This document discusses vitamins and vitamin deficiencies. It begins by defining vitamins and their essential roles in the body. It then discusses the etiology of vitamin deficiencies, including malnutrition and alcoholism. The document categorizes vitamins as either fat-soluble (A, D, E, K) or water-soluble and provides details on the physiology and deficiencies of each individual vitamin. It also discusses vitamin B complex, trace elements, and the relationship between diet and cancer.

1. Presented by:
Ashok ku. singh
Pharm.D
CHITKARA UNIVERSITY
Department of Pharmacy Practice
Chitkara College of Pharmacy

2. DISORDER OF VITAMINS
Vitamins are organic substances which cannot be synthesised within the body and are
essential for maintenance of normal structure and function of cells. Thus, these substances
must be provided in the human diet. Most of the vitamins are of plant or animal origin so
that they normally enter the body as constituents of ingested plant food or animal food.
They are required in minute amounts in contrast to the relatively large amounts of essential
amino acids and fatty acids. Vitamins do not play any part in production of energy.

3. ETIOLOGY OF VITAMIN DEFICIENCIES :
In the developing countries, multiple deficiencies of vitamins and other nutrients are common
due to generalised malnutrition of dietary origin. Chronic alcoholism is a common denominator
in many of vitamin deficiencies. A few other noteworthy features about vitamins are as under:
1. While both vitamin deficiency and excess may occur from another disease, the states of
excess and deficiency themselves also cause disease.
2. 2. Vitamins in high dose can be used as drugs.
CLASSIFICATION OF VITAMINS :
Vitamins are conventionally divided into 2 groups:
a) Fat-soluble and
b) water-soluble.

4. a) Fat-soluble vitamins :
There are 4 fat-soluble vitamins: A, D, E and K. They are absorbed from intestine in the
presence of bile salts and intact pancreatic function. Their deficiencies occur more readily
due to conditioning factors (secondary deficiency). Beside the deficiency syndromes of these
vitamins, a state of hypervitaminosis due to excess of vitamin A and D also occurs.
b) Water-soluble vitamins.
This group conventionally consists of vitamin C and members of B complex group. Besides,
choline, biotin and flavonoids are new additions to this group. Water-soluble vitamins are
more readily absorbed from small intestine. Deficiency of these vitamins is mainly due to
primary (dietary) factors. Being water soluble, these vitamins are more easily lost due to
cooking or processing of food.

5. FAT-SOLUBLE VITAMINS :
a)Vitamin A (Retinol)
PHYSIOLOGY :
:Vitamin A or retinol is a fat-soluble alcohol. It is available in diet in 2 forms: As preformed
retinol, the dietary sources of which are animal-derived foods such as yolk of eggs, butter,
whole milk, fish, liver, kidney . Retinol is stored in the liver cells and released for transport to
peripheral tissues after binding to retinol-binding protein found in blood .

6. LESIONS IN VITAMIN A DEFICIENCY:
Nutritional deficiency of vitamin A is common in countries of South-East Asia, Africa,
Central and South America whereas malabsorption syndrome may account for conditioned
vitamin A deficiency in developed countries.
The physiologic functions of retinol are as follows:
a) Maintenance of normal vision in reduced light.
b) Maintenance of structure and function of specialised epithelium.
c) Maintenance of normal cartilaginous and bone growth.
d) Increased immunity against infections in children.
e) . Anti-proliferative effect.

7. Vitamin D (Calcitriol)
PHYSIOLOGY :
This fat-soluble vitamin exists in 2 activated sterol forms:
Vitamin D2 or calciferol; and Vitamin D3 or cholecalciferol.
The material originally described as vitamin D1 was subsequently found to be impure
mixture of sterols. Since vitamin D2 and D3 have similar metabolism and functions, they are
therefore referred to as vitamin D.
There are 2 main sources of vitamin D:
i) Endogenous synthesis. 80% of body’s need of vitamin D is met by endogenous synthesis
from the action of ultraviolet light on 7-dehydrocholesterol widely distributed in oily
secretions of the skin. The vitamin so formed by irradiation enters the body directly through
the skin. Pigmentation of the skin reduces the beneficial effects of ultraviolet light.

