Year 12 BiologyModule 8 · IQ2⏱ ~45 minPractice bank · 3 Short AnswerLesson 9 of 21
Nutritional Disease: When Nutrient Balance Affects Body Function
A nutritional disease develops when a nutrient is deficient, in excess or out of balance and this changes how the body works. Learn the explanation pattern that matters: nutrient pattern → biological change → disease effect.
Today's hook: Iron is needed to make haemoglobin, which carries oxygen. What happens to body cells when there is not enough iron? Now reverse the idea: how can a long-term nutrient excess contribute to Type 2 diabetes or cardiovascular disease without being the only cause?
0/5TASKS
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You’re here
Get oriented and predict
Meet the reasoning pattern for nutritional disease, learn the key words, and commit to a first prediction.
Warm up first
Three quick questions from earlier lessons. Pulling old material back to mind before you learn something new makes the new material stick better, so this is not busywork.
Worksheets
Practise this lesson
Four printable worksheets that build from the foundations up to exam-style questions, start at whatever level suits you.
Start with what the nutrient normally does. Then trace what changes when there is too little, too much or an imbalance.
Name the nutrient pattern.Deficiency, excess or imbalance.
State the biological change.Link it to a cell, molecule, tissue or control system.
Explain the disease effect.Connect the change to a symptom, damage or increased risk.
Know what matters
Must Know
Nutritional disease can involve deficiency, excess or imbalance.
Answers must link nutrient pattern to a biological change and disease effect.
Four deficiency profiles: vitamin D, vitamin C, iodine, iron.
Type 2 diabetes and cardiovascular disease have multiple contributing factors.
Should Know
A micronutrient with a widespread role causes multi-system symptoms when it is deficient.
Chronic high blood glucose can damage blood vessels over time.
Raised LDL can contribute to atherosclerosis through inflammation in artery walls.
Going Deeper
The enzyme and feedback detail behind each deficiency (cofactors, TSH feedback).
How genetic, environmental, social and nutritional factors interact.
Why supplements alone rarely fix a community's nutrition.
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Predict first: low energy
connect
A person has iron deficiency and feels tired during exercise. Which explanation best connects the deficiency to the symptom?
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Key vocabulary, translated
vocab
DeficiencyTaking in less of an essential nutrient than the body needs, for long enough that a process depending on that nutrient starts to fail.Like this: too little dietary iron means not enough haemoglobin can be built, giving anaemia with fatigue and breathlessness.
ExcessTaking in more energy or more of a nutrient than the body can use or safely store, so the surplus itself causes damage over time.Like this: years of energy intake above energy use leads to excess fat storage, insulin resistance and a sharply raised type 2 diabetes risk.
HaemoglobinThe iron-containing protein inside red blood cells that binds oxygen in the lungs and releases it to tissues. No iron means less haemoglobin, which means less oxygen delivered.Like this: someone iron deficient is breathless on the stairs because low haemoglobin limits how much oxygen reaches working muscle.
Insulin resistanceCells stop responding properly to insulin, so glucose is not taken up as it should be. The pancreas compensates by making more insulin until it can no longer keep up.Like this: an insulin-resistant person can have high blood glucose and high blood insulin at the same time, which is the early stage of type 2 diabetes.
AtherosclerosisFatty plaque builds up in artery walls, so the vessel narrows and stiffens and blood flow drops. A plaque that ruptures can block the artery outright.Like this: plaque in a coronary artery limits blood to heart muscle, causing chest pain on exertion and a heart attack if the vessel blocks.
True or false: a nutritional disease always has one simple cause and is entirely a person's fault.
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Two eras of nutritional disease in Australia
example
In 1900 the leading nutritional diseases in Australia were deficiency diseases: rickets from vitamin D deficiency, scurvy from vitamin C deficiency and anaemia from iron deficiency. They tracked poverty, food insecurity and limited dietary variety, and they were a routine part of childhood illness.
