Vitamins and Minerals Part 1 - NT Module

Vitamins and Minerals Part 1

• Course: University of Baghdad College of Medicine, 2024-2025
• Grade: Third Grade
• Module: Nutrition, Water & Electrolytes Imbalance Module (NT)
• Speaker: Ola Hussein Jasim
• Date: 30-9-2024

Learning Objectives

• Define hidden hunger.
• Identify signs and symptoms of vitamin A deficiency.
• State methods for preventing and controlling vitamin A deficiency.
• Identify the causes of vitamin D deficiency.
• State methods for preventing and controlling vitamin D deficiency.

Hidden Hunger

• "Hidden hunger" describes vitamin and mineral deficiencies that may not be immediately obvious.
• Micronutrient malnutrition is associated with metabolic disorders, immune, endocrine, and cognitive function issues, and delayed/inadequate physical development.
• It can also be an underlying factor in chronic disease.
• Coined by WHO in 1986, pertaining to deficiencies in iron, vitamin A, iodine, and vitamin D.

Vitamin A

• Retinoids (pre-formed): Found only in animal-based foods (eggs, fatty fish, dairy, liver).

• High retinol content in animal liver, fish liver oil.

• Absorbed at approximately 90%.

• Carotenoids (provitamin A): Found in plant-based foods (carrots, mangoes, melons, apricots).

• Absorption efficiency varies.

• Function: Essential for vision, maintaining tissues in the intestinal, respiratory, and urinary tracts, skin, and eyes.

• Promotes growth, reproduction.

• Retinol and retinoic acid function as steroid hormones.

• Essential for maintaining a proper immune system.

• Carotenoids act as antioxidants and reduce cancer risk.

Vitamin A Deficiency (VAD)

• WHO defines VAD as tissue vitamin A concentration enough to cause adverse health consequences.
• Occurs most commonly with clinical xerophthalmia.
• VAD can cause preventable blindness in children.
• A major controllable public health and nutrition problem (estimated 250 million preschool children are deficient.)
• Estimated 250,000 to 500,000 vitamin A-deficient children become blind every year, half dying within 12 months of losing their sight.

Vitamin A Deficiency - Recommendations and RDA

• RDA Values (Retinol Activity Equivalents): Provided in a table.
• Risk Factors: Low vitamin A diet, suboptimal breastfeeding and weaning practices, poverty, overcrowding, poor sanitation, low educational status, infections, protein-energy malnutrition, liver problems, malabsorption issues.

Vitamin A Deficiency - Signs and Symptoms

• Ocular (Specific):
• Xerophthalmia: All ocular manifestations of VAD, leading to preventable blindness.
• Bitot's spots: Triangular, pearly white/yellowish foamy spots.
• Conjunctival xerosis: Dry, wrinkled, and thickened conjunctiva.
• Corneal xerosis: Dry and dull cornea, which may progress to corneal ulceration.
• Keratomalacia: Liquefaction of the cornea, a grave medical emergency.
• Extra-ocular (Non-specific): Follicular hyperkeratosis, dry hair/nails, acne, loss of appetite/weight loss, increased risk of anemia, fatigue, growth retardation, low immunity, increased cancer risk.

Vitamin D Deficiency

• Sources:

• Sunshine: 90% from sun exposure (UVB radiation).

• Dietary sources: Fatty fish, cod liver oil, fortified foods (dairy, orange juice, soy milk, cereals), raw milk, beef liver, egg yolks, cheese contain minimal amounts.

• Chemical Forms: Vitamin D is synthesized by the body (skin) from sunlight to Vitamin D3. This is the natural form that exists in animals, including humans.

• Functions: Supporting bone health (promoting calcium absorption), promoting muscle health, modulating the immune system, aiding in cell growth, reducing inflammation, regulating blood pressure, supporting cardiovascular health.

• Vitamin D3 is more potent than D2. D2 has a lower potency and a shorter shelf-life.

• Pathways of Vitamin D synthesis: Shown in a diagram.

• Deficiency factors: insufficient/inadequate UV radiation due to seasonal/environmental factors; skin color; pollution; barriers (e.g., clothing, sunscreen), air pollution; Northern latitudes; pigmentation, certain medical conditions, drugs, breastfeeding.

• Clinical manifestations: a lack of vitamin D in children causes rickets, characterized by bowed or bent bones, muscle weakness, bone pain, and joint deformities.

Vitamin D Deficiency - Epidemiology and Risk Factors

• Epidemiology: A significant global issue (about one billion people worldwide have deficiency, 50% have insufficiency).

• Risk Factors: Lack/inadequate UVB sunlight, air pollution, northern latitudes, pigmented skin, sunscreen with SPF 15+ (99% of V.D. synthesis is blocked), institutionalization/housebound, poor mobility, vegetarian diets.

• Maternal Vitamin D Deficiency: Vitamin D is transferred to the fetus across the placenta and poor maternal stores lead to low levels in infants. Premature infants have less time to accumulate maternal vitamin D.

• Drugs: Laxatives, cholestyramine, orlistate, glucocorticoids

• Recommended Daily Amounts (RDA): Shown in a table.

Vitamin D Deficiency - Signs and Symptoms (Adults)

• Adults suffering from V.D. may exhibit the following: Fatigue, Bone discomfort/pain, muscle weakness, muscle aches/cramps, falls, impaired physical function, osteomalacia, osteoporosis, fractures, mood changes (depression/anxiety), increased susceptibility to infection.

Vitamin D Deficiency Treatment and Prevention

• Supplementation: Recommended amounts are outlined. Specific supplementation suggestions are given for various age groups.
• Preventing factors: emphasis on proper supplementation for mothers, importance of vitamin D supplementation for breastfed infants during the period of breastfeeding. Supplementing based on individual needs (obese children, use of medications affecting vitamin levels)
• Measurement of serum 25-OH levels: Levels should be measured during or shortly after treatment.

Summary

• VAD is a leading cause of preventable blindness in children.
• Vitamin A supplementation is a preventative measure in Iraq.
• Vitamin D is a crucial hormone-like vitamin influencing nearly every cell.
• Vitamin D supplementation and monitoring are essential preventative measures.