5-Nutrition Flashcards
All of the following are considered “shortfall nutrients,” meaning more than 25% of the US population does not have adequate intake, EXCEPT:
A) Fiber
B) Potassium
C) Vitamin C
D) Vitamin E
E) Saturated fats
E.
The food components that Americans get too much of are:
1. added sugars: candies, desserts and sugar sweetened beverages,
2. processed grains: white flour, white rice and white pasta,
3. cholesterol mostly from animal foods,
4. sodium: processed and packaged foods,
5. saturated fats: meats, dairy, eggs, processed foods and oils and
6. trans fat: hydrogenated plant oils, processed foods (trans fats are banned after 2018).
Answers A through D listed the shortfall nutrients: fiber, potassium, Vitamin C and Vitamin E, which are predominately found in nutrient-dense, whole, plant-based foods. Less than 9% of the US population consumes more than two cups of vegetables daily.
The top five sources of saturated fats in the US include all of the following EXCEPT:
A) Cheese
B) Refined grain-based desserts
C) Dairy-based desserts
D) Chicken
E) Walnuts
E.
The top five sources of saturated fats in the US are: cheese, pizza, refined grain-based desserts, dairy desserts and chicken. Walnuts are high in polyunsaturated fats and low in saturated fats.
Which statement is NOT TRUE about the clinical findings in the study, “Effects of a dietary portfolio of cholesterol-lowering foods versus Lovastatin on serum lipids and hypercholesterolemia,” by DA Jenkins et al, in the American Journal of Clinical Nutrition, 2006:
A) Diets that focus on low saturated fat and increased viscous fiber, plant sterols, vegetable protein and nuts appear to reduce low density lipoproteins (LDL-cholesterol) levels similarly to the initial therapeutic dose of a Lovastatin 20 mg (a first generation statin medication).
B) Study participants were able to lower their LDL cholesterol more than 50%, which is equal to the amount it would drop using a statin (cholesterol lowering medication).
C) Participants were randomized to one of three interventions: a very low saturated fat; a very low saturated fat diet plus Lovastatin 20 mg; or a diet that was high in plant sterols, soy protein, viscous fiber and almonds.
D) The Food and Drug Administration (FDA) now permits health claims that foods that deliver adequate amounts of plant sterols reduce the risk for coronary heart disease (CHD).
E) The portfolio diet group showed a reduction in the cardiovascular inflammatory marker c-reactive protein (CRP).
B.
Participants who ate the dietary portfolio of cholesterol-lowering foods, (plant sterols, soy protein, nuts and viscous fiber) were able to lower LDL-cholesterol concentrations >20%. This was statistically significantly compared to the control group and almost equal (no significant difference found) to the response to Lovastatin 20 mg, a first-generation statin medication.
Which dietary intervention showed significant regression in coronary artery stenosis after one year of following a comprehensive lifestyle intervention that included: a low-fat vegetarian diet, smoking cessation, moderate exercise and stress management?
A) DASH Diet
B) Ornish Diet
C) Mediterranean diet
D) CHIP program
E) Walnuts
B. Ornish Diet
A. DASH Diet for hypertension: a combination of vegetables, low salt and low-fat dairy, which has been found to be adequate first-line treatment for essential hypertension.
B. The Ornish diet for coronary artery disease (CAD): a low-fat, plant-based diet reversed coronary artery disease stenosis in one year and maintained reversal at the five year follow-up.
C. Mediterranean diet for secondary prevention of coronary artery disease: the Mediterranean diet was found to be superior to a prudent Western diet in preventing recurrence of coronary artery disease events.
D. CHIP program and diet for diabetes: The CHIP multifactorial lifestyle intervention was effective in treating type 2 diabetes.
E. Walnuts for hyperlipidemia and hypertension: adding a daily serving of walnuts to ad libitum diet (as you desire) showed effectiveness in lowering serum cholesterol.
All of the following are TRUE in regard to nutrition and physical activity prescriptions EXCEPT:
A) The US Preventative Services Task Force (USPSTF) recommends that nutrition and physical activity counseling for people who are overweight and have chronic disease is intensive and focused on specific behavioral interventions.
B) Patients receiving physical activity prescriptions and advice from their health care provider increased their exercise by 18 minutes per week.
