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VITAMINS AND DEFICIENCY DISEASES
AISWARYA THOMAS 2nd year Pharm
D
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INTRODUCTION Vitamins are organic compounds
required in the diet in small quantities to perform biological functions.
We obtain them from : foods we eat or via vitamin
supplements.
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HISTORY OF VITAMINS
In 1749 the prevention of scurvy by citrus foods was first discovered by Scottish surgeon James Lind.
In Orient: Beriberi was common due to polished white rice.
In 1913 Funk coined the term “VITAMINE”.
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VITAMINS According to solubility vitamins are of: Fat-soluble & Water-soluble
Thirteen vitamins are known of which: Four are fat-soluble : Vitamins A ,
D , E ,K Nine are water- soluble.
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Distinction between fat-soluble and water-soluble vitamins.
Fat soluble vitamins are readily stored in the body.
Not readily excreted in urine.
Excess consumption can lead to their accumulation and toxic effects.
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VITAMIN SUPPLEMENTS Synthetic or natural substances which
can be purchased as pills, capsules, powders or liquids.
Best when accompanied by a well balanced diet.
Do not replace a healthy diet.
Do not provide calories or energy.
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RECOMMENDED DIETARY ALLOWANCES (RDA)
These are suggested levels of essential nutrients considered adequate to meet nutritional needs of healthy individuals.
Requirements are influenced by physical characteristics , dietary habits, sex, pregnancy, lactation and age.
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MULTIVITAMIN SUPPLEMENT A multivitamin should contain
fat-soluble vitamins A,D,E ; water-soluble vitamins B1,B2,B6,B12 , niacin, biotin , folic acid , pantothenic acid and vitamin C.
Contains minerals :zinc, magnesium, copper, and calcium.
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VITAMINS
Fat-soluble
Water-soluble Vitamin A Non B- Complex B-
Complex Vitamin D Vitamin C Thiamine (B1) Vitamin E Riboflavin(B2) Vitamin K Niacin (B3) Pantothenic
acid(B5)
Pyridoxine(B6) Biotin(B7) Folic acid (B9) Vitamin B12
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FAT-SOLUBLE VITAMINS
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VITAMIN- A It is the name given to a group of
related compounds : Retinol (vitamin A alcohol) Retinal ( vitamin A aldehyde) Retinoic acid ( vitamin A acid) Its provitamin carotenes are found
in plants.
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SOURCES:
Fish oil , liver, egg yolk, milk, cheese , butter.
Vegetable sources contains provitamin A carotenes.
Yellow and dark vegetables and fruits are sources of carotenes.
Carrots mango papaya spinach.
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FUNCTIONS OF VITAMIN A
Maintenance of normal vision.
Maintenance of normal cartilaginous and bone growth.
Increased immunity against infections in children.
Anti-proliferative effect.
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VITAMIN- A DEFICIENCY
May be due to : inadequate dietary intake impaired intestinal
absorption Chronic alcoholism. Impaired vision – Night blindness. Extremely dry skin ,hair or nails. Epithelial metaplasia and
keratinization. Xerophthalmia ( dry eye ).
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WHO IS AT RISK ?
Young children's.
Children with inadequate health care.
Adults with diseases of : pancreas liver intestine
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Too Much Can Be Toxic !!Hypervitaminous A leads to toxic
symptoms: Dry , itchy skin Hair loss Liver damage Skin coloration Loss of appetite Head ache and fatigue Blurred vision.
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SIDE EFFECTS OF VITAMIN A
Severe birth defects. women of child bearing
age should not consume more than 8000 IU per day.
Skin can take on yellow or orange glow.
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VITAMIN D SUNSHINE VITAMIN.
CALCITRIOL.
Exists in two activated sterol forms:
Vitamin D2 - CALCIFEROL Vitamin D3 -
CHOLECALIFEROL.
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SOURCES:
Sunlight. Milk. Fish. Orange juice . Fortified cereals.
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FUNCTIONS OF VITAMIN D
Maintenance of adequate plasma levels of calcium and phosphorous.
Metabolic functions.
Bone mineralization.
Neuromuscular transmission.
