1. Soluble in fat or fat solvent

2. Fairly stable to heat, as in cooking

3. Organic substance (contain carbon)

4. Do not contain nitrogen

5. Absorbed in the intestine along with fats and other lipids

6. Requires bile for absorption

• Coenzyme in metabolism of energy nutrients through the Krebs cycle to produce energy
• Provides normal functioning for the brain, nerves, muscles, heart
• Synthesis of niacin B3
• Helps to regulate appetite

• Works as a coenzyme for the metabolism of carbs, protein, fat
• Necessary for synthesis of niacin & B6
• Maintenance of mucous membranes

• Crucial coenzyme in ATP production
• Works with riboflavin(B2) to produce & metabolize glucose
• Lipid and protein metabolism
• Works to breakdown sucrose to produce organic acid

1. Protein metabolism-Synthesis of unsaturated fatty acids from EAA's
2. Conversion of tryptophan to niacin
3. Hemoglobin synthesis
4. Produce energy from glycogen
5. Proper functioning of nervous system- Includes synthesis of neurotransmitters 

1. Coenzyme in conjunction with folate metabolism in nucleic acid synthesis
2. Metabolism of some amino acids, fatty acids, carbohydrates, folate
3. Essential in formation and regeneration of RBC's
4. Myelin synthesis

1. Production of Collagen
2. Formation of Fibroblasts-Strengthens Tissues
3. Promotes capillary Integrity
4. Facilitates development of RBC's
5. Aids body in use of folate and Vitamin B12
6. Metabolism of Amino Acids
7. Synthesis of Bile Acids,Thyroxine, epinephrine, and steroid hormones
8. May affect immune responses

Primary....not enough in take

Secondary....lack of body function

1. Gingivitis-Periodontitis
2. Deep red-purple gingiva
3. Hyperplasia
4. Enlarged parotid gland(s)
5. BOP
6. Nosebleeds
7. Vomitus or stools containing blood
8. Petechiae (especially lower legs and back

1. Depression
2. Irritability
3. Anorexia
4. Fatigue
5. Inability to concentrate
6. CNS deficiency
7. Beriberi
8. Glossitis
9. Wernicke-Korsakoff Syndrome

Associated with alcoholism

Mental confusion

Nystagmus

Ataxia

1. Pebbly tongue - SlD
2. Glossitis - SlD
3. Dermatitis - SlD
4. Anemia - SlD
5. Progressive papillary atrophy - SeD
6. Progressive patchy, irregular denudation of tongue - SeD
7. Purplish red or magenta tongue - SeD
8. Entire tongue - atrophic and smooth - AdD

1. Stomatitis
2. Lesions on GI tract
3. Pellagrous glossitis
4. Atrophic changes in the papillae

1. Cheilitis
2. Impaired immune response
3. Anemia
4. induced glossitis

1. During pregnancy - increased risk of neural tube disorders
2. Glossitis
3. Candidiasis
4. Appear first in GI Tract, RBC's, WBC'sMegaloblastic anemia's

1. Pernicious anemia
2. Achlordydria
3. Glossophyrosis
4. Glossitis

No documentation of naturally occurring dietary deficiency

1. Pallor of tongue
2. Glossitis
3. Lingual and mucous pallor
4. Patchy atrophy of lingual papillae

Confined to lateral margins or Generalized to entire dorsum

The oral cavity is the site of many systemic disease that can manifest in the oral first because of....

• rapid cellular turnover
• under the constant assault of microorganisms
• trauma-intense environment

Contains Antigenic substances

Separates environment from underlying connective tissue

Replacement of traumatized tissue

Taste buds on papillae

Foliate

Circumvallate Lingual

What modifies the DRI amounts of necessary vitamins?