8. . ii) Exogenous sources : The other source of vitamin D is diet such as deep sea
fish, fish oil, eggs, butter, milk, some plants and grains.
Irrespective of the source of vitamin D, it must be converted to its active metabolites
LESIONS IN VITAMIN D DEFICIENCY :
Deficiency of vitamin D may result from:
i) reduced endogenous synthesis due to inadequate exposure to sunlight;
ii) dietary deficiency of vitamin D;
iii) malabsorption of lipids due to lack of bile salts such as in intrahepatic biliary obstruction,
pancreatic insufficiency and malabsorption syndrome;
iv) derangements of vitamin D metabolism as occur in kidney disorders (chronic renal failure,
nephrotic syndrome, uraemia), liver disorders and genetic disorders; and
v) resistance of end-organ to respond to vitamin D.

9. Vitamin E (αα αα α-Tocopherol)
PHYSIOLOGY :
Out of many naturally-occurring tocoferols and tocotrienols, α-tocopherol is biologically the
most active fat soluble compound for humans. Vitamin E is found in most of the ordinary
foods such as vegetables, grains, nuts and oils. It is absorbed from the intestine and
transported in blood in the form of chylomicrons. It is stored in fat depots, liver and muscle .
The main physiologic functions of vitamin E are as under:
1. Anti-oxidant activity
2. . Scavenger of free radicals
3. Inhibits prostaglandin synthesis
4. Activates protein kinase C and phospholipase A2.

10. LESIONS IN VITAMIN E DEFICIENCY:
The deficiency of vitamin E is mainly by conditioning disorders affecting its absorption and
transport such as abetalipoproteinaemia, intra- and extrahepatic biliary cholestasis, cystic
fibrosis of the pancreas and malabsorption syndrome. Low birth weight neonates, due to
physiologic immaturity of the liver and bowel, may also develop vitamin E deficiency .
Lesions of vitamin E deficiency are as follows:
1. Neurons with long axons develop degeneration in the posterior columns of spinal cord.
2. Peripheral nerves may also develop myelin degeneration in the axons.
3. Skeletal muscles may develop denervation.
4. Retinal pigmentary degeneration may occur.
5. Red blood cells deficient in vitamin E such as in premature infants have reduced lifespan.
6. In experimental animals, vitamin E deficiency can produce sterility in both male and female
animals.

11. Vitamin K
PHYSIOLOGY :
Vitamin K (K for Koagulations in Danish) exists in nature in 2 forms:
 Vitamin K1 or phylloquinone, obtained from exogenous dietary sources such as most green
leafy vegetables; and
 Vitamin K2 or menaquinone, produced endogenously by normal intestinal flora.
Phylloquinone can be converted into menaquinone in some organs.
The main physiologic function of vitamin K is in hepatic microsomal carboxylation reaction for
vitamin K dependent coagulation factors
LESIONS IN VITAMIN K DEFICIENCY :
Since vitamin K is necessary for the manufacture of prothrombin, its deficiency leads of
hypoprothrombinaemia . Estimation of plasma prothrombin, thus,

12. affords a simple in vitro test for determining whether there is deficiency of vitamin K. The
conditions which may bring about vitamin K deficiency are as follows:
1. Haemorrhagic disease of newborn
2. Biliary obstruction
3. Due to malabsorption syndrome
4. Due to anticoagulant therapy
5. Due to antibiotic therapy
6. Diffuse liver disease.

13. WATER-SOLUBLE VITAMINS
Vitamin C (Ascorbic Acid)
PHYSIOLOGY :
Vitamin C exists in natural sources as L-ascorbic acid closely related to glucose. The major
sources of vitamin C are citrus fruits such as orange, lemon, grape fruit and some fresh
vegetables like tomatoes and potatoes. It is present in small amounts in meat and milk. The
vitamin is easily destroyed by heating so that boiled or pasteurised milk may lack vitamin C.
It is readily absorbed from the small intestine and is stored in many tissues, most abundantly
in adrenal cortex. The physiologic functions of vitamin C are due to its ability to carry out
oxidation-reduction reactions:
L-Ascorbic Acid Dehydro L-Ascorbic acid + 2H+ + 2e

