NUTRITION-V Dr M.Rashid Anjum Community Medicine Department Army Medical College.

NUTRITION-V NUTRITION-V

Dr M.Rashid AnjumDr M.Rashid AnjumCommunity Medicine DepartmentCommunity Medicine Department

Army Medical College Army Medical College

VITAMINSVITAMINS(Micronutrients)(Micronutrients)

QUESTIONS?QUESTIONS?

1.What are vitamins?1.What are vitamins?

2.Why these are essential for body?2.Why these are essential for body?

3.What happens if there is deficiency3.What happens if there is deficiency of vitamins?of vitamins?

VITAMINSVITAMINS

Organic Compounds (C-containing)Organic Compounds (C-containing)

Essential forEssential for GrowthGrowth Body functionsBody functions MaintenanceMaintenance

VITAMINS:TWO-GROUPSVITAMINS:TWO-GROUPS

FAT SOLUBLE WATER SOLUBLEFAT SOLUBLE WATER SOLUBLE Vit-A 8 B-VITAMINS & VIT-CVit-A 8 B-VITAMINS & VIT-C Vit-D Vit-D B-1 ThiaminB-1 Thiamin Vit-K Vit-K B-2 Riboflavin B-2 Riboflavin Vit-EVit-E B-3 Niacin B-3 Niacin B-6 PyridoxineB-6 Pyridoxine B-12 CyanocobalaminB-12 Cyanocobalamin Pantothenic acidPantothenic acid BiotinBiotin FolateFolate

PROVITAMINSPROVITAMINS

““An inactive form of a vitamin that the body An inactive form of a vitamin that the body can convert into an active use-able form.can convert into an active use-able form.

Example: CarotenoidExample: Carotenoid Precursor of Vit A in foods of plant origin. Precursor of Vit A in foods of plant origin.

Present in many fruits and vegetables.Present in many fruits and vegetables.

Major Role of Vitamins:Major Role of Vitamins:

AntioxidantsAntioxidants CoenzymesCoenzymes Vit E 8 B-VitaminsVit E 8 B-Vitamins Vit C Vit C VisionVision Carotenoids Vit ACarotenoids Vit A Bone Health Blood ClottingBone Health Blood Clotting Vit D Vit KVit D Vit K Vit KVit K

VITAMIN-A (The Retinoids)VITAMIN-A (The Retinoids)

Three active (03) Forms:Three active (03) Forms:

Retinol The alcohol form (Retinol The alcohol form (KEY PLAYERKEY PLAYER) ) ((reproduction& bone healthreproduction& bone health)) Retinal The aldehyde formRetinal The aldehyde form ((night & color visionnight & color vision)) Retinoic acid The acid formRetinoic acid The acid form ((cell growth & differentiationcell growth & differentiation) )

Vitamin A interconversionsVitamin A interconversions

Retinol Retinal Retinoic acid

STORAGE &TRANSPORTSTORAGE &TRANSPORT

Liver 90 %Liver 90 %Adipose tissuesAdipose tissuesLungs & kidneys 10%Lungs & kidneys 10% (stored as retinyl esters)(stored as retinyl esters)

Transported by retinol binding protein (RBP) Transported by retinol binding protein (RBP)

Serum range of RBP = 40-50 mcg/dL.Serum range of RBP = 40-50 mcg/dL.

SOURCES OF VITAMIN-ASOURCES OF VITAMIN-A

Animal food 50%Animal food 50% (as preformed Vit-A)(as preformed Vit-A)

Cod liver oil, Milk fat, Meat, EggsCod liver oil, Milk fat, Meat, Eggs,Fortified foods like Margarine.,Fortified foods like Margarine. Fruits and Vegetables 50%Fruits and Vegetables 50% (as provitamin-A , carotenoids)(as provitamin-A , carotenoids)

Carrots,Spinach,Broccoli,Potatoes,Carrots,Spinach,Broccoli,Potatoes, Apricot,Mangoo.Papaya,PumpkinApricot,Mangoo.Papaya,Pumpkin

MEASURING UNITMEASURING UNIT

RAE RAE (Retinol Activity Equivalent) (Retinol Activity Equivalent)

1 RAE = 1 microgram Retinol1 RAE = 1 microgram Retinol

= 12 microgram beta carotene= 12 microgram beta carotene

= 24 microgram carotenoids= 24 microgram carotenoids

RECOMMENDED DAILY ALLOWANCERECOMMENDED DAILY ALLOWANCE

MALE 900 microgram RAEMALE 900 microgram RAE

FEMALE 700 microgram RAEFEMALE 700 microgram RAE

PREGNANT WOMEN 770 microgram RAEPREGNANT WOMEN 770 microgram RAE

LACTATING WOMEN 1300 microgram RAELACTATING WOMEN 1300 microgram RAE

INFANTS 400 microgram RAEINFANTS 400 microgram RAE

FUNCTIONS OF VIT-AFUNCTIONS OF VIT-A

Vit-A and Vision ( Retinal)Vit-A and Vision ( Retinal)

Vit-A and cell differentiation (Retinoic acid)Vit-A and cell differentiation (Retinoic acid)

Vit-A and immune functions (Retinoic acid)Vit-A and immune functions (Retinoic acid)

Vit-A and reproduction (Retinol+Retinal)Vit-A and reproduction (Retinol+Retinal)

Vit-A and bone health (Retinol+Retinal+Retinoic)Vit-A and bone health (Retinol+Retinal+Retinoic)

BABY TELLING SOMETHING ?BABY TELLING SOMETHING ?

VITMIN-A DEFICIENCYVITMIN-A DEFICIENCY

EYE:EYE: The signs of vitamin A deficiency are The signs of vitamin A deficiency are predominantly ocularpredominantly ocular• NightblindnessNightblindness• Conjunctival xerosisConjunctival xerosis• Bitot’s spotsBitot’s spots• Corneal xerosisCorneal xerosis• Keratomalacia Keratomalacia

XEROPHTHALMIA: (dry eyes) includes all ocular XEROPHTHALMIA: (dry eyes) includes all ocular manifestations ranging from night blindness to manifestations ranging from night blindness to keratomalacia. keratomalacia.

NIGHTBLINDNESS NIGHTBLINDNESS Lack of vitamin A first causes night blindness or Lack of vitamin A first causes night blindness or

inability to see in dim light. inability to see in dim light.

CONJUNCTIVAL XEROSISCONJUNCTIVAL XEROSIS This is the first clinical sign of vitamin A deficiency. This is the first clinical sign of vitamin A deficiency.

The conjunctiva becomes dry and non-wettable. The conjunctiva becomes dry and non-wettable.

VITMIN-A DEFICIENCY

CONJUNCTIVAL XEROSISCONJUNCTIVAL XEROSIS

VITAMIN- A DEFICIENCYVITAMIN- A DEFICIENCY

BITOT’S SPOTSBITOT’S SPOTS

• Bitot’s spots are triangular, pearly-white or Bitot’s spots are triangular, pearly-white or yellowish, foamy spots on the bulbar conjunctiva yellowish, foamy spots on the bulbar conjunctiva on either side of the cornea. They are frequently on either side of the cornea. They are frequently bilateral. Bitot’s spots in young children usually bilateral. Bitot’s spots in young children usually indicate vitamin A deficiency. In older individuals, indicate vitamin A deficiency. In older individuals, these spots are often inactive sequelae of earlier these spots are often inactive sequelae of earlier disease. disease.

BITOT’S SPOTSBITOT’S SPOTS

VITAMIN-A DEFICIENCYVITAMIN-A DEFICIENCY

CORNEAL XEROSISCORNEAL XEROSIS

• The cornea appears dull, dry and non-wettable The cornea appears dull, dry and non-wettable and eventually opaque. It does not have a moist and eventually opaque. It does not have a moist appearance. In more severe deficiency there may appearance. In more severe deficiency there may be corneal ulceration. The ulcer may heal leaving be corneal ulceration. The ulcer may heal leaving a corneal scar which can affect vision. a corneal scar which can affect vision.

CORNEAL XEROSISCORNEAL XEROSIS

VITAMIN-A DEFICIENCYVITAMIN-A DEFICIENCY

KERATOMALACIA KERATOMALACIA

• Keratomalacia or liquefaction of the cornea is a Keratomalacia or liquefaction of the cornea is a grave medical emergency. The cornea (a part or grave medical emergency. The cornea (a part or whole) may become soft and may burst open. The whole) may become soft and may burst open. The process is a rapid one. If the eye collapses, vision process is a rapid one. If the eye collapses, vision is lost. is lost.

KERATOMALACIA KERATOMALACIA

EXTRA-OCULAR MANIFESTATIONSEXTRA-OCULAR MANIFESTATIONS

• SKIN: Follicular Hyperkeratosis.( goose flesh)SKIN: Follicular Hyperkeratosis.( goose flesh)

• GROWTH :retardation, bone deformities.GROWTH :retardation, bone deformities.

• IMMUNE FUNCTION: IMMUNE FUNCTION: Increased morbidity and mortality due to Increased morbidity and mortality due to

respiratory and intestinal infection.respiratory and intestinal infection. decreased sperm production,female infertility.decreased sperm production,female infertility.

TREATMENT TREATMENT

All the early stages of xero-ophthalmia can be All the early stages of xero-ophthalmia can be reversed by administration of a massive oral reversed by administration of a massive oral dose (200,000 IU or 110 mg) of Retinyl dose (200,000 IU or 110 mg) of Retinyl Palmitate on two successive days.Palmitate on two successive days.

Children with corneal ulcers should receive Children with corneal ulcers should receive

vitamin A whether or not a deficiency is vitamin A whether or not a deficiency is suspected.suspected.

EPIDEMIOLOGYEPIDEMIOLOGY

An estimated 250 million preschool children An estimated 250 million preschool children and 19 million pregnant women are vitamin A and 19 million pregnant women are vitamin A deficient globally.deficient globally.

An estimated 250 000 to 500 000 vitamin A An estimated 250 000 to 500 000 vitamin A deficient children become blind every year, deficient children become blind every year, half of them dying within 12 months of losing half of them dying within 12 months of losing their sight. their sight.

PREVENTION PREVENTION

Improvement of diet so as to ensure a regular and Improvement of diet so as to ensure a regular and adequate intake of food rich in vitamin Aadequate intake of food rich in vitamin A

Reducing respiratory tract infections, diarrhoea and Reducing respiratory tract infections, diarrhoea and measles. measles.

Both are long term measures involving intensive Both are long term measures involving intensive nutrition education of the public and community nutrition education of the public and community participation.participation.

Supply of fortified foods . Supply of fortified foods . Vitamin-A capsule 200000 iu 4-----6 monthsVitamin-A capsule 200000 iu 4-----6 months ( children 6months-------6 years)( children 6months-------6 years)

THANKYOUTHANKYOU