Vitamins

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DEFINITION The term vitamin is derived from the words

vital and amine, because vitamins arerequired for life and were originally thought tobe amines

They are organic compounds required by

humans in small amounts from the diet

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I!"O#T$N%E OF

&IT$!IN'VITAMINS FUNCTION

(), (*, (+, (, ( -, (., (/, ()*,%, 0

%OEN12!E

(), (*, (+, (, (-, (. !ET$(O3I'! OF ENE#42 2IE3DIN4 N5T#IENT'

( -, ( /, ()* #ED (3OOD %E33 '2NT6E'I'

(-, (/, ()* $!INO $%ID !ET$(O3I'!

( ., ( , ( + F$TT2 $%ID '2NT6E'I'

% , E $NTIO7ODENT "#OTE%TION

(), (-, ()* NE#&E T#$N'!I''ION

$, D 4ENE E7"#E''ION

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F$%T' $(O5T &IT$!IN'&itamins are found in almost everything you

eat"rocessing a8ects vitamin content

Dietary supplements can boost vitamin inta9e

Not all of what you eat can be used by the

body

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%3$''IFI%$TION OF&IT$!IN'

&itamins have traditionally been groupedbased on their solubility in water or fat

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WATER SOLUBLE VITAMINS FAT SOLUBLE VITAMINS

( &IT$!IN'• T6I$!IN ()• #I(OF3$&IN (*• NI$%IN (+•(IOTIN•"$NTOT6ENI% $%ID•( -•FO3$TE•( )*

&IT$!IN $

&IT$!IN % &IT$!IN D

&IT$!IN E

&IT$!IN 0

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:$TE#;'O35(3E

&IT$!IN' The contain %,6,O and may contain ' and %o

They are not stored in body

They are secreted into urine They not cause to<icity

They cannot synthesi=ed by body

They are not dietary essential

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:$TE#;'O35(3E

&IT$!IN'

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&IT$!IN () A.k.a. Thiamine

acts as a coen=yme in decarbo<ylation

reactions in ma>or carbohydrate pathways andin branched;chain amino acid metabolism

It is rapidly absorbed from food in the smallintestine and e<creted in the urine

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&itamin () De?ciency is caused by@

Decreased inta9e

impaired absorption

increased requirements

(eri;beri

The clinical condition associated with chronicthiamine de?ciency

$lthough usually occurring in underdevelopedcountries of the world, beriberi may be found inthe 5nited 'tates among persons with chronicalcoholism

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T6I$!INE I!"O#T$N%E

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(E#I;(E#I

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Dietary 'ources@

It is widely distributed in foods 2east and liver are the most highly

concentrated sources

6owever, cereal grains are the most

important dietary sources of thiamin in thediet as these foods are consumed readily inmost diets

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#I(OF3$&IN O# &IT$!IN( * functions primarily as a component of two

coen=ymes, Flavin !ononucleotide and Flavin

$denine Dinucleotide AF$DB These two coen=ymes cataly=e various o<idation;

reduction reactionsDietary riboCavin is absorbed in the small

intestine The body stores of a well;nourishedperson are adequate to prevent riboCavinde?ciency for monthsE<cess riboCavin is e<creted in the urine and has

no 9nown to<icity

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#I(OF3$&IN I!"O#T$N%E

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'2!"TO!' OF #I(OF3$&IN

DEFI%IEN%2'tomatitis$nemia'wollen and dar9 tongue$ngular chelosis@ crac9s in corners of mouth and lips

#iboCavin de?ciency occurs with@ other nutritional de?ciencies alcoholism chronic diarrhea!alabsorption

%ertain drugs antagoni=e the action or metabolism ofriboCavinA phenothia=ine, oral contraceptives, and tricyclicantidepressantsB

