Learning Outcome 10

What is the difference between fat

soluble and water soluble vitamins?

Fat Soluble (A,D,E,K) stored in fatty

compartments of the body. Most come
from food sources.

Hypervitaminosis results from mega

doses (intentional or not)

Water soluble (C and B complex (8

vitamins)).

Learning Outcome 11

The use of vitamin supplements:

Vitamins and minerals should come from

food sources 1st Vitamin supplements
2nd.

Should evaluate diet 1st.

Can supplement what is missing

Vitamin C and D

Individuals who take vitamins should

limit to 100% of RDA to avoid toxicity

Learning Outcome 12

Functions of vitamins discussed:

Food sources

http://ods.od.nih.gov/factsheets/list-VitaminsMinerals/?print=1

Fat Soluble Vitamins

Vitamin A Retinol up to a years

supply is stored in the liver. Need
protein to synthesize.

Food sources of Vitamin A? (liver, egg

yolk, carrots, sweet potatoes, apricots)

Body Functions Dim light vison,

Differentiation of epithelial cells (esp.
eyes).
Deficiency Night blindness,

Fat Soluble Vitamins

Vitamin D ergocalciferol (D2-SUNLIGHT) and cholecalciferol (D3SUPPLEMENT)

Essential for proper bone metabolism. (Rickets) (Cod liver oil)-vit d creates
bridge for calcium and phosphorus to get into bone; bones become soft
and malformed; lack of sunlight
Osteomalacia - adults
Recent research has found it may be essential in preventing many other
chronic diseases including breast cancer.
Converted by both the liver and Kidneys (protein bound to the liver)

Vitamin D Continued

Absorbed in the duodenum and distal small intestine.-gastric bypass pts,

resection
Intestinal absorption decreases with age.
Obesity (BMI > 30) may cause deficiency due to absorption into
subcutaneous fat.
What surgical treatment for obesity may cause Vitamin D deficiency?
gastric bypass

No RDA why? every individual is different (diet, exercise, exposure)

recommendation for sun exposure is 15 minutes per day

Vitamin D Continued

For individuals with low sunlight exposure, diet is critical.

Food sources: highest level to lowest

Fish (salmon, swordfish, tuna-all can be canned) 3 oz serving; Cod liver

oil (453 IU per tsp)

Fortified Milk (good source of calcium)

Liver and beef

Egg yolk

Shitake mushrooms

Fat soluble vitamins

Vitamin E

Protects integrity of cell membranes. Antioxidant,

Absorbed in the jejunum (fat and bile required for maximum

absorption)

Deficiency is rare due to diet, usually related to lipid metabolism

disorders.

Supplementing vitamin E is not recommended due to increase risk of

stroke, prostate cancer.

Vitamin E continued

Food sources for vitamin E

Vegetable oils (wheat germ oil, 1 tbsp, 20.3 mg)

Nuts (almonds, hazelnuts, peanuts)

Sunflower seeds

Peanut butter

Fat soluble vitamins

Vitamin K

Blood clotting

Necessary for the liver to make clotting factors II (prothrombin), VII,

IX, and X

Bone metabolism

2 types of vitamin K

Phylloquinone found in plant foods

Menaquinone synthesized by intestinal bacteria; antibiotic use effects

blood clotting b/c of K deficiency (effects absorption)

Vitamin K continued

Food sources:

Green leafy vegetable (cooked is higher in vitamin K)

Cabbage

Pharmaceutical source (phytonadione) oral or injection. Oral water soluble

solution available for those with malabsorption disorders
Overconsumption of vitamin E and A can interfere with absorption
of Vitamin K
Warfarin (Coumadin) and Vitamin K-keep the limit the amounts of green
leafy vegetables the samedon't decrease but definitely don't increase;
will have to take higher levels of coumadin if Vit K is present, consult
dietician for any dietary changes
Infants and vitamin K deficiencies- infants are not born with gut flora, will
need shot of Vit K after birth

Fat Soluble vitamins

Water and fat do not mix

Fats are circulated in the water-based blood.

The liver attaches fat-soluble vitamins to protein carriers

Protein deficiency can hinder the use of fat soluble vitamins

Water Soluble vitamins

Vitamin C (Ascorbic acid)

Diverse functions

Wound, burn and fracture healing

Antioxidant

Enhances absorption of iron

Assists in the synthesis of hormones and neurotransmitters

(adrenals) (serotonin)
Necessary for the formation of collagen

Vitamin C continued

Deficiency

Scurvy

Signs and symptoms:

Tender sore gums that easily bleed

Weakened blood vessels (Petechiae)

Breakdown of collagen

Delayed wound healing

Separation of scar tissue

Ends of long bones soften, leading to

Vitamin C Continued

Scurvy still exist today with certain

populations.

Elderly

Neurodevelopmental disabilities

Psychiatric illnesses

Unusual dietary habits

In America, often times dietary

deficiencies are not included in

Food sources for vitamin C

Fruits with the highest sources of vitamin C include:

Cantaloupe

Citrus fruits and juices, such as orange and grapefruit

Kiwi fruit

Mango

Papaya

Pineapple

Strawberries, raspberries, blueberries, cranberries

Watermelon

Vegetables with the highest sources of vitamin C include:

Broccoli, Brussels sprouts, cauliflower

Increased needs of Vitamin C

Smokers

Exposed to second hand smoke (esp. children)

Critically ill individuals

Vitamin C levels fall after uncomplicated surgery and fall even

more in patients in the SICU.
Supplementation is recommended in those post gastrointestinal
surgery.

Water Soluble Vitamins

B-Complex Vitamins

Thiamin

Riboflavin

Niacin

Vitamin B6

Folate

Vitamin B12

B-Complex Vitamins

Thiamin

Essential coenzyme in metabolism of glucose and certain amino acids.

