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The Fat-Soluble Vitamins


The Fat-Soluble Vitamins. Vitamin A. Vitamin D. Vitamin E. Vitamin K. Dr. Latifah. Al-Oboudi. 2012 – PowerPoint PPT presentation

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Title: The Fat-Soluble Vitamins

The Fat-Soluble Vitamins
  • Vitamin A
  • Vitamin D
  • Vitamin E
  • Vitamin K

Dr. Latifah Al-Oboudi 2012
Vitamins Essential Dietary Components
  • Vitamins are essential, organic compounds needed
    for important metabolic reactions in the body.
  • They are not a source of energy. Instead, they
    promote many energy-yielding and other reactions
    in the body, thereby aiding in the growth,
    development, and maintenance of various body

Dr. Latifah Al-Oboudi 2012
  • Vitamins cannot be synthesized in the body at all
    or are synthesized in insufficient amounts.
  • Vitamins A, D, E, and K are fat soluble, whereas
    the B-vitamins and vitamin C are water soluble.

Dr. Latifah Al-Oboudi 2012
Absorption of vitamins
  • Fat-soluble vitamins are absorbed along with
    dietary fat. Thus adequate absorption depends on
    the efficient use of bile and pancreatic lipase
    in the small intestine to digest dietary fat and
    the adequate absorptive capacity of the
    intestinal mucosa.
  • Under optimal condition, about 40 to 90 of the
    fat-soluble vitamins are absorbed when they are
    consumed in recommended amounts.

Dr. Latifah Al-Oboudi 2012
Malabsorption of vitamins
  • Fat malabsorption (resulting from GI tract and
    pancreatic disease) may cause poor absorption of
    fat-soluble vitamins.
  • In disease states that limit fat digestion,
    fat-soluble vitamin absorption may be
    compromised, thereby increasing the risk of
    deficiency in these individuals.

Dr. Latifah Al-Oboudi 2012
Transport of vitamins
  • They travel by way of the lymphatic system into
    general circulation, carried by chylomicrons.

Dr. Latifah Al-Oboudi 2012
Vitamin Toxicity
  • Fat soluble vitamins are excreted less readily
    from the body than water-soluble vitamins and
    thus pose a potential threat for toxicity,
    especially of vitamins A and D.
  • Toxicities of these fat- soluble vitamins
    generally occur with high doses of supplements,
    rather than from foods

Dr. Latifah Al-Oboudi 2012
Vitamin A
  • Vitamin A contributes to the maintenance of
    vision, the normal development of cells
    (especially mucous-forming cells), and immune

Dr. Latifah Al-Oboudi 2012
Vitamin A
  • Vitamin A refers to the preformed retinoids and
    provitamin A carotenoids that can be converted to
    vitamin A activity.
  • Retinoids is a collective term for the
    biologically active forms of vitamin A because,
    unlike carotenoids, they do not need to be
    converted to become biologically active.

Dr. Latifah Al-Oboudi 2012
Vitamin A
  • Retinoids exist in 3 forms retinal(an
    aldehyde), retinol(an alcohol), and retinoic
  • Carotenoids are yellow-orange pigmented
    materials in vegetables and fruits, some of which
    are provitamins---that is, they can be converted
    into vitamin A.
  • A plant derivative, known as beta-carotene, along
    with 2 other carotenoids(alpha-carotene and beta-
    cryptoxanthin), yields vitamin A after metabolism
    by the small intestine or liver.

Dr. Latifah Al-Oboudi 2012
Interconversions of beta-carotene and various
retinoids. Notice that the synthesis of retinoic
acid is a dead end in metabolic terms.
Dr. Latifah Al-Oboudi 2012
Dr. Latifah Al-Oboudi 2012
Vitamin A in Foods
  • Retinoids (preformed vitamin A) are found in
    foods of animal origin, such as liver, fish, fish
    oils, fortified milk and eggs.
  • A carotenoids are found mainly in dark green and
    yellow-orange vegetables and fruits, such as
    carrots, spinach and other greens, winter squash,
    sweet potatoes, broccoli, mangoes, cantaloupe,
    peaches, and apricots.