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#I(OF3$&IN de?ciency

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Dietary 'ources@Foods high in riboCavin include mil9, liver,

eggs, meat, and leafy vegetables

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#D$$dult males@ )+ mgday

$dult females@ )) mgday

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NI$%IN O# &IT$!IN ( + The requirement for niacin in humans is met, to some

e<tent, by the conversion of dietary tryptophan to

niacinNiacin is the generic term for both nicotinic acid and

nicotinamide

Niacin functions as a component of the twocoen=ymes AN$DB and AN$D"B, which are necessary for

many metabolic processes, including tissuerespiration, lipid metabolism, fatty acid metabolism,and glycolysis

Niacin is absorbed in the small intestine, and e<cess ise<creted in the form of metabolites in the urine

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I!"O#T$N%E OF NI$%IN O#

&IT$!IN ( +

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'O5#%E' OF NI$%IN

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DEFI%IEN%2 OF NI$%IN"ellagra@ dermatitis

the clinical syndrome resulting from niacin

de?ciency, is associated with diarrhea,dementia, dermatitis, and death

!uscular wea9ness

$nore<ia

Indigestion'9in eruptions

Diarrhea

Niacin de?ciency may result from alcoholism

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DEFI%IEN%2 OF NI$%IN O# (+

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"E33$4#$

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"E33$4#$

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#D$ OF NI$%INadult males@ )- mgday

adult females@ ) mgday

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&IT$!IN ( O# "$NTOT6ENI%

$%ID"art of %oen=yme $ which plays an important

role in energy metabolism

Is essential for the formation of $T" from thebrea9down of carbohydrates, protein, fat andalcohol

$ growth factor occurring in all types of

animal and plant tissue was ?rst designatedvitamin (+ and later named pantothenic acidAfrom 4ree9 for everywhereGB

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"antothenate is metabolically converted to;phosphopantetheine, which becomescovalently bound to either serum acylcarrier protein or coen=yme $

%oen=yme $ is a highly important acyl;group transfer coen=yme involved in many

reactions of many reaction types

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DIET$#2 'O5#%E'!eat

!il9

!ushrooms3iver

"eanuts

Eggs

2east

3egumes

'almon whole grains

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DEFI%IEN%2 OF ( 6eadache

Fatigue

Impaired muscle coordination4I tract disorders

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#D$ FO# "$NTOT6ENI% $%ID

#D$ for adults is mg day

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&IT$!IN ( - O#"2#IDO7INE&ery important vitamin since it plays a coen=yme

role in more than )HH en=ymatic reactions

&itamin (- is three related compounds@

pyrido<ine, occurring mainly in plants

"yrido<al

pyrido<amine, which are present in animal products

#eadily absorbed from the intestinal tract,vitamin (- is e<creted in the urine in the form ofmetabolites

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Those particularly at ris9 for de?ciency arepatients with@

5remia

liver disease

absorption syndromes

!alignancies

chronic alcoholism

De?ciency is associated withhyperhomocystinemia

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DIET$#2 'O5#%E'!eat

"oultry

Fish"otatoes

&egetables

dairy products

4rains

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&IT$!IN (- F5N%TION'

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DEFI%IEN%2 OF &IT$!IN

( -:ea9ness

'leeplessness

"eripheral neuropathy"ersonality changes

Dermatitis

4lossitis

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#D$ of vitamin (-adult males@)+J). mgday

adult females @)+J) mgday

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(IOTIN O# &IT$!IN ( .(iotin participate in reactions in which carbon

dio<ide is added to a compound

(iotin is a coen=yme for several en=ymes thattransport carbo<yl units in tissue and plays anintegral role in gluconeogenesis, lipogenesis,and fatty acid synthesis

Dietary biotin is absorbed in the smallintestine, but it is also synthesi=ed in the gutby bacteria

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F5N%TION' OF ( .Essential cofactor for carbo<ylase en=yme

that add %O* to various compounds

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'O5#%E' OF (IOTIN:hole grains

EggsNuts

legumes

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DEFI%IEN%2 OF (IOTIN(iotin de?ciency can be produced by

ingestion of large amounts of avidin, found inraw egg whites that bind to biotin

(iotin de?ciency has been noted in patientsreceiving long;term parenteral nutrition and ininfants with genetic defects of carbo<ylaseand biotinidase en=ymes

