VITAMIN DEFICIENCY — the morbid condition caused by a vitamin deficiency in an organism. The morbid conditions coming at full insufficiency of any polyneuramins an organism are called avitaminosis. For the specification of types of full V. of N add designation of vitamins to the term «avitaminosis» (e.g., avitaminosis of A, B 1 , B 2 , C, E, K, etc.). At a partial vitamin deficiency there come preferential the disturbances of functional character called by hypovitaminoses.
Depending on the reasons which caused V. of N distinguish its exogenous and endogenous forms. V. of N caused by the low content of polyneuramins to food at uniform, unbalanced food (dominance of a carbohydrate component is most widespread exogenous, or primary, at the low content of proteins of animal origin and fats, in the absence of fresh vegetables and fruit).
Less often forms B. of N meet endogenous, or secondary. Disturbances of absorption of polyneuramins can be their reasons went. - kish. a path at acute and hron, his diseases, helminthic invasions, disturbances of digestion of vitamins and their loss with urine and a stake at acute and hron, diseases of a liver. Endogenous forms B. of N develop at malignant new growths, leukoses, hereditary diseases as enzymopathies (a phenyl-pyruvic ketonuria, a haemo cystinuria, insufficiency 5-methyl-tetrahydrofolate - transferases, an orotovy aciduria, etc.); at endocrine disturbances (a hyperthyroidism, disturbance of functions of adrenal glands, etc.); at receipt in an organism as a part of foodstuff of substances with properties of antivitamins (a thiaminase, avidin, etc.); at to lay down. use of pharmaceuticals with structure of analogs — antagonists of vitamins (streptomycin, levomycetinum, sulfanamide drugs, an isoniazid, etc.).
Cases when increase in need for vitamins can be V.'s cause of N at the sufficient content of polyneuramins food are especially allocated. It can occur under the influence of low or high temperature of air, at the increased physical or psychological tension, air hunger, during the work with nek-ry harmful substances etc. The need for vitamins, in particular in ascorbic to - those, a pyridoxine, folic to - those, calciferols, tokoferola and phylloquinones increases also at pregnancy and feeding.
Under all conditions it is necessary to take existence of a synergism of a number of vitamins into account (see. Synergism ), V. detaining development in N (e.g., a synergism ascorbic to - you with thiamin, folic to - that, cobalamines, etc.; thiamin with Riboflavinum and a pyridoxine; Riboflavinum with Retinolum and pantothenic to - that; a pyridoxine with pantothenic to - that; nicotinic to - you with Riboflavinum; folic to - you with cobalamine, biotin and sincaline; Retinolum with tocopherol, etc.), and also a possibility of antagonism of some vitamins (tocopherol with a pyridoxine; nicotinic to - you with thiamin, sincaline, pantothenic to - that; Retinolum with phylloquinones, etc.). It limits a possibility of introduction pharmakol, doses of these vitamins without secondary action of antagonists on security with vitamins of an organism.
Avitaminosis often arises during wars both among the military personnel, and among the civilian population. Quite often they are a consequence of uniform food for an appreciable length of time preferential dried and tinned. products (e.g., among crews of vessel during the long voyages and among participants of expeditions to the remote areas). Avitaminosis, hl. obr. And, B 1 , B 2 and PP, meet in underdeveloped, dependent and the developing countries of Asia, Africa and South America. In economically developed countries hypovitaminoses which development is connected with seasonal fluctuations of content of polyneuramins to food, the wrong storage of products, imperfection of technological processing of products etc. are noted. Most often the following types of V. of N
== Insufficiency of ascorbic acid (redoxon) == meet . Insufficiency ascorbic to - you are widespread in its initial stages widely and is registered in all climatic areas of the globe. Extreme degree of avitaminosis With (see. Scurvy ) also the hl meets seldom. obr. as complication of other diseases.
Ascorbic to - that plays an important role in maintenance of body resistance to infectious diseases. At its insufficiency decrease in a row immunobiol is observed. reactions. Disturbance of exchange ascorbic to - you lead to development of the S-hypovitaminosis which comes long before emergence of characteristic clinical symptoms and can exist for years. At the same time single petechias, decrease in resistance of skin capillaries, the general weakness and disturbances from a nervous system are noted. The clinical picture of avitaminosis With is followed by petekhialny rash, hemorrhagic exudates in joints and a pleura. Along with it the hypochlorhydria, an achlorhydria and anemia owing to in parallel the arising insufficiency folic to - you are found.
See also Ascorbic acid .
- 1 Insufficiency of cholecalciferol (vitamin D)
- 2 Insufficiency of niacin (PP vitamin)
- 3 Insufficiency of a pyridoxine (vitamin B 6 )
- 4 Insufficiency of Retinolum (vitamin A)
- 5 Insufficiency of Riboflavinum (vitamin B 2 )
- 6 Insufficiency of thiamin (vitamin B 1 )
- 7 Insufficiency of tokoferol (vitamin E)
- 8 Insufficiency of phylloquinones (vitamin K)
- 9 Insufficiency of folic acid
- 10 Insufficiency of cyanocobalamine (vitamin B 12 )
- 11 The vitamin deficiency at radiation injury
- 12 Mental disorders
- 13 Treatment
- 14 Prevention
- 15 A vitamin deficiency
- 16 A vitamin deficiency at advanced and senile age
- 17 Tables
Insufficiency of cholecalciferol (vitamin D)
Typical manifestation of insufficiency of calciferols at children is rickets (see), at adults — osteomalacy (see). Insufficiency of calciferols at adults is noted preferential among women in some countries where owing to religious traditions they lead a solitary life. Disturbance of absorption of fats at a disease of bilious ways belongs to a D-vitamin deficiency of an endogenous origin.
