Vitamin d


Published on

eto na.... eto na.... eto na !!!! waaaaaaaahhhhh

Published in: Health & Medicine
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • First time a letter was used to designate a specific vitamin
  • Vitamin d

    2. 2. VITAMIN A
    3. 3. Discovery <ul><li>Ancient Greece </li></ul><ul><ul><li>Night blindness was cured by ingestion of cooked liver or topical application of juice from cooked liver to the eyes </li></ul></ul><ul><li>Vitamin A itself was not discover until the early part of twentieth century </li></ul>
    4. 4. <ul><li>McCollum and Davis, Osborne and Mendel (1913) </li></ul><ul><ul><li>Extracted accessory food factor from butterfat by the use of ether </li></ul></ul><ul><ul><li>Fat-soluble </li></ul></ul><ul><ul><li>Addition of butterfat to diet of animals ameliorated xeropthalmia </li></ul></ul><ul><ul><ul><li>An abnormal dryness of cornea and membrane of the eyes </li></ul></ul></ul>
    5. 5. <ul><li>McCollum and Davis </li></ul><ul><ul><li>Named it fat-soluble A </li></ul></ul><ul><li>C.E. Bloch </li></ul><ul><ul><li>Addition of milk product to children’s diet could cure their xeropthalmia </li></ul></ul><ul><li>Animal-feeding experiments </li></ul><ul><ul><li>Only certain types of fats have this curative ability </li></ul></ul><ul><ul><ul><li>None in vegetable oil but present in butterfat, cod liver oil, and ether extract of egg yolk </li></ul></ul></ul>
    6. 6. <ul><li>Fat-soluble A </li></ul><ul><ul><li>Specific active principle in fats responsible for maintaining healthy eyes </li></ul></ul><ul><li>Vitamin A </li></ul><ul><ul><li>In 1920, fat-soluble was dropped and the factor was simply called Vitamin A </li></ul></ul>
    7. 7. <ul><li>Plant pigment carotene </li></ul><ul><ul><li>In 1920, its relationship to vitamin A was first demonstrated </li></ul></ul><ul><ul><li>In 1957, it was proved that carotene is a precursor of vitamin A and converted in the body </li></ul></ul><ul><li>Vitamin A includes: </li></ul><ul><ul><li>Retinol (vitamin A alcohol) </li></ul></ul><ul><ul><li>Retinal (vitamin A aldehyde) </li></ul></ul><ul><ul><li>Retinoic Acid (vitamin A acid) </li></ul></ul>
    8. 8. Vitamin A <ul><li>Pale yellow, almost colorless </li></ul><ul><li>Soluble in fat or fat solvents </li></ul><ul><li>Insoluble in water </li></ul><ul><li>High degree of unsaturation </li></ul><ul><ul><li>It can be destroyed by oxidation when fats or oils become rancid </li></ul></ul><ul><ul><li>Vitamin E or storage in cool, dry place will prevent oxidation and rancidity </li></ul></ul>
    9. 9. General Sources <ul><ul><li>Preformed vitamin A found in animal foods </li></ul></ul><ul><ul><ul><li>Dairy foods and fish liver oils </li></ul></ul></ul><ul><ul><li>Precursor carotene (provitamin A) </li></ul></ul><ul><ul><ul><li>Plant foods with deep yellow or deep green pigment </li></ul></ul></ul><ul><ul><ul><li>The deeper the yellow or green, the more carotene </li></ul></ul></ul><ul><ul><ul><li>Chlorophyll (green pigment of plant) does not have any vitamin A activity </li></ul></ul></ul>
    10. 10. 2 Forms of Vitamin A <ul><li>Vitamin A1 </li></ul><ul><ul><li>Found in liver and body fat of fish and other foods of animal origin </li></ul></ul><ul><ul><ul><li>Liver, milk, butter and egg yolk </li></ul></ul></ul><ul><li>Vitamin A2 </li></ul><ul><ul><li>Found in fresh-water fish </li></ul></ul>
