Nutrition Chapter 11: The Fat-Soluble Vitamins A, D, E, and K

Case Study: Because Joan is concerned about skin cancer, she uses a sunscreen when she is outside. At what SPF level will sunscreen start to interfere with vitamin D synthesis? a. 16 b. 64 c. 2 d. 32 e. 8

e. 8

The classic sign of vitamin E deficiency is _____. a. thalassemia b. hemochromatosis c. thrombocytopenia d. aplastic anemia e. erythrocyte hemolysis

e. erythrocyte hemolysis

Free radicals: a. are unstable and highly reactive molecules because they contain one or more unpaired electrons. b. act as antioxidants in the body. c. defend against heart disease. d. defend against cancer. e. occur in fruits and vegetables.

a. are unstable and highly reactive molecules because they contain one or more unpaired electrons.

Case Study: Since she is on a blood thinner, Joan has been warned about her intake of foods rich in vitamin K. Which of the following food groups is rich in vitamin K? a. dark green leafy vegetables b. poultry c. freshwater fish d. lunch meats e. ground beef

a. dark green leafy vegetables

Foods rich in vitamin C seem to protect against certain types of cancers, especially _____ cancer. a. head and neck b. breast c. lung d. colorectal e. prostate

a. head and neck

In the 2008 Physicians' Health Study II, the results not only indicated that taking vitamin E could lead to negative health benefits, but it also showed that taking vitamin E led to an increased risk for ________. a. hemorrhagic strokes b. necrotizing fasciitis c. diabetes mellitus d. ulcerative colitis

a. hemorrhagic strokes

The active, or usable, form of vitamin D, is synthesized in the _____ . a. kidneys b. blood c. skin

a. kidneys

If a supplement contains 20,000 IU of beta-carotene, approximately how many µg RAE does it provide? a. 300.5 µg RAE b. 3000 µg RAE c. 3.0 µg RAE d. 30.5 µg RAE

b. 3000 µg RAE

Which of the following is true about Vitamin D synthesis? a. Tanning lamps do not stimulate vitamin D synthesis. b. Dark-skinned people require more sunlight exposure than light-skinned people to make an equivalent amount of vitamin D. c. Sunscreens with SPF of 10 and above prevent the synthesis of vitamin D. d. Smog or heavy cloud cover do not block the ultraviolet rays of the sun that promote Vitamin D synthesis in the skin.

b. Dark-skinned people require more sunlight exposure than light-skinned people to make an equivalent amount of vitamin D.

True or False? In a 2007 study funded by the National Cancer Institute (NCI), smokers who took vitamin E supplements had a decreased risk of lung cancer. a. True b. False

b. False

Which of the following are great food sources for naturally occurring vitamin E? a. Yogurt and cheese b. Nuts, seeds, and leafy green vegetables c. Hotdog and hamburger d. Carrots and tomatoes

b. Nuts, seeds, and leafy green vegetables

In order for this synthesis to occur, a series of steps are necessary and any disruption in this process can result in a deficiency of vitamin D. With this in mind, choose the situations or conditions that could contribute to a vitamin D deficiency. Check all that apply. a. Living in a region with a lot of sunlight b. Wearing protective clothing and sunscreen when outdoors c. Having kidney disease d. Having a lighter skin pigmentation

b. Wearing protective clothing and sunscreen when outdoors c. Having kidney disease

The production of _____, a protein that binds calcium in the intestinal cells, slows as a result of a vitamin D deficiency. a. 7-dehydrocholesterol b. calbindin c. calciferol d. cholecalciferol e. ergocalciferol

b. calbindin

All of the following foods are sources of Vitamin D, except: a. sardines. b. red meats. c. fortified milk. d. egg yolks. e. salmon.

b. red meats.

