In developed countries, clinical vitamin A deficiency is rare in infants and occurs only in those with malabsorption disorders . However, preterm infants do not have adequate liver stores of vitamin A at birth and their plasma concentrations of retinol often remain low throughout the first year of life [17,18]. Preterm infants with vitamin A deficiency have an increased risk of eye, chronic lung, and gastrointestinal diseases .
Vitamin D requirements cannot ordinarily be met by human milk alone [1,31], which provides <25 IU/L to 78 IU/L . (The vitamin D content of human milk is related to the mother's vitamin D status, so mothers who supplement with high doses of vitamin D may have correspondingly high levels of this nutrient in their milk .) A review of reports of nutritional rickets found that a majority of cases occurred among young, breastfed African Americans . A survey of Canadian pediatricians found the incidence of rickets in their patients to be 2.9 per 100,000; almost all those with rickets had been breast fed . While the sun is a potential source of vitamin D, the AAP advises keeping infants out of direct sunlight and having them wear protective clothing and sunscreen . As noted earlier, the AAP recommends that exclusively and partially breastfed infants be supplemented with 400 IU of vitamin D per day , the RDA for this nutrient during infancy.
^ "Scientific Opinion on the substantiation of health claims related to vitamin E and protection of DNA, proteins and lipids from oxidative damage (ID 160, 162, 1947),... maintenance of normal cardiac function (ID 166),... maintenance of normal blood circulation (ID 216)... pursuant to Article 13(1) of Regulation (EC) No 1924/2006". European Food Safety Authority EFSA Journal. 8 (10): 1816. 2010. doi:10.2903/j.efsa.2010.1816.
The role of vitamin E in infant nutrition has a long research history. From 1949 onward there were trials with premature infants suggesting that oral alpha-tocopherol was protective against edema, intracranial hemorrhage, hemolytic anemia and retrolental fibroplasia. A 2003 Cochrane review concluded that vitamin E supplementation in preterm infants reduced the risk of intercranial hemorrhage and retinopathy, but noted an increased risk of sepsis.
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Prolonged exclusive breastfeeding without the AAP-recommended vitamin D supplementation is a significant cause of rickets, particularly in dark-skinned infants breastfed by mothers who are not vitamin D replete . Additional causes of rickets include extensive use of sunscreens and placement of children in daycare programs, where they often have less outdoor activity and sun exposure [20,29]. Rickets is also more prevalent among immigrants from Asia, Africa, and the Middle East, possibly because of genetic differences in vitamin D metabolism and behavioral differences that lead to less sun exposure.
Bedri, A., Gudetta, B., Isehak, A., Kumbi, S., Lulseged, S., Mengistu, Y., Bhore, A. V., Bhosale, R., Varadhrajan, V., Gupte, N., Sastry, J., Suryavanshi, N., Tripathy, S., Mmiro, F., Mubiru, M., Onyango, C., Taylor, A., Musoke, P., Nakabiito, C., Abashawl, A., Adamu, R., Antelman, G., Bollinger, R. C., Bright, P., Chaudhary, M. A., Coberly, J., Guay, L., Fowler, M. G., Gupta, A., Hassen, E., Jackson, J. B., Moulton, L. H., Nayak, U., Omer, S. B., Propper, L., Ram, M., Rexroad, V., Ruff, A. J., Shankar, A., and Zwerski, S. Extended-dose nevirapine to 6 weeks of age for infants to prevent HIV transmission via breastfeeding in Ethiopia, India, and Uganda: an analysis of three randomised controlled trials. Lancet 7-26-2008;372(9635):300-313. View abstract.
Naturally sourced d-alpha-tocopherol can be extracted and purified from seed oils, or gamma-tocopherol can be extracted, purified, and methylated to create d-alpha-tocopherol. In contrast to alpha-tocopherol extracted from plants, which is also called d-alpha-tocopherol, industrial synthesis creates dl-alpha-tocopherol. "It is synthesized from a mixture of toluene and 2,3,5-trimethyl-hydroquinone that reacts with isophytol to all-rac-alpha-tocopherol, using iron in the presence of hydrogen chloride gas as catalyst. The reaction mixture obtained is filtered and extracted with aqueous caustic soda. Toluene is removed by evaporation and the residue (all rac-alpha-tocopherol) is purified by vacuum distillation." Specification for the ingredient is >97% pure. This synthetic dl-alpha-tocopherol has approximately 50% of the potency of d-alpha-tocopherol. Manufacturers of dietary supplements and fortified foods for humans or domesticated animals convert the phenol form of the vitamin to an ester using either acetic acid or succinic acid because the esters are more chemically stable, providing for a longer shelf-life. The ester forms are de-esterified in the gut and absorbed as free alpha-tocopherol.
