Our Lady of Lourdes College Foundation Learning Module

College of Nursing and Midwifery Nutrition and Diet Therapy

Instructor: Raquel B. Torres

Module 7: Vitamins

OVERVIEW This module will introduce you the importance of vitamins in our body.
The function of water soluble and fat soluble.

LEARNING OUTCOMES

At the end of this module, you will be able to:

1. Identify the types of vitamins
2. Discuss and differentiate the essential and nonessential vitamins
3. Discus the function of vitamins and their works.

LEARNING EXPERIENCES AND SELF ASSESSMENT ACTIVITY

VITAMINS

Vitamins are group of organic chemicals with no general link between them except they are
required in tiny amount (milligrams or micrograms) to perform specific functions that promote
growth, reproduction, or maintenance of health and life.

Three key characteristics of vitamins:

1. Vital organic substance that does not produce energy but utilized for energy production
from carbohydrates, fats, or protein
2. It cannot be manufactured by the body and must therefore be supplied in the diet.
3. Its absence or underutilization causes specific nutritional deficiency

 Organic molecules required in very small amounts

 Each vitamin perform a specific metabolic function

 Vitamins except Vitamin D. are not synthesized by the body so it must be provided in
the diet.

 Recommended eating of five fruits and vegetables per day throughout life span reduces
diet related diseases in the future.

What are the sources of vitamins?

Generally found in foods but mostly concentrated in vegetables and fruits.

How much vitamins are needed?

Vitamin allowances are minute but should be met to prevent deficiency.

Are vitamin supplements necessary?

The need for vitamin supplement depends on health and physiologic condition of individuals.

 Can correct deficiencies (Vit.A)

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Nutrition and Diet Therapy
Instructor: Raquel B. Torres

Module 7: Vitamins

 Can reduce the risk of disease

 Supplement may also improve the body’s immune system ( Vit.C)

The following are the specific individuals who may need vitamin supplements :

 Individuals with specific nutrient deficiencies

 Individuals with low energy in take (< 1200kcal /day) need B vitamins
 Pure vegetarians (vegan) need the vitamin B vitamin
 People with atrophic gastritis need additional B
 Women who bleed excessively during menstruation need vitamin K
 People in certain stages in the life cycle (e.g. women at child bearing age need folate,
the elderly need vitamin D.

Terminology

 DRI (Dietary Reference Intake) umbrella term included in RDA.

 RDA (Recommended Dietary Allowance) RENI

 AI (Adequate Intake)

 UL (Tolerable Upper Intake Level)

VITAMIN CATEGORIES

1. Water –Soluble vitamins – are vital components in the metabolic process. They play a
role in energy production, blood formation, tranquillity and radical formation .Some
vitamins are required for the maturation of red blood cell.

 B COMPLEX Vitamins

 Vitamin C

2. Fat Soluble Vitamins – (dissolve in fatty tissues or substances) excess vitamins are
stored in the liver and adipose tissues. The body maintains blood concentration by
retrieving these vitamins from storage as needed. Deficiency tends to develop slowly,
at the same time, they are not easily excreted.

> A, D, E, and K

Vitamin A-Retinol

Vitamin D- Calciferol

Vitamin E –Tocoferol

Vitamin D –Menadione

Water Soluble Vitamins

 Easily absorbed by the body, especially the small intestines and to the circulation

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Nutrition and Diet Therapy
Instructor: Raquel B. Torres

Module 7: Vitamins

 They are not stored by the body which means deficiencies can develop quickly and
therefore needs to consume on a daily basis.

 Excess of Water Soluble vitamins may cause toxicity.

The WATER SOLUBLE VITAMINS:

1. THIAMINE (B1)

 Beriberi (Thai word) means “I can’t, I can’t”

 A serious disease which afflicted people in Asia which causes wasting of muscles

 This disease results from Thiamine deficiency.

Function:

> Coenzyme in energy metabolism and nerve functioning related to muscle actions.

RDA = 1.2 mg. for men/ 1.1 mg for women

In increases during physical activity.

