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198
Chapter 11 – The Fat-Soluble Vitamins: A, D, E, and K
An. Page(s)/difficulty K = knowledge-level, A = application level
Multiple Choice
Questions for Section 11.0 Introduction
a. Require bile for absorption
b. Found in the fat and oily parts of foods
c. Transported permanently to the liver and adipose tissue
d. Pose a greater risk for developing a toxicity than water-soluble vitamins
the circulation?
a. Albumin
b. Cholesterol
c. Chylomicrons
d. Liposoluble binding proteins
a. Most of them are synthesized by intestinal bacteria
b. Intestinal transport occurs by way of the portal circulation
c. Deficiency symptoms may take years to develop on a poor diet
d. Toxicity risk is higher for vitamins E and K than for other fat-soluble vitamins
Questions for Section 11.1 Vitamin A and Beta-Carotene
vitamin A?
a. Eyes
b. Kidneys
c. Adipose cells
d. Intestinal cells
a. Tryptophan
b. Chlorophyll
c. Xanthophyll
d. Beta-carotene
a. 1
b. 2
c. 3
d. 5
a. retinol.
b. retinal.
c. retinoic acid.
d. retinoquinone.
199
tissues?
a. Albumin
b. Rhodopsin
c. Retinol-binding protein
d. Transcarotenoid protein
processes?
a. Blood clotting
b. Growth of bones and teeth
c. Synthesis of visual pigment
d. Maintaining mucous membranes
only source of vitamin A?
a. Growth is stunted
b. Blindness develops
c. Retinal synthesis is stimulated
d. Retinol synthesis is stimulated
a. Retinoic acid is the form required for synthesis of retinoblasts
b. Light causes retinal to shift from a cis to a trans configuration
c. Retinol is the form bound to beta-carotene in the corneal membrane
d. Pigment molecules in the retina are composed of a molecule of vitamin A bound to
an omega-3 fatty acid
response?
a. Opsin
b. Keratin
c. Retinal
d. Carotene
a. Light energy strikes the retina and excites pigments to release retinal
b. Light energy strikes the cornea and excites pigments to release retinoic acid
c. Visual pigments deep in the brain are excited by light transmitted through the retina
d. Epithelial cells on the surface of the eye respond to light energy by transmitting
opsin molecules along nerve pathways to the brain
a. 20
b. 50
c. 70
d. 90
a 358(K) 15. What tissue contains the majority of the body’s store of vitamin A?
a. Liver
b. Adipose
c. Retinal cells
d. Intestinal mucosal cells
200
a. It stimulates uptake of calcium from the intestines
b. It promotes synthesis of specific bone proteins involved in the mineralization process
c. It assists enzymes that degrade certain regions of the bone thereby allowing
remodeling to occur
d. It inhibits oxidation of bone mucopolysaccharides thereby preserving bone crystal
integrity and promoting growth
how much time would pass before the first deficiency symptoms would appear?
a. 2 weeks
b. 1 to 2 months
c. 6 months
d. 1 to 2 years
enough vitamin A. Today he said he didn’t eat any carrots and is worried that there is not
enough vitamin A in his system. What would you say to Greg to allay his fear?
a. “Take a vitamin A supplement as soon as you can!”
b. “As long as you eat some chicken tonight you will not develop chicken eyes.”
c. “Well, there isn’t any vitamin A in carrots so you probably haven’t consumed
vitamin A for some time now.”
d. “Don’t worry; fat-soluble vitamins are stored in the body. It takes a lot longer than
one day to develop any adverse effects.”
a. 5 million
b. 25 million
c. 250 million
d. 500 million
a. Adequate protein intake is a marker for liberal intake of the vitamin
b. Dietary protein assures synthesis of the vitamin’s GI tract transporter
c. Adequate protein intake reduces the risk for infection from bacteria that degrade the
vitamin
d. Transport of the vitamin within the body requires sufficient protein to synthesize
retinol-binding protein
measles can be significantly reduced by providing supplements of
a. iron.
b. vitamin A.
c. folic acid.
d. phylloquinone.
a. Inhibition of oxidation
b. Prevention of keratinization
c. Inhibition of bone calcium loss
d. Prevention of hemolytic anemia
201
a. xerosis.
b. xerophthalmia.
c. night blindness.
