Dr Feba S Raj 1
Occur in small quantities in different natural foods
and are necessary for growth and maintenance of
good health
essential food factors, which are required for the
proper utilization of the proximate principles of food
like carbohydrates, lipids and proteins.
All the vitamins are usually available in an ordinary
Indian diet.
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CLASSIFICATION
FAT SOLUBLE
• VITAMIN A
• VITAMIN D
VITAMINS • VITAMIN E
• VITAMIN K
WATER SOLUBLE
• B COMPLEX
• VIT C
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FAT SOLUBLE WATER SOLUBLE
SOLUBILITY IN FAT SOLUBLE NOT SOLUBLE
WATER SOLUBILITY NOT SOLUBLE SOLUBLE
ABSORPTION ALONG WITH LIPIDS ABSORPTION SIMPLE*
REQUIRES BILE SALTS
CARRIER PROTEINS PRESENT NO CARRIER PROTEINS*
STORAGE STORED IN LIVER NO STORAGE*
EXCRETION NOT EXCRETED EXCRETED
DEFICIENCY MANIFESTS ONLY WHEN MANIFESTS RAPIDLY AS
STORES ARE DEPLETED THERE IS NO STORAGE*
TOXICITY HYPERVITAMINOSIS MAY UNLIKELY,SINCE EXCESS
RESULT IS EXCRETED
TREATMENT OF SINGLE LARGE DOSES MAY REGULAR DIETARY SUPPLY
DEFICIENCY PREVENT DEFICIENCY IS REQUIRED
MAJOR VITAMINS A,D,E,K B,C
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CHEMISTRY
Absorption
Biochemical Role
Deficiency Manifestations
. Dietary Sources of Vitamin
. Daily Requirements of Vitamin
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V
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VITAMIN A
Beta carotene
CHEMISTRY
fat soluble
Provitamin - beta-carotene are found in plants
One molecule of beta-carotene can theoretically give rise to two
molecules of vitamin A.
Vitamin A has a beta-ionone (cyclohexenyl) ring system
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Three different compounds with vitamin A activity are :
retinol (vitamin A alcohol),
retinal (vitamin A aldehyde) and
retinoic acid
retinal reductase
Retinal retinol.
This reaction is readily reversible
Retinal is oxidized to retinoic acid, cannot be converted to other forms
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Side chain contains alternate double bonds, hence
many isomers are possible
All- trans variety of retinal (vit A1) most common
Biologically important compound is 11-CIS RETINAL
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2. Absorption of Vitamin A
The absorption is along with other fats and requires bile
salts.
In biliary tract obstruction and steatorrhea, vitamin A
absorption is reduced.
It is carried by chylomicrons and transported to liver.
In the liver cells, vitamin is stored as retinol palmitate
3. Transport from Liver to Tissues
The vitamin A from liver is transported to peripheral tissues as trans-
retinol by the retinol binding protein or RBP
4. Uptake by Tissues
Inside the cytoplasm of cells,
vitamin binds to cellular
retinoic acid binding protein
(CRBP) and finally to
hormone responsive elements
(HRE) of DNA. Thus
genes are activated
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5. Biochemical Role of Vitamin A
A. Wald's Visual Cycle
Rhodopsin is a membrane protein found in the photoreceptor cells of the
retina.
Rhodopsin is made-up of the protein opsin and 11-cisretinal.
When light falls on the retina, the 11-cis-retinal isomerises to all-transretinal
Generation of Nerve Impulse: In visual pigments, the 11-cis retinal locks
opsin in its inactive form.
The isomerisation and photo-excitation leads to generation of the nerve
impulse.
This is a G-protein coupled reaction.
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A single photon can excite the rod cell. The photon produces immediate
conformational change in rhodopsin and all-transretinal is produced.
The all-transretinal is then released from the opsin protein
opsin remains in retina; but transretinal enters the blood circulation
all-transretinal is isomerised to 11-cis-retinal in the retina itself in the dark
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Alternatively, all-transretinal is transported to liver and then reduced to all-transretinol by alcohol dehydrogenase(ADH).
The all-trans-retinol is isomerized to 11-cis-retinol
then oxidized to 11-cisretinaL in liver
This is then transported to retina
This completes the Wald's visual cycle
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Dark Adaptation Mechanism
Bright light depletes stores of rhodopsin in rods.