Today the dominant nutritional diseases are Type 2 diabetes and cardiovascular disease, both linked to chronic excess of refined carbohydrate and saturated fat. Australians are now, on average, overfed in energy yet still underfed in some micronutrients, so deficiency and excess sit side by side in the same population.
The AusDiab study (Baker IDI, 1999 to 2005) screened 11,247 Australians and found 7.5% already had Type 2 diabetes, most without knowing it. Insulin resistance typically develops over 10 to 15 years before symptoms appear, which is why the excess diseases are often called silent.
Two truths and a lie: click the statement that is false.
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Frame it: nutrient, function, consequence
One reasoning chain works for every nutritional disease in this lesson.
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The nutritional disease framework
explain
Every nutrient has an essential function. A nutritional disease appears when a deficiency removes that function, or a chronic excess overloads a pathway that normally works. A micronutrient often serves many processes, so one deficiency can produce widespread, multi-system symptoms. Vitamin C, for example, is needed for collagen in skin, blood vessels, bone and gums, so scurvy affects all of these at once.
Nutritional disease framework: name the nutrient and its essential function, state the biological change caused by too little (deficiency) or too much (excess), then explain the disease effect. Deficiency removes a function; chronic excess overloads a normal pathway.
Pause, copy the highlighted definition into your notes before you go on.
Remember!
Write "can contribute to" or "increases the risk of", not "causes". Most nutritional diseases, especially excess diseases, are multifactorial, so avoid blame and overclaiming.
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Deficiency and excess break the body differently
explain
Deficiency diseases remove a molecule the body cannot make for itself. Because a micronutrient usually serves many processes at once, one deficiency produces widespread, multi-system symptoms. Vitamin C is required for collagen in skin, blood vessels, bone, gums and healing wounds, so scurvy appears in all of them simultaneously.
Excess diseases work differently. No single molecule is missing; instead, cells and control systems are overloaded by too much of a macronutrient over years to decades. Chronic excess of refined carbohydrate keeps blood glucose and insulin high until cells stop responding, while excess saturated fat raises LDL cholesterol, which builds plaque in artery walls.
The exam structure follows directly from this logic. Name the nutrient and its essential function, state what changes when there is too little or too much, then explain the disease effect. Naming a disease and listing its symptoms earns partial marks; the function and the biological change are what marking criteria reward.
Fill the gap: every nutritional disease follows the chain: nutrient, essential [___], deficiency or excess, disrupted physiology.
Interactive · Nutrient Balance Scale
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Deficiency diseases: four profiles
Vitamin D, vitamin C, iodine and iron, each as function, then deficiency effect.
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Four deficiency diseases
apply
Vitamin D, rickets
Vitamin D is needed to absorb calcium and phosphate and to mineralise bone. Deficiency means calcium cannot be absorbed well, so bones stay soft and poorly mineralised, bowed legs in children (rickets) and weaker bones in adults (osteomalacia).
Vitamin C, scurvy
Vitamin C is needed to build stable collagen, the structural protein in skin, blood vessels and gums. Deficiency means defective collagen, so scurvy causes bleeding gums, poor wound healing and weakened blood vessels.
Iodine, goitre
Iodine is a building block of thyroid hormones (T3 and T4). Deficiency means the thyroid cannot make enough hormone, so it enlarges (goitre); in pregnancy severe deficiency harms brain development.
Iron, anaemia
Iron is the core of haem in haemoglobin, which carries oxygen. Deficiency means less haemoglobin, so blood carries less oxygen, causing fatigue and breathlessness (iron-deficiency anaemia).
Trace one chain in full. Iron is an essential part of haemoglobin, so if iron intake, absorption or stores are insufficient the body makes less haemoglobin, blood carries less oxygen, and working tissues receive less oxygen during exercise.
1Nutrient patternIron is deficient
->
2Normal roleIron helps make haemoglobin
->
3Biological changeLess functional haemoglobin
->
4System effectLess oxygen transported
->
5Disease effectFatigue can occur
Build the explanation+7 XP
Put the iron-deficiency explanation in order.
Less oxygen reaches active tissues, contributing to fatigue.
Iron is needed to make haemoglobin.
