By
Dr. LASYA

Contents:
• Introduction
• History and Nomenclature
• Classification of Vitamins
• Differences between water and fat soluble Vitamins
• Fat soluble Vitamins
• Water soluble Vitamins
• Vitamins deficiency and Oral manifestations
• Public health significance
• Conclusion
• References

INTRODUCTION
• Vitamins may be regarded as organic compounds required in the diet in small
amounts to perform specific biologic functions for normal maintenance of
optimum growth and health of the organisms
• Generally, vitamins are not synthesized by the body, and need to be supplied
through the diet

History and Nomenclature
• HOPKINS - Coined term ACCESSORY FACTORS to unknown and
essential nutrients present in the natural foods
• FUNK - 1) Isolated an active principle from rice polishing's and in yeast
cured Beri - Beri in pigeons
2) Coined the term VITAMINE from the words vital + amines
3) Later it was called “ VITAMIN ”
• Mc COLLUM and DAVIS - Introduced the usage of A, B, and C to vitamins

CLASSIFICATION
• There are about 13 vitamins, essential for humans classified as follows

Energy - Releasing Hematopoietic
Vitamins
Water Soluble Fat Soluble
Others
Non-B-Complex B-Complex
Ascorbic acid
(vitamin C)
Vitamin A
Vitamin D
Vitamin E
Vitamin K
Thiamine (B1)
Riboflavin (B2)
Niacin (B3)
Biotin
Pantothenic Acid
Folic Acid
Vitamin (B12)
Pyridoxine (B6)
Pyridoxal
Pyridoxamine

1) Major vitamins
2) Solubility in fat
3) Water solubility
4) Absorption
5) Storage
1) A,D,E,K
2) Soluble
3) Not soluble
4) Along with lipids,
requires bile salts
5) Stored in liver and
adipose tissues
1) B and C
2) Not soluble
3) Soluble
4) Simple absorption
5) No storage
Fat soluble Water Soluble

6) Excretion
7) Toxicity
8) Deficiency
9) Treatment of
deficiency
6) Not excreted
7) Hypervitaminosis may
result
8) Manifests only when
stores are depleted
9) Single large doses may
prevent deficiency
6) Excreted
7) Non toxic, since excess is
excreted
8) Manifests rapidly as there
is no storage
9) Regular dietary supply is
required
Fat Soluble Water Soluble

Vitamers:
• Chemically similar substances that possess qualitatively similar vitamin activity
Eg:
Retinol
A
Retinal
Retinoic Acid
Pyridoxine Pyridoxal
Pyridoxamine
B6

FAT SOLUBLE VITAMINS

VITAMIN A
• Fat soluble vitamin
• Present only in foods of animal origin
• Carotenes - Plants

Dietary Sources:
Animal sources
• Liver
• Kidney
• Egg yolk
• Milk
• Cheese
• Fish liver oils
Plant sources
• Carrots
• Papaya, Mangoes
• Avocado, Melon
• Pumpkins

RDA (Recommended Dietary Allowance):
Men - 1000 RE (3500 IU)
Women - 800 RE (2500 IU)
Children - below 6 years - 350 - 400 µg Retinol
- 6-17 years – 600 µg Retinol
Pregnancy – 800 µg Retinol
Lactation – 950 µg Retinol
1 RE – 1 µg of Retinol
1 IU – 0.3 mg of Retinol

Biochemical Functions:
• Vision - the role of vit A in the process
of vision was first elucidated
by GEORGE WALD(1968)
• The events occur in a cyclic process
known as Rhodopsin Cycle (or) Wald’s Cycle

RODS and CONES:
• Retina of eye possesses rods and cones
• Human eye - 10 million rods
5 million cones
• Rods –Periphery – Dim light vision
• Cones – Centre – Bright light and color vision

Other Biochemical Functions:
Involved in cell growth and differentiation by
regulating protein synthesis
Maintenance of proper Immune system
Synthesis of Glycoproteins
Synthesis of Transferrin – Iron transport protein
Helps in Cholesterol synthesis
Beta carotenes has Antioxidant property
Prevent Keratin synthesis by maintaining healthy
epithelial tissue

Deficiency of Vitamin A:
1) Night Blindness
2) Conjuctival Xerosis
3) Bitot Spots
4) keratomalacia
Night Blindness:
Difficulty to see in dim light
• Due to impairment in dark adaptation
• Prolonged deficiency irreversibly damages number of visual cells

