INTRODUCTION
Vitamins may be regarded as organic compounds required in the diet in small amounts to perform specific biologic functions for normal maintenance of optimum growth and health of the organisms
Generally, vitamins are not synthesized by the body, and need to be supplied through the diet
History and Nomenclature
HOPKINS - Coined term ACCESSORY FACTORS to unknown and essential nutrients present in the natural foods
FUNK - 1) Isolated an active principle from rice polishing's and in yeast cured Beri - Beri in pigeons
2) Coined the term VITAMINE from the words vital + amines
3) Later it was called “ VITAMIN ”
Mc COLLUM and DAVIS - Introduced the usage of A, B, and C to vitamins
CLASSIFICATION
There are about 13 vitamins, essential for humans classified as follows
Vitamers:
Chemically similar substances that possess qualitatively similar vitamin activity
VITAMIN A
Fat soluble vitamin
Present only in foods of animal origin
Carotenes - Plants
Dietary Sources:
Animal sources
Liver
Kidney
Egg yolk
Milk
Cheese
Fish liver oils
Plant sources
Carrots
Papaya, Mangoes
Avocado, Melon
Pumpkins
RDA (Recommended Dietary Allowance):
Men - 1000 RE (3500 IU)
Women - 800 RE (2500 IU)
Children - below 6 years - 350 - 400 µg Retinol
- 6-17 years – 600 µg Retinol
Pregnancy – 800 µg Retinol
Lactation – 950 µg Retinol
1 RE – 1 µg of Retinol
1 IU – 0.3 mg of Retinol
Biochemical Functions:
Vision - the role of vit A in the process
of vision was first elucidated
by GEORGE WALD(1968)
The events occur in a cyclic process known as Rhodopsin Cycle (or) Wald’s Cycle
RODS and CONES:
Retina of eye possesses rods and cones
Human eye - 10 million rods
5 million cones
Rods –Periphery – Dim light vision
Cones – Centre – Bright light and color vision
Deficiency of Vitamin A:
1) Night Blindness
2) Conjuctival X
VITAMIN D
ANGUS – Isolated and named it as CALCIFEROL
Resembles sterols in structure
Functions like hormone
Dietary Sources:
Fatty acids
Fish liver oils
Egg yolk
Cheese
Butter
RDA:
400 IU or 10 mg of cholecalciferol
Countries with good sunlight – 200 IU or 5 mg
Deficiency:
1) RICKETS - In young children aged 6 months to 2 years
Due to reduced calcification of young bones
Characterized by Growth failure
Bone deformity
Muscular hypotonia
Tetany and convulsions
Elevated conc. Of alkaline phosphatase in serum
Bony deformities - Bow legs, Deformed pelvis, Pigeon chest, Harrison’s sulcus
walking and teething are delayed.
OSTEOMALACIA
In adults, women, during pregnancy and lactation
Prevention:
Educating parents to expose their children regularly to sunshine.
2. Contents:
• Introduction
• History and Nomenclature
• Classification of Vitamins
• Differences between water and fat soluble Vitamins
• Fat soluble Vitamins
• Water soluble Vitamins
• Vitamins deficiency and Oral manifestations
• Public health significance
• Conclusion
• References
3. INTRODUCTION
• Vitamins may be regarded as organic compounds required in the diet in small
amounts to perform specific biologic functions for normal maintenance of
optimum growth and health of the organisms
• Generally, vitamins are not synthesized by the body, and need to be supplied
through the diet
4. History and Nomenclature
• HOPKINS - Coined term ACCESSORY FACTORS to unknown and
essential nutrients present in the natural foods
• FUNK - 1) Isolated an active principle from rice polishing's and in yeast
cured Beri - Beri in pigeons
2) Coined the term VITAMINE from the words vital + amines
3) Later it was called “ VITAMIN ”
• Mc COLLUM and DAVIS - Introduced the usage of A, B, and C to vitamins
6. Energy - Releasing Hematopoietic
Vitamins
Water Soluble Fat Soluble
Others
Non-B-Complex B-Complex
Ascorbic acid
(vitamin C)
Vitamin A
Vitamin D
Vitamin E
Vitamin K
Thiamine (B1)
Riboflavin (B2)
Niacin (B3)
Biotin
Pantothenic Acid
Folic Acid
Vitamin (B12)
Pyridoxine (B6)
Pyridoxal
Pyridoxamine
7.
