Worked solution
### Part 1: Causes and Symptoms of Iron-Deficiency Anaemia (Maximum 8 marks)
#### Causes:
* **Inadequate dietary intake:** Consuming insufficient amounts of iron-rich foods.
* **Poor absorption of iron:** Eating non-haem iron without enhancers, or high intake of inhibitors.
* **Lack of Vitamin C (ascorbic acid) in the diet:** Vitamin C is essential to reduce ferric iron to ferrous iron for absorption.
* **High intake of absorption inhibitors:** Consuming substances like phytates (in whole grains), polyphenols/tannins (in tea and coffee), or oxalates (in spinach) which bind to iron.
* **Excessive blood loss:** Caused by heavy menstruation, bleeding ulcers, or major surgery/trauma.
* **Increased physiological demand:** Rapid growth during adolescence, pregnancy, and lactation increase the body's iron requirements.
* **Gastrointestinal disorders:** Conditions like coeliac disease or Crohn's disease that damage the gut lining and impair absorption.
#### Symptoms:
* **Fatigue / extreme tiredness / lethargy:** Due to reduced haemoglobin levels causing less oxygen to be transported to tissues and muscles.
* **Paleness (pallor):** Pale skin, particularly visible inside the lower eyelids, nail beds, and palms.
* **Shortness of breath (dyspnea):** Feeling breathless easily, especially during mild physical exertion.
* **Dizziness or lightheadedness:** Caused by reduced oxygen supply to the brain.
* **Headaches:** Frequent headaches due to low oxygen levels in the brain.
* **Cold hands and feet:** Poor circulation and oxygen delivery to extremities.
* **Weakness:** General muscle weakness and lack of physical stamina.
* **Brittle or spoon-shaped nails (koilonychia):** Sign of chronic, severe iron deficiency.
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### Part 2: Planning and Preparing Family Meals to Maximise Iron Intake and Absorption (Maximum 8 marks)
#### Meal Planning & Food Selection:
* **Incorporate haem iron sources:** Include red meat (beef, lamb), offal (liver, kidney), poultry, and fish regularly in meals, as haem iron is highly bioavailable and easily absorbed by the body.
* **Incorporate non-haem iron sources:** For vegetarian members or to supplement meals, include pulses (lentils, chickpeas, kidney beans), dark green leafy vegetables (kale, broccoli), dried fruits (apricots, figs), and pumpkin seeds.
* **Use fortified foods:** Select commercial foods that are fortified with iron, such as breakfast cereals, wheat flour, and bread.
#### Enhancing Absorption:
* **Pair non-haem iron with Vitamin C:** Serve Vitamin C-rich foods (e.g., citrus fruits, bell peppers, tomatoes, kiwi) alongside non-haem iron foods (e.g., squeeze lemon juice over steamed spinach, or serve a glass of fresh orange juice with fortified breakfast cereal).
* **Combine haem and non-haem sources:** Small amounts of meat or fish cooked alongside plant sources of iron (the "meat factor") enhance the absorption of the non-haem iron.
#### Avoiding Inhibitors:
* **Limit tea and coffee with meals:** Do not serve tea, coffee, or cocoa during or immediately after meals, as the tannins and polyphenols bind to iron and prevent its absorption.
* **Separate calcium and iron intake:** Avoid serving high-calcium dairy foods (like cheese sauces or milk) with major iron-rich meals, as calcium competes with iron for absorption.
#### Preparation and Cooking Methods:
* **Use cast-iron cookware:** Cooking acidic foods (such as tomato-based sauces or stews) in cast-iron pots can significantly increase the iron content of the meal by leaching dietary iron into the food.
* **Soak, sprout, or ferment grains and pulses:** These processes reduce the phytate content, thereby increasing the bioavailability of non-haem iron.
Marking scheme
Award 1 mark for each valid, explained point up to a total of 15 marks.
### Part 1: Causes and Symptoms (Maximum 8 marks)
#### Causes (1 mark per point):
* Inadequate dietary intake of iron-rich foods.
* Deficiency of Vitamin C (needed to absorb non-haem iron).
* High consumption of inhibitors (phytates, tannins, oxalates) with meals.
* Blood loss (e.g., heavy menstruation, ulcers).
* Increased demand during specific life stages (pregnancy, adolescence, lactation).
* Malabsorption disorders (e.g., coeliac disease).
#### Symptoms (1 mark per point):
* Fatigue / lethargy / constant tiredness.
* Pale skin / pallor (especially under eyelids/nails).
* Breathlessness / shortness of breath on exertion.
* Dizziness / lightheadedness.
* Headaches.
* General muscle weakness.
* Brittle or spoon-shaped nails (koilonychia).
* Cold extremities (hands/feet).
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### Part 2: Planning and Preparing Family Meals (Maximum 8 marks)
#### Diet and Meal Planning (1 mark per point):
* Include haem iron sources (red meat, liver, poultry, fish) which are easily absorbed.
* Include plant-based non-haem iron sources (pulses, dried fruits, dark green leafy vegetables).
* Choose fortified products (cereals, flours).
#### Promoting Absorption (1 mark per point):
* Serve Vitamin C-rich foods (citrus fruits, bell peppers, tomatoes) with non-haem iron sources.
* Combine plant sources with animal proteins ("meat factor") to boost non-haem absorption.
#### Avoiding Inhibitors (1 mark per point):
* Avoid serving tea, coffee, or cocoa with or immediately after meals (tannins inhibit absorption).
* Separate calcium-rich foods (dairy) from main iron-containing meals.
* Avoid excessive dietary fibre/bran at the same meal as iron sources.
#### Preparation and Cooking (1 mark per point):
* Use cast-iron pots/pans for cooking (especially for acidic/tomato dishes) to leach dietary iron.
* Employ techniques like soaking, sprouting, or fermenting of pulses/grains to reduce phytates and improve bioavailability.