See also Calciferols .
Insufficiency of niacin (PP vitamin)
at the person gives Insufficiency of niacin (PP vitamin) in the expressed exogenous form to to a pellagra (see). The pellagra meets in some countries of Africa and Asia. Endogenous insufficiency nicotinic to - you meets at schizophrenia and other mental diseases, neuritis, an allergic dermatosis, went. - kish. diseases, lead poisoning, benzene etc.
See also Niacin .
Insufficiency of a pyridoxine (vitamin B 6 )
Insufficiency of a pyridoxine (vitamin B 6 ) leads to epileptiform spasms and development of hypochromia microcytic anemia. A pyridoxine more than other vitamins, it is capable to be synthesized by intestinal microflora. This synthesis is broken at intestinal infections and other diseases went. - kish. a path, and also at long reception of antibiotics of a broad spectrum of activity and streptocides. Extremely prolonged use of antitubercular drugs has an adverse effect on endogenous synthesis of a pyridoxine. Endogenous insufficiency of a pyridoxine is found at toxicosis of pregnant women.
See also Piridoksin .
Insufficiency of Retinolum (vitamin A)
Avitaminosis And meets at children in the developing countries of Asia, Africa and Latin America more often, accompanying proteinaceous insufficiency. At good nutrition in an organism such reserves of Retinolum are created that its exception of a diet leads to emergence of clinical symptoms of insufficiency only in 2 — 3. Endogenous insufficiency of Retinolum develops at disturbance of its absorption and transformation of carotene into Retinolum at some diseases of a liver and intestines.
Insufficiency of vitamin A leads to considerable changes of an epithelium, in Krom is disturbed fiziol. regenerations, its atrophy, reparative proliferation of basal cells and their differentiation develops in a multilayer flat keratosic epithelium.
Due to formation of a multilayer keratosic epithelium in a cornea and a conjunctiva their respective sites become dry, whitish, opaque (see. Xerophthalmia ). Further there can come the necrosis of a cornea — a keratomalacia (see. Eye , pathology) and panophthalmia (see). Because of decrease in protective function of an epithelium of bronchial tubes pathogenic microorganisms easily get into lungs, pneumonia — the most frequent cause of death of experimental animals develops at avitaminosis And. The strengthened exfoliating of a neogenic epithelium of output channels of sialadens leads to obstruction them and to developing of retentsionny cysts. Secretion at the same time is broken though the ferruterous epithelium not, is struck.
In an oral cavity it is noted hyperkeratosis (see), thickness of a layer at the same time depends on V.'s duration of N. Histochemical in surface layers of an epithelium — lack of acid phosphatase, noticeable decrease of the activity of a succinatedehydrogenase in basal layers. The metaplasia of an epithelium of a renal pelvis, ureters and a bladder promotes development of pyelites and cystitis, and the keratosic epithelium which strenuously is exfoliated can serve as the reason of formation of stones. In skin the hyperkeratosis of both epidermis, and hair follicles, an atrophy of sweat and sebaceous glands is observed.
Changes of an epithelium are connected with influence of Retinolum on a histogenesis and induction of certain types of an epithelium. The reason of a metaplasia and keratinization consider influence of pathological products of lipid metabolism, disturbance of exchange of sulfur and catalytic oxidation of copper, neurotrophic frustration, disturbances of interaction between Retinolum and sex hormones.
The damages of eyes leading to a blindness are caused not only by a xerophthalmia, but also changes of a retina and optic nerves. In a retina destruction of sticks and flasks, narrowing of neuroepithelial and granulyarnokletochny layers is noted. Damages of optic nerves occur from a prelum their giperplazirovanny bone in the place of escaping of a head cavity.
See also Retinolum .
Insufficiency of Riboflavinum (vitamin B 2 )
Insufficiency of Riboflavinum (vitamin B 2 ) meets together with deficit of protein of animal origin and nicotinic to more often - you in food. The earliest symptom of insufficiency of Riboflavinum — damage of a mucous membrane in corners of a mouth with fracturing, erosion and ulcers, then joins damage of a mucous membrane of lips with vertical cracks on site of their smykaniye — a cheilosis. There occurs change of language (see. Glossitis ). Endogenous insufficiency of Riboflavinum meets at diseases went. - kish. path, hepatitises, diseases of skin.
See also Riboflavinum .
Insufficiency of thiamin (vitamin B 1 )
Insufficiency of thiamin (vitamin B 1 ) in the form of clinically expressed form of a disease (see. Beriberi ) the hl is registered seldom. obr. in the countries of Indochina. The endogenous form of insufficiency of thiamin meets at hron, alcoholism, neuritis, diseases went. - kish. path, thyrotoxicosis, diabetes, various poisonings.
