VITAMINSRequirement And Deficiencies

Dr Soumar DuttaCDMO

Guwahati Refinery Hospital

DEFINITION

These are organic compounds occurring in natural foods either as such or as utilizable precursors which are required in minute amounts for normal growth, maintenance and reproduction.

CLASSIFICATION: broadly classified based on solubility

A. Fat soluble vitamins B. Water soluble vitamins

1. Vitamin A 1. Vitamin C

2. Vitamin D 2. Vitamin B-complex group

3. Vitamin E

4. Vitamin K

VITAMIN A SOURCES

Animal sources•Liver oil•Butter•Milk•Cheese•Egg yolk

Plant sources•Tomatoes•Carrot•Green-yellow vegetables•Spinach•Mangoes•Papaya•Corn•Sweet potato

RDA: Adults 3000-5000 IU/day Children, pregnant and lactating women

Absorption, Storage and Transport

• Vit A and its precursors absorbed in Small Intestine• Stored in Liver• Transported in blood with a special Retinol Binding Protein (RBP)

FUNCTIONS Role in normal vision Role in bone and teeth formation Role in epithelialization Normal growth Body metabolisms Role in reproduction

Deficiency symptoms Xeropthalmia Follicular conjunctivitis Keratomalacia Nyctalopia (night blindness) Follicular hyperkeratosis and keratizing

metaplasia Urolithiasis

Follicular Hyperkeratosis

HYPERVITAMINOSIS A

Excess of vitamin A induce series of toxic effects known as hypervitaminosis A syndrome. Seen usually among Eskimos who consume livers of polar bear and arctic foxes.

SYMPTOMS Alteration of skin and mucous membrane Hepatic dysfunction Headache Drowsiness Peeling of skin about the mouth and elsewhere

VITAMIN D

It is a steroid hormone.

Biologically active form

is Calcitriol

SOURCES• Fish liver oil• Egg yolk• Milk• Butter• Cheese• Margarine

RDA: 100 IU/day in adults

pregnancy, lactation, infant and children ( 220 IU)

FUNCTIONS

Intestinal absorption of calcium and phosphates Mineralization of bones Promotes bone resorption and calcium mobilization to raise blood Ca

and P in relation to PTH. Renal reabsorption of Ca and P

DEFICIENCY Ricket Osteomalacia Renal osteodystrophy

RICKETS OSTEOMALACIA

HYPERVITAMINOSIS D

Effects are mainly due to hypercalcaemia

IMMEDIATE DELAYED Anorexia Urinary lithiasis.

Thirst Metastatic calcificationLassitude

Constipation

Polyuria

VITAMIN E (Tocopherols)

Alpha –tocopherol is the most active forms

SOURCES• Cottonseed oil• Corn oil• Sunflower oil• Wheat germ oil• Margarine• Green leafy

vegetables

RDA: 25-30 IU/day

FUNCTIONS

Antioxidant property

DEFICIENCY Muscular dystrophies

Nocturnal muscular cramps

Intermittent claudication

Fibrocystic Breast Disease

Atherosclerosis Hemolytic anemia- susceptibility of RBCs to hemolysis Dietary hepatic necrosis Neurological disorders

TOXICITY

None

VITAMIN K

Antihemorrhagic /coagulation vitamin or prothrombin factor.Three variants K1,K2 and K3 .All are napthoquinone derivatives.

SOURCES• Cabbage• Cauliflower• Tomato• Alfa alfa• Spinach• Green leafy vegetables• Egg yolk• Meat• Liver• Cheese & dairy products

RDA: 70-140 microgm/day

FUNCTIONS

Blood coagulation:

Blood factors such as prothombin, factors II,VII,IX,X. Calcium binding protein

DEFICIENCY

Rare, present sufficiently in food. Hemorrhagic conditions. Prothrombin level and clotting time Hemorrhagic disease of newborn

HYPERVITAMINOSIS K

Hemolytic anemia and jaundice (in large doses)

ANTAGONIST TO VITAMIN K

Heparin, Dicumarol, Salicylates

WATER SOLUBLE VITAMINS

Non B-complex B-complex

Vitamin C

Energy releasing Hematopoietic

Thiamine (B1) Folic Acid

Riboflavin (B2) Vitamin B12 / Cyanocobalamin

Niacin(B3)

Pantothenic Acid(B5)

Pyridoxine(B6)

Biotin(B7)

VITAMIN C (Ascorbic Acid)

SOURCES Citrous fruits- orange, lemon Papaya Pineapple Banana Strawberry Green leafy vegetables Cabbage Cauliflower Germinating seed Green peas and beans Gooseberry(Amla)

(richest source)

RDA: Adults 60-70 mg/day

FUNCTIONS

Collagen formation Iron and hemoglobin metabolism Tryptophan metabolism Tyrosine metabolism Folic acid metabolism Cholesterol synthesis Cellular respiration Immunological function Prevents cataract formation Preventive action on chronic diseases

DEFICIENCY SCURVY- defect lies in the failure of intercellular cement substance

Fragile capillaries-petechial, sub-cutaneous ,sub-periostial

or internal hemorrhages. Poor /Delayed wound healing. Poor dentine formation Gum bleed- gums are swollen, spongy bleeds on pressure Poor mineralization of bones Anemia- microcytic - hypochromic

Vitamin B1 (Thiamine)

SOURCES Cereals Pulses Oil seeds Nuts Yeast Meat Fish Egg Milk

RDA: Adults 1.2-1.5 mg/day

FUNCTIONS

Essential for normal growth Essential for normal functioning of nerves Co-enzymatic activities- carbohydrate, nucleic acid and energy

synthesis

DEFICIENCY Beri beri

Earliest symptoms:

anorexia

dyspepsia

heaviness and weakness of legs.

calf tenderness

Wet beri beri Dry Beri beri

Oedema of legs, face Progressive muscle weaknes and

trunk and serous cavities. disability Calf muscles are swollen and tender Neurological manifestations Palpitation and breathlessness Low diastolic BP, high systolic. Fast pulse Heart becomes weaker

and patient dies of heart failure

Infantile Beri beri Infants born to mother with low thiamine in their breast milk. Restlessness and sleeplessness Anorexia, vomiting and breathlessness Symptoms d/t cardiac dilatation and failure. Sudden death if not treated urgently with thiamine.

