Vitamin malnutrition

In humans, vitamin A deficiency manifests itself in the following ways night blindness, xerophthalmia, Bitot s spots, and corneal involvement and ulceration. Changes in the skin have also been observed. Although vitamin A deficiency is seen in adults, the condition is particularly harmful in the very young. Often, this results from malnutrition (56). 

Pantothenic acid is found in extracts from nearly all plants, bacteria, and animals, and the name derives from the Greek pantos, meaning everywhere. It is required in the diet of all vertebrates, but some microorganisms produce it in the rumens of animals such as cattle and sheep. This vitamin is widely distributed in foods common to the human diet, and deficiencies are only observed in cases of severe malnutrition. The eminent German-born biochemist Fritz Lipmann was the first to show that a coenzyme was required to facilitate biological acetylation reactions. (The A in... 

In historical terms, folates are among the most recently identified of the vitamins. Wills was the first to describe a form of anaemia associated with pregnancy and malnutrition which could be cured by yeast or liver extract (Wills, 1933 Wills et al, 1937). The active constituent of these dietary... 

Vitamin K is an essential factor in the production of coagulation proteins within the liver. Elevated clotting times from decreased protein synthesis are indistinguishable from those produced by low vitamin K levels caused by malnutrition or poor intestinal absorption. Vitamin K (phytonadione) 10 mg subcutaneously daily for 3 days can help to establish whether the prolonged bleeding time results from loss of synthetic function in the liver or vitamin K deficiency. 

Water-soluble vitamins removed by hemodialysis (HD) contribute to malnutrition and vitamin deficiency syndromes. Patients receiving HD often require replacement of water-soluble vitamins to prevent adverse effects. The vitamins that may require replacement are ascorbic acid, thiamine, biotin, folic acid, riboflavin, and pyridoxine. Patients receiving HD should receive a multivitamin B complex with vitamin C supplement, but should not take supplements that include fat-soluble vitamins, such as vitamins A, E, or K, which can accumulate in patients with renal failure. 

Malnutrition can also cause secondary osteoporosis in persons with different deficiencies of substances such as calcium and vitamin D. Malnutrition due to starvation caused by most severe or terminal chronic diseases and malabsorption due to inflammatory bowel diseases (colitis, Mb Crohn) can give rise to rapidly diminishing bone tissue. 

A healthy diet usually covers average daily vitamin requirements. By contrast, malnutrition, malnourishment (e.g., an unbalanced diet in older people, malnourishment in alcoholics, ready meals), or resorption disturbances lead to an inadequate supply of vitamins from which hypovitaminosis, or in extreme cases avitaminosis, can result. Medical treatments that kill the intestinal flora—e. g., antibiotics—can also lead to vitamin deficiencies (K, Bi2, H) due to the absence of bacterial vitamin synthesis. 

Chronic excessive consumption of alcohol can result in physical dependence or alcoholism. There is often a steady progress in the need to drink, so that the person starts drinking early in the day to maintain blood alcohol levels and avoid withdrawal effects. Alcoholism often results in a variety of organ system effects, some of which are related to accompanying malnutrition. Treatment for alcoholism must address the withdrawal effects as well as associated vitamin deficiencies associated with malnutrition. 

The effectiveness of various therapeutical modalities of supplemental vitamin A has been examined in numerous studies using tablets or capsules. On the basis of these studies, increased consumption of dietary vitamin A has been advocated (World Health Organization, 1984,1992). In India and Indonesia, the provision of extra vitamin A resulted in considerable reduction of mortality (ca. 40%) in preschool children (Bhandari et al 1994 Humphrey et al, 1996). While the efficacy of excessive oral doses over more than 8-12 weeks has been questioned, it is evident that an insufficient, low dose given once per week is apparently of little effect on morbidity or mortality (Ramakrishnan et al, 1995a,b). Indeed, recurrent diarrheal episodes or the existence of malnutrition may explain the poor efficacy seen with oral supplementation with low doses (Ramakrishnan et al., 1995a). 