With respect to acne, _____. a. massive oral doses of vitamin A are effective for all types b. high doses of vitamin A are especially useful in acne associated with pregnancy c. vitamin A compounds are far more likely to aggravate acne than cure it d. Accutane (isotretinoin), which is made from vitamin A, is effective against cystic acne e. topical vitamin A is effective for mild to moderate cases

d. Accutane (isotretinoin), which is made from vitamin A, is effective against cystic acne

Case Study: What features of Joan's diet and supplement use might explain why she now has osteoporosis? a. She spends most of her time indoors b. Her blood levels of vitamin D are low. c. She occasionally drinks 1 cup of Vitamin-D-fortified milk per day. She needs at least 3 cups of dairy per day. d. Her low vitamin D and calcium intakes and her history of taking a multi-vitamin pill containing 5000 IU Vitamin A per day can all lead to the development of osteoporosis. e. Her intake of vitamin D is inadequate to meet her needs of 20 µg per day.

d. Her low vitamin D and calcium intakes and her history of taking a multi-vitamin pill containing 5000 IU Vitamin A per day can all lead to the development of osteoporosis.

Which is a potential side effect from eating abundant carotenoid plant foods? a. excessive calcium intake b. dry, scaly skin c. night blindness d. a temporary orange tint to skin e. toxic levels of vitamin A in the bloodstream

d. a temporary orange tint to skin A side effect from eating abundant carotenoid plant foods is skin that may have a temporary orange tint.

Case Study: Of the foods Joan eats, which is the best source of vitamin D? a. vegetables b. fruit c. meat d. fortified milk e. poultry

d. fortified milk

Case Study: Joan is a 90-year-old Caucasian woman who has recently been diagnosed with osteoporosis after a fall that broke her hip. She is 64 inches tall and weighs 115 pounds. Lately she has been complaining about muscle pain in her legs. She eats a limited diet due to a chronic low appetite. A recent blood test shows Joan's serum vitamin D level is below normal. Her daily diet includes juice or fruit and toast with butter for breakfast, cottage cheese and fruit for lunch, and salad or a frozen vegetable with meat or poultry for dinner. She dislikes most fish except canned tuna and she often drinks a glass of fortified milk before going to bed at night. Although she lives in New Mexico, she spends most days indoors. Joan has been taking a blood-thinning medication since she was discharged from the hospital. She has been taking a daily multivitamin that contains 5000 IU vitamin A and 400 IU vitamin D for many years.

...

D3 or Calciol

Derived from animal foods in the diet or made in the skin.

D2 or Ergocalciferol

Derived from plant foods in the diet.

Calbindin

Transport protein needed to absorb calcium from the intestine.

Osteomalacia

Vitamin D deficiency disease in adults

Rickets

Vitamin D deficiency disease in children.

If 3 oz. of liver provides 6,582 µg RAE, what percentage of the RDA for vitamin A does an adult female receive from 1 oz. of liver? a. 313% b. 131% c. 33% d. 10%

a. 313%

Vitamin E's primary function is as _______ that neutralizes potentially harmful free radicals in the body. a. an antioxidant b. an attached radical c. a catchall d. none of the above

a. an antioxidant

One ounce of ________ provides more than three times the RDA for vitamin A. a. beef liver b. chicken breast c. tofu d. pinto beans e. plain yogurt

a. beef liver

_____ therapy may lead to a _____ deficiency of vitamin K because bacteria provide some of the vitamin K necessary to meet the vitamin K RDA.

antibiotic; secondary A primary deficiency means that the diet is lacking in the nutrient; in this case, vitamin K. A secondary deficiency means that a deficiency occurs, but is not due to insufficient intake of the nutrient. Antibiotics can lead to a secondary deficiency of vitamin K because the vitamin K-producing bacteria in the gut are killed by the antibiotic. Part of our vitamin K requirement is satisfied by the vitamin K produced by gut bacteria. Anticoagulant therapy can lead to a vitamin K deficiency because anticoagulants interfere with vitamin K metabolism and activity.

Even when using sunscreen with an SPF of 15 to 30, sufficient vitamin D synthesis can be obtained in as little as _____ of sun exposure. a. 5 minutes b. 10 to 20 minutes c. 20 to 30 minutes d. 30 to 60 minutes e. 1 to 2 hours

b. 10 to 20 minutes

Which of the following would be a consequence of taking high-dose supplements of vitamin A? a. Keratinization of tissues would occur b. Xerophthalmia would occur c. During pregnancy, high intakes of Vitamin A supplements increases the risk of birth defects. d. Acne would disappear

c. During pregnancy, high intakes of Vitamin A supplements increases the risk of birth defects.