See also Thiamine .
Insufficiency of tokoferol (vitamin E)
Exogenous insufficiency of tokoferol is found at considerable physical. tension at athletes.
Insufficiency of vitamin E in experimental conditions on animals conducts to morfol, to changes in muscles, a liver, gonads.
Dystrophy of skeletal muscles is considered the most universal display of avitaminosis E. Naiboley severe defeats arise in a diaphragm. Changes of mitochondrions in the form of destructions of inner membranes, fragmentations of cristas, formations of intramitokhondrialny myelin figures and dense granules develop in early terms. Muscle fibers are exposed to disintegration, are englobed by macrophages, sarcolemmic tubules form. In nekrotizirovanny fibers salts of calcium are laid. Along with it it is possible to see also the regenerating muscle fibers. In unstriated and cross-striped muscles the sudanophil acid resisting brown pigment similar with tseroidy is postponed.
In a liver necroses, fatty dystrophy, expansion of sinusoid, reduction of maintenance of a glycogen are described.
At a number of animals (a rat, Guinea pigs, dogs, monkeys) there comes the atrophy of testicles.
In a hypophysis of rats males there occur changes of the same look, as well as at castration.
Demyelination and a gliosis of dorsal columns of a spinal cord, the small centers of a necrosis in a myocardium, defeats of tubules of kidneys like a nephrosis is noted.
See also Tokoferola .
Insufficiency of phylloquinones (vitamin K)
Insufficiency of phylloquinones (vitamin K) occurs at adults seldom. At newborns it is shown by hemorrhagic diathesis (went. - kish. bleedings, intradermal, hypodermic hemorrhages etc.).
See also Fillokhinona .
Insufficiency of folic acid
Insufficiency of folic acid in a look to a spr (see) met on Yu. our country, in particular in Central Asia and Transcaucasia. The reasons and conditions of development of insufficiency folic to - you at the person are difficult and diverse. They can consist in exogenous alimentary insufficiency folic to - you, incomplete splitting of the conjugated forms folic to - you in the digestive tract, disturbances of absorption caused acute and hron, diseases, disorders of comprehensibility folic to - you, the cobalamines caused by insufficiency or ascorbic to - you, and also introduction of antagonists folic to - you. Megaloblastichesky anemia at pregnant women can develop owing to a shortcoming folic to - you in food, frequent vomiting, the increased requirement of a fruit in folic to - those, etc. One of forms of insufficiency folic to - you are its deficit at alcoholics.
See also Folic acid .
Insufficiency of cyanocobalamine (vitamin B 12 )
Alimentary (exogenous) insufficiency occurs at senile age at limited consumption of meat and dairy products, and also at middle-aged persons at strictly vegetarian food. Avitaminosis In 12 endogenous origin Pernicious anemia of Addison — Birmera is (see. Pernicious anemia ). The main reason for pernicious anemia — absence in a digestive tract of gastromucoprotein (internal factor), necessary for absorption of cyanocobalamine, which owing to an atrophy of glands of a greater cul-de-sac is not developed. The invasion, napr, a wide tape-worm is intestinal parasites other reason of endogenous insufficiency of cobalamines.
Insufficiency of polyneuramin 12 can be followed by changes in a spinal cord of type funicular myelosis (see). In peripheral nerves sudanophil dystrophy and segmented demyelinations is noted.
See also Cyanocobalamine .
Insufficiency of other vitamins either is not described at all, or meets seldom and therefore has no practical value.
The vitamin deficiency at radiation injury
the Vitamin deficiency is also observed at radiation injury. The first references of action of ionizing radiation on vitamins meet in K. Funk (1916) and Kramer's works (Cramer et al., 1921) which noted symptoms of avitaminosis at radiation injury.
V.'s development by N at radiation injury is to a certain extent caused by a number of the factors preceding radiation. Among them inferiority of food and in particular deficit of supply of an organism with vitamins, exhaustion, infectious diseases, etc. can matter. At radiation injuries
the lowered consumption of food, including vitamins, owing to anorexia, vomiting and other factors connected with deficit of food components is the cornerstone of V.'s development by N. The endogenous reasons of V. of N — change of vsasyvatelny function went. - kish. a path, disintegration of radio sensitive fabrics and the increased release of vitamins from an organism and also destroying action of ionizing radiation on molecules ascorbic to - you, thiamin, a pyridoxine and cobalamines. Besides, dependence of radio sensitivity of vitamin from its physical is revealed. - chemical stability. The most sensitive is ascorbic to - that. Rate of decay of vitamins depends not only on a dose of radiation, but also that Wednesday, in a cut this vitamin is. In metaphytes the probability of direct action of ionizing radiation on a molecule of vitamin during the use of size of doses about 1500 — 2000 r is small.
Existence in the environment of proteins, nucleic acids or other high-molecular compounds in a certain measure protects vitamins from destructions because in complex systems of a molecule of vitamins are surrounded with a huge number of more labile molecules which react with products of a radiolysis of the environment more actively, than stabler molecules of the majority of vitamins. These circumstances explain a high threshold dose of destruction of vitamins at the person and animals.