C) Nutrition prescriptions are believed to be helpful in changing patients’ behavior toward food.
D) Nutrition prescriptions can be written for prevention and treatment for multiple chronic diseases, such as diabetes and heart disease.
E) Nutrition prescriptions are not one of the 15 Physician Competencies for Prescribing Lifestyle Medicine.
E.
Nutrition prescriptions are one of the 15 Physician Competencies for Prescribing Lifestyle Medicine.
The SMART Basic Nutrition Prescription Guidelines include all of the following EXCEPT:
A) A specific type of food.
B) Realistic goals of budget, time and foods available.
C) Achievable and attainable goals for who will be doing the cooking and shopping.
D) Time commitment for the prescription (frequency and duration).
E) The role of the physician or medical provider.
E. The SMART acronym for nutrition prescriptions includes:
Specific type of foods.
Measurable, meaning how much of the food.
Achievable/attainable goals for who will be doing the cooking and the shopping.
Realistic goals for what food is available, the budget, time commitment and what will the patient actually do.
Time connected, meaning what is the frequency for eating the food, and for what duration of time is the prescription written.
The doctor or health care provider’s roles are not part of the patient’s written prescription.
All of the following are true about the macronutrient fat EXCEPT:
A) Poly-unsaturated fats include omega 3s and omega 6s.
B) Mono-unsaturated fats include nuts, avocado, olive oil and canola oil.
C) Saturated fats include lauric acid, stearic acid, palmitic acid and myristic acid.
D) The largest source of saturated fats in the American diet is cheese.
E) Trans fats made from partially hydrogenated vegetable oil are not associated with increased risk of heart disease.
E.
Trans fats are associated with increased risks of heart attacks and strokes. Starting in 2018 in the US, trans fats are no longer allowed to be used by the food industry.
All of the following statements about dietary fiber are true EXCEPT:
A) The best sources of fiber are found in meat and dairy products.
B) Women should consume at least 25 grams of fiber daily.
C) Men should consume at least 38 grams of fiber daily.
D) Fiber has been shown to decrease the risk of colon cancer.
E) Fiber is not digested, and it increases stool bulk and viscosity.
A.
The best sources of fiber are legumes, whole grains, vegetables, fruits, nuts and seeds. Meat and dairy products do not contain fiber.
Which of the following food groups DO NOT increase inflammatory markers?
A) Foods fried in oils. B) Salad dressings and spreads made from hydrogenated oils. C) Breads made with lard or butter. D) Cruciferous vegetables. E) High glycemic index processed grains.
D. Cruciferous vegetables.
Anti-inflammatory foods include all of the following:
Cruciferous vegetables (broccoli, cauliflower and Brussels sprouts)
Cabbage and bok choy
Dark berries and fruits
Allium vegetables
Carotenoids
Dark green leafy vegetables
Advanced Glycation End-Products (AGEs) are a family of oxidative stressors found in proteins and glucose that cause inflammation and cell damage. Certain types of food preparation can increase the AGEs. The best way to prepare food in order to decrease the amount of AGEs produced is:
A) Smoking
B) Roasting
C) Frying
D) Boiling
E) Grilling
D.
Foods that are fried, smoked, grilled, baked or roasted have higher AGEs. Foods that are prepared with moist heat cooking, such as boiling, stewing and broiling, have fewer AGEs.
Reducing the intake of what micronutrient will decrease the risk of hypertension:
A) Calcium
B) Magnesium
C) Sodium
D) Potassium
E) Vitamin C
C.
Sodium restriction typically reduces blood pressure by 2.5 to 7 mmHg. According the American Heart Association, the ideal limit of sodium should be less than 1.5 grams daily, with the upper limit being 2,300 mg daily. The largest sources of sodium in the US are processed foods and canned foods.
Which of the following statements about type 2 diabetes is FALSE?
A) Higher fiber intake reduces the risk of diabetes.
B) Processed sugars like syrup, malt and fruit concentrate can increase blood sugar levels.
C) Artificial sweeteners create dysbiosis, which can alter weight control.
D) Processed grains have a higher glycemic index.
E) Aggressive therapeutic lifestyle changes cannot decrease or reverse diabetes.
E.
Type 2 diabetes is generally a reversible disease with aggressive therapeutic lifestyle changes, such as: reducing dietary saturated fats, trans fats, processed sugars and processed grains; eliminating artificial sweeteners; and increasing daily exercise.