8. 1) Major vitamins
2) Solubility in fat
3) Water solubility
4) Absorption
5) Storage
1) A,D,E,K
2) Soluble
3) Not soluble
4) Along with lipids,
requires bile salts
5) Stored in liver and
adipose tissues
1) B and C
2) Not soluble
3) Soluble
4) Simple absorption
5) No storage
Fat soluble Water Soluble
9. 6) Excretion
7) Toxicity
8) Deficiency
9) Treatment of
deficiency
6) Not excreted
7) Hypervitaminosis may
result
8) Manifests only when
stores are depleted
9) Single large doses may
prevent deficiency
6) Excreted
7) Non toxic, since excess is
excreted
8) Manifests rapidly as there
is no storage
9) Regular dietary supply is
required
Fat Soluble Water Soluble
10. Vitamers:
• Chemically similar substances that possess qualitatively similar vitamin activity
Eg:
Retinol
A
Retinal
Retinoic Acid
Pyridoxine Pyridoxal
Pyridoxamine
B6
14. RDA (Recommended Dietary Allowance):
Men - 1000 RE (3500 IU)
Women - 800 RE (2500 IU)
Children - below 6 years - 350 - 400 µg Retinol
- 6-17 years – 600 µg Retinol
Pregnancy – 800 µg Retinol
Lactation – 950 µg Retinol
1 RE – 1 µg of Retinol
1 IU – 0.3 mg of Retinol
15. Biochemical Functions:
• Vision - the role of vit A in the process
of vision was first elucidated
by GEORGE WALD(1968)
• The events occur in a cyclic process
known as Rhodopsin Cycle (or) Wald’s Cycle
16. RODS and CONES:
• Retina of eye possesses rods and cones
• Human eye - 10 million rods
5 million cones
• Rods –Periphery – Dim light vision
• Cones – Centre – Bright light and color vision
17. Other Biochemical Functions:
Involved in cell growth and differentiation by
regulating protein synthesis
Maintenance of proper Immune system
Synthesis of Glycoproteins
Synthesis of Transferrin – Iron transport protein
Helps in Cholesterol synthesis
Beta carotenes has Antioxidant property
Prevent Keratin synthesis by maintaining healthy
epithelial tissue
18. Deficiency of Vitamin A:
1) Night Blindness
2) Conjuctival Xerosis
3) Bitot Spots
4) keratomalacia
Night Blindness:
Difficulty to see in dim light
• Due to impairment in dark adaptation
• Prolonged deficiency irreversibly damages number of visual cells
19. Conjuctival Xerosis:
• First clinical sign of vitamin A deficiency
• Conjunctiva becomes dry and non – wettable
• Appears muddy and wrinkled instead of smoothy and shiny
20. Bitot spot’s:
• Triangular, pearly white or yellowish foamy spots on bulbar conjunctiva on either
side of the cornea
• Frequently bilateral
21. Keratomalacia:
• The cornea may becomes soft and may burst
• It’s a rapid process
• If the eye collapses, vision is lost
• Treatment:
• Administration of massive (2,00,000 IU
or 110 mg of retinol palmitate ) orally on 2 successive days
22. Other Deficiency Manifestations:
• Growth retardation due to impairment in skeletal formation
• Sterility in males
• Skin becomes dry and rough
• Keratinization of epithelial cells of GIT, Urinary tract, Respiratory tract
increased Bacterial infections
23. Hypervitaminosis A :
• Total serum vit A level is elevated (Normal -20 -50 µg/dl)
• Symptoms: Dermatitis
Enlargement of liver
Skeletal decalcification
Tenderness of long bones
Weight loss
Hair loss
Irritability
Joint pains
24. Treatment:
• Stopping high intake of vitamin A – in case of hypervitaminosis
• Administration of massive dose (2,00,000 IU or retinol palmitate) orally on 2
successive days
25. VITAMIN D
• ANGUS – Isolated and named it as CALCIFEROL
• Resembles sterols in structure
• Functions like hormone
28. RDA:
• 400 IU or 10 mg of cholecalciferol
• Countries with good sunlight – 200 IU or 5 mg
29. Biochemical Functions:
Increases the intestinal
absorption of calcium and
phosphate by increasing of
a specific Calcium binding
protein
Essential for bone formation
Along with Parathyroid hormone
increases mobilization of
calcium and phosphate from the
bone
Minimizes the excretion of