d. corneal keratinization.
a. Toxicity of vitamin A
b. Toxicity of beta-carotene
c. Deficiency of vitamin A
d. Deficiency of vitamin D
a. Acne
b. Rickets
c. Osteomalacia
d. Night blindness
a. Adults
b. Elderly
c. Newborns
d. Adolescents
vitamin A?
a. Osteomalacia
b. Osteoporosis
c. Xerophthalmia
d. Prolonged blood-clotting time
a. toxicity of vitamin A.
b. toxicity of vitamin D.
c. deficiency of vitamin A.
d. deficiency of vitamin D.
a. Bone
b. Liver
c. Cornea
d. Immune cells
a. toxicity of vitamin A.
b. toxicity of beta-carotene.
c. deficiency of vitamin A.
d. deficiency of vitamin D.
a. They are teratogenic
b. They are highly toxic
c. They are usually taken orally
d. They have chemical structures similar to vitamin A
202
a. Children
b. Adolescents
c. Adults
d. Elderly
a. They increase teratogenic risk
b. They are effective in treating acne
c. They lead to keratinization of tissue
d. They reduce risk for neural tube defects
a. milligram.
b. global unit.
c. international unit.
d. retinol activity equivalent.
a. It is effective in treating rickets
b. It is less toxic than pure vitamin A
c. It is known to be effective in treating mild but not severe acne
d. It is known to cause birth defects when used by pregnant women
a. overconsumption from foods is harmless.
b. overconsumption from supplements is harmless.
c. drinking alcohol worsens the adverse effects of supplements.
d. smoking cigarettes aggravates the detrimental effects of supplements.
equivalent?
a. 2
b. 4
c. 8
d. 12
units?
a. 3
b. 5
c. 8
d. 10
large quantities of carrots or carrot juice?
a. Bone pain
b. Dermatitis
c. Skin yellowing
d. Vitamin A toxicity
a. It may aggravate existing edema
b. It may lead to prolongation of labor
c. It is a teratogen and can be harmful to the baby
d. It contains high concentrations of vitamin D that can cause birth defects
203
a. Adolescent women
b. Overweight adults
c. Those taking vitamin A supplements
d. Those consuming more than 100 g of carrots daily
women limit vitamin A supplements to less than
a. 5,000 RAE.
b. 10,000 RAE.
c. 4 times the RDA.
d. 10 times the RDA.
a. 400 mg.
b. 1,000 mg.
c. 800 retinol activity equivalents.
d. 5,000 retinol activity equivalents.
a. Eating beef liver once a month
b. Consuming high-dose vitamin A supplements
c. Drinking 2 quarts of vitamin A-fortified milk daily
d. Consuming large amounts of dark green and deep orange vegetables
a. Most carotenoids can be converted to vitamin A
b. The carotenoid with the highest conversion rate to vitamin A is lycopene
c. Carotenoid absorption efficiency from salads is higher when regular dressing is used
compared with low-fat dressing
d. Carotenoid absorption is inhibited by foods rich in chlorophyll
a. Anthocyanin in beets masks the presence of beta-carotene
b. Margarine made from corn oil is a poor source of vitamin A
c. Most carotenoids can be converted in the body to active vitamin A
d. Chlorophyll in dark green leafy vegetables masks the presence of beta-carotene
a. Most carotenoids have vitamin A activity
b. Bioavailability depends in part on the presence of preformed vitamin A
c. Absorption from the GI tract is blunted by consuming a salad with fat-free dressing
d. Bioavailability is highest for alpha-carotene but this form is present in least amounts
in the diet
the nutritional status of children in Indonesia. Once there, she saw that many of the
children and some adults suffer from night blindness. Which of the following foods
should she recommend be incorporated into the Indonesian diet to help prevent future
generations from developing this condition?
a. Sweet potato
b. Orange juice
c. Peanut butter
d. Powdered skim milk
204
a. liver.
b. bananas.
c. apricots.
d. sweet potatoes.
a. Corn
b. Pumpkin pie
c. Baked potato
d. Whole-grain bread
a. Fast foods are generally considered good sources of vitamin A
b. A regular intake of chicken liver is known to induce toxicity in children
c. Xanthophylls in certain vegetables can be converted to active vitamin A in the liver
d. Chlorophyll in vegetables can be converted to active vitamin A in the intestinal cells
a. Corn
b. Spinach
c. Carrots
d. Cantaloupe
Questions for Section 11.2 Vitamin D
a. ergocalciferol.
b. foliocalciferol.
c. cholecalciferol.
d. phyllocalciferol.
a. ergocalciferol.
b. foliocalciferol.
c. cholecalciferol.
d. phyllocalciferol.
