VITAMINS

• Vitamins are nutrients that are essential for normal cellular

function, but are required in much smaller quantities than

the aliments(carbohydrates, fats and proteins). Vitamins
are essential cofactors to or components of enzymes that
are integral in intermediary metabolism and many other
biochemical processes.

• An abnormal condition resulting from excessive intake of

toxic amounts of one or more vitamins, especially over a

long period, is called Hypovitaminosis. Hypovitaminosis
may occur due to a deficiency of one or more vitamins.
 Vitamins are divided into two
categories:

Water soluble Fat soluble
• vitamin B complex • vitamins A, D, E and K
(including vitamin B12,
folate, thiamine, nicotinic
acid, pantothenic acid
and biotin), vitamin C
 Vitamin A (Retinoic acid)

• Vitamin A (retinol) has essential roles in the development of vision,

b on e g r ow t h , t h e m a i n t e n a n ce of e p i t h e l i a l t i s s u e , t h e

immunological process, and normal reproduction.

• Three forms: - retinol, retinal and retinoic acid

• Sources: - animal – retinol vegetable – provitamins (carotenes)

which are converted to vitamin A in liver

• Normal Laboratory value: adult – 20-100 mcg/dl

• Causes of deficiency

• Iodine adequate dietary intake

• Pregnancy Lactation

• Mal-absorption syndrome and Hepato-biliary disease

 Manifestations of deficiency:

• Xerophthalmia - involves xerosis (dryness) of eye,

• night blindness (nyctalopia) progressing to total
blindness,
• Dry and rough skin with papules,
• hyperkeratinisation,
• Keratinization of bronchopulmonary epithelium,
• increased susceptibility to infection
 Uses

• Tretinoin (all trans-retinoic acid) and isotretinoin
(synthetic retinoid) are used in acne vulgaris and to
facilitate healing of skin. For prophylaxis in children.
 Adverse effects

• Lo ng- te rm inge stio n o f mo re than d o uble the

recommended daily intake of vitamin A can lead to
toxicity and chronic hypervitaminosis.
• itching and dry skin;
• raised intracranial pressure irritability and headache;
• tender hyperostoses in the skull and long bones;
• hepatotoxicity;
• congenital abnormalities
 Contraindications

• Excess vitamin A during pregnancy causes birth defects.

Therefore, pregnant women should not take vitamin A
supplements.
 Vitamin D

• Vitamin D (calciferol) is another fat-soluble vitamin that
is chemically related to steroids and essential for the
normal formation of bones and teeth and for the
absorption of calcium and phosphorus from the GI tract.

• Ultraviolet rays activate a form of cholesterol in an oil of

the skin and convert it to a form of the vitamin, which is
then absorbed. Def ic iency of the vitamin results in
rickets in children, the destruction of bony tissue, and
osteoporosis.
• Vitamin D is used for the prophylaxis and treatment of
rickets, osteomalacia, and other hypocalcemic disorders
(tetany) and hypoparathyroidism.

• Vitamin D3 is the predominant form of vitamin D of

animal origin. It is found in most f ish liver oils, butter,
bran, and egg yolks. It is formed in skin exposed to
sunlight or ultraviolet rays.
• Hypervitaminosis D produces a toxicity syndrome that
may result in hypercalcemia, malabsorption (which can
lead to constipation), kidney stones, and calcium
deposits on bones.

• Vitamin D therapy is contraindicated in hypercalcemia,

malabsorption syndrome, and renal dysfunction, or if an
individual has evidence of vitamin D toxicity or abnormal
sensitivity to the effects of vitamin D. Vitamin D2 is also
called ergocalciferol.
 Vitamin E

• Vitamin E (tocopherol) is a fat-soluble vitamin that is essential

for normal reproduction, muscle development, and resistance
of erythrocytes to hemolysis. It is an intracellular antioxidant
and acts to maintain the stability of polyunsaturated fatty acids.
• Deficiency of vitamin E is rare, but can lead to anemia in babies,
especially if premature. In adults, erythrocytes may have a
shortened lifespan, which may result in muscle degeneration
of vascular system abnormalities and kidney damage.
 Vitamin E
• Vitamin E is relatively non- toxic , and may c ause
problems only in the large-dosage range of about 300 mg
per day (RDA is only 10 mg per day).