All of the following are TRUE about cancer and diet EXCEPT:
A) Anti-cancer nutrition goals include: support the immune system, decrease inflammation, and eat real food, not supplements.
B) Foods high in saturated fats, foods high in sugar, and processed and red meat increase the risk of colon and breast cancer.
C) Obesity increases the risk of breast cancer.
D) Prostate cancer risk is decreased with the consumption of red and processed meats.
E) Antioxidant-rich foods, such as carrots, berries, nuts and green leafy vegetables, decrease the risk of cancer.
D.
The risk of breast, colon and prostate cancer are increased with the consumption of red meat, processed meat, highly processed grains, added sugars, high saturated fats and trans fats.
Which one of the following statements best describes a situation with ZERO risk of developing heart disease from hypercholesterolemia?
A) Trans-fatty acid consumption is associated with an increased risk of heart disease.
B) A whole food, plant-based diet, as demonstrated in the Lifestyle Heart Trial, produces regression of plaque stenosis and reduction in cholesterol.
C) A decrease in HDL may occur with a plant-based diet, but the ratio of the drop of LDL compared to HDL still provides a benefit.
D) If the serum total cholesterol is 90 to 140 mg/dl (2.327 - 3.620mmol/L), and the LDL is less than 70 mg/dl (1.810mmol/L), there is no evidence of atherosclerotic plaque formation or risk of heart disease.
E) Eating an omnivorous diet decreases the risk of heart disease.
D.
Facts learned from 2013 Baylor University Conference: If the serum total cholesterol is 90 to 140 mg/dl (2.327 - 3.620mmol/L), there is no evidence that cigarette smoking, systemic hypertension, diabetes, inactivity or obesity produces atherosclerotic plaques. Hypercholesterolemia is the only direct atherosclerotic risk factor, the others are all indirect. Optimal LDL is 50 to 70 mg/dl (1.293 - 1.810mmol/L). Plaque progression ceases with total cholesterol < 150 mg/dl (3.879mmol/L).
The Diabetes Prevention Program (DPP) trial was the first major study to compare lifestyle intervention to medications to prevent diabetes. All are true about the DPP trial EXCEPT:
A) Metformin showed a 31% reduction in developing diabetes.
B) Lifestyle intervention showed a 58% reduction in the incidence of diabetes.
C) The two major goals of the lifestyle intervention were a 7% weight loss and 150 minutes weekly of physical activity similar to brisk walking.
D) Participants were placed on a strict diet.
E) Behavioral and self-management strategies for weight loss and physical activity were taught to participants.
D. Participants were not placed on a strict diet.
Rather, they were encouraged to gradually achieve the fat and calorie levels through: better choices of meals and snack items; healthier food preparation techniques; and careful selection of restaurants, including fast food and the items offered. The initial focus of the dietary intervention was on reducing total fat rather than calories. This allowed participants to accomplish a reduction in caloric intake while at the same time emphasizing overall healthy eating. It also streamlined the self-monitoring requirements, which was important given the diversity of educational and literacy levels among participants. After several weeks, the concept of calorie balance and the need to restrict calories as well as fat was introduced.
The calorie goals were calculated by estimating the daily calories needed to maintain the participant’s starting weight and subtracting 500 to 1,000 calories per day (depending on initial body weight) to achieve a one to two pound per week of weight loss. The fat goals, given in grams of fat per day, were based on 25% of calories from fat. Four standard calorie levels were used: 1,200 kcal per day (33 grams fat) for participants with an initial weight of 120 to 170 lbs; 1,500 kcal per day (42 grams fat) for participants with a weight of 175 to 215 lbs; 1,800 kcal per day (50 grams fat) for participants with a weight of 220 to 245 lbs; and 2,000 kcal per day (55 grams fat) for participants weighing >250 lbs. The fat and calorie goals were used as a means to achieve the weight loss goal rather than as a goal in and of itself. Therefore, if a participant reported consuming more than the calorie or fat goal but was losing weight as planned, the coach did not emphasize greater calorie or fat reduction.
*Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Knowler et al. N Engl J Med. 2002 Feb 7;346(6):393-403.
