Nutritional Biochemistry: Case Study of Vitamin D and Iron Deficiency

This report examines the metabolic processes, storage, and absorption of essential nutrients, specifically iron and Vitamin D, in relation to Liz's case. Liz exhibits symptoms of Vitamin D deficiency, including fatigue and muscle pain, linked to inadequate hepatic and renal conversion of vitamin D due to a lack of magnesium-rich foods in her diet. This deficiency increases her risk of myocardial infarction and osteoporosis. She also shows signs of iron deficiency anemia, exacerbated by a lack of vitamin C-rich foods that enhance iron uptake. Dietary interventions for Liz, a vegetarian, involve incorporating green leafy vegetables, beans, legumes, whole grains, and vitamin C-rich fruits and vegetables. Chickpeas are recommended due to their high iron, magnesium, calcium, and vitamin C content. Sunlight exposure and consumption of calcium-rich dairy products, magnesium-rich foods, and vitamin D supplements are also advised to improve her vitamin D status and alleviate calcium deficiency risk. Addressing both iron and vitamin D deficiencies through combined dietary interventions is crucial for managing her health.

Running head: NUTRITIONAL BIOCHEMISTRY
NUTRITIONAL BIOCHEMISTRY
Name of the Student:
Name of the University:
Author note:

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Introduction
The following report will demonstrate the various processes of metabolism, storage and
absorption of essential nutrients like iron and Vitamin D and their associations with disease
pathology, with regards to the case of Liz.
Discussion
Vitamin D and Iron
Liz is suffering from a deficiency of Vitamin D. Prevalent symptoms which demonstrate
deficient nutrient status include: excessive weakness, tiredness or fatigue, pain and aches in
muscles - which indeed can be observed in Liz (Manson et al., 2016).
As evidenced by Quraishi and Camargo (2012), after traversing the systemic circulation,
vitamin D – which is now bound to vitamin D binding protein – undergoes hepatic hydroxylation
25(OH)D. 25(OH)D. The compound 25(OH)D also undergoes renal conversion with the help of
enzymes, to calcitriol, the hormonal form of vitamin D, which is also its metabolite of the
highest potency. According to Uwitonze and Razzaque (2018), both hepatic and renal regulated
conversion of vitamin D is controlled by enzymes 25-hydroxylase and 1α hydroxylase, both of
whose enzymatic activities are regulated with the aid of magnesium. Subsequently the binding
processes of vitamin D and vitamin D binding protein is also driven by magnesium. Foods rich
in magnesium include nuts, seeds leafy green vegetables, legumes like chickpeas, black and
kidney beans, fruits like bananas, avocado and raspberries as well as seafood. It is evident that
such magnesium rich foods are absent in Liz’s diet and may contribute to deficiency (Du et al.,
2018).

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According to Mozos and Marginean (2015), a deficient vitamin D status increases risk of
myocardial infarction since vitamin D may possess abilities of modulation of inflammatory
cytokines. Hyperlipidemia and fatty streak deposition in the endothelium results in LDL
cholesterol oxidation, a key pathology of myocardial infarction whose risk may hence be further
enhanced in Liz due to her low vitamin D status. Liz’s risk is already demonstrated by her state
of obesity, hypertension and tachycardia as per her vital signs. The lack of antioxidant rich
vegetables in her diet also increases her risk of inflammation-associated destruction of vitamin D
binding protein and vitamin D deficiency.
This conversion of 25(OH)D to calcitriol, as researched by Bikle (2017), 25(OH)D plays
a key role in absorption of calcium across the membranes of brush border cells and hence a
deficiency also increases Liz’s risk of calcium deficient, increased bone porosity, loss of bone
strength, osteoporosis and future susceptibility of fractures.
Liz’s symptoms of fatigue, distorted nails, cracked mouth corners and hypoxia-associated
tachypnea demonstrate iron deficiency anemia. Iron is absorbed from the proximal jejunum and
duodenum where it is reduced to ferrous iron, transported across enterocytes’ apical membrane
and transported across circulation with the help of transferrin. In addition to uptake by tissues,
transferring transports iron to ferritin, the primary compound for iron storage. It has been
evidenced that ascorbate, derived from dietary vitamin C, enhances iron uptake by cells and
expression of ferritin (Lane & Richardson, 2014). Liz’s diet clearly demonstrates a lack of
vitamin C rich citrus foods, cauliflowers and broccoli and hence may have contributed to her iron
deficiency. The randomized controlled trial by Toxqui et al., (2014) reported an relationship
between iron deficiency and increased bone resorption in women. Hence, of not addressed