Wernicke-korsakoff psychosis

Seen mostly in chronic alcoholics Body demand of thiamine increases in alcoholism

Characterized by:• Dementia• Apathy• Nystagmus

VITAMIN B2 (Riboflavin)

SOURCES: Yeast Whole grain Dry beans and pea Green vegetables

RDA: 1.5-1.8 mg/day in adults

FUNCTIONS:

In two active forms FMN and FAD serves as coenzyme in various reactions

DEFICIENCY Cheilosis-fissuring at angle of the mouth Glossitis-tongue smooth and purplish Seborrhagic Dermatitis:scaly,greasy,desquamation Eyes: corneal vascularization

Chronic alcoholics are susceptible to deficiencies.

VITAMIN B3 (NIACIN/NICOTONIC ACID)

SOURCES: Liver Kidney Meat fish Legumes(pea,beans,lentil) Nuts Green vegetables Coffee Tea Synthesize from A. acid Tryptophan

RDA: 17-21 mg/day in adults

FUNCTIONS:

It has two active forms NAD+,NADP+ serves as co-enzymes in various oxido-reductive reactions in ETC

DEFICIENCY PELLEGRA (pelle-skin; agra- rough)

“3D” Disease: Dermatitis, Dementia, Diarrhoea Gingivitis and stomatis Achlorhydria Fatty liver Effect on plasma

lipids

VITAMIN B5 (Pantothenic Acid)

SOURCES Kidney Liver Egg yolk Yeast Cereals Legumes Sunflower oil

RDA: 5-10 mg/day

FUNCTION Acts through CoA and helps in the formation of

Energy Triactlglycerol Vit D Steroid hormones

DEFICIENCY

Nausea, vomiting ,GI disorders, Irritability. Inadequate growth. Fatty liver Steroid synthesis. Burning foot syndrome- Pain and numbness in the toes

Insomnia

Fatigue

VITAMIN B6 (Pyridoxine)SOURCE Yeast Rice polishing Germinal portion of seeds Liver kidney Fish

RDA: 2-2.2 mg/day

FUNCTION

Active form is Pyridoxal Phosphate (PLP).It serves as coenzyme in various bio-chemical reactions like Transaminase, Decarboxylation, Deamination.

DEFICIENCY

Neurological symptoms • Depression• Irritability• Nervousness• Mental confusion• Convulsions• Peripheral neuropathy• Demyelination of neurons

Anaemia • Hypochromic microcytic anaemia d/t reduced heme production.

Pyridoxine deficiencies are mostly seen in women taking OCPs, alcoholics infants and those on ATT especially INH

VITAMIN B7 (Biotin)

SOURCES: Egg yolk Liver Kidney Yeast Milk Tomato Fruits Vegetables

RDA: 50-60 microgms/day

FUNCTIONS: it acts as co enzyme

In various carboxylation reactions

DEFICIENCY Dermatitis of extremities Pallor of skin & mucous membrane Anorexia & nausea Muscle pain and hyperesthesia Depression, Lassitude and Somnolence Hypercholesterolemia

A rare congenital disease of genetic deficiency to utilize Biotin

Characterized by :

Dermatitis Loss of hair

Grating of hairs Incordinated movements

Leiner’s disease: In exclusive breast fed infants with persistant diarrhoea

VITAMIN B9 (Folic Acid)

SOURCES Liver Yeast Kidney Green leafy vegetables Meat Fish

RDA: 100 microgm/day

FUNCTIONS:

The active form of folic acid is Tetrahydrofolate.It acts as coenzymes in various bio-chemical reactions.

DEFICIENCY:

It is the most common vitamin deficiency observed primarily in pregnant women, lactating mother , women on OCPs and alcoholics.

In pregnancy decreased absorption and increased clearance is the cause.

Anaemia: macrocytic type

FIGLU test - to detect folate deficiency.

VITAMIN B12 (Cyanocobalamine)

SOURCES Liver Kidney Milk Curd Egg Fish Fish Chicken

RDA: 3 microgm/day

FUNCTION: Required with folic acid for development of RBCs. Stimulates appetite and required for normal health. Cures neurological symptoms of pernicious anaemia.

DEFICIENCY

Megaloblastic anaemia Mucosal atrophy of mouth Glossitis Disease of nervous system both central and peripheral Psychiatric symptoms Amblyopia A severe form of acidosis in children

CONCLUSION

Vitamins are required in trace amounts. They do not directly provide energy. They are not required by normal otherwise healthy individuals

consuming a balanced diet, rather should be reserved for those who are under stressful conditions ACUTELY ILL PATINTS PREGNANT AND LACTATING MOTHER CHRONIC DEBILITATING ILLNESS DURING CONVALESCENCE MALNOURISHED PERSON UNDERTAKING CERTAIN DRUGS- ANTIMICROBIALS