calcium and phosphate
through the kidney, by
decreasing their excretion
and enhancing Reabsorption
30. Deficiency:
1) RICKETS - In young children aged 6 months to 2 years
• Due to reduced calcification of young bones
• Characterized by Growth failure
Bone deformity
Muscular hypotonia
Tetany and convulsions
• Elevated conc. Of alkaline phosphatase in serum
31. • Bony deformities - Bow legs
Deformed pelvis
Pigeon chest
Harrison’s sulcus
Rickety rosary kyphoscoliosis
• Walking and Teething are delayed
32. 2) OSTEOMALACIA:
• In adults
• Women
• During pregnancy and lactation
• Demineralization of bones
increased susceptibility to
fractures
33. Prevention:
• Educating parents to expose their children regularly to sunshine
• Periodic dosing of young children with Vitamin D
• Vitamin D rich diet
34. Hypervitaminosis D:
• Vitamin D is most toxic in overdoses (10-100 times RDA)
• Toxic effects – demineralization of bones
• Increased calcium absorption from the intestine Increased calcium in
plasma Deposition of calcium in kidneys and arteries
• Formation of stones in kidneys
• Also associated with nausea, loss of appetite, increased thirst and weight loss
36. • ANTI STERILITY HORMONE - as it is essential for normal reproduction
in many animals
• Vitamin in search of a disease - due to lack of any specific vitamin E
deficiency disease in humans
• EVANS and his associates - Isolated compounds of vitamin E activity
and named as “TOCOPHEROL”
38. RDA:
• Women - 8 mg (12 IU) of alpha Tocopherol
• Men – 10 mg (15 IU) of alpha Tocopherol
1 mg of alpha Tocopherol - 1.5 IU
39. Biochemical functions:
Prevents peroxidation of PUFA (Poly unsaturated
fatty acids) in various tissues and membranes.
Protects RBC from hemolysis by oxidizing agents
Essential for the membrane structure and integrity of
the cell – regarded as Membrane Antioxidant along
with ‘Se’
Increases synthesis of Heme by enhancing the
activity of enzymes delta – ALA (aminolevulenic
acid) synthase and dehydratase
Associated with reproductive functions and
prevents sterility
40. Required for cellular respiration through electron
transport chain
Essential for optimal absorption of amino acids
from the intestine
Involved in proper synthesis of Nucleic acids
Protects liver from toxic compounds like carbon
tetrachloride
Works in association with vit A, C, and beta
carotenes to delay the onset of cataract
41. Deficiency symptoms:
• In Animals – Sterility
Degenerative changes in muscle
Megaloblastic anaemia
Changes in CNS
• In Humans – Increased fragility of erythrocytes
Minor neurological symptoms
42. VITAMIN K
• Only fat soluble vitamin with a specific coenzyme functions
• Required for production of blood clotting factors
45. Biochemical Functions:
Brings about the post translational modification of
Blood Clotting factors
The clotting factors 2, 7, 9, 10 are synthesized as
inactive precursors in the liver
Acts as a coenzyme for the carboxylation of
Glutamic acid present in the proteins
46. Deficiency Symptoms:
Leads to lack of active prothrombin in circulation
Increased blood clotting time
Treatment – Injection of vitamin K (IM)
48. Antagonists of vitamin K:
• Heparin
• Bishydroxy coumarin
• Salicylates
• Dicumarol - Structurally related to vitamin K and acts as
competitive inhibitor in the synthesis of active
Prothrombin
Acts as Anticoagulants
50. VITAMIN C
• Water soluble versatile vitamin
• Plays important role in human health and disease
51. Dietary Sources
• Citrus fruits
• Gooseberry (Amla)
• Guava
• Cabbage
• Spinach
• Tomatoes
• Adrenal glands
• gonads High source of vitamin C
52. RDA:
• Adults - 60 -70 mg
• 20 – 40% increase – Recommended for women during pregnancy and lactation
53. Biochemical Functions:
Required for bone formation
Plays an important role in collagen formation. Acts as
coenzyme in hydroxylation of proline and lysine