Clinical symptoms of V. of N at acute radiation injuries are shown not so clearly, they have no specific character and are shaded by other manifestations of a radial illness. In a case hron, influences of radiations (e.g., radiation therapy) the typical picture of a pellagra, avitaminosis of B can develop 1 and In 2 . Feature of dynamics of change of content of polyneuramins biol, substrates at radiation
injury is its waviness depending on the period of a disease.
Exchange of vitamins at radiation injury is broken in an unequal measure. It is conditionally possible to allocate groups of redoxons with the expressed radio-sensitivity (ascorbic to - that, thiamin, Riboflavinum), relative radiation resistance (cobalamines) and intermediate (Retinolum, a pyridoxine, folic and nicotinic acids).
Mental disturbances at V. of N belong to symptomatic psychoses and are observed most often at insufficiency of thiamin, cobalamines and nicotinic to - you. Mental disturbances at V. of N are known on clinic of well studied avitaminosis (a pellagra, beriberi, Pernicious anemia), on observations over the persons receiving the food deprived of any vitamin and also on the basis of observation of psychoses at which disturbance of vitamin exchange takes place. Mental disorders at V. of N are various. Asthenic, depressive, alarming and depressive, maniacal, pseudoparalytic, apathetic states, syndromes of the upset and dulled consciousness (a delirium, an amentia, twilight states), gallyutsinoza are observed; in far come V.'s stage of N — an apathetic stupor, Korsakov's syndrome, dismnestichesky states, weak-mindedness. Encephalopathy owing to insufficiency nicotinic to - you is characterized by disorder of consciousness, extrapyramidal rigidity of muscles and existence of sucking and prehensile reflexes. Gayet's encephalopathy — Vernike (see. Alcoholic encephalopathies ) it is observed owing to insufficiency of thiamin and it is caused hron, alcoholism. Similar to Gayet's encephalopathy — Vernike states arise also at diseases went. - kish. path, malignant anemia, toxicoses of pregnancy. In these cases symptomatic psychoses can develop. At persons who received the food deprived of thiamin «the organic neurasthenia», the general feeling of weakness, irritability, apathy, decrease in memory developed; sleeplessness, headaches, anorexia, nausea, vomiting, locks, later neuritis were noted. At pernicious anemia also depressions are observed maniacal. Psychosis can pass the following stages: hypochiondrially - depressive, purely depressive, depressive and paranoid, paranoido-hallucinatory, delirious. The symptomatic psychoses with confusion of consciousness at persons of senile age (without the phenomena of senile dementia) arising in connection with V. of N are known to psychiatrists, some of them successfully recovered use nicotinic to - you.
Insufficiency of cobalamines can lead to developing of epileptic seizures. Alcoholic polyneuritic psychosis of Korsakov is a combination of encephalopathy to a polyneuritis, and both encephalopathy, and polyneurites are caused first of all by insufficiency of thiamin. It is considered to be that the combination of encephalopathy and polyneurites at symptomatic psychoses indicates that in their pathogeny also V. of N
== Diagnosis == takes place At V.'s diagnosis of N when the specific clinical phenomena either are absent, or are expressed very poorly, it is necessary to consider vitamin security of people, to-ruyu it is possible to estimate by determination of content of vitamins and products of their exchange in urine, blood and various bodies (V. V. Efremov, 1969).
Changes of content in blood of a number of the coenzymes which are formed of the corresponding vitamins can serve as indicators of disturbance of vitamin security (e.g., thiamin, Riboflavinum, Niacinum and a pyridoxine). For assessment of security ascorbic to - that investigate its excretion with morning urine on an empty stomach in 1 hour after bladder emptying. This method can be applied also to definition in urine of thiamin, Riboflavinum, nicotinic to - you (its metabolite of Ni-metilnikotinamid) and a pyridoxine.
Methods of definition of a vitamin deficiency by loading of an organism their considerable doses, up to so-called saturation, are not exact since the concept «saturation», or «ceiling», does not reflect fiziol, the needs for vitamins. The sensitive method of detection of insufficiency folic to - you in an initial stage is based on increase in allocation with urine forminoglutaminovy to - you after loading a histidine. At V. of N the content in blood ascorbic to - you, folic to - you, cobalamines, Retinolum and carotene, tokoferol which are defined biochemical, methods, and contents folic to - you and cobalamines — mikrobiol, tests early decreases.
Along with biochemical, the reactions which are directly determining the level of polyneuramins of blood and urine use as well biochemical, the tests allowing to judge indirectly disturbances of exchange of vitamins. So, e.g., for diagnosis of insufficiency of thiamin define activity in erythrocytes transketomanholes which enzyme is the thiamin-diphosphate which is formed of thiamin. For assessment of security with a pyridoxine investigate allocation with urine xanthurenic to - you after loading tryptophane. Techniques are used as well fiziol: definition of resistance of skin capillaries to negative pressure for recognition of insufficiency ascorbic to - you and bioflavonoids, definition of light sensitivity of an eye (adaptometriya), disturbance a cut is connected generally with insufficiency of Retinolum and partly Riboflavinum. Along with it apply also immunobiol. tests: complementary activity, phagocytal reaction, content of gamma-globulins, etc. Data of some biochemical, and fiziol, reactions, the characterizing average standards of the contents of vitamin at almost healthy people who allow to judge security with their vitamins are provided in tab. 1. Early and exact recognition of V. of N requires comparison of datas of laboratory to clinical symptoms (tab. 2).