    11. 11. Carotene <ul><li>Found in orange-yellow and dark green fruits and vegetables </li></ul><ul><li>Three types are known: alpha- , beta-, gamma- </li></ul><ul><ul><li>Beta-carotene is the most important </li></ul></ul><ul><ul><ul><li>it has the highest vit. A activity and is the most plentiful </li></ul></ul></ul><ul><li>The fourth is cryptoxanthin </li></ul>
    12. 12. Absorption of Vitamin A <ul><li>Fat, bile salts and pancreatic juices – essential for complete absorption of vitamin A </li></ul><ul><ul><ul><li>Sprue and celiac disease can cause vitamin A deficiency because it interferes with fat metabolism </li></ul></ul></ul><ul><ul><ul><li>Diarrhea or excessive intake of mineral oil may interfere with absorption </li></ul></ul></ul>
    13. 13. Utilization of Vitamin A <ul><li>Conversion of absorbed carotene to retinol </li></ul><ul><ul><li>Half of the biological activity is lost </li></ul></ul><ul><ul><li>Only 1/3 of carotene is available, therefore its utilization efficiency is only 1/6 of vitamin A </li></ul></ul><ul><ul><li>Vitamin A equivalent of carotene </li></ul></ul><ul><ul><ul><li>Milligrams of carotene multiplied by 0.167 factor </li></ul></ul></ul>
    14. 14. Storage of Vitamin A <ul><li>Stored in the liver </li></ul><ul><ul><li>Enough to meet vitamin A requirement for many months </li></ul></ul><ul><ul><li>Deficiency in vitamin A signs and symptoms develop very slowly </li></ul></ul><ul><ul><li>Cirrhosis of liver markedly reduces vitamin A storage </li></ul></ul>
    15. 15. Functions <ul><li>Formation of visual purple for maintenance of retina </li></ul><ul><li>Control of the differentiation of epithelium in mucus-secreting structures </li></ul><ul><li>Promotion of bone remodeling </li></ul><ul><li>Promotion of normal reproduction in rats </li></ul><ul><li>Activation of cell membrane systems such as the E.R. and plasma membrane </li></ul><ul><li>Promotion of health of the oral structures </li></ul>
    16. 16. Formation of Visual Purple <ul><li>George Wald – Nobel Prize in medicine, 1967 </li></ul><ul><ul><li>Discovered the biochemical role of vitamin A in the retina </li></ul></ul><ul><li>Human retina contains rods and cones </li></ul><ul><ul><ul><li>Photoreceptor systems </li></ul></ul></ul><ul><li>Rods contain visual purple pigment rhodopsin </li></ul><ul><ul><ul><li>Sensitive to light of low intensity </li></ul></ul></ul>
    17. 17. <ul><li>When light strikes retina, rhodopsin is split into </li></ul><ul><ul><li>Opsin – protein component </li></ul></ul><ul><ul><li>Retinal – prosthetic group </li></ul></ul><ul><li>Visual purple becomes visual yellow in this process </li></ul><ul><li>This causes a nervous excitation to the optic nerve which allows transmission of images to the brain </li></ul>
    18. 18. <ul><li>Retinal is reduced to retinol in this process </li></ul><ul><li>Most of the retinol is oxidized back to retinal </li></ul><ul><li>In the dark, retinal combines with opsin to form rhodopsin </li></ul><ul><ul><ul><li>Loss of degradation products will require new supplies of Vitamin A. </li></ul></ul></ul>
    19. 19. Vitamin A Deficiency: Vision <ul><li>Ability to reproduce rhodopsin is reduced </li></ul><ul><li>Faulty adaptation of eyes to the dark or night blindness </li></ul>
    20. 20. Vitamin A Deficiency and Cancer <ul><li>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 </li></ul>
    21. 21. Maintenance of Epithelial Cells and Tissues <ul><li>Presence of vitamin A allows certain cells of the epithelium that resemble a cube to form mucus-secreting cells </li></ul><ul><li>Absence of vitamin A will cause the mucus-secreting cell to degenerate </li></ul><ul><ul><li>Produces keratin instead of mucus </li></ul></ul><ul><li>Vitamin A produces glycoprotein </li></ul><ul><ul><ul><li>Substance from which mucus is made </li></ul></ul></ul>
