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Vitamins Reqirement And Deficiencies

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Vitamins Reqirement And Deficiencies

  1. 1. VITAMINS Requirement And Deficiencies Dr Soumar Dutta CDMO Guwahati Refinery Hospital
  2. 2. DEFINITION <ul><li>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. </li></ul><ul><li>CLASSIFICATION: broadly classified based on solubility </li></ul><ul><li>A. Fat soluble vitamins B. Water soluble vitamins </li></ul><ul><li>1. Vitamin A 1. Vitamin C </li></ul><ul><li>2. Vitamin D 2. Vitamin B-complex group </li></ul><ul><li>3. Vitamin E </li></ul><ul><li>4. Vitamin K </li></ul>
  3. 3. VITAMIN A <ul><li>SOURCES </li></ul><ul><li>Animal sources </li></ul><ul><li>Liver oil </li></ul><ul><li>Butter </li></ul><ul><li>Milk </li></ul><ul><li>Cheese </li></ul><ul><li>Egg yolk </li></ul><ul><li>Plant sources </li></ul><ul><li>Tomatoes </li></ul><ul><li>Carrot </li></ul><ul><li>Green-yellow vegetables </li></ul><ul><li>Spinach </li></ul><ul><li>Mangoes </li></ul><ul><li>Papaya </li></ul><ul><li>Corn </li></ul><ul><li>Sweet potato </li></ul><ul><li>RDA : Adults 3000-5000 IU/day </li></ul><ul><li>Children, pregnant and lactating women </li></ul>
  4. 4. Absorption, Storage and Transport <ul><li>Vit A and its precursors absorbed in Small Intestine </li></ul><ul><li>Stored in Liver </li></ul><ul><li>Transported in blood with a special Retinol Binding Protein (RBP) </li></ul><ul><li>FUNCTIONS </li></ul><ul><li>Role in normal vision </li></ul><ul><li>Role in bone and teeth formation </li></ul><ul><li>Role in epithelialization </li></ul><ul><li>Normal growth </li></ul><ul><li>Body metabolisms </li></ul><ul><li>Role in reproduction </li></ul>
  5. 5. Deficiency symptoms <ul><li>Xeropthalmia </li></ul><ul><li>Follicular conjunctivitis </li></ul><ul><li>Keratomalacia </li></ul><ul><li>Nyctalopia (night blindness) </li></ul><ul><li>Follicular hyperkeratosis and keratizing metaplasia </li></ul><ul><li>Urolithiasis </li></ul>
  6. 6. Follicular Hyperkeratosis
  7. 7. HYPERVITAMINOSIS A <ul><li>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. </li></ul><ul><li>SYMPTOMS </li></ul><ul><li>Alteration of skin and mucous membrane </li></ul><ul><li>Hepatic dysfunction </li></ul><ul><li>Headache </li></ul><ul><li>Drowsiness </li></ul><ul><li>Peeling of skin about the mouth and elsewhere </li></ul>
  8. 8. VITAMIN D <ul><li>It is a steroid hormone. </li></ul><ul><li>Biologically active form </li></ul><ul><li>is Calcitriol </li></ul><ul><li>SOURCES </li></ul><ul><li>Fish liver oil </li></ul><ul><li>Egg yolk </li></ul><ul><li>Milk </li></ul><ul><li>Butter </li></ul><ul><li>Cheese </li></ul><ul><li>Margarine </li></ul><ul><li>RDA : 100 IU/day in adults </li></ul><ul><li>pregnancy, lactation, infant and children ( 220 IU) </li></ul>
  9. 9. FUNCTIONS <ul><li>Intestinal absorption of calcium and phosphates </li></ul><ul><li>Mineralization of bones </li></ul><ul><li>Promotes bone resorption and calcium mobilization to raise blood Ca and P in relation to PTH. </li></ul><ul><li>Renal reabsorption of Ca and P </li></ul><ul><li>DEFICIENCY </li></ul><ul><li>Ricket </li></ul><ul><li>Osteomalacia </li></ul><ul><li>Renal osteodystrophy </li></ul>