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VITAMIN -D DEFICIENCYMay be due to: Limited exposure to sunlight Diet deficiency. Renal disorders.
Rickets. Osteomalacia ( in adults). Hypocalcaemictetanydue to
neuromuscular dysfunction.
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CAUSES
Increased risk of: Cancers Autoimmune diseases Hypertension
WHO IS AT RISK ?
Covered and protected skin Elderly breast – fed infants
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Too Much Vitamin D !!!
High dose can cause accumulation in the liver.
Produces symptoms of poisoning.
Signs of toxicity include: excess calcium in the
blood. nausea vomiting decreased appetite.
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VITAMIN EVitamin E describes a family of
eight antioxidants: four tocopherols four tocotrienols.
It is an antioxidant in cells.
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SOURCES
Vegetables: spinach carrot EggBreadAlmondsPeanuts. vegetable oils
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FUNCTIONS OF VITAMIN- E
Antioxidant.
Inhibits platelets aggregation.
Enhances vasodilation.
Scavenger of free radicals.
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VITAMIN -E DEFICIENCY Increased risk of cardiovascular
diseases.
Hemolytic anaemia in children.
Neurological symptoms (impaired coordination and muscle relaxation).
RISK FACTOR : fat malabsorption syndrome.
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THERAPEUTIC USES
DIABETES MELLITUS.
CANCER PREVENTION.
PREVENTION OF CARDIOVASCULAR DISEASES.
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TOXICITY Excess vitamin E causes : Impaired blood clotting
leading to risk of bleeding in some persons.
Recommended that vitamin E supplements to be stopped one month before surgery.
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VITAMIN K K derived from the German word
KOAGULATION
Two naturally occuring forms : Plants synthesize phylloquinone –
Vitamin K1 Bacteria synthesize menaquinone-3
– Vitamin K2
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SOURCES
Vegetable oilsAlmondsPeanutsSpinachBody can produce its own(from
bacteria in intestine).
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FUNCTIONS OF VITAMIN -K
Helps in clotting .
Assist in bone mineralization.
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VITAMIN K DEFICIENCY It is common in adults.Biliary obstruction .Due to antibiotic therapy.Due to malabsorption syndrome.Hemmorhage.Deficiency may appear in infants
or in people.Who take anticoagulants such as
Warfarin.
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WATER-SOLUBLE VITAMINS
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VITAMIN C Exist as L- ascorbic acid.
Smokers and lactating mother needs higher range.
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SOURCES
Fruits Vegetables Tomato juice Sweet potato Citrus fruit Orange juice.
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FUNCTIONS OF VITAMIN C
Collagen synthesis.
Body to fight against infections.
Keep gum’s healthy.
Aids in the prevention of heart disease and cancer.
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VITAMIN C DEFICIENCY
Leads to scurvy.Weight loss.Slow healing of wound and
fractured bone.Fatigue and joint pain.Skin rash . Anaemia.
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THERAPEUTIC USES Cardiovascular diseases. Cataracts. Diabetes mellitus. Cancer prevention. Common cold. Lead toxicity.
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VITAMIN B Group of seven water-soluble vitamins : Thiamine Riboflavin Niacin Pyridoxine Cobalamin Biotin Pantothenic acid Folic acid
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Biotin and pantothenic acid deficiencies are rare.
As it is found in numerous foods.
Biotin deficiency may occur with prolonged antibiotic therapy.
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VITAMIN B1-THIAMINESOURCES
Yeasts Cereals liver
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FUNCTIONS OF THIAMINE ATP production.
Stabilizing the appetite.
Proper nerve function.
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VITAMIN -B1 DEFICIENCYBERI-BERI.WERNICKE –KORSAKOFF
SYNDROME.
RISK OF THIAMIN DEFICIENCY
Excessive loss: hemodialysis and diuretics.
Low intake and alcoholism.
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THERAPEUTIC USE
CONGESTIVE HEART FAILURE.
CANCER PREVENTION.
ALZHEIMER’S DISEASE.
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VITAMIN B2-RIBOFLAVINAlso called YELLOW
RESPIRATORY ENZYME.