Dr. Latifah Al-Oboudi 2012
Food sources of vitamin A
Dr. Latifah Al-Oboudi 2012
  • At one time the amounts of vitamin A were
    expressed in International Units (IUs). Today,
    there are more sensitive means for measuring
    nutrients. Consequently, milligram (1/1000 of a
    gram) and microgram (1/1,000,000 of a gram)
    measurements have generally replaced IUs as the
    units of measure. However, some food and vitamin
    supplement labels may still display the older IU
  • Dietary vitamin A activity is currently expressed
    in Retinol Activity Equivalents(RAE)

Dr. Latifah Al-Oboudi 2012
Dr. Latifah Al-Oboudi 2012
Vitamin A Needs
  • The RDA for vitamin A is 900 µg Retinol Activity
    Equivalents(RAE) per day for adult men and 700 µg
    RAE per day for adult women.

Dr. Latifah Al-Oboudi 2012
Absorption, Transport, Storage, and Excretion of
Vitamin A
  • Up to 90 of retinol is absorbed into the cells
    of the small intestine.
  • After absorption, a fatty acid is attached to
    retinol to form a new retinyl ester. These
    retinyl esters are packaged into chylomicrons
    before entering the lymphatic circulation.

Dr. Latifah Al-Oboudi 2012
Absorption, Transport, Storage, and Excretion of
Vitamin A
  • The provitamin A carotenoids can be enzymatically
    split within the intestinal cells or liver
    cells to form retinal or, to lesser extent,
    retinoic acid.
  • The carotenoid absorption is much lower than that
    of retinol.
  • After being absorbed in the small intestine ,
    carotenoids can be cleaved to yield retinal,
    which is then converted to retinol.

Dr. Latifah Al-Oboudi 2012
Absorption, Transport, Storage, and Excretion of
Vitamin A
  • The chylomicrons deliver vitamin A to tissue for
    storage or cellular use.
  • Storage Over 90 of the bodys vitamin A stores
    are found in the liver, with small amounts in
    adipose tissue, kidneys, bone marrow, testicles,
    and eyes. Normally, the liver stores enough
    vitamin A to last for several months to protect
    against vitamin A deficiency.

Dr. Latifah Al-Oboudi 2012
Excretion of Vitamin A
  • Although vitamin A is not readily excreted by
    the body, some is lost in the urine.
  • Kidney disease increases the risk of vitamin A
    toxicity because this urinary route of excretion
    is compromised.

Dr. Latifah Al-Oboudi 2012
Functions of Vitamin A ( Retinoids)
  • Growth and Development.
  • Cell Differentiation.
  • Vision.
  • Immune Function.

Dr. Latifah Al-Oboudi 2012
Vitamin A deficiency Diseases
  • Conjunctiva
  • Xerophthalmia

Dr. Latifah Al-Oboudi 2012
Vitamin A Toxicity
  • Preformed vitamin A can be quite toxic when
    taken at doses 2 to 4 times or more the RDA.
  • Use of vitamin A supplements is especially
    dangerous during pregnancy because it can lead to
    fetal malformations.

Dr. Latifah Al-Oboudi 2012
Vitamin A Toxicity
  • Consuming the right amount of vitamin A is
    critical to overall health. Avery low (deficient)
    or very high (toxic)vitamin A intake (as
    retinoids) can produce harmful symptoms and can
    even lead to death.

Dr. Latifah Al-Oboudi 2012
Golden rice was genetically engineered to
synthesize beta-carotene. This rice was developed
for use as a fortified food in areas of the world
that have limited access to vitamin A-rich foods.
Dr. Latifah Al-Oboudi 2012
Dr. Latifah Al-Oboudi 2012
Vitamin D
  • In presence of sunlight, skin cell synthesize a
    sufficient supply of vitamin D from a derivative
    of cholesterol.
  • Dietary source is not required if synthesis is
    adequate to meet needs, the vitamin is more
    correctly classified as a conditional vitamin
    or prohormone (a precursor of an active hormone).

Dr. Latifah Al-Oboudi 2012
Vitamin D
  • In the absence of UV light exposure, an adequate
    dietary intake of vitamin D is essential to
    prevent the deficiency diseases rickets and
    osteomalacia and to provide for cellular needs.
  • After exposure to the sun, humans produce vitamin
    D3 (cholecalciferol) from a derivative of
  • The liver and kidneys each add a hydroxyl
    group(-OH) to this to yield the active form of
    vitamin D ( 1,25 dihydroxy D3, or calcitriol).

