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
•Immunity: important for activation of T
lymphocyte, maturation of WBC & integrity
of physiological barrier.
•Growth & development
 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.
Recommended Allowance
Life stage mg/day
Infants 400-500
Children 300-600
Adolescent 900M- 700F
Adult 900M- 700F
Pregnant women 750-800
Lactating women 122-1300
RICH DIETARY SOURCES
Animal Foods Plant Foods
Cod liver oil Sweet potato
Liver & kidney Carrots
Egg Cantaloupe
Butter Spinach
Milk & cheese Apricot
Fish & meet Papaya
 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