    22. 22. <ul><li>Without vitamin A: </li></ul><ul><ul><li>Scleral and corneal epithelia of the eye becomes keratinized </li></ul></ul><ul><ul><li>Normal mucosal surfaces of the conjunctiva become dry and granular </li></ul></ul><ul><ul><li>Severe secondary infection may occur </li></ul></ul><ul><ul><ul><li>Pus is exuded and the eye will hemorrhage </li></ul></ul></ul><ul><li>Bitot’s spots – keratin debris accumulated in whitish plaques </li></ul>
    23. 23. <ul><li>Keratinization and thickening of corneal epithelium causes xeropthalmia </li></ul><ul><ul><ul><li>Impairs vision </li></ul></ul></ul><ul><li>Keratomalacia – softening of cornea leading to deformation and destruction </li></ul>
    24. 24. <ul><li>In the absence of vitamin A: </li></ul><ul><ul><li>Ciliated columnar epithelium of the respiratory tract is replaced by non-ciliated stratified squamous epithelium </li></ul></ul><ul><ul><li>Impairment of normal defensive function of the mucosa </li></ul></ul><ul><ul><li>Keratin formation may act as a foreign body </li></ul></ul><ul><ul><ul><li>Produces irritation and infection </li></ul></ul></ul>
    25. 25. <ul><li>Follicular hyperkeratosis – rough sandpaper like skin and numerous papules caused by the plugging of hair shafts and sebaceous gland ducts </li></ul>
    26. 26. Promotion of Bone Remodeling <ul><li>Vitamin A deficiency is accompanied by cessation of bone growth </li></ul><ul><li>Intramembranous bone formation is normal but bone remodeling sequences become abnormal and stop </li></ul><ul><ul><ul><li>Failure of conversion of osteoblasts to osteoclasts </li></ul></ul></ul><ul><li>Thickening of the bone is present when there is vitamin A deficiency </li></ul>
    27. 27. <ul><li>Thickening of the skull or vertebral column may cause compression of nerve tissue resulting to nerve lesion </li></ul><ul><li>Excess of vitamin A causes resorption of cartilage and old bone </li></ul>
    28. 28. Promotion of Normal Reproduction in Rats <ul><li>In the absence of vitamin A: </li></ul><ul><ul><li>Failure in spermatogenesis occurs in the male </li></ul></ul><ul><ul><li>Fetal resorption occurs in the female </li></ul></ul>
    29. 29. Activation of Cell Membranes <ul><li>Vitamin A ensures the normal structure and function of the cell membranes </li></ul><ul><li>Severe vitamin A deficiency can cause abnormalities in RNA metabolism and protein synthesis </li></ul>
    30. 30. Vitamin A Deficiency: Oral Structures <ul><li>Periodontium </li></ul><ul><ul><ul><li>Produces hyperkeratosis and hyperplasia of gingival tissue </li></ul></ul></ul><ul><ul><ul><li>Tendency of periodontal pocket formation due to proliferation of basal cells of gingival epithelium and decreased cellular infiltrate of the lamina propria </li></ul></ul></ul>
    31. 31. <ul><li>Teeth </li></ul><ul><ul><li>In rodents, </li></ul></ul><ul><ul><ul><li>Growth of incisor teeth is slowed down or completely stopped </li></ul></ul></ul><ul><ul><ul><li>Enamel formation is affected due to disturbance in differentiation and function of ameloblasts </li></ul></ul></ul><ul><ul><ul><li>Hypoplastic (incompletely developed) chalky white incisors plus a loss of the usual orange pigment </li></ul></ul></ul><ul><ul><ul><li>Disorders of the labial and lingual odontoblasts produce regular labial dentin with interglobular spaces and thin, atubular lingual dentin </li></ul></ul></ul><ul><ul><ul><li>Crowding of teeth, stunting and thickening of tooth roots can also be present </li></ul></ul></ul>