(16)

1. Rapid growth
2. Pregnancy
3. Lactation
4. Fever
5. Recovery from
6. Accidents
7. Disease
8. Surgery
9. Burns
10. Age
11. Sex
12. Smoking
13. Use of alcohol
14. Caffeine
15. Drugs
16. Stress

1. Papaya
2. Citrus fruits
3. Cantaloupe
4. Green and red pepper
5. Broccoli
6. Kiwi
7. Strawberries
8. Mango

1. Peaches
2. Cabbage
3. Potatoes
4. Sweet Potatoes
5. Tomatoes

Men - 90mg

Women - 75mg

Moderate-heavy physical activity for energy

Need increased for:

Pregnancy

Lactation

Hemodialysis

Perotoneal dialysis

Fever

Hyperthyroidism

Cardiac conditions

Alcoholism

Men 1.2mg/day

Women 1.1mg/day

Whole grains       1 slice/1 cup/3.5-4"

Enriched grains

Pork                                 3 oz

Ham                                 3 oz

Green Peas                      1 cup

Peanuts                              1/4 cup

Soy Milk                           1 cup

Sweet Potatoes                       1 medium

• Mental confusion
• Nystagmus
• Ataxia

No UL

IOM.....

Men 1.1mg/day

Women 1.1mg/day

Milk products

Yogurt                                                    8 oz

Milk                                                          1 cup

Low-fat cottage cheese                      1 cup

Cheddar cheese                                    1 cup

Meat                                                                    3 oz

Uncommon usually a secondary def.

If the pt has poor B2 absorption it can lead to def in vit B6 and niacin

What are the dietary requirements for B3?

(UL & RDA)

UL 35mg/day

RDA for adults 14-16mg/day

Liver, Chicken, Tuna Salmon, Halibut   3 oz

Wheaties                                 1 Cup

Peanuts                                   1/4 Cup

• Nicotinic acid (3-6 g/day) - reduces LDL and triglycerides; increases HDL
• Can improve CHD

• 250 mg/day nicotinic acid - vasodilator
• Extended-release doses
• GI symptoms
• Liver damage
• Larger doses
• Abnormal liver function and gout

Pyridoxine

(Phyridoxine, pyridoxal, pyridoxamin)

• RDA - Adults - 1.1-1.7 mg/day
• Increases with protein intake
• UL - 100/day for adults

Meat, fish, chicken      3 oz

Prune Juice                    8 oz

Tomato Juice                 6 oz

Potato, baked               1 medium

Banana                            1

Alcoholicsc

Elderly

Although this is rarely seen alone

Which one of these  (Folate/Folic acid) is found in foods and which one is in a synthetic form?

Folate - natural form - in foods

Folic acid - synthetic form

RDA 400 ug/day

this can increase during.....

Growth and development, Pregnancy, Lactation

Liver                                                          3 oz

Whole Grain                                              1 cup

Pinto & Navy Beans                                  1/2 cup

Asparagus, Spinach,                                  1/2 cup

Turnip Greens, Broccoli

Romaine Lettuce                                       1 cup

Enriched white rice                                   1/2 cup

Orange juice                                             1 cup

Tomato juice                                             6 oz

Dry roasted peanuts                                  1oz

Folic acid is the most common vit B complex def.

Usually secondary to alcohol consumption, pregnancy, lactation, kidney dialysis, liver disease, inadequate dietary intake, GI disease, medication that interfere with folate absorption and/or metabolism

• Protects against cancer initiation
• Facilitates progression and growth of preneoplastic cells and subclinical cancers

• Kidney Damage
• Mask symptoms of Vitamin B12 deficiency
• Affect natural killer cells in postmenopausal women

Adults 2.4ug/day

no UL

What is the only vitamin to contain a mineral?

What is that mineral?

