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Flashcards in Fat-Soluble Vitamins Deck (83):
1

What are the Fat Soluble Vitamins?

ADEK

2

General properties for fat soluble vitamins?

- require bile and fats for absorption
- excess stored in liver and adipose tissue
- not readily excreted (because of efficient enterohepatic circulation); results in increased risk of toxicity

3

How are vitamins unbound to proteins?

Vitamins are bound to proteins as we eat them, but once in the stomach, proteins are degraded into small peptides releasing vitamins.

4

Where does absorption occur for fat-soluble vitamins?

In the jejunum

5

Explain how absorption of fat-soluble vitamins occur

In the jejunum, fat-soluble vitamins forms micelle with bile salts allowing them to be passively transported into the intestinal enterocytes.

6

What occurs once the micelle enters the intestinal enterocyte?

In the enterocytes, micelles are packaged into chylomicrons and released into the lymphatic system. Once inside the lymphatic system, chylomicrons travel up the thoracic duct and enter the left subclavian vein.

7

Where do we obtain vitamin A from?

Either from animal foods in the form of retinyl esters or from plant foods as beta carotene

8

Discuss the conversion of the different forms of vitamin A in the body.

Retinol (which comes from retinyl esters) to retinal (which comes fro beta-carotene) is reversible. Retinal to retinoic acid is irreversible.

9

Sources of vitamin A

liver, sweet potatoes and carrots

10

Does the ingestion of equal amounts of beta carotene and retinyl esters yield similar amounts of vitamin A?

No. The absorption of beta carotene is not as efficient as that of retinyl ester

11

What is the form of vitamin A circulating in chylomicrons?

Retinyl ester

12

Where is retinyl ester converted to retinol?

In the hepatocyte

13

After conversion from retinyl ester to retinol, where is retinol stored?

Retinol is transported into stellatte cells for storage

14

What are stellate cells?

Account for 5%-8% of the cells in the liver. In a healthy liver, stellate cells are quiescent and contain numerous vitamin A lipid droplets, constituting the largest reservoir of vitamin A in the body

15

Function of retinol?

Supports reproduction and major transport and storage form

16

Function of retinal?

Active in vision

17

Function of retinoic acid?

Regulates cell differentiation, growth, and embryonic development

18

Function of beta-carotene?

Antioxidant

19

Why is retinoic acid unique?

Retinoic acid functions as a transcription factor, which means it participates in protein synthesis and cell differentiation through regulating gene expression (via RAR - its nuclear receptor)

20

Name specific cells affected by retinoic acid

Retinoic acid promotes differentation of both epithelial cels and goblet cells which protects mucous membranes

21

Pharamacological use of retinoids?

1. Retinoic acid - treatment of acute promyelocytic anemia
2. Tretionin - specifically Retin-A - treatment for acne, agining, dark pigments
3. Isotretinoin - specifically accutane - oral treatment for cystic acne but is a teratogenic, therefore women who are using Accutane are required to use reliable forms of birth control

22

What is the pigment molecule found in rods (a cell of the retina)

Rhodopsin

23

What is rhodopsin?

Rhodopsin is composed of a protein caled opsin which is bonded to a molecule of retinal.

24

Explain how light affects the conformation of rhodopsin

As light interacts with rhodopsin, retinal changes from cis to trans configuration. Configuration change (cis to trans) releases retinal from opsin. Alone, opsin initiates a signal transduction cascade to nerve cells that communicate with the brain's visual center. Trans retinal is enzymatically converted back to cis retinal which combines with opsin to regenerate rhodopsin.

25

What is a primary deficiency?

Inadequate intake

26

What is a secondary deficiency?

Poor absorption of fats

27

What is a deficiency in vitamin A called?

Hypovitaminosis A

28

What diseases can cause a secondary deficiency in vitamin A?

Cystic fibrosis, Crohn's disease, liver disease, excessive alcohol intake

29

Symptoms of vitamin A deficiency?

Night blindness . If left untreated, it can progress to complete blindness known as xerophthalmia

30

Explain how a deficiency in vitamin A can lead to dry eyes.

Reduction in goblet cells and production of mucin leads to dry eyes.

31

Other changes developing with vitamin A deficiency

Bitot spots, corneal ulcer and keratomalacia

32

What causes corneal ulcers (keratitis)?

Due to inflammation of cornea

33

What causes keratomalacia?

Due to softening of the cornea

34

How is immunity affected in patient with a vitamin A deficiency?

Immunity is impaired

35

What is keratinization?

Kertinization, also known as hyperkeratosis, results from a vitamin A deficiency. The skin becomes dry, rough and scaly.

36

Results of toxiticy of vitamin A

birth defects

37

What are the birth defects in a child whose mother took accutane?

Cranofacial malformations and malformations of the CNS, thymus, and heart

38

Symptoms of Beta-carotene excess

Not harmful. Excess beta-carotene is stored in the fat under skin

39

How is vitamin D different from other nutrients?

Vitamin D can be synthesized in the body with the help of UV light using cholesterol as a precursor

40

Describe what occurs in the skin that leads to vitamin D3 formation.

In response to sunlight exposure, pro-vitamin D3 (7-dehydrocholesterol) is converted to pre-vitamin D3. Pre-vitamin D3 undergoes isomerization to become Vitamin D3 (cholecalciferol).

41

What form of vitamin D is food?

Vitamin D3 (cholecalciferol)

42

Describe what occurs in the liver, with regard to vitamin D.

Vitamin D3 binds to a vitamin D-binding protein in the bloodstream and is transported to the liver. D3 is hydroxylated by the liver. Enzyme responsible is 25-hydroxylase. The result is 25(OH)D3

43

Describe what occurs in the kidney, with regard to vitamin D.