Which vitamin A compound(s) act(s) like hormones, regulating cell differentiation, growth, and embryonic development? a. carotenoids b. retinol c. retinoic acid d. retinoids e. retinal

c. retinoic acid

The World Health Organization and UNICEF recommend two doses of vitamin A supplements, given 24 hours apart, for all children with _____. a. acne b. mumps c. chicken pox d. measles e. bone fractures

d. measles

Which food is a source of preformed vitamin A? a. carrots b. sweet potatoes c. leafy greens d. milk e. black beans

d. milk Preformed vitamin A is found in animal-based foods like dairy, fish, and meat.

Vitamin K is essential for the synthesis of _____ and other clotting factors. a. phylloquinone b. osteocalcin c. calcidiol d. prothrombin e. calcitriol

d. prothrombin

Which of the following is NOT one of the forms of vitamin A in your body and in food listed in the video? a. retinyl esters b. retinal c. retinol d. retinase e. retinoic acid

d. retinase The vitamin A family of retinoids includes retinol, retinal, retinyl esters, and retinoic acid.

Decreased activation of vitamin D will result in _____ absorption of calcium in the small intestine and _____ risk of inadequate bone mineralization.

decreased; increased The active, usable form of vitamin D is termed calcitriol. It is produced following the conversion from calcidiol in the kidneys. In order for this conversion to occur, the inactive form of vitamin D must be obtained from dietary sources or from skin exposure to ultraviolet sunlight. Therefore, a situation where your kidneys are not functioning properly, such as in the case of kidney disease, as well as risk factors for decreased sun exposure, such as wearing protective clothing, would increase your risk of vitamin D deficiency. The activation of vitamin D is required to increase blood calcium levels, resulting in adequate bone mineralization. Decreased vitamin D activation leads to decreased absorption of calcium in the small intestine, which would increase the risk of inadequate bone mineralization.

International units are _____. a. preferred for water-soluble vitamins b. three times the vitamin's weight c. no longer used on vitamin labels d. ½ the vitamin's weight e. used to measure a vitamin's biological effects

e. used to measure a vitamin's biological effects

Some studies report a cancer-preventing effect of consuming _____ , rich in beta-carotene, but do not find a reduction in cancer risk from beta-carotene present in ____ .

fruits and vegetable; supplements Beta-carotene, present in some fruits and veggies, may protect against certain cancers because the beta-carotene may protect DNA from oxidative damage. However, several studies have indicated that beta-carotene supplements are not protective in reducing cancer risk. In fact, one study on cancer prevention was terminated early when it was found that beta-carotene supplements increased the risk of lung cancer in smokers. Fruits and veggies contain many other factors such as other antioxidants and phytochemicals that interact together to prevent certain chronic diseases. Supplements only provide one such compound. Beta-carotene is only found in deep orange, yellow vegetables and fruits and in dark leafy greens. It is not present in animal foods nor in nuts, seeds, or oils.

Infants are injected with Vitamin K shortly after birth to prevent _____ hemolysisItem 1 because they are born with a _____ intestinal tract.

hemorrhagic; sterile Gut bacteria produce vitamin K, but the infant is born with a sterile gut, no bacteria are present. It takes weeks for vitamin K-producing bacteria to become established in the gut. In addition, not very much vitamin K is transferred through the placenta. Thus, an intramuscular injection of vitamin K is given at birth so that the infant is able to form a blood clot when necessary.

Vitamin E acts as an antioxidant, defending _____ in the cell membrane against _____ damage.

lipids; oxidative Vitamin E is a fat-soluble antioxidant, and thus can protect fat-soluble compounds such as the fatty acids that are located in the cell membrane. Proteins are water-soluble. Vitamin C is a water-soluble antioxidant that protects water-soluble compounds from oxidative damage.

Marie is a 63-year-old African American woman from the Midwest. She is lactose intolerant and prefers staying indoors as opposed to going outside. Lately, she has had terrible bone and joint pain and a recent checkup confirms that Marie is deficient in vitamin D and has a disease called _____ , or poor bone mineralization. This would be considered a _____ deficiency that _____ be directly treated with vitamin D supplementation.

osteomalacia; primary; could A vitamin deficiency disease is a disease that is directly caused by inadequate concentrations of a particular nutrient. The diseases are generally reversible once the person begins consuming adequate levels of the nutrient. A primary deficiency is caused by inadequate intake of a particular vitamin, whereas a secondary deficiency is caused by an underlying problem, such as the inability to absorb a vitamin. The deficiency disease associated with inadequate intake of vitamin D is loss of bone mass. In adults, this is called osteomalacia, which is often characterized by a severe pain in the bones and joints.