14. LESIONS IN VITAMIN C DEFICIENCY :
Vitamin C deficiency in the food or as a conditioned deficiency results in scurvy. The
lesions and clinical manifestations of scurvy are seen more commonly at two peak ages: in
early childhood and in the very aged. These are as under :
1. Haemorrhagic diathesis
2. Skeletal lesions
3. Delayed wound healing
4. Anaemia
5. Lesions in teeth and gums
6. Skin rash

15. VITAMIN B COMPLEX
The term vitamin B was originally coined for a substance capable of curing beriberi (B from
beriberi). Now, vitamin B complex is commonly used for a group of essential compounds
which are biochemically unrelated but occur together in certain foods such as green leafy
vegetables, cereals, yeast, liver and milk .
The principal members of vitamin B complex are thiamine (vitamin B1), riboflavin (vitamin
B2), niacin/nicotinic acid (vitamin B3), pantothenic acid (vitamin B5), pyridoxine (vitamin
B6), folate (folic acid), cyanocobalamin (vitamin B12) and biotin. There is no definite
evidence that any clinical disorder results from deficiency of pantothenic acid (vitamin B5).

18. METALS AND TRACE ELEMENTS
Several minerals in trace amounts are essential for health since they form components of
enzymes and cofactors for metabolic functions. Besides calcium and phosphorus required for
vitamin D manufacture, others include: iron, copper, iodine, zinc, selenium, manganese, nickel,
chromium, molybdenum, fluorine. However, out of these, the dietary deficiency of first five
trace elements is associated with deficiency states which are discussed in detail in respective
chapters later. These are as under
: i) Iron: Microcytic hypochromic anaemia.
ii) Calcium: reduced bone mass, osteoporosis.
iii) Phosphorous: Rickets, osteomalacia.
iv) Copper: Muscle weakness, neurologic defect, anaemia, growth retardation.

19. iv) Copper: Muscle weakness, neurologic defect, anaemia, growth retardation.
v) Iodine: Goitre and hyperthyroidism, cretinism.
vi) Zinc: Growth retardation, infertility, alopecia.
vii)Selenium: Cardiomyopathy, muscle degeneration.
viii) Fluoride: Dental caries.
ix) Manganese: Impaired growth and skeletal development.
x) Molybdenum: Severe neurological abnormalities

20. DIET AND CANCER
Before closing the discussion of nutritional pathology, it is worthwhile to sum up relationship of
these factors to carcinogenesis discussed in previoius chapter. There are three possible
mechanisms on which the story of this relationship can be built up:
1. Dietary content of exogenous carcinogens:
i) The most important example in this mechanism comes from naturally-occurring carcinogen
aflatoxin which is strongly associated with high incidence of hepatocellular carcinoma in those
consuming grain contaminated with mould, Aspergillus flavus.
ii) Artificial sweeteners (e.g. saccharine cyclomates), food additives and pesticide contamination
of food are implicated as carcinogens derived from diet.
2. Endogenous synthesis of carcinogens or promoters

21. i) In the context of etiology of gastric carcinoma, nitrites, nitrates and amines from the
digested food are transformed in the body to carcinogens—nitrosamines and nitrosamides.
ii) In the etiology of colon cancer, low fibre intake and high animal-derived fats are implicated.
High fat diet results in rise in the level of bile acids and their intermediate metabolites
produced by intestinal bacteria which act as carcinogens. The low fibre diet, on the other hand,
does not provide adequate protection to the mucosa and reduces the stool bulk and thus
increases the time the stools remain in the colon.
iii) In the etiology of breast cancer, epidemiologic studies have implicated the role of animal
proteins, fats and obesity with as yet unsubstantiated evidence.

22. 3. Inadequate protective factors: As already mentioned, some components of diet such as
vitamin C, A, E, selenium, and β -carotenes have protective role against cancer. These
substances in normal amounts in the body act as antioxidants and protect the cells against
free radical injury but their role of supplementation in diet as prevention against cancer is
unproven.