Dr. Latifah Al-Oboudi 2012
Vitamin D2 in foods
  • The best food sources of vitamin D are
  • Fatty fish (e.g. sardines, mackerel, and salmon).
  • Cod liver oil.
  • Fortified milk.
  • Some fortified breakfast cereals.
  • Although eggs, butter, liver, and a few brands of
    margarine contain some vitamin D, large servings
    must be eaten to obtain an appreciable amount of
    the vitamin. Thus, these foods are not considered
    a significant source.

Dr. Latifah Al-Oboudi 2012
Cod liver oil was a common supplements for
children in the US until 1933, when milk was
first fortified with vitamin D
Dr. Latifah Al-Oboudi 2012
Vitamin D2 in foods
  • Most fortified foods and supplements containing
    vitamin D are in the form of ergocalciferol, or
    vitamin D2, the same form found naturally in
  • Ergocalciferol has vitamin D activity in humans,
    but in lesser amounts than provided by
    cholecalciferol (vitamin D3).

Dr. Latifah Al-Oboudi 2012
Food sources of vitamin D
Dr. Latifah Al-Oboudi 2012
Dr. Latifah Al-Oboudi 2012
Vitamin D3 Formation in the Skin
  • The synthesis of vitamin D3 begins with a
    compound called 7-dehydrocholesterol, a precursor
    of cholesterol synthesis located in the skin.
  • 1 ring on the molecule undergoes a chemical
    transformation, forming the more stable vitamin
    D3 (cholecalciferol).
  • This change allows vitamin D3 to enter the
    bloodstream for transport to the liver and
    kidneys, where it undergoes hydroxylation (the
    addition of -OH) and subsequent conversion to its
    bioactive form 1,25 dihydroxy D3 (calcitriol).

Dr. Latifah Al-Oboudi 2012
Vitamin D3 Formation in the Skin
  • For many individuals, sun exposure provides 80 to
    100 of the vitamin D3 required by the body.
  • The amount of sun exposure needed , however,
    depend on the time of day, the geographic
    location, the season of the year, ones age,
    ones skin color, and the use of sunscreen.

Dr. Latifah Al-Oboudi 2012
  • The production of vitamin D3 in the skin
    decreases by about 70 when one reaches the age
    of 70. older people are advised to get small
    amounts of sun exposure, or to take vitamin D
    supplements to prevent deficiency.
  • The large amount of melanin (skin pigment) in
    dark-skinned individuals may block UV light and
    prevent adequate vitamin D3 synthesis.

Dr. Latifah Al-Oboudi 2012
  • Scientists recommend that people expose their
    hands, face, and arms to UV light at least 2 or 3
    times a week for 10 to 15 minutes.
  • Individuals with dark skin may need sun exposure
    of 3o minutes or more (or vitamin D
  • People who do not receive enough UV light
    exposure to synthesize adequate amounts of
    vitamin D3 should make certain that they have
    adequate sources of vitamin D in their diets.

Dr. Latifah Al-Oboudi 2012
Vitamin D Needs
  • The adequate intake for vitamin D is 5µg/day (200
    IU/day) for people under age 51, 10µg/day (400
    IU/ day) for people between 51 and 70, and
    15µg/day (600 IU/ day) for older adults.
  • Older adults may need 20 to 25µg/day (800 to 1000
    IU/ day) from a combination of vitamin
    D-fortified foods and a supplement to decrease
    the risk of bone loss and other chronic diseases.
  • The daily value used on food and supplements
    labels is 10 µg.
  • Breastfed infants recommended to be given a
    vitamin D supplement of 5 µg/day (200 IU) until
    they are weaned to infant foods fortified with,
    or rich in, vitamin D .

Dr. Latifah Al-Oboudi 2012
Absorption, Transport, Storage, and Excretion
of Vitamin D
  • About 80 of vitamin D2 is incorporated (along
    with other dietary fats) into micelles in the
    small intestine, absorbed, and transported to the
    liver by chylomicrons through the lymphatic

Dr. Latifah Al-Oboudi 2012
Whether synthesized in the skin or obtained from
dietary sources, vitamin D ultimately function as
a hormone 1,25(OH)2 vitamin D3 (calcitriol)
Dr. Latifah Al-Oboudi 2012
Function of Vitamin D
  • Vitamin D has hormone like functions, which help
    regulate the bodys concentration of calcium and

