1. 1
   A doctor examines a patient who has been eating a diet almost entirely lacking in fresh fruit and vegetables for several months. The patient presents with bleeding gums, slow wound healing and joint pain.

   (a)

   Which dietary deficiency is most likely responsible for these symptoms?

   [1 mark]

   • AVitamin D deficiency, causing rickets
   • BVitamin C deficiency, causing scurvy
   • CFibre deficiency
   • DIron deficiency

   (b)

   The doctor advises the patient to include more citrus fruits in their diet. Which nutrient found in citrus fruits would most directly help prevent the symptoms described?

   [1 mark]

   • ACalcium
   • BFibre
   • CVitamin C
   • DFat

   (c)

   Describe a simple food test the doctor's laboratory could use to check whether a fruit juice sample contains vitamin C, including the expected positive result.

   [2 marks]

   Total for question 1: 4 marks

2. 2
   A separate patient, an elderly person who rarely goes outdoors and has a diet low in dairy products, is diagnosed with soft, weakened bones.

   (a)

   Which combined deficiency is most likely responsible for this condition, known as rickets in children or osteomalacia in adults?

   [1 mark]

   • AVitamin C and fibre
   • BCarbohydrate and fat
   • CProtein and water
   • DVitamin D and calcium

   (b)

   Which mineral ion, alongside calcium, is particularly important for maintaining healthy blood, and whose deficiency causes anaemia?

   [1 mark]

   • AIron
   • BSodium
   • CPotassium
   • DMagnesium

   (c)

   State two dietary sources of calcium, and describe the importance of calcium in the body.

   [2 marks]

   Total for question 2: 4 marks

3. 3
   A dietician plans a balanced meal for a client and must include appropriate amounts of each major nutrient group.

   (a)

   State what is meant by a balanced diet, and name three nutrient groups, other than vitamins and mineral ions, that must be included in appropriate amounts and proportions.

   [3 marks]

   (b)

   Explain the dietary importance of fibre (roughage) and of water, and state one food source of each.

   [4 marks]

   Total for question 3: 7 marks

4. 4
   A school nurse notices that several students who follow very restrictive diets, avoiding entire food groups, show a range of health problems: some have weak bones, some bleed easily from the gums, and some feel constantly tired.

   (a)

   Explain the possible dietary deficiencies responsible for the weak bones and the bleeding gums, including the specific nutrients involved and their functions in the body.

   [6 marks]

   (b)

   Explain the possible dietary cause of the constant tiredness reported by some of the students, and discuss why following a genuinely balanced diet, rather than avoiding entire food groups, is important for avoiding all of these health problems.

   [6 marks]

   Total for question 4: 12 marks

End of questions