Blood carries less oxygen.
Iron availability is too low.
Haemoglobin production is reduced.
Going Deeper the enzyme and feedback detail (extension) +
Vitamin C is a cofactor for the enzymes that hydroxylate proline and lysine in procollagen. Without this step collagen cannot cross-link, so connective tissue weakens body-wide, which is why "bleeding gums" alone earns few marks: state the biochemical function first.
Iodine deficiency lowers T3/T4, so by negative feedback the pituitary releases more TSH; TSH drives thyroid growth (goitre). The enlarged gland still cannot make enough hormone because iodine is the missing substrate.
Copy pattern for any deficiency: nutrient, its biochemical function, the molecule or process that fails without it, then the multi-system symptom.
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Vitamin D and vitamin C in depth
explain
Vitamin D: the calcium gatekeeper
Vitamin D (calcitriol) is required for absorbing calcium and phosphate from the intestine and for mineralising bone. Most vitamin D is synthesised in skin from 7-dehydrocholesterol under UVB radiation rather than eaten, which is why sunscreen use, indoor work and darker skin leave about 23% of Australians deficient (serum 25-OH vitamin D below 50 nmol/L).
Without vitamin D, calcium absorption falls no matter how much calcium is eaten. Blood calcium drops, so calcium is pulled out of bone to protect nerve and muscle function. In children the softened, poorly mineralised bones deform under body weight (rickets: bowed legs, delayed tooth eruption); in adults, bones progressively lose density (osteomalacia and osteoporosis).
Vitamin C: the collagen cofactor
Vitamin C is the essential cofactor for prolyl hydroxylase and lysyl hydroxylase, the enzymes that hydroxylate proline and lysine residues in procollagen. This step lets collagen fibres cross-link into stable connective tissue, the structural framework of skin, blood vessels, bone, gums and every healing wound.
Without the cofactor, collagen cannot cross-link, so connective tissue fails everywhere at once: bleeding gums, perifollicular haemorrhages around hair follicles, poor wound healing, joint pain and corkscrew hairs. Scurvy appeared within two to three months on long sea voyages without fresh produce; in Australia today it is rare outside severely restricted diets.
Book notes
Vitamin D: calcium and phosphate absorption plus bone mineralisation; deficiency demineralises bone (rickets, osteomalacia).
Main source is skin synthesis under UVB, not diet; about 23% of Australians are deficient.
Vitamin C: cofactor for prolyl and lysyl hydroxylase, needed for collagen cross-linking.
Why does vitamin C deficiency (scurvy) cause bleeding gums and poor wound healing?
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Iodine and iron in depth
explain
Iodine: the missing substrate
Iodine is a structural component of the thyroid hormones T3 and T4, which set basal metabolic rate and drive growth and brain development. When iodine is scarce, hormone output falls, and by negative feedback the pituitary releases more TSH. TSH stimulates thyroid growth, so the gland enlarges into a visible goitre, yet still cannot make hormone without the missing substrate.
In pregnancy the stakes are higher: severe iodine deficiency causes cretinism, permanent intellectual disability and growth failure in the child. Iodised salt has been mandatory in Australian bread since 2009, but mild deficiency is re-emerging as people switch to sea salt, which contains negligible iodine.
Iron: the oxygen carrier
Iron sits at the centre of the haem group in haemoglobin, the red blood cell protein that binds and transports oxygen. It also serves in myoglobin, which stores oxygen in muscle, and in the cytochrome enzymes of the electron transport chain, so deficiency restricts both oxygen delivery and aerobic respiration.
Iron-deficiency anaemia produces small, pale red blood cells (microcytic, hypochromic) with reduced oxygen-carrying capacity, causing fatigue, pallor and breathlessness on exertion. It is the most common nutritional deficiency on Earth, affecting about 1.2 billion people. In Australia the highest-risk groups are menstruating women, pregnant women, toddlers and vegetarians, because plant (non-haem) iron is less bioavailable.
Book notes
Iodine: component of T3 and T4; deficiency lowers hormone, raises TSH, grows a goitre.