 Sources: lean pork, whole or enriched grains and flours, legumes, seeds and nuts.

 It can be lost during cooking.

 Deficiency: Beri-Beri

 Alters nervous, muscular, GIT and Cardiovascular system

 Chronic deficiency characterized by ataxia, pain, anorexia, mental

disorientation,

 Severe deficiency of Beri-beri may cause a cerebral form of beri-beri called

Wernicke-Korsakoff Syndrome a disease resulting from too much intake or
excessive use of alcohol with the S/S of loss of memory, extreme mental
confusion, and ataxia

 Deficiency: Beri-Beri

 Alters nervous, muscular, GIT and Cardiovascular system

2. RIBOFLAVIN (B2)

A Coenzyme of energy metabolism

Milk is the excellent source of B2, although also found in plant food.

Sensitive to ultraviolet rays that’s why is packed in opaque cardboard and non-
transparent plastic containers.

RDA: 1.3 mg for men/1.1 mg for women

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Nutrition and Diet Therapy
Instructor: Raquel B. Torres

Module 7: Vitamins

 Conditions such as wound healing, growth periods of childhood and lactation

Sources:

 Milk, enriched grains, eggs, meat and poultry, broccoli, asparagus, dark green
leafy vegetables are good sources of Riboflavin

 DEFICIENCY:

1. Ariboflavinosis with S/S of swollen lips, crack develops in the sides of

the mouth (Cheilosis)

2. Tongue becomes purple and swollen (Glossitis)

3. Seborrheic dermatitis may also occur in the ears, nose and mouth

4. It may also affect the availability of pyridoxine and niacin.

3. NIACIN (B3)
Occurs naturally in two forms: Nicotinic acid and niacinamide
People who suffer from niacin deficiency are psychologically disoriented, it can cause
Psychosis but can disappear when sufficient amounts of B3 is consumed.
Functions:
> needed for glycolysis and tricarboxyclic acid cycle.
> Coenzyme for many enzymes involved in energy metabolism
 RDA = 16 mg NE for male/ 14 NE for female
Diets adequate in Protein is adequate in Niacin as the body is able to convert
Tryptophan to Niacin.
Sources: Meats, poultry, legumes, milk, enriched wheat cereals, coffee and tea
Deficiency:
Pellagra – characterized by 3 D’s
> Diarrhea – due to damage in the GIT
> Dermatitis – a symmetrical body rash occurs on skin exposed to sun
> Dementia – with severe deficiencies, the CNS is affected with S/S of
confusion, anxiety, insomnia, and paranoia.
4. PYRIDOXINE (B6)
= represent a group of related chemicals known as:
1. Pyridoxine
2. Pyridoxal
3. Pyridoxamine
= These 3 can be converted to coenzyme Pyridoxal Phosphate (PLP)
FUNCTION:
> B6 in the form of PLP acts as coenzyme in the metabolism of AA and
proteins.
> They are involve in the formation of neurotransmitters and essential for
functioning of the nervous system.

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Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Nutrition and Diet Therapy
Instructor: Raquel B. Torres

