This document summarizes key vitamins and minerals, including their sources, functions, and deficiency states. It discusses Vitamins A, D, E, K, B complex vitamins, Vitamin C, and important minerals like calcium, iron, iodine, and fluorine. Key points covered include roles in growth, vision, bone health, energy metabolism, and preventing deficiencies like rickets, anemia, and dental caries. The document emphasizes the importance of obtaining these micronutrients through a varied diet or supplements to maintain health.

1. Vitamins and minerals

2. • Vita + Amines
• Micronutrients
• Do not yield energy
• Not synthesized by the body

4. Vitamin A - sources
• Retinol in animal foods
• Beta carotene in plant foods
• Animal foods – liver, eggs, cheese, butter, whole milk, fish and meat. fish liver oils are
the richest source.
• Plant foods – green leafy vegetables e.g. spinach, papaya, mango, pumpkin, carrot
• Fortified foods – vanaspati, milk, margarine.
• Carotenes are converted to retinol in small intestine.

5. Functions
1. Production of retinal pigments.
2. Supports skeletal growth
3. Maintains the integrity and normal functioning of glandular and
epithelial tissue lining the respiratory, intestinal tract as well as skin
and eyes.
4. Anti-infective property

6. Vitamin A deficiency
• Ocular - xerophthalmia
a) Night blindness – impairment in dark adaptation.
b) Conjunctival xerosis – first clinical sign. Dry and non-wettable conjunctiva. Muddy
and wrinkled.
c) Bitot’s spot – triangular, pearly white or yellowish foamy spots on the bulbar
conjunctiva on either side of the cornea.
d) Corneal xerosis – cornea appears dull, dry non-wettable and opaque. There may be
ulceration – scarring.
e) Keratomalacia – liquefaction of the cornea. Cornea may become soft and burst
open. Vision may be lost.

8. • Extra ocular manifestations –
1. Anorexia
2. Growth retardation
3. Follicular hyperkeratosis
4. Increased respiratory and intestinal infections.

9. Treatment -
• Administration of 200000 IU of retinol palmitate on two successive
days.
• All children with corneal ulcers should receive vitamin A.

10. Prevention
• Administration of single dose of 200000 IU vitamin A oil orally every
6 months (1 to 6 years)
• 100000 IU between 6 months to 1 year.

11. Vitamin D
• Calciferol ( vit –D2) – derived from plant
• Cholecalciferol ( vit D3) – animal fats and fish liver oils
• UV rays also convert skin cholsesterol to vitamin .
• Endogenous transformation into 25 HCC and 1;25 DHCC in liver and
kidney.
• Can be considered a kidney Hormone.

12. Sources
• Sunlight – synthesized in the body bu action of UV rays on 7
dehydrocholesterol.
• Foods – only in foods of animal origin.
liver, egg yolk, butter, cheese,
Fish liver oils are the richest source
Fortified foods such as milk, vanaspati etc

13. Functions
• Intestine – promotes absorption of calcium and phospohorus
• Bone – stimulates normal mineralisation, enhances bone resorption
• Kidney – increases tubular reabsorption of phosphates, variable effect
on calcium

14. Deficiency
1. Rickets – Young children
• 6 months to 2 years
• Reduced calcification of growing bone
• Growth failure, bone deformity, muscular hypotonia, tetany and convulsions
• Elevated alkaline phosphatase
• Curved legs, deformed pelvis, pigeon chest, Hrrison’s sulcus, rickety rosary,
kyphoscoliosis
• Delayed developmental milestones such as walking and teething.

16. • Osteomalacia – in adults, mainly women.
• Prevention –
• Exposing children regularly to sunshine
• Periodic dosing of children with vitamin D
• Food fortification with vitamin D

17. Vitamin E
• Tocopherols – alpha tocopherols most potent
• Source – vegetable oils, cotton seeds, sunflower seed, egg yolk and
butter.
• No clear symptoms of vitamin E deficieny
• Requirement - 8 -10 mg per day

18. Vitamin K
• Vitamin K1 – fresh green vegetables, fruits. Cow milk > human milk.
• Vitamin K2 – synthesized in intestinal bacteria.
• Stored in liver.
• Stimulates the production and release of coagulation factors.
• In Vit K deficiency, prothrombin decreases and coagulation time
increases.
• New-borns are deficient in vitamin K.

19. Vitamin B1 – Thiamine
• Essential for carbohydrate metabolism.
• thiamine pyrophosphate activates transketolase enzyme involved in
direct oxidative pathway of glucose metabolism
• In thiamine deficiency – accumulation of pyruvic and lactic acids.
•
• Sources – whole grain cereals, wheat, gram, yeast, pulses, oilseeds,
nuts
• Milk important source for infants.

20. Deficiency
• Beriberi –
• Dry form – characterized by nerve involvement, (peripheral neuritis)
• Wet form – heart involvement
• Infantile – seen in infants between 2 to 4 months.
• Wernicke’s encephalopathy – ophthalmoplegia, polyneuritis, mental
deterioration. Seen in alcoholics and people who fast.

21. Riboflavin B2
• Role in cellular oxidation
• Maintain the integrity of mucocutaneous structure
• Co-factor for glutathione reductase – helps in metabolism of other vitamins like
B6, niacin and Vitamin K
• Sources
• Milk, eggs, liver, kidney and green leafy vegetables.
• Cereals and pulses are relatively poor source.
• Deficiency – Angular stomatitis, Cheilosis, Glossitis

22. Niacin B3
• Essential for metabolism of carb, fats and proteins
• Essential for normal functioning of skin, intestine and nervous system.
• Tryptophan is the precursor.
• Sources –
• liver, kidney, meat, poultry, fish, legumes, ground nut.
• Milk poor source for niacin, but rich in tryptophan.

