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D R . J O K O W AH Y U W I B O W O , M K E S
B AG I AN : G I Z I – I K M
F K . U N I S S U L A
DIGESTING AND ABSORBING WATER-
SOLUBLE VITAMINS
Figure 10.1
Water-Soluble Fat-Soluble
Vitamins Vitamins
Absorbed in the Small Intestine Small Intestine
Hydrophobic or
Hydrophilic Hydrophobic
Hydrophilic
Absorbed into the Blood Lymph
• Varies based on
• Amount in food
• Preparation
• Efficiency of digestion and absorption of food
• Individual nutritional status
• Natural or synthetic
• Fat-soluble vitamins are generally less bioavailable than water-
soluble vitamins
• Vitamins from animal foods are generally more bioavailable
than those in plant foods
LIPID SOLUBLE VITAMINS
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Vitamin А
Retinol. Antixerophthalmic
Biological functions of
carotenes
•Antioxidants
•Anticancer properties
Biological functions of vitamin A
•Modulator of biomembranes
-changes the permeability
-synthesis of membranes components
•Growth vitamin
-stimulates the synthesis of proteins
(especially in cartilages)
-stimulates the synthesis of purine and
pyrimidine nucleotides
•Participates in oxidation-reduction
reactions
CONTINUED.........
Inner
segment Capillary
Function: Carotenoids
• Antioxidants for singlet oxygen;
Lycopene > vitamin E > carotene >
cryptoxanthin > zeaxanthin, carotene >
lutein
(also work better when used together)
• Antioxidant for lipid peroxides (works with
vitamin E)
• Lower incidence of atherosclerosis through
prevention of oxidation of LDLs
Functions: Vitamin A
•Vision
•Cell differentiation, growth, reproduction
•Bone development
•Immune system
Interaction with other nutrients:
• Vitamins E and K (inversely related; high A, low E and K)
• Zinc and iron
• Protein
Excretion: most in urine as oxoretinoic acid, small amounts in expired air, some in
feces
Toxicity:
• Hypervitaminosis A
• Nausea, vomiting, double vision,
headache, dizziness, and
desquamation of the skin
• Teratogen
VITAMIN D
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VITAMIN D METABOLISM
• Skin
• UV light photo-isomerises provitamin D to D3
(cholecalciferol)
• Transported by Vit D binding proteins to liver
• Intestine
• Absorbed by enterocytes & packaged into chylomicrons
• Transported to liver by portal circulation
• Hydroxylated in liver to 25-ODH
• Further in kidneys to 1,25-OHD
• Physiologically active
Two forms of vitamin D
•Vitamin D2 – ergocalciferol
•Vitamin D3 - cholecalciferol
cholecalciferol
ergocalciferol
Both ergo-
calciferol and
cholecalciferol
are metabo-
lized in liver
1,25-dihydroxycholecalciferol
Vit.D acts in
concert with
parathyroid
hormone
(PTH)
PTH
stimulates
the
production of
1,25-(OH)2D
Functions of
vitamin D
regulates the Ca and
P levels in the blood
•promotes absorption of
Ca and P in the
intestine
•promotes reabsorption
of Ca in the kidneys
•high levels of serum Ca
and P increase the rate
of bone mineralization
•promote bone
resorption (at low Ca in
blood)
Functions of vitamin D
affects immune system
•promotes
phagocytosis
•immunomodu-
latory activity
•induces
differentiation
of immune cells
Functions of vitamin D
CYP27B1: a gene
that encodes an
enzyme to convert
inactive vitamin D to
active vitamin D
Active vitamin D
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K1, phyloquinone (in green vegetables)
K2, menaquinone (is synthesized by
intestinal bacteria)
Biological functions
•Stimulates the synthesis of
coagulation factors in liver
•Increases the resistance of
capillaries
•Stimulates the synthesis of
albumins, pepsin, trypsis, lipase,
amilase
•Increases the peristalsis of
intestine
•Inhibits free radical oxidation
The best dietary sources of
vitamin K are green leafy
vegetables such as spinach,
broccoli, Brussels sprouts,
cabbage and lettuce. Other rich
sources are certain vegetable oils.
