Vitamins Lecture Notes PDF

# VITAMIN A - **VITAMIN** (A large letter A is made out of various fruits and vegetables) - **Signs of Xerophthalmia:** - Top left: Bitot's spot - Top right: Comea with typical dry appearance and ulcer stained green with fluorescein dye; - Bottom right: Corneal scarring: - Bottom...

# VITAMIN A - **VITAMIN** (A large letter A is made out of various fruits and vegetables) - **Signs of Xerophthalmia:** - Top left: Bitot's spot - Top right: Comea with typical dry appearance and ulcer stained green with fluorescein dye; - Bottom right: Corneal scarring: - Bottom left: Deep corneal ulceration progressing towards keratomalacia. # Dietary Sources of Vitamin A - **Animal foods:** Liver, fish oil, kidney, egg yolk, butter - **Plants:** Carrots, dark green leafy vegetables (beta-carotene), spinach, broccoli, sweet potatoes - **RDA:** Adults 3000-5000 IU/day - ↑ Children, pregnant and lactating women # STRUCTURE & TYPES - All three compounds contain common structural unit - Trimethyl cyclohexenyl ring - (ẞ - ionone) - All trans configurated polyene chain (isoprenoid chain) - Four double bonds - All Compounds with vitamin A activity are called RETINOIDS - Three different compounds with vitamin A activity are: Retinols, retinal, retinoic acid - β-CAROTENE is PROVITAMIN A, PRESENT IN PLANT TISSUE - **Diagram:** - **Retinol** - **Retinol (retinaldehyde)** - **Retinoic Acid** - **β-Carotene** # Vitamin A: Biological functions - **Role in vision:** - Vitamin A (retinal) is an essential precursor for visual pigment, Rhodopsin, in the retina of the eye. - Retinal plays an important role in vision, especially night vision. - **Role in Bone and teeth formation:** - Promotes the proper growth of bones and teeth. - Bone cells (osteoblasts and osteoclasts) depend on vitamin A for their normal functioning. - **Role in growth:** Helps regulate cell development, cell differentiation and cell division. - **Antioxidant** - Beta-carotene # Vitamin A: Biological functions - **Role in reproduction** - Vitamin A holds an important place in sexual reproduction. - Adequate levels of vitamin A are needed for normal sperm production. - **Role in immunity** - Helps to increase body resistance to infectious diseases. - **Cell growth and differentiation** - **Regulation of gene expression by retinoic acid which acts as transcription regulator by binding to specific sequences of DNA in the nucleus affected cells include epithelium of skin and gut, and bone, ovary and testis.** # Problems associated with Vitamin A - **Vit A deficiency:** 1. Night blindness - unable to see in dim light. 2. Increased susceptibility to infection and cancer and anemia equivalent to iron deficient. 3. Keratinization of the cornea, a condition known as xerophthalmia. 4. Abnormal bone development in fetal and neonatal life. - Skeletal malformations - Spontaneous fractures - Internal hemorrhages - Loss of appetite - Slow growth or weight loss - **Vit A excess:** - **Hypervitaminosis A:** - Symptoms --- dry, pruritic skin with excessive itching and increase in intracranial pressure. - Seen in people of arctic region by eating polar bear or seal liver. # CLINICAL MANIFESTATION - **1N Night blindness** - **2B Bitot's spots** - **X3 Corneal xerosis** - **X4 Corneal ulcerations- Keratomalacia** - **X5 Corneal scars - permanent blindness** # Vitamin A Deficiency Clinical Manifestations - 1. Night blindness - 2. Bitot's spots - Abnormal squamous cell proliferation and keratinization of the conjunctiva # RICKETS - Two images of legs, one with severely bow-legged appearance and one with visible bone structure. # FUNCTIONS - **Intestinal absorption of calcium and phosphates** - **Mineralization of bones** - **Promotes bone resorption and calcium mobilization to raise blood Ca and P in relation to PTH.