1. By Jennifer Turley and Joan Thompson
Fat Soluble Vitamins
By Jennifer Turley and Joan Thompson
© 2013 Cengage A D E K

2. Presentation Overview
Comparison of vitamins in the body.
Diagnosing deficiency and toxicity.
The fat soluble vitamins, A, D, E, K.
Notable health implications.
Vitamin A
Vitamin D
Vitamin E
Vitamin K
Chemical Forms. Intake Need. Functions. Deficiency. Toxicity. Food Sources.

3. Comparison of Vitamins in the Body
Vitamin A
Vitamin D
Vitamin E
Water Soluble: absorbed into blood stream directly, circulate, travel, and stored in water
compartments, excrete in urine, without intake deficiency signs and symptoms occur more quickly, toxicity is possible though shorter lived when intake is normalized.
Vitamin K
Thiamin
Vitamin C
Riboflavin
B12
Pantothenic Acid
Biotin
Niacin
Folate B6
Choline
Fat Soluble: absorbed into lymph, many require protein carriers, associate with fat, not readily excreted, without intake deficiency signs and symptoms occur more slowly, toxicity is possible and longer lived even when intake is normalized.

4. Diagnosing Nutritional Deficiency or Toxicity
Dietary records: Demonstrate low/high intake and/or confirm a metabolic or physiological problem that creates an altered need.
Clinical deficiency or toxicity symptoms: Are compatible with low/high dietary intake or altered need.
Biochemical tests: Such as blood levels, tissue levels & urine levels demonstrate low/high body levels of the nutrient.
Nutrient supplementation: Serves as biological evidence by correcting the deficiency signs & symptoms. For toxicity, removal of the excess.

5. The Fat Soluble VitaminsD E K

6. Vitamin A Chemistry A family of compounds including:
Retinol, Retinal, Retinoic acid
Pro-Vitamin A carotenoids like beta-carotene
Retinyl Esters
(animal foods)
Beta-Carotene
(plant foods)
Retinal
(vision)
Retinol
(reproduction)
Retinoic Acid
(Growth Regulator)

7. Vitamin A Functions Vision
Internal & external surface linings (epithelial cells)
Growth
Reproduction
Embryonic development
Gene expression
Immune function
Provitamin A forms have antioxidant properties

8. Vitamin A Deficiency vs Toxicity
(<66% of DRI)
Approx. <500 µg RE/day
Adequacy
DRI: µg RE/day
RDI: 5,000 IU
Toxicity
(>UL)
>3,000 µg RE/day
Hypovitaminosis A
Bone & tooth: Impaired growth
Central Nervous System: Night blindness, complete blindness (Xerophthalmia)
GI System: Diarrhea
Immunity: Depressed immunity, more
infections
Skin: Hyperkeratosis (thickened skin)
Normal vision, gene expression, reproduction, embryonic development, epithelial cell maintenance, growth, and immune function
Bone & tooth: Decreased bone mineral density
Central Nervous System: Headache, vertigo
GI System: Nausea and vomiting, liver abnormalities
Neuro-Muscular: Incoordination
Skin: orange color with excess beta-carotene
Other: Retinoid embryopathy
25 mg beta-carotene (pro-vitamin A is safe to take daily if you are not a smoker or drinker).
Toxicity possible with supplements or acne medications . Pg 229
Adult deficient, adequate, toxic values

9. Vitamin A: Food Sources
Retinol: (animal)
Fortified milk, cheese, butter, margarine
Eggs
Liver 
Beta-Carotene: (Plant)
dark green leafy vegetables
broccoli, deep orange fruits, & vegetables

10. Vitamin A in Foods
Adult DRI: µg RE/day

11. Vitamin D Chemistry Synthesis & Functions
REGULATES
Ca-P Balance
Increases bone mineralization
Increases intestinal absorption of calcium
Increase phosphorus excretion
Antiproliferative
Prodifferentiation
Pg 230 vitamin D synthesis for detailed review of pathophysiology.