Dr. Latifah Al-Oboudi 2012
  • Figure 12-13 The active vitamin D
  • Hormone 1,25 (OH)2 vitamin D3 --and parathyroid
    hormone interact to control blood calcium
    concentration. Low blood calcium is a trigger for
    the following actions, all of which raise blood
    calcium levels.
  • Parathyroid hormone (PTH) and 1,25(OH)2
    vitamin D3 mobilize calcium from the bone.
  • PTH also
  • a. Reduces calcium excretion by the
  • b. stimulates kindly synthesis of
    1,25(OH)2 vitamin D3.
  • 1,25(OH)2 vitamin D3 stimulates intestinal
    calcium absorption.
  • Conversely, when calcium levels in the blood
    become too high, the hormone calcitonin responds
    by promoting calcium disposition in the bone (see
    chapter 14)/.

Dr. Latifah Al-Oboudi 2012
Function of Vitamin D
  • Vitamin D promotes increased intestinal
    absorption of calcium and phosphorus from foods
    to maintain blood levels of these minerals.
  • This makes calcium and phosphorus available for
    body cells and for incorporation into bones when
    there is more than needed for basic functions.

Dr. Latifah Al-Oboudi 2012
Function of Vitamin D
  • When blood levels of calcium and phosphorus start
    to fall, vitamin D (with PTH from the parathyroid
    gland) can release calcium and phosphorus from
    bone into the blood to restore blood levels of
    these minerals.
  • This action can eventually weaken the bones if it
    continues for a prolonged period of time, it
    helps provide the calcium and phosphorus needed
    for many basic life functions. If the bones did
    not supply calcium and phosphorus for these
    functions, a person could quickly have serious,
    even fatal, health consequences. Thus, vitamin D
    preserves these important functions even if
    dietary intakes of these minerals are inadequate.

Dr. Latifah Al-Oboudi 2012
Function of Vitamin D
  • Vitamin D has important functions beyond its role
    in maintaining calcium and phosphorus homeostasis
    and bone health.
  • Vitamin D also is involved in immune function and
    cellular metabolism.

Dr. Latifah Al-Oboudi 2012
Function of Vitamin D
  • Vitamin D also may be involved in cell cycle
  • Additionally, vitamin D may decrease the risk of
    certain types of infections and autoimmune
    diseases, such as multiple sclerosis, through its
    action in the immune system and offer protection
    against diabetes, hypertension, and certain

Dr. Latifah Al-Oboudi 2012
Vitamin D Deficiency Diseases
  • Vitamin D deficiency results in harmful changes
    in bone, a condition known as rickets in children
    and osteomalacia in adults.

Dr. Latifah Al-Oboudi 2012
The bone deformities and bowed legs of rickets,
a vitamin D deficiency disease in children.
Dr. Latifah Al-Oboudi 2012
Vitamin D Toxicity
  • Vitamin D toxicity can occur from excessive
    vitamin D supplementation, causing the deposition
    of calcium in the kidneys, heart, and lungs.

Dr. Latifah Al-Oboudi 2012
Vitamin E
  • The importance of vitamin E was first noted in
    1922 in rats.
  • Vitamin E was not fully recognized as an
    essential nutrient in humans until the mid-1960s.
  • The first RDA for vitamin E was established in
  • Vitamin E is a family of 8 naturally occurring
    compounds- 4 tocopherols ( alpha, beta, gamma,
    delta) and 4 tocotrienols (alpha, beta, gamma,
    delta)with widely varying degrees of biological

Dr. Latifah Al-Oboudi 2012
Vitamin E
  • The most active form of the vitamin E is
  • This is the form found in some foods and in
    varying amounts in vitamin supplements.
  • Gamma-tocopherol is a potentially beneficial form
    of vitamin E found in many vegetable oils. It
    does not have as much biological activity as

Dr. Latifah Al-Oboudi 2012
Vitamin E in foods
  • Vitamin E is plentiful in plant oils(e.g.,
    cottonseed, canola, safflower, and sunflower
    oils), wheat germ, asparagus, almonds, peanuts,
    and sunflower seeds.
  • Products made from the plant oilsmargarine,
    shortenings, and salad dressings also are good

Dr. Latifah Al-Oboudi 2012
Food sources of vitamin E
Dr. Latifah Al-Oboudi 2012
Vitamin E in foods
  • Animal fats and dairy products contain little
    vitamin E.
  • The vitamin E content of a food depends on
    harvesting, processing, storage, and cooking
    because vitamin E is highly susceptible to
    destruction by oxygen, metals, light, and
    deep-fat frying. Thus, foods that are highly
    processed and/or deep-fried are usually poor
    sources of vitamin E.