    32. 32. <ul><ul><li>In humans, </li></ul></ul><ul><ul><ul><li>Teeth are less sensitive to deficiencies </li></ul></ul></ul><ul><ul><ul><li>No absolute correlation between vitamin A deficiency and dental caries or enamel hypoplasia </li></ul></ul></ul><ul><ul><ul><li>Deficiency in vitamin A should probably be very severe which is rare </li></ul></ul></ul>
    33. 33. <ul><li>Salivary glands </li></ul><ul><ul><ul><li>Atrophy of salivary glands </li></ul></ul></ul><ul><ul><ul><li>Reduced salivary flow </li></ul></ul></ul><ul><ul><ul><li>Increases caries </li></ul></ul></ul>
    34. 34. <ul><li>Oral Mucous Membranes </li></ul><ul><ul><ul><li>Epithelial metaplasia – reversible change wherein one cell type is replaced by another </li></ul></ul></ul><ul><ul><ul><li>Hyperkeratinization </li></ul></ul></ul><ul><ul><ul><li>Leukoplakia – thickened white patches on mucous membranes </li></ul></ul></ul>
    35. 35. <ul><li>Cleft Lip and Palate </li></ul><ul><ul><ul><li>Deficiency or high doses of vitamin A induces cleft lip and palate </li></ul></ul></ul>
    36. 36. Recommended Dietary Allowance <ul><li>1 retinol equivalent = 1 µg of retinol or 0.6 µg of beta-carotene </li></ul><ul><li>1 international unit (IU) = 0.3 µg of retinol or 0.6 µg of beta-carotene </li></ul><ul><li>Adult man => 1000 RE or 5000 IU </li></ul><ul><li>Adult woman => 800 RE or 4000 IU </li></ul>
    37. 37. Food Sources <ul><li>Preformed Vitamin A (available only in animal products) </li></ul><ul><ul><li>Liver </li></ul></ul><ul><ul><li>Kidney </li></ul></ul><ul><ul><li>Cream </li></ul></ul><ul><ul><li>Butter </li></ul></ul><ul><ul><li>Egg yolk </li></ul></ul>
    38. 38. <ul><li>Major Dietary Plant Source </li></ul><ul><ul><li>Carrots </li></ul></ul><ul><ul><li>Sweet potatoes </li></ul></ul><ul><ul><li>Squash </li></ul></ul><ul><ul><li>Apricots </li></ul></ul><ul><ul><li>Spinach </li></ul></ul><ul><ul><li>Collards </li></ul></ul><ul><ul><li>Brocolli </li></ul></ul><ul><ul><li>Cabbage </li></ul></ul><ul><ul><li>Dark leafy greens </li></ul></ul>
    39. 39. <ul><li>Processing and cooking cause little loss of vitamin A because of water insolubility </li></ul><ul><li>Pureeing, mashing or cutting increases availability of carotenes due to rupture of cell walls </li></ul>
    40. 40. Therapy <ul><li>Mild Vitamin A deficiency </li></ul><ul><ul><ul><li>Oral administration of 30,000 IU of vitamin A daily </li></ul></ul></ul><ul><ul><ul><li>Toxic if taken for more than a month </li></ul></ul></ul><ul><li>Advanced cases of epithelial metaplasia in adults with xeropthalmia and skin disorders such as keratomalacia </li></ul><ul><ul><ul><li>Initial dose 500,000 IU in the first few days </li></ul></ul></ul><ul><ul><ul><li>Reduced to half by the next few days and reduced to ¼ by the middle of second week </li></ul></ul></ul><ul><ul><ul><li>Third week, dosage = 30,000 IU </li></ul></ul></ul>
    41. 41. <ul><li>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. </li></ul><ul><li>Supportive therapy consisting of high-protein and high-calorie diet rich in sources of vitamin A and carotene is recommended </li></ul>
    42. 42. Toxicity: Hypervitaminosis <ul><li>Vitamin A has a potential for toxicity because it is stored in the body </li></ul><ul><li>Chronic hypervitaminosis in adults has occurred when they are given 100,000 to 150,000 IU (20 to 30 times the RDA) </li></ul><ul><li>Misinformed people </li></ul><ul><ul><li>“ IF SOME IS GOOD, MORE IS BETTER” </li></ul></ul>