D except the
a. skin.
b. liver.
c. kidney.
d. intestines.
d 363(K) 56. Which of the following shows the highest vitamin D activity?
a. Cholecalciferol
b. 7-Dehydrocholesterol
c. 25-Hydroxy vitamin D
d. 1,25-Dihydroxy vitamin D
205
of vitamin D?
a. Cholesterol
b. Tryptophan
c. Beta-carotene
d. Eicosapentanoic acid
a. Bone
b. Carotene
c. Tryptophan
d. Exposure to sunlight
compound that is fully active?
a. Liver only
b. Kidney only
c. Liver and kidney
d. Liver and intestines
a. calciferol.
b. calcitonin.
c. cholecalciferol.
d. dihydroxy vitamin D.
a. Vitamin D
b. Vitamin K
c. Phylloquinone
d. Alpha-tocopherol
except the
a. liver.
b. bone.
c. kidney.
d. intestine.
a. Promotes secretion of calcitonin
b. Promotes synthesis of 7-dehydrocholesterol
c. Promotes synthesis of carotenoids and controls absorption of fat-soluble vitamins
d. Promotes calcium and phosphorus absorption and promotes calcium mobilization
from bone
a. A.
b. K.
c. E.
d. D.
206
a. Rickets
b. Osteomalacia
c. Keratomalacia
d. Hyperkeratosis
a. Infants
b. Elderly men
c. Adult women
d. Children ages 2-12 years
a. Nervous
b. Skeletal
c. Muscular
d. Circulatory
a. Bowed legs
b. Rupture of red blood cells
c. Frequent respiratory infections
d. Abnormally high blood calcium level
the same nutrient?
a. Osteomalacia and rickets
b. Xerophthalmia and breath pentane release
c. Kwashiorkor and fibrocystic breast disease
d. Hemolytic anemia and large-cell type anemia
a. It causes a calcium deficiency
b. It causes excess iron absorption
c. It leads to overt signs only rarely
d. It leads to low blood calcium which in turn promotes seizures
a. deficient intake may lead to altered bone composition.
b. excessive intake may lead to mineral deposits in the kidneys.
c. fortified milk is the major dietary source in the U.S. population.
d. the requirement is increased in most people who are exposed to the sun.
a. Consumption of little or no milk
b. Excessive use of hypertension medications
c. Wearing protective clothing and using sunscreen while outdoors
d. Diminished capacity of liver and kidney synthesis of activated vitamin D
reasons except reduced
a. exposure to sunlight.
b. milk intake of older people.
c. absorption of dietary vitamin D.
d. activation of vitamin D by the kidneys.
207
a. Increased bone density
b. Increased bone calcification
c. Deformity of leg bones, ribs, and skull
d. Mineral deposits in soft tissues such as the kidney
research on bats in caves. She typically works in the caves during the day when the bats
are there and leaves at sundown when the bats are active. Since your friend only
purchases organic and all natural foods, which of the following would you most likely
advise she buy regularly at the grocery store?
a. Whole-grain bread
b. Vitamin D-fortified milk
c. Vitamin A-fortified carrot juice
d. Omega-3 fatty acid-fortified milk
a. The bioavailability of vitamin D from soy milk is low
b. Lifeguards on southern beaches have increased risk for vitamin D toxicity
c. Most adults living in the southern United States need small amounts of dietary
vitamin D
d. The average consumption in the United States does not meet the recommended
intake
a. Vitamin D deficiency may be created by a calcium deficiency
b. Only about one-half of the world’s population relies on sunlight to maintain adequate
vitamin D nutrition
c. Prolonged exposure to sunlight degrades the vitamin D precursor in skin, thus
preventing vitamin D toxicity
d. In people living in northern U.S. cities, vitamin D stores from synthesis during the
summer are usually sufficient to meet the needs during the winter
vitamin D status?
