Vitamin d
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Vitamin d

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  • First time a letter was used to designate a specific vitamin
  • EXAMPLES!!

Vitamin d Vitamin d Presentation Transcript

  • FAT SOLUBLE VITAMINS
  • VITAMIN A
  • 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
    • 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
    • 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
    • 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
    • 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)
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
    • 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
    • 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.
  • Vitamin A Deficiency: Vision
    • Ability to reproduce rhodopsin is reduced
    • Faulty adaptation of eyes to the dark or night blindness
  • 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
  • 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
    • 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
    • Keratinization and thickening of corneal epithelium causes xeropthalmia
        • Impairs vision
    • Keratomalacia – softening of cornea leading to deformation and destruction
    • 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
    • Follicular hyperkeratosis – rough sandpaper like skin and numerous papules caused by the plugging of hair shafts and sebaceous gland ducts
  • 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
    • 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
  • 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
  • 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
  • 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
    • 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
      • 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
    • Salivary glands
        • Atrophy of salivary glands
        • Reduced salivary flow
        • Increases caries
    • Oral Mucous Membranes
        • Epithelial metaplasia – reversible change wherein one cell type is replaced by another
        • Hyperkeratinization
        • Leukoplakia – thickened white patches on mucous membranes
    • Cleft Lip and Palate
        • Deficiency or high doses of vitamin A induces cleft lip and palate
  • 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
  • Food Sources
    • Preformed Vitamin A (available only in animal products)
      • Liver
      • Kidney
      • Cream
      • Butter
      • Egg yolk
    • Major Dietary Plant Source
      • Carrots
      • Sweet potatoes
      • Squash
      • Apricots
      • Spinach
      • Collards
      • Brocolli
      • Cabbage
      • Dark leafy greens
    • 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
  • 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
    • 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
  • 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
      • “ IF SOME IS GOOD, MORE IS BETTER”
    • 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
  • 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
  • VITAMIN D
  • 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
  • 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.
  • 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.
  • 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)
  • 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).)
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  •  
  • 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)
  • 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
  • Vitamin d (Indications for Vit D Supplementation)
    • Elderly (house-bound)
    • Lactose intolerant
    • infants
  • 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.
  • 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
  • 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.
  • 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
  • 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.
  • 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
  • Vitamin E
  • 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
    • 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
  • Vitamin E
    • Seed oils = major source
    • wheat germ oil
    • vegetable oils
    • nuts and seeds
    • whole grains
    • egg yolk
    • leafy green vegetables
  • 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
  • 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
  • Vitamin E
    • Severe vitamin E deficiencies are rare
    • Lack of vitality
    • Lethargy
    • Apathy
    • Inability to concentrate
    • Muscle weakness
  • 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:
  • 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
  • VITAMIN K Vitamins Home Page
  • VITAMIN K’S METABOLIC/BIOCHEMICAL FUNCTIONS
    • 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
  • AIDS IN BLOOD CLOTTING
    • Primary function of Vitamin K
    • Initiates the healing process by slowing and stopping the bleeding
    • Given to patients before surgery to prevent excessive bleeding
  • VITAMIN K SYNOPSIS
    • 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
  • DIETARY SOURCES OF VITAMIN K
    • 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
  • RECOMMENDATIONS FOR PREGNANT & LACTATING WOMEN
    • < 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.
  • VITAMIN K DEFICIENCY
    • 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