Vitamin C Vitamin D Functions,Food Sources,Deficiency,Overdosage

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Nutrition in Children

Micronutrients Articles

Vitamin C and Vitamin D

NUTRITION IN CHILDREN

Micronutrients in Children

Role of Micronutrients in Diet of Preschooler

Micronutrient Status of Children in India

Micronutrient Supplementation and it's Effect on Children

Micronutrients Vitamin B complex

Micronutrients Vitamin C and Vitamin D

Calcium and phosphorus in diet

Vitamin D insufficiency and deficiency in children

Community Level Micronutrient Deficiency in Preschoolers

Micronutrients: Vitamin A, E and K

Immunity and Growth of Children

Nutrition For Healthy Growth and Immunity

Nutrition and Brain Development

Nutrition and Infections

Dietary Inadequacy in First Three Years of Life

Feeding guidelines for infants and young children in India

Prebiotics for Children

Prebiotics & Probiotics And Gut Health in Children

Prebiotics and Probiotics for Healthy Children

Role of probiotics in children

Role of prebiotics in children

Prebiotics and probiotic combinations in children

DHA in children

DHA Need and Importance During Growing Period

Malnutrition in children

Problems of Malnutrition in India among Children

Adult Onset Diseases and Malnutrition

Nutrition In Indian Urban Children

Malnutrition Among Preschoolers

Nutrition Growth Charts

Length/Height for age

Subscapular skin fold thickness

Triceps skin fold thickness

VITAMIN C AND VITAMIN D

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Vitamin C :

Vitamin C is a water-soluble vitamin that is necessary for normal growth and development. It is called as L-ascorbic acid.

Functions: It is an antioxidant and helps protect cells from free radical damage (1). It is necessary to form collagen which is necessary for growth, and repair of bone, skin, and connective tissue. (2,3,4) It helps maintain healthy teeth and gums. It helps in absorption of iron in the body.

Food Sources: All fruits and vegetables contain some amount of vitamin C. Highest sources of vitamin C are parsley, bell pepper, strawberries, citrus fruits and juices (oranges, lemon juice), papaya, leafy greens (cauliflower, broccoli) kale, mustard greens, and Brussels sprouts. (2,3). Vitamin C is highly sensitive to air, water, and temperature. About 25% of the vitamin C in vegetables can be lost simply by blanching (boiling or steaming the food for a few minutes). This same degree of loss occurs in the freezing and unthawing of vegetables and fruits. (3)

Recommended daily allowance: 40-70mg/d. The body does not manufacture vitamin C on its own, nor does it store it. It is therefore important to include plenty of vitamin C-containing foods in daily diet. (2)

Deficiency: Vitamin C deficiency may result from a diet deficient in fresh fruits and vegetables. (4) Deficiency of vitamin C causes "scurvy" in humans. Scurvy in infants is rare because breast milk usually supplies enough vitamin C. (4) The symptoms of scurvy develop after a few months of deficiency. Scurvy is characterized by bleeding gums (gums become swollen, purple, and spongy and the teeth eventually loosen), bleeding under the skin (presents as petechiae, purpura and bruises) and even bleeding in the periosteum (presents as pseudoparalysis). This is because synthesized collagen is too unstable to perform its function and thus bleeding in tissues can occur. The hair becomes dry and brittle, and the skin becomes dry, rough, and scaly. Anemia may develop. Infections may develop, and wounds do not heal. (4) In advanced scurvy there are open, suppurating wounds and loss of teeth and, eventually, death. (1)

Overdosage: Vitamin C toxicity is very rare, because the body cannot store the vitamin. However, amounts greater than 2,000 mg/day are not recommended because such high doses can lead to stomach upset and diarrhea. (2)

Vitamin D :

Vitamin D is a fat soluble vitamin with two available forms: vitamin D2 (ergocalciferol - This form is synthesized from plants and yeast precursors. It is also the form used in very high dose supplements.) and vitamin D3 (cholecalciferol - This form is the most active form of vitamin D. It is formed in the skin when the skin is exposed to ultraviolet B rays in direct sunlight.). (5,8) However, too much sun exposure can lead to skin aging and skin cancer. So many people try to get their vitamin D from other sources. (6) Vitamin D₂ and D₃ are not active in the body. Both forms must be metabolized into an active form called calcitriol. (8)

Vitamin D is carried in the bloodstream to the liver, where it is converted into the calcidiol (25 hydroxy vitamin D₃). Circulating calcidiol is then converted into calcitriol (1,25 dihydoxy vitamin D₃), the biologically active form of vitamin D, either in the kidneys or by monocyte-macrophages in the immune system. When synthesized by monocyte-macrophages, calcitriol acts locally as a cytokine, defending the body against microbial invaders. When synthesized in the kidneys, calcitriol circulates as a hormone, regulating the concentration of calcium and phosphate in the bloodstream. (5) Calcitriol mediates its biological effects by binding to the vitamin D receptor (VDR), which is principally located in the nuclei of target cells. (5) VDR activation in the intestine, bone, kidney, and parathyroid gland cells leads to the maintenance of calcium and phosphorus levels in the blood. (5) Vitamin D also affects the immune system, and VDRs are expressed in several white blood cells, including monocytes and activated T and B cells. (5) Once triggered by vitamin D, macrophage cells are capable of releasing antibacterial peptides like cathelicidin, and these antibacterial proteins play a critical role in the immune system's prevention of infection. Of special interest in this area has been infection by Mycobacterium tuberculosis and Mycobacterium leprae. Vitamin D deficiency has emerged as a clear risk factor for these diseases (7).