Potential confounding factors are the form of vitamin E used in prospective studies and the amounts. Synthetic, racemic mixtures of vitamin E isomers are not bioequivalent to natural, non-racemic mixtures, yet are widely used in clinical trials and as dietary supplement ingredients. One review reported a modest increase in cancer risk with vitamin E supplementation while stating that more than 90% of the cited clinical trials used the synthetic, racemic form dl-alpha-tocopherol.
The German-speaking scientists who isolated and described vitamin K (in addition to naming it as such) did so because the vitamin is intimately involved in the coagulation of blood following wounding (from the German word Koagulation). At the time, most (but not all) of the letters from F through to J were already designated, so the use of the letter K was considered quite reasonable. The table Nomenclature of reclassified vitamins lists chemicals that had previously been classified as vitamins, as well as the earlier names of vitamins that later became part of the B-complex.
Cho, E., Hunter, D. J., Spiegelman, D., Albanes, D., Beeson, W. L., van den Brandt, P. A., Colditz, G. A., Feskanich, D., Folsom, A. R., Fraser, G. E., Freudenheim, J. L., Giovannucci, E., Goldbohm, R. A., Graham, S., Miller, A. B., Rohan, T. E., Sellers, T. A., Virtamo, J., Willett, W. C., and Smith-Warner, S. A. Intakes of vitamins A, C and E and folate and multivitamins and lung cancer: a pooled analysis of 8 prospective studies. Int.J.Cancer 2-15-2006;118(4):970-978. View abstract.
Yu, A. L., Gilman, A. L., Ozkaynak, M. F., London, W. B., Kreissman, S. G., Chen, H. X., Smith, M., Anderson, B., Villablanca, J. G., Matthay, K. K., Shimada, H., Grupp, S. A., Seeger, R., Reynolds, C. P., Buxton, A., Reisfeld, R. A., Gillies, S. D., Cohn, S. L., Maris, J. M., and Sondel, P. M. Anti-GD2 antibody with GM-CSF, interleukin-2, and isotretinoin for neuroblastoma. N.Engl.J Med. 9-30-2010;363(14):1324-1334. View abstract.
Vitamin D has other roles in the body, including modulation of cell growth, neuromuscular and immune function, and reduction of inflammation [1,3,4]. Many genes encoding proteins that regulate cell proliferation, differentiation, and apoptosis are modulated in part by vitamin D . Many cells have vitamin D receptors, and some convert 25(OH)D to 1,25(OH)2D.
^ Jump up to: a b c d e Péter S, Friedel A, Roos FF, Wyss A, Eggersdorfer M, Hoffmann K, Weber P (December 2015). "A Systematic Review of Global Alpha-Tocopherol Status as Assessed by Nutritional Intake Levels and Blood Serum Concentrations". International Journal for Vitamin and Nutrition Research. Internationale Zeitschrift Fur Vitamin- und Ernahrungsforschung. Journal International de Vitaminologie et de Nutrition. 85 (5–6): 261–281. doi:10.1024/0300-9831/a000281. PMID 27414419.
Ortega, J. J., Madero, L., Martin, G., Verdeguer, A., Garcia, P., Parody, R., Fuster, J., Molines, A., Novo, A., Deben, G., Rodriguez, A., Conde, E., de la Serna, J., Allegue, M. J., Capote, F. J., Gonzalez, J. D., Bolufer, P., Gonzalez, M., and Sanz, M. A. Treatment with all-trans retinoic acid and anthracycline monochemotherapy for children with acute promyelocytic leukemia: a multicenter study by the PETHEMA Group. J Clin.Oncol. 10-20-2005;23(30):7632-7640. View abstract.