  10. 10. RICKETS OSTEOMALACIA
  11. 11. HYPERVITAMINOSIS D <ul><li>Effects are mainly due to hypercalcaemia </li></ul><ul><li>IMMEDIATE DELAYED Anorexia Urinary lithiasis. Thirst Metastatic calcification Lassitude </li></ul><ul><li>Constipation </li></ul><ul><li>Polyuria </li></ul>
  12. 12. VITAMIN E (Tocopherols) <ul><li>Alpha –tocopherol is the most active forms </li></ul><ul><li>SOURCES </li></ul><ul><li>Cottonseed oil </li></ul><ul><li>Corn oil </li></ul><ul><li>Sunflower oil </li></ul><ul><li>Wheat germ oil </li></ul><ul><li>Margarine </li></ul><ul><li>Green leafy </li></ul><ul><li>vegetables </li></ul><ul><li>RDA : 25-30 IU/day </li></ul>
  13. 13. FUNCTIONS <ul><li>Antioxidant property </li></ul><ul><li>DEFICIENCY </li></ul><ul><li>Muscular dystrophies </li></ul><ul><li>Nocturnal muscular cramps </li></ul><ul><li> Intermittent claudication </li></ul><ul><li> Fibrocystic Breast Disease </li></ul><ul><li> Atherosclerosis </li></ul><ul><li>Hemolytic anemia- susceptibility of RBCs to hemolysis </li></ul><ul><li>Dietary hepatic necrosis </li></ul><ul><li>Neurological disorders </li></ul><ul><li>TOXICITY </li></ul><ul><li>None </li></ul>
  14. 14. VITAMIN K <ul><li>Antihemorrhagic /coagulation vitamin or prothrombin factor.Three variants K 1, K 2 and K 3 .All are napthoquinone derivatives. </li></ul><ul><li>SOURCES </li></ul><ul><li>Cabbage </li></ul><ul><li>Cauliflower </li></ul><ul><li>Tomato </li></ul><ul><li>Alfa alfa </li></ul><ul><li>Spinach </li></ul><ul><li>Green leafy vegetables </li></ul><ul><li>Egg yolk </li></ul><ul><li>Meat </li></ul><ul><li>Liver </li></ul><ul><li>Cheese & dairy products </li></ul><ul><li>RDA: 70-140 microgm/day </li></ul>
  15. 15. FUNCTIONS <ul><li>Blood coagulation: </li></ul><ul><li>Blood factors such as prothombin, factors II,VII,IX,X. </li></ul><ul><li>Calcium binding protein </li></ul><ul><li>DEFICIENCY </li></ul><ul><li>Rare, present sufficiently in food. </li></ul><ul><li>Hemorrhagic conditions. Prothrombin level and clotting time </li></ul><ul><li>Hemorrhagic disease of newborn </li></ul><ul><li>HYPERVITAMINOSIS K </li></ul><ul><li>Hemolytic anemia and jaundice (in large doses) </li></ul><ul><li>ANTAGONIST TO VITAMIN K </li></ul><ul><li>Heparin, Dicumarol, Salicylates </li></ul>
  16. 16. WATER SOLUBLE VITAMINS <ul><li>Non B-complex B-complex </li></ul><ul><li>Vitamin C </li></ul><ul><li>Energy releasing Hematopoietic </li></ul><ul><li>Thiamine (B 1 ) Folic Acid </li></ul><ul><li> Riboflavin (B 2 ) Vitamin B 12 / Cyanocobalamin </li></ul><ul><li>Niacin(B 3 ) </li></ul><ul><li>Pantothenic Acid(B 5 ) </li></ul><ul><li>Pyridoxine(B 6 ) </li></ul><ul><li>Biotin(B 7 ) </li></ul>
  17. 17. VITAMIN C (Ascorbic Acid) <ul><li>SOURCES </li></ul><ul><li>Citrous fruits- orange, lemon </li></ul><ul><li>Papaya </li></ul><ul><li>Pineapple </li></ul><ul><li>Banana </li></ul><ul><li>Strawberry </li></ul><ul><li>Green leafy vegetables </li></ul><ul><li>Cabbage </li></ul><ul><li>Cauliflower </li></ul><ul><li>Germinating seed </li></ul><ul><li>Green peas and beans </li></ul><ul><li>Gooseberry(Amla) </li></ul><ul><li>(richest source) </li></ul><ul><li>RDA : Adults 60-70 mg/day </li></ul>