Radio isotope diagnosis. The N at the person and animals is applied to V.'s studying a method of radio indication. Use of marked vitamins which separate atoms are replaced by radioactive allows to investigate their intravital distribution, movement, transformation and allocation from an organism.
In pilot studies with success marked are applied 13 With, 60 About thiamin, cobalamines, ascorbic to - that, etc., however long half-life, and also soft beta radiation of radiocarbon do these connections almost unsuitable for the clinical purposes. In medical practice marked is most widely used 58 Co or 57 Co cyanocobalamine.
Method of introduction: at an izucheniivsasyvaniye marked vitamins are appointed inside; for definition of loss of vitamins through went. - kish. the path them is entered intravenously.
Preparation for a research consists in cancellation prior to the beginning of and during a research of antibiotics, and also vitamin drugs which condition of exchange is studied.
The procedure of a research consists that after purpose of marked vitamin inside or intravenously count by means of the well scintillation counter radioactivity in blood or in urine and Calais and establish percentage of the entered dose the size of absorption of vitamins or their loss through went. - kish. path. In the analysis of the received results it is necessary to consider that at disturbance of absorption and digestion of vitamins low level (after peroral introduction) polyneuramins of blood and urine and their considerable allocation with a stake is noted. Along with these methods the increasing value in clinical practice gets V.'s studying N by radioactivity measurement of all body. Use of the counter of the general radioactivity of a body allows to watch a long time in fiziol, conditions the nature of accumulation and redistribution in various bodies of vitamins and to calculate necessary standard daily rate them on the speed of absorption and allocation.
Radio isotope studying of exchange of vitamins can be carried out as during remission, and an exacerbation of a disease; the fact that these tests allow to receive quantitative results is very positive.
Sources of mistakes depend on care of collecting biosubstrates and errors of the account on calculating installations.
The radio isotope research B. of N is not recommended to be applied at pregnant women and children because of a possibility of genetic effects; for the rest contraindications the general for use of radioisotopes during the carrying out radio isotope diagnosis (see).
Treatment — diets with inclusion of the products rich with the vitamins lacking in an organism, reception of the corresponding vitamin and polyvitaminic drugs inside and their introduction parenterally in the dosages several times exceeding the daily need for them of a healthy organism (tab. 2). Duration of vitamin therapy depends on speed of elimination of all clinical symptoms of V. of N and normalization of exchange of vitamins. During the performing treatment it is necessary to consider that excessive reception of some vitamins can cause intoxication (hypervitaminosis) with a number of the clinical phenomena of both functional, and organic character (see. Hypervitaminoses ).
Prevention matters for primary, or exogenous, forms B. of N and includes the following events: increase in production of foodstuff, vitamin-rich, and also vitamin and polyvitaminic drugs; the correct storage and rational technological processing of foodstuff at catering establishments and the plants of the food industry; creation of new foodstuff with addition to them of natural feedstuffs, vitamin-rich; increase in content of polyneuramins foodstuff by selection of page - x. cultures and rational fattening of page - x. animals. The actions directed to increase in awareness of the population in questions of hygiene of food and vitaminology are not less important. Development of the exact, unified methods of a research of content of polyneuramins foodstuff and ready dishes is necessary. In cases of their shortcoming — additional enrichment of food vitamin drugs and the vitaminized foodstuff of mass consumption — flour, milk, food fats, etc. (see. Vitaminization of foodstuff ).
In the USSR norms of daily consumption of vitamins were made and approved the Narkomzdravy USSR in 1944, M3 of the USSR in 1960 are reconsidered. As the need for a number of vitamins is connected with the energy balance, calculation of need for thiamin is accepted (vitamin B 1 ) adjusted for a covering of individual variations — 0,6 mg on 1000 kcal of a daily diet, in Riboflavinum — 0,8 mg, in nicotinic to - those (Niacinum) — 6,5 mg on 1000 kcal. During the calculation of individual requirement criteria of its dependence on a floor were accepted: need of women in a number of vitamins owing to smaller intensity of exchange processes and smaller ideal weight is on average 15% lower, than at men; from age — with its increase owing to decrease in caloric content of food requirement decreases; groups of intensity of work and conditions of life (tab. 3); additional exercise stress, edge raises energy expenditure on 120 — 200 kcal; from the degree of psychological tension increasing the need for vitamins; from climate — in a zone of Far North energy expenditure and need of N separate vitamins increases on average by 30 — 50%.
Prevention of a vitamin deficiency in troops
Prevention of a vitamin deficiency in troops — system of the events held on purpose not to allow emergence at the military personnel of the diseases connected with insufficient consumption of vitamins.
It is known that warring armies suffered a big loss from avitaminosis. In 13 century mass avitaminosis was authentically recorded in troops of crusaders. During the Crimean war in the English, French and Turkish armies 40 000 diseases of a scurvy are registered.
In the Russian-Turkish war of 1877 — 1878 in parts of the Danube army incidence of a scurvy made 10,8, and in Caucasian — 27,4 cases on 1000 people of staff. In World War I in the Russian army was ill a scurvy St. 300 000 persons.