Dr. Latifah Al-Oboudi 2012
Vitamin E needs
  • The RDA for vitamin E is 15 mg/day of
    alpha-tocopherol for both men and women.
  • The 15-mg allotment is equivalent to 22 IU of a
    natural source and 33 IU of a synthetic source of
    vitamin E .
  • Adults consume, on average, only two-thirds of
    the RDA for vitamin E each day.

Dr. Latifah Al-Oboudi 2012
Absorption, Transport, Storage, and Excretion of
Vitamin E
  • Absorption can vary from 20 to 70 of dietary
    intake. Vitamin E must be incorporated into
    micelles in the small intestine, a process
    dependent on bile and pancreatic enzymes.
  • Once taken up by the intestinal cells, vitamin E
    is incorporated into chylomicrons for transport
    by the lymph and eventually the blood.

Dr. Latifah Al-Oboudi 2012
Absorption, Transport, Storage, and Excretion of
Vitamin E
  • As chylomicrons are broken down, most of the
    vitamin E is carried to the liver as chylomicron
    remnants. A small amount is carried directly to
    other tissues.
  • The liver repackages the vitamin E from the
    chylomicron remnants with other lipoproteins
    (VLDL, LDL, and HDL) for delivery to body
  • Vitamin E carried by these lipoproteins.
  • Vitamin E does not accumulate in the liver
    instead, most of the vitamin E in the body is
    localized in adipose tissue.

Dr. Latifah Al-Oboudi 2012
Excretion of Vitamin E
  • Vitamin E can be excreted via the bile, urine,
    and skin.
  • However, because vitamin E absorption is often
    low, most vitamin E is excreted via the small
    amount of bile that exits the body in the feces.

Dr. Latifah Al-Oboudi 2012
Function of Vitamin E
  • Vitamin E is an antioxidant that stops chain
    reactions caused by free radicals that can
    potentially damage cells. Vitamin E acts
    primarily in lipid-rich areas of the body, where
    free radicals can initiate a chain of reactions
    known as peroxidation.

Dr. Latifah Al-Oboudi 2012
Function of Vitamin E
  • Lipid peroxidation reactions break apart fatty
    acids and create free radicals called lipid
    peroxyl radicals (also called reactive oxygen
    species because they contain oxygen radicals).
  • The chain of reactions continues to break apart
    fatty acids until 2 free radicals pair and
    stabilize each other. However, many lipid peroxyl
    radicals may be produced through these reactions
    before stabilization occurs.

Dr. Latifah Al-Oboudi 2012
Function of Vitamin E
  • Vitamin E is one of the most effective
    mechanisms for stopping lipid peroxidation chain
    reaction in the body. By donating hydrogen to
    lipid radicals, vitamin E stops the chain of
    oxidation reaction, which protects the lipids in
    the body. For example, recall that cell membranes
    are composed of a phospholipid bilayer

Dr. Latifah Al-Oboudi 2012
Fat-soluble vitamin E can donate an electron to
stop free radical chain reaction. If not
interrupted, these reactions cause extensive
damage to cell membranes
Dr. Latifah Al-Oboudi 2012
Function of Vitamin E
  • To vitamin E, the body has various other
    antioxidant compounds, such as glutathione
    peroxidase, catalase, and superoxide dismutase,
    to protect against oxidative damage.

Dr. Latifah Al-Oboudi 2012
The body does not rely solely on vitamin E for
antioxidant protection. Such protection is a team
effort, utilizing a number of nutrients,
metabolites, and enzyme systems.
Dr. Latifah Al-Oboudi 2012
Vitamin E Deficiency
  • Overt vitamin E deficiency is rare in humans.
  • Vitamin E deficiency is characterized by the
    premature breakdown of red blood cells(hemolysis)
    and the development of hemolytic anemia.
  • Vitamin E deficiency also can impair immune
    function and cause neurological changes in the
    spinal cord and peripheral nervous system.

