BI8.1-6 | Vitamins and Nutrition — Summary & Reflection

REFLECT

A 32-year-old woman presents to your PHC at 10 weeks of pregnancy. She is strictly vegetarian and eats mostly rice, lentils, and vegetables. She cannot afford dairy products.

Describe: (1) Which specific vitamin deficiency puts her baby at greatest risk of neural tube defects? (2) Which single vitamin is almost certainly deficient in this strictly vegetarian patient, and what are the TWO distinct clinical consequences in her? (3) What dietary advice and supplementation would you prescribe? (4) What biochemical test would you use to screen for her nutritional risk?

KEY TAKEAWAYS

Fat-Soluble Vitamins (A, D, E, K):
- Absorbed with fat; stored in liver; risk of toxicity in excess
- Vitamin A → vision (rhodopsin) + cell differentiation; deficiency → night blindness, xerophthalmia, Bitot's spots
- Vitamin D → calcitriol (kidney activation); promotes Ca/P absorption; deficiency → rickets (children), osteomalacia (adults)
- Vitamin K → carboxylation of clotting factors II, VII, IX, X; prophylaxis for all neonates

B-Complex Vitamins (water-soluble coenzymes):
- B1 (thiamine/TPP) → dehydrogenases; beriberi, Wernicke's (polished rice, alcoholism)
- B3 (niacin/NAD) → 400+ redox reactions; pellagra (3Ds) in sorghum-belt India
- B6 (PLP) → transamination; neuropathy, sideroblastic anaemia
- Folate → 1-carbon transfer, DNA synthesis; megaloblastic anaemia + NTDs (supplement in pregnancy)
- B12 → methionine synthesis + propionyl metabolism; megaloblastic anaemia + SACD of cord (in vegetarians)

Nutritional Assessment:
- ABCD framework: Anthropometry, Biochemical, Clinical, Dietary
- India bears double burden: undernutrition (stunting, wasting, anaemia) + overnutrition (T2DM, obesity)