During the Great Patriotic War in the Soviet armed forces prevention of avitaminosis and hypovitaminic states was carried out, thanking a cut it was practically succeeded to prevent their emergence. Actions for V.'s prevention and. in troops included in the Great Patriotic War: medical control of full value of food and content of polyneuramins a diet, observance of rules of storage and technology of cooking, use of vitamin drugs and vitamin infusions, use in food of the vitaminized products, wild-growing greens, a tops of vegetable of garden plants, and also early identification of initial symptoms of hypovitaminoses.
Medical control of food of troops in the Great Patriotic War was aimed at providing good nutrition — observance in a diet of the military personnel of optimum quantity and a ratio of feedstuffs (proteins, fats, carbohydrates, vitamins, mineral salts) and products of an animal and plant origin. Considering close connection of a nitrogen metabolism with exchange of vitamins, the medical service paid special attention to control of a proteinaceous component of food.
For V.'s prevention and. in troops vitamin drugs were widely used. Troops systematically received vitamins during stay in unfavorable climatic conditions, during the spring period, at hard physical activity and big energy expenditure. Patients and wounded in hospitals were constantly supplied with vitamins. At purpose of vitamin drugs data of laboratory researches of food on the content of vitamins and physical condition of troops were considered. The vitamin industry of the country provided supply of army and fleet with necessary amount of vitamins. The army was supplied with the foodstuff which is also vitaminized in the industrial way: the fats enriched with Retinolum, the flour enriched with thiamin, Riboflavinum and nicotinic to - that, the sugar and vegetable canned food enriched ascorbic to - that. At the narrowed range of products replacement of one products with others was made whenever possible, taking into account them biol, values.
A part was played by collecting and use in food of wild-growing vitaminonositel, a tops of vegetable of garden plants, etc. that diversified food and improved its flavoring properties. On many fronts as an additional source of polyneuramins large numbers vitamin infusions from a dogrose, needles and leaves of some trees prepared (birches, lindens).
For increase vitamin (and at the same time proteinaceous) values of food of soldiers in the Great Patriotic War big distribution was gained by use for drink of the yeast containing vital amino acids, vitamins of group B, nicotinic to - that and provitamin D. Also dry yeast was applied. Yeast for drink under control of medical service prepared in army bakeries, in military units and hospitals.
Early identification of signs of V. of N was of great importance. It was carried out by systematic overseeing by physical condition of the military personnel on monthly medical examinations, daily control of the state of health of soldiers and officers, the analysis of incidence of staff. If necessary definition of various diagnostic tests for identification of the early, clinically not expressed symptoms of a C-vitamin deficiency was carried out. In case of detection of signs of V. of N at the certain military personnel urgent measures to bystreyshy recovery of a condition of their health were taken.
Good nutrition of the military personnel, planned supply of troops with high-standard foodstuff in necessary assortment and other actions exclude possibility of avitaminosis in Armed Forces of the USSR in peace time. The medical service of the Soviet Army and the Navy at least once a month exercises laboratory control behind contents ascorbic to - you in ready food, fresh vegetables and sauerkraut. During natural decrease in content of redoxon in fresh vegetables and potatoes preventive vitaminization of ready food by introduction ascorbic to - you is carried out to the third dishes before their delivery at the rate of 50 mg on the person daily. At some types of military work, and also in difficult climatic conditions the need for vitamins increases; in these cases the military personnel receives a complex of vitamins.
A vitamin deficiency
Avitaminosis at children occurs at children seldom, but hypovitaminoses arise more often than at adults, especially at early age. The special importance for the growing organism Retinolum, thiamin, Riboflavinum, a pyridoxine, cobalamines, ascorbic to - that have, calciferols. With women's milk the child receives enough Retinolum and the vitamins of a complex B playing an important role in processes of growth and development.
In process of growth of the child the increasing value gets interdependent influence on its development of vitamins and hormones. A number of vitamins selectively influences function of hemadens. So, there is an interaction between hormones of a thyroid gland and Retinolum, hormones of parathyroids and calciferols. Vitamins increase the general reactive ability of an organism of the child, natural resilience of children to infectious diseases.
During the periods of the strengthened growth (the first two years of life), at the age of 6 — 8 years and during the period preceding puberty (12 — 14 years), the child especially needs the increased amounts of vitamins.
Century of N especially easily arises at premature children owing to a small reserve of polyneuramins an organism, functional inferiority of a liver and other bodies.
At newborns insufficiency of phylloquinones has a characteristic clinical picture. Since 2 — the 3rd day of life the quantity of a prothrombin in blood and coagulability of blood goes down, at some children the hematemesis is observed (see. Hematemesis ), excrements with impurity of blood (see. Melena ), nasal and umbilical bleedings. Sometimes there are hemorrhages in skin, hypodermic cellulose and intracraneal hemorrhages. For the prevention of hemorrhages reasonablly early feeding of newborns since their intestines at the birth are sterile and only gradually becomes populated by microflora, edges participates in synthesis of phylloquinones. Also appointment is recommended to their women before childbirth. In development of a hemorrhagic syndrome has value and insufficiency ascorbic to - you and bioflavonoids. At the newborns who were born from mothers with toxicosis of pregnancy in connection with deficit of a pyridoxine spasms can be observed, the D-vitamin deficiency of mother can be the reason of inborn rickets. At newborns also decrease in level of tocopherol is noted, but clinical manifestations of its insufficiency are not described.