Plays an important role in degradation of
hemoglobin to bile pigments
Enhances Iron absorption
Essential in the synthesis of Serotonin
54. Required for oxidation of P – hydroxyphenylpyruvate
to homogentisic acid in tyrosine metabolism
Reduces risk of Cancer, Cataract, Coronary Heart
diseases
Essential in the synthesis of Corticosteroid hormones,
Immunoglobulins
Essential for formation of tetrahydrofolate
Involved in maturation of Erythrocytes
56. • Decreased immunocompetence
• Delayed wound healing
• Sluggish hormonal function of adrenal cortex and glands
• Perifollicular haemorrhage with Corkscrew hair
• Osteoporosis
• Scorbutic tongue
Treatment – 300mg/day – Children
500 – 1000/day – Adults
for about 3 months or until resolution of clinical sequele
57. THIAMINE (B1)
• Anti Beri Beri, Anti Neuritic Vitamin
• Water soluble
• Has specific coenzyme – THIAMINE PYROPHOSPHATE – Associated with
carbohydrate metabolism
59. RDA:
• Adults - 1-1.5 mg/day
• Children - 0.7 – 1.2 mg/day
• 2 mg/day – Pregnancy
Lactation
Old age
Alcoholism
60. Biochemical Functions:
Plays an important role in transmission of
Nerve Impulse
Most of the enzymes namely Pyruvate
dehydrogenase, alpha - Ketoglutarate
dehydrogenase, Transketolase – requires
TPP in carbohydrate metabolism
61. Deficiency Symptoms:
• BERI BERI
• Commonly seen in people consuming exclusively polished rice as staple food
Symptoms:
• Loss of appetite
• Weakness
• Nausea
• Mental depression
62. • Constipation
• Peripheral Neuropathy
• Irritability
• Numbness in the legs
Treatment - Adults – 1- 1.5 mg/day
Children - 0.7 - 1.2 mg/day
Pregnancy and Lactation – 2 mg/day
63. • Neurological manifestations -
Peripheral neuritis
• Muscle weakness
Difficulty in walking
• Edema of legs, face, trunk, serous
cavities
• Breathlessness
• Palpitations
• Calf muscles slightly swollen
• Systolic BP , Diastolic BP
• Heart becomes weak
Dry Beri Beri Wet Beri Beri
65. RIBOFLAVIN (B2)
• Water soluble vitamin
• Takes part in various cellular oxidation – reduction reactions
• Coenzymes – Flavin mononucleotide (FMN)
Flavin Adenine dinucleotide
66. Dietary sources:
• Milk and its products
• Eggs
• Meat
• Liver
• Kidney
• Cereals
• Fruits
• Vegetables
• Fish
67. RDA:
• Adult – 1.2 – 1.7 mg/day
• Requirement increases in Pregnancy and lactation
68. Biochemical Functions:
Flavin coenzymes – responsible for energy
production by participating in many redox
reaction
Co enzymes are associated with enzymes
involved in carbohydrate, lipid, protein and
purine metabolism and electron transport
chain
72. RDA:
• Adults – 15 – 20 mg/day
• Children – 10 – 15 mg/day
1 NE = 1 mg Niacin
or
60 mg of Tryptophan
73. Biochemical Functions:
Coenzymes NAD+ and NADP+ involved
in variety of Oxidation – Reduction
reactions
NADH – generates ATP by oxidation in
Electron Transport Chain
NADPH – important for many
biosynthetic reactions as it donates
reducing equivalents
74. Deficiency Symptoms:
• PELLAGRA – seen among people whose staple diet is corn or maize
• Involves skin, GIT, CNS
Symptoms:
• 3D’s - Dermatitis – neck ( Casal necklace) dorsal part of feet, ankle, parts of face
Diarrhoea – in the form of loose stools, often associated with
blood and mucus
Dementia – degeneration of nervous tissue – anxiety, irritability,
poor memory, insomnia
Death
75. PYRIDOXINE (B6)
• Represents 3 compounds – Pyridoxine
Pyridoxal
Pyridoxamine
• Active form of B6 is the coenzyme – PYRIDOXAL PHOSPHATE (PLP)
78. Biochemical Functions:
Pyridoxal phosphate participates in
reactions like Transamination,
Decarboxylation, Deamination,
Transsulfuration, Condensation
PLP – required for synthesis of delta –
amino Levulinic acid
Energy Releasing Vitamin – as it
participates in Transamination
reactions
79. Deficiency Symptoms:
• Pyridoxine deficiency is associated with neurological symptoms such as