25(OH)D3 is further hydroxylated in the kidney by (1-OHase). This yields the active 1,25 (OH)2D3 which is calcitriol

44

Sources of vitamin D?

Several types of fish, mushrooms, and fortified milk

45

Functions of vitamin D?

calcium and phosphorus homeostasis (main), bone health (main), immune function, reduction of inflammation and apoptosis, blood pressure regulation, regulation of gene expression as a pro-hormone

46

How does vitamin D modulate gene transcription?

The active form of vitain D, calcitriol, can modulate gene transcription following binding to its cognate nuclear receptor, the vitamin D receptor (VDR)

47

Factors that contribute to a vitamin D deficiency

Dark skin, breastfeeding without supplementation, lack of sunlight, use of non-fortified milk, lose ability to active vitamin D (elderly), little or no milk in diet, vegan diet

48

Diseases resulting from a vitamin D deficiency

Rickets, osteomalacia, osteoporosis

49

Symptoms of Rickets?

(1) Growth retardation, skeletal abnormalities such as bowing of the legs. (2) Poorly formed attachments of bones to cartilage. (3) Delayed closure of fontanel resulting in rapid enlargement of head

50

Who in the US is more suspectible to rickets?

young, breast-fed black children. Breast milk does not have much vitamin D and pigments in dark skin reduce vitamin D synthesis

51

What is osteomalacia?

poor mineralization of bones due to vitamin D deficiency leads to soft, brittle and deformed bone

52

How can osteomalacia develop?

Result of taking anticonvulsants such as phenobarbital and phenytoin for a long period of time. Also, in patients with chronic kidney disease where the production of the active form of vitamin D is greatly reduced

53

What causes toxiticis in vitamin D?

occurs with supplementation; cannot occur via sunlight or dietary sources

54

Harm from increased vitamin D?

Excess vitamin D increases the concentration of blood calcium which tends to precipitate in the soft tissues suh as blood vessels, kidney, heart, lungs where it can cause death

55

Another name for vitamin E?

Tocopherol

56

What is tocopherol?

Tocopherol is a general term describing 8 related compounds (4 tocopherols: alpha, beta, gamma & delta and 4 tocotrienols), one of which has vitamin E activity.

57

Which compond has vitamin E activity?

D-isomer of alpha tocopherol

58

Sources of vitamin E?

Nuts and oils

59

Functions of vitamin E?

effective lipid soluble antioxidant (main), inhibition of platelet aggregation and monocyte adhesion, assisting in maintenance of fertility

60

How is vitamin E an effective lipid soluble antioxidant?

Protects polyunsaturated fatty acids within cell membranes from peroxidation

61

What is lipid peroxidation?

Lipid peroxidation is the oxidative degradation of lipids. It is the process in which free radicals "steal" electrons from the lipids in cell membranes, resulting in cell damage.

62

Common target for peroxidation?

Unsaturated fatty acids present in membrane phospholipids

63

How does vitamin E stop peroxidation?

Vitamin E stops peroxidation by donating a hydrogen to lipid radicals

64

What is vitamin C's role in aiding vitamin E?

After donating its hydrogen, active vitamin E is regenerated by vitamin C

65

Who generates the most reactive oxygen species?

The mitochondrial electron transport chain generates most of the reactive oxygen species such as superoxide or hydrogen peroxide

66

Results from a deficiency in vitamin E?

characterized by the premature destruction of red blood cells leading to hemolytic anemia

67

How could a vitamin E deficiency occur?

inadequate intake (rare) or fat malabsrption because of cystic fibrosis or pancreatic insufficiency (secondary deficiency) or in preterm infants

68

How can vitamin E toxicity occur?

rare; but may develop when exogenously supplemented

69

Results of excess vitamin E?

(1) interference with vitamin K which can lead to issues with clotting and increase likelihood of a hemorrhage
(2) nerve daage

70

How is vitamin K unique?

Synthesized by the bacteria in our gut

71

Animal source of vitamin K?

menaquinones (also the form synthesized by gut bacteria)

72

Plant source of vitamin K?

phylloquinones

73

Sources of vitamin K?

Green, leafy vegetables and oils

74

Function of vitamin K?

involved in blood clotting and bone mineralization

75

What is vitamin K's main role as a cofactor?

Vitamin K is a required cofact for the posttranslational modification of glutamate to the unusual amino acid, gamma-carboxyglutamate (Gla)

76

Which enzyme catalyzes the conversion of glutamate to gamma-carboxyglutamate (Gla)?

Gamma-glutamyl carboxylase

77

What is the importance of gamma-carboxyglutamate (Gla) ?

Several blood proteins require the presence of nine to thirteen Gla residues for normal function; these are the so called vitamin K-dependent (VKD) proteins

78

Role of vitamin K in blood coagulation?

Vitamin K participates in both the intrinsic and extrinsic blood-clotting pathways

79

Causes of a possible deficiency in vitamin K?

Deficiency of vitamin K may develop with the use of antibiotics and malabsorption. Newborns have low stores of vitamin K at birth due to the laack of gut bacteria.

80

Symptoms of vitamin K deficiency?

hemorrhaging, bruisability, mucosal bleeding

81

How could a patient have a toxicity in vitamin K?

Toxicity may develop in patients taking warfarin. Warfarin works by decreasing the activity of vitamin K

82

What do vitamins A, D, and K have in common?

Play important role in bone growth and remodeling

83

What is the relationship between vitamin E and A?

Vitamin E protects vitamin A from oxidation