Module 7: Vitamins

> It is essential for hemoglobin synthesis

> It also is responsible for conversion of tryptophan to Niacin
> Serves as co enzyme for fatty acids and carbohydrate metabolism
> Reduces risk for Coronary Artery Disease (CAD)
RDA = 1.3 mcg for men and women.
Deficiency:
> Deficiency of B6 occurs with the low intake of other B vitamins.
> Drugs Bioavailability of B6, Oral Contraceptives maybe among the most widely
used.
5. FOLATE
Folium (Latin for “leaf”); they are rich in Green Leafy Vegetables.
FUNCTION:
Proper formation of the Fetal Neural Tubes.
May result to Spina Bifida and Anacephaly.
RDA = 400 mcg / 600 mcg during pregnancy/ 500 mcg for lactating mother
> Increase levels could be provided by natural resources, fortified foods or
supplements.
> FDA mandates that cereal and grain products be fortified with 140 mcg/100 g folic
acid.
Deficiency:
> Fetal neural defect Spina Bifida and Anancephaly
> Megaloblastic anemia – large RBC that cannot carry oxygen
> Liver cirrhosis interferes with folate metabolism which may result in excessive
loss of vitamins in feces and urine.
6. COBALAMIN (B12) CYNACOBALAMIN
Functions:
> As coenzyme in humans, and folate metabolism in synthesizing DNA and RNA
and also fatty acids and amino acid metabolism.
> It also maintains the myelin sheaths that surround and protect the nerve
fibers.
> Together w/ B6 and Folate, reduces levels of homocyste in decreasing the risk
for CAD
RDA = 2.4 mcg
> Foods of animal origin are the only reliable source of B12
Deficiency:
> Deficiencies are secondary to other deficiencies.
> Pernicious Anemia –
> Neurologic defects due to breakdown of myelin sheath synthesis
> Older persons more at risk for B12 deficiency because of reduction of intrinsic
factor in the GIT which affects absorption of B12.
7. BIOTIN ( B8)

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Nutrition and Diet Therapy
Instructor: Raquel B. Torres

Module 7: Vitamins

a. Humans needs biotin in small amounts.

b. Helps in transfer of Carbon dioxide from one compound to another which
help in CHO, protein and fat metabolism
c. It is synthesize in the lower GIT by bacterial microorganisms (human body
do not synthesize biotin, but the bacteria does it.)
Sources: Liver, kidney, peanuts, butter egg yolks and yeast
RDA = 30 mcg
Deficiency:
> Scaly red skin rash, hair loss, loss of appetite, depression and Glossitis.
> Antibiotics reduce the number of biotin producing bacteria
> AVIDIN a protein found in raw egg white also causes deficiency
> Clients receiving long term IV feeding are prone to deficiency of biotin.
8. PANTOTHENIC ACID
a. Coenzyme in CHO, protein and Fat Metabolism
b. Widespread in foods, and easily consumed in cereal, peanuts, meat fish and
poultry.
c. No deficiency occurs in human
9. CHOLINE
 Needed for the synthesis of acetylcholine (neurotransmitter) and lecithin
(phospholipid)
 As essential nutrient RDA is 550 mg/day for men / 425 mg for women/day
VITAMIN C
 Ascorbic Acid (means no scurvy)
 Scurvy – fatal disease associated with Vitamin C which weakens the connective tissues
and causes inflammation of them.
Functions:
> Antioxidant and coenzyme
> Collagen formation for bone matrix, teeth, cartilage, and connective tissues
depends on Vitamin C.
> provides cement that hold structures together
> promotes wound healing
 It protects the folate, Vitamin E and polyunsaturated substances from destruction by
oxygen as they move throughout the body.
 It also enhances the absorption of non heme iron found in plant foods.
 It also works together with Vitamin E as antioxidants they destroys substances
released as cells age.
 May reduce risk of CA development
RDA = 90 mg for men/ 75 mg for women. Minimum requirements 10 mg daily to prevent
scurvy.
 DEFICIENCY:
> Scurvy – extreme result of Vitamin C deficiency.

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Nutrition and Diet Therapy
Instructor: Raquel B. Torres

Module 7: Vitamins

When not replaced, glue like substances of collagen, tissues

throughout the body degenerate.
> Gingivitis – cause gums bleed, teeth become loose, joint and limbs ache from
muscle degeneration, bruising and hemorrhages occur due to weakened vascular system,
plaque form in the arteries.
> Marginal symptoms include poor wound healing, inadequate tooth and bone
growth, increase risk for infection.
Fat Soluble Vitamins

3. Fat Soluble Vitamins – (dissolve in fatty tissues or substances) excess vitamins are
stored in the liver and adipose tissues. The body maintains blood concentration by
retrieving these vitamins from storage as needed. Deficiency tends to develop slowly,
at the same time, they are not easily excreted.

> A, D, E, and K

Vitamin A-Retinol

Vitamin D- Calciferol

Vitamin E –Tocoferol

Vitamin D –Menadione

 Follows a more complicated route of other fat substances.

