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Flashcards in 31 - Vitamins Deck (44):
1

What should you focus on

Folate and methylation

2

What are vitamins?

Heterogeneous group of organic compounds required in small amounts for cellular functions; cannot be synthesized in adequate amounts

3

What are the biological roles of vitamins?

- Essential cofactors in enzymatic reactions
- Biological regulatory molecules
- Antioxidants

4

Describe the solubility of vitamins

Water soluble vitamins
- Vitamin B
- Vitamin C
- Circulate free (not stored)

Fat soluble vitamins
- Vitamin A
- Vitamin D
- Vitamin E
- Vitamin K
- Absorbed with bile salts
- Require carriers and stored in body fat

5

What are the daily recommendations for vitamins?

Recommended by Food and Nutrition Board of the Institute of Medicine – based on optimal nutritional intakes for large populations of healthy individuals
- Dietary Reference Intake (DRI)
- Recommended Dietary Allowance (RDA)
- Adequate Intake (AI)
- Estimated Average Requirement (EAR)

Just different recommendation systems

6

Describe the DRI

Dietary reference intake

Used to plan and assess
nutrient intakes of healthy people; vary by gender/life stage

7

Describe RDA

Recommended dietary allowance

Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%-98%) healthy people

8

Describe AI

Adequate intake

Established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy

9

Describe EAR

Estimated average requirement

Expected to satisfy the needs of 50% of the people in that age group based on a review of the scientific literature.

10

What are the functions of vitamin B?

- Energy releasing quality
- Hematopoietic quality
- Others

11

What is the joint role of folate and cobalamin (B12)?

***

- Joint role in one-carbon transfer pathway
- Necessary for production and maintenance of new cells, DNA/RNA synthesis

12

Describe the relationship between folate and cobalamin

***

Folate works as a substrate for cobalamin

13

Describe the effects a deficiency of coabalamin

***

- Deficiency of cobalamin can lead to a “methyl trap” in methylation pathway
- Cobalmin deficiency – pernicious anemia

14

Describe the effects of folate deficiency

***

Folate deficiency
- Megaloblastic anemia
- Neural tube defects (during pregnancy)

15

Describe the clinical effects of nutritional anemia

- Fatigue
- Pale skin
- Etc.

16

Describe the methylation pathway

***

- Homocystine needs to be converted back to cysteine so it can contribute to cell proliferation, RNA synthesis, etc.
- The other side of the pathway uses dietary folate to form purine and pyrimidine synthesis
- In about 10-15% of the population, there is a deformity in the methyltetrahydrofolate
- The defect means you need more folate in your diet to keep the pathway going

17

What are the sources of B12 (cobalamin)?

Animal sources only

18

Describe the absorption of B12 (cobalamin)

- Absorbed via intrinsic factor
- Any interruption along pathway (absorption, transport, excretion) can result in deficiency of B12

19

What does cobalamin deficiency lead to?

Pernicious anemia
- Most common B12 deficiency
- Parietal cells fail to secrete intrinsic factor

20

What people is cobalamin deficiency is common in?

- Risk increases with age (occurring in up to 15% of elderly)
- Gastrointestinal conditions/surgeries
- Crohn’s
- Atrophic gastritis
- Autoimmune destruction of gastric mucosa
- Gastric bypass
- Diphyllobothrium latum – tapeworm from eating raw fish

21

How do you diagnose cobalamin deficiency?

Macrocytosis on CBC, peripheral blood smear, cobalamin levels, elevated methylmalonic acid and homocysteine levels, Schilling test (measures B12 and IF deficiency)

22

What is the overall outcome of coabalamin deficeincy?

Neurologic abnormalities due to demyelination of nerves

23

What is the result of folate deficiency?

Megaloblastic anemia
- Maturation of hematopoietic precursor cells is disrupted due to defect in DNA synthesis
- White and red blood cells are enlarged
- Many cells die in bone marrow which leads to anemia

24

Describe the symptoms of megaloblastic anemia

- Symptoms are largely indistinguishable from pernicious anemia
- More often malnourished than those with cobalamin deficiency

Gastrointestinal manifestations
- Diarrhea is often present
- Cheilosis
- Glossitis

Neurologic abnormalities do not occur

25

What are the stages of folate deficiency?

