This document discusses vitamin and mineral deficiencies. It describes the fat-soluble and water-soluble vitamins, how deficiencies can be primary or secondary, and provides details on specific vitamin deficiencies like vitamins A, D, and C. Vitamin A deficiency can cause night blindness and xerophthalmia. Vitamin D deficiency results in rickets in children and osteomalacia in adults. Scurvy is caused by vitamin C deficiency and is characterized by bone disease and hemorrhages.

1. VITAMIN & MINERAL
DEFICIENCIES
Dr Shahin Hameed
AIMS

2.  Thirteen vitamins are necessary for health
 Vitamins A, D, E, and K are fat-soluble, and
all others are water-soluble

3.  The distinction between fat- and water-
soluble vitamins is important.
 Fat-soluble vitamins are more readily
stored in the body, but they may be poorly
absorbed in fat malabsorption disorders

4.  A deficiency of vitamins may be
 primary (dietary in origin) or
 secondary because of disturbances in
intestinal absorption, transport in the blood,
tissue storage, or metabolic conversion

5. Vitamin A
 Vitamin A is the name given to a group of
related compounds
 retinol (vitamin A alcohol),
 retinal (vitamin A aldehyde),
 retinoic acid (vitamin A acid)
 The generic term retinoids encompasses
vitamin A in its various forms and both
natural and synthetic chemicals that are
structurally related to vitamin A

7. Functions of vitamin A
 Maintenance of normal vision
 Cell growth and differentiation
 Metabolic effects of retinoids
 Host resistance to infections

8. Vitamin A Deficiency
 Earliest manifestations of vitamin A
deficiency is impaired vision, particularly in
reduced light (night blindness).
 Persistent deficiency gives rise to a series
of changes involving epithelial metaplasia
and keratinization.

9.  The most devastating changes occur in the
eyes and are referred to as xerophthalmia
(dry eye).
 First, xerosis conjunctivae
 Buildup of keratin debris in small opaque
plaques (Bitot spots) and, eventually,
 Erosion of the roughened corneal surface with
softening and destruction of the cornea
(keratomalacia) and total blindness.

10.  Epithelium lining the upper respiratory
passage and urinary tract is replaced by
keratinizing squamous cells (squamous
metaplasia)
 Another very serious consequence is
immune deficiency

12.  Vitamin A Toxicity
 Acute
 Chronic
 Well-established teratogenic effects of
retinoids – contraindicated in pregnancy

13. Vitamin D
 Major function of the fat-soluble vitamin D
is the maintenance of adequate plasma
levels of calcium and phosphorus
 Metabolic functions,
 Bone mineralization, and
 Neuromuscular transmission

14.  Rickets (in children whose epiphyses have
not already closed)
 Osteomalacia (in adults), and
 Hypocalcemic tetany [Extracellular
concentration of ionized calcium, which is
required for normal neural excitation and
the relaxation of muscles]

17.  Normal reference range for circulating 25-
(OH)-D is 20 to 100 ng/mL;
 concentrations of less than 20 ng/mL
constitute vitamin D deficiency
 Causes
 Diet deficiency
 Limited exposure to sunlight
 Renal disorder

18. Morphology.
 Basic derangement in both rickets
and osteomalacia is an excess of
unmineralized matrix

19. Rickets
 Most common during the first year of life.
 The gross skeletal changes depend on
 the severity and duration of the process
 the stresses to which individual bones are
subjected.

20.  During the nonambulatory stage of infancy,
the head and chest sustain the greatest
stresses.
 Craniotabes
 Frontal bossing and a squared appearance
to the head
 Rachitic rosary
 Pigeon breast deformity

22.  Ambulating child deformities are
likely to affect the spine, pelvis,
and tibia
lumbar lordosis and bowing of the
legs

23.  In adults, the lack of vitamin D deranges
the normal bone remodeling that occurs
throughout life.
 Production the excess of persistent
osteoid that is characteristic of
osteomalacia.
 Bone is weak and vulnerable to gross
fractures or microfractures, which are most
likely to affect vertebral bodies and femoral
necks.

24. Non-Skeletal Effects of Vitamin
D
 Effective against infection by
Mycobacterium tuberculosis (stimulates
the synthesis of cathelicidin, an
antimicrobial peptide from the defensin
family)
 Innate and adaptive immunity
 Gene expression (>200 genes)
 Ca colon, prostrate, breast

25. Vitamin C (Ascorbic Acid)
 Scurvy, characterized principally by
 bone disease in growing children and
 by hemorrhages and healing defects in both
children and adults
 Vitamin C is present in milk and some
animal products (liver, fish) and is
abundant in a variety of fruits and
vegetables

26. Function
 Best-established function of vitamin C is
the activation of prolyl and lysyl
hydroxylases from inactive precursors,
providing for hydroxylation of procollagen
 Collagen, which normally has the highest
content, of hydroxyproline, particularly in
blood vessels, accounts for the
predisposition to hemorrhages in scurvy

27.  Antioxidant properties
 scavenge free radicals directly and
 Act indirectly by regenerating the antioxidant
form of vitamin E

29. MINERAL DEFICIENCIES