VITAMINS

The word vitamin was originally derived from

term "vital amine.”
They are micronutrients
The body is unable to synthesize them and
therefore it should be provided from outside
Classification:
Fat soluble: vitamin A, D, E, K
Water soluble: Vitamins of B group and
Vitamin C.
VITAMIN-A
 VITAMIN-A
It was the 1st fat-soluble vitamin to be discovered.
Forms:
 Pre - formed vitamin – retinol (in animal foods)
 Pro - vitamin – beta carotene (plant foods)
converted to retinol in intestinal mucosa
Units
Amount of Retinol a vit-A compound will yield is
called as Retinol equivalent (RE).
1 IU of retinol = 0.3 mcg of retinol
1 mcg of retinol = 1 mcg of RE
1 mcg of B-Carotene = 0.167 mcg of RE
6 mcg of ß-carotene = 1 mcg Retinol = 1 RE
Sources
 Sources
ANIMAL FOODS: Liver, eggs, butter, cheese,
whole milk, fish and meat.
Richest natural source: fish liver oil.

PLANT FOODS: Green leafy vegetables

(cheapest source), most green and yellow
fruits (papaya, mango, pumpkin), some roots
(carrots)

FORTIFIED FOODS: Foods fortified with

vitamin A (vanaspati, milk etc.)
 Vitamin A: Functions
Vision: indispensable for normal vision.
Production of retinal pigments needed for
vision in dim light.
Cellular Differentiation
Retinoic acid acts as a hormone to affect gene
expression and control cell development.
Necessary for maintaining the integrity and
normal functioning of glandular and epithelial
tissue which lines intestinal, respiratory,
urinary tracts, skin and eyes.
 Functions contd……
Growth - Supports skeletal growth (Bone
development and maintenance (bone
remodeling).)
Other Functions:
Vitamin A is necessary in several aspects of
the immune system and is essential for the
reproductive process.
It is anti-infective
Other Functions contd…
The possible “anticarcinogenic effects” of
carotenoids may be linked with enhancement
of the immune system.

The antioxidant role of carotenoids is linked to

a decreased cancer risk. May protect against
some epithelial cancers viz. bronchial cancers
 The RDAs of vitamin A (ICMR 1989)

Group Retinol (mcg)

Lactation 950
Man 600
Woman 600
Pregnancy 800
Adolescents 13- 19 yrs 600
Children 7 to 12 yrs 600
Children 1 to 6 yrs 400
Infants 350
Beta Carotene values: 4 X retinol values
 Vitamin A deficiency
Causes:

1) LOW INTAKE.

2) LOW ABSORPTION.

3) LOW FAT INTAKE

4) LOW PROTEIN INTAKE

5) INCREASED DEMAND
 Vitamin A deficiency
Symptoms and signs:
The signs of Vit A deficiency are predominantly
ocular – termed as “XEROPHTHALMIA”
It includes:
Nightblindness:
First symptom.
Inability to see in dim light
It is due to impairment in dark adaptation.
 Vitamin A deficiency signs contd….
Conjunctival xerosis:
First sign.
The conjunctiva becomes dry and non-wettable
(muddy and wrinkled).
Described as “emerging like sand banks at
receding tide.”
 Vitamin A deficiency signs contd…
Bitot’s spots:
Triangular, pearly white or
yellowish foamy spots on the
bulbar conjunctiva on either
side of the cornea.
Frequently bilateral.
In older individuals, they are
inactive sequelae of earlier
disease.
 Vitamin A deficiency

Corneal xerosis:
Cornea appears dull, dry
and non wettable and
eventually opaque.
In more severe deficiency
there may be corneal
ulceration which may heal
leaving a scar.
 Vitamin A deficiency signs contd....
Keratomalacia:
Liquefaction of cornea is a medical emergency.
The cornea becomes soft and may burst open.
It leads to blindness.
WHO CLASSIFICATION OF XEROPHTHALMIA
PRIMARY SIGNS:-
X1A - Conjuctival xerosis.
X1B - Bitot’s spot.
X2 - Corneal xerosis.
X3A - Corneal ulceration <1/3th
X3B - Corneal ulceration >1/3th
SECONDARY SIGNS:-
XN- Nightblindness.
XF - Fundal changes.
XS - Corneal sclerosis.
 Vitamin A deficiency
Extraocular manifestations
Anorexia
Growth retardation
Susceptibility to infections
Enlargement of hair follicles
(follicular hyperkeratosis)
Keratinization of epithelial
(mucous) cells
Failure of normal cell
differentiation
 Vitamin A deficiency contd…

Increased Demand: malabsorptive disorders,

such as steatorrhea, pancreatic, liver or gall
bladder disease, Alcoholism, chronic
nephritis.