  18. 18. FUNCTIONS <ul><li>Collagen formation </li></ul><ul><li>Iron and hemoglobin metabolism </li></ul><ul><li>Tryptophan metabolism </li></ul><ul><li>Tyrosine metabolism </li></ul><ul><li>Folic acid metabolism </li></ul><ul><li>Cholesterol synthesis </li></ul><ul><li>Cellular respiration </li></ul><ul><li>Immunological function </li></ul><ul><li>Prevents cataract formation </li></ul><ul><li>Preventive action on chronic diseases </li></ul>
  19. 19. DEFICIENCY <ul><li>SCURVY- defect lies in the failure of intercellular cement substance </li></ul><ul><ul><ul><ul><li>Fragile capillaries-petechial, sub-cutaneous ,sub-periostial </li></ul></ul></ul></ul><ul><ul><ul><ul><li>or internal hemorrhages. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Poor /Delayed wound healing. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Poor dentine formation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Gum bleed- gums are swollen, spongy bleeds on pressure </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Poor mineralization of bones </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Anemia- microcytic - hypochromic </li></ul></ul></ul></ul>
  20. 20. Vitamin B 1 (Thiamine) <ul><li>SOURCES </li></ul><ul><li>Cereals </li></ul><ul><li>Pulses </li></ul><ul><li>Oil seeds </li></ul><ul><li>Nuts </li></ul><ul><li>Yeast </li></ul><ul><li>Meat </li></ul><ul><li>Fish </li></ul><ul><li>Egg </li></ul><ul><li>Milk </li></ul><ul><li>RDA: Adults 1.2-1.5 mg/day </li></ul>
  21. 21. FUNCTIONS <ul><li>Essential for normal growth </li></ul><ul><li>Essential for normal functioning of nerves </li></ul><ul><li>Co-enzymatic activities- carbohydrate, nucleic acid and energy </li></ul><ul><li> synthesis </li></ul><ul><li>DEFICIENCY </li></ul><ul><li>Beri beri </li></ul><ul><li>Earliest symptoms: </li></ul><ul><li>anorexia </li></ul><ul><li>dyspepsia </li></ul><ul><li>heaviness and weakness of legs. </li></ul><ul><li>calf tenderness </li></ul>
  22. 22. Wet beri beri Dry Beri beri <ul><li>Oedema of legs, face Progressive muscle weaknes and </li></ul><ul><li>trunk and serous cavities. disability </li></ul><ul><li>Calf muscles are swollen and tender Neurological manifestations </li></ul><ul><li>Palpitation and breathlessness </li></ul><ul><li>Low diastolic BP, high systolic. </li></ul><ul><li>Fast pulse </li></ul><ul><li>Heart becomes weaker </li></ul><ul><li>and patient dies of heart failure </li></ul><ul><li>Infantile Beri beri </li></ul><ul><li>Infants born to mother with low thiamine in their breast milk. </li></ul><ul><li>Restlessness and sleeplessness </li></ul><ul><li>Anorexia, vomiting and breathlessness </li></ul><ul><li>Symptoms d/t cardiac dilatation and failure. </li></ul><ul><li>Sudden death if not treated urgently with thiamine. </li></ul>
  23. 23. Wernicke-korsakoff psychosis <ul><li>Seen mostly in chronic alcoholics </li></ul><ul><li>Body demand of thiamine increases in alcoholism </li></ul><ul><li>Characterized by: </li></ul><ul><li>Dementia </li></ul><ul><li>Apathy </li></ul><ul><li>Nystagmus </li></ul>