Functions: It helps to optimize calcium and phosphorus metabolism by promoting absorption of calcium and phosphorus from the intestine and increasing deposition into the bones. (7,8)

Food Sources: The most common food source is fortified foods, mainly cereals and dairy products. Vitamin D3 is also present in fish liver oils and fatty fish. Human breast milk contains only small amounts of vitamin D. (5,7)

Recommended daily allowance: 5mcg/day or 200IU. With respect to women who are breastfeeding, the American Academy of Pediatrics (AAP) and the Canadian Pediatric Society (CPS) have both recommended vitamin D supplementation for both mothers and infants. The APP has recommended 200 IU of vitamin D per day for all infants 2 months and older, and 400 IU for newborns during the first days of life. This direct supplementation for the infant is separate and apart from any vitamin D supplementation that the mother herself might need. (7)

Deficiency: Deficiency of Vitamin D is very common in Indian children. This is because of deficient Vitamin D in breast milk due to deficiency in mother's milk and subsequently due to poor intake in food. Almost no one consumes enough vitamin D from foods to prevent vitamin D deficiency when exposure to sunlight is inadequate. (8) The deficiency can also occur in the winter at northern and southern latitudes or in people who keep their bodies covered, such as Muslim women. (8) Vitamin D deficiency leads to decrease blood calcium and phosphorus levels. This can lead to hypocalcemic tetany. To try to increase the low calcium level in blood caused by vitamin D deficiency, the parathyroid hormone level increases (secondary hyperparathyroidism), which draws calcium out of bone to increase the calcium level in blood. Thus, bones are weakened. (8) Patients may have muscle aches, weakness, and bone pain. Persistent deficiency of vitamin D can lead to rickets in children and osteomalacia in adults. This results in thin, brittle, or misshapen bones (5).

Overdosage: Taking very high daily doses of vitamin D for example, 50 or more times the recommended daily allowance (RDA)-over several months can cause toxicity and hypercalcemia and nephrocalcinosis. (8) For infants (birth to 12 months) the tolerable Upper Limit (maximum amount that can be tolerated without harm) is set at 25 micrograms/day (1000 IU). The U.S. Dietary Reference Intake Tolerable Upper Intake Level (upper limit) of vitamin D for children and adults is set at 50 micrograms/day (2,000 IU). (5)

Conclusion :

Daily sufficient intake of vitamin C and D is needed to prevent deficiency and general well being. Eating a balanced diet with adequate intake of vegetables and fruits is essential to prevent Vitamin C deficiency. Vitamin D deficiency is common due to improper sunlight exposure and also due to deficient intake. Fortification of food and supplement with vitamin D is needed to prevent deficiency.

References:

1.		Vitamin C. From Wikipedia, the free encyclopedia. Available at URL: http://en.wikipedia.org/wiki/Vitamin_C. Accessed on 10th July 2010.
2.		Vitamin C: MedlinePlus Medical Encyclopedia. Available at URL: http://www.nlm.nih.gov/medlineplus/ency/article/002404.htm. Accessed on 10th July 2010.
3.		WHFoods: Vitamin C. Available at URL: http://www.whfoods.com/genpage.php?tname=nutrient&dbid=109. Accessed on 10th July 2010
4.		Vitamin C: Vitamins: Merck Manual Home Edition. Available at URL: http://www.merck.com/mmhe/sec12/ch154/ch154i.html. Accessed on 10th July 2010
5.		Vitamin D. From Wikipedia, the free encyclopedia. Available at URL: http://en.wikipedia.org/wiki/Vitamin_d. Accessed on 10th July 2010-07-10
6.		Vitamin D: MedlinePlus Medical Encyclopedia. Available at URL: http://www.nlm.nih.gov/medlineplus/vitamind.html. Accessed on 10th July 2010
7.		WHFoods: Vitamin C. Available at URL: http://www.whfoods.com/genpage.php?tname=nutrient&dbid=110. Accessed on 10th July 2010
8.		Vitamin C: Vitamins: Merck Manual Home Edition. Available at URL: http://www.merck.com/mmhe/sec12/ch154/ch154j.html. Accessed on 10th July 2010

Last updated: 1^st July 2010 . Copyrighted Pediatric Oncall

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