Decreased Absorption: Measles depress

vitamin A status, which may already be low
in children in developing countries, resulting
in high mortality.
 Vitamin A deficiency: Treatment

Should be treated urgently

Nearly all the early stages are reversible
Deficiency
Treatment
 200,000 IU OR 110 mg Retinol Palmitate on 2
successive days
 All children with corneal ulcers should receive vitamin
A irrespective of deficiency.
 All children with measles: 1 dose Vit A if not received
in previous 1 month
 Severe malnutrition: 2 doses
 Prophylaxis –
 1970: 1-5 yr
 1992: 9 Month to 3 year
 2006: Upto 5 yr
 Vitamin A deficiency: Prevention
Long term measures:
 Improvement of people’s diet- for regular and
adequate intake
 Reducing the frequency and severity of
contributory factors.
 Nutrition education
 Public and community participation.
Short term measure:
 6 months - 1 yr : 1 lakh IU
 1- 6 yrs : 2 lakh IU of vitamin A orally every 6m
 Under the CSSM programme, total 9 doses: 9 m-
5 yrs
 Antenatal mothers to be given Vitamin A
not exceeding 10,000 IU per day till
symptoms disappear or levels come to
normal
 Vitamin A deficiency: Assessment

Prevalence criteria for determining the

xerophthalmia problem.

Prevalence in population
Criteria at risk (6m – 6yrs)
Nightblindness >1%
Bitot’s spot >0.5%
Corneal ulcer >0.05%
Keratomalacia >0.01%
Serum retinol(<10 mcg/dl) >5%
 Vitamin A toxicity
A chronic intake of vitamin A 10 times more than
the RDA can result in Hypervitaminosis A.
Symptoms:
Nausea,
Vomiting,
Anorexia,
Sleep disorders,
Skin desquamation,
Enlarged liver
Papillar edema.
Possible teratogenic effects??
Transplacental transfer in 1st
trimester
VITAMIN D
 VITAMIN D
The nutritionally important forms are:
 Calciferol (Vitamin D2) – derived by
irradiation of the plant sterol
 Cholecalciferol (Vitamin D3) – Naturally
occuring (preformed) vitamin D found in
animal fats and fish liver oils.
 Also derived from exposure to UV rays which
convert the cholesterol in the skin to Vitamin
D.
 Functions of vitamin D and its
metabolites
 Intestine: Promotes intestinal absorption of
calcium and phosphorus
 Bone: Stimulates normal mineralization,
Enhances bone reabsorption, Affects
collagen maturation
 Kidney: Increases tubular reabsorption of
phosphate
 Other: Permits normal growth.
 Vitamin D: Sources
 Sunlight: Synthesized by the body by the
action of UV rays on 7-dehydrocholesterol
stored in the skin.
 Foods: Liver, egg yolk, butter, cheese, milk
and other fortified foods.
 Fish liver oil is the richest source.
 Deficiency of vitamin D
 Rickets: failure of osteoid to calcify in young
children (6m–2 yrs).
 Characteristics: growth failure, bone deformity,
muscular hypotonia, tetany, convulsions due to
hypocalcemia.
 Elevated serum alkaline phosphate.
 Bony deformities: curved legs, deformed pelvis,
pigeon chest, harrison’s sulcus, rickety rosary,
kyphoscoliosis. Milestones of bony development
are delayed.
 Osteomalacia:
 More in females during pregnancy and lactation
Vitamin D Deficiency: Prevention
Measures:
 Educating the parents to expose their
children regularly to sunshine
 Periodic dosing with Vitamin D in those who
remain indoors
 Vitamin fortification of the foods
 Vitamin D: Hypervitaminosis
Signs:
 Anorexia,  Coma,
 Vomiting,  Cardiac
 Thirst, arrhythmias
 Drowsiness,  Renal failure

