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Vitamin Deficiency Disorders

Abdelaziz Elamin
MD, PhD, FRCPCH
Professor of Child Health
College of Medicine
Sultan Qaboos University
Muscat, Oman
azizmin@hotmail.com
BACKGROUND
Vitamins are organic substances that
are essential for several enzymatic
functions in human metabolism
Thiamine was discovered in 1912 & was
thought to be a vital amine compound &
thus the term vitamin was invented
VITAMINS
Vitamins are classified according
to solubility into fat soluble & water
soluble.
13 vitamins are known, 4 fat
soluble (KEDA) & 9 water soluble
(C, Folate & the B group).
VITAMIN A
Vitamin A is a generic term for many
related compounds.
Retinol (alcohol), Retinal (aldehyde)
are often called preformed vitamin A.
Retinal can be converted by the body to
retinoic acid which is known to affect
gene transcription.
Body can convert b-carotene to retinol,
thus called provitamin A.
FUNCTIONS
Vision: integrity of eye & formation of
rodopsin necessary for dark adaptation.
Regulation of gene expression: vital to
cell differentiation & physiologic processes
Growth & development
Immunity: important for activation of T
lymphocyte, maturation of WBC & integrity
of physiological barrier.
Nutrient Interactions
Zinc deficiency interfere with vitamin A
metabolism in several ways:
It decreases the synthesis of retinol binding
protein, which transports retinol to tissues.
It decreases the activity of the enzyme
retinyl palmitate, which is necessary for
release of retinol from the liver.
Zn is needed for the enzyme that convert
retinol into retinal.
Nutrient Interactions/2

Iron & vitamin A.

Vitamin A deficiency may exacerbate IDF
Vitamin A supplementation improves
iron status among children & pregnant
women.
Combining vitamin A with iron controls
IDA more quickly & effectively than using
iron alone.
VITAMIN A UNITS

1 mg of retinol = 6 mg of b-carotene.
3 mg of retinol = 10 international units
of vitamin A.
100 mg carrots contain 10 mg of b-
carotene.

Life stage
mg/day
Infants 400-500
Children 300-600
Adolescent 900M- 700F
Adult 900M- 700F
Pregnant women 750-800
Lactating women 122-1300
Recommended Allowance
Animal Foods Plant Foods
Cod liver oil Sweet potato
Liver & kidney Carrots
Egg Cantaloupe
Butter Spinach
Milk & cheese Apricot
Fish & meet Papaya
RICH DIETARY SOURCES
Vitamin A deficiency
Deficiency of vitamin A leads to:
Night blindness & xerophthalmia
Growth retardation
Acquired immune deficiency
Keritinization of epithelia in RT, GIT &
UT with increased risk of RTI,
malabsorption & UTI.

THERAPEUTIC USES
Vitamin A deficiency
Boosting immunity of infants
Skin disorders
Acute promyelotic leukemia
Cancer prevention (lung & breast)

TOXICITY
Vitamin A in excess leads to:
Dermatitis with xanthosis cutis
Hepatosplenomegaly
Bone pain & increased risk of fracture
Pseudotumor Cerebri


VITAMIN D
Vitamin D comprises a group of sterols; the
most important of which are cholecalciferol
(vitamin D3) & ergosterol (vitamin D2).

Humans & animal utilize only vitamin D3 &
they can produce it inside their bodies from
cholesterol.

Cholesterol is converted to 7-dehydro-
cholesterol (7DC), which is a precursor of
vitamin D3.
VITAMIN D

Exposure to the ultraviolet rays in the
sunlight convert 7DC to cholecalciferol.

Vitamin D3 is metabolically inactive until it is
hydroxylated in the kidney & the liver to the
active form 1,25 Dihydroxycholecalciferol.

1,25 DHC acts as a hormone rather than a
vitamin endocrine & paracrine properties.
FUNCTIONS
Calcium metabolism: vitamin D enhances
ca absorption in the gut & renal tubules.
Cell differentiation: particularly of
collagen & skin epithelium
Immunity: important for Cell Mediated
Immunity & coordination of the immune
response.
Vitamin D deficiency
Deficiency of vitamin D leads to:
Rickets in small children.
Osteomalacia
Osteoporosis

GROUPS AT RISK
Infants
Elderly
Dark skinned
Covered women
Kidney failure patients
Patients with chronic liver disease
Fat malabsorption disorders
Genetic types of rickets
Patients on anticonvulsant drugs
Sources of Vitamin D
Sunlight is the most important source
Fish liver oil
Fish & sea food (herring & salmon)
Eggs
Plants do not contain vitamin D3

THERAPEUTIC USES
Rickets & Osteomalacia
Osteoporosis
Psoriasis
Cancer prevention (prostate & colorectal)
Autoimmune diseases

TOXICITY
Hypervitaminosis D
causes hypercalcemia, which manifest as:
Nausea & vomiting
Excessive thirst & polyuria
Severe itching
Joint & muscle pains
Disorientation & coma.

RICKETS