Vitamins

Vitamins
• Fat soluble (A, D, E, K)
• Water souluble ( B and C )

• The B vitamins include biotin, folate, niacin,

pantothenic acid, riboflavin (B2), thiamin (B1),
B6 ( pyridoxine), and B12 (cobalamins).
 Daily Recommended Intake (DRI)
• Recommended daily allowance (RDA):meet
needs of 97 to 98% of healthy people.
• Adequate intake (AI): When data to calculate an
RDA are insufficient, AIs are based on observed
or experimentally determined estimates of
nutrient intake by healthy people.
• Tolerable upper intake level (UL): largest
amount of a nutrient that most adults can ingest
daily without risk of adverse health effects.
 Recommended Daily Intakes
• Recommended DIs.png
 Sources and Functions
• Sources, functions.htm
 Vitamins
• Vitamin deficiency due to :
 Poverty
 Malabsortion
 Alcoholism
 Drugs
• Vitamin dependancy – due to genetic defect in
vitamin metabolism
• Vitamin toxicity-results from taking megadoses of
vitamin A, D, C, B6, or niacin.
 Micronutrient Malnutrition
• Supplementation –children, elderly and
pregnant women
• Food fortification
 Calcium
Supplementation
 Calcium occurrence
In nature
• Mostly in soil systems as limestone (CaCO3), gypsum
(CaSO4*2H2O) & fluorite (CaF2)

In the body
• Average adult body contains approx 1 kg
• 0,1 % in extra cellular fluid
• 1 % in cells
• Rest approx 99 % in skeleton
 Calcium functions
• Major structural element in the vertebrate
skeleton (bones and teeth)
• Key component in maintenance of the cell
structure
• Membrane rigidity, permeability and viscosity are
partly dependent on local calcium concentrations
• As a cofactor for many enzymes (e.g. Lipase)
and proteins
• As component in the blood clotting cascade
 Calcium functions
An active role: as an intracellular signal

• In the relaxation and constriction of blood

vessels
• In cell aggregation and movement
• In muscle protein degradation
• In secretion of hormones as insulin
• In cell division
• In nerve impulse transmission
 Interactions
• Phosphate: ↓ calcium excretion in the urine
• Caffeine: ↑ urinary and fecal excretion of
calcium
• Sodium: ↑ sodium intake, ↑ loss of calcium in
urine
• Dietary constituents: Phytic acid can reduce
absorption of calcium by forming an insoluble
salt (calcium phytate)
• Iron: calcium might have inhibitory effect on iron
absorption
 Absorption and excretion
• Usual intakes is 1000 mg/day
• About 35 % is absorbed (350 mg/day)
by the intestines [elemental Ca]
• Calcium remaining in the intestine is
excreted in the feces
• 250 mg/day enters intestine via
secreted gastrointestinal juices and
sloughed mucosal cells
• 90 % (900 mg/day) of the daily intake
is excreted in the feces
• 10 % (100 mg/day) of the ingested
calcium is excreted in the urine
• Best absorbed after meals
• Calcium must be in a soluble and
ionized form before it can be absorbed
 Bone health through life

Bone is continuously being remodelled -

old bone tissue is replaced by new.
Bone formation and bone resorption
(replacement of old bone tissue) take
place throughout life, although at
different rates at different times. In
childhood the process enables the bone
to grow; in adulthood the purpose is to
maintain bone strength.
 Absorption and excretion
factors
• Absorption • Excretion
increased by: increased by:
- Body need - Low parathyroid
- Vitamin D hormone (PTH)
- Protein - High extracellular fluid
- Lactose volume
- Acid medium - High blood pressure
- Low plasma phosphate
• Absorption - Metabolic alkalosis
decreased by: • Excretion
- Vitamin D deficiency
- Calcium-phosphorus decreased by:
imbalance - High parathyroid
- Oxalic acid hormone
- Phosphorous - Low extracellular fluid
volume
- Dietary fiber - Low blood pressure
- Excessive fat - High plasma phosphate
- High alkalinity - Metabolic acidosis
- Also stresses and lack
of exercise - Vitamin D3
 Adequate daily intake (AI)
Males
(mg/day) Females
Life Stage Age (mg/day)
Infants 0-6 months 210 210
Infants 7-12 months 270 270
Children 1-3 years 500 500
Children 4-8 years 800 800
Children 9-13 years 1,300 1,300
Adolescents 14-18 years 1,300 1,300
Adults 19-50 years 1,000 1,000
51 years and
Adults older 1,200 1,200
18 years and
Pregnancy younger - 1,300
19 years and
 What is peak bone mass?