Clinical manifestations of V. and. at children of early age have some features. Symptoms of hypovitaminoses are expressed by the most part poorly. In an initial stage of a hypovitaminosis And at small children the xeroderma, easily arising intertrigo which will difficult respond to treatment are observed. Defeat of an epithelium is noted (metaplasia) of respiratory system, went. - kish. path, middle ear and uric ways. Conjunctivitis, a photophobia, and afterwards a xerophthalmia and a keratomalacia develop. The most characteristic sign of insufficiency of Retinolum at children is hemeralopia (see). At long deficit of Retinolum children lag behind in the weight and growth.
Idiosyncrasies are inherent in insufficiency ascorbic to - you. Children become slow-moving, on skin the smallest petechias which are especially easily appearing on a face, a neck and an upper part of a trunk after long crying or cough are found. At an injury, a prick there are also hemorrhages. In an urocheras — a small amount of erythrocytes in the absence of any disease of kidneys. If the cause of a hypovitaminosis With is not removed, develops anemia owing to a shortcoming folic to - you and other vitamins connected with a hemopoiesis. At long forms delay of increase of weight, a growth inhibition and even exhaustion comes to light. A S-hypovitaminosis leads to a considerable susceptibility of children to an infection therefore its current quite often is complicated by otitis, a pyelitis, pneumonia, etc.
The clinical picture at insufficiency of calciferols is characteristic at children of early age (see. Rickets ).
At the same age symptoms of different types of insufficiency of a complex of polyneuramins at the same time can be observed. At detailed inspection the symptoms characterizing insufficiency of any one vitamin of this group are found. For a hypovitaminosis In 1 disorders of function of digestive organs are characteristic: loss of appetite, tendency to dyspepsias, vomiting. Hypovitaminosis of B 1 is one of the leading reasons of development of hypotrophies. At the same time cyanochroic coloring of integuments, a «marble» type of skin owing to expansion of saphenas, cold extremities is observed. Separate cases of a hypovitaminosis of B are described 1 , being followed by the general concern, increase in reflexes, the general spasms or spasms.
At insufficiency nicotinic to - you at children of early age it is possible to allocate the leading symptom — the persistent diarrhea which is not giving in to usual methods of treatment, but quickly liquidated by appointment nicotinic to - you. Changes on skin in the form of easy pigmentation on a forehead, a neck, the back of phalanxes, a stomach, in the field of axillary and inguinal folds are less often observed. Such children make an impression of badly washed up. Sometimes sharply expressed changes of a mucous membrane of a mouth and language (a hyperemia and smoothing of nipples) are found. Psychological changes are expressed poorly.
At a lack of Riboflavinum at children early symptoms are changes of skin and mucous membranes. In corners of a mouth fracturing and yellowish crusts on them is noted to a moknutya of skin. Gradually sores — perleches (angulus infectiosus) are in these parts formed. The mucous membrane of lips reddens, dries, bursts and shelled. There are changes of skin later (seborrhea pleated of auricles, at a nose bridge, in a corner of a palpebral fissure, in nasolabial folds), the phenomena of a glossitis (nipples of a mucous membrane smooth out, language accepts purple coloring). The phenomena of aphthous stomatitis are frequent. Is surprised as well a conjunctiva of eyes, the photophobia, lachrymation is observed. Believe that avitaminosis In 2 in combination with avitaminosis of B 1 cause a clinical picture of intestinal infantility.
The clinic of the states developing at children owing to a lack of other vitamins of group B is studied less.
Deficit in an organism of the child of a pyridoxine matters in genesis and manifestation first of all of such morbid conditions as ex-sudativno - catarral diathesis, spasms, an asthmatoid syndrome at pneumonia, eczema, neurodermatitis.
Development of seborrheal eczema in children quite often contacts action of the attendee in crude ovalbumin of the avidin (see) having ability to connect biotin that leads to depletion of an organism by it.
Owing to insufficiency folic to - you and cobalamines at children develop anemia. Clinical observations show positive effect of use of cyanocobalamine and folic to - you at the anemias connected with insufficiency of these substances. Relative insufficiency of Retinolum and ascorbic to - you develops at pneumonia.
Hron, frustration of food at children of early age also quite often are followed by V.'s symptoms of N. Initially developed V. of N can be in turn the cause of dystrophic states. At insufficiency of Retinolum and vitamins of group B there is an oppression of enchondral growth. Streptocides, antibiotics suppress life activity of an indestinal flora that can be the reason of insufficiency of vitamin group B and phylloquinones at children.
At children with hypo - and an athyreosis transformation of provitamin A into Retinolum is slowed down, the amount of carotene in blood is increased, the amount of Retinolum is lowered. Dry skin and a rough voice of the children suffering from an athyreosis can speak the changes in skin and mucous membranes of phonatory bands characteristic of an A-vitamin deficiency.