 Bile is required for absorption in the small intestine
 Fat malabsorption may also lead to deficiencies of fat soluble vitamins
 If we consume more than the daily requirement, our bodies store the excess rather
than excrete in the urine.
 Over loading the storage capabilities can be toxic and produce illnesses. (Toxicity is the
result of improper use of vitamin supplements.
Vitamin A (Retinol)
Function:
> maintain skin and mucous membranes of the body
> In enhances vision, bone growth, functioning of the immune system, and normal
reproduction
> Without Vitamin A, Rhodopsin a substance in the retina cannot be formed
which helps in responding to light changes. Night Blindness develop.
> Vitamin A maintains integrity of the epithelial tissues of the body which
provide protection against infections.
> Hormone like effects of Vitamin A aids in cell synthesis for reproduction.
RDA =
> is measured in Retinol activity equivalents. (REA)
> 900 mcg for men / 700 mcg for women.

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Nutrition and Diet Therapy
Instructor: Raquel B. Torres

Module 7: Vitamins

> Active forms of Vitamin A are:

Retinoid (found in animal foods)
Carotenoids (found in plant foods)
Deficiency:
> Primary: lack of dietary Intake
> Secondary: chronic fat malabsorption.

> Xerophthalmia – night blindness, which may progress to keratinization of the Cornea
which may result to complete blindness.
> Hyperderatosis white hard lumps of keratin in the hair follicle
> Compromised immune system
Vitamin D (Calciferol)
 With sufficient exposure to UV light or sunshine, the body can manufacture its
own supple of Vitamin D.
 Because the body can Produce Vitamin D, is practically a hormone; But when
supplied in the Diet, it is a Vitamin.
 Dehydrocholesterol (found in the skin), is converted to Cholecalciferol under the
UV/sunlight.
 Cholecalciferol active form of Vitamin D.
Functions:
> Aids in intestinal absorption of Calcium and phosphorous
> Also affect bone mineralization and mineral homeostasis by regulating Blood
calcium levels.
RDA =
> 5 mcg but increases for older people 10 mcg
>
Deficiency:
> Ricketts – (Children) insufficient mineralization of bone and tooth matrix leads
to malformed skeletons (bowed legs) which unable to bear body weight, abnormal tooth
formation and angled rib bones and chest.
> Osteomalacia – (old) characterized by soft bones that are risk for fractures.
> Osteoporosis – decrease bone density, which make bones brittle
 Toxicity:
 High Vitamin D intake can result to hypercalcemia and hypercalciuria.
Vitamin E (Tocoferol)
Acts as an antioxidant, protecting polyunsaturated fatty acids and Vitamin A in cell
membranes .This function is particularly important protecting the integrity of the lung
and red blood cell membranes, which are exposed to large amount of oxygen.
Recommended Intake:
30 -70 mg a – TE (50 TO 100 IU)

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Nutrition and Diet Therapy
Instructor: Raquel B. Torres

Module 7: Vitamins

Check with a primary health care provider before supplementing with Vitamin E,
especially if an individual has hypertension.
Vitamin E may increase the risk of strokes for those with hypertension .It is also
contraindicated for the individuals taking warfarin ( Coumadin ) or other medicines that
inhibits blood clots because vitamin E may affect the efficacy of the medications.
Sources:
Vegetables oils (corn, soy, safflower and cottonseed) and margarine.
Whole grains, seed, nuts, wheat germ and green leafy vegetables also provide adequate
amount of vitamin E
Vitamin E deficiency
A primary deficiency of vitamin E is rare, Secondary deficiencies occur in premature
infants and others who are unable to absorb fats normally, some chronic fat absorption
disorder in which deficiency may occur are cystic fibrosis, biliary atresia, and other
disorders of the hepatobiliary system
Symptoms of vitamin E include neurologic disorder resulting from cell damage and
anemia caused by hemolysis of red blood cell (hemolytic anemia).
Toxicity: there is no evidence of toxicity associate with excessive intake of vitamin E.