** - **Renal reabsorption of Ca and Phosphate** # DEFICIENCY - **Rickets** - **Osteomalacia** - **Renal osteodystrophy** # VITAMIN D ACTIVATION - **Diagram:** - Shows how and where vitamin D (produced in the skin) is circulated through the body. - Includes: - Parathyroid glands - Skin - Liver - Intestine - Kidney - Bone - Immune cells - Dietary sources of vitamin D - Tumor microenvironment # Definition - **Osteoporosis:** It is a disease in which bone weakening increases the risk of a broken bone. Common in elderly people. Bones that commonly break include the vertebrae in the spine, the bones of the forearm, and the hip. Until a broken bone occurs there are typically no symptoms. - **Osteomalacia:** It is a disease characterized by the softening of the bones caused by impaired bone metabolism primarily due to inadequate levels of available phosphate, calcium, and vitamin D, or because of resorption of calcium. The impairment of bone metabolism causes inadequate bone mineralization. - **Diagram:** - Shows *Osteomalacia* in the microscopic structure of bone. # Osteoporosis/Osteomalacia - Shows a diagram comparing normal bone matrix to the microscopic structure of bones with osteoporosis. - **Side-by-side comparison:** - **Normal bone matrix** - **Osteoporosis:** - **Diagram of x-ray** # VITAMIN K - **VITAMIN** (A large letter K made of fruit and vegetables. ) - **Foods High in Vitamin K (With Benefits)** - 6 food items are pictured (Kiwi, Green Grapes, Green Apple, Avocado, Broccoli, Cabbage) - **Antihemorrhagic/coagulation vitamin or prothrombin factor. Three variants K₁, K₂ and K₃ .All are napthoquinone derivatives.** - **SOURCES** - Cabbage - Cauliflower - Tomato - Spinach - Green leafy vegetables (Richest) - Egg yolk - Meat - Liver - Cheese & dairy products - **RDA: 70-140 µg/day** - **Food sources of vitamin K include cabbage, cauliflower, spinach and other green, leafy vegetables, as well as cereals** - **Diagram:** - **Vitamin K** - Pictures of the food sources listed above. # VITAMIN C - **VITAMIN** (A large letter C made of fruit and vegetables. ) - **Diagram:** - **Vitamin C** - Image of various fruits and vegetables. - **Vitamin C Deficiency** - Two pictures of skin problems. # VITAMIN C (Ascorbic Acid) - **SOURCES** - Citrus fruits- orange, lemon - Papaya - Pineapple - Banana - Strawberry - Green leafy vegetables - Cabbage - Cauliflower - Germinating seed - Green peas and beans - Gooseberry(Amla) - (richest source) - **RDA: Adults 60-70 mg/day** - **Vitamin** - **Citrus fruits, green peppers, strawberries, tomatoes, broccoli and sweet and white potatoes are all excellent food sources of vitamin C (ascorbic acid)** # FUNCTIONS - **Collagen formation** - **Iron and hemoglobin metabolism** - **Tryptophan metabolism** - **Tyrosine metabolism** - **Folic acid metabolism** - **Cholesterol synthesis** - **Cellular respiration** - **Immunological function** - **Prevents cataract formation** - **Preventive action on chronic diseases** # DEFICIENCY - **SCURVY - defect lies in the failure of intercellular cement substance** - **Fragile capillaries-petechial, sub-cutaneous,sub-periostial or internal hemorrhages.** - **Poor/Delayed wound healing.** - **Poor dentine formation** - **Gum bleed - gums are swollen, spongy bleeds on pressure** - **Poor mineralization of bones** - **Anemia - microcytic - hypochromic** - **Diagram:** - Two pictures of symptoms mentioned above. # DEFICIENCY - **Wet Beri Beri** - Edema of legs, face and trunk and serous cavities. - Calf muscles are swollen and tender - Palpitation and breathlessness - Low diastolic BP, high systolic. - Fast pulse - Heart becomes weaker - And patient dies of heart failure - **Infantile Beri beri** - Infants born to mother with low thiamine in their breast milk. - Restlessness and sleeplessness - Anorexia, vomiting and breathlessness - Symptoms d/t cardiac dilatation and failure. - Sudden death if not treated urgently with thiamine. - **Dry Beri Beri** - Progressive muscle weakness disability - Neurological manifestations # FUNCTIONS - **Essential for normal growth** - **Essential for normal functioning of nerves** - **Co-enzymatic activities - carbohydrate, nucleic acid and energy synthesis** # DEFICIENCY - **Beri Beri (** - **Earliest symptoms:** - Anorexia - Dyspepsia - Heaviness and weakness of legs. - Calf tenderness # VITAMIN B₂ - RIBOFLAVIN - **Functions:** - Active forms of riboflavin are FMN and FAD. - They act as prosthetic groups of several enzymes. - Catalyzes oxidation-reduction reactions. - Growth, repair, development of body tissues - healthy skin, eyes and tongue # VITAMIN B₂ (Riboflavin) - **SOURCES:** - Yeast - Whole grain - Dry beans and pea - Green vegetables - **RDA: 1.5-1.8 mg/day in adults** - **Vitani** - **Food sources of Riboflavin (vitamin B2):** - Cereal, nuts, milk, eggs, green leafy vegetables and lean meat - **FUNCTIONS:** - **In two active forms FMN and FAD serves as coenzyme in various reactions** - **DEFICIENCY** - Cheilosis-fissuring at angle of the mouth - Glossitis-tongue smooth and purplish - Seborrhagic Dermatitis:scaly, greasy, desquamation - Eyes: corneal vascularization - **Chronic alcoholics are susceptible to deficiencies.** - **Diagram:** - Image of the mouth and tongue showing symptoms mentioned above. # Wernicke-korsakoff psychosis - **Seen mostly in chronic alcoholics** - **Body demand of thiamine increases in alcoholism** - **Characterized by:** - **Dementia** - **Apathy** - **Nystagmus** - **Diagram:** - A side-by-side comparison of Wet Beri Beri and Dry Beri Beri, listing the symptoms of each. - **THIAMINE DEFICIENCY (Benberi): Common early manifestations:** - Painful tender muscles - Foot Drop - Dyspnea, Orthopnea - Loss of reflexes in knees & feet - Paresthesia, Numbness of feet - Emaciation - Wrist Drop - Great Weakness - Aphonia (may appear), Poor prognosis: vagus nerve involved - Dilatation of right heart: Heart failure - **Edama** - **Wernicke's Syndrome** - Ophthalmoplegia - Confusion - Coma - Death # DEFICIENCY - **Nausea, vomiting, GI disorders,** - **Irritability.** - **Inadequate growth.** - **Fatty liver** - **Steroid synthesis.** - **Burning foot syndrome - Pain and numbness in the toes** - **Insomnia** - **Fatigue** # VITAMIN B₅ (Pantothenic Acid) - **SOURCES:** - Kidney - Liver - Egg yolk - Yeast - Cereals - Legumes - Sunflower oil - **RDA: 5-10 mg/day** - **FUNCTION:** - **Acts through CoA and helps in the formation of** - **Energy** - **Triacylglycerol** - **Vita D** - **Steroid hormones** # FUNCTIONS: - **It has two active forms NAD+, NADP+ serves as co-enzymes in various oxido-reductive reactions in ETC ** # DEFICIENCY - **PELLEGRA (pelle-skin; agra- rough)** - **"3D" Disease: Dermatitis, Dementia, Diarrhea** - **Gingivitis and stomatis** - **Achlorhydria** - **Fatty liver** - **Effect on plasma lipids** - **Diagram:** - **Deficiency:** - **Pellagra:** - pelle - skin, agra - rough - Found in population eating high corn-based diet - Alcoholics - Hartnup disease - Carcinoid syndrome - Characterized by dermatitis, diarrhea, and dementia - Incidence more in women - **An inability to absorb niacin (vitamin B3) or the amino acid tryptophan may cause pellagra, a disease characterized by scaly sores, mucosal changes and mental symptoms** # VITAMIN B₅ (Pantothenic Acid) - **SOURCES:** - Kidney - Liver - Egg yolk - Yeast - Cereals - Legumes - Sunflower oil - **RDA: 5-10 mg/day** - **FUNCTION:** - **Acts through CoA and helps in the formation of** - **Energy** - **Triacylglycerol** - **Vita D** - **Steroid hormones** # DEFICIENCY - **Nausea, vomiting, GI disorders,** - **Irritability.** - **Inadequate growth.** - **Fatty liver** - **Steroid synthesis.** - **Burning foot syndrome - Pain and numbness in the toes** - **Insomnia** - **Fatigue** # VITAMIN B₇ (Biotin) - **SOURCES:** - Egg yolk - Liver - Kidney - Yeast - Milk - Tomato - Fruits - Vegetables - **RDA: 50-60 microgms/day** - **FUNCTIONS: it acts as co enzyme** - **In various carboxylation reactions** # DEFICIENCY - **Neurological symptoms** - **Depression** - **Irritability** - **Nervousness** - **Mental confusion** - **Convulsions** - **Peripheral neuropathy** - **Demyelination of neurons** - **Anemia** - **Hypochromic microcytic anemia d/t reduced heme production.