The pathogenesis of diabetes is best described as:
A) Insulin resistance in muscle facilitates the development of fatty liver. Increased fatty acids produced by the liver damage pancreatic beta cells, suppressing glucose-mediated insulin secretion, and leading to hyperglycemia.
B) Muscle insulin resistance determines the rate at which fatter liver digresses.
C) Eventually the pancreas is unable to produce sufficient amounts of leptin to push glucose into the cells, so serum glucose levels rise.
D) Loss of sensitivity to insulin causes a decrease in adipose tissue and leptin levels.
E) Increasing caloric intake in the early stages of insulin resistance can reverse the disease process.
A.
Insulin resistance begins to occur as inflammatory mediators cause damage to liver and beta cells and as muscle and adipocyte cells begin resisting further fat storage. Adipocytes are key factors in the development of insulin resistance. As weight gain occurs, adipocytes undergo hyperplasia and hypertrophy (that is, they grow in number and in size) and begin accumulating in ectopic tissues, such as the liver and muscle cells. Intramyocellular fat accumulation disrupts insulin receptors via production of lipotoxic mediators, causing insulin resistance. Muscle insulin resistance determines the rate of fatty liver progression. Fatty liver progression and the deposit of fatty acids in pancreas are responsible for the rate of hepatic insulin resistance (failure to appropriately respond to blood glucose levels) and beta cell dysfunction.
Which is NOT considered a current trend in US food consumption:
A) 40% of food consumption comes from processed foods.
B) 25% comes from animal-based foods.
C) 6% comes from processed plant-based foods.
D) 6% comes from unprocessed vegetables, fruits, legumes, grains, nuts and seeds.
E) The current US average intake of sugar is 13% of calories per day or about 13 teaspoons (52 grams) of sugar per day.
A.
63% of US food consumption comes from processed foods with added fats, oils, sugars and refined grains.
Epigenetics are the non-DNA sequence components of genetic inheritance. Key epigenetic influencers are:
A) Diet and lifestyle
B) Sleep deprivation
C) High fat diets
D) Hyperglycemia
E) All of the above
E.
Diet, exercise, sleep, obesity and hyperglycemia are able to up-regulate or down-regulate gene expression
The outcome of the The Nurse’s Health Study Eight-Year Follow-Up showed:
A) Meat-eating Adventists compared to non-meat-eating Adventists showed a 97% increased risk for diabetes in men and a 93% increased risk in women.
B) Every 5% increase in calories from animal protein resulted in a 30% increase in risk of diabetes.
C) People who ate a plant-based diet that specifically emphasized healthy plant-based foods had ~34% lower risk of diabetes. Whereas, plant-based diets that were high in less healthy plant foods (such as processed foods) had a 16% increased risk for diabetes.
D) HgbA1c dropped more than three times for participants on a plant-based diet compared to participants on the American Diabetic Association diet (ADA).
E) Consuming processed meat more than five times per week was associated with an increased risk of type 2 diabetes.
E.
The Nurses’ Health Study Eight-Year Follow-Up showed that the consumption of processed meat greater than five times weekly increased the risk of diabetes.
The Adventist Health Study showed regular meat consumption was associated with two times greater risk of diabetes. Among meat eating Adventists compared to non-meat eaters, there was a 97% increased risk of diabetes in men and 93% increased risk in women.
The EPIC study showed that for every 5% of calories consumed from animal protein, there was a 30% increase in diabetes.
The National Institutes of Health (NIH) study compared a plant-based diet to the American Diabetes Association diet (ADA). It found that participants following the plant-based diet dropped their HbA1c three times more, decreased their LDL cholesterol twice as much, lost more weight and had greater reductions in medications.
Data from three large cohorts (Nurses’ Health Study 1984-2012, Nurses’ Health Study 1991-2011, Health Professionals Follow-up Study 1986-2010) found the type of plant-based diet is important in diabetes risk. A plant-based diet that specifically emphasized healthy plant-based foods had ~34% lower risk of diabetes. Whereas, plant-based diets that were high in less healthy plant foods (such as processed foods) had a 16% increased risk of diabetes.
A positive patient prescription for foods to increase in one’s diet include all the following EXCEPT:
A) Eat seven different colors of fruits and vegetables per day.
B) Increase fiber intake to more beneficial levels: 40 grams per day for women, and 45 grams per day for men.