Therefore when a person shifts suddenly from bright light to a dimly lit area,
there is difficulty in seeing,
for example, entering a cinema theater.
After a few minutes, rhodopsin is resynthesized and vision is improved. This
period is called dark adaptation time
It is increased in vitamin A deficiency
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Rods are for Vision in Dim Light
In the retina, there are two types of photosensitive cells, the rods and the
cones.
Rods are responsible for perception in dim light. RHODOPSIN is made up
of 11-cisretinal + opsin.
Deficiency of cis-retinal will lead to increase in dark adaptation time and
night blindness.
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8. Cones are for Color Vision
i. Cones are responsible for vision in bright light as well as color vision.
They contain the photosensitive protein, conopsin (photopsin).
ii. In cone proteins also, 11-cis-retinal is the chromophore.
Reduction in number of cones or the cone proteins, will lead to color
blindness
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9. Biochemical Functions of Vitamin A
i. Retinal is the active form required for normal vision.
ii. Retinoic acid is important for growth and differentiation of tissues.
iii. Retinol is necessary for normal reproduction.
In vitamin deficiency, miscarriages are noticed in female rats while atrophy
of germinal epithelium and sterility are seen in male rats.
iv. Antioxidant property: Fresh vegetables containing carotenoids were
shown to reduce the incidence of cancer.
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10. Deficiency Manifestations of Vitamin A
a. Night Blindness or Nyctalopia: Visual acuity is diminished in dim light.
The patient cannot read in poor light. The dark adaptation time is increased
b. Xerophthalmia: The conjunctiva becomes dry, thick and wrinkled. The
conjunctiva gets keratinized and loses its normal transparency.
Cornea is also keratinized. Infections may supersede
c. Bitot's Spots: These are seen as greyish-white triangular plaques firmly
adherent to the conjunctiva. This is due to increased thickness of
conjunctiva in certain areas.
All the ocular changes mentioned so far are completely reversible when
vitamin is supplemented
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NORMAL VISION NIGHT BLINDNESS
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d. Keratomalacia: When the xerophthalmia persists for a long time, it
progresses to keratomalacia (softening of the cornea).
Later, corneal opacities develop. Bacterial infection
leads to corneal ulceration, and total blindness.
e. Preventable Blindness: The deficiency of vitamin A is the most common
cause of blindness in Indian children below the age of 5.
One third of the world's blind population are residing in India.
About 40% of blindness is preventable
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f. Skin and Mucous Membrane Lesions:
i. Hyperkeratosis of the epithelium occurs.
Epithelium is atrophied.
ii. The alterations in skin may cause increased occurrence of generalized
infections.
Therefore in old literature, vitamin A is referred to as anti-inflammatory
vitamin.
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11. Causes for Vitamin A Deficiency
i. Decreased intake.
ii. Obstructive jaundice causing defective absorption.
iii. Chronic nephrosis, where RBP is excreted through urine.
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ASSESSMENT OF DEFICIENCY
Dark adaptation test-
It is the time required to adapt the eye to see
objects in dim light. It is increased in vitamin
A deficiency
RBP (Retinol Binding Protein) level in serum-
decreased (normal:40-60 mg/ml)
Vitamin A in serum-decreased
[normal blood level:25-50µg/dl]
12. Dietary Sources of Vitamin A
Animal sources include milk, butter, cream, cheese, egg yolk and liver. Fish
liver oils (cod liver oil and shark liver oil) are very rich sources of the
vitamin.
Vegetable sources contain the yellow pigment beta carotene.
Carrot contains significant quantity of beta carotene.
Papaya, mango, pumpkins, green leafy vegetables (spinach, amaranth) are
other good sources for vitamin A activity
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13. Daily Requirements of Vitamin A
The recommended daily allowance (RDA) for
i. Children = 400-600 microgram/day
ii. Men = 750-1000 microgram/day
iii. Women = 750 microgram/day
iv. Pregnancy = 1000 microgram/day
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14. Hypervitaminosis A or Toxicity
Excessive intake can lead to toxicity since the vitamin is stored.
Symptoms of toxicity include anorexia, irritability, headache, peeling of skin,
drowsiness and vomiting. Enlargement of liver is also seen in children
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National immunisation schedule
1 lakh IU at 9 months along with
MMR
2 lakh IU every 6 months upto 5
years
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