Conjuctival Xerosis:
• First clinical sign of vitamin A deficiency
• Conjunctiva becomes dry and non – wettable
• Appears muddy and wrinkled instead of smoothy and shiny

Bitot spot’s:
• Triangular, pearly white or yellowish foamy spots on bulbar conjunctiva on either
side of the cornea
• Frequently bilateral

Keratomalacia:
• The cornea may becomes soft and may burst
• It’s a rapid process
• If the eye collapses, vision is lost
• Treatment:
• Administration of massive (2,00,000 IU
or 110 mg of retinol palmitate ) orally on 2 successive days

Other Deficiency Manifestations:
• Growth retardation due to impairment in skeletal formation
• Sterility in males
• Skin becomes dry and rough
• Keratinization of epithelial cells of GIT, Urinary tract, Respiratory tract
increased Bacterial infections

Hypervitaminosis A :
• Total serum vit A level is elevated (Normal -20 -50 µg/dl)
• Symptoms: Dermatitis
Enlargement of liver
Skeletal decalcification
Tenderness of long bones
Weight loss
Hair loss
Irritability
Joint pains

Treatment:
• Stopping high intake of vitamin A – in case of hypervitaminosis
• Administration of massive dose (2,00,000 IU or retinol palmitate) orally on 2
successive days

VITAMIN D
• ANGUS – Isolated and named it as CALCIFEROL
• Resembles sterols in structure
• Functions like hormone

Synthesis:

Dietary Sources:
• Fatty acids
• Fish liver oils
• Egg yolk
• Cheese
• Butter

RDA:
• 400 IU or 10 mg of cholecalciferol
• Countries with good sunlight – 200 IU or 5 mg

Biochemical Functions:
Increases the intestinal
absorption of calcium and
phosphate by increasing of
a specific Calcium binding
protein
Essential for bone formation
Along with Parathyroid hormone
increases mobilization of
calcium and phosphate from the
bone
Minimizes the excretion of
calcium and phosphate
through the kidney, by
decreasing their excretion
and enhancing Reabsorption

Deficiency:
1) RICKETS - In young children aged 6 months to 2 years
• Due to reduced calcification of young bones
• Characterized by Growth failure
Bone deformity
Muscular hypotonia
Tetany and convulsions
• Elevated conc. Of alkaline phosphatase in serum

• Bony deformities - Bow legs
Deformed pelvis
Pigeon chest
Harrison’s sulcus
Rickety rosary kyphoscoliosis
• Walking and Teething are delayed

2) OSTEOMALACIA:
• In adults
• Women
• During pregnancy and lactation
• Demineralization of bones
increased susceptibility to
fractures

Prevention:
• Educating parents to expose their children regularly to sunshine
• Periodic dosing of young children with Vitamin D
• Vitamin D rich diet

Hypervitaminosis D:
• Vitamin D is most toxic in overdoses (10-100 times RDA)
• Toxic effects – demineralization of bones
• Increased calcium absorption from the intestine Increased calcium in
plasma Deposition of calcium in kidneys and arteries
• Formation of stones in kidneys
• Also associated with nausea, loss of appetite, increased thirst and weight loss

VITAMIN E
• Tocopherol
• Naturally occurring Antioxidant

• ANTI STERILITY HORMONE - as it is essential for normal reproduction
in many animals
• Vitamin in search of a disease - due to lack of any specific vitamin E
deficiency disease in humans
• EVANS and his associates - Isolated compounds of vitamin E activity
and named as “TOCOPHEROL”

Dietary sources:
• Wheat germ oil
• Cotton germ oil
• Peanut oil
• Corn oil
• Sunflower oil
• Meat
• Milk
• Butter
• Eggs

RDA:
• Women - 8 mg (12 IU) of alpha Tocopherol
• Men – 10 mg (15 IU) of alpha Tocopherol
1 mg of alpha Tocopherol - 1.5 IU

Biochemical functions:
Prevents peroxidation of PUFA (Poly unsaturated
fatty acids) in various tissues and membranes.
Protects RBC from hemolysis by oxidizing agents
Essential for the membrane structure and integrity of
the cell – regarded as Membrane Antioxidant along
with ‘Se’
Increases synthesis of Heme by enhancing the
activity of enzymes delta – ALA (aminolevulenic
acid) synthase and dehydratase
Associated with reproductive functions and
prevents sterility

Required for cellular respiration through electron
transport chain
Essential for optimal absorption of amino acids
from the intestine
Involved in proper synthesis of Nucleic acids
Protects liver from toxic compounds like carbon
tetrachloride
Works in association with vit A, C, and beta
carotenes to delay the onset of cataract