'ymptoms Include@'9in rashNeurological disordersImpaired growth

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#D$ FO# (IOTIN#D$ for (iotin is +H Kg day for adults

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FO3$TE O# &IT$!IN ( /Folate is derived from 3atin word means leaf

because dar9 leafy vegetables are the bestsource for folate

Folate is the generic term for componentsnutritionally and chemically similar to folic

acid Folate functions metabolically as coen=ymes

involved in various one;carbon transferreactions

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Folate and vitamin ()* are closely related

metabolically The hematologic changes that

result from de?ciency of either vitamin are

indistinguishableFolate in the diet is absorbed in the >e>unum, and

the e<cess is e<creted in the urine and feces3arge quantities of folate are also synthesi=ed by

bacteria in the colon'tructural relatives of pteroylglutamic acid Afolic

acidB are metabolically active compounds usually

referred to as folates

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&IT$!IN (/ 'O5#%E'Food folates are primarilyfound in green and leafyvegetables, fruits, organmeats, and yeast

(oiling food and using largequantities of water result infolate destruction

(eans3egumes

%itrus fruit3iverFishEggs!il9 and mil9 products

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FO3I% $%ID F5N%TION'

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DEFI%IEN%2 OF FO3$TEFolate requirement is increased during pregnancyand especially during lactation

The increase during lactation results, in part, from

the presence of high;aLnity folate binders in mil9Dietary supplementation of folate in pregnant

women reduces the incidence of fetal neural tubedefects

Other instances of increased folate requirementinclude hemolytic anemia, iron de?ciency,prematurity, and multiple myeloma

"atients receiving dialysis treatment rapidly losefolate

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%linical conditions associated with folatede?ciency include@

megaloblastic anemia, alcoholism, malabsorption

syndrome, carcinoma, liver disease, chronichemodialysis, and hemolytic and sideroblasticanemia

%ertain anticonvulsants and other drugs that

interfere with folate metabolism includesulfasala=ine, isonia=id, and cycloserine

Folate de?ciency of dietary origin commonlyoccurs in older persons

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"henytoin ADilantinB therapy acceleratesfolate e<cretion and interferes with folateabsorption and metabolism

$lcohol interferes with folateMs enterohepaticcirculation,

!ethotre<ate, a chemotherapeutic agent,

inhibits the en=yme dihydrofolate reductase 3ow levels of serum folate can occur with use

of oral contraceptives

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FO3I% $%ID F5N%TION

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#D$ FO# FO3$TE The #D$ is HH gday for adult males andfemales. In women of childbearing age, HH g offolate per day is recommended to prevent or

reduce the incidence of neural tube defects

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&IT$!IN ( )* or

%yanocobalaminIt plays an important role in many %oen=ymes

refers to a large group of cobalt;containingcompounds

Intestinal absorption of vitamin()* ta9esplace in the ileum and is mediated by aunique binding protein called intrinsic factor,which is secreted by the stomach

&itamin ()* participates as a coen=yme inen=ymatic reactions necessary forhematopoiesis and fatty acid metabolismE<cess vitamin ()* is e<creted in the urine

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!ost vitamin ()* absorption occurs through acomple< with intrinsic factor, a proteinsecreted by gastric parietal cells

"lasma contains both types of transportproteins, transcobalamins, and the threeforms of vitamin ()* Ahydro<ycobalamin,methylcobalamin, anddeo<yadenosylcobalaminB

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'O5#%E' OF &IT$!IN (

)*!eat

"oultry

'eafoodEggs

!il9 and mil9products

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DEFI%IEN%2 The term pernicious anemia is now mostcommonly applied to vitamin ()* de?ciencyresulting from lac9 of intrinsic factor

$ntibodies to intrinsic factor and parietal cellsare common in patients with perniciousanemia, their healthy relatives, and patientswith other autoimmune disorders

De?ciency of ()* can occasionally occur instrict vegetarians because of dietaryde?ciency