Vitamin E deficiencies are rare, but they do occur in _____ infants, the primary symptom being erythrocyte _____ .

pre-term; hemolysis Vitamin E deficiency occurs in premature infants because vitamin E is not transferred to the fetus from the mother until the last weeks of pregnancy. Because vitamin E is needed to prevent the oxidation of the polyunsaturated fatty acids in cell membranes, the red blood cells (erythrocytes) break apart (hemolysis) in the premature infant, due to lack of vitamin E.

_____ is the form of vitamin A which acts like a hormone and is necessary for maintaining the health of _____ tissue.

retinoic acid; epithelial Retinoic acid regulates cell differentiation, the process in which immature cells develop to perform a specific function. Epithelial tissue lining the inside of the body are mucous membranes. Retinoic acid promotes the differentiation of epithelial cells and goblet cells. The goblet cells secrete mucus which coats the epithelial cells.

Vitamin E is found predominantly in _____ oils and appears to be one of the _____ toxic of the fat-soluble vitamins.

vegetable; least Vitamin E content in vegetable oils is high, ranging from 5.6 mg per Tbsp in sunflower oil to 1.9 mg per Tbsp in olive and peanut oils. The RDA for Vitamin E is 15 mg/day. Coconut oil only contains 0.01 mg per Tbsp, a very poor source of Vitamin E. The UL for Vitamin E (1000 mg) is more than 65 times greater than its RDA, compared to the ULs for Vitamin A (3000 µg/day) and Vitamin D (100 µg/day). The ULs for Vitamin A and Vitamin D are approximately 3-4 times and 7 times greater, respectively, than their RDAs.

Vitamins have many functions throughout the body. For example, vitamin A is important for _____ , vitamin C is important for _____ , and vitamin D is important for _____ .

vision; collagen synthesis; calcium regulation . Vitamin A is an important vitamin involved with vision and preventing night blindness, vitamin C is important for collagen synthesis, and vitamin D is a hormone required for the regulation of calcium in the blood.

A _____ is an organic compound that must be obtained from the diet and is needed to sustain life.

vitamin Both vitamins and minerals are nutrients required in small amounts to sustain life. Vitamins are organic compounds that cannot be synthesized in the body and therefore must be obtained from the diet. Different vitamins perform various functions throughout the body.

A number of risk factors contribute to inadequate levels of vitamin D and increase the likelihood of developing a deficiency disease. Choose the image that depicts the individual at greatest risk for vitamin D deficiency. A. Finn is a 15-year-old Caucasian boy with a fair complexion who spends a lot of time outdoors playing on his high school soccer team. B. Ryan is a 15-year-old Caucasian boy with a medium complexion who spends a lot of time outdoors playing pick-up basketball. C. Zeshawn is a 15-year-old African American boy who spends a lot of time outdoors competing on his high school track team.

C. Zeshawn is a 15-year-old African American boy who spends a lot of time outdoors competing on his high school track team. A major source of vitamin D is synthesized in the body when ultraviolet B photons (UVB) from the sun are absorbed by 7-dehydrocholesterol in the skin, leading to the eventual conversion to the active form of vitamin D. Pigmentation reduces this production in the skin. Therefore, darker-skinned individuals will experience slower vitamin D synthesis than lighter-skinned individuals.

itamin D has many functions throughout the body. While severe deficiency directly leads to poor bone mineralization, resulting in rickets and osteomalacia, current research suggests that a deficit in vitamin D may be involved in the etiology of many disorders, including cardiovascular disease, respiratory infection, diabetes, infectious disease, and some cancers. Given what you know about the characteristics of a deficiency disease, which of the following would be considered a deficiency disease resulting from inadequate levels of vitamin D? Check all that apply. a. Rickets b. Type 1 diabetes c. Cardiovascular disease d. Osteomalacia e. Skin cancer

a. Rickets d. Osteomalacia A primary deficiency disease is a direct result of not taking in enough of a particular nutrient, such as vitamin D, and would not occur with adequate intake. In the case of vitamin D, the primary deficiency is an inability to mineralize bone, resulting in rickets or osteomalacia. A secondary deficiency disease may be associated with decreased intake and is likely due to an underlying disorder that limits the body's ability to use the vitamin.