• At this range, interference with thyroid function and a

prolonging of blood clotting time may occur. Sources of
vitamin E include vegetable oils such as soybean, corn,
cottonseed, and sun f lower, as well as nuts, seeds, and
wheat germ.
 Vitamin K

• Vitamin K is essential for the synthesis of prothrombin in
the liver. The naturally occurring forms, also called
quinones, are vitamin K1 (phylloquinone), which occurs
in green plants, and vitamin K2 (menaquinone), which is
formed as the result of bacterial action in the intestinal
tract.
• Water soluble forms of vitamins K1 and K2 are also
av ai l abl e . The fat - so l ubl e synt he t i c c o mpo und ,
menadione (vitamin K3), is about twice as potent
biologically as the naturally occurring vitamins K1 and K2,
• Vitamin K is used for coagulation disorder and vitamin K

deficiency.

• I t is give n pro phylac tic ally to infants to preve nt

hemorrhagic disease of the newborn. Natural vitamin K

is stored in the body and is not toxic

 Vitamin B Complex

• Vitamin B complex is a group of water-soluble vitamins that differ

from each other structurally and in their biologic effects. Heat and
prolonged cooking, especially cooking with water, can destroy B
vitamins.
 Vitamin B1 (thiamine)
• Vitamin B1 (thiamine) is a water-soluble component of the B vitamin
complex that is essential for normal metabolism and the health of the
cardiovascular and nervous systems.
• Thiamine plays a key role in the metabolic breakdown of carbohydrates.
Rich source s of vit am in B1 are pork, organ m e at s, gre e n le afy
vegetables, legumes, sweet corn, egg yolks, corn meal, brown rice, yeast,
and nuts.

• Def iciency of thiamine leads to the disease called beriberi, which has
neurologic, cardiovascular, and GI symptoms. Thiamine toxicity can
occur if very large doses are taken for long periods, and this can result in
hepatotoxicity.
 Vitamin B2
• Vitamin B2 (ribof lavin) is one of the heat-stable components of the
B vitamin complex. It is essential for certain enzyme systems in the
metabolism of fats and proteins. It is sensitive to light. It plays an
important role in preventing some visual disorders, especially
cataracts.
 Vitamin B3
• Vitamin B3 (niacin or nicotinic acid) contains parts of two enzymes
that regulate energy metabolism. It is essential for a healthy skin,
tongue, and digestive system. Severe def iciency results in pellagra,
mental disturbances, various skin eruptions, and GI disturbances.
Pellagra may also occur during prolonged isoniazid therapy, and in
cancer patients.

• Major sources of vitamin B3 include: lean meats, chicken, eggs, fish,

cooked dried beans and peas, liver, nonfat or low-fat milk and
cheese, soybeans, and nuts.
 Vitamin B6.
•Vitamin B6 (pyridoxine) is a coenzyme essential for the synthesis and
breakdown of amino acids, the conversion of tryptophan to niacin, the
breakdown of glycogen to glucose, and the production of antibodies.

•Therefore, vitamin B6 is important in the metabolism of blood, CNS,

and skin. Def iciency of pyridoxine is rare, because most foods contain
vitamin B6.