depression, irritability, nervousness, mental confusion
• In children – there is drastically reduced GABA production
Convulsions (epilepsy)
• In severe deficiency – convulsions, peripheral neuropathy
• Decrease in Hb levels, associated with Hypochromic microcytic anemia also seen
Treatment – 10 – 100mg IV – Active seizures
25 – 600mg Orally – less serious or less acute presentations
80. BIOTIN
• Formerly known as Anti Egg White Injury Factor, Vitamin B7 or Vitamin H
• It is a sulfur containing B complex vitamin
• Directly participates as a coenzyme in the carboxylation reactions
83. Biochemical functions:
Gluconeogenesis and citric acid cycle
Pyruvate oxaloacetate
pyruvate carboxylase
BIOTIN
BIOTIN
BIOTIN
Fatty acid synthesis
Acetyl coA Malonyl coA
Acetyl co A carboxylase
Propionyl coA Methylmalonyl coA
Propionyl co A carboxylase
84. Deficiency Symptoms:
• Anaemia
• Loss of appetite
• Hair loss (alopecia)
• Nausea
• Dematitis
• Glossitis
• Depression, Hallucinations
• Muscle pain
88. Biochemical Functions:
Involved in carbohydrate, protein
and lipid synthesis
Serves as a carrier of activated Acetyl
or Acyl groups
Involved in formation of Fatty
acids
Regarded as coenzyme of metabolic
integration
Succinyl coA involved in synthesis
of porphyrins of Heme
89. Deficiency Symptoms:
• Deficiency manifestations – not reported in humans
• Dr. Gopalan – linked Burning feet syndrome with B5 deficiency
• Burning feet syndrome - Pain and numbness in the toes
Sleeplessness
Fatigue
Treatment – Pantothenol or Calcium Pantothenate
Symptoms resolves usually in 4 weeks
90. FOLIC ACID
• Vitamin B9 or Folacin
• Water soluble vitamin
• Active form of folic acid – Tetrahydrofolate (THF or FH4)
93. Biochemical Functions:
Tetrahydrofolate involved in one carbon
metabolism
THF serves as an acceptor or donor of one
carbon units in reactions involving amino
acid and nucleotide metabolism
Amino acids like Glycine, Serine,
Ethanolamine and Choline are synthesized
N – Formylmethionine, the initiator of
protein biosynthesis is formed
94. Deficiency Symptoms:
• Pregnant women, lactating women, and women on oral contraceptives, alcoholics
are susceptible to folate deficiency
• Impaired DNA synthesis – decreased production of Purines and Pyrimidines
• Macrocytic anemia
• FIGLU (Formiminoglutamate) accumulates and excreted in urine
• Hyperhomocystenemia
Treatment – 1-5 mg of folic acid per day Orally
95. COBALAMIN (B12)
• Anti – Pernicious Anemia Vitamin
• Unique vitamin synthesized by only microorganisms
• Coenzymes – 1) 5- deoxyadenosyl cobalamine
2) Methylcobalamin
98. Biochemical Functions:
Synthesis of Methionine from homocysteine
Homocysteine Methionine
Homocysteine
methyltransferase
Methylcobalamine
Isomerization of Methylmalonyl coA to
Succinyl coA
Methyl Succinyl coA
malonyl coA Methylmalonyl
coA mutase
Deoxyadenosyl
cobalamine
99. Deficiency Symptoms:
• Deficiency of vitamin B 12 is seen among the strict vegetarians
• Pernicious anemia
• Neuronal degeneration and demyelination of nervous system
Symptoms:
1) Paresthesia of fingers and toes
2) In advanced stages – confusion, loss of memory, psychosis
• Impaired fatty acids synthesis
• Excretion of methylmalonic acid in urine
Treatment – 100 -1000 µg IM
100. CONCLUSION
• Vitamins are essential to our life.
• First of all, vitamin is that component of a balanced diet, which the human body
generally cannot be synthesized on its own.
• So we must consume vitamins directly in the form of food or through supplements
as tonic or tablets.
• The whole process of assimilaton of vitamins depends on ingestion of food
• Vitamins play an important role in normal health of oral structures especially fat
soluble vitamins deficiency which affects hard tissues
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Mar- Apr 7(2): 324-330
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