Peak bone mass is

reached at the age of
about 20 – 35 years.
Around this age bone is
at its strongest. After
this age, bone mass
gradually decreases.
Achieving a good peak
bone mass is important
in reducing the risk of
osteoporosis in later life.
This is because bones
are strong before bone
 Calcium sources
• Rich calcium sources (600-961mg/100g)
- Cheese
- Wheat-soy flour
- Blackstrap molasses

• Good sources (122-354mg/100g)

- Dairy products as milk, yoghurt, sour cream, ice
cream
- Green leafy vegetables as collard, kale and raw
turnip
- Fish as trout, salmon and sardines
- Almonds, brazil nuts, dried figs, hazel nuts
- Also soybean flour and cottonseed flour
• Poor sources
- Most fresh fruit
 deficiency
• Rickets
• Osteomalacia
• Osteoporosis
 Deficiency
• A negative calcium balance occurs when
net calcium absorption is unable to
replace losses
• The most dramatic symptoms are
manifested in the teeth and bones of
young humans and animals → stunted
growth, poor quality of bones and teeth
and malformation of bones
• Hypocalcaemia (low serum calcium levels
in the blood cause the nervous system to
become more excited)
• Osteoporosis (bone resorption exceeds
formation)
- Occurs particularly in women. Increases in bone
loss and osteoporotic fracture with age is a
consequence of calcium deficiency
• Osteomalacia, tetany and kidney stones are other
calcium related diseases
 Hypocalcaemia – Clinical Features
• Neuromuscular excitability
• Paraesthesia (tingling sensation) around mouth, fingers and
toes
• Muscle cramps, carpopedal spasms
• Tetany
• Seizures – focal or generalised
• Laryngospasm, stridor and apneas (neonates)
• Cardiac rhythm disturbances (prolonged QT interval)
• Chvostek’s and Trousseau’s signs – latent hypocalcemia
 Causes of deficiency
• Low Ca2+ intake
• Vitamin D deficiency
• Insufficiency or failure of
parathyroid gland
• Chronic kidney failure
• Low blood magnesium level (in
cases with severe alcoholism)
• Diet high in phytate
 Human health studies
• Resent studies showed
- Calcium may play a substantial contributing
role in reducing the incidence of obesity and
prevalence of the insulin resistance syndrome
- High calcium intake is associated with a
plasma lipoprotein-lipid profile predictive of a
lower risk of coronary heart disease compared
with a low calcium intake
- Dairy product intake (with recommended
calcium levels) protect women consuming oral
contraceptives from spine and hip bone loss
- Children who avoid drinking cow milk have low
dietary calcium intakes and poor bone health
 Calsuba
• Calcium carbonate 500mg, sucrose
• 35 – 40% elemental calcium
• Requires production of stomach acid to be
absorbed so is absorbed best when taken with
meals
• S/E constipation
 Caltrate
• Calcium carbonate 600mg, Vit D, Magnesium,
Zinc, Copper, Manganese
 Cal – C – Sandoz
• Calcium lactate – gluconate 2 940 mg, calcium
carbonate 300 mg
• Provides 500 mg elemental calcium
• Effervescent tab
CalMag powder
 Others
• Bioplus – ca gluconate 900mg, Ca citrate
180mg, Vit B1, B2, B3, B6, B12, caffeine, d-
Pentothenol/ 30ml

• Cal – C – Vita – Calcium 250mg, Vit C, Vit D, Vit

B6