** - **Pyridoxine deficiencies are mostly seen in women taking OCPs, alcoholics, infants and those on ATT especially INH** # VITAMIN B₆ (Pyridoxine) - **SOURCE** - Yeast - Rice polishing - Germinal portion of seeds - Liver - Kidney - Fish - **RDA: 2-2.2 mg/day** - **Vitami** - **Food sources of vitamin B6 (pyridoxine) include beans, legumes, nuts, eggs, meats, fish breads and cereals** - **FUNCTION** - **Active form is Pyridoxal Phosphate (PLP). It serves as coenzyme in various bio-chemical reactions like Transaminase, Decarboxylation, Deamination.** # DEFICIENCY - PERNICIOUS ANEMIA - **Megaloblastic anemia** - **Mucosal atrophy of mouth** - **Glossitis** - **Disease of nervous system both central and peripheral** - **Psychiatric symptoms** - **Diagram:** - **Vitamin B12 is essential for:** - Red blood cell formation - Neurological function - DNA synthesis # VITAMIN B₉ (Folic Acid) - **SOURCES** - Liver - Yeast - Kidney - Green leafy vegetables - Meat - Fish - **RDA: 100 microgms/day** - **FUNCTIONS:** - **The active form of folic acid is Tetrahydrofolate. It acts as coenzymes in various bio-chemical reactions.** - **Vitami** - **Food sources of folate include beans and legumes, citrus fruits and juices, whole grains, dark green leafy vegetables, poultry, pork, shellfish and liver** # Addition of raw egg- white to the diet as a source of protein - **Symptoms of biotin deficiency** - Dermatitis - Glossitis - Loss of appetite - Loss of hair - Nausea - Scaly red rash around the eyes, nose, mouth, and genital area. - **Neurologic symptoms in adults** - Depression - Lethargy - Hallucination - Numbness - Tingling of extremities. - **Raw egg white contains a glycoprotein, avidin which tightly binds biotin which prevents its absorption from the intestine.** - **Cooking egg white denatures avidin which renders it digestable. This is unable to prevent the absorption of dietary biotin.** # CONCLUSION  - Vitamins are required in trace amounts. - They do not directly provide energy. - They are not required by normal otherwise healthy individuals consuming a balanced diet, rather should be reserved for those who are under stressful conditions - ACUTELY ILL PATIENTS - PREGNANT AND LACTATING MOTHER - CHRONIC DEBILITATING ILLNESS - DURING CONVALESCENCE - MALNOURISHED PERSON - UNDERTAKING CERTAIN DRUGS- ANTI - MICROBIALS # Water-Soluble Vitamins | Name | Coenzyme or Active Form | Primary biochemical function | | :--------- | :------------------------ | :-------------------------------------- | | Thiamin | Thiamine pyrophosphate (TPP) | Aldehyde-group transfer | | Riboflavin | Flavin mononucleotide (FMN) | Hydrogen-Atom (electron) transfer | | | Flavin adenine dinucleotide (FAD) | Hydrogen-Atom (electron) transfer | | Nicotinic Acid | Nicotinamide adenine dinucleotide (NAD) | Hydrogen-Atom (electron) transfer | | | Nicotinamide adenine dinucleotide phosphate (NADP)| Hydrogen-Atom (electron) transfer | | Pantothenic Acid | Coenzyme A (CoA) | Acetyl-group transfer | | Pyridoxine | Pyridoxal Phosphate | Amino-group transfer | | Biotin | Biocytin | Carboxyl transfer | | Folate | Tetrahydrofolate | One-carbon group transfer | | Vitamin B₁₂ | Coenzyme B₁₂ | 1.2 shift hydrogen atoms | | Lipoic Acid | Lipoyllysine | Hydrogen-Atom and Acetyl-group transfer | | Ascorbic Acid | Ascorbic acid, dehydroascorbic acid | Cofactor in hydroxylation | # Water-Soluble Vitamins | Vitamin | Function | Deficiency | | :------- | :------------------------------------------------------------------- | :------------------------------------------- | | A | Part of RHODOPSIN / VISION | NIGHT BLINDNESS | | D | GI (Incr. Calcium absorption) | Rickets / Osteomalacia | | E | Antioxidant | Ataxia | | K | CARBOXYLATION (of glutamate) / Calcium "chelation" with glutamate. | Factor 2/7/9/10 bleeding disorders | | B-1 | ALDEHYDE transfer / DECARBOXYLATION | BERIBERI | | B-2 | H+ Transfer / FMN - FAD (Flavins) | CHEILOSIS / GLOSSITIS | | B-3 | H+ Transfer / NAD - NADP | PELLEGRA (Dementia, Diarrhea, Dermatitis) | | B-5 | ACYL Group Transfer / Co-A | Burning Feet / HA / Nausea | | B-6 | AMINO Group transfer / De-& Trans "aminations" | Microcytosis / Neuropathy | | B-12 | METHYL Transfer / Methionine Synth. | Macrocytosis / Pernicious Anemia / Neuropathy | | VIT-C | H+ Transfer / Hydroxylation of Proline& Lysine | SCURVY | | BIOTIN | CARBOXYLATION | Seborrheic Dermatitis. Nervous disorders. Bound by Avidin (in egg white) | | FOLATE | METHYL Transfer | Macrocytosis / Glossitis / Colitis | # Fat-Soluble Vitamins | Vitamin | Name | Active Form (co-factor) | Biochemical Function | Physiological/cellular Role | | :------- | :----------- | :--------------------- | :--------------------- | :---------------------------------- | | B₅ | Pantothenic Acid | Coenzyme A | Acyl Transfer | Energy production from foodstuff | | | | | | Fatty acid synthesis | | B₆ | Pyridoxine | Pyridoxal Phosphate (PLP) | Transamination | Amino acid breakdown | | | | | Racemization | Glycogen breakdown | | | | | Decarboxylation | | | | | | β/γ-Elimination | | | | | | Carboxylation | | | B₇ | Biotin | Biotin | | Glucose & fatty acid synthesis | | | | | | Leucine synthesis | | | | | | Amino Acid & nucleotide synthesis | | B₉ | Folic Acid | Tetrahydrofolate (THF) | One-Carbon Group Transfer | Nucleotide synthesis | | | | | | Amino acid metabolism | | | | | | Fatty acids breakdown | | | | | | Folic acid regeneration | | B₁₂ | Cobalamin | Coenzyme B₁₂ | Intramolecular rearrangements | | | | | | Methyl transfer | | | C | Ascorbic Acid | Ascorbic Acid | Proline Hydroxylation | Collagen synthesis | | | | | Reduction | Antioxidation | | D | Calciferol | Calcitriol | Gene expression | Bone growth | # Fat-Soluble Vitamins | Vitamin | Name | Active Form (co-factor) | Biochemical Function | Physiological/cellular Role | | :------- | :----------- | :-------------------- | :--------------------- | :---------------------------------- | | A | B-carotene | Retinal | Conversion of light to neural signals | Sight | | | | Retinoic Acid | Growth Factor | Tissue growth | | B₁ | Thiamine | Thiamine diphosphate (TPP, TDP)| Decarboxylation | Energy production from carbohydrates | | | | | Decarbonylation | Nucleotide synthesis | | B₂ | Riboflavin | FADH₂ | Oxidation-Reduction | Energy production from foodstuff | | | | | | Lipid breakdown & synthesis | | B₃ | Niacin | NADH | Oxidation-Reduction | Energy production from foodstuff | | | | | | Lactic fermentation | | | | NADPH | Oxidation-Reduction | Lipid synthesis | | | | | | Synthesis of lipids, nucleotides & neurotransmitters | | | | | | Antioxidation | | | | | | Detoxification of drugs & toxins | | | | | | Anti-pathogen action | # Fat-Soluble Vitamins | Vitamin | Name | Active Form (co-factor) | Biochemical Function | Physiological/cellular Role | | :------- | :----------- | :-------------------- | :--------------------- | :---------------------------------- | | A | B-carotene | Retinal | Conversion of light to neural signals | Sight | | | | Retinoic Acid | Growth Factor | Tissue growth | | B₁ | Thiamine | Thiamine diphosphate (TPP, TDP)| Decarboxylation | Energy production from carbohydrates | | | | | Decarbonylation | Nucleotide synthesis | | B₂ | Riboflavin | FADH₂ | Oxidation-Reduction | Energy production from foodstuff | | | | | | Lipid breakdown & synthesis | | B₃ | Niacin | NADH | Oxidation-Reduction | Energy production from foodstuff | | | | | | Lactic fermentation | | | | NADPH | Oxidation-Reduction | Lipid synthesis | | | | | | Synthesis of lipids, nucleotides & neurotransmitters | | | | | | Antioxidation | | | | | | Detoxification of drugs & toxins | | | | | | Anti-pathogen action | # Vitamins - **Water-soluble** - **Non-B-Complex** - Ascorbic acid (vitamin C) - **B-Complex** - **Energy-releasing** - Thiamine (vitamin B₁) - Riboflavin (vitamin B₂) - Niacin (vitamin B₃) - Biotin - Pantothenic acid - **Hematopoietic** - Folic acid - Vitamin B₁₂ - **Other** - Pyridoxine (vitamin B₆) - Pyridoxal - Pyridoxamine - **Fat-soluble** - Vitamin A (retinol, β-carotenes) - Vitamin D (cholecalciferol) - Vitamin K (phylloquinones, menaquinones) - Vitamin E (tocopherols)