•However, def iciency may result from malabsorption, alcoholism, oral

contraceptive use. Vitamin B6 def iciency may cause anemia, anorexia,
neuritis, nausea, dermatitis, and depressed immunity.
 Vitamin B12
• Vitamin B12 (hydroxocobalamin) is often found as cyanocobalamin
in pharmaceutical preparations. It is involved in the metabolism of
protein, fats, and carbohydrates.
• It aids in hemoglobin synthesis, is essential for normal functioning
of all cells, and is important in energy metabolism.
• Vitamin B12 is available in meat and animal protein foods. Its
absorption is complex; it occurs in the terminal portion of the small
intestine (ileum) and requires intrinsic factor (a secretion of the
stom ach walls). De f ic ie ncy cause s pe rnicious ane m ia and
neurological disorders.
 Vitamin C

• Vitamin C (ascorbic acid) is essential for the formation of collagen

tissue and for normal intercellular matrices in teeth, bone, cartilage,
connective tissues, and skin.
• Ascorbic acid may protect the body against infections and help heal
wounds. Therefore, ascorbic acid has multiple functions as either a
coenzyme or cofactor.
• Its role in enhancing absorption of iron is well recognized. Deficiency
causes scurvy, lowered resistance to infections, joint tenderness,
dental caries, bleeding gums, delayed wound healing, bruising,
hemorrhage, and anemia.
 Minerals
• They are inorganic elements occurring in nature. They are
inorganic because they do not originate in animal or plant life
but rather from the earth’s crust.
• Minerals are not metabolized, that is, they are not broken down
and rearranged in the body, nor destroyed during food
preparation. Although minerals make up only a small portion of
body
• tissues, (constitutes 4% of total body weight) they are
essential for growth and normal functioning of the body.
Minerals are classif ied in to two major groups (macro Minerals
and micro minerals).
 Minerals (Iodine, Iron and Copper)
The Major Minerals (Macrominerals)
– present, and needed in larger
amounts in the body.
– Needed in large amounts (>100
milligrams per day)
– help to maintain the body’s f luid
balance
– sodium, chloride, and potassium
are most noted
• Inorganic elements
– Un l i ke the organ i c vi tami n s,
whi c h are eas i l y d es tro yed ,
minerals are inorganic elements
that always retain their chemical
identity. Once minerals enter the
body proper, they remain there
until excreted; they cannot be
changed into anything else.
The trace minerals (microminerals)
• S o , n a m e d b e c a us e t he y a re
present, and needed, in relatively
small amounts in the body (less
than 100 milligrams per day). The
body requires the trace minerals in
m i n us cul e q uan ti ti es . They
participate in diverse tasks all over
the b od y, each havi n g sp eci al
duties that only it can perform. All
together, they would hardly f il l a
teaspoon.
• They are no less important than
the major minerals or any of the
other nutrients. Each of the trace
minerals performs a vital role. A
def iciency of any of them may be
fatal, and excesses are equally
deadly.
• E xam p l e : I ro n , Zi n c , Co p p e r,
 Iodine


– Was second to iron to be recognized as an essential trace
element for health (Sauberlich 1999)
– Was discovered by a saltpeter manufacturer in 1811 in France
(Zimmermann 2009)
– Iodine has been used in the treatment of goiter since 1820
(Kimball 1923)
– Its def iciency was shown to be the causative agent for thyroid
enlargement in 1917 (Zimmermann 2009)
– Was recognized to be an essential component of the thyroid in
1895 for the first time
– Nowadays it is well accepted that iodine is an integral
constituent of the thyroid hormones
• 3,5,3’,5’-tetraiodothyronine (thyroxine, T4)

• 3,5,3’-triiodothyronine (T3) (Zimmermann 2009)

– These hormones regulate numerous functions

» Biochemical reactions (e.g., protein synthesis,

enzyme activities)
» Influence early organ development (e.g., brain)

– Present in minute amounts (15-20 mg) in the body

– > 90% of iodine is stored in the thyroid

Physiological functions of iodine

– Biosynthesis of thyroid hormones produced by the thyroid gland.

