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Chapter 10 – Fat-Soluble Vitamins
Multiple-Choice
Key Page(s)
b 372 1. Which of the carotenoid pigments has the greatest vitamin A activity?
a. alpha-carotene
b. beta-carotene
c. gamma-carotene
d. delta-carotene
E
b 373 3. Which is retinyl palmitate?
a. A
b. B
c. C
d. D
e. E
a 379 11. In what cells will you find most of the retinol and vitamin A stored?
a. stellate
b. gallbladder
c. fundus
d. antrum
a 379 12. How will retinol, once secreted from the liver, be found in the blood?
a. attached to RBP and transthyretin
b. attached to albumin
c. attached to a chylomicron
d. attached to RBP and stellate cells
a 380 13. Which of the following is needed for the visual cycle?
a. 11-cis retinal
b. 9-cis retinoic acid
c. lycopene
d. cryptoxanthin
Instructions: For questions 14-16, complete the following paragraph with the choices given.
Vitamin A functions in the visual cycle. This mechanism involves a vitamin A molecule called A ,
combining with B to form C . When photon energy strikes this molecule, it splits and causes a
conformational change in the molecule, causing an electrical signal to be sent to the brain.
a 382-383 17. Within the nucleus, all trans-retinoic acid and/or 9-cis retinoic acid binds to
_____.
a. nuclear retinoic acid receptors
b. mannosylated glycoproteins
c. cell aggregates
d. transcription factors
b 384 21. Which vitamin is said to be essential for growth and immune system
function?
a. K
b. A
c. D
d. E
c 386, 389 25. Would you recommend β-carotene supplementation to a smoker to decrease
risk to lung cancer?
a. Yes—β-carotene can quench singlet oxygen.
b. Yes—smoking increases free radical formation; β-carotene can decrease
free radicals.
c. No—β-carotene supplements may be harmful to smokers and are their
use is not advised for the general public.
d. No—β-carotene supplements can cause a vitamin A toxicity and liver
cirrhosis.
b 385-386,389 26. Choose the phrase which best explains the following statement: “β-carotene
is no magic bullet.”
a. β-carotene does not decrease the reactivity of singlet oxygen molecules.
b. β-carotene is not the only health-promoting molecule in fruits and
vegetables.
c. β-carotene supplements cannot be manufactured cheaply enough.
d. β-carotene can replace vitamin E in terminating the auto-oxidation of
fatty acids.
b 387, 389 27. Which micromineral deficiency interferes with vitamin A metabolism by
reducing retinol-binding protein?
a. manganese
b. zinc
c. selenium
d. iron
d 388 28. Which symptom of a vitamin A deficiency is most likely responsible for
deficiency-related deaths?
a. its function as a teratogen
b. poor cellular differentiation and growth
c. keratinization of the cornea
d. severe infections
a 389 29. An individual with poor vitamin A status would have a _____ RDR than
someone with a good vitamin A status.
a. greater
b. lesser
b 389 30. Which is the best technique to assess status of vitamin A liver stores?
a. serum retinol levels
b. the relative dose response
c. clinical eye examinations
c 391-392 31. Imagine you are a nutritionist working in a country other than the U.S.
Which is an assumption about vitamin D status that is NOT true?
a. The latitude makes a difference as regards how much vitamin D can be
self-synthesized.
b. Customs of dress make a difference as regards how much vitamin D can
be self-synthesized.
c. Cow’s milk is a reliable source of vitamin D in the food supply.
d. Skin color makes a difference as regards how much sun is needed to
synthesize vitamin D.
d 391 32. Which vitamin D molecule would you expect to see in fortified foods?
a. ergocalciferol – vitamin D2
b. calcidiol – 25-OH D3
c. calcitriol – 1,25-OH2 D3
d. cholecalciferol – vitamin D3
d 391, 398 33. It’s a good thing that milk is fortified with vitamin D so that we can consume
the RDA if we drink the recommended number of glasses of milk each day.