Dr. Latifah Al-Oboudi 2012
Vitamin E Toxicity
  • Toxicity from megadose therapy inhibits vitamin K
    activity and, in turn, increases the risk of

Dr. Latifah Al-Oboudi 2012
Vitamin K
  • The discovery of vitamin K centered on its role
    in blood clotting.

Dr. Latifah Al-Oboudi 2012
Vitamin K
  • Vitamin K contributes to the bodys
    blood-clotting ability by facilitating the
    conversion of precursor proteins, such as
    prothrombin, to active clotting factors that
    promote blood coagulation.

Dr. Latifah Al-Oboudi 2012
Vitamin K Sources
  • About 10 of the vitamin K absorbed each day
    comes from bacterial synthesis in the colon.
  • The remainder comes from dietary sources, green
    leafy vegetables (e.g., Kale, turnip greens,
    parsley, salad greens, cabbage, and spinach),
    broccoli, peas, and green beans are the best
  • Vegetable oils, such as soy and canola, also are
    good sources.
  • Vitamin K can be destroyed by exposure to light.

Dr. Latifah Al-Oboudi 2012
Food sources of vitamin K
Dr. Latifah Al-Oboudi 2012
Vitamin K Needs
  • For women, the adequate intake for vitamin K is
    90µg/day for men, it is 120µg/day.
  • The daily value for vitamin K is 80µg/day.

Dr. Latifah Al-Oboudi 2012
Absorption, Transport, Storage, and Excretion of
Vitamin K
  • Approximately 80 of dietary vitamin K as
    phylloquinone and menaquinone is taken up by the
    small intestine and incorporated into
    chylomicrons. This process requires bile and
    pancreatic enzymes.
  • The menquinones synthesized by bacteria in the
    colon also are absorbed, but provide only 10 of
    the vitamin K we need.
  • Vitamin K can be incorporated into the
    lipoproteins VLDL and LDL for transport
    throughout the body or for storage in the liver.

Dr. Latifah Al-Oboudi 2012
Excretion of Vitamin K
  • Most vitamin K excretion occurs via the bile that
    passes out of the body in the feces, with a small
    amount of excretion via the urine.

Dr. Latifah Al-Oboudi 2012
Function of Vitamin K
  • Vitamin K is needed for the synthesis of
    blood-clotting factors by the liver and the
    conversion of preprothrombin to the active
    blood-clotting factor called prothrombin.

Dr. Latifah Al-Oboudi 2012
Forming a blood clot requires the participation
of vitamin K in both the intrinsic and extrinsic
blood-clotting pathways. Vitamin K specifically
imparts calcium-binding capacity to the proteins
in these pathways, as in the conversion of
preprothrombin to prothrombin, an active clotting
Dr. Latifah Al-Oboudi 2012
Function of Vitamin K
  • Vitamin K also may play a role in bone
  • Vitamin K also may help protect the body
    from inflammation, thereby providing protection
    against cardiovascular disease and osteoporosis.

Dr. Latifah Al-Oboudi 2012
Vitamin K deficiency
  • A deficiency of vitamin K is rare, but it can
    occur with prolonged use of antibiotics that
    disrupt vitamin K synthesis or with impaired fat
  • Vitamin K deficiency also can occur in newborns.
    Newborn infants are given vitamin K injections
    within 6 hours of delivery to prevent this
    possible vitamin K deficiency.

Dr. Latifah Al-Oboudi 2012
Vitamin K Toxicity
  • To date, no upper level has been set for vitamin
  • Although vitamin K can be stored in the liver and
    bone, it is more readily excreted than other
    fat-soluble vitamins.
  • Can cause hemolytic anemia.

Dr. Latifah Al-Oboudi 2012
Dr. Latifah Al-Oboudi 2012
Dietary supplements Healthful or Harmful?
Dr. Latifah Al-Oboudi 2012
  • Which food provide very little vitamin A?
  • a. Mangob. Spinachc. Bananad. Liver

Dr. Latifah Al-Oboudi 2012
  • Vitamin D deficiency in children results in a
    condition called--------a. osteomalacia
  • b. Berberi
  • c. Rickets
  • d. xerophthalmia

Dr. Latifah Al-Oboudi 2012
Which vitamin aids in blood clotting? a. Vitamin
Ab. Vitamin D c. Vitamin E d. Vitamin K
Dr. Latifah Al-Oboudi 2012