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FAT SOLUBLE VITAMINS

I. Vitamin A
Two general sources in human diet:
preformed vitamin A (A1 & A2) &
precursor carotene (provitamin A)
preformed vitamin A: animal
foods such as dairy foods
and fish liver oils
provitamin A: plant foods
that have deep yellow or
green pigment; betacarotene most important =
highest vitamin A activity &
is most plentiful
Retinol (vitamin A alcohol), retinoic
acid (vitamin A acid)
Sprue may induce a vit. A
deficiency
Liver stores reserves
Functions:
Formation of visual purple
for normal maintenance of
retina
Control of differentiation of
epithelium in mucussecreting structures
Promotion of bone
remodeling
Activation of cell membrane
systems
Promotion of health of oral
structures
Vitamin A deficiency
Bitot's spot, xeropthalmia,
keratomalacia, follicular
hyperkeratosis
Hyperkeratosis and
hyperplasia of gingival
tissue; retardation and
eventual stop of growth of
incisor teeth; crowding of
teeth, & stunting &
thickening of tooth roots,
reduction of salivary flow &
increase in caries
1 retinol equivalent (RE) = 1 g of
retinol/6 g of beta-carotene; 1 IU
= 0.3 g of retinol/0.6 g of betacarotene
RDA: 1000 RE or 5000 IU (M); 800
RE or 4000 IU (F)
Preformed vitamin A: liver, kidney,
cream, butter, egg yolk
Provitamin A: carrots, sweet
potatoes, squash, apricots,

spinach, broccoli, cabbage, dark


leafy greens
Tx of mild vitamin A deficiency:
30,000 IU orally daily (do not take
for more than a month)
Hypervitaminosis: if individuals are
given 100,000-150,000 IU (20-30X
the RDA)
anemia, irritability, weight
loss, tenderness over long
bones, enlarged spleen &
liver

II. Vitamin D
Vitamin D2 (Ergocalciferol)
derived from ergosterol,
found in fungi & yeasts
1 mg = 40,000 IU
Vitamin D3 (Cholecalciferol)
produced in the skin
present in small amounts in
egg yolk, liver & fish
(salmon, herring, tuna)
Both equally potent as dietary
supplements
Functions both as a vitamin &
hormone
Principal action: Promote intestinal
calcium and phosphate absorption
Necessary for formation of normal
bone & calcification or repair of
diseased bone
RDA: Daily intake of 400 IU (10 ug)
from birth-22 y/o
Pregnant & lactating
women: around 500 IU/day;
19-22 y/o = 300 IU (7.5 g)
200 IU for adult men &
women
Sunlight major non-food source
amount depends on length
of intensity of exposure &
amount of pigment in skin
Fatty fish, eggs, liver & butter
(naturally occurring but in small
amounts); fish liver oil or fortified
milk
Vitamin D supplements for elderly
who are house-bound and
individuals who are lactose
intolerant
Rickets: Lack of orderly change
from cartilaginous material to
calcified bone during bone
development

Tx: 5000 IU/day, depending


on severity
food source of
calcium given (4
glasses of milk/500
mL); if milk is
refused, give 5 g of
calcium lactate
diet should include
eggs, vitamin Dfortified butter,
margarine
intake of iron &
ascorbic acid
Osteomalacia: Adult counterpart of
rickets
Softening of bones due to
failure of remineralization
Pain in ribs, spine, pelvis,
legs; waddling gait
Tx: 5,000-20,000 IU with 5 g
calcium gluconate/calcium
lactate 3x/day
**Enamel hypoplasia - first
dental change seen with
vitamin D deficiency

III. Vitamin E
Includes tocopherols; alphatocopherol is most biologically
active form
Absorbed best in the presence of
fat; biliary tract diseases,
pancreatic insufficiency, excessive
mineral oil ingestion reduce
amount of vitamin E absorbed
Biological antioxidant to limit freeradical chain rxns, protect body
cells from lipid peroxidation &
ultimate destruction (cellular
membranes are major sites of
damage) = Make cell membranes
more stable & spare cell wall
constituents from damage
Prevents fats from becoming rancid
Vitamin E requirement is
proportional to amount & degree of
unsaturation of polyunsaturated
fatty acids (PUFA) in diet
less PU fats eaten, less
vitamin E required
Vitamin E deficiency rare in
humans; if present, is due to
congenital or malabsorption
diseases