- Negative folate balance (decreased serum folate)
- Decreased RBC folate levels and hypersegmented neutrophils
- Macroovalocytes, increased MCV, and decreased hemoglobin

26

Describe the effect of folate deficiency on the cellular level

- Requirement of THF for synthesis of purine and pyrimidines is likely the basis of the development of megaloblastic anemia (hematopoiesis requires DNA synthesis for continuing cell production)
- B12 not used for methyl donor for reactions involving DNA synthesis
- “Methyl Trap”
- Hypersegmented neutrophils

27

Describe the neural tube defects associated with folate deficiency

- Folate deficiency in first trimester leads to an increased risk of neural tube defects (e.g. spina bifida)
- Possibly due to increased DNA synthesis and/or increased homocysteine concentrations
- Supplementation before and during pregnancy dramatically decreases incidence of neural tube defects
- 1998 US decided to supplement all cereal grain products
- Serum folate increased 2.5 fold in US population

28

Describe the relationship between serum B12 and folate

- When B12 is low and folate is normal, macrocytosis anemia and cognitive impairment occur
- When B12 is normal and folate is high, there is no cognitive impairment
- When B12 is low and folate is high, there is a 5x increase in the occurrence of cognitive impairment because high folate can mask a B12 deficiency***

29

Describe reactive species and antioxidants

Reactive oxygen/nitrogen species – highly reactive free radicals due to imbalance of electrons

Formed with exposure to chemicals, drugs, ionizing radiation, normal physiological processes (e.g. electron transport chain), etc.

“Antioxidant” refers to any molecule capable of stabilizing or deactivating free radicals before they attack cells - act as electron donors to stabilize the reactive species – different types based on solubility

30

Describe oxidative stress

- Can lead to disease
- Can effect any part of the body (heart, brain, arthritis, inflammation)

31

How can vitamin E prevent cadiovascular disease?

Only one study showed a benefit of vitamin E in the prevention of cardiovascular disease

32

What can the combination of vitamin E and vitamin C decrease atherosclerosis?

Supplementation of both of these vitamins can decrease the formation of plaques

Don't know the role of this or how it decreases this

33

Describe antioxidant properties of foods

- Most foods have a number for antioxidant potential
- Fruits and vegetables are higher in antioxidant potential
- The more colorful, the more the antioxidant potential

34

Describe the antioxidant potential between supplements and actual foods (fruits and veggies)

Fruits and vegetables did a better job of the supplements

35

Describe vitamin D

- Able to synthesize if adequate UV light
- Little from diet
- Can be considered a hormone – synthesized at 1 site, converted into active hormone at another site, exerts action at target tissues

36

What are the functions of vitamin D?

- Kidney, bone, intestine in order to maintain blood calcium
- May be involved in cell differentiation
- Immunity

37

Describe the conversion of vitamin D

- D3 from UV rays and D2 and D3 from diet supplements enter liver enzyme pathway
- Converted to calcidiol in the liver (can measure this in the blood)
- Then goes to the kidney where calcitriol (active) and calcitroic acid (inactive)

38

How can vitamin D act as a hormone?

Calcitriol (1,25-dihydroxy vitamin D)
- Acts on parathyroid gland
- Also plays a role in macrophages and immunity

39

Describe calcitriol in macrophages and immunity

- Calcitriol turns on B cells and T cells
- Increases immunity
- Emerging research

40

What does vitamin D synthesis depend on?

- Season
- Time of day

Need to have skin exposed (10 am - 4 pm, highest peak 12 pm - 2 pm)

41

What else does vitamin D synthesis depend on?

- Latitude
- Exposure
- Age
- Skin pigmentation
- Sun screen

42

Describe the role of calcitriol on parathyroid hormone

*** KNOW THIS ***

- When there is low blood calcium, it acts on the parathyroid gland
- Parathyroid hormone is excreted and works on the bone to release calcium
- Parathyroid hormone also works on the kidney, which then releases calcitriol to work on the gut
- Calcitriol aids in increased uptake of calcium from the cut
- This all functions to increase the serum calcium

43

How does vitamin D effect the absorption of calcium?

65% higher absorption of calcium when treated with vitamin D

44

How much calcium supplementation do we need in order to decrease hip and nonvertebral fracture?

600-800 international units

This allows us to reach 40/kg (?)... Previous recommendation of 400 international units is not enough

Can also decrease other factors for mortality