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$ loss of ()* also occurs in individualsinfected with ?sh tapeworm or because ofmalabsorption diseases, such as sprue or

celiac disease3ow vitamin ()* levels occur with folate

de?ciency, and a vitamin ()* de?ciency canbe mas9ed by large doses of folate

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#D$ OF &IT$!IN ( )*

#D$ for adults is * Kg dayDe?ciency can cause anemia

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&IT$!IN % O# $'%O#(I% $%ID

Is involved in many processes in human body

The most important function for vitamin % isthe synthesis of collagen, the principal tissueprotein found in tendon, arteries

is a strong reducing compound that has to be

acquired via dietary ingestion

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$scorbic acid is important in formation andstabili=ation of collagen by hydro<ylation ofproline and lysine for cross;lin9ing and

conversion of tyrosine to catecholamines Abydopamine ;hydrolaseB

It increases the absorption of certainminerals, such as iron, and is absorbed in the

upper small intestine and distributedthroughout the water;soluble compartments ofthe body

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Drugs 9nown to increase urinary e<cretion of

ascorbate include aspirin, aminopyrine,

barbiturates, hydantoin, and paraldehyde

$scorbic acid requirements are more increasedwith acute stress in>ury and chronic inCammatory

states, but are also increased with pregnancyand oral contraceptive use

E<cessive inta9e may interfere with vitamin ()*metabolism and drug actions Aeg, aminosalicylic

acid, tricyclic antidepressants, and

anticoagulantsB

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F5N%TION' OF &IT$!IN %6ealthy immune system

6elps in wounds healing!aintains the connective tissues

$ids in iron absorption

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$'%O#(I% $%ID O# &IT$!IN %

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'O5#%E' OF &IT$!IN %Fruits and vegetables

%itrus fruits

(roccoli

4reen pepper

%abbage

3eafy greens

"otatoes

Tomatoes


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% The well;9nown de?ciency is 'curvy

Is characteri=ed by hemorrhagic disorders,including swollen, bleeding gums and impaired

wound healing and anemia:ea9ness

Fatigue

depression

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'%5#&2 IN 65!$N

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#D$ FO# &IT$!IN %

#D$ for vitamin c for adults is -H mg day

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CARNITINE which includes 3;carnitine and its fatty acidesters AacylcarnitineB

is described as a conditionally essential

nutrient

'ynthesis occurs in liver, brain, and 9idney

3;%arnitine facilitates entry of long;chain

fatty acids into mitochondria for o<idation andenergy production

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DIET$#2 'O5#%E'!eat, poultry, ?sh, and dairy products

Foods of plant origin generally

contain little carnitine, e<cept for peanutbutter

and asparagus.

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DEFI%IEN%2 The ma>or signs of carnitine de?ciency aremuscle wea9ness and fatigue

6uman de?ciency can be either hereditary or

acquiredby inadequate inta9e, increasedrequirement Apregnancy and breastfeedingB, orincreased urinary loss Avalproic acid therapyB

Infants and patients following a course of long;

term parenteral nutrition and those onhemodialysis are most vulnerable to de?ciency

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They contain %,6,O

They are stored in the body

They are secreted into faeces

They cause to<icity

They are not synthesi=ed by body butsometimes synthesi=ed

They are dietary essential4eneral source for fat soluble vitamin are green

pasture, green fodder, green leafy hay, ?sh liveroil, yellow corn grains, sunlight

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F$T;'O35(3E &IT$!IN'&IT$!IN $

&IT$!IN D

&IT$!IN E

&IT$!IN 0

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&itamin $#etinol and retinoic acid are derived directly fromdietary sources, primarily as retinyl esters, orfrom metabolism of dietary carotenoids

Aprovitamin $B, primarily beta carotene&itamin $ is stored in the liver and transported in

the circulation comple<ed to #(" andtransthyretin

&itamin $ and related retinoic acids are a groupof compounds essential for vision, cellulardi8erentiation, growth, reproduction, and immunesystem function

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$ clearly de?ned physiologic role for retinol is invision

#etinol is o<idi=ed in the rods of the eye to retinal,

which, when comple<ed with opsin, formsrhodopsin, allowing dim;light vision

This vitamin and vitamin D a through speci?cnuclear receptors in the regulation of cell

proliferation Fruits and vegetables containcarotene, which is a precursor of retinol