Cytochrome oxidase enzyme.
Rapidly absorbed from the bowel and stored in tissues.
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SOURCES Eggs. Meat. Leafy green vegetables. Milk
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FUNCTIONS OF RIBOFLAVIN
Energy production.
Cell respiration.
Maintenance of good vision ,skin ,nails.
Carbohydrate ,fat and protein metabolism.
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RIBOFLAVIN DEFICIENCY Itching and burning eyes.
Oily skin.
Dermatitis.
Digestive disturbances.
Cracks and sores in mouth and lips.
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WHO’S AT RISK ?
Alcoholics
People with cataracts.
People with sickle-cell anemia.
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VITAMIN B3 - NIACIN
Includes biologically active derivative: NICOTINAMIDE
Essential for the formation of two oxidative coenzymes ( dehydrogenases ).
NAD ( Nicotinamide adenine dinucleotide )
NADP.
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SOURCES
Liver Kidney Meat Green vegetables Grain cereals.
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FUNCTIONS OF NIACINEnergy production.
Improves circulation.
Maintenance of skin and tongue.
Maintenance of nervous system.
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VITAMIN B3 DEFICIENCY
Pellagra – rare in Western societies.Nervousness . irritabilityFatigue . Head ache. Insomnia.Mental depression.
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VITAMIN B5-PANTOTHENIC ACIDFUNCTIONS
Produces energy.
SOURCESFruits ,meats, poultry ,legumes .
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VITAMIN B6-PYRIDOXINERelated to two naturally occuring
substance: pyridoxine , pyridoxal ,
pyridoxamine.
SOURCES Meat Eggs Green vegetables
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FUNCTIONS OF VITAMIN B6
Production of red blood cells. Nervous system function. Immunity. Reducing muscle spasm ,
cramps and numbness. Maintaining proper balance of
sodium and phosphorous.
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DEFICIENCY OF VITAMIN B6
Nervousness , Insomnia
Skin lesions
Loss of muscle control, muscle weakness.
Arm and leg cramps.
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VITAMIN B7 - BIOTINSOURCES
Meat Egg yolk Soya beans
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FUNCTIONS OF VITAMIN B7
Produce energy.
Helps produce body chemicals (insulin).
In gene expression.
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VITAMIN-B7 DEFICIENCY Nausea.
Anorexia.
Mental and neurological symptoms :
Hallucination Depression
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VITAMIN B9-FOLIC ACIDSOURCES Yeasts leafy vegetables
FUNCTION
Synthesis of nucleic acids
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FOLIC ACID DEFICIENCY Neural tube defects. Anaemia.
THERAPEUTIC USE: Chronic hemolytic anaemia.
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VITAMIN B12- COBALAMIN
FUNCTIONS Proper nerve function. Production of red blood cells. DNA reproduction. Prevention of anaemia. Metabolizing fats and
proteins.
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VITAMIN- B12 DEFICIENCYAnemia nerve damage
hypersensitive skin.
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WHO’S AT RISK ?Pernicious anemia. B12 injection often taken
regularly. HIV Chronic fatigue syndrome.
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ROLE OF PHARMACIST IN VITAMIN DEFICIENCY DISORDES
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Pharmacist by counselling patients provides safe consumption of vitamins.
Counselling on vitamin supplements is a part of their role in pharmaceutical care.
Provides responses to specific knowledge questions such as:
Interaction of vitamins with drugs or the recommended dietary allowance of vitamins for infants , children , pregnant women.
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Provides consequences of vitamin consumption.
Informs the patients that: beat ways to meet nutrient needs
is by consuming appropriate foods .
Vitamins supplementation is only suggested for:
individuals with chronic diarrhoea.
Pregnant and breast-feeding women.
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Food allergies.Food intolerance.Surgical removalToo much calcium leads to
kidney stones.Excess vitamin D can damage
heart.
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REFERENCETEXTBOOK OF PATHOPHYSIOLOGY -
HARSH MOHAN.TEXTBOOK OF BIOCHEMISTRY - U.
SATYANARAYANA. aggie-horiculture.tamu.edu
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THANK YOU