Vitamin K (phylloquinone, menadione)

Discovered by a Danish scientist, vitamin K was called coagulation vitamins,
For its blood clotting properties. Later research revealed that vitamin K several related
compound with similar functions in the body.
Functions:
Vitamin K’s main function is a cofactor in the synthesis of blood clotting factors,
including prothrombin .Protein formation in bone, kidney and plasma also depends on the
actions of vitamin K.
Recommended Intake:
120 mcg Male
90 mcg Female
 Sources :
Primary food sources of vitamin K are dark green leafy vegetables .Lesser
amounts are found in dairy products, cereals meat and fruits.
 Deficiency:
Deficiency of vitamin K inhibits coagulation. Long term intensive antibiotic
therapy destroys the intestinal micro flora that produce Vitamin K
Vitamin K also has a role in bone metabolism

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Nutrition and Diet Therapy
Instructor: Raquel B. Torres

Module 7: Vitamins

Characteristics Water soluble Fat- soluble

Absorption Directly into the blood First into lymph; the
stream blood
Transport Travel free Many require protein
carriers
Storage Circulate freely in Store in the cells
water-filled parts of associated with fat
the body
Excretion Kidneys detect and Less readily excreted;
remove excess in urine tend to remain in fat-
storage sites
Toxicity Likely to reach toxic Very likely to reach
levels when consumed toxic levels when
from supplements consumed from
supplements
Requirements Needed in frequent Needed in periodic doses
doses (perhaps 1-3 (perhaps week or even
days) month). Periodic doses
mean supplementation

References:

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Nutrition and Diet Therapy
Instructor: Raquel B. Torres

Module 7: Vitamins

Books:
Foundations and Clinical Applications of Nutrition a Nursing Approach, Grodner Long De Young (Mosby)
Fundamentals of Nutrition, Leonora N. Panlasigue, Cecilia Leah P.Tionson- Bayaga
Basic Nutrition and Diet Therapy (Second edition) Maria Lourdes Cruz –Caudal, RND, MEM (2019)

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Nutrition and Diet Therapy
Instructor: Raquel B. Torres

Module 7: Vitamins

KEY POINTS

 Nightingale has been called

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Nutrition and Diet Therapy
Instructor: Raquel B. Torres

Module 7: Vitamins

\


END OF MODULE ASSESSMENT

Name: ____________________________________________ Score:________________

Year and Section:____________________________________ Date:_________________

Instruction:

1.

Total:

RUBRIC
5 POINTS - The answer is complete, correct and very clear.
4 POINTS - The answer is complete, clear but with minimal error in the concept.
3 POINTS - The answer is incomplete, correct and clear.
2 POINTS - The answer is incomplete and partially correct.
1 POINT - The answer is incomplete and incorrect.

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Nutrition and Diet Therapy
Instructor: Raquel B. Torres

Module 7: Vitamins

LOOKING AHEAD

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END SECTION

MODULE EVALUATION

Circle the number corresponding to your rating for each indicator. Please refer to the following rating scale.

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Nutrition and Diet Therapy
Instructor: Raquel B. Torres

Module 7: Vitamins

4 - Strongly Agree 3- Agree 2 - Disagree 1 - Strongly Disagree

Indicators Rating
1. Provides a brief yet compelling overview of the topic. 4 3 2 1
2. States learning outcomes following the SMART principles. 4 3 2 1
3. Discusses contents logically and clearly. 4 3 2 1
4. Presents contents in an engaging manner through effective use 4 3 2 1
of narration, examples or illustrations.
5. Provides opportunities for self-checking of understanding. 4 3 2 1
6. Provides a summary of the key concepts of the lesson. 4 3 2 1
7. States specific instructions all throughout the module. 4 3 2 1
8. Conducts assessment that are well-aligned to the learning 4 3 2 1
outcomes.
9. Develops independent learning and higher order thinking skills 4 3 2 1
of the learner.
10. Indicates necessary citations and references. 4 3 2 1

REFERENCES

Books

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Websites

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