Vitamin A, D, E and K
Dr Swetha
Overview
• What is the vitamin
• Functions
• Requirement
• Sources
• Deficiency
• Prevention
Characteristics
• Fat soluble vitamins
• Require bile for digestions and absorption
• Travel through the lymphatic system
• Excess is stored in the liver and adipose tissue
• Risk of toxicity
Vitamin A
• Vitamin A – retinol (biologically active),
carotenoids (provitamin)
• Fat soluble
• Stable to heat at ordinary cooking temperatures
• Liable to oxidation and destruction on rancidity
of fat.
• Carotenoids cannot wholly be converted into
retinol in the body and man absorbs and utilizes
these pigments less efficiently.
Functions
• Vision
• Cellular differentiation, transcription,
morphogenesis-Gene transcription
• Immunity: important for activation of T
lymphocyte, maturation of WBC & integrity of
physiological barrier.
• Haemopoiesis -Iron metabolism
• Growth -Skeletal
• Fertility- Male and female
Vitamin A (retinol) and β-Carotene
Roles in the Body
• Reproduction and growth
– Sperm development
– Normal fetal development
– Growth of children
• Weight and Height
• Bone remodeling
• Antioxidant, cancer protection
– Beta-carotene, not Vitamin A
Vitamin A Deficiency
– Def. symptoms can take 1-2 yrs to appear for adult, much
sooner for growing child
– Vitamin A status depends on
• Adequacy of stores, 90% in liver
• Protein status for RBP mfg.
• Consequences of deficiency
– Risk of infectious diseases
– Blindness
– Death
Vitamin A Deficiency
• Infectious diseases
– Measles, pneumonia, diarrhea
– Malaria, lung diseases/infections, HIV- AIDS
• Night blindness
– Inadequate supply of retinal to retina
• Blindness (xerophthalmia)
– Lack of vitamin A at the cornea
– Develops in stages
Vitamin A Deficiency
– Keratin- hard, insoluble hair & nail protein
• Keratinization
– Change in shape & size of epithelial cells due to
accumulation of keratin
• Skin becomes dry, rough, and scaly
• Fewer and less active goblet cells, so normal digestion and
absorption of nutrients from GI tract falters
• Weakened defenses in epithelial cells of respiratory tract,
vagina, inner ear, and urinary tract
Vitamin A (retinol) and β-Carotene
Roles in the Body
• Reproduction and growth
– Sperm development
– Normal fetal development
– Growth of children
• Weight and Height
• Bone remodeling
• Antioxidant, cancer protection
– Beta-carotene, not Vitamin A
Vitamin A Deficiency
– Def. symptoms can take 1-2 yrs to appear for adult, much
sooner for growing child
– Vitamin A status depends on
• Adequacy of stores, 90% in liver
• Protein status for RBP mfg.
• Consequences of deficiency
– Risk of infectious diseases
– Blindness
– Death
Vitamin A Deficiency
• Infectious diseases
– Measles, pneumonia, diarrhea
– Malaria, lung diseases/infections, HIV- AIDS
• Night blindness
– Inadequate supply of retinal to retina
• Blindness (xerophthalmia)
– Lack of vitamin A at the cornea
– Develops in stages
Xerophthalmia
X1A- Conjunctival Xerosis
X1B- Bitot’s spots
X2-Corneal Xerosis
X3-Keratomalasia
XS-Corneal scar
Vitamin A Deficiency
– Keratin- hard, insoluble hair & nail protein
• Keratinization
– Change in shape & size of epithelial cells due to
accumulation of keratin
• Skin becomes dry, rough, and scaly
• Fewer and less active goblet cells, so normal digestion and
absorption of nutrients from GI tract falters
• Weakened defenses in epithelial cells of respiratory tract,
vagina, inner ear, and urinary tract
Hyperkeratosis of skin
Causes of Vitamin A deficiency
• Inadequate dietary intake
• Inadequate intestinal absorption – infections
• Increased excretion – cancers, UTI
• Improper methods of cooking
Vitamin A Toxicity
• Develops when binding proteins are swamped