  24. 25. VITAMIN B 2 (Riboflavin) <ul><li>SOURCES: </li></ul><ul><li>Yeast </li></ul><ul><li>Whole grain </li></ul><ul><li>Dry beans and pea </li></ul><ul><li>Green vegetables </li></ul><ul><li>RDA: 1.5-1.8 mg/day in adults </li></ul><ul><li>FUNCTIONS: </li></ul><ul><li>In two active forms FMN and FAD serves as coenzyme in various reactions </li></ul><ul><li>DEFICIENCY </li></ul><ul><li>Cheilosis-fissuring at angle of the mouth </li></ul><ul><li>Glossitis-tongue smooth and purplish </li></ul><ul><li>Seborrhagic Dermatitis:scaly,greasy,desquamation </li></ul><ul><li>Eyes: corneal vascularization </li></ul><ul><li>Chronic alcoholics are susceptible to deficiencies. </li></ul>
  25. 26. VITAMIN B 3 (NIACIN/NICOTONIC ACID) <ul><li>SOURCES: </li></ul><ul><li>Liver </li></ul><ul><li>Kidney </li></ul><ul><li>Meat </li></ul><ul><li>fish </li></ul><ul><li>Legumes(pea,beans,lentil) </li></ul><ul><li>Nuts </li></ul><ul><li>Green vegetables </li></ul><ul><li>Coffee </li></ul><ul><li>Tea </li></ul><ul><li>Synthesize from A. acid Tryptophan </li></ul><ul><li>RDA: 17-21 mg/day in adults </li></ul>
  26. 27. FUNCTIONS: <ul><li>It has two active forms NAD + ,NADP + serves as co-enzymes in various oxido-reductive reactions in ETC </li></ul><ul><li>DEFICIENCY </li></ul><ul><li>PELLEGRA (pelle-skin; agra- rough) </li></ul><ul><li>“ 3D” Disease: Dermatitis, Dementia, Diarrhoea </li></ul><ul><li>Gingivitis and stomatis </li></ul><ul><li>Achlorhydria </li></ul><ul><li>Fatty liver </li></ul><ul><li>Effect on plasma </li></ul><ul><li>lipids </li></ul>
  27. 28. VITAMIN B 5 (Pantothenic Acid) <ul><li>SOURCES </li></ul><ul><li>Kidney </li></ul><ul><li>Liver </li></ul><ul><li>Egg yolk </li></ul><ul><li>Yeast </li></ul><ul><li>Cereals </li></ul><ul><li>Legumes </li></ul><ul><li>Sunflower oil </li></ul><ul><li>RDA: 5-10 mg/day </li></ul><ul><li>FUNCTION </li></ul><ul><li>Acts through CoA and helps in the formation of </li></ul><ul><ul><li>Energy </li></ul></ul><ul><ul><li>Triactlglycerol </li></ul></ul><ul><ul><li>Vit D </li></ul></ul><ul><ul><li>Steroid hormones </li></ul></ul>
  28. 29. DEFICIENCY <ul><li>Nausea, vomiting ,GI disorders, </li></ul><ul><li>Irritability. </li></ul><ul><li>Inadequate growth. </li></ul><ul><li>Fatty liver </li></ul><ul><li>Steroid synthesis. </li></ul><ul><li>Burning foot syndrome- Pain and numbness in the toes </li></ul><ul><li> Insomnia </li></ul><ul><li> Fatigue </li></ul>
  29. 30. VITAMIN B 6 (Pyridoxine) <ul><li>SOURCE </li></ul><ul><li>Yeast </li></ul><ul><li>Rice polishing </li></ul><ul><li>Germinal portion of seeds </li></ul><ul><li>Liver </li></ul><ul><li>kidney </li></ul><ul><li>Fish </li></ul><ul><li>RDA: 2-2.2 mg/day </li></ul><ul><li>FUNCTION </li></ul><ul><li>Active form is Pyridoxal Phosphate (PLP).It serves as coenzyme in various bio-chemical reactions like Transaminase, Decarboxylation, Deamination. </li></ul>
  30. 31. DEFICIENCY <ul><li>Neurological symptoms </li></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Nervousness </li></ul></ul><ul><ul><li>Mental confusion </li></ul></ul><ul><ul><li>Convulsions </li></ul></ul><ul><ul><li>Peripheral neuropathy </li></ul></ul><ul><ul><li>Demyelination of neurons </li></ul></ul><ul><li>Anaemia </li></ul><ul><ul><li>Hypochromic microcytic anaemia d/t reduced heme production. </li></ul></ul><ul><ul><li>Pyridoxine deficiencies are mostly seen in women taking OCPs, alcoholics infants and those on ATT especially INH </li></ul></ul>