a. Outdoor exposure of the skin to sunlight
b. Wide availability of low-cost fish products
c. Wide availability of food assistance programs
d. World Health Organization distribution of vitamin D capsules
the blood vessels and kidney?
a. Excessive intake of vitamin D
b. Inadequate intake of vitamin D
c. Excessive intake of tocopherols
d. Inadequate intake of tocopherols
a. Toxicity from vitamin D may result from overexposure to the sun
b. Requirements are much higher in the elderly due to degenerative bone diseases
c. Fortification of milk with the vitamin is common in order to provide people with a
reliable source
d. Absorption from most food sources is very poor, necessitating the enrichment of
grain products
208
a. Meat
b. Fortified milk
c. Fruits and vegetables
d. Enriched breads and cereals
a. Tanning lamps and tanning booths do not stimulate vitamin D synthesis
b. Sunscreens with sunburn protection factors of 2 and above prevent synthesis of
vitamin D
c. The ultraviolet rays of the sun are able to easily pierce heavy clouds and smog to
promote vitamin D synthesis
d. Dark-skinned people require longer sunlight exposure than light-skinned people to
synthesize equivalent amounts of vitamin D
a. Egg yolks
b. Red meats
c. Tomato juice
d. Whole-wheat bread
a. A dietary source is oily fish
b. The DRI fails to account for skin synthesis of vitamin D
c. Excessive exposure to the sun increases risk for vitamin D toxicity
d. People who are not outdoors are advised to drink at least 2 cups of vitamin D-
fortified milk daily
a 367(K) 85. What is the Adequate Intake level for vitamin D in individuals around 20 years of age?
a. 5 μg
b. 8 μg
c. 10 μg
d. 14 μg
Questions for Section 11.3 Vitamin E
Which of the following vitamins has been noted as preventing the oxidation of low-
density lipoproteins?
a. A
b. E
c. K
d. D
a. peroxide.
b. coenzyme.
c. antioxidant.
d. free radical.
a. Carrier
b. Promoter
c. Eliminator
d. Synthesizer
209
a. Both function as antioxidants
b. Both require bile for absorption
c. Neither participates in protein synthesis
d. Neither is affected by the processing of foods
a. It inhibits absorption of dietary cholesterol
b. It slows oxidation of low-density lipoproteins
c. It interferes with cholesterol synthesis by the liver
d. It speeds removal of blood cholesterol by the liver
d 368(K) 91. The major function of vitamin E is to inhibit the destruction of
a. lysosomes.
b. free radicals.
c. mucopolysaccharides.
d. polyunsaturated fatty acids.
a. Alpha
b. Beta
c. Gamma
d. Delta
vitamins except
a. vitamin A.
b. vitamin K.
c. vitamin E.
d. vitamin D.
a. Rickets
b. Xerophthalmia
c. Muscular dystrophy
d. Erythrocyte hemolysis
a. Functions as a hormone-like substance
b. Toxicity symptoms include bone abnormalities
c. Deficiencies occur from inability to absorb dietary lipids
d. Important food sources include enriched breads and pasta
a. The vitamin is not essential
b. The vitamin is widespread in foods
c. Most people take vitamin E supplements
d. The vitamin can be synthesized by the body
groups except
a. premature infants.
b. people with intermittent claudication.
c. women with fibrocystic breast disease.
d. people with problems of sexual impotence.
210
a. Diabetes
b. Pernicious anemia
c. Muscular dystrophy
d. Intermittent claudication
factor
a. 0.8.
b. 1.4.
c. 2.0.
d. 3.3.
a. Easily destroyed by air and oxygen
b. Act as precursors for the menaquinones
c. May dissolve from foods into cooking water
d. Absorbed from the intestines into the portal circulation
a. Vitamin E is fairly stable to heat
b. Most convenience foods are poor sources of vitamin E
c. Saturated oils are the major dietary sources of vitamin E
d. The amount of alpha-tocopherol in foods is underestimated
a. Meats
b. Citrus fruits
c. Vegetable oils
d. Milk and dairy products
a. Butter
b. Carrots
c. Milk fat
d. Corn oil
Upper Intake Level?
a. 2
b. 10
c. 25
d. 65
a. A.
b. E.
c. K.
d. D.