• B12-colbalamin
• cobalt

Beef liver, lean beef, shrimp,                      3oz

salmon, lean pork, chicken breast 

Egg                                                                       1

NE Clam Chowder/Milk                                  1 Cup

Special K                                                             1 cup

Yogurt, skim; low-fat milk                             8 oz

NO

• Water-soluble
• No benefit
• No harm

• Formation and regeneration of RBC's
• Myelin synthesis
• Normal functioning nervous system

Key role in carbohydrate, fat, and protein metabolism

• EAR, RDA and UL not determined for any age group
• AI for adults is 5 mg/day

Whole grain, trail mix                1 cup

Liver, lean beef                           3 oz

Sunflower seeds                         1/4 cup

Baked beans                               1/2 cup

Synthesis and degradation of:

Triglycerides

Phospholipids

Sterols  

Digestive tract bacteria also produce PA

No documentation of naturally occurring dietary deficiency

• Coenzyme in metabolism of carbohydrates, proteins, fats
• Maintains metabolic homeostasis
• Regulates some gene transcription
• Aids in use of protein, folic acid, pantothenic acid, and vitamin B12

Def can be produced by ingestion of avidin(protein from raw egg whites) but no associated problems associated with cooked eggs

12-24 raw egg white/day

Anorexia

Nausea

Vomiting

Glossitis

Pallor of skin

Depression

Dry scaly dermatitis

Fat-Solube vitamins are stored in the body?

T/F

• True

Vitamins provide energy?

T/F

• False

Animal foods are the principal dietary source of beta carotene?

T/F

• False
• Beta Carotene is found in FRUITS and VEGETABLES
• Retinol is obtained from animal foods

Xerophthalmia occurs with a deficiency of vitamin A?

T/F

• True

The liver and kidney help convert vitamin D to its active form?

T/F

• True

An excess of vitamin D causes rickets?

T/F

• False
• A deficiency of vitamin D causes rickets

Vitamin K is essential for regulation of blood calcium and phosphorus levels?

T/F

• False
• vitamin K is essential for blood clotting
• vitmain D functions in regulation of blood calcuium and phosphorus levels

Vitamin C is needed for wound healing?

T/F

• True

Milk is a good source of riboflavin?

T/F

• True

Vitamin B6 is the sunshine vitamin?

T/F

• False
• Vitamin D is called the "sunshine vitamin" because sun facilitates the body's production of vitamin D
• Vitamin B6 is also called pyridoxine, pyridoxal and pyridoxamine

Carrots are a good source of folate?

T/F

• False
• Liver, leafy vegetables, legumes, grapefruit and oranges are rich sources of folate

http://fda.gov/medwatch and submitting complaints to the FTC regarding misleading advertising:  http://www.ftc.gov/ftc/complaint.htm

Beriberi is caused by niacin deficiency?

T/F

• False
• Beriberi is caused by a thiamine deficiency
• Niacin deficiency causes pellagra

• ASK
• BE
• COMMUNICATE
• DOCUMENT
• DO

Individuals who limit the variety of foods in their diet may need a MVM supplement.

Most effictive when taken with food.

Ask when patient last had a complete physical - what were the results.

If immunocompromised - when did they last see their specialist and what were the results?

Encourage patients for first obtain nutrients from dietary sources.

T/F

• False
• Adverse effects associated with excessive amounts of vitamin E are related to vitamin E supplements only
   

• C - the first sentence is true, the second sentence if false

• D - all of the above

A deficiency in Vitamin K can lead to bleeding problems?

T/F

• True

Vitamin K in its synthetic form is recognized as:

a. K2
b. phylloquinone
c. K1
d. menadione
e. none of the above

• menadione

The three forms of Vitamin K, known as quinones, have a UL of:

a. 3,000
b. 1,500
c. 900
d. no UL has been established

• No UL has been established

The primary role of vitamin D is mineralization of bones and teeth and the regulation of blood calcium and phosphorous levels?

T/F

• True

Milk is required by the FDA to be fortified with vitamin D?

T/F

• False

Which of the following can be caused by a deficiency of vitamin D?

A. Osteoporosis

B. Osteomalacia

C. Rickets

D. All of the above

• all of the above

When is the need for Vitamin A increased?