%arotenes provide more than one;half of theretinol requirements in the $merican diet

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!a>or dietary sources of these compoundsinclude

animal products and pigmented fruits and

vegetables

AcarotenoidsB

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DEFI%IEN%2&itamin $ de?ciency leads to night blindnessAnyctalopiaB and, when prolonged, may causetotal blindness

In vitamin $ de?ciency states, epithelial cellsAcells in the outer s9in layers and cells in thelining of the gastrointestinal, respiratory, andurogenital tractsB become dry and 9eratini=ed

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It is most common among children living innonindustriali=ed countries and is usually aresult of insuLcient dietary inta9e

De?ciency may also occur because of chronicfat malabsorption or impaired liver function ormay be associated with severe stress andprotein malnutrition

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To<icity:hen ingested in high doses, either chronicallyor acutely, vitamin $ causes many to<icmanifestations and may ultimately lead to liver

damage due to hypervitaminosis6igh doses of vitamin $ may be obtained frome<cessive ingestion of vitamin supplements orlarge amounts of liver or ?sh oils, which are richin vitamin $

%arotenoids, however, are not 9nown to be to<icbecause of a reduced eLciency of caroteneabsorption at high doses and limited conversionto vitamin $

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#ETINO"$T62

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NI46T (3INDNE''

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&IT$!IN $

'O5#%E'

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'O5#%E'

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#D$adult males@/HH g

adult females@ .HH g

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&IT$!IN D&itamin D refers to a group of related metabolitesused for proper s9eleton formation and mineralhomeostasisIt is in two forms@D! Er"o#a$#i%ero$ It is mostly present in plants

D&! #ho$i#a$#i%ero$ It is synthesi=ed by animal body in sunlight

E<posure of the s9in to sunlight Aultraviolet lightB

cataly=es the formation of cholecalciferol from .;dehydrocholesterol The other ma>or form of vitamin D is ergocalciferol

Avitamin D*B &itamin D occurs in foods ascholecalciferol or ergocalciferol

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The most active metabolite of vitamin D is),*AO6B*D+

It stimulates intestinal absorption of calcium

and phosphate for bone growth and metabolismand, together with parathyroid hormone,stimulates bone to increase the mobili=ation ofcalcium and phosphate

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),*AO6B*D+ has an important proapoptotice8ect, acting through a vitamin D hormonalsystem, that depends on binding of the active

ligand to a vitamin D receptor This led to important drug discovery

developments in which calcium andphosphate release is minimi=ed and

proliferative and anti;inCammatory e8ects ofD;analogues are modulated

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In northern climates, it is diLcult to receiveenough ultraviolet e<posure to fully meetminimum requirementsA* hours per dayB

$bsorbed in the small intestine, vitamin Drequires bile salts for absorption

It is stored in the liver and e<creted in the bileIt is important to measure the metabolic form of

vitamin D P),*AO6B*D+Q, parathyroid hormone,and calcium levels when diagnosing primaryhyperparathyroidism and di8erent types ofric9ets, when monitoring

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F5N%TION'

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DIET$#2 'O5#%E'include irradiated foods

commercially prepared mil9

'mall amounts are found in@(utteregg yol9s3iver'ardines6erring Tuna'almon

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'O5#%E'

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DEFI%IEN%2'evere de?ciency in children causes a failure tocalcify cartilage at the growth plate in metaphysicalbone formation, leading to the development ofric9ets

In adults, the de?ciency leads tounderminerali=ation of bone matri< in remodeling,resulting in osteoma$a#ia

3ow levels of vitamin D are reported with the use ofanticonvulsant drugs and in small bowel disease,chronic renal failure, hepatobiliary disease,pancreatic insuLciency, and hypoparathyroidism

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&IT$!IN D DEFI%IEN%2

#I%0ETT'

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#I%0ETT'

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O'TEO"O#O'I'