The DRI for 9-69 year olds is 600 IU (15 g). This equals _____ cups of milk.
a. two
b. three
c. four
d. six
b 395 40. Which vitamin has as its primary function the maintenance of calcium
homeostasis?
a. A
b. D
c. E
d. K
d 395 41. Choose the correct order of the phrases below to explain the response of the
body to a decline in serum calcium levels. Choose the BEST answer.
1. Increased release of PTH
2. Decreased release of PTH
3. Increased synthesis of calbindin
4. Increased synthesis of 1,25-(OH)2 D3
5. Increased bone absorption
6. Increased calcium absorption
7. Decreased bone resorption
8. Increased calcium excretion
9. Increased bone resorption
a. 1, 5, 4, 8
b. 1, 3, 5, 9
c. 2, 3, 9, 6
d. 1, 4, 3, 6
d 397 42. What vitamin is associated with diminished proliferation and enhanced
differentiation of cells, which serves as a basis for its use as treatment of skin
diseases such as psoriasis?
a. A
b. E
c. K
d. D
a 398 43. The RDA for vitamin D for people over the age of 70 is _____ the RDA for
teenagers.
a. greater than
b. less than
c. equal to
c 398, 399 44. If asked about the relationship of vitamin D to autoimmune disease, the best
information for a dietetic professional to provide is:
a. the evidence does not support a relationship at this time.
b. the evidence is only in animals, not humans.
c. some evidence suggests a protective effect of vitamin D.
d. take a supplement containing 2000 IU vitamin D each day.
c 399 46. Toxicity of which vitamin is related to increased deposition of calcium in soft
tissues?
a. lipoic acid
b. biotin
c. D
d. E
a 399 48. Sun exposure does not cause hypervitaminosis D because _____.
a. cutaneous production of the vitamin reaches a maximum
b. sunburned skin is not sensitive to the UV wavelength that causes
previtamin D3 synthesis
c. inactive products are synthesized from pre-vitamin D3 and D3
d. vitamin D-binding protein is not saturated with D3
a 400 49. In assessing the vitamin D status of an individual, which measure would you
use?
a. circulating 25-OH cholecalciferol
b. circulating 1,25-OH2 cholecalciferol
c. circulating cholecalciferol
d. serum calcium levels
a 400, 401 50. Which tocopherol form provides the most vitamin E activity in the U.S. food
supply?
a. alpha
b. beta
c. gamma
d. delta
e 402 54. Immediately following a balanced meal that contained vitamin E (such as
fortified milk), where would you most likely find most of the vitamin E in
the body?
a. in the portal blood as α-tocopherol
b. in the general circulation bound to RBC
c. inside cells as free α-tocopherol
d. stored in adipose tissue
e. in chylomicrons in the lymphatic vessels and general circulation
a 403 55. In what type of tissue is the largest amount of vitamin E stored?
a. adipose
b. heart
c. lung
d. brain
b 403, 404 56. Which fat-soluble vitamin has as its principal function the maintenance of
membrane integrity?
a. vitamin D
b. vitamin E
c. vitamin A
d. vitamin K
c 406 57. Which vitamin is associated with improved plasma membrane structure and
glucose transport/metabolic control in people with type 2 diabetes?
a. A
b. D
c. E
d. K
c 407 58. For which vitamin is the Tolerable Upper Intake Level set because of
increased tendency for bleeding?
a. A
b. D
c. E
d. K
d 409 59. Which of the fat-soluble vitamins is consumed in the form of phylloquinone
from plant foods?
a. A
b. D
c. E
d. K
d 410-412 60. Which fat-soluble vitamin appears to operate as a coenzyme that modifies
proteins to bind with calcium?
a. A
b. β-carotene
c. E
d. K
b 411 61. The action of vitamin K is the post-translational synthesis of blood clotting
factors occurs:
a. in the blood.
b. in the liver.
c. in the small intestine.
d. in the bone marrow.
a 412 62. Anticoagulant drugs that act by inhibiting vitamin K activity do so by which
mechanism?