C) Vitamin D intake of: 600 IUs daily for people age one to 70 years old, and 800 IUs daily for people over 70 years old.
D) Consume at least half of your grain intake as whole grains.
E) Limit trans fats as much as possible.
E.
Limiting trans fat intake as much as possible is an example of a negative food prescription. Negative food prescriptions are usually not as well received and should be cautiously prescribed. Generally, adding in healthy foods is easier to accomplish then limiting unhealthy foods.
According to the 2013 American College of Cardiology (ACC)/ American Heart Association (AHA) Guidelines on the Assessment of Cardiovascular Risk, the “A” recommendations include all of the following except:
A) Reduce the percent of calories from saturated fat to less than 5 to 6% of daily calories.
B) Eliminate trans fats in the form of processed foods and animal proteins.
C) Consume a dietary pattern that emphasizes intake of unprocessed vegetables, fruits and whole grains (e.g., DASH, whole foods, plant-based or Mediterranean).
D) Reduce the total caloric intake from fat to less than 10% of the total daily intake.
D.
Although Dean Ornish, MD has found that reversing coronary artery stenosis requires the total daily caloric intake from fat to be less than 10% of the total daily intake, that’s not one of the American College of Cardiology (ACC) / American Heart Association (AHA) guidelines.
Which of the following is incorrect about weight maintenance:
A) When calorie content is held constant, there is little to no evidence that food groups or beverages have a unique impact on body weight.
B) There is moderate evidence that increasing whole grains, vegetables and fruits may protect against weight gain.
C) There is little evidence that children who consume more sugar-sweetened beverages have higher body weights.
D) There is moderate evidence that adults who consume sugar-sweetened beverages have higher body weights.
C.
There’s strong evidence that children who consume sugar-sweetened beverages have higher body weights.
All of the following are true of epigenetics (mechanisms that control gene expression), EXCEPT:
A) They can be altered by lifestyle changes to improve short- and long-term clinical outcomes by changing gene expression.
B) Epigenetics is unaffected by diet, exercise, sleep and stress.
C) The ability of lifestyle change to turn on or off genes was demonstrated in prostate cancer outcomes by Dean Ornish, MD in the GEMINAL study.
D) The GEMINAL study demonstrated down-regulation of oncogenes that are known to promote prostate cancer.
E) The GEMINAL study demonstrated an up-regulation of cancer-fighting genes.
B. All of the above are correct except B.
Epigenetic changes can all be induced by diet, exercise, sleep, stress, obesity and many other environmental factors.
Regarding the prevalence or risk of developing diabetes, all of the following are true EXCEPT:
A) There is an 80% higher prevalence of diabetes in men who consume meat versus those who don’t.
B) For non-vegetarians, the age-adjusted risk of diabetes (as noted on death certificates) was the same for males and females.
C) Consuming more than five eggs per week was associated with an increased risk of developing diabetes.
D) Diabetes risk increased significantly as total protein intake increased.
E) None of the above; all statements are true.
B.
Compared with vegetarians, the relative risk of diabetes on the death certificate, adjusted only for age, was 2.2 (1.5, 3.4) for male non-vegetarians and 1.4 (1.0, 1.9) for female non-vegetarians. [188] During 10 years of follow-up, 918 incident cases of diabetes were documented. Diabetes risk increased with higher total protein (hazard ratio 2.15 [95% CI 1.77 to 2.60] highest versus the lowest quartile) and animal protein (2.18 [1.80 to 2.63]) intake. Adjustment for confounders essentially did not change these results. Further adjustment for adiposity measures attenuated the associations. Vegetable protein was not related to diabetes. Consuming 5% energy from total or animal protein at the expense of 5% energy from carbohydrates or fat increased diabetes risk. Diets high in animal protein are associated with an increased diabetes risk. Our findings also suggest a similar association for total protein itself instead of only animal sources. In this study, high total and animal protein intake, but not vegetable protein intake, was associated with increased diabetes risk. We observed that both high total and animal protein were associated with higher diabetes risk. Fat intake did not change much over the quartiles of protein intake, and the association was not altered after correction for fat intake. Moreover, after correction for meat or dairy intake, the association between total and animal protein and diabetes remained, suggesting a detrimental role for protein per se in diabetes risk.
