Chapter 5 (Study Group) - Nutrition Science, Assessment and Prescription

Question 1

Which of the following forms the ABCD nutrition assessment approach?

A. Ascertain food diary, Body measurements, Chemical analysis, Drugs/supplements
B. Anthropometric data, Body measurements, Clinical assessment, DEXA to measure body fat/composition
C. Anthropometric data, Biochemical data, Clinical assessment, Dietary assessment
D. Ascertain dietary assessment, Bioelectrical impedance analysis, Chemical analysis, Drugs/supplements

Answer 1

C (p122)

Question 2

Which of the following is an example of a SMART goal?

A. Eat more leafy greens, whole grains, legumes
B. Eat less processed meats, milk products, sweets
C. Eat a small piece of fruit eg apple/mandarin/pear/lady finger banana for morning tea 3 times a week at work on weekdays for the next 2 weeks
D. Eat food, not too much, mostly plants

Answer 2

C correct answer. A (positive prescription). B (negative prescription). C Michael Pollan quote

Question 3

Which of the following is not considered a shortfall nutrient?

A. Fiber
B. Calcium
C. Sodium
D. Potassium

Answer 3

C Sodium (overconsumed food) p117

Question 4

Which of the following statements is incorrect?

A. Liquid calories contribute more sugar calories to the American diet than any other category of food
B. Common sources of saturated fat in the US diet include cheese, pizza, burgers
C. Highly concentrated saturated fats include foods with 4-7grams of saturated fats per serve
D. Daily fiber recommendations are ~25g/day for women and ~38g/day for men with greater benefits if >40g/day for women and ~45g/day for men

Answer 4

A True p116. B True p117 C False (>8g/serve p117) D True

Question 5

With regards to AGE Advanced Glycation End Products which of the following food preparation methods would you advise patients to avoid?

i) cook foods at higher temperature for longer
ii) cook foods by grilling, baking, frying, roasting, searing
iii) moist heat cooking: boiling, stewing

A. i) and ii)
B. ii) and iii)
C. All 3 options
D. None of the above

Answer 5

A

Question 6

A patient has read about the harmful effects of trans fats and wondered which foods he should avoid consuming to avoid eating trans fats. You advise which of the following?

A. Reassure there is no need to worry, the FDA has mandated the food industry remove all trans fats by 2018 so he can eat anything he wants
B. He can eat dairy products and meat which do not contain trans fats
C. He should avoid coffee creamer and drink his coffee black
D. He can order doughnuts to go with his coffee every morning if he is a police officer

Answer 6

C (p135)

Question 7

Which is statement is untrue regarding the American dietary guidelines?

A. The guidelines are updated every 10 years
B. Food industries can influence public policy so therefore the guidelines are a middle position and there may be discrepancies between scientific evidence and the current recommendations
C. The 2015-2020 Dietary Guidelines for Americans recommends that nutrition and health professionals help people find a healthy eating pattern that works for them and includes a variety of food and beverages within an appropriate calorie level
D. One way that health professionals, both within and outside of the Federal government, can communicate the Dietary Guidelines with the public is through MyPlate, which serves as a reminder to build healthy eating patterns by making healthy choices across the food groups.

Answer 7

A Guidelines updated every 5 years

Question 8

Which of these is NOT one of the key recommendations made in the US Dietary guidelines?

A. A healthy eating pattern includes a variety of vegetables from all of the subgroups— dark green, red and orange, legumes (beans and peas), starchy, and fruits, especially whole fruits and grains, at least half of which are whole grains
B. Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages
C. A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products.
D. ​Consume less than 30% of calories per day from added sugars

Answer 8

D is incorrect – should be <10%

A healthy eating pattern includes:
​A variety of vegetables from all of the subgroups— dark green, red and orange, legumes (beans and peas), starchy, and other
Fruits, especially whole fruits
Grains, at least half of which are whole grains
Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages
A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products.
Oils
​A healthy eating pattern limits:
​Saturated and trans fats, added sugars, and sodium.
Key Recommendations that are quantitative are provided for several components of the diet that should be limited. These components are of particular public health concern, and the specified limits can help individuals achieve healthy eating patterns within calorie limits:

Consume less than 10% of calories per day from added sugars
Consume less than 10% of calories per day from saturated fats
Consume less than 2,300 milligrams (mg) per day of sodium
If alcohol is consumed, it should be consumed in moderation – up to one drink per day for women and up to two drinks per day for men – and only by adults of legal drinking age.

Question 9

Which of these foods is not considered to be high in saturated fat?

A. Milk
B. Avocado
C. Beef
D. Coconut oil

Answer 9

B Avocado has 2.1g/per serving (one fruit) compared with others all >4grams per serving

Question 10

Which of these is NOT one of the top 5 sources of sodium in the US diet?

A. Burgers
B. Tacos
C. Pasta
D. Cheese

Answer 10

D the top five sources are mixed dishes (A/B/C are examples of these), protein foods, grains, vegetables ( usually as part of mixed dishes) and sweets/snacks

Question 11

Which of these is not one the top 5 sources of calories in the US diet?

A. Chicken
B. Sweetened beverages
C. Cheese
D. Pizza

Answer 11

C Top 5 ( product of energy density and volume eaten) are refined grain based desserts, