Nutrition Part

~ Fat-Soluble Vitamin
Deficiency

UMFA2053
General Pathology
(JAN)
Lan Yen Min
 Learning Outcome

• List 2 important food sources and list major

functions for each vitamin
• Describe the deficiency symptoms for each
fat-soluble vitamin
• Describe the toxicity symptoms caused by
excess consumption of certain fat-soluble
vitamin
Structure

Dietary Source

Digestion & Absorption

Function

Deficiency & toxicity

 Vitamins

Vitamins are must be organic and be an

essential player in at least one necessary
chemical reaction or process in the human
body. Also, a vitamin cannot be made in the
human body, either at all, or in sufficient
quantities to meet individual needs.
Vitamins are noncaloric substance and
required in relatively small amounts.
 Vitamins

The vitamins are broadly classified based

upon their water solubility. In general, there
are water-soluble and fat-soluble vitamins.
 Fat-soluble Vitamins
The fat-soluble vitamins are very
dependent upon the process of normal lipid
digestion and absorption, such as the
presence of bile and the incorporation into
chylomicrons in the intestinal mucosa.
Any situation whereby there is decreased
bile production and delivery to the small
intestine would greatly decreased fat-soluble
vitamin digestion and absorption.
 General Characteristics of Fat-soluble Vitamins
Food source • Typically found in fatty portion of food.

Digestion • Very little needed.

Absorption • Occurs mostly in small intestine.

• Requires incorporate into micelles and action of bile.
• Once transported into the intestinal cell, vitamins are
packaged with other lipids into chylomicrons.
Circulation away • Initially circulated in lymph, then in the blood.
from GI tract
Function • Various functions

Toxicity • Except vitamin K, toxicities are dangerous.

Vitamin A
 Structure of vitamin A (Retinoid)

• Retinoids is a collective term for the

biological active forms of vitamin A.
Vita A has three primary forms.
retinol (alcohol), retinal (aldehyde),
retinoic acid (acid form)
 Retinal

Vitamin A family
 beta-carotene (Provitamin A)
• Carotenoids are yellow-orange pigmented
materials in fruits and vegetables- they
can be converted into vitamin A.
Only a few carotenoids have vitamin A
activity; the beta-carotene with the greatest
vitamin A activity which can be converted
into retinol within human cells.
 beta-carotene

Cleavage at this point

can yield two Vitamin A

Retinol
 Dietary Sources of Vit A

• The richest sources of retinoid derived from

animals such as liver, fish oils, milk, milk
products, and egg.
• The richest sources of beta-carotene are
dark green, leafy vegetables.
Yellow and green leafy vegetables provide beta-carotene
Digestion & Absorption of Vitamin A

• Vitamin A and carotenoids are absorbed in

the small intestine, and this required the
presence of dietary lipid and bile.
• Upon entering the enterocytes, Vitamin A
and carotenoids are incorporated into
chylomicrons, which then enter the lymph
and subsequently the blood.
• Once in the blood, some of them can be
taken up by many cell types such as adipose,
muscle, and eye tissue. The rest can be
delivered to liver.
• In liver, vitamin A is attached to the
transport protein (retinol-binding
protein/RBP) which direct them to
functional sites in the cell.
 Function of Vitamin A
• Vitamin A and vision
Vitamin A is needed in the retina if the eye
turn visual light into nerve signal to the
brain. Thus, vitamin A plays a critical role
in allowing you to process light into sight.
Vitamin A is important for maintaining the
health of the outermost tissue layer of the
eye, called the cornea.
Vitamin A and vision
Both cones and rods require vitamin A
to function effectively
Vitamin A allows the eyes to adapt to
low-light situations. If vitamin A pool
become depleted, the process of dark
adaption is impaired, night vision becomes
especially difficult-resulting in a condition
called night blindness.
Adequate vitamin A is also needed to
prevent prolonged “bleaching”, which is a
phenomenon that sometimes occurs after
exposure to intense light. This is why the
people with vita A deficiency have an
especially difficult time driving in the dark.
When exposed to the bright flash of light
from an oncoming vehicle, the person
becomes temporarily “blinded”
• Vitamin A and cell differentiation
Vitamin A is involved in cell signaling,
stimulating synthesis of protein needed for
differentiation and maturation of epithelial
cells. Moreover, Vitamin A maintain
normal differentiation of the cells that make
up the structure component of the eye, such
as the retina.
• Vitamin A and growth, and reproduction
Vita A play an important role in
embryonic development. During
embryonic growth, vita A directs the
differentiation and maturation of various
cell types that give rise to specific tissues
and organs.
• Vitamin A and Immune system
Vitamin A has a variety of immunological
functions, including the maintenance of
protective barriers such as the skin and
lining of the intestinal and respiratory tract,
most of epithelial tissue. The body also
requires vita A to produce lymphocyte,
as well as antibody.
Manifestations of Vit A deficiency

• Vitamin A deficiency disorder (VADD)

VADD has important implication for
worldwide health, especially among
children.
In milder form, VADD causes night
blindness.
More severe VADD damages the cornea,
leading to dry eyes, scarring, and even
blindness, is called xerophthalmia, is often
accompanied by the presence of Bitot’s spot.
Vitamin A deficiency also cause
hyperkeratosis, in which skin and nails
become rough and scaly. Hyperkeratosis
occurs in response to the inability of
epithelial cells constituting the skin and
nails to mature.
 Manifestations of vit A toxicity