Deficiency symptoms:
• In Animals – Sterility
Degenerative changes in muscle
Megaloblastic anaemia
Changes in CNS
• In Humans – Increased fragility of erythrocytes
Minor neurological symptoms

VITAMIN K
• Only fat soluble vitamin with a specific coenzyme functions
• Required for production of blood clotting factors

Dietary sources:
• Cauliflower
• Cabbage
• Alfa Alfa
• Tomatoes
• Spinach
• Egg yolk
• Cheese
• Liver
• meat

RDA:
• Adult – 70 – 140 µg/day

Biochemical Functions:
Brings about the post translational modification of
Blood Clotting factors
The clotting factors 2, 7, 9, 10 are synthesized as
inactive precursors in the liver
Acts as a coenzyme for the carboxylation of
Glutamic acid present in the proteins

Deficiency Symptoms:
Leads to lack of active prothrombin in circulation
Increased blood clotting time
Treatment – Injection of vitamin K (IM)

Hypervitaminosis K:
• Increased levels of vitamin K results in Haemolytic Anaemia
Jaundice
In Infants

Antagonists of vitamin K:
• Heparin
• Bishydroxy coumarin
• Salicylates
• Dicumarol - Structurally related to vitamin K and acts as
competitive inhibitor in the synthesis of active
Prothrombin
Acts as Anticoagulants

WATER SOLUBLE VITAMINS

VITAMIN C
• Water soluble versatile vitamin
• Plays important role in human health and disease

Dietary Sources
• Citrus fruits
• Gooseberry (Amla)
• Guava
• Cabbage
• Spinach
• Tomatoes
• Adrenal glands
• gonads High source of vitamin C

RDA:
• Adults - 60 -70 mg
• 20 – 40% increase – Recommended for women during pregnancy and lactation

Biochemical Functions:
Required for bone formation
Plays an important role in collagen formation. Acts as
coenzyme in hydroxylation of proline and lysine
Plays an important role in degradation of
hemoglobin to bile pigments
Enhances Iron absorption
Essential in the synthesis of Serotonin

Required for oxidation of P – hydroxyphenylpyruvate
to homogentisic acid in tyrosine metabolism
Reduces risk of Cancer, Cataract, Coronary Heart
diseases
Essential in the synthesis of Corticosteroid hormones,
Immunoglobulins
Essential for formation of tetrahydrofolate
Involved in maturation of Erythrocytes

Deficiency symptoms:
• SCURVY – Spongy, Sore gums
Loose teeth
Anaemia
Swollen joints
Fragile blood vessels

• Decreased immunocompetence
• Delayed wound healing
• Sluggish hormonal function of adrenal cortex and glands
• Perifollicular haemorrhage with Corkscrew hair
• Osteoporosis
• Scorbutic tongue
Treatment – 300mg/day – Children
500 – 1000/day – Adults
for about 3 months or until resolution of clinical sequele

THIAMINE (B1)
• Anti Beri Beri, Anti Neuritic Vitamin
• Water soluble
• Has specific coenzyme – THIAMINE PYROPHOSPHATE – Associated with
carbohydrate metabolism

Dietary Sources:
• Cereals
• Oil seeds
• Pulses
• Nuts
• Pork
• Liver
• Heart
• Kidney
• Milk

RDA:
• Adults - 1-1.5 mg/day
• Children - 0.7 – 1.2 mg/day
• 2 mg/day – Pregnancy
Lactation
Old age
Alcoholism

Biochemical Functions:
Plays an important role in transmission of
Nerve Impulse
Most of the enzymes namely Pyruvate
dehydrogenase, alpha - Ketoglutarate
dehydrogenase, Transketolase – requires
TPP in carbohydrate metabolism

Deficiency Symptoms:
• BERI BERI
• Commonly seen in people consuming exclusively polished rice as staple food
Symptoms:
• Loss of appetite
• Weakness
• Nausea
• Mental depression

• Constipation
• Peripheral Neuropathy
• Irritability
• Numbness in the legs
Treatment - Adults – 1- 1.5 mg/day
Children - 0.7 - 1.2 mg/day
Pregnancy and Lactation – 2 mg/day

• Neurological manifestations -
Peripheral neuritis
• Muscle weakness
Difficulty in walking
• Edema of legs, face, trunk, serous
cavities
• Breathlessness
• Palpitations
• Calf muscles slightly swollen
• Systolic BP , Diastolic BP
• Heart becomes weak
Dry Beri Beri Wet Beri Beri