23. Deficiency –
• Pellagra –
• Diarrheal, Dermatitis, Dementia.
• Glossitis and stomatitis
• Dermatitis – bilaterally symmetrical, occurs in skin exposed to sun
• Mental changes as depression, delirium and irritability can also occur.
• Prevention –
• Good mixed diet containing milk and/or meat
• Avoidance of diet dependent of maize or sorghum

24. Pyridoxine B6
• 3 forms – pyridoxine, pyridoxal, pyridoxamine
• Metabolism of amino acids, fats and carbohydrates
• Source – milk, liver, meats, egg yolk, fish, whole grain cereals,
legumes and vegetables.
• Deficiency – peripheral neuritis.

25. Vitamin B12
• Cooperates with folates in synthesis of DNA.
• Synthesis of fatty acids in myelin.
• Sources – liver, kidney, meat, fish, egg, milks and cheese.
Synthesised by bacteria in colon.
Stored in liver.
Deficiency –
• Megaloblastic anaemia, demyelinating lesion in spinal cord

26. Vitamin C
• Potent antioxidant
• Formation of collagen – supportive matrix for blood vessels, connective
tissues, bone and cartilages.
• Sources – fresh fruits and green leafy vegetables, germinating pulses, amla,
guavas.
• Deficiency –
• Scurvy – swollen and bleeding gums, subcutaneous bruising, bleeding into the skin
and joint, delayed wound healing, anaemia and weakness.

27. Minerals
• Major minerals – calcium, phosphorus, sodium, potassium,
magnesium
• Trace elements – irone, iodine, fluorine, zinc, copper, cobalt,
chromium, manganese, molybdenum, selenium, tin, nickel, silicon,
vanadium
• Trace contaminants with no known functions – lead, mercury, barium,
boron and aluminium.

28. Calcium
• 1.5 – 2% of body weight.
• Equilibrium between blood calcium and skeleton
• Functions –
1. Formation of bones and teeth
2. Coagulation
3. Muscle contraction
4. Cardiac action
5. Milk production
6. Transformation of light to electrical impulse in retina

29. • Sources –
• Milk and milk products, eggs and fish.
• Cheapest source - green leafy vegetables, cereals and millets.
• Calcium oxalate limits absorption.
• Calcium phytate in cereals.
• Sitaphal good source of calcium
Absorption – enhanced by vitamin D, decreased by phytates, oxalates and fatty acids

30. Iron
• Source –
• Two forms – haem iron and non haem iron
• Haem iron – liver, meat, poultry, fish.
• Non haem iron – cereals, green leafy vegetables, legumes, nuts, oilseeds,
jaggery, dried fruits
• Poor bioavailability due to phytates, oxalates carbonates, phosphates and
dietary fibres.
• Milk, egg, tea inhibits iron absorption.

31. Absorption
• Mostly absorbed from duodenum and upper intestine in ferrous stae.
• Rate of absorption depends on –
• Iron storage
• Presence of inhibitors such as phosphates
• Promoters such as ascorbic acid and ascorbic acid rich food
• Disorders of jejunum and ileum
• Iron losses –
• Through haemorrhage
• Basal loss

32. Iron deficiency
• 3 stage –
• Decreased storage – no detectable abnormality
• Latent iron deficiency – storage exhausted, no anaemia, low serum ferritin,
low transferrin saturation
• Overt – decrease in haemoglobin concentration

34. Evaluation of iron status
• Hb concentration –
• Serum iron concentration – normal 0.8 – 1.8 mg/dl.
• Serum ferritin – measures the iron storage in body. < 10mcg/dl indicates low
storage
• Serum transferrin saturation – normal value 30%. Should be above 16%

35. National Iron Plus Initiative

36. Iodine
• Required for synthesis of thyroid hormone.
• Daily requirement – 150 mcg.
• Sources –
• Sea foods (sea salt, sea fish) and cod liver oil.
• 90% of iodine comes from food, rest from drinking water.
• Iodine content of the ground determines the iron content of water and food grown.
• Goitrogens –
• Interfere with iodine utilisation of thyroid gland.
• Cauliflower, cabbage
• Most important are cyanoglycosides and thiocyanates.

37. Spectrum of Iodine
Deficiency Disorder

38. Control
• Iodized salt – iodine concentration 30 ppm at production level and 15 ppm at
consumer level.
• Iodized oil – injectable method, 1 ml provides protection for 4 years
• Iodized oil, oral.
• Iodine monitoring –
• Iodine excretion determination,
• level of iodine in salt, water and food
• Determination of iodine in salt
• Neonatal hypothyroidism indicator for environmental iodine deficiemcy.

39. Fluorine
• Essential for normal mineralisation of bones and dental enamel formation.
• Sources-
• Drinking water – 0.5 mg/L, in fluorosis endemic area 3 -12 mg/L
• Foods – sea fish, cheese and tea.
• Deficiency/excess – prolonged ingestion in excess through drinking water
dental and skeletal fluorosis
• Inadequate intake – dental caries

40. • Dental fluorosis –
• excess fluoride ingestion (>1.5 mg/L) during first 7 years of life .
• Mottling of dental enamel. (upper incisor)
• Chalk white patches – becomes yellow then brown or black.
• In severe cases complete loss of dental enamel.
• Skeletal fluorosis –
• Daily intake > 3.0 – 6.0 mg/L. heavy fluoride deposition.
• >10mg/L crippling fluorosis