    43. 43. <ul><li>Causes anorexia, irritability, loss of weight, tenderness over long bones, enlarged spleen and liver </li></ul><ul><li>Vitamin A concentration in serum = 0.1mg/ml </li></ul><ul><li>Effective therapy: stop administration of Vitamin A </li></ul>
    44. 44. Hypercarotenemia <ul><li>Serum carotene level = 250 µg/ml </li></ul><ul><li>Produces yellow orange discoloration of skin and oral mucosa but not jaundiced eyes </li></ul><ul><li>Caused by excessive ingestion of carrots in various forms, especially in juices </li></ul><ul><li>Not harmful </li></ul><ul><li>Therapy: stop carotene ingestion </li></ul>
    45. 45. VITAMIN D
    46. 46. Vitamin D (Discovery) <ul><ul><li>Sir Edward Mellanby (1918) </li></ul></ul><ul><ul><ul><li>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). </li></ul></ul></ul><ul><ul><li>(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. </li></ul></ul><ul><ul><ul><li>Vitamin A is destroyed </li></ul></ul></ul>
    47. 47. Vitamin D (Discovery) <ul><ul><ul><li>Animals are cured when they were fed with diets containing abnormal calcium to phosphorus ratio(Vitamin D). </li></ul></ul></ul><ul><ul><ul><li>It is called vitamin D because it is the fourth vitamin to be discovered. </li></ul></ul></ul><ul><ul><ul><li>After discovering vitamin D, many researchers studied the relationship of ultraviolet light to the formation of vit. D in animals and food. </li></ul></ul></ul>
    48. 48. Vitamin D (Chemistry) <ul><li>There are 3 types </li></ul><ul><ul><li>Only 2 are of nutritional importance (Vit. D2 and D3) </li></ul></ul><ul><ul><ul><li>Fat soluble and stable to cooking, processing, storage, and acids but sensitive to light. </li></ul></ul></ul>
    49. 49. Vitamin D (Chemistry) <ul><li>Vit. D2 </li></ul><ul><ul><li>Ergocalciferol </li></ul></ul><ul><ul><li>From provitamin ergosterol </li></ul></ul><ul><ul><ul><li>Present in plants, especially in fungi and yeast. </li></ul></ul></ul><ul><ul><li>Synthetic form produced by irradiating ergosterol with UV light. </li></ul></ul><ul><ul><li>1 mg=40,000 IU (internation unit) </li></ul></ul>
    50. 50. Vitamin D (Chemistry) <ul><li>Vit. D3 </li></ul><ul><ul><li>Cholecalciferol </li></ul></ul><ul><ul><li>Naturally occurring form of viamin D in animal tissues </li></ul></ul><ul><ul><ul><li>Produced in the skin </li></ul></ul></ul><ul><ul><li>Precursor-7-dehydrocalciferol </li></ul></ul><ul><ul><li>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).) </li></ul></ul>
    51. 51. Vitamin D (Chemistry) <ul><li>People derive most of their vit. D from the irradiation activity of the sunlight on oils in the skin. </li></ul><ul><li>D2 and D3 are equally potent as dietary supplement. </li></ul>
    52. 52. Vitamin D (Absorption) <ul><li>Absorbed in the intestinal tract </li></ul><ul><ul><li>By the presence of bile salts and fats. </li></ul></ul><ul><ul><li>Transported into the lymph circulation via chylomicrons(particles of emulsified fat fount in the blood). </li></ul></ul><ul><ul><li>The ff can aversely affect vit. D absorption. </li></ul></ul><ul><ul><ul><li>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. </li></ul></ul></ul>
    53. 53. Vitamin D (Transport and Storage) <ul><li>Carried by the blood to the liver. </li></ul><ul><li>Converted to calcitrol (active form of vit. D). </li></ul><ul><li>Found in skin and brain, with smaller quantities in the lungs, spleen, and bones. </li></ul>
