1. Nutrition for Health Professions Lecture 8 Mr. Adham I. Ahmed “BSN, RN, MCN” University of Palestine Health Sciences College Associate Degree Program

2. Mr. Adham Ahmed Vitamins

3. Mr. Adham Ahmed3 Objectives  State one or more functions of each of the thirteen vitamins discussed  Identify at least two food sources of each of the vitamins discussed  Identify some symptoms of, or diseases caused by, deficiencies of the vitamins discussed

4. Mr. Adham Ahmed4 Facts  Organic (carbon-containing) compounds that are essential in small amounts for body processes.  Do not provide energy.  Enable the body to use the energy provided by fats, carbohydrates, and proteins.  Megadoses can be toxic.

5. Mr. Adham Ahmed5 Vitamin types (13)  Fat soluble (4): A, D, E, K  Water soluble (9): Vitamin C Vitamin B complex which includes: thiamin (B 1 ), riboflavin (B 2 ), niacin(B 3 ), vitamin B 6, folate (B 9 ), vitamin B 12 (cobalamin), pantothenic acid (B 5 ), biotin (B 7 )

6. Mr. Adham Ahmed6 Vitamin Deficiency People prone to vitamin deficiency Alcoholics Poor and incapacitated elderly Clients with serious diseases that affect appetite Mentally retarded Children receiving inadequate care

7. Mr. Adham Ahmed7 Deficiency of Fat-soluble Vitamins Chronic malabsorption diseases Cystic fibrosis Celiac disease Crohn’s disease

8. Mr. Adham Ahmed8 1. Avitaminosisa. Concentrated form of vitamins 2. Hypervitaminosisb. Without vitamins 3. Vitamin supplementc. Condition caused by ingestion of excess vitamins Match the following terms with the correct definition.

9. Mr. Adham Ahmed9 Answers: 1. b 2. c 3. a

10. Mr. Adham Ahmed10 Avoiding Vitamin Loss  Buy fresh, unbruised vegetables and fruits and use them raw when possible.  Prepare fresh vegetables and fruits just before serving.  Heat canned vegetables quickly and in their own liquid.

11. Mr. Adham Ahmed11 Avoiding Vitamin Loss  Follow package directions when cooking frozen vegetables or fruit.  Steam, or use as little water as possible.  Cover pan and cook for a short period of time.  Save cooking liquid for soups, stews يخنه, and gravy صلصلة مرق اللحم.  Store in a cool, dark place.

12. Mr. Adham Ahmed12 Fat-Soluble Vitamins  Vitamins A, D, E, K

13. Mr. Adham Ahmed13 Vitamin A Preformed (retinol) - Retinoids Active form of vitamin A Carotenoids Inactive form of vitamin A found in plants

14. Mr. Adham Ahmed14 Functions of Vitamin A  Antioxidant  Maintains healthy eyes and skin  Helps prevent infection.

15. Mr. Adham Ahmed15 Sources of Vitamin A Preformed vitamin A (retinol) Carotenoids (provitamin A or beta-carotene) Fat-containing animal foods: liver, butter, cream, whole milk, cheeses Green leafy vegetables & fruits, carrots, sweet potatoes, squash, spinach, broccoli, mango, cantaloupe, pumpkin

16. Mr. Adham Ahmed16  What are the signs and symptoms you may expect to see with too much vitamin A?  …too little?

17. Mr. Adham Ahmed17 Excess Birth defects, hair loss, dry skinBirth defects, hair loss, dry skin, headaches, nausea, dryness of mucous membranes, liver damage, and bone and joint pain Deficit Night blindness; dry, rough skin; increased susceptibility to infections; and blindness or xerophthalmia

18. Mr. Adham Ahmed18 Vitamin D  Prohormone–converted to a hormone in the body.  D 2 (ergocalcifenol) is formed in plants.  D 3 (cholecalciferol) is formed in humans from cholesterol in the skin.

19. Mr. Adham Ahmed19 Sources of Vitamin D  Sunlight  Milk, fish liver oils, egg yolk, butter, fortified margarine  Most milk in the U.S. has 10  g of vitamin D concentrate added per quart.