impaired neuromuscular
function
Tx: 30-100 mg daily
People taking coagulants (ex.
Coumadin) should not take high
doses of vitamin E
headaches, fatigue,
weakness, blurred vision,
flatulence, diarrhea
Take caution when there is
consumption above 600 mg
1 IU = 1 mg dl-alpha tocopherol
(equivalent)
Infants: 3-4 ATE
Men & Pregnant women: 10
Women: 8
Lactacting women: 11
Seed oils, soybean, safflower,
cottonseed, corn, peanut oils
plants with dark, green
leaves; meat; milk; fish &
fish liver oils; eggs
IV. Vitamin K
Absorption requires bile &
pancreatic juice
Primary function: catalyze
synthesis of prothrombin by the
liver
also essential for other
clotting factors (VII, IX, X)
absence of these factors
leads to a development of
prothrombin deficiency &
blood clotting is greatly
prolonged
Formation of fibrin clot
precursor (vitamin K)
prothrombin +
thrompoplastin (calcium)
thrombin in liver
thrombin + fibrinogen
fibrin clot
Vitamin K deficiency: when there is
a conditioning factor (ex. biliary
disease, severe liver disease)
intestinal disease
associated with
malabsorption of fat (ex.
celiac disease), pancreatic
disease, hypermotility of
intestine
prolonged antibiotic therapy
& those who have poor diets

most likely deficiency is


inadequate vitamin reserve
of the newborn
Infants: 1-2 mg very shortly after
birth to prevent hemorrhagic
disease of the newborn
Vitamin K therapy also indicated for
pxs suffering from obstructive
jaundice or impaired function of
intestinal mucosa
terminal disease or to
counteract effects of
dicumarol
prolonged therapy for
rheumatoid arthritis
Hypoprothombinemia: 2-5 mg daily
of synthetic, water-soluble tablet
RDA: 70-140 g (adults)
Sources: bacteria in intestine &
green leafy vegetables; lettuce,
spinach, kale, cauliflower, cabbage

EFFECTS OF DIET AND NUTRITION ON


THE HEALTH OF THE ELDERLY
Factors that influence eating habits of the
elderly:
Low income
Loneliness
Poor cooking facilities
Lack of knowledge about food
choices
Dental and medical infirmities
Nutritionally related diseases
Nutritional factors that contribute to
osteoporosis:
Insufficient intake of calcium-rich
foods
Increase urinary excretion of
calcium
Decrease blood level of 1,25dihydroxycholecalciferol (Vitamin
D)
*Vitamin D is essential for regulation
and promotion of the intestinal
absorption of calcium and phosphorus

Non-nutritional factors that increase


bone demineralization:
Inadequate amount of physical
exercise
Immobilization of an extremity
after an accident after a necessary
period for healing
An estrogen deficiency
Gustation(taste perception)
- mediated through the papillae, taste
buds, and free nerve endings that are
found primarily in the tongue, hard and
soft palates, and the pharynx.
- In general the number of these
structures appears to decrease with age.
Olfaction: The act of perceiving odors; the
odors of food contribute to palatability.
The olfactory sense is the special chemical
sense that is activated by stimulation of
the olfactory receptors situated in the
upper part of the activity.
- In the process of aging,
hyperkeratinization of the epithelium that
may occlude the taste bud ducts
diminishes taste perception.
Xerostomia (dry mouth)
Causes:
Emotions ( fear and anxiety)
Neuroses
Organic brain disorder
Drug therapy
Drugs that produce xerostomia:
Anticonvulsants
Antihypertensives
Antidepressants
Tranquilizers

Anti- Parkinson drug


A major function of saliva which
contains calcium phosphates, is to
buffer the acids and to remineralize
the eroded enamel surface.
Lack of saliva will:
1. Hinder chewing of food because it
prevents the formation of bolus.
2. Make the mouth sore and chewing
painful
3. Make swallowing difficult due to
loss of salivas lubricating effect
4. Cause changes in taste perception
that decrease adequate food
intake.

Painful, burning tongue: often


associated with nutritional anemia
associated with deficiencies with
vitamin B12 , folic acid and iron.
Pernicious anemia- vitamin B12
deficiency
Triad:
1. Generalized weakness
2. Sore, painful tongue
3. Numbness or tingling of extremities
Other characteristic feature of pernicious
anemia:
4. Achlorhydria absence of
Hydrochloric acid in stomach
secretion
5. Sensory disturbances
6. Difficulty in walking
7. Incoordination
8. Loss of vibratory sensation
Oral mucous membrane problem
The mucous membranes of the lips,
the buccal and palatal tissues, and

the floor of the mouth change with


age.
Patients chief complaint:
- Burning sensation
- Pain
- Dryness of the mouth
- Cracks in the lips
Temporomandibular joint pain
- Bruxism, attrition, of incisal
and occlusal surfaces can produce
overclosure of the jaws and affect the
relations of the mandibular condyle to the
glenoid fossa.
- With age the glenoid fossa can become
shallower and the head of the condyle
flatter. Thus, it is possible for the meniscus
or articular disc between the condyle and
the fossa, to be perforated or damage by
this change in the TM relationship causing
pain and limitation of range of movement
of jaws.

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