Good sources include oats,
potatoes, tomatoes, asparagus
and butter. Lower levels are found
in beef, pork, ham, milk, carrots,
corn, most fruits and many other
vegetables.
dicumarol
Vitamin K deficiencies are rare for two reasons... 1. part of the body’s
needs of this vitamin are produced in the intestinal tract 2. Vitamin K
is “conserved” in the body. That means it is recycled… it can be used
over and over. The process is called the Vitamin K cycle.
Easy bruising
associated with
Vitamin K
deficiency.
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VITAMIN E
Nutrient Interactions:
• Function closely linked to selenium (needed for GSH peroxidase), vitamin C, sulfur
containing amino acids,
• Inhibits carotene absorption and conversion to retinol; may impair vitamin K absorption;
may cause vitamin -D dependent bone mineralization problems
Deficiency:
Rare except in populations with fat malabsorption (cystic fibrosis)
myopathy and weakness, croid pigment accumulation, and degenerative neurologic
problems
Toxicity: one of the least toxic; bleeding problems
•Dermatitis
•Dry skin
•Exema
•Atherosclerosis
Exema Dry skin
Atherosclerosis
B COMPLEX VITAMINS
• Energy metabolism
• Thiamin (B-1), Riboflavin (B-2), Niacin (B-3), Pyridoxine (B-6),
Biotin, Pantothenic Acid
• Red blood cell synthesis
• Folate, B12
• Homocysteine metabolism
• Folate, B12, B6
VIT. B12
• Intestinal malabsorbtion
• Atrophic gastritis
• H. Pylori
• Bacterial overgrowth
• Food-bound vitamin B12 malabsorbtion
• Surgical resection of the stomach or portions of
small intestine
PATHOPHYSIOLOGY- DEF. VIT B12
• Coenzyme
• Activate enzymes needed for metabolism of CHO,
fat , protein
• Synthesize nonessential amino acid via
transamination
• Synthesize neurotransmitters
• Synthesize hemoglobin and WBC
B6 DEFICIENCY
Widespread symptoms
• Depression
• Vomiting
• Skin disorders
• Nerve irritation
• Impaired immune system
B6 TOXICITY
• Nerve damage
• Difficulty walking
• Numbness in hands/feet
RDA FOR VITAMIN B-6
Well absorbed
• Meat, fish, poultry
• Enriched cereals
• Potatoes
• Milk
Less well absorbed
• Fruits and vegetables: Banana, spinach,
avocado
Heat and alkaline sensitive
FOLATE
• Coenzyme
• DNA synthesis
• Homocysteine metabolism
• Neurotransmitter formation
DIGESTION & ABSORPTION
• Megaloblastic Anemia
• decreased DNA synthesisstrands of DNA more
susceptible to damage
• failure of bone marrow cells to divide
• normal protein synthesis
• results in large immature RBC’s
• contrast with microcytic hypochromic anemia
NEURAL TUBE DEFECTS
• Spina bifida
• Spinal malformation
• Paralysis
• Anencephaly
• No brain cortex
• Stillborn or die within hours
• Importance of folate before and during
pregnancy
• Government requires folate enrichment of
flour and cereal
• May prevent 50% neural tube defects
FOOD SOURCES OF FOLATE
• Liver
• Fortified breakfast cereals
• Grains, legumes
• Foliage vegetables
• Susceptible to heat, oxidation, ultraviolet light
• Synthetic form better absorbed
RDA FOR FOLATE
• Main manifestations
• glossitis, symptoms of anemia (weakness, pallor, shortness of
breath), and GI problems (weight loss and infertility)
• Lab work
• an increase in MCV-- larger than 96 fL
• Best test for folate levels is the red blood cell
level
• this is the level in tissues and is not affected by recent intake
• Recommended intake of folate for adults is 400
micrograms per day, and for women of
childbearing age is 600 micrograms per day
ANTICONVULSANT DRUGS AND
FOLATE DEFICIENCY