a. inhibiting the formation of the active form of vitamin K
b. interfering with micelle formation so vitamin K is not absorbed
c. not allowing calcium to interact with Gla residues
d. stimulating osteocalcin synthesis
b 412 63. Mr. S. takes warfarin due to his valve replacement surgery. He is an avid
gardener and enjoys eating the many green leafy vegetables he grows. You
caution Mr. S. to tell his physician about this because the amount of warfarin
he takes may need to be _____
a. decreased
b. increased
d 414 66. For which vitamin is a severe deficiency associated with an increased
tendency for bleeding?
a. A
b. D
c. E
d. K
Enrichment (these questions are related to but go beyond the text chapter)
Key Page(s)
a 382-383 68. Induction of a protein (i.e., increasing the amount of a protein) via increasing
gene expression can be accomplished by:
a. vitamin A.
b. folate.
c. vitamin C.
d. more than one of these vitamins
True/False
Indicate whether each of the following statements is true or false. If the statement is false, explain why it
is false.
Key Page(s)
F 414 1. Gut bacteria can produce some vitamins, but this rarely contributes to our
requirements because they are not absorbed.
Explanation: Vitamin K, folate, biotin—all contribute to the requirement.
F 371 2. Because β-carotene can be converted into retinol, plant sources are referred
to as preformed vitamin A.
Explanation: Plant sources are provitamin A.
T 391-393 3. Production of active vitamin D requires skin, sunlight, cholesterol, the liver,
and the kidneys.
T 395-397 4. Calcium homeostasis in the blood depends on intestinal absorption, bone
resorption, and kidney reabsorption.
T 412 5. Many anticoagulants inhibit the vitamin K cycle, thereby preventing
activation of clotting proteins.
F 379 6. All three forms of vitamin A (retinol, retinal, retinoic acid) are stored in the
liver as retinyl esters.
Explanation: Only retinol is stored in the liver, as retinyl esters.
T 395 7. Vitamin D increases the abundance of calbindin (Ca ++ transporter) in
enterocytes by increasing the transcription of the calbindin gene.
T 380 8. Rhodopsin is simply the opsin protein after it has been activated by 11-cis-
retinal.
T 412 9. Many anticoagulants work by inhibiting the regeneration of active vitamin K
(i.e., dihydrovitamin KH2) during the vitamin K cycle.
F 380 10. All of the functions of vitamin A are carried out by retinoic acid via
transcriptional mechanisms.
Explanation: E.g., retinal for the visual cycle.
F 391 11. A good source of vitamin D is milk, because it is fortified with 1,25-(OH)2-
vitamin D3.
Explanation: Fortified with vitamin D3 (cholecalciferol)—not hydroxylated at
either carbon 25 or carbon 1.
F 391 12. 7-dehydrocholesterol is the form of vitamin D that is added to fortify milk.
Explanation: Cholecalciferol is the form added to fortify milk.
Matching
Fill-in-the-Blank
Page(s)
412 1. The synthesis of the specific bone protein osteocalcin is dependent on the presence of
three fat-soluble vitamins: _____, _____, and _____.
Key: vitamin K, calcitriol, retinoic acid
393, 394 2. When serum Ca is low, the synthesis of the hormone _____ is stimulated in the
kidney to restore serum Ca to normal.
Key: calcitriol
391 3. The 2 forms of naturally occurring provitamin D are: _____ and _____.
Key: ergosterol, 7-dehydrocholesterol
382-384 4. The active form of vitamin A that regulates cell differentiation through gene
expression is _____.
Key: retinoic acid
377-379 5. The absorbed carotenoids that enter the liver can follow three routes: _____, _____
and _____.
Key: cleaved to form retinol, incorporated into and released via VLDL for transport, stored in
the liver
Page(s)
410-413 1. Indicate: (1) the active form of vitamin K, (2) the general function of vitamin K, and
(3) an example of the general function (this could be a specific reaction or simply
indicate a pathway/ process where it occurs). Your answers do not need to be long!
Key: Vitamin K
(1) Dihydrovitamin KH2 or hydroquinone
(2) Carboxylation
(3) Activation of clotting proteins (prothrombin to thrombin); activation of bone proteins
(osteocalcin)
Key: As stated, we are talking about induction—that means we are increasing the abundance
of a particular protein by increasing gene expression.