A.      In times of rapid growth

B.      When GI problems affect absorption or conversion

C.      With hepatic diseases that might limit the storage of Vitamin A.

D.      None of above

E.       A, B, and C

• E - in times of rapid growth, when GI problems affect absorption or conversion and with hepatitic diseases that might limit the storage of vitamin A

Vitamin A can be found in all of these forms except this one:

A.      Retinol

B.      Beta-carotene

C.      Retinoic acid

D.      Quinones

• D - quinones

Over-supplementation is the most common cause of Vitamin A toxicity?

T/F

• True

Vegans may be prone to Vitamin B12 deficiency?

T/F

• True

Complaints of flushing and intestingal distrubances are symptoms of thiamin toxicity?

T/F

• False
• No toxicity symptoms have been observed for thiamin
• Flushing and intestinal distrubances are symptoms of niacin toxicity

A smooth purplish red or magenta tongue may be observed in patients with vitamin B6 deficiency?

T/F

• True

Whole grains are rich in thiamin?

T/F

• True

Thiamin requirement is determinded by one's caloric requirement?

T/F

• True

The first signs of a nutritional deficiency often occur in the oral cavity?

T/F

• True

• bile

• enamel hypoplasia

• ameloblasts

• vitamin E

• vitamin C
• scurvy

• vitamin E

• antioxidants

• vitamin K

Vitamin deficiencies usually occur together?

T/F

• True
• they are often dependent on each other

• Folic Acid

• Lack of vitamin A
• broccoli

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• cataracts

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• scorbotic periodontitis

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• perifollicular petechiae

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[image]

• pebbly tongue
• seen in vitamin B2 deficiencies

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[image]  [image]    [image]

[image]  [image]   [image]

• glossitis

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• angular cheilitis

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[image]

• cleft lip

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• Pellagra dermatitis
• associated with deficienceis in B3 (Niacin)

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[image]

• Pellegra
• associated with deficiencies in Niacin

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[image]  [image]

• ulcerative gingivitis

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[image]

• dermatitis

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[image]

• iron deficiency

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• Fungiform Papillary Hypertrophy

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• candida

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[image] [image]

[image]  [image]

• neural tube disorders (includes spina bifida)

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[image]

• glossopyrosis

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• oral manifestation of achlorhydria

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• BeriBeri

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[image]  [image]

• stomatitis

1-3yrs      .4mg/d

4-8yrs      .5mg/d

9-13yrs    .8mg/d

14-18yrs    1.1mg/d

19>70yrs   1.1mg/d

1-3yrs      .4mg/d

4-8yrs      .5mg/d

9-13yrs    .8mg/d

14-18yrs    .9mg/d

19>70yrs   .9mg/d

pregnancy 14-50yrs     1.2mg/d

Lactation    1.3mg/d

1-3yrs      .5mg/d

4-8yrs      .6mg/d

9-13yrs    .9mg/d

14-18yrs    1 mg/d

19>70yrs   1.1mg/d

pregnancy 14-50yrs     1.4 mg/d

Lactation    1.6 mg/d

1-3yrs      .5mg/d

4-8yrs      .6mg/d

9-13yrs    .9mg/d

14-18yrs    1.3 mg/d

19>70yrs   1.3mg/d

0-6 months   .3mg/d

7-12 months .4mg/d

1-3yrs      .4mg/d

4-8yrs      .5mg/d

9-13yrs    .7mg/d

14-18yrs    1mg/d

19>70yrs   1mg/d

1-3yrs      .4mg/d

4-8yrs      .5mg/d

9-13yrs    .7mg/d

14-18yrs    1 mg/d

19>70yrs   .9 mg/d

pregnancy 14-50yrs     1.2 mg/d

Lactation    1.2 mg/d

1-3yrs      .5mg/d

4-8yrs      .6mg/d

9-13yrs    .9mg/d

14-18yrs    1 mg/d

19>70yrs   1.1 mg/d

pregnancy 14-50yrs     1.4 mg/d

Lactation    1.4 mg/d

1-3yrs      .5mg/d

4-8yrs      .6mg/d

9-13yrs    .9mg/d

14-18yrs    1.2 mg/d

19>70yrs   1.2 mg/d

0-6months  .2mg/d

7-12months  .3mg/d