Dry Beri Beri Wet Beri Beri

RIBOFLAVIN (B2)
• Water soluble vitamin
• Takes part in various cellular oxidation – reduction reactions
• Coenzymes – Flavin mononucleotide (FMN)
Flavin Adenine dinucleotide

Dietary sources:
• Milk and its products
• Eggs
• Meat
• Liver
• Kidney
• Cereals
• Fruits
• Vegetables
• Fish

RDA:
• Adult – 1.2 – 1.7 mg/day
• Requirement increases in Pregnancy and lactation

Biochemical Functions:
Flavin coenzymes – responsible for energy
production by participating in many redox
reaction
Co enzymes are associated with enzymes
involved in carbohydrate, lipid, protein and
purine metabolism and electron transport
chain

Deficiency Symptoms:
• Cheilosis
• Glossitis
• Dermatitis

NIACIN (B3)
• Pellagra preventive factor
Coenzymes:
1) NAD+
2) NADP+
Synthesized by essential
amino acids - Tryptophan
B3

Dietary Sources:
• Liver
• Yeast
• Whole grains
• Cereals
• Pulses
• Milk
• Eggs
• Vegetables
• Fish

RDA:
• Adults – 15 – 20 mg/day
• Children – 10 – 15 mg/day
1 NE = 1 mg Niacin
or
60 mg of Tryptophan

Biochemical Functions:
Coenzymes NAD+ and NADP+ involved
in variety of Oxidation – Reduction
reactions
NADH – generates ATP by oxidation in
Electron Transport Chain
NADPH – important for many
biosynthetic reactions as it donates
reducing equivalents

Deficiency Symptoms:
• PELLAGRA – seen among people whose staple diet is corn or maize
• Involves skin, GIT, CNS
Symptoms:
• 3D’s - Dermatitis – neck ( Casal necklace) dorsal part of feet, ankle, parts of face
Diarrhoea – in the form of loose stools, often associated with
blood and mucus
Dementia – degeneration of nervous tissue – anxiety, irritability,
poor memory, insomnia
Death

PYRIDOXINE (B6)
• Represents 3 compounds – Pyridoxine
Pyridoxal
Pyridoxamine
• Active form of B6 is the coenzyme – PYRIDOXAL PHOSPHATE (PLP)

Dietary Sources:
• Egg yolk
• Fish
• Milk
• Wheat
• Corn
• Cabbage
• Roots
• Tubers

RDA:
• Adult – 2 -2.2mg /day
• Pregnancy
Lactation
2.5 mg/day

Biochemical Functions:
Pyridoxal phosphate participates in
reactions like Transamination,
Decarboxylation, Deamination,
Transsulfuration, Condensation
PLP – required for synthesis of delta –
amino Levulinic acid
Energy Releasing Vitamin – as it
participates in Transamination
reactions

Deficiency Symptoms:
• Pyridoxine deficiency is associated with neurological symptoms such as
depression, irritability, nervousness, mental confusion
• In children – there is drastically reduced GABA production
Convulsions (epilepsy)
• In severe deficiency – convulsions, peripheral neuropathy
• Decrease in Hb levels, associated with Hypochromic microcytic anemia also seen
Treatment – 10 – 100mg IV – Active seizures
25 – 600mg Orally – less serious or less acute presentations

BIOTIN
• Formerly known as Anti Egg White Injury Factor, Vitamin B7 or Vitamin H
• It is a sulfur containing B complex vitamin
• Directly participates as a coenzyme in the carboxylation reactions

Dietary Sources:
• Egg yolk
• Tomatoes
• Grains
• Milk
• Liver
• Kidney

RDA:
• Adults – 100 - 300mg

Biochemical functions:
Gluconeogenesis and citric acid cycle
Pyruvate oxaloacetate
pyruvate carboxylase
BIOTIN
BIOTIN
BIOTIN
Fatty acid synthesis
Acetyl coA Malonyl coA
Acetyl co A carboxylase
Propionyl coA Methylmalonyl coA
Propionyl co A carboxylase

Deficiency Symptoms:
• Anaemia
• Loss of appetite
• Hair loss (alopecia)
• Nausea
• Dematitis
• Glossitis
• Depression, Hallucinations
• Muscle pain

PANTOTHENIC ACID
• Formerly known as Chick Anti – Dermatitis
• Widely spread vitamin
• Coenzyme A

