NOTA SLAID

Deficiency

• Diet deficient in vitamin D in conjunction with
inadequate sun exposure

• Causes softening of the bones:

– Rickets (in children)
– Osteomalacia (in adults)

Rickets

• Rickets

• In most cases, the child suffers from
severe and long-term malnutrition
(usually during early childhood)

• Causes – deficiency or impaired
metabolism of vitamin D, P or Ca

• The predominant cause: vitamin D deficiency
• Lack of adequate Ca in the diet may also lead

to rickets

• Bones soften
• Malformation of bones
• Cannot withstand ordinary stresses & strains

– prone to fractures

• Result in bowlegs, knock-knees, pigeon breast



Osteomalacia

• Osteomalacia is a disease in adults that results
from vitamin D deficiency

• Characteristics: softening of the bones
• Leading to

– bending of the spine
– bowing of the legs
– proximal muscle weakness
– bone fragility
– increased risk for fractures

• Osteomalacia reduces Ca absorption and
increases Ca loss from bone

• Osteomalacia is usually present when:

– 25-hydroxyvitamin D levels are < ~ 10 ng/mL

Tolerable Upper Intake

Age group 0 – 6 months μg/day of vitamin D
Infant 7 – 12 months 25
37.5
> 1 year 100
Pregnancy & lactation 100

Toxicity

• Vitamin D toxicity (hypervitaminosis D) is rare
• Usually caused by megadoses of vitamin D

supplements

• The main
consequence of
vitamin D toxicity
is a buildup of
calcium in blood
(hypercalcemia)

• Hypercalcemia symptoms:

– Poor appetite, nausea
and vomiting

– Weakness, frequent
urination and kidney
problems also may
occur

VITAMIN E

Vitamin E

• "Vitamin E“

– Is the collective name for a group of fat-soluble
compounds with distinctive antioxidant activities

– Include both tocopherols & tocotrienols

Naturally occurring vitamin E exists in 8 chemical
forms:

Tocopherols Tocotrienols

αα
ββ

γγ
δδ

α-tocopherol

• The most biologically active form of vitamin E
• The only form that is recognized to meet

human requirements

Appears as a light yellow, viscous, odorless, oily liquid

• The only form of vitamin E that is actively
maintained in the human body

• Therefore, it is the form of vitamin E found in
the largest quantities in blood and tissues

• Fairly stable to heat & acids
• Unstable to alkali, ultraviolet light and oxygen
• It is destroyed when in contact with rancid fats, lead & iron
• It is stored in liver & fat tissues

RNI for Malaysia (2017)

Age group 0 – 11 months mg/day
Infant 1 – 6 years 3
7 – 9 years 5
Children 7
10
≥10 years (Male) 7.5
≥10 years (Female) 7.5

Pregnancy &
lactation

Food Sources

• Nuts, seeds, and vegetable oils are among the
best sources of α-tocopherol

• And significant amounts are available in green
leafy vegetables

Food Vit E (mg)
Wheat germ oil, 1 tablespoon 20.3
Almonds, dry roasted, 1 ounce 6.8
Sunflower oil, 1 tablespoon 5.6
4.6
Safflower oil, 1 tablespoon 4.3
Hazelnuts, dry roasted, 1 ounce

Food Vit E (mg)
Peanut butter, 2 tablespoons 2.9
Peanuts, dry roasted, 1 ounce 2.2
1.9
Corn oil, 1 tablespoon 1.9
Spinach, boiled, ½ cup 1.2
Broccoli, chopped, boiled, ½ cup

Food Vit E (mg)
Soybean oil, 1 tablespoon 1.1
1.1
Kiwifruit, 1 medium 0.7
Mango, sliced, ½ cup 0.7
Tomato, raw, 1 medium 0.6
Spinach, raw, 1 cup

Functions

Antioxidant Enzymatic
activity

Gene
expression

Role - antioxidant

• Antioxidants protect cells from the damaging
effects of free radicals

• Vitamin E acts as a peroxyl radical scavenger

– preventing the propagation of free radicals in
tissues



Role – enzymatic activity regulator

• α-tocopherol:

– Inhibits protein kinase C, which plays a role in
smooth muscle growth

– Has stimulatory effect on the dephosphorylation
enzyme, protein phosphatase 2A

Role – gene expression

• α-tocopherol was found to:

– Downregulate the expression of the CD36
scavenger receptor gene and the scavenger
receptor class A (SR-A)

– Modulates expression of the connective tissue
growth factor (CTGF) gene

Deficiency

• Rare
• Deficiency is more evident in patients with

• fat malabsorption syndromes,
• genetic abnormalities in production of the α-tocopherol transfer

protein (α-TTP), and
• protein-energy malnutrition

Tolerable Upper Intake

Age group mg/day of any form of supplementary
Infant α-tocopherol

Not possible to establish; source of
intake should be formula and food only

Children 1 – 3 years 200
4 – 8 years 300
Adolescents/ 9 – 13 years 600
pregnancy/lactation 14 – 18 years 800

≥ 19 years 1000

Toxicity

• Among least toxic - humans able to tolerate rather high levels.
• No evidence of adverse effects from the naturally occurring in

foods.
• High dose of synthetic form can lead to

• pro-oxidant damage
• hemorrhagic effects in premature infants

VITAMIN K

History

• 1929 - Henrik Dam

– Investigated role of cholesterol by feeding
chickens a cholesterol-depleted diet

• After several weeks, the animals developed
hemorrhages and bleeding

– These defects could not be restored by adding
purified cholesterol to the diet

• Conclusion:

– There is another compound responsible

• The compound was called the coagulation
vitamin

• Named vitamin K

– because the initial discoveries were reported in a
German journal, in which it was designated
as Koagulationsvitamin

Vitamin K

• Exist in at least 3 forms

– all belong to a group of compound known as
quinones

The 3 forms are:

Vit. K1 (phylloquinone)

• occurs in green plant

Vit. K2 (menaquinone)

• formed as a result of bacterial action in the intestinal
tract

Vit. K3 (menadione)

• fat-soluble synthetic compound

• Vitamin K is fairly resistant to heat
• Vitamin K is not destroyed by ordinary cooking

methods

Recommended Intake

• Not included in RNI for Malaysia
2005

• Vitamin K is a newly added vitamin in
RNI for Malaysia 2017

RNI for Malaysia (2017)

Age group 0 – 5 months μg/day
Infant 6 – 12 months 5
10
Children 1 – 3 years 15
4 – 6 years 20
Adolescent 7 – 9 years 25
≥19 years (Male)
≥19 years (Female) 16 – 18 years 35-55
Pregnancy & lactation 65
55
55

Food Sources

• Mainly found in green leafy vegetables

Food Vit K (µg)
Kale, cooked, ½ cup 531
Spinach, cooked, ½ cup 444
Mustard greens, cooked, ½ cup 210
Parsley, raw, ¼ cup 246

Spinach, raw, 1 cup 145

Functions

Ccccaoaorfrfbabaoccotxtxooyyrrllaaffsooseerr Blood clotting Bone health

Prevents Lower risk of

atherosclerosis Alzheimer’s

Role - cofactor for carboxylase

• Essential as cofactor for carboxylase

• Carboxylase

– converts glutamic acid residues (GLU residues) of
precursor proteins to form
gammacarboxyglutamic acid (GLA residues); the
residues bind Ca

• In the process of generating residues:

– vitamin K is oxidized to an epoxide
– It is then restored to hydroquinone form by

epoxide reductase
– This is known as vitamin K cycle

Role - aids in blood clotting

• Vitamin K is the coenzyme to vitamin K-
dependent coagulation proteins in the blood

Role – bone health

• Aids in the prevention and treatment of
osteoporosis and the loss of bone density

• Vitamin K activates a protein (osteocalcin)

– responsible for building and maintaining strong
bone tissue

Prevents atherosclerosis

• Atherosclerosis is the hardening of arteries
which inhibits the flow of blood around the
body