Severe deficiency in pregnancy causes cretinism; iodised salt mandatory in bread since 2009.
Iron: central atom of haem in haemoglobin; also myoglobin and cytochrome enzymes.
Anaemia: microcytic, hypochromic red cells, less oxygen carried; about 1.2 billion people affected worldwide.
Match each nutrient to its essential function. Click a nutrient, then click its function.
Vitamin D
Vitamin C
Iodine
Iron
Central atom of haem in haemoglobin, which carries oxygen
Absorption of calcium and phosphate for bone mineralisation
Structural component of thyroid hormones T3 and T4
Cofactor for the enzymes that cross-link collagen
Interactive · Nutritional Disease Classifier
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Chronic excess, and why it is multifactorial
Type 2 diabetes and cardiovascular disease, plus why abundance does not prevent nutritional disease.
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Chronic excess: stage the detail
explain
Type 2 diabetes
Long-term dietary patterns can contribute to insulin resistance. Cells then take up glucose less effectively, so blood glucose can remain high, and chronic high glucose can damage blood vessels over time. Genetics, activity, sleep, medicines, stress and access to food also affect risk.
Cardiovascular disease
Diets high in saturated fat can raise LDL cholesterol. LDL in artery walls can trigger inflammation and plaque formation (atherosclerosis), narrowing arteries. Smoking, blood pressure, genetics and social conditions also contribute to risk.
HSC exam move
The Australian Dietary Guidelines recommend limiting saturated fat, and the biology explains why: high saturated fat raises LDL, LDL drives atherosclerosis. State the guideline and the mechanism together.
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Type 2 diabetes in depth
analyse
The primary nutritional driver is chronic excess of refined carbohydrate and saturated fat. Sustained high blood glucose forces the pancreas to keep insulin high, and liver, muscle and fat cells respond by downregulating their insulin receptors. This is insulin resistance: insulin is still produced, but target cells respond to it less and less.
For years the pancreatic beta cells compensate by secreting more insulin, which is why AusDiab found most cases undiagnosed. Eventually the beta cells exhaust, insulin secretion falls, and blood glucose climbs chronically; a fasting glucose above 7 mmol/L is diagnostic. About 1.3 million Australians are diagnosed with Type 2 diabetes, with an estimated 500,000 more undiagnosed (AIHW 2022).
Chronic hyperglycaemia damages vessels through non-enzymatic glycation: glucose spontaneously binds to proteins in vessel walls, stiffening and thickening them, and it also promotes oxidative stress and inflammation. The complications split into macrovascular (coronary artery disease, stroke) and microvascular (retinopathy, nephropathy, neuropathy). Type 2 diabetes is the leading cause of preventable blindness, dialysis and lower-limb amputation in Australia.
Contrast Type 1 diabetes (L07): there the beta cells are destroyed by autoimmune attack, so no insulin is made at all. Both types produce chronic hyperglycaemia and the same vascular complications, which is why the long-term damage looks identical even though the causes differ completely. Genetics matters in Type 2 as well: first-degree relatives carry two to three times the risk.
Book notes
Excess refined carbohydrate and fat, sustained high insulin, cells downregulate receptors: insulin resistance.
Beta cells compensate, then exhaust; fasting glucose above 7 mmol/L is diagnostic.
Hyperglycaemia glycates vessel-wall proteins: stiffened vessels, macrovascular and microvascular complications.
Type 1: no insulin (autoimmune). Type 2: insulin present, cells resistant. Genetics plus diet plus lifestyle.
What distinguishes the mechanism of Type 2 diabetes from Type 1 diabetes?
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Atherosclerosis in depth: inflammation, not plumbing
analyse
Diets high in saturated fat raise LDL cholesterol, and LDL particles infiltrate the artery wall and oxidise. Oxidised LDL triggers inflammation: monocytes enter the wall, become macrophages and engulf the LDL, turning into foam cells. Foam cells accumulate into a fatty streak and then a fibrous atherosclerotic plaque that thickens, stiffens and narrows the artery.