20. Mr. Adham Ahmed20 What are the signs and symptoms you may expect to see with too much vitamin D? …too little?

21. Mr. Adham Ahmed21 Excess Deposits of calcium and phosphorus in soft tissues, kidney and heart damage, and bone fragility Deficit Poor bone and tooth formation, rickets which causes malformed bones and pain in infants

22. Mr. Adham Ahmed22 Deficit Osteomalacia (softening of bones)Osteomalacia (softening of bones) Osteoporosis (brittle, porous bones)Osteoporosis (brittle, porous bones)

23. Mr. Adham Ahmed23 Vitamin E  Tocopherols Alpha (most biologically active) Beta, delta, gamma  Tocotrienols (4 Tocopherols)

24. Mr. Adham Ahmed24 Functions of Vitamin E  Antioxidant  Prevention of hemolytic anemia among premature infants  Enhance immune system  Retard spoilage of commercial foods

25. Mr. Adham Ahmed25 Sources of Vitamin E  Vegetable oils: corn, soybean, safflower, and cottonseed, and products made from them such as margarine  Wheat germ, nuts, green leafy vegetables

26. Mr. Adham Ahmed26 Your client asks you if it is possible to take too much vitamin E. How would you advise the client? What signs and/or symptoms can result from too little vitamin E?

27. Mr. Adham Ahmed27 Excess Relatively nontoxic, fat- soluble vitamin. Excess stored in adipose tissue. Avoid long-term megadoses. Deficit Serious neurological defects can occur from malabsorption.

28. Mr. Adham Ahmed28 Vitamin K  Made up of several compounds essential to blood clotting.

29. Mr. Adham Ahmed29 Functions of Vitamin K  Formation of prothrombin; clotting of blood  Candidates likely to receive Vitamin K Newborns immediately after birth Clients who suffer from faulty fat absorption After extensive antibiotic therapy Antidote for an overdose of anticoagulant Clients being treated for hemorrhage

30. Mr. Adham Ahmed30 Sources of Vitamin K  Green leafy vegetables such as broccoli, cabbage, spinach, and kale.  Dairy products such as eggs, meats, fruits, and cereals.  Bacteria in small intestine synthesizes some vitamin K but must be supplemented by dietary sources.

31. Mr. Adham Ahmed31 What signs and/or symptoms can result from too much vitamin K? … too little?

32. Mr. Adham Ahmed32 Water-soluble Vitamins  Vitamin B complex  Vitamin C

33. Mr. Adham Ahmed33 Vitamin B Complex: Thiamin Thiamin B 1 Essential for nerve and muscle action, and metabolism of carbohydrates and some amino acids. Sources include unrefined and enriched cereals, yeast, wheat germ, lean pork, organ meats, and legumes.

34. Mr. Adham Ahmed34 Vitamin B Complex: Thiamin Average adult female requires 1.1 mg/day. Average adult male requires 1.2 mg/day. Deficiency symptoms include loss of appetite, fatigue, nervous irritability, and constipation. Beriberi is a disease caused by extreme deficiency of vitamin B 1.

35. Mr. Adham Ahmed35 Vitamin B Complex: Riboflavin Riboflavin B 2 Necessary for: the metabolism of carbohydrates, protein, and fats; tissue maintenance (especially the skin around the mouth); and healthy eyes. Sources include milk, meats, poultry, fish, enriched breads, cereals, broccoli, spinach, and asparagus.

36. Mr. Adham Ahmed36 Vitamin B Complex: Riboflavin Average adult female requires 1.1 mg/day. Average adult male requires 1.3 mg/day. Deficiency can result in cheilosis (a condition characterized by sores on the lips and cracks at the corners of the mouth); glossitis (inflammation of the tongue); dermatitis; and eye strain in the form of itching, burning, and eye fatigue.

37. Mr. Adham Ahmed37 Vitamin B Complex: Niacin Generic name for nicotinic acid and nicotinamide. A coenzyme in energy metabolism. Sources include meats, poultry, fish, peanuts, legumes. Milk and eggs are sources of tryptophan (precursor). Milk and eggs are sources of tryptophan (precursor). tryptophan (an amino acid that is a precursor of niacin).

38. Mr. Adham Ahmed38 Vitamin B Complex: Niacin Deficiency symptoms include weakness, anorexia, indigestion, anxiety, and irritability. Pellagra is an extreme deficiency causing sores on the skin, diarrhea, anxiety, confusion, irritability, poor memory, dizziness, and untimely death.

39. Mr. Adham Ahmed39 Vitamin B Complex: B 6 Pyridoxine, pyridoxal, pyridoxamine Essential for protein metabolism and absorption, and aids in release of glucose from glycogen. Serves as catalyst in conversion of tryptophan to niacin; helps synthesize neurotransmitters such as serotonin and dopamine.