a. Good food sources include lean meats and dairy
b. The various tocopherols perform similar roles in the body
c. They are usually found in foods high in polyunsaturated fats
d. The various tocopherol compounds can be converted to the active alpha-tocopherol
211
Questions for Section 11.4 Vitamin K
a. Both are synthesized in the body
b. Both are required for normal vision
c. Neither has an effect on bone metabolism
d. Neither has an effect on erythrocyte function
a. A storage protein for vitamin K
b. A transport protein for vitamin E
c. A protein needed for bone formation
d. A protein needed for blood clot formation
a. Albumin
b. GI mucosa
c. Prothrombin
d. Mucopolysaccharides
a. Blood clotting
b. Energy metabolism
c. Calcium utilization
d. Epithelial tissue renewal
a. It participates in synthesis of bone proteins
b. Large amounts can be stored in adipose tissue
c. Good food sources are legumes and raw fruits
d. Intestinal bacterial synthesis provides over 90% of the body’s need for most people
a. A deficiency increases the risk for hemophilia
b. A deficiency leads to keratinization of the cornea
c. Bacteria in the intestines synthesize bioavailable vitamin K
d. There are multiple forms in the diet of which menadione is the naturally occurring
form
c 370-371(K) 113. Which of the following is a feature of osteocalcin?
a. It activates lysosomes involved in remodeling bone
b. It binds calcium in the GI tract to enhance absorption
c. It requires vitamin K to bind to bone-forming minerals
d. It works synergistically with the kidneys to reduce urinary calcium excretion
a. Achlorhydria
b. Antibiotic therapy
c. Presence of oxalic acid in food
d. Insufficient intake of green leafy vegetables
212
details of her hospital stay. She mentions that shortly after the birth, Thomas received an
intramuscular injection of vitamin K, and she wondered why this was done, as it made
him cry. You explained that it
a. was needed to prevent eye disease.
b. prevented possible bleeding events.
c. protected the baby from lipid oxidation.
d. was needed to promote good bone growth.
a. infants frequently require a supplement at birth.
b. good food sources are plants of the cabbage family.
c. risk of deficiency is increased in people taking antibiotics for prolonged periods.
d. gut microflora synthesis supplies sufficient amounts to meet the needs of most
healthy adults.
a. A
b. E
c. K
d. D
c 371(K) 118. Which vitamin is routinely given as a single dose to newborns?
a. Vitamin A
b. Vitamin E
c. Vitamin K
d. Vitamin B12
large quantities?
a. Liver
b. Pancreas
c. Gallbladder
d. Small intestine
a. Adults
b. Elderly
c. Newborns
d. Teenagers
a. Deficiencies lead to intravascular clotting
b. Major dietary sources are whole grains and legumes
c. No adverse effects have been reported with high intakes
d. Primary deficiencies are more common than secondary deficiencies
a. Cold water fish
b. Processed soups
c. Enriched breads
d. Green leafy vegetables
213
a. ergodione.
b. menadione.
c. tocopherone.
d. phylloquinone.
bacterial synthesis?
a. Less than 5
b. 25
c. 50
d. 85
a. 45-60 µg
b. 90-120 µg
c. 150-300 µg
d. 500-550 µg
Question for Section 11.5 The Fat-Soluble Vitamins—In Summary
a. Retinol
b. Tocopherol
c. Phylloquinone
d. Cyanocobalamin
Questions for Section 11.6 Antioxidant Nutrients in Disease Prevention
a. An antioxidant substance that prevents accumulation of cell-damaging oxides
b. A substance in food that interacts with nutrients to decrease their utilization
c. A nutrient in excess of body needs that the body is free to degrade with no
consequence
d. A molecule that is unstable and highly reactive because it contains unpaired
electrons
a. They are destroyed by cigarette smoking
b. They arise from normal metabolic reactions
c. They typically stop chain reactions associated with the production of peroxides
d. They are known to accumulate even in the presence of abundant antioxidant
nutrients
a 376(K) 129. Substances that promote oxidation are usually termed
a. prooxidants.
b. antioxidants.
c. free radical generators.
d. reactive electron oxidants.