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timely, Liz’s iron deficiency may further increase her risk of bone related disorders in
congruence with her previously identified vitamin D deficiency and poor calcium absorption.
Dietary Interventions
Considering that Liz is a vegetarian, dietary interventions are of special concern in terms
of enhancing her vitamin D and iron status. The systematic review by Haider et al., (2018),
evidenced an association between vegetarian diets and deficient status of iron. However, Liz can
be advised to consume vegetarian sources like green leafy vegetables, beans, legumes, whole
grains along with vitamin C rich citrus fruits and cruciferous vegetables. Since vegetarian iron
sources have iron bound to antinutrient complexes like tannins, phytates and phenols as
compared to easily absorbable haeme-iron from meat sources, consuming such sources with
vitamin C rich foods have been found to enhance absorption. Additionally, a key ingredient
which Liz can be advised to consume are chickpeas, since they are rich in iron, magnesium,
calcium as well as Vitamin C (Wallace, Murray and Zelman 2016).
For enhancing her vitamin D status, Liz must be advised to improve her habits and go out
more, since sunlight induces the most effective uptake of vitamin D. Additionally, consuming
foods rich in vitamin D as well as calcium will be helpful to enhance absorption and alleviate
calcium deficiency risk in Liz. Dietary interventions will hence include consumption of calcium
rich dairy products and magnesium rich foods, vitamin D supplements or fortified cereals and
beverages (Rosanoff, Dai & Shapses, 2016).
Conclusion
Hence, a poor status of iron and vitamin D have been evidenced to be associated with
major chronic illnesses and deficiency disorders. Combined dietary interventions comprising of

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incorporating vitamin D, calcium, iron, magnesium and vitamin C rich foods will prove to be
beneficial to collectively address the same.

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References
Bikle, D. (2017). Vitamin D: Production, metabolism, and mechanisms of action. In Endotext
[Internet]. MDText. com, Inc..
Dai, Q., Zhu, X., Manson, J. E., Song, Y., Li, X., Franke, A. A., ... & Murff, H. (2018).
Magnesium status and supplementation influence vitamin D status and metabolism:
results from a randomized trial. The American journal of clinical nutrition, 108(6), 1249-
1258.
Haider, L. M., Schwingshackl, L., Hoffmann, G., & Ekmekcioglu, C. (2018). The effect of
vegetarian diets on iron status in adults: A systematic review and meta-analysis. Critical
reviews in food science and nutrition, 58(8), 1359-1374.
Lane, D. J., & Richardson, D. R. (2014). The active role of vitamin C in mammalian iron
metabolism: much more than just enhanced iron absorption!. Free radical biology and
medicine, 75, 69-83.
Manson, J. E., Brannon, P. M., Rosen, C. J., & Taylor, C. L. (2016). Vitamin D deficiency-is
there really a pandemic?. The New England journal of medicine, 375(19), 1817.
Mozos, I., & Marginean, O. (2015). Links between vitamin D deficiency and cardiovascular
diseases. BioMed research international, 2015.
Quraishi, S. A., & Camargo Jr, C. A. (2012). Vitamin D in acute stress and critical
illness. Current opinion in clinical nutrition and metabolic care, 15(6), 625.

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Rosanoff, A., Dai, Q., & Shapses, S. A. (2016). Essential nutrient interactions: does low or
suboptimal magnesium status interact with vitamin D and/or calcium status?. Advances in
nutrition, 7(1), 25-43.
Toxqui, L., Pérez-Granados, A. M., Blanco-Rojo, R., Wright, I., de la Piedra, C., & Vaquero, M.
P. (2014). Low iron status as a factor of increased bone resorption and effects of an iron
and vitamin D-fortified skimmed milk on bone remodelling in young Spanish
women. European journal of nutrition, 53(2), 441-448.
Uwitonze, A. M., & Razzaque, M. S. (2018). Role of magnesium in vitamin D activation and
function. J. Am. Osteopath. Assoc, 118(3), 181-189.
Wallace, T., Murray, R., & Zelman, K. (2016). The nutritional value and health benefits of
chickpeas and hummus. Nutrients, 8(12), 766.