Thyroid hormones are essential for maintaining the body’s
metabolic rate by controlling
• cellular energy production and oxygen consumption, normal
growth and neural and sexual development.
 IODINE DEFICIENCY DISORDERS
(IDDS)


Causes of IDD
• Soil devoid of iodine
– Erosion of the land owing to the mountainous topography

– Crops growing in this type of soil are deficient in iodine

– Animal products from animals grazing grass growing in thissoil

are deficient in iodine
• Water will also be deficientPoor consumption of sea foods
• Increased consumption of goitrogens
– Foods that contain goitrogenic factors include cabbage, cassava,
beetroot, bamboo shoot
• Deficiency of other micronutrients (Iron, selenium, and Vit A)
 Health consequences of iodine
deficiency:

• Inadequate intake of iodine leads to iodine deficiency disorders (IDD)
• The term IDD encompasses all consequences of IDD which can be
prevented by optimal iodine nutrition
• The most damaging effect of inadequate intake of iodine is on the
developing brain
• Cretinism is an extreme form of neurological damage due to severe
iodine deficiency or fetal hypothyroidism
• Cretinism is a congenital disease characterized by mental and
physical retardation and commonly caused by maternal iodine
deficiency during pregnancy.
• Iodine def iciency can induce thyroid enlargement at any period in
life. Goiter ref le cts an attempt of the thyroid gland to adapt to
increased need to produce thyroid hormones
• Impaired reproductive outcomes
• Child mortality
• High degree of apathy
• Reduced work productivity in the adult population living in severely
iodine de f ic ie nt are as, le ading t o e conom ic st agnat ion of
communities.
 Recommended intakes (WHO/UNICEF/ICCIDD, 2001)
Category Intake (µg/day)
Infants, 0 – 59 months 90
School children, 6 – 12 years 120
Children > 12 years and adults 150
Pregnant and lactating women 200
At a level that assures 150 µg/day is
safe for all populations (WHO, UNICEF,
FAO, ICCIDD, IAEA)
 Intervention strategies

– Programs may include one or both of the following strategies

• Food based approaches

• Fortification

• Nutrition education

• Nutraceutical approach (supplementation)

 IRON
 One of the essential trace elements for life. Found in the body in
two different forms, namely the functional or essential and storage
forms

• Functional iron

• Serves metabolic or enzymatic function

• Mediates its physiological function through iron containing

proteins including iron containing non-enzymatic proteins
(hemoglobin and myoglobin) and others

• Storage iron

• Primarily as ferritin and hemosiderin

•
 Causes of iron deficiency:

The main causes for failure to meet iron needs could be

Dietary Non dietary factors

– Inadequate intake of both • Increased physiological requirements

heme and non-heme iron such as menstruation

rich diets • Frequent parasitic infections

– Regular consumption of including

high phytate plant-based – Malaria

meals – Hookworm
– Inadequate intake of iron – Trichuriasis
absorption enhancers – Schistosomiasis
– Inadequate intake of vit A, • Abnormal blood cell production
PUBLIC HEALTH IMPLICATIONS OF IDA


 IDA is associated with

 Poor reproductive performance

 High proportion of maternal death (10 – 20% of total deaths)

 High incidence of LBW (< 2500 g at birth)

 Intrauterine malnutrition

 Impaired scholastic performance (impaired psychomotor

development and intellectual performance)

 Decreased resistance to infection

 Reduction of work capacity/productivity

 Prevention and control of IDA


 The basic principles in the prevention of IDA are to ensure regular
consumption of iron to meet the requirements of the body and to
increase the content and bioavailability of iron in the diet

 There are four main approaches

• Provision of iron supplements

• Fortification of commonly consumed foods with iron

• Nutrition education

• Hor t i cu l t u r e ba se d a ppr oa ch e s t o i m pr ov i n g t h e i r on
bioavailability of common foods
 The essential principle of management of IDA is

 iron replacement therapy and

 treatment of the underlying causes such as parasitic infections

or gastrointestinal bleeding

 Oral iron therapy is the preferred form of treatment

 Ferrous sulfate is the most inexpensive and widely used oral iron
preparation

 A total dose equivalent to 60 mg of elemental iron (300 mg of

ferrous sulfate) per day is adequate for adults and should be given
between meals either in the morning or at bedtime

 In the case of infants and young children, 30 mg/day of elemental

iron would be adequate
 COPPER

• Sources of copper include green vegetables, f is h,oysters and liver;

these foods provide copper at approximately 4 µmol/kcal. Milk, meat
and bread provide less than 0.5 µmol/kcal.

Function

• Copper is an important component of enzymes, including cytochrome

oxidase and superoxide dismutase. Copper may also have a role in iron
metabolism, when Fe 2+ released from ferritin is oxidized to Fe 3+ for
binding to transferrin. Copper is excreted in bile and eliminated in the
faeces.
Deficiency

• Copper def iciency has not been reported in humans, as there is a

wide variety of dietary sources. Premature birth may result in low
copper stores. Menke’s syndrome is a rare congenital failure of
copper absorption, with poor mental development, failure to
keratinise hair, skeletal problems and degenerative changes in the
aorta.

Excess

• Copper can accumulate excessively in the body in rare, genetically

determined conditions. Acute poisoning and toxicity may present
with haemolysis, and brain and hepatic cellular damage. In chronic
excess there is interference in the absorption of zinc and iron.
 Recommended requirements

• The normal adult diet provides 1.5 mg/day. The RNI for an infant is
0.3 mg/day. For children, the RNI is 0.7–1.0 mg/day and for adults
an RNI of 1.2 mg/day is required.
 WATER
• Water is the basic chemical of life, acting both as a bulk and a
localised solvent for the body.

Function
• Water is the major solute for the processes of metabolism and life.
Water forms 50–60% of body weight. One-third is extracellular f luid,
and two thirds are intracellular (e.g. in a 65 kg man, 15 and 30 litres,
respectively). These compartments are separated by cell membranes,
often freely permeable to water movement, dictated by osmolality.
• Homoeostasis of water ensures that water intake meets metabolic
requirements and losses. Humans meet their requirements for
water by drinking at regular intervals.
• This is dictated by social habits, or by drinking water after or during
meals, stimulated by thirst and regulated by water-retention
mechanisms through antidiuretic hormone (ADH, vasopressin),
regulated by enteroreceptors.
 Deficiency of water
• Water depletion may result from a lack of available water, an
inability to ingest water or increased losses from the skin, lungs,
alimentary tract and urine.
• These occur in association with a hot environment, excessive
exercise, hyperventilation, high altitudes, prolonged vomiting and
diarrhea, osmotic diuresis (as in diabetes mellitus) and loss from
fistulae or nasogastric tube suction.
• Evidence of loss of water includes: the features (particularly the eyes)
are sunken, the skin and tongue are dry, and the skin becomes loose
and lacks elasticity. A useful symptom and sign is a reduced urine
output; this indicates the need for increased water intake.
• The most important sign, however, is haemoconcentration, in which
there is an increase in the blood urea and possibly, but not always,
increased plasma sodium and potassium. In severe water loss, caused
for example by diarrhea in cholera and other enteric infections, oral
water with glucose and sodium chloride is the basis of therapy and
restoration of fluid volume.
 Toxicity
• Excess water intake may rapidly induce hyponatraemia and cause
pulmonary oedema. Alternatively, cerebral damage may lead to
essential hypernatraemia,
• in which there is an effect on the osmotic regulation of water intake
and ADH release. Water on its own is drunk in excess only in illness
(polydipsia).
• More frequently, f luid intake is dictated by social circumstances and
the vehicle for the water, e.g. alcoholic beverages, tea or coffee. The
effect of excess then becomes entwined with the congener, e.g.
alcohol or caffeine. An immediate effect of increased f luid intake is
increased urinary output, which is dictated by plasma osmolality,
plasma ADH concentration and urinary osmolality.