Two good examples of this are vitamin D and vitamin A. Induction means an increase in the
amount of the protein. Micronutrients such as vitamin A and vitamin D accomplish this by
directly increasing the transcription of a given gene. A good example for vitamin D is its
ability to increase the number of calcium transporters (CaBP) in the intestinal cell. It does
this by binding in the cytosol to a vitamin D-binding protein (VDBP), which delivers it to the
nucleus. In the nucleus, another protein, the vitamin D receptor (VDR), binds vitamin D and
a second protein, the retinoid X receptor (RXR), binds to them. Collectively, this complex
(VDR-RXR) can then bind to the vitamin D response element (VDRE) located in the
promoter region of the gene that encodes for CaBP. When the VDRE is activated by the VDR-
RXR complex, it increases the transcription of CaBP; thus, there are more CaBP made in the
cell and more calcium is transported in.
You can discuss a very similar scenario for vitamin A (retinoic acid, that is). You have
cytosolic proteins (CRABP) to take the retinoic acid to the nucleus, where it binds to a
retinoic acid receptor (RAR) and then RXR. Together, they (RAR-RXR) bind to the retinoic
acid response element (RARE) located on specific genes (such as the gene encoding for growth
hormone receptor or PEPCK) to increase the transcription of that gene; thus, more protein,
like growth hormone or the enzyme PEPCK, is made.
Remember, that regulation of gene expression by vitamin D and vitamin A is cell type-
specific depending on the protein that is being induced. For CaBP, this occurs in the
enterocyte, but not other tissues. For growth hormone, this will occur in certain brain cells,
but no where else. We don’t produce growth hormone and CaBP in every cell that is exposed
to vitamin A or D. Also, remember that once the expression of a gene is turned on, that
results in making more mRNA corresponding to that gene (via transcription), and then the
mRNA leaves the nucleus—it is translated into the desired protein.
Also note that this is essentially the same mechanism (different names, different response
elements) through which zinc and copper regulate metallothionein or SOD. It is different for
iron, where the response elements are on mRNA and the regulation is at the level of
translation in the cytosol.
410-413 3. Although for micronutrients increasing the amount of a protein by directly inducing
gene expression is certainly a common mechanism, we have encountered other
mechanisms by which vitamins can regulate proteins. Provide one example of
posttranslational modification, being as specific as possible.
Key: A possible example is vitamin K, which is required for the carboxylation of a number of
proteins involved in coagulation (e.g., prothrombin to thrombin) to make them more active. It
also covalently modifies bone proteins. In both cases, the carboxylation of glutamate residues
in the protein allows the protein to bind Ca++, thus making it more active in coagulation or
bone formation.
397 5. Discuss the role of calcitonin in maintaining normal blood calcium concentration.
Multiple-Choice
Key Page(s)
a 419 1. Free radicals take electrons from all of the following EXCEPT _____.
a. calcitriol
b. DNA
c. proteins
d. PUFAs
b 423 4. The current thought about using antioxidant supplements to decrease risk to
cancer and heart disease is:
a. more is better.
b. eat antioxidant-rich foods instead.
c. vitamin E supplements work; β-carotene does not.
d. only vitamin C has much promise.
Page(s)
420 1. Discuss the process by which superoxide dismutase (SOD), found in both the cytosol
and the mitochondria, interacts with microminerals to prevent cell damage.
Armour, 89.
Attainders, 53.
Bells, 91.
Brasses, 88.
Briefs, 74.
Chantries, 69.
Charities, 66.
Costume, 89.
Dialect, 108.
Etymology, 13.
Fonts, 90.
Forfeitures, 53.
Glass, 89.
Heraldry, 89.
Maps, 14.
Monuments, 86.
Muster Rolls, 54.
Originalia, 26.
Pardons, 53.
Placita, 29.
Plate, 91.
Re-consecration, 82.
Re-dedication, 83.
“Reliquary,” 91.
Restoration, 96.
Sequestrations, 53.
Sheriffs, 54.
Wills, 52.
NOTES ON
The Churches of Derbyshire.
Updated editions will replace the previous one—the old editions will
be renamed.