RDA:
 Adults: 2.5mcg (100 IU)
 Infants and children: 5 mcg (200 IU)
 Pregnancy and lactation: 10 mcg (400 IU)
 Vitamin E
Sources: Vegetable oils, cotton seed,
sunflower seed, egg yolk, butter, foods rich in
PUFA.
 Vitamin K
Occurs in 2 major forms:
Vit K1 (Fresh green vegetables and fruits)
Vit K2 (Synthesized by the intestinal bacteria)
Functions: Stimulate the production and
release of certain coagulation factors
RDA: 0.03 mg/kg for adults
Deficiency: Decrease in prothrombin content
of blood and blood clotting time is prolonged.
 THIAMINE (Vitamin B1)
 It is essential for the utilization of
carbohydrates.
 Thiamine pyrophosphate (TPP), the
coenzyme of cocarboxylase plays a part in
activating transketolase, an enzyme
involved in the direct oxidative pathway for
glucose.
 Deficiency – accumulation of pyruvic and
lactic acids in tissues and body fluids.
 THIAMINE
Sources:
 Whole grain cereals, wheat, gram, yeast,
pulses, oilseeds and nuts.
Thiamine losses:
 Milling (polished rice)(75% loss of thiamine,
60% of riboflavin and niacin and 15%
protein), washing, cooking, prolonged
storage of fruits and vegetables, cooking with
baking soda
RDA:
 0.5 mg per 1000 kcals of energy intake.
 Prevention of thiamine losses
PARBOILING: Central Food Technological
Research Institute recommends “hot
soaking process”
Soak the paddy in hot water (65-70oC) for 3-4 hr

Drain the water

Steam the soaked paddy in the same container

for 5-10 min.

Drying followed by homepounding or milling

 Benefits of Parboiling
During steaming- a greater part of vitamins
and minerals present in the outer aleurone
layer are driven into the inner endosperm.
During drying process- the germ gets attached
more firmly to the grain.
The heat used in drying hardens the rice grain.
The grain becomes more resistant to insect
invasion and therefore more suitable for
storage.
Disadvantage: development of a peculiar
smell
 Deficiency of thiamine
The two principal deficiency diseases are:
 Beriberi:
It may occur in three main forms:
 Dry form: Peripheral neuritis,
 Wet form: Cardiac beriberi
 Infantile beriberi: in infants b/w 2-4m of life. The
affected baby is usually breast-fed by a
thiamine-deficient mother who commonly shows
signs of peripheral neuropathy.
 Wernicke’s encephalopathy
 seen in alcoholics: characterized by
ophthalmoplegia, polyneuritis, ataxia and mental
deterioration
 RIBOFLAVIN (Vitamin B2)
Functions:
Cellular oxidation, acts as a cofactor in a number
of enzymes involved with energy metabolism.
Sources:
 Milk, eggs, liver, kidney and GLV
 Germination increases the riboflavin content.
Deficiency
 Angular stomatitis
RDA
 0.6mg/1000 kcal of energy intake.
 NIACIN
Functions:
For metabolism of carbohydrates, fat and
protein
Also essential for normal functioning of the
skin, intestinal and nervous systems.
Sources:
 Liver, kidney, meat, poultry, fish, legumes and
groundnut
 Milk is a poor source
 NIACIN (Vitamin B3)
Deficiency
 Pellagra (3 D’s- Diarrhea, dermatitis and
dementia)
 In addition – Glossitis and stomatitis
 Dermatitis is bilaterally symmetrical on body
surfaces exposed to sunlight
RDA
 6.6mg/1000 kcal of energy intake.
 PYRIDOXINE (Vitamin B6)
Functions:
 Important role in the metabolism of amino
acids, fats and carbohydrate.

Sources:
 Milk, liver, meat, egg yolk, fish, whole grain
cereals, legumes and vegetables.
 PYRIDOXINE (Vitamin B6)
Deficiency:
 Riboflavin deficiency impairs its optimal
utilization.
 Associated with peripheral neuritis.
 INH acts as an antagonist. Supplement with
10mg/d pyridoxine.

