Download Vitamin and Mineral Deficiencies and Toxicities

Module 5.1
Fat Soluble
Vitamins
By Jennifer Turley and Joan Thompson
© 2013 Cengage
Presentation Overview
 Comparison
of vitamins in the body
 Diagnosing deficiency and toxicity
 The fat soluble vitamins, A, D, E, K
 Notable health implications
Comparisons of Vitamins in the Body
Water soluble



absorbed directly into the blood stream, circulate, travel,
and stored in water compartments in cells, excreted in urine
without intake, deficiency signs and symptoms occur more
quickly
Thiamin, Riboflavin, Niacin,
Pantothenic acid, B6 & B12,
Vitamin C, Biotin, Folate &
Choline
Comparisons of Vitamins in the Body
Fat soluble

absorbed into lymph; many require protein carriers

associate with fat, not readily excreted

without intake deficiency signs and symptoms occur more
slowly, toxicity is possible and
longer lived even when intake

is normalized
Vitamins A, D, E & K
Diagnosing Nutritional Deficiency or
Toxicity
1.
Dietary records: Demonstrate low/high intake and/or
confirm a metabolic or physiological problem that
creates an altered need.
2.
Clinical deficiency or toxicity symptoms: Are compatible
with low/high dietary intake or altered need.
3.
Biochemical tests: Such as blood levels, tissue levels &
urine levels demonstrate low/high body levels of the
nutrient.
4.
Nutrient supplementation: Serves as biological evidence
by correcting the deficiency signs & symptoms. For
toxicity, removal of the excess.
Vitamin A Chemistry
A


family of compounds including:
Retinol, Retinal, Retinoic acid
Pro-Vitamin A carotenoids like beta-carotene
Retinyl Esters
(animal foods)
Retinol
(reproduction)
Beta-Carotene
(plant foods)
Retinal
(vision)
Retinoic Acid
(Growth Regulator)
Vitamin A Functions







Vision
Internal & external surface linings (epithelial cells)
Growth
Reproduction (esp embryonic development)
Gene expression
Immune function
Pro-vitamin A forms have
antioxidant properties
Adult deficient, adequate, toxic values
Deficiency
Adequacy
(<66% of DRI)
DRI: 700-900 µg RE/day
Approx. <500 µg RE/day
RDI: 5,000 IU
Hypovitaminosis A
Bone & tooth: Impaired
growth
Central Nervous
System: Night
blindness, complete
blindness
(Xerophthalmia)
GI System: Diarrhea
Immunity: Depressed
immunity, more
infections
Skin: Hyperkeratosis
(thickened skin)
Normal vision, gene
expression,
reproduction, embryonic
development, epithelial
cell maintenance,
growth, and immune
function
25 mg betacarotene (provitamin A is safe
to take daily if you
are not a smoker
or drinker).
Toxicity
(>UL)
>3,000 µg RE/day
Bone & tooth:
Decreased bone mineral
density
Central Nervous
System: Headache,
vertigo
GI System: Nausea and
vomiting, liver
abnormalities
Neuro-Muscular:
Incoordination
Skin: orange color with
excess beta-carotene
Other: Retinoid
embryopathy
Vitamin A Food Sources







Retinol: (animal)
Fortified milk, cheese, butter, margarine
Eggs
Liver
Beta-Carotene: (Plant)
dark green leafy vegetables
broccoli, deep orange fruits, & vegetables
Vitamin A Food Sources
Vitamin D Chemistry




Increases bone mineralization
Increases intestinal absorption of calcium
Increase phosphorus excretion
Regulates Ca-P balance
Deficiency
Adequacy
Toxicity
(<66% of DRI)
Approx. <3 µg/day
DRI: 15 µg/day
(>UL)
>50 µg/day
Rickets (children)
Osteomalacia (adults)
Bone & tooth: poor growth,
bowed legs, soft bones,
pigeon chest, knocked knees,
and malformed teeth in
children. Porous bones in
adults.
Cardio-Vascular:
increased circulating levels
(PTH) and (AlkP) and
decreased circulating levels
of serum phosphorus
GI System: Decreased
calcium absorption
RDI: 400 IU = 6.5 µg
Normal calcium
and
phosphorus
balance and
cell metabolism
Needs are based
upon an inadequate
exposure to
sunlight.
Sunlight not
implicated in
toxicity.
Hypervitaminosis D
characterized by high
levels of 25(OH)D from
supplementation
Cardio-Vascular: High
blood calcium
Central Nervous
System: Weakness
GI System: Nausea,
vomiting, anorexia
Other: Kidney stones,
increased thirst,
urination, and urinary
calcium
Vitamin D Food Sources

Fortified products like milk, margarine, & some cereals

Eggs & fatty fish

Self-synthesis with unprotected peak sunlight exposure
Vitamin D Food Sources
Vitamin E Chemistry
A
family of alpha, beta, gamma, delta tocopherols
& tocotrienols
 Alpha-tocopherol
form
is believed to be the most active
Vitamin E Functions
 Membrane
anti-oxidant & stabilizer
Deficiency
Adequacy
Toxicity
(<66% of DRI)
Approx. <10 mg/day
DRI: 15 mg/day
(>UL)
>1,000 mg/day
Premature
infants:
hemolytic
anemia
Adults: not well
characterized
RDI: 30 IU
Normal cell
membrane
integrity, reduced
oxidative stress,
and molecular
functioning
Relatively nontoxic
Toxicity with
supplements
Interferes with
vitamin K’s role in
blood clotting,
augmentation of
anti-blood clotting
medication and
increases
hemolysis
Vitamin E Food Sources
 Nuts
 Seeds
 Plant
oils
 Wheat germ
 Fortified cereals
 Vegetables
Vitamin E Food Sources
Vitamin K Chemistry

Phylloquinone (K1) from plant sources &
naphthaquinones (K2, multiple forms) from animal
sources & gut bacteria.
Deficiency
Adequacy
Toxicity
(<66% of DRI)
Approx. <60 µg/day
DRI: 90-120 µg /day
RDI: 90 µg
(>UL)
Not Determined
CardioNormal blood
Vascular:
clotting & bone
Increases
metabolism
clotting time,
hemorrhaging
with cut or injury
Poorly described in adults
GI System: High levels
from supplemented
menadione causes
jaundice and liver
damage in infants
Cardio-Vascular:
Interference with antiblood clotting
medication
Vitamin K Food Sources
 Green
leafy & cruciferous vegetables
 Soybeans
Vitamin K is made by
 Some plant oils
bacteria in the
gastrointestinal tract
Vitamin K Food Sources
Summary

Diagnosing & confirming a nutrient deficiency or toxicity
requires a diet analysis, clinical evaluation, biochemical
analysis, & evaluating the response to corrected intake levels

Toxicities and deficiencies take longer to develop for fat
soluble vitamins as compared to water soluble vitamins

The fat soluble vitamins are grouped by their solubility in oil

The fat soluble vitamins have specific chemical forms &
functions in the body

DRIs exist for essential fat soluble vitamins: A, D, E, & K

Deficiency & toxicity signs & symptoms are unique for each of
these nutrients as are their food sources
References for this presentation are the same as those for this topic found in module 3 of the textbook