  31. 32. VITAMIN B 7 (Biotin) <ul><li>SOURCES: </li></ul><ul><li>Egg yolk </li></ul><ul><li>Liver </li></ul><ul><li>Kidney </li></ul><ul><li>Yeast </li></ul><ul><li>Milk </li></ul><ul><li>Tomato </li></ul><ul><li>Fruits </li></ul><ul><li>Vegetables </li></ul><ul><li>RDA: 50-60 microgms/day </li></ul><ul><li>FUNCTIONS: it acts as co enzyme </li></ul><ul><li>In various carboxylation reactions </li></ul>
  32. 33. DEFICIENCY <ul><li>Dermatitis of extremities </li></ul><ul><li>Pallor of skin & mucous membrane </li></ul><ul><li>Anorexia & nausea </li></ul><ul><li>Muscle pain and hyperesthesia </li></ul><ul><li>Depression, Lassitude and Somnolence </li></ul><ul><li>Hypercholesterolemia </li></ul><ul><li>A rare congenital disease of genetic deficiency to utilize Biotin </li></ul><ul><li>Characterized by : </li></ul><ul><li>Dermatitis Loss of hair </li></ul><ul><li> Grating of hairs Incordinated movements </li></ul><ul><li>Leiner’s disease: In exclusive breast fed infants with persistant diarrhoea </li></ul>
  33. 34. VITAMIN B 9 (Folic Acid) <ul><li>SOURCES </li></ul><ul><li>Liver </li></ul><ul><li>Yeast </li></ul><ul><li>Kidney </li></ul><ul><li>Green leafy vegetables </li></ul><ul><li>Meat </li></ul><ul><li>Fish </li></ul><ul><li>RDA: 100 microgm/day </li></ul><ul><li>FUNCTIONS: </li></ul><ul><li>The active form of folic acid is Tetrahydrofolate.It acts as coenzymes in various bio-chemical reactions. </li></ul>
  34. 35. DEFICIENCY: <ul><li>It is the most common vitamin deficiency observed primarily in pregnant women, lactating mother , women on OCPs and alcoholics. </li></ul><ul><li>In pregnancy decreased absorption and increased clearance is the cause. </li></ul><ul><li>Anaemia: macrocytic type </li></ul><ul><li>FIGLU test - to detect folate deficiency. </li></ul>
  35. 36. VITAMIN B 12 (Cyanocobalamine) <ul><li>SOURCES </li></ul><ul><li>Liver </li></ul><ul><li>Kidney </li></ul><ul><li>Milk </li></ul><ul><li>Curd </li></ul><ul><li>Egg </li></ul><ul><li>Fish </li></ul><ul><li>Fish </li></ul><ul><li>Chicken </li></ul><ul><li>RDA: 3 microgm/day </li></ul><ul><li>FUNCTION: </li></ul><ul><li>Required with folic acid for development of RBCs. </li></ul><ul><li>Stimulates appetite and required for normal health. </li></ul><ul><li>Cures neurological symptoms of pernicious anaemia. </li></ul>
  36. 37. DEFICIENCY <ul><li>Megaloblastic anaemia </li></ul><ul><li>Mucosal atrophy of mouth </li></ul><ul><li>Glossitis </li></ul><ul><li>Disease of nervous system both central and peripheral </li></ul><ul><li>Psychiatric symptoms </li></ul><ul><li>Amblyopia </li></ul><ul><li>A severe form of acidosis in children </li></ul>
  37. 38. CONCLUSION <ul><li>Vitamins are required in trace amounts. </li></ul><ul><li>They do not directly provide energy. </li></ul><ul><li>They are not required by normal otherwise healthy individuals consuming a balanced diet, rather should be reserved for those who are under stressful conditions </li></ul><ul><ul><li>ACUTELY ILL PATINTS </li></ul></ul><ul><ul><li>PREGNANT AND LACTATING MOTHER </li></ul></ul><ul><ul><li>CHRONIC DEBILITATING ILLNESS </li></ul></ul><ul><ul><li>DURING CONVALESCENCE </li></ul></ul><ul><ul><li>MALNOURISHED PERSON </li></ul></ul><ul><ul><li>UNDERTAKING CERTAIN DRUGS- ANTIMICROBIALS </li></ul></ul>

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