Without vitamin K, _____ cannot bind to the minerals that normally form bones, resulting in low bone density. a. osteocalcin b. calcidiol c. calcitriol d. phylloquinone e. prothrombin

a. osteocalcin

What vitamin A compound(s) bind(s) with opsin to form rhodopsin? a. retinal b. carotenoids c. retinol d. retinoids e. retinoic acid

a. retinal

Case Study: If Joan wants to increase her intake of vitamin A, which of the following foods would be best? a. sweet potatoes b. poultry c. broccoli d. tofu e. watermelon

a. sweet potatoes

Retinal, the _____ form of vitamin A, is part of the visual pigment _____ which is essential to see objects in dim light.

aldehyde; rhodopsin Rhodopsin is composed of the protein opsin—the cis form of retinal. Rhodopsin is present in the cells of the retina. When light enters the eye and strikes the retina, the rhodopsin absorbs the light causing retinal to change from the cis form to the trans form. These changes trigger an electrical impulse that carries visual information to the brain. Retinoic acid is not involved in this vision cycle. Beta-carotene is a yellow-orange pigment present in certain vegetables and fruits.

Case Study: Joan has taken a multivitamin supplement every day that provides 5000 IU of vitamin A. What is the UL for vitamin A in IUs/day? a. 3000 b. 10000 c. 700 d. 5000 e. 2330

b. 10000

Vitamin K plays a key role in _____ and in the metabolism of _____ .

blood clotting; bone proteins Vitamin K is involved in the complex process of blood clotting. Blood clots are formed after a series of reactions in which each step creates a compound that activates the next step. Vitamin K is needed to make thrombin (an active enzyme) from the precursor, prothrombin, an inactive protein. Vitamin K is also required to form several other factors preceding the formation of prothrombin. Vitamin K must be present so that the bone protein osteocalcin can bind to the minerals that form bone.

Case Study: Joan's low serum vitamin D levels and low dietary vitamin D intake indicate that she is vitamin D deficient. She needs a vitamin D supplement to raise blood vitamin D levels and to lower the risk of falls. Based upon her vitamin D RDA, what supplement dose should she take daily? a. 600 IUs b. 1000 IUs c. 200 IUs d. 800 IUs e. 400 IUs

d. 800 IUs

If you made a sandwich with ½ oz. of liverwurst (containing 641 µg of retinol) and ¼ cup of shredded carrots (containing 2760 µg of beta-carotene), how many µg RAE does the sandwich contain? a. 2021 µg RAE b. 3401 µg RAE c. 1742 µg RAE d. 871 µg RAE

d. 871 µg RAE

Case Study: Which of the following is not known to promote vitamin D deficiency in the elderly? a. Spending most their time indoors b. Wearing protective clothing and using sunscreen while outdoors. c. Diminished capacity of the skin, liver, and kidneys to make and activate vitamin D. d. Reduced absorption of vitamin D e. Consumption of little or no milk

d. Reduced absorption of vitamin D

All of the following statements about Vitamin E are true, except: a. Vitamin E deficiency can cause hemolytic anemia in premature infants. b. Vitamin E is easily destroyed by heat and exposure to air. c. Vitamin E's main function if to prevent the oxidation of polyunsaturated fatty acids in the cell membrane. d. Vitamin E is the most toxic of all the vitamins. e. Dietary vitamin E requirements increase with increasing intakes of polyunsaturated fats.

d. Vitamin E is the most toxic of all the vitamins.

A _____ is a lack or shortage of a particular vitamin, and prolonged insufficiency can eventually lead to a _____ , characterized by harmful symptoms.

vitamin deficiency; vitamin deficiency disease A vitamin deficiency disease is a disease that is directly caused by inadequate concentrations of a particular nutrient. When the body is deficient in a vitamin, the function associated with that vitamin is impaired.