At hereditary diseases of exchange at children a number of vitaminzavisimy states is revealed. In a pathogeny of the disease of Hartnup (see Hartnup a disease) inherited on autosomal recessively type, essential value has insufficient synthesis nicotinic to - you connected with deficit of tryptophane.
The whole group of hereditary morbid conditions has a basis the increased need of an organism for a pyridoxine connected with genetically caused changes of the enzymes participating in exchange of tryptophane and other amino acids. The various clinical picture of the states caused by insufficiency of a pyridoxine is noted at the euzymatic block at the level of kynurenine: skin changes, urtikariya, bronchial asthma, peptic ulcer, spasms. Among other syndromes of these states anemia, a tsistationinuriya, lag in mental development are described. There are single observations of the syndrome caused by insufficiency of the cobalamine proceeding with lag of physical and intellectual development.
Inborn disturbance of metabolism of vitamin D is considered the reason of family gipofosfatemichesky rickets. In developing of inborn false rickets the inborn enzymatic defect causing blockade of transformation of D3 vitamin into biologically active metabolite 1,25 dioxycalciferol matters.
Since in V.'s development by N in children the alimentary factor is of great importance, for prevention the correct catering services of the healthy child are important. A proper correlation of feedstuffs — one of conditions of the maximum digestion of vitamins.
The balanced diet of the nursing mother has extremely important value in V.'s warning to N at the baby.
In the first 3 — 4 months of life the child at natural feeding and a balanced diet of mother receives necessary amount of Retinolum and vitamins of group B. But the content in women's milk ascorbic to - you and calciferols is not enough therefore from 1 — 1,5 month of life the child needs preventive administration of these vitamins. From 5 — 6 months maternal milk not quite covers needs of the child for vitamins (see. Feeding of children ). The great value gets wide use of the preserved and vitaminized products in baby food.
Insufficient stay of the child on air can lead to development of rickets even if he receives calciferols with food.
Healthy children taking into account age have various need for vitamins (tab. 4). At use in high doses of calciferols, Retinolum and thiamin there can be a danger of emergence of a hypervitaminosis.
With the preventive purpose it is better to apply natural products — vitaminonositel, than ready drugs. At detection of these or those symptoms of V. of N first of all it is necessary to find out the reason of their emergence. For treatment children need high doses of vitamins (tab. 5) therefore it is not always obviously possible to give required quantity in natural products and it is necessary to appoint factory drugs or extracts.
However and at use of redoxons to lay down. the appropriate effect is reached by the purpose only at a balanced diet of children. If V. of N developed for the second time, it is necessary, in addition to introduction for the sick child of the increased amount of vitamins, treatment of a basic disease.
A vitamin deficiency at advanced and senile age
the Changes of functional activity of system of digestion occurring at advanced and senile age, decrease in secretion of a gastric juice, its acidity, disturbance of a fermentoobrazovaniye and neurohumoral regulation in a stomach and a pancreas weakening of functions of a liver affect absorption of feedstuffs, including water - and fat-soluble vitamins that causes V.'s development by N.
The disturbances of protein metabolism noted at these persons worsen conditions of fixation in an organism of vitamins (ascorbic to - you, thiamin, Riboflavinum, a pyridoxine, nicotinic to - you). Restriction in fats adversely affects intake of fat-soluble vitamins, in particular Retinolum, and dominance in a diet of people of advanced and senile age of a carbohydrate component, a cut often takes place, promotes the raised expenditure of thiamin, Riboflavinum, nicotinic to - you.
Along with this V. the N at people of advanced and senile age can arise because of the increased need for some vitamins, edges depends on many factors, including and on hypoxemic conditions of various genesis. V.'s development by N is promoted as well the diseases of digestive organs which are often found at people of these age periods, dysbacteriosis (see), dysfunction of closed glands. So, decrease at senile age of function of a thyroid gland leads to insufficiency of Retinolum.
Prevention and V.'s treatment and. polyvitaminic drugs (dekamevit, Undevitum, kvadevit, Panhexavitum, Pentovitum, ampevit, etc.) are at the same time and the measure directed to the prevention and treatment of a senilism. In V.'s warning to N the diet balanced on components of food and on the need for the main feedstuffs and vitamins is of great importance. The need for the main vitamins for people of the senior age groups is presented in table 6.
Table 1. MAIN BIOCHEMICAL INDICATORS of SECURITY of the PERSON with VITAMINS (on average)
Table 2. DIAGNOSTIC CHARACTERS AND TREATMENT of the MOST OFTEN FOUND TYPES of the VITAMIN DEFICIENCY
Table 3. The DAILY NEED FOR SOME VITAMINS AT MEN AND WOMEN DEPENDING ON AGE, the RESIDENCE, CONDITIONS of LIFE AND INTENSITY of WORK (in milligrams)
Table 4. The DAILY NEED FOR SOME VITAMINS of HEALTHY CHILDREN DEPENDING ON AGE
Table 5. DOSES of SOME VITAMINS FOR the MEDICAL PURPOSES AT CHILDREN DEPENDING ON AGE
- At a pellagra to &200nbsp; &mgnbsp; in days
Table 6. The DAILY NEED FOR SOME VITAMINS of PEOPLE of ADVANCED AND SENILE AGE (in milligrams)
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