a. Both protect against LDL oxidation
b. Neither reduces arterial inflammation
c. Neither participates in regulating blood clotting
d. Both act as prooxidants at physiological intakes
214
Matching
T 356 01. Transport protein of vitamin A
F 358 02. Promotes bone dismantling prior to bone growth
N 359 03. Condition that results from severe vitamin A deficiency
C 359 04. The protein of hair and nails
A 360 05. Chronic inflammation of skin follicles and oil-producing glands
E 361 06. Pigment in carrots and pumpkins
I 363 07. Precursor for vitamin D synthesis
B 364 08. Vitamin D deficiency disease in children
L 364 09. Vitamin D deficiency disease in adults
M 365 10. Term denoting high blood calcium
G 369 11. May be beneficial for treating fibrocystic breast disease
R 369 12. Vitamin E deficiency disorder in premature infants
Q 369 13. Typical food source of vitamin E
D 369 14. Type of anemia prevented by vitamin E
H 370 15. Substance that promotes synthesis of prothrombin
J 370 16. Another term for blood clotting
K 371 17. Use of this increases risk for vitamin K deficiency
O 371 18. Substance that prevents clotting of the blood
P 371 19. Synthetic form of vitamin K
S 371 20. Food source of vitamin K
215
Essay
Page(s)
355-356 01. Outline the interconversions of the different forms of vitamin A, and the chief
functions of each form.
356-357;363-364 02. Explain why vitamin A and vitamin D may function as hormones rather than as
vitamins.
357 03. Explain the mechanism associated with the function of vitamin A in the visual
response.
358 04. Explain the role of vitamin A in growth and reproduction.
358-359 05. What is the role of vitamin A supplementation for the treatment and prevention of
infectious diseases, especially measles, in developing countries?
359 06. Distinguish between the roles of vitamin A in preventing night blindness and
permanent blindness.
359 07. Why is the eye especially vulnerable to vitamin A degradation at night?
360 08. Why are children more likely than others to be affected by vitamin A toxicity?
360 09. Under what circumstances and for what reasons may intake of beta-carotene become
toxic?
360-362 10. Discuss the availability of preformed and precursor vitamin A.
363 11. Describe how the body can synthesize active vitamin D with the help of sunlight.
363-364 12. How does vitamin D function to raise blood levels of calcium and phosphorus?
364 13. Compare and contrast the characteristics of the two deficiency diseases osteomalacia
and rickets.
364-365;366-367 14. What population groups are prone to vitamin D deficiency and why?
365 15. Why do the elderly have increased risk for deficiency of vitamin D?
365-366 16. Discuss risk for vitamin D toxicity from the diet, supplements, and sunlight
exposure.
366 17. Explain the difficulties in obtaining the recommended amounts of vitamin D from
the diet.
366 18. Why does overexposure to the sun not result in vitamin D toxicity?
366 19. Discuss factors that inhibit the synthesis of vitamin D.
368 20. List the different forms of vitamin E found in the diet as well as their vitamin E
activity in the body. What are the major food sources of vitamin E?
369 21. Distinguish between hemolytic anemia and erythrocyte hemolysis.
216
369 22. Describe the known functions of vitamin E and proposed therapeutic treatment for
specific disorders.
369 23. How is vitamin E thought to prevent hemolytic anemia?
369 24. Discuss food sources and stability of vitamin E.
370-371 25. Discuss the role of vitamin K in bone metabolism.
371 26. What are the major food and non-food sources of vitamin K? What factors may
adversely affect vitamin K nutrition in the body?
371 27. Discuss the conditions under which deficiencies of vitamin K are most likely to
occur.
372 28. Compare and contrast the risks for toxicity among the fat-soluble vitamins.
376-377 29. Discuss the beneficial and adverse effects of free radicals.
377-378 30. Explain the relationship of free radicals and degenerative diseases.
377-378 31. Discuss the beneficial effects of antioxidant supplements on risk for cancer and heart
disease.
377-378 32. Discuss the role of antioxidant nutrients in the prevention of degenerative diseases.
377-379 33. Discuss the potential applications of antioxidant nutrients in disease prevention.
378 34. How are supplements of vitamins C and E thought to benefit individuals who have
risk factors for heart disease?
378 35. Discuss the similarities between vitamins C and E in defending against heart disease.
378-379 36. Discuss the advantages of increasing the intake of phytochemicals from food rather
than from supplements.
378-379 37. Discuss the pros and cons of taking antioxidant supplements.
379 38. Why can antioxidants behave differently in the body depending upon their level of
intake?