40. Mr. Adham Ahmed40 Vitamin B Complex: B 6 Sources include poultry, fish, liver, kidney, potatoes, bananas, spinach, and unrefined whole grains (oats and wheat). Deficiency symptoms include irritability, depression, and dermatitis. Deficiency in infants can cause various neurological symptoms and abdominal problems. Toxicity is rare; may cause temporary neurological problems.

41. Mr. Adham Ahmed41 Vitamin B Complex: Folate Folate, folacin, and folic acid are chemically similar compounds, and names are used interchangeably. Needed for DNA synthesis, protein metabolism, formation of hemoglobin. Sources include cereals fortified with folate, green leafy vegetables, legumes, sunflower seeds, fruits such as orange juice and strawberries.

42. Mr. Adham Ahmed42 Vitamin B Complex: Folate Deficiency linked to neural tube defects in fetus such as spina bifida (spinal cord or spinal fluid bulge through the back) and anencephaly (absence of the brain). Other signs include inflammation of mouth and tongue, poor growth, depression and mental confusion, problems with nerve functions, megaloblastic anemia.

43. Mr. Adham Ahmed43 Vitamin B Complex: B 12 Cobalamin–contains mineral cobalt. Stored in body three to five years. Involved in folate metabolism, maintenance of the myelin sheath, and healthy red blood cells. To be absorbed, must bind with intrinsic factor in stomach. Pernicious anemia may result from loss of intrinsic factor.

44. Mr. Adham Ahmed44 Vitamin B Complex: B 12 Sources include animal foods, especially organ meats, lean meat, seafood, eggs, dairy products. Average adult requires 2.4  g/day. Increased need during pregnancy and lactation. Amount absorbed will depend on current need.

45. Mr. Adham Ahmed45 Vitamin B Complex: Pantothenic Acid Involved in metabolism of carbohydrates, fats, proteins. Essential for synthesis of neurotransmitter acetylcholine and steroid hormones. Sources include meats, poultry, fish, eggs, whole grain cereals, and legumes. Thought to be synthesized by the body.

46. Mr. Adham Ahmed46 Vitamin B Complex: Biotin Coenzyme in synthesis of fatty acids and amino acids. Sources include liver, egg yolk, soy flour, cereals, yeast. Synthesized in intestine by microorganisms, amount available for absorption unknown. Food and Nutrition Board suggests adequate intake of 30  g for adults.

47. Mr. Adham Ahmed47 Vitamin B Complex: Biotin Toxicity from excess unknown. Deficiency symptoms include nausea, anorexia, depression, pallor, dermatitis, increase in serum cholesterol.

48. Mr. Adham Ahmed48 Vitamin C Ascorbic acid Has antioxidant properties and protects food from oxidation. Role in formation of collagen. Aids in absorption of nonheme iron. May be involved with formation or functioning of norepinephrine, some amino acids, folate, leukocytes, the immune system, allergic reactions.

49. Mr. Adham Ahmed49 Vitamin C Sources include citrus fruits, melon, strawberries, tomatoes, potatoes, red and green peppers, cabbage, broccoli. Average female adult requires 75 mg/day. Average male adult requires 90 mg/day. Stress and cigarette smoking increase need.

50. Mr. Adham Ahmed50 What disease results from a deficiency in vitamin C? What are the associated signs and/or symptoms? What results from excess?

51. Mr. Adham Ahmed51 Scurvy: disease characterized by gingivitis, easy bruising, pinpoint hemorrhages of the skin, poor wound healing, sore joints and muscles, weight loss. Extreme cases result in death. Found in sailors who lived without fresh fruits and vegetables.

52. Mr. Adham Ahmed52 Deficiency of Vitamin C: bleeding gums, loose teeth, tendency to bruise easily, poor wound healing, scurvy. Excess: diarrhea, nausea, cramps, excessive absorption of food iron, rebound scurvy (when megadoses are stopped abruptly) and possibly oxalate kidney stones. Generally considered nontoxic.

53. Mr. Adham Ahmed53 Vitamin Supplementation Balanced diet provides nutritional needs of healthy people. No amount of vitamins will build muscles. Vitamins do not provide energy; they help to release the energy provided by nutrients. Heart disease, cancer and the common cold cannot be cured by vitamin supplements.

54. Mr. Adham Ahmed54 Conclusion Organic compounds that regulate body functions and promote growth. Each vitamin has a specific function. Well-balanced diet provides sufficient vitamins to fulfill body requirements. Fat-soluble vitamins: A, D, E, K Water-soluble vitamins: B complex, C