Located primarily in the skeletal muscles. Also located in the

liver, heart, kidneys and brain.

Absorbed in the small intestine, primarily jejunum and ileum.

As energy expenditure increases, need for thiamin increases.

Mainly excreted in urine

B-Complex Vitamins

Thiamin deficiencies:

Dry Beriberi:

Muscle weakness and wasting, primarily lower extremeties.

Symmetrical sensory and motor conduction problems affecting
limbs

Wet Beriberi:

Progression to right sided heart failure.(cor pulmonale)

Occurs in infants 2 to 6 months old who do not get enough thiamin.

Alcoholism: liver dysfunction effects the usage of the vitamins due

to storage problems (of the vitamins)

food sources: pasta, breads, liver, nuts, seeds

B-Complex Vitamins

Vitamin B2 Riboflavin

Coenzyme in the metabolism of protein and other vitamins.

Clients undergoing major healing processes such as burns require

more than the average person.

Turns urine yellow/orange color

B-Complex Vitamins

Riboflavin (B2) deficiencies

Signs and symptoms (usually occur after 4 months)

Painful lesions on outside of lips and corners of the mouth

Redness and swelling in the mouth

Inflammation of the skin

Anemia

Peripheral nerve dysfunction

B-Complex Vitamins

Riboflavin deficiencies cont.

Clients at risk:

Those who avoid dairy products

Congenital heart disease

Some cancers

Alcoholism

Hypothyroidism

Adrenal insufficiency

B-Complex Vitamin

Food sources for Riboflavin

Dairy products.

Eggs.

Green leafy vegetables.

Lean meats.

Legumes.

Milk.

Nuts.

B-Complex Vitamins

Niacin (vitamin B3)

Coenzyme required for energy metabolism.

Participates in the synthesis of steroid hormones and fatty

acids.

Requisite for more than 200 enzymes

Liver can convert Tryptophan to Niacin (requires riboflavin, B6, and

iron). When Tryptophan levels are low protein synthesis takes
precedence.

B-Complex Vitamins

Niacin Deficiency

Pellegra

Signs and symptoms

Symptoms can present as soon as 60 days

diarrhea, dermatitis, dementia, and death

High risk population

Alcoholism

Aids

B-Complex Vitamins

Food sources for Niacin

Fish (Cooked Yellowfin Tuna)

Chicken & Turkey (Cooked Chicken

Breast)

Pork (Cooked Lean Chop)

Liver (Cooked Lamb Liver)

Peanuts (Oil Roasted)

Beef (Cooked Lean Rib)

B-Complex Vitamins

Vitamin B6

Coenzyme in the metabolism of amino acids

Involved in the metabolism of over 100 enzymes

Including those that convert tryptophan to niacin and heme for

hemoglobin

Proper immune funtion

B-Complex Vitamins

Vitamin B6 cont.

High risk for deficiency

Women of childbearing age

Current and former oral contraceptive users

Smokers

Non-Hispanic Black

Elderly

High heat during commercial processing of foods

B-Complex Vitamins

Vitamin B6 deficiencies:

Signs and symptoms:

Rash on face, neck, shoulders and buttocks

Mouth lesions

Fatigue and weakness

Confusion

Peripheral neuropathy

anemia

B-Complex Vitamins

Vitamin B6 food sources

richest sources of vitamin B6 include fish, beef liver and other organ
meats (any animal source)

Whole grains

Vegetables (potatoes and other starchy vegetables)

Fruit (non-citrus)

Fortified Cereals

B-Complex Vitamins

Folate

Involved in protein synthesis, including

amino acids, DNA, RNA and Heme.

Folate participates in the reproduction of

every cell.

Particularly for rapidly growing cells (GI

tract, blood and fetal tissue)

Absence of adequate folate can be

catastrophic. Birth defects occur 1st 3-4

B-Complex Vitamins

Folate deficiency

Poor dietary intake most common cause.

Results in impaired cell division and

protein synthesis, including red blood
cells (anemia).

Signs and Symptoms:

Bright red tongue

Fatigue and weakness

B-Complex Vitamins

Folate food sources;

Beef liver, braised, 3 ounces

Green leafy vegetable (spinach), cooked

Black-eyed peas

Breakfast cereals, fortified with 25% of the DRV

Rice, white, medium-grain cooked

Asparagus cooked

Spaghetti, cooked, enriched

Brussels sprouts

B-Complex Vitamins

B-Complex Vitamins

Vitamin B12 deficiency:

Common cause of neuropsychiatric problems in the elderly

Pernicious anemia

Signs and Symptoms:

Fatigue

Pallor

Shortness of breath

Heart palpitations

Numbness and tingling in the extremeties

Abnormal gait, poor coordination of movement

Memory loss, disorientation

B-Complex Vitamins

Vitamin B12 Food sources:

meat

poultry

Shellfish

eggs

dairy products

Learning Outcome 13

What is the importance of minerals

to the body?

Necessary for biochemical reactions in

the body

Obtained from the Earths crust,

absorbed by plants, animals eat plants,
humans eat animals and plants.

Water is the medium of absorption of

nutrients for plants and the basis of the
bodys nutrient delivery system.

Learning Outcome 14

How are minerals classified?

Macrominerals DR is >100 mg, help to balance pH. (calcium,
chlorine, magnesium, phosphorus, potassium, sodium, and
sulfur).

Microminerals DR is < 100mg (chromium, cobalt, copper,

fluorine, iodine, iron, manganese, molybdenum, selenium, and
zinc).

Healthy People 2020

Weight and growth

Food and nutrient consumption

Iron deficiency and anemia

Schools, worksites, and nutrition

counseling
Food security