RDA:
 Adults- 2 mg/day,
 Pregnancy and lactation- 2.5 mg/day.
 VITAMIN B12
Functions:
 It cooperates with folate in the synthesis of DNA.
 Useful in synthesis of fatty acids in myelin
Sources:
 Liver, kidney, meat, fish, eggs, milk and cheese.
 Not found in foods of vegetable origin.
 Also synthesized by colonic bacteria.
 Stored in liver (2 mg)- acute deficiency is rare.
RDA
 Infants and children – 0.2 mcg
 Normal adults – 1mcg
 Pregnancy and lactation – 1.5 mcg
 Vitamin B12 deficiency
 Megaloblastic anaemia (pernicous
anaemia),
 Demyelinating neurological lesions in the
spinal cord and
 Infertility (in animal species).
 Folate
Function:
 Synthesis of nucleic acid.
 Normal development of blood cells in the marrow.
 Folic acid supplementation during pregnancy
increases the birth weight of infants and decrease
the incidence of LBW babies
Sources:
 GLV, Liver, meat, dairy products, eggs, milk, fruits,
cereals
 Overcooking destroys much of folic acid.
 Folate
Deficiency
 Megaloblastic anaemia, glossitis, cheilosis,
GI disturbances viz. diarrhea, distension
and flatulence, infertility
RDA:
 Requirements are greatest in conditions
where there is rapid cell multiplication.
 Children and healthy adults: 100mcg
 Lactation: 150 mcg
 Pregnancy: 400mcg
 VITAMIN C
 It is the most heat sensitive vitamin.
 Man, monkey and guinea pig are perhaps the only
species known to require vitamin C in their diet
Functions:
 In tissue oxidation.
 Formation of collagen, which accounts for 25% of
total body protein. Collagen provides a supporting
matrix for the blood vessels, connective tissues,
bones and cartilage.
 Facilitates absorption of iron from vegetable foods.
 VITAMIN C
Sources:
 fresh fruits, GLV, germinating pulses. Amla is one
of the richest source both in fresh and dry form.
RDA: 60mg
Deficiency leads to Scurvy characterized by:
 Swollen and bleeding gums,
 Subcutaneous bruising or bleeding into the skin or
joints,
 Delayed wound healing,
 Anaemia and weakness.
MINERALS
 MINERALS
More than 50 chemical elements are found in the
human body, which are required for growth, repair
and regulation of vital body functions
Can be divided into three groups:
 Major Minerals: Ca, P, Na, K and Mg
 Trace Elements: Requirement is less than few
mg/day - Fe, I, F, Zn, Cu, Co, Cr, Mn, Mo, Se, Ni,
Sn, Si, Vanadium.
 Trace contaminants with no known function:
Pb, Hg, Ba, Boron, Al
 CALCIUM
An average adult body contains about 1200 g of Ca
98% of which is found in the bones.
Functions:
 Formation of bones and teeth,
 Coagulation of blood,
 Contraction of muscles,
 Cardiac action,
 Milk production,
 Relay of electrical and chemical messages.
 CALCIUM
Sources:
Milk and milk products, eggs and fish
Cheapest dietary sources: GLV, cereals and millets
Absorption:
Enhanced by Vit. D and decreased by phytates,
oxalates and fatty acids.
Deficiency:
No clear cut disease due to Ca deficiency has been
observed even with low intake until the Vit D intake
is adequate
RDA:
400-500 mg
 IRON
The adult human body contains 3-4g of iron – 60 -
70% of which is present in the blood as
circulating iron.
Functions:
 Formation of Hb, myoglobin, cytochromes,
catalase and certain enzymes
 Oxygen transport and cell respiration
 Brain development and function
 Regulation of body temperature
 Muscle activity
 Catecholamine metabolism
 IRON
Sources: Two forms-
 Haem iron (liver, meat, poultry and fish)
 Non-haem iron (vegetable origin - cereals, GLV,
legumes, nuts, oilseeds, jaggery, dried fruits)

Absorption:
 Enhanced by haem iron rich foods, ascorbic acid
and cooking in iron vessels
 Decreased by phytates, oxalates, carbonates,
phosphates, dietary fibre, milk, eggs, tea
 Iron absorption from habitual Indian diets is less
than 5%
 IRON
Iron losses:
 1mg/d in an adult and 2mg/d in menstruating
women
Deficiency: 3 stages:
 Decreased storage of iron without any
detectable abnormalities
 Latent iron deficiency- iron stores are
exhausted: detected by serum ferritin level
 Overt iron deficiency- decrease in
concentration of circulating Hb – anaemia, .
Diagnosis of anaemia: Cut off points
g/dl (venous
blood)
Adult males 13