12. Vitamin D Deficiency vs Toxicity
There is an epidemic of vitamin D deficiency
Deficiency
(<66% of DRI)
Approx. <3 µg/day
Adequacy
DRI: 15 µg/day
RDI: 400 IU = 6.5 µg
Toxicity
(>UL)
>50 µg/day
Rickets (children)
Osteomalacia (adults)
Bone & tooth: poor growth, bowed legs, soft bones, pigeon chest, knocked knees, and malformed teeth in children. Porous bones in adults.
Cardio-Vascular:
increased circulating levels (PTH) and (AlkP) and decreased circulating levels of serum phosphorus
GI System: Decreased calcium absorption
Normal calcium and phosphorus balance and cell metabolism
Hypervitaminosis D characterized by high levels of 25(OH)D from supplementation
Cardio-Vascular: High blood calcium
Central Nervous System: Weakness
GI System: Nausea, vomiting, anorexia
Other: Kidney stones, increased thirst, urination, and urinary calcium
Needs are based upon an inadequate exposure to sunlight.
Sunlight not implicated in toxicity.
Adult deficient, adequate, toxic values

13. Vitamin D: Sources
Fortified products like milk, margarine, & some cereals
Eggs & fatty fish
Self-synthesis with unprotected peak sunlight exposure

14. Vitamin D in Foods
Adult DRI: 15 µg/day

15. Vitamin E Chemistry
A family of alpha, beta, gamma, delta tocopherols & tocotrienols.
Alpha-tocopherol is believed to be the most active form.

16. Vitamin E Functions Membrane Antioxidant & Stabilizer And at the
molecular level
Donates electron wihtout becoming reactive itself.

17. Vitamin E Deficiency vs Toxicity
(<66% of DRI)
Approx. <10 mg/day
Adequacy
DRI: 15 mg/day
RDI: 30 IU
Toxicity
(>UL)
>1,000 mg/day
Premature infants: hemolytic anemia
Adults: not well characterized
Normal cell membrane integrity, reduced oxidative stress, and molecular functioning
Relatively nontoxic
Toxicity with supplements
Interferes with vitamin K’s role in blood clotting, augmentation of anti-blood clotting medication and increases hemolysis
Adult deficient, adequate, toxic values

18. Vitamin E: Food Sources
Nuts
Seeds
Plant oils
Wheat germ
Fortified cereals
Vegetables

19. Vitamin E in Foods
Adult DRI: 15 mg/day

20. Vitamin K Chemistry
Phylloquinone (K1) from plant sources & naphthaquinones (K2, multiple forms) from animal sources & gut bacteria.

21. Vitamin K Deficiency vs Toxicity
(<66% of DRI)
Approx. <60 µg/day
Adequacy
DRI: µg /day
RDI: 90 µg
Toxicity
(>UL)
Not Determined
Cardio-Vascular:
Increases clotting time, hemorrhaging with cut or injury
Normal blood clotting & bone metabolism
Poorly described in adults
GI System: High levels from supplemented menadione causes jaundice and liver damage in infants
Interference with anti-blood clotting medication
Adult deficient, adequate, toxic values

22. Vitamin K: Sources Green leafy & cruciferous vegetables Soybeans
Some plant oils
Vitamin K is made by bacteria in the gastrointestinal tract

23. Vitamin K in Foods
Adult DRI: µg/day

24. Summary
Diagnosing & confirming a nutrient deficiency or toxicity requires a diet analysis, clinical evaluation, biochemical analysis, & evaluating the response to corrected intake levels.
Toxicities and deficiencies take longer to develop for fat soluble vitamins as compared to water soluble vitamins.
The fat soluble vitamins are grouped by their solubility in oil.
The fat soluble vitamins have specific chemical forms & functions in the body.
DRIs exist for essential fat soluble vitamins: A, D, E, & K.
Deficiency & toxicity signs & symptoms are unique for each of these nutrients as are their food sources.
References for this presentation are the same as those for this topic found in module 5 of the textbook