– Free vitamin A damages cells
• Toxicity is a real possibility
– Preformed vitamin A from animal sources
– Fortified foods
– Supplements
• Children are most vulnerable
β-Carotene Overload
• β-carotene
– Found in many excellent fruits and vegetables
– Excess cannot evolve to Vitamin A toxicity
– Overconsumption from food harmless
• β-carotene storage in fat under skin
– Overconsumption from supplements risky
• Antioxidant becomes prooxidant, promotes cell division,
destroys Vitamin A
• Most adverse effects for those with heavy EtOH and tobacco
use
Vitamin A Toxicity (Hypervitaminosis A)
• Bone defects
– May weaken bones
• Osteoporosis
• Overstimulation of osteoclasts
– Interferes with vitamin D and serum calcium
• Birth defects
– Cell death in the spinal cord with >10,000 IU/d
before 7th week
• Vitamin A relatives prescribed for Acne
– Accutane, topical Retin-A
Acute Side Effects
• Ulcerative colitis
• Crohn’s Disease,
• Inflammatory Bowel Disease
• Severe depression, suicidal thoughts
• Birth defects
• Liver damage, with nausea, loss of appetite, weight
loss, and jaundice
• Allergic reaction to isotretinoin, resulting in liver
disease and other health complications
Vitamin A and Beta-Carotene
• Recommendations
– Expressed as retinol activity equivalents (RAE)
– 1 RAE =
• 1 µg. retinol
• 12 µg. β-carotene
• 3.33 international units (IU’s)
– Supplements often measured in International
Units (IU)
Vitamin A and β-Carotene
• Food sources
– Animal sources for Vitamin A
• Liver (1 oz = 3x RDA), dairy fat, eggs
– Plant sources for β-Carotene
• Vitamin A precursors
• Bioavailability with fat in the same meal
• Dark green and bright orange fruits and vegetables
β-rich Fruits & Vegetables
• FRUITS
– Apricots, Cantaloupe, Peaches, Persimmon, Mango,
Papaya, Purple(on the inside) plums, Watermelon
• VEGETABLES
• Beet greens, Bok Choi, Broccoli, Carrots Collards,
Dandelion Greens, Kale, Mustard Greens, Pumpkin,
Spinach, Sweet Potatoes, Yams, Winter Squash
• Bold italics mean also C-rich
Vitamin A / β-carotene in Foods
Vitamin A and β-Carotene
• Food sources
– Animal sources for Vitamin A
• Liver (1 oz = 3x RDA), dairy fat, eggs
– Plant sources for β-Carotene
• Vitamin A precursors
• Bioavailability with fat in the same meal
• Dark green and bright orange fruits and vegetables
Sources of Vitamin A
Effect of cooking and processing
• Steaming/pressure cooking is better (with lid)
• Cooking greens with tomato – lycopene
• Oil while cooking
• Drying the leaves in shade
Control and Prevention
◻ Treatment
◻ Prophylaxis
◻ Control of infections
◻ Food fortification
◻ New plants
◻ Disaster relief
◻ Dietary interventions
Dietary Modification
◻ Nutrition education or communication, often using a social
marketing approach, to improve practices related to the
consumption of available vitamin A-rich food sources.
◻ Horticultural interventions (or home food provisioning), e.g. home
gardening, that aim to increase availability of vitamin A-rich foods.
◻ 3) Economic/food policies affecting availability, price and effective
demand of vitamin A-rich foods
◻ 4) Technological advances concerning food preservation, plant
breeding etc.
Vitamin A supplementation
Prophylaxis:
5 oral doses of Vit-A
◻ 1st -9 moths -1 lakh IU
◻ 2nd- 15 monhs age-2 lakh IU
◻ Subsequent doses every 6 months- 2 Lakh IU
Treatment:
• Single dose – at diagnosis- 2 lakh IU
• Follow-up another dose 4 weeks later
Intervention
• Colostrum
• Breastfeeding
• Pregnant and lactation diet
• Complementary feeding
• Kitchen gardens
Additional info.
• Vitamin supplementation
- 2 ml, the mark on the spoon
- Kept away from sunlight, store in cold dark
room
- Once bottle opened- to be used within 6 – 8
weeks