Adult females, non- pregnant 12

Adult females, pregnant 11

Children, 6m – 6 yrs 11

Children, 6 – 14 yrs 12
 Evaluation of iron status
 Haemoglobin concentration: relatively insensitive
index of nutrient depletion
 Serum iron concentration:
More useful than Hb concn.
Normal range: 0.8-1.8mg/l. Values <0.5mg/l
indicate deficiency
 Serum ferritin:
Reflects the size of iron stores.
Most useful in population where prevalence of iron
deficiency is not high.
Values <10mcg/l indicate absence of iron stores.
 Serum transferrin saturation: s/b >16%. N - 30%
 Iron Requirements
CATEGORY Mg/day CATEGORY Mg/day
Man 28 Boys 10-12 yrs 34
Woman 30 Girls 10-12 yrs 19
Pregnancy 38 Boys 13-15 yrs 41
Lactation 30 Girls 13-15 yrs 28
Children 1-3 yrs 12 Boys 16-18 yrs 50
Children 4-6 yrs 18 Girls 16-18 yrs 30
Children 7-9 yrs 26
 Interventions for anaemia
 Severe (<10g/dl): high doses of Iron or blood
transfusion
 If b/w 10- 12 g/dl:
1. Iron and folic acid supplementation
2. Iron fortification
3. Other strategies
Changing dietary habits, deworming, nutrition
education
 IFA supplementation
Age group Elemental FA Frequency Colour
Fe (mg) (mcg)
6m-59 m 20 100 Biweekly Syrup
5-9 yr 45 400 Weekly Pink
10-19 yr 60 500 Weekly Blue Sugar
coated
Women non 60 500 Weekly Red Sugar
pregnant 20- coated
49 yr
Pregnant, 60 500 Daily from 4th Red sugar
lactating month till 180 coated
days
postpartum
 Iodine
 It is an essential micronutrient.
 Required for the synthesis of the thyroid hormones.
 Blood level is 8-12 mcg/dl.
 Sources:
Sea foods and cod liver oil
 Goitrogens:
Chemical substances which interfere with iodine
utilization by the thyroid gland e.g. brassic group of
vegetables.
 RDA:
150 mcg/day
 Spectrum of IDD in approximate order of
increasing severity
Disorders Level of severity
Goitre Grade I
Grade II
Grade III
Multinodular
Hypothyroidism Varying combinations of
clinical signs
Subnormal intelligence Variable severity
Delayed motor milestones
Mental deficiency
Hearing defects
Speech defects
 Spectrum of IDD in approximate order of
increasing severity
Disorders Level of severity
Strabismus Unilateral
Bilateral
Nystagmus
Spasticity
(extrapyramidal)
Neuromuscular weakness Muscle weakness in legs,
arms, trunk
Spastic diplegia
Spastic quadriplegia
Endemic cretinism Hypothyroid cretinism
Neurological cretinism
Intrauterine death
Spontaneous abortion
(miscarriage)
 Epidemiological assessment of Iodine
deficiency
 Indicators:
• Prevalence of goitre
• Prevalence of cretinism
• Urinary iodine excretion
• Measurement of thyroid function by
determination of serum T4 and TSH
• Prevalence of neonatal hypothyroidism:
Sensitive indicator of environmental iodine
deficiency
 Goitre control
 WHO targets - <10% prevalence in endemic areas
 4 essential components
Fortification
• Iodized salt: Not less than 30 ppm at production
point and not less than 15 ppm at consumer level
• Injectable Iodized oil (IM)
• Oral Iodized oil
Iodine monitoring
Manpower training
Mass communication
 FLUORINE
• Essential for the normal mineralization of bones and
formation of dental enamel
 Sources:
• Drinking water: N- 0.5 mg/L to 3-12 mg/L
• Foods: Sea fish, cheese and tea
 Deficiency:
• Dental caries
 Excess:
• Dental Fluorosis (>1.5 mg/l of intake)
• Skeletal fluorosis (lifetime daily intake of >3-6 mg/l )
• Genu valgum and osteoporosis in predominant
sorghum eaters.
• RDA: 0.5 to 0.8 mg/l
 INTERVENTIONS
• Changing the water source: Surface water
• Chemical treatment : Nalgonda Technique by
National Environmental engineering research
institute (NEERI).
• By lime and alum sequentially followed by
flocculation, sedimentation and filtration
• Use of fluoride toothpastes in fluorosis
endemic areas is not recommended.