
        • Major source
        • Depends on intensity and length of exposure
        • Color of skin
      • Fatty fish, eggs, liver, butter
        • Small amount
      • Fish liver oil fortified milk
        • Major food sources
      • Milk and cheese products
        • Excellent supply of calcium and phosphorus in the ideal ratio of 1.2:1
        • Can help in the absorption of vit D and bone formation
    • 62. Vitamin d (Indications for Vit D Supplementation)
      • Elderly (house-bound)
      • Lactose intolerant
      • infants
    • 63. Vitamin D (Diseases)
      • Rickets
        • Lack of orderly change from cartilaginous material to calcified bone during bone development.
        • Mineralization of osteoid (young boen that has not undergone calcification) matrix does not occur.
        • Overgrown and disorganized zone of cartilage, capillaries, and fibroblast at the end of long bone shafts where bone and cartilage join.
    • 64. Vitamin D (Diseases)
      • Rickets
        • Bone deformities occur
          • Example rickets rosary
        • Radiograph
          • Outline of joins are blurred and hazy, and the epiphyseal line becomes broadened.
        • Treatment
          • 1000 to 5000 IU/day
            • Depends on he severity
          • 1ml halibut liver oil
            • 30-40 times more than cod liver oil
            • children
          • 4 glasses of milk/day or 5g of calcium lactate
    • 65. Vitamin D (Diseases)
      • Rickets
        • Treatment
          • (Diet)- Egg, fortified butter, margarine, ascorbic acid, and iron
          • Vitamin D supplements should gradually reduced to prophylactic doses of 400 IU daily after serum alkaline phosphatase decreases to normal levels.
        • Prevention
          • Exposure to sunlight, diet rich in vitamin D.
    • 66. Vitamin D (Diseases)
      • Osteomalacia
        • Softening of bone due to failure of mineralization as they undergo remodeling
        • Adult counterpart of rickets
        • Most often seen in women
          • Repeated pregnancies
          • Who have little exposure to sunlight and who eats diet with low dairy content.
        • Experiences pain in ribs, spine, pelvis, and legs
          • leg bones may bend, leads to waddling gait
    • 67. Vitamin D (Diseases)
      • Osteomalacia
        • Treatment
          • 5000 to 20,000 IU of vitamin D accompanied by 5g of calcium gluconate or calcium lactate three times a day.
    • 68. Vitamin D (Diseases)
      • Enamel Hypoplasia
        • Incomplete development of the enamel and dentin
        • Enamel calcifies poorly and in some areas fail to form.
        • Uncalcified dentin matrix
        • Earliest sign
          • Calciotraumatic line in the dentin
    • 69. Vitamin E
    • 70. Vitamin E
      • Fat soluble
      • Antioxidant
        • Stop the free radical from forming in the first place
        • Interrupt an oxidizing chain reaction to minimize the damage of free radicals
    • 71.
      • Protects cell membranes and other fat-soluble parts of the body
      • Promotes normal growth and development
      • Promotes normal red blood cell formation
      • Acts as anti-blood clotting agent
      Vitamin E
    • 72. Vitamin E
      • Seed oils = major source
      • wheat germ oil
      • vegetable oils
      • nuts and seeds
      • whole grains
      • egg yolk
      • leafy green vegetables
    • 73. Specific Food Sources
      • vegetable oils
        • Corn, cottonseed, and peanut oil
      • nuts and seeds
        • Almonds, hazelnuts, sunflower seeds, walnuts, and margarine
      • whole grains
        • whole-wheat flour, wheat germ
      • Vegetables and fruits
        • Spinach, lettuce, onions, blackberries, apples, and pears
    • 74. Vitamin E Recommended Daily Allowances (RDA): Males 18+ 10 mg 30 IU Females 18+ 8 mg 24 IU pregnant 12 mg lactating 11 mg 3-4 6-7 8 10 8 2 3 mg mg mg mg mg mg mg
    • 75. Vitamin E
      • Severe vitamin E deficiencies are rare
      • Lack of vitality
      • Lethargy
      • Apathy
      • Inability to concentrate
      • Muscle weakness
    • 76. Vitamin E
      • No harmful effects at 50 times RDA (1200 – 1500 IU)
      • Vitamin E toxicity is rare
      • Vitamin E requirement is proportional to the amount of unsaturation of polyunsaturated fatty acid in the diet.
      • It helps fats not become rancid (antioxidant)
      Additional Information:
    • 77. Vitamin E
      • Freezing may destroy Vitamin E
      • Extreme heat causes Vitamin E to break down
      • Avoid deep-fat frying foods that are natural sources of Vitamin E
    • 78. VITAMIN K Vitamins Home Page
      • Aids in blood clotting (primary function)
        • Prothrombin by the liver
        • Factor VII, IX, X
      • In the process of blodclotting, prothrombin is converted to thrombin
      • Thrombin will then convert Fibrinogen to Fibrin, the basis of blod clot
      • Normal human blood when shed will clot within 5-8mins in room temp
      • Primary function of Vitamin K
      • Initiates the healing process by slowing and stopping the bleeding
      • Given to patients before surgery to prevent excessive bleeding
      • There are 3 forms of Vitamin K:
        • Vitamin K 1
        • principle natural dietary source of Vitamin K found in green leafy vegetables
        • Vitamin K 2
          • Produced in bacterial synthesis in the intestine
          • *both are unstable in ultravioletlight and destroyed by strong acids and alkalis
        • Vitamin K 3
          • Synthetic form of the vitamin K
          • also referred to as menadione
      • Lentils
      • Egg Yolks
      • Whole wheat
      • Fruits
      • Cheese
      • Ham
      • Beef
      • Liver
      • Green tea
      • Tomatoes
      • yogurt
      § Freezing foods may destroy vitamin K, but heating has no effect
      • < 18 years = 75 µg
      • 19-30 years= 90 µg
      • 31-50 years = 90 µg
      • Brest fed infants may be at an increased risk for vitamin K deficiency because human milk is not a good source of this nutrient. To improve the amount of vitamin K in breast milk the mother should eat the recommended amount of green vegetables daily.
      • Since Vitamin K is obtained easily from the diet and synthesized in the body
      • *deficiencies are rare
      • Antibiotics will interfere with the normal production of Vitamin K in the intestine
      • Health problems that may lead to Vitamin K deficiency are:
        • Gallbladder or biliary disease
        • Liver disease
        • Ongoing diarrhea
        • Heavy menstrual bleeding