Dietary Sources:
• Eggs
• Meat
• Liver
• Yeast
• Milk

RDA:
• Adults – 5 – 10 mg/day

Biochemical Functions:
Involved in carbohydrate, protein
and lipid synthesis
Serves as a carrier of activated Acetyl
or Acyl groups
Involved in formation of Fatty
acids
Regarded as coenzyme of metabolic
integration
Succinyl coA involved in synthesis
of porphyrins of Heme

Deficiency Symptoms:
• Deficiency manifestations – not reported in humans
• Dr. Gopalan – linked Burning feet syndrome with B5 deficiency
• Burning feet syndrome - Pain and numbness in the toes
Sleeplessness
Fatigue
Treatment – Pantothenol or Calcium Pantothenate
Symptoms resolves usually in 4 weeks

FOLIC ACID
• Vitamin B9 or Folacin
• Water soluble vitamin
• Active form of folic acid – Tetrahydrofolate (THF or FH4)

Dietary Sources:
• Green vegetables
• Whole grains
• Cereals
• Liver
• Kidney
• Yeast
• Eggs

RDA:
• 200 µg/day
• 300 µg/day – Pregnancy and lactation

Biochemical Functions:
Tetrahydrofolate involved in one carbon
metabolism
THF serves as an acceptor or donor of one
carbon units in reactions involving amino
acid and nucleotide metabolism
Amino acids like Glycine, Serine,
Ethanolamine and Choline are synthesized
N – Formylmethionine, the initiator of
protein biosynthesis is formed

Deficiency Symptoms:
• Pregnant women, lactating women, and women on oral contraceptives, alcoholics
are susceptible to folate deficiency
• Impaired DNA synthesis – decreased production of Purines and Pyrimidines
• Macrocytic anemia
• FIGLU (Formiminoglutamate) accumulates and excreted in urine
• Hyperhomocystenemia
Treatment – 1-5 mg of folic acid per day Orally

COBALAMIN (B12)
• Anti – Pernicious Anemia Vitamin
• Unique vitamin synthesized by only microorganisms
• Coenzymes – 1) 5- deoxyadenosyl cobalamine
2) Methylcobalamin

Dietary Sources:
• Chicken
• Pork
• Fish
• Eggs
• Curd
• Milk
• Liver
• Kidney

RDA:
• Adults - 3 µg/day
• Children - 0.5 – 1.5 µg/day
• Pregnancy
Lactation
4 µg/day

Biochemical Functions:
Synthesis of Methionine from homocysteine
Homocysteine Methionine
Homocysteine
methyltransferase
Methylcobalamine
Isomerization of Methylmalonyl coA to
Succinyl coA
Methyl Succinyl coA
malonyl coA Methylmalonyl
coA mutase
Deoxyadenosyl
cobalamine

Deficiency Symptoms:
• Deficiency of vitamin B 12 is seen among the strict vegetarians
• Pernicious anemia
• Neuronal degeneration and demyelination of nervous system
Symptoms:
1) Paresthesia of fingers and toes
2) In advanced stages – confusion, loss of memory, psychosis
• Impaired fatty acids synthesis
• Excretion of methylmalonic acid in urine
Treatment – 100 -1000 µg IM

CONCLUSION
• Vitamins are essential to our life.
• First of all, vitamin is that component of a balanced diet, which the human body
generally cannot be synthesized on its own.
• So we must consume vitamins directly in the form of food or through supplements
as tonic or tablets.
• The whole process of assimilaton of vitamins depends on ingestion of food
• Vitamins play an important role in normal health of oral structures especially fat
soluble vitamins deficiency which affects hard tissues

REFERENCES
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• Newman et al. Carranza’s Clinical Periodontology. 11th Edition: Elsevier
• Park. Park’s Textbook Of Preventive and Social Medicine. 24th Edition: Bhanot
• Aparna Sheetal et al. Malnutrition and its oral outcome – A review. J Clin Diagn
Res 2013, Jan 7(1): 178-180
• Abhishek Ghosh et al. Role of vitamins and diseases: An overview. Indian
journal of applied research. 2015, December 12(5): 292-295

• Aparna P et al. Vitamin D deficiency in India. J Family Med Prime Care. 2018,
Mar- Apr 7(2): 324-330
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perspective from North India. Indian journal of Endocrinology and Metabolism.
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Dec 17. StatPearls Publishing.
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• Maxfield L, Crane JS. Vitamin C deficiency (scurvy). InStatPearls [Internet] 2019
Mar 18. StatPearls Publishing.
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(Pyridoxine). InStatPearls [Internet] 2018 Oct 27. StatPearls Publishing.