The acute event is rupture, not gradual narrowing alone. A ruptured plaque triggers a thrombus, a blood clot that can block the artery completely. In a coronary artery that causes myocardial infarction; in a cerebral artery, stroke. Coronary heart disease remains Australia's leading cause of death, around 10% of all deaths annually (AIHW), despite falling age-standardised mortality since the 1970s.
The dietary picture is more precise than "fat clogs arteries". Saturated and trans fats raise LDL, while soluble fibre and polyunsaturated fats (omega-3, omega-6) lower it. And diet is only one factor: smoking, hypertension, inactivity, diabetes and genetics such as familial hypercholesterolaemia all contribute, which is why cardiovascular disease is the model multifactorial disease.
Book notes
Saturated fat raises LDL; LDL infiltrates the artery wall and oxidises.
Macrophages engulf oxidised LDL and become foam cells, which build into plaque.
Plaque rupture triggers a thrombus: myocardial infarction or stroke.
Coronary heart disease is Australia's leading cause of death (about 10% of deaths, AIHW); risk is multifactorial.
True or false, three statements: answer each row.
Atherosclerosis is best described as passive fat deposition that physically clogs the artery like a blocked pipe.
Scurvy is caused by vitamin C deficiency and results in defective collagen synthesis, leading to weakened blood vessels and poor wound healing.
Obesity is caused solely by genetic factors and cannot be influenced by diet or physical activity levels.
Australia: a double burden
Abundant food does not guarantee good nutrition. Australia faces deficiency and excess at once: vitamin D deficiency affects roughly a quarter of the population, iron deficiency is common in women of reproductive age, and iodine deficiency is re-emerging, all alongside high rates of obesity and Type 2 diabetes. In some remote Indigenous communities, iron-deficiency anaemia and Type 2 diabetes occur together. This reflects food access, cost and history, not simply individual choice, which is why supplements alone rarely fix a community's nutrition.
Common error treating nutritional disease as one cause and the person's fault +
Weak answers say "they ate badly, so it is their fault." This misreads the biology.
Excess diseases are multifactorial: diet is one factor alongside genetics, activity, medicines, food cost and access. Explain the biological change and the range of contributing factors, and avoid blame.
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Apply it: choose your route
Pick the level that stretches you and write a nutrient-to-effect explanation.
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Choose your route
differentiate
Pick one route, whichever matches how confident you feel right now. Supported gives you the most structure, Stretch asks for the most independent judgement. You only need to complete one.
Supported
Complete the iron-deficiency explanation using the frame.
Cover Iron is needed for … . When iron is deficient, … decreases. This means … , which can lead to … .
Core
Explain how insulin resistance can lead to high blood glucose. Include one factor other than diet that can affect Type 2 diabetes risk.
Cover When cells are insulin resistant, … . Therefore … . Another factor is … because … .
Stretch
Evaluate the claim: "Cardiovascular disease is caused by eating fat." Improve it into a biologically accurate statement.
Cover The claim is too simple because … . A better statement is … . The biological link is … .
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Final step
Exit check
Retrieve the framework from memory before you move to Practice.
A nutrient pattern changes a biological process, which produces a disease effect.
Apply
Use a deficiency profile (vitamin D, vitamin C, iodine or iron) or a chronic-excess example in the full nutrient, change, effect chain.
Avoid
Do not reduce a multifactorial disease to one food choice or one cause.
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Independent practice
01
Multiple Choice
+5 XP
A fresh set drawn from this lesson's question bank, feedback shown immediately. +5 XP per correct · +25 XP all correct
Pick your answer, then rate your confidence, that tells the system what to drill next.
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Short Answer, 15 marks
+5 XP
ApplyBand 4(4 marks) 1. Use nutrient pattern → biological change → disease effect to explain why iron deficiency can cause fatigue during exercise.
AnalyseBand 4–5(5 marks) 2. Explain how raised LDL can contribute to cardiovascular disease. Include plaque formation and one factor other than diet that can affect risk.