• Chronic consumption of large vita A can

lead to vita A toxicity, called
hypervitaminosis A.
Hypervitaminosis A cause serious
complication including blurred vision,
liver abnormalities, and reduced bone
strength.
Vitamin D
Structure of vitamin D (Calciferol)

• Vitamin D comes in two major forms:

vitamin D2 (ergocalciferol, from plant foods)
vitamin D3 (cholecalciferol, from animal
foods and synthesis in skin from sun).
Form of vit D from Biological active form
foods intake of Vit D within body
 Dietary Sources of Vit D

• Only a few foods contain vitamin D

naturally. However, butter, cream, egg york,
and fatty fish (sardines, salmon) are good
sources of Vitamin D
• The best food sources are fish liver oil
How does body made vitamin D?
Vitamin D absorption and activation

• In the small intestine, dietary vita D is

packaged into micelles with the help of bile.
It is then taken up into the enterocyte, where
it is incorporated into chylomicrons, then
enter the lymph and subsequently the blood.
Chylomicrons deliver vita D to cells, and
what is not taken up is delivered to the liver
in chylomicron remnants.
• Before vita D can be utilized by cells, it
must be activated. This two-step activation
process:
1st add OH group- in liver
2nd add OH group- in kidney
1,25(OH)2 vitamin D (calcitriol,
active vitamin D)
regulate by parathyroid gland (PTH)
Metabolism of Vitamin D
PTH/Ca
 Function of Vitamin D

• Vitamin D and Calcium homeostasis

Calcium homeostasis involves the intestine,
kidney, and bones. Vitamin D help maintain
healthy level of calcium in the blood, ensuring
that Ca is always available to the body’s
tissues.
 Vitamin D and Ca homeostasis

Vita D and PTH together

increased Ca release
from bones

Eventually, increased blood

Ca concentration

Vita D increased Ca
absorption in the Vita D and PTH
small intestine decreased Ca excretion
by the kidneys
Manifestations of Vit D deficiency

• Vitamin D deficiency can cause rickets

in children
In rickets, the bone fail to calcify normally,
causing growth retardation and skeletal
abnormalities. The bones become so weak
that they bend when they have to support
the body’s weight.
• Vitamin D deficiency can cause
Osteomalacia and osteoporosis in adult.
Vita D deficiency results in both poor
mineralization and increased bone
demineralization.
• Inadequate bone mineralization resulting
from vita D deficiency causes bones to
become soft and weak, called
Osteomalacia.
People with Osteomalacia are at increased
risk for bone fractures.
Manifestations of Vit D deficiency
• Vita D deficiency also result in
demineralization of previously healthy
bone, leading to osteoporosis.
Manifestations of Vit D toxicity

• Vita D toxicity from food source is

uncommon.
• Vita D supplementation with high doses
can cause hypercalcemia and
hypercalciuria. Hypercalcemia can affect
the function of CNS. Hypercalciuria can
cause kidney stone formation.
Vitamin E
Structure of vitamin E(Tocopherol)

• Vitamin E activity in foods is contributed by

the tocopherol-alpha, beta, gamma and delta.
Alpha-tocopherol is recognized having
vitaminE activity in human body.
Is bioactive form in the body
 Dietary Sources of Vitamin E

• Vitamin E is abundant in oils, nuts, and

seeds
• Wheat germ oil is especially rich in
vitamin E.
 Metabolism of Vitamin E

• The degree of vitamin E absorption depends

on the amount consumed and the absorption
of dietary fat.
Once taken up by intestinal cells, vitamin E
is incorporated into chylomicrons for
transport in the lymph and eventually the
blood.
 Function of Vitamin E

• Vitamin E is a potent antioxidant

Vitamin E acts as an antioxidant that
protects biological membrane from the
destructive effects of free radical. It also
protect the DNA from oxidative harm.
Manifestations of Vit E deficiency

• Vitamin E deficiency causes

hemolytic anemia
Hemolytic anemia occurs when vita E is not
able to protect red blood cell membrane
from oxidative damage. The diminished
capacity to transport oxygen in the blood
causes weakness and fatigue, especially
seen in premature infants.
 Manifestations of Vit E toxicity

• Toxicity is rare.
Vitamin K
 Structure of Vitamin K (Quinone)
bioactive form
From green plant

From intestinal bacteria

Produced commerically
 Dietary Sources of Vitamin K

• Vitamin K can be obtain both from foods

and a nonfood sources. Bacteria in the GI
tract synthesize vitamin K that the body can
absorb.
• Notable food sources of vitamin K include
dark green vegetable, fish and legumes.
 Function of Vitamin K
• Vita K involved in blood clotting cascade

Vitamin K acts as a coenzyme in enzymatic reaction

involved in the formation of blood clots
Manifestations of Vit K deficiency

• A primary vitamin K deficiency is rare.

• A secondary deficiency may occur in two
circumstances. First, whenever fat
absorption impaired, vitamin K absorption
diminishes. Second, some drugs like
antibiotic can kill the vitamin K-producing
bacteria in the intestine. Some severe Vita K
deficiency causes severe bleeding.
Manifestations of vit K toxicity

• None reported
The End