Chintu, C., Bhat, G. J., Walker, A. S., Mulenga, V., Sinyinza, F., Lishimpi, K., Farrelly, L., Kaganson, N., Zumla, A., Gillespie, S. H., Nunn, A. J., and Gibb, D. M. Co-trimoxazole as prophylaxis against opportunistic infections in HIV-infected Zambian children (CHAP): a double-blind randomised placebo-controlled trial. Lancet 11-20-2004;364(9448):1865-1871. View abstract.
General: Recommended Dietary Allowance (RDA) levels for adults have been established: men 14 years and older, 900 mcg/day (3000 IU); women 14 years and older, 700 mcg/day (2300 IU); pregnancy 14 to 18 years, 750 mcg/day (2500 IU); 19 years and older, 770 mcg/day (2600 IU); lactation 14 to 18 years, 1200 mcg/day (4000 IU); 19 years and older, 1300 mcg/day (4300 IU). Tolerable Upper Intake Levels (UL) for vitamin A have also been established. The UL is the highest level of intake that is likely to pose no risk of harmful effects. The ULs for vitamin A are for preformed vitamin A (retinol) and do not include provitamin A carotenoids: adolescents 14 to 18 years (including pregnancy and lactation), 2800 mcg/day (9000 IU); adults age 19 and older (including pregnancy and lactation), 3000 mcg/day (10,000 IU).
Comparing vitamin D intake estimates from foods and dietary supplements to serum 25(OH)D concentrations is problematic. One reason is that comparisons can only be made on group means rather than on data linked to individuals. Another is the fact that sun exposure affects vitamin D status; serum 25(OH)D levels are generally higher than would be predicted on the basis of vitamin D intakes alone . The NHANES 2005–2006 survey found mean 25(OH)D levels exceeding 56 nmol/L (22.4 ng/mL) for all age-gender groups in the U.S. population. (The highest mean was 71.4 nmol/L [28.6 ng/mL] for girls aged 1–3 years, and the lowest mean was 56.5 nmol/L [22.6 ng/mL] for women aged 71 and older. Generally, younger people had higher levels than older people, and males had slightly higher levels than females.) 25(OH)D levels of approximately 50 nmol/L (20 ng/mL) are consistent with an intake of vitamin D from foods and dietary supplements equivalent to the RDA .
Vitamin A is POSSBILY UNSAFE when taken by mouth in high doses. Some scientific research suggests that higher doses might increase the risk of osteoporosis and hip fracture, particularly in older people. Adults who eat low-fat dairy products, which are fortified with vitamin A, and a lot of fruits and vegetables usually do not need vitamin A supplements or multivitamins that contain vitamin A.
The U.S. Department of Agriculture's (USDA's) FoodData Central lists the nutrient content of many foods and provides a comprehensive list of foods containing vitamin D arranged by nutrient content and by food name. A growing number of foods are being analyzed for vitamin D content. Simpler and faster methods to measure vitamin D in foods are needed, as are food standard reference materials with certified values for vitamin D to ensure accurate measurements .
Kang, S., Leyden, J. J., Lowe, N. J., Ortonne, J. P., Phillips, T. J., Weinstein, G. D., Bhawan, J., Lew-Kaya, D. A., Matsumoto, R. M., Sefton, J., Walker, P. S., and Gibson, J. R. Tazarotene cream for the treatment of facial photodamage: a multicenter, investigator-masked, randomized, vehicle-controlled, parallel comparison of 0.01%, 0.025%, 0.05%, and 0.1% tazarotene creams with 0.05% tretinoin emollient cream applied once daily for 24 weeks. Arch Dermatol 2001;137(12):1597-1604. View abstract.
Vitamins are classified as either water-soluble or fat-soluble. In humans there are 13 vitamins: 4 fat-soluble (A, D, E, and K) and 9 water-soluble (8 B vitamins and vitamin C). Water-soluble vitamins dissolve easily in water and, in general, are readily excreted from the body, to the degree that urinary output is a strong predictor of vitamin consumption. Because they are not as readily stored, more consistent intake is important. Fat-soluble vitamins are absorbed through the intestinal tract with the help of lipids (fats). Vitamins A and D can accumulate in the body, which can result in dangerous hypervitaminosis. Fat-soluble vitamin deficiency due to malabsorption is of particular significance in cystic fibrosis.