EvaluateBand 5–6(6 marks) 3. Evaluate the claim: “Cardiovascular disease is caused by eating fat.” Improve it into a biologically accurate explanation.
Show all answers
Multiple choice
MC answers and full explanations are shown inline as you complete each question. Use the retry button to attempt a fresh set from the lesson bank.
Short Answer Model Answers
SA1 (4 marks): Nutrient pattern: iron is deficient (low intake, poor absorption or depleted stores) [1]. Normal role: iron is the central atom of haem in haemoglobin, the red-blood-cell protein that carries oxygen [1]. Biological change: with less iron the body makes less functional haemoglobin, so the blood's oxygen-carrying capacity falls [1]. Disease effect: during exercise the muscles demand more oxygen, but the oxygen-depleted blood cannot supply it, so aerobic respiration is limited and the person experiences fatigue and breathlessness (iron-deficiency anaemia) [1].
SA2 (5 marks): Raised LDL: elevated blood LDL cholesterol infiltrates the wall (intima) of an artery, where it is oxidised [1]. Inflammation: oxidised LDL triggers an inflammatory response; monocytes enter the wall, become macrophages and engulf the LDL, forming foam cells [1]. Plaque formation: the foam cells and further lipid build up into an atherosclerotic plaque that thickens and stiffens the artery wall [1]. Effect on blood flow: the plaque narrows the arterial lumen, reducing blood flow; if the plaque ruptures a clot can block the artery, cutting off oxygen to the tissue beyond (for example a heart attack) [1]. One factor other than diet: smoking damages the artery lining (endothelium), making LDL infiltration and plaque formation more likely; high blood pressure or genetic predisposition would also be accepted [1].
SA3 (6 marks): What the claim gets right: diet is a genuine contributing factor. A diet high in saturated fat can raise LDL cholesterol, and raised LDL drives the atherosclerosis that underlies most cardiovascular disease, so reducing saturated fat can lower risk [2]. Why it is too simple: cardiovascular disease is multifactorial, not caused by "eating fat" alone. The mechanism runs through LDL and inflammation in the artery wall, not fat in the diet directly, and "fat" is not one thing (unsaturated fats do not raise LDL the same way). Other major factors, smoking, high blood pressure, physical inactivity, genetics and social conditions such as food cost and access, also change risk and are not dietary choices [2]. Improved statement: "A diet high in saturated fat can raise LDL cholesterol, which contributes to atherosclerosis and increases the risk of cardiovascular disease, alongside other factors such as smoking, blood pressure, genetics and physical activity." This keeps the correct biological link, replaces "causes" with "increases the risk of", and recognises that the disease is multifactorial [2].
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Retrieve and reflect
Check what actually stuck
Take the full module quiz
quiz
A full module quiz covering every lesson in this module, not just this one. Set aside a decent block of time and treat it like a real assessment.
Answer questions on vitamin D, vitamin C, iodine, iron, Type 2 diabetes and atherosclerosis. Pool: lessons 1–9.
How did your thinking change?
Return to your Think First responses and connect them to the AusDiab study (Baker IDI, 1999-2005). That study found that many Australians already had Type 2 diabetes or pre-diabetes, showing why nutritional disease must be explained as a long-term risk pattern rather than a single meal or single choice. Use current class data if your teacher provides it, and focus your answer on the mechanism: chronic excess energy intake and high blood glucose can increase insulin resistance and vascular damage over time.
Q1, why one nutrient causes widespread symptoms: Each micronutrient performs a specific biochemical function needed across multiple tissues simultaneously. Vitamin C is needed by every tissue that makes collagen, skin, blood vessels, bone, gums, wound sites. Micronutrients are cofactors or structural components with body-wide roles.
Q2, how high blood glucose damages vessels (as documented in the AusDiab study's complication data): Non-enzymatic glycation, glucose spontaneously binds proteins in blood vessel walls, stiffening and thickening them. Chronic hyperglycaemia also promotes oxidative stress and endothelial inflammation.
Write the nutrient → function → deficiency consequence chain for any two deficiency diseases from memory.