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TO7I%IT2&itamin D can be to<ic, especially in childrenElevated levels of vitamin D are present inhyperparathyroidism and hypophosphatemia

and during pregnancyE<cess vitamin D produces hypercalcemia and

hypercalciuria, which can lead to calciumdeposits in soft tissue and irreversible renal

and cardiac damage

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#D$ adults@ to ) g per day, depending on age

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&itamin EIt is a$so #a$$e' to#o%ero$(It has been name for vitamin E is tocopherol, which

includes several biologically active isomersIt is present in + forms alpha, beta , gamma

$lpha;tocopherol is the predominant isomer in plasma andthe most potent isomer by current biologic assaysis a powerful antio<idant and the primary defense

against potentially harmful o<idations that causedisease and aging, protecting unsaturated lipids frompero<idation Acleavage of fatty acids at unsaturated

sites by o<ygen addition across the double bond andformation of free radicalsB The role of vitamin E in protecting the erythrocyte

membrane from o<idant stress is presently the ma>ordocumented role of vitamin E in human physiology

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DIET$#2 'O5#%E'vegetable oil

fresh leafy vegetables

Egg yol9

3egumes"eanuts

!argarine

Diets suspect for vitamin E de?ciency arethose low in vegetable oils, fresh greenvegetables, or unsaturated fats

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DEFI%IEN%2"atients with conditions that result in fat malabsorption,especially cystic ?brosis and abetalipoproteinemia, are

also susceptible to vitamin E de?ciency

$ relationship e<ists between vitamin E de?ciency andprogressive loss of neurologic function in infants andchildren with chronic cholestasis

The ma>or symptom of vitamin E de?ciency is hemolyticanemia

$lthough the use is still controversial, prematurenewborns are commonly supplemented with vitamin Eto stabili=e red blood cells and prevent hemolyticanemia

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Functions of vitamin E

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F5N%TION' OF &IT$!IN E

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'O5#%E'

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#D$) mgday for adult males andor females

The most widely distributed and mostbiologically active form of vitamin E is alpha;tocopherol, which is the form commonlymeasured in the laboratory using 6"3%methods

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&IT$!IN 0 Afrom the 4erman word 9oagulationGB is the

group of substances essential for the formation

of prothrombin and at least ?ve other

coagulation proteins, including factors &II, I7, and7 and proteins % and '

The quinone;containing compounds are ageneric description for menadione and

derivatives e<hibiting this activity&itamin 0 helps convert precursor forms of these

coagulation proteins to functional forms this

transformation occurs in the liver

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Dietary vitamin 0 is absorbed primarily in theterminal ileum and, possibly, the colon

&itamin 0 is synthesi=ed by intestinal bacteria

this synthesis provides HR of the vitamin 0requirement

It has three forms

)*! +hy$$o,-inone

)! Meno,-inone It is nat-ra$$y present

)&! Meno'ione It is arti?cially synthesi=ed

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DIET$#2 'O5#%E' !a>or are cabbage,cauliCower, spinachand other leafy

vegetables, por9,liver, soybeans, andvegetable oils

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DEFI%IEN%2&itamin 0 de?ciency may be caused by antibiotic

therapy, which results from decreased synthesis

of the vitamin by intestinal bacteria

:hen vitamin 0 antagonists, such as warfarinsodium A%oumadinB, are used for anticoagulant

therapy, anticoagulant factors II, &II, I7, and 7are synthesi=ed but nonfunctional

$n apparent vitamin 0 de?ciency may lead to ahemorrhagic episode or may result when

anticoagulants, such as warfarin sodium, are

used

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"rothrombin time Avelocity of clotting afteraddition of thromboplastin and calcium tocitrated plasmaB determination is an e<cellent

inde< of prothrombin adequacy"rothombin time is prolonged in vitamin 0

de?ciency and in liver diseases characteri=edby decreased synthesis of prothrombin

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&itamin 0 de?ciency also results inprolongation of the partial thromboplastintime, but the thrombin time is within the

reference intervalDe?ciency symptoms are prolonged bleeding

and increased clotting time

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Functions of vitamin 0

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&IT$!IN 0 DEFI%IEN%2

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#D$males@ )*H gday

Females@/H gday

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Vitamins