We found that supplementation of vitamin A in the form of an aerosol is an effective, safe, and routinely manageable method to enhance vitamin A and RBP concentrations. Consequently, this modality of treatment may serve as an alternative vitamin A therapy during chronic or acute episodes of malnutrition, malabsorption, or in case of insufficient compliance to other therapies and might be useful in respiratory diseases associated with vitamin A deficiency. 

Vitamin A deficiency can result from insufficient dietary intake, from malabsorption and it has been recognized that also malfunction of RAR-receptors can lead to symptoms of vitamin A deficiency. These symptoms include skin lesions, night blindness, corneal ulcerations and conjunctivitis and poor bone remodeling. Vitamin A deficiency associated with malnutrition is wide spread in large parts of the world and may be fatal in infants and young children suffering from kwashiorkor or marasmus. 

Vitamin E may be indicated in some rare forms of anemia such as macrocytic, megaloblastic anemia observed in children with severe malnutrition and the hemolytic anemia seen in premature infants on a diet rich in polyunsaturated fatty acids. Also anemia s in malabsorption syndromes have shown to be responsive to vitamin E treatment. Finally, hemolysis in patients with the acanthocytosis syndrome, a rare genetic disorder where there is a lack of plasma jS-lipoprotein and consequently no circulating alpha tocopherol, responds to vitamin E treatment. In neonates requiring oxygen therapy vitamin E has been used for its antioxidant properties to prevent the development retrolental fibroplasia. It should be noted that high dose vitamin E supplements are associated with an increased risk in allcause mortality. 

Medical personnel who work in affluent areas are unlikely to see large numbers of people with vitamin deficiency diseases. However, certain groups of the population are particularly at risk, such as low-income families and chronically ill patients. The classic symptoms of any vitamin deficiency disease as observed in laboratory animals are often blurred in humans. The clinical picture is often complicated by deficiencies of other vitamins, minerals, calories, and protein and by infections and parasite infestations, which usually accompany longstanding malnutrition. Biochemical, physiological, and behavioral changes can occur in the marginal deficiency state without or before the appearance of more specific symptoms. Since the nonspecificity of these changes makes them difficult to detail, this section focuses on the symptoms associated with individual vitamin deficiency diseases. 

The symptoms of pantothenic acid deficiency have not been clinically described. Since pantothenic acid is a ubiquitous vitamin, isolated deficiency is unlikely. However, marginal deficiency may exist in persons with general malnutrition. 

Individuals with chronic alcoholism are prone to gastritis and have increased susceptibility to blood and plasma protein loss during drinking, which may contribute to anemia and protein malnutrition. Alcohol also reversibly injures the small intestine, leading to diarrhea, weight loss, and multiple vitamin deficiencies. 

Malnutrition from dietary deficiency and vitamin deficiencies due to malabsorption are common in alcoholism. 

Pantothenate deficiency is rare, occurring only in cases of severe malnutrition characteristic symptoms include vomiting, intestinal distress, insomnia, fatigue and occasional diarrhoea. Pantothenate is widespread in foods meat, fish, poulty, whole-grain cereals and legumes are particularly good sources. Although no RDA or RNI value has been established for panthothenate, safe and adequate intake of this vitamin for adults is estimated to be 3-7 mg day-1. Pantothenate is non-toxic at doses up to 10 g day-1. 

FUNK, CAS1M.IR 11884-1948). Bom in Poland and later becoming an American citizen. Funk in 1911 isolated a food factor, extracted from rice hulls, that he found to he a cure for a disease caused bv malnutrition (beriberi). Believing this to be an amine compound essential to life, he coined the name vilamine, from which the final e was later dropped. The various Ivpcs and functions of vitamins were not differentiated until some years later as a result of the work of McCollum, Szent-Gyorgi, R.J. Williams, and others. 

Dietary deficiency of vitamin B12 Vegetarian diets, especially in vegans Prolonged severe malnutrition... 

In the setting of established B12 deficiency, treatment is usually by parenteral injection, with 1000 tg given daily for the first 5 days. Thereafter, cyanocobalamin (1000 tg) is given monthly by intramuscular or deep subcutaneous injection. While orally administered drug is not recommended in most patients who have a B12 deficiency due to malnutrition or achlorhydria (failure to release food-bound B12), 1000 jig oral vitamin B12 can be administered daily. A... 

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