    54. 54. Vitamin D (Metabolism) <ul><li>Deluca (1969) showed that vit. D must first be converted to atleast two biologically active metabolites before it can induce physiological changes. </li></ul>
    55. 55. Vitamin D (Metabolism) <ul><ul><li>Vit. D is hydroxylated in the liver and intestine to form 25-hydroxyvitamin D3(25-hydroxycholecalciferol [25-Oh-D]) </li></ul></ul><ul><ul><li>Carried to the kidney for further hydroxylation to form 1,25-dihydroxyvitamin (1,25 dihydroxycholecalciferol or calcitrol) </li></ul></ul><ul><ul><ul><li>Regulated by circulating calcium, parathyroid hormone, and calcitonin. </li></ul></ul></ul>
    56. 56. Vitamin D (Metabolism) <ul><li>Calcitrol enters epithelial cells of small intestine and acts on nucleic acid. </li></ul><ul><ul><li>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). </li></ul></ul><ul><ul><ul><li>Increased conc. of calcium promotes deposition. </li></ul></ul></ul>
    57. 57. Vitamin D (Function) <ul><li>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). </li></ul><ul><li>Promotes intestinal calcium and phosphate absorption. </li></ul><ul><ul><li>Involved in formation and functioning of bones, teeth, nerves, and muscle. </li></ul></ul>
    58. 58. Vitamin D (Function) <ul><li>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. </li></ul><ul><li>Stimulates renal tubular transport of calcium and phosphorus(Deluca). </li></ul><ul><li>Aids in the treatment of serious bones disease. </li></ul>
    59. 60. Vitamin D (Recommended Dietary Allowance) <ul><li>400IU(10ug)/day </li></ul><ul><ul><li>Birth to 22 years of age </li></ul></ul><ul><ul><li>Due to bone formation and mineralization during active growth and development </li></ul></ul><ul><li>500IU/day </li></ul><ul><ul><li>Pregnant and lactating </li></ul></ul><ul><li>300IU(7.5)/day </li></ul><ul><ul><li>19-22-year-old female(not pregnant) </li></ul></ul><ul><li>Allowance of 200 IU of vitamin D is recommended for adult men and women </li></ul><ul><ul><li>Maintain calcium </li></ul></ul><ul><ul><li>Reduce osteoporosis (past menopause) </li></ul></ul>
    60. 61. Vitamin D (Sources) <ul><li>Sunlight </li></ul><ul><ul><li>Major source </li></ul></ul><ul><ul><li>Depends on intensity and length of exposure </li></ul></ul><ul><ul><li>Color of skin </li></ul></ul><ul><li>Fatty fish, eggs, liver, butter </li></ul><ul><ul><li>Small amount </li></ul></ul><ul><li>Fish liver oil fortified milk </li></ul><ul><ul><li>Major food sources </li></ul></ul><ul><li>Milk and cheese products </li></ul><ul><ul><li>Excellent supply of calcium and phosphorus in the ideal ratio of 1.2:1 </li></ul></ul><ul><ul><li>Can help in the absorption of vit D and bone formation </li></ul></ul>
    61. 62. Vitamin d (Indications for Vit D Supplementation) <ul><li>Elderly (house-bound) </li></ul><ul><li>Lactose intolerant </li></ul><ul><li>infants </li></ul>
    62. 63. Vitamin D (Diseases) <ul><li>Rickets </li></ul><ul><ul><li>Lack of orderly change from cartilaginous material to calcified bone during bone development. </li></ul></ul><ul><ul><li>Mineralization of osteoid (young boen that has not undergone calcification) matrix does not occur. </li></ul></ul><ul><ul><li>Overgrown and disorganized zone of cartilage, capillaries, and fibroblast at the end of long bone shafts where bone and cartilage join. </li></ul></ul>
    63. 64. Vitamin D (Diseases) <ul><li>Rickets </li></ul><ul><ul><li>Bone deformities occur </li></ul></ul><ul><ul><ul><li>Example rickets rosary </li></ul></ul></ul><ul><ul><li>Radiograph </li></ul></ul><ul><ul><ul><li>Outline of joins are blurred and hazy, and the epiphyseal line becomes broadened. </li></ul></ul></ul><ul><ul><li>Treatment </li></ul></ul><ul><ul><ul><li>1000 to 5000 IU/day </li></ul></ul></ul><ul><ul><ul><ul><li>Depends on he severity </li></ul></ul></ul></ul><ul><ul><ul><li>1ml halibut liver oil </li></ul></ul></ul><ul><ul><ul><ul><li>30-40 times more than cod liver oil </li></ul></ul></ul></ul><ul><ul><ul><ul><li>children </li></ul></ul></ul></ul><ul><ul><ul><li>4 glasses of milk/day or 5g of calcium lactate </li></ul></ul></ul>
    64. 65. Vitamin D (Diseases) <ul><li>Rickets </li></ul><ul><ul><li>Treatment </li></ul></ul><ul><ul><ul><li>(Diet)- Egg, fortified butter, margarine, ascorbic acid, and iron </li></ul></ul></ul><ul><ul><ul><li>Vitamin D supplements should gradually reduced to prophylactic doses of 400 IU daily after serum alkaline phosphatase decreases to normal levels. </li></ul></ul></ul><ul><ul><li>Prevention </li></ul></ul><ul><ul><ul><li>Exposure to sunlight, diet rich in vitamin D. </li></ul></ul></ul>
    65. 66. Vitamin D (Diseases) <ul><li>Osteomalacia </li></ul><ul><ul><li>Softening of bone due to failure of mineralization as they undergo remodeling </li></ul></ul><ul><ul><li>Adult counterpart of rickets </li></ul></ul><ul><ul><li>Most often seen in women </li></ul></ul><ul><ul><ul><li>Repeated pregnancies </li></ul></ul></ul><ul><ul><ul><li>Who have little exposure to sunlight and who eats diet with low dairy content. </li></ul></ul></ul><ul><ul><li>Experiences pain in ribs, spine, pelvis, and legs </li></ul></ul><ul><ul><ul><li>leg bones may bend, leads to waddling gait </li></ul></ul></ul>
    66. 67. Vitamin D (Diseases) <ul><li>Osteomalacia </li></ul><ul><ul><li>Treatment </li></ul></ul><ul><ul><ul><li>5000 to 20,000 IU of vitamin D accompanied by 5g of calcium gluconate or calcium lactate three times a day. </li></ul></ul></ul>
    67. 68. Vitamin D (Diseases) <ul><li>Enamel Hypoplasia </li></ul><ul><ul><li>Incomplete development of the enamel and dentin </li></ul></ul><ul><ul><li>Enamel calcifies poorly and in some areas fail to form. </li></ul></ul><ul><ul><li>Uncalcified dentin matrix </li></ul></ul><ul><ul><li>Earliest sign </li></ul></ul><ul><ul><ul><li>Calciotraumatic line in the dentin </li></ul></ul></ul>
    68. 69. Vitamin E
    69. 70. Vitamin E <ul><li>Fat soluble </li></ul><ul><li>Antioxidant </li></ul><ul><ul><li>Stop the free radical from forming in the first place </li></ul></ul><ul><ul><li>Interrupt an oxidizing chain reaction to minimize the damage of free radicals </li></ul></ul>
    70. 71. <ul><li>Protects cell membranes and other fat-soluble parts of the body </li></ul><ul><li>Promotes normal growth and development </li></ul><ul><li>Promotes normal red blood cell formation </li></ul><ul><li>Acts as anti-blood clotting agent </li></ul>Vitamin E
    71. 72. Vitamin E <ul><li>Seed oils = major source </li></ul><ul><li>wheat germ oil </li></ul><ul><li>vegetable oils </li></ul><ul><li>nuts and seeds </li></ul><ul><li>whole grains </li></ul><ul><li>egg yolk </li></ul><ul><li>leafy green vegetables </li></ul>
    72. 73. Specific Food Sources <ul><li>vegetable oils </li></ul><ul><ul><li>Corn, cottonseed, and peanut oil </li></ul></ul><ul><li>nuts and seeds </li></ul><ul><ul><li>Almonds, hazelnuts, sunflower seeds, walnuts, and margarine </li></ul></ul><ul><li>whole grains </li></ul><ul><ul><li>whole-wheat flour, wheat germ </li></ul></ul><ul><li>Vegetables and fruits </li></ul><ul><ul><li>Spinach, lettuce, onions, blackberries, apples, and pears </li></ul></ul>
    73. 74. 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
    74. 75. Vitamin E <ul><li>Severe vitamin E deficiencies are rare </li></ul><ul><li>Lack of vitality </li></ul><ul><li>Lethargy </li></ul><ul><li>Apathy </li></ul><ul><li>Inability to concentrate </li></ul><ul><li>Muscle weakness </li></ul>
    75. 76. Vitamin E <ul><li>No harmful effects at 50 times RDA (1200 – 1500 IU) </li></ul><ul><li>Vitamin E toxicity is rare </li></ul><ul><li>Vitamin E requirement is proportional to the amount of unsaturation of polyunsaturated fatty acid in the diet. </li></ul><ul><li>It helps fats not become rancid (antioxidant) </li></ul>Additional Information:
    76. 77. Vitamin E <ul><li>Freezing may destroy Vitamin E </li></ul><ul><li>Extreme heat causes Vitamin E to break down </li></ul><ul><li>Avoid deep-fat frying foods that are natural sources of Vitamin E </li></ul>
    77. 78. VITAMIN K Vitamins Home Page
    78. 79. VITAMIN K’S METABOLIC/BIOCHEMICAL FUNCTIONS <ul><li>Aids in blood clotting (primary function) </li></ul><ul><ul><li>Prothrombin by the liver </li></ul></ul><ul><ul><li>Factor VII, IX, X </li></ul></ul><ul><li>In the process of blodclotting, prothrombin is converted to thrombin </li></ul><ul><li>Thrombin will then convert Fibrinogen to Fibrin, the basis of blod clot </li></ul><ul><li>Normal human blood when shed will clot within 5-8mins in room temp </li></ul>
    79. 80. AIDS IN BLOOD CLOTTING <ul><li>Primary function of Vitamin K </li></ul><ul><li>Initiates the healing process by slowing and stopping the bleeding </li></ul><ul><li>Given to patients before surgery to prevent excessive bleeding </li></ul>
    80. 81. VITAMIN K SYNOPSIS <ul><li>There are 3 forms of Vitamin K: </li></ul><ul><ul><li>Vitamin K 1 </li></ul></ul><ul><ul><li>principle natural dietary source of Vitamin K found in green leafy vegetables </li></ul></ul><ul><ul><li>Vitamin K 2 </li></ul></ul><ul><ul><ul><li>Produced in bacterial synthesis in the intestine </li></ul></ul></ul><ul><ul><ul><li>*both are unstable in ultravioletlight and destroyed by strong acids and alkalis </li></ul></ul></ul><ul><ul><li>Vitamin K 3 </li></ul></ul><ul><ul><ul><li>Synthetic form of the vitamin K </li></ul></ul></ul><ul><ul><ul><li>also referred to as menadione </li></ul></ul></ul>
    81. 82. DIETARY SOURCES OF VITAMIN K <ul><li>Lentils </li></ul><ul><li>Egg Yolks </li></ul><ul><li>Whole wheat </li></ul><ul><li>Fruits </li></ul><ul><li>Cheese </li></ul><ul><li>Ham </li></ul><ul><li>Beef </li></ul><ul><li>Liver </li></ul><ul><li>Green tea </li></ul><ul><li>Tomatoes </li></ul><ul><li>yogurt </li></ul>§ Freezing foods may destroy vitamin K, but heating has no effect
    82. 83. RECOMMENDATIONS FOR PREGNANT & LACTATING WOMEN <ul><li>< 18 years = 75 µg </li></ul><ul><li>19-30 years= 90 µg </li></ul><ul><li>31-50 years = 90 µg </li></ul><ul><li>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. </li></ul>
    83. 84. VITAMIN K DEFICIENCY <ul><li>Since Vitamin K is obtained easily from the diet and synthesized in the body </li></ul><ul><li>*deficiencies are rare </li></ul><ul><li>Antibiotics will interfere with the normal production of Vitamin K in the intestine </li></ul><ul><li>Health problems that may lead to Vitamin K deficiency are: </li></ul><ul><ul><li>Gallbladder or biliary disease </li></ul></ul><ul><ul><li>Liver disease </li></ul></ul><ul><ul><li>Ongoing diarrhea </li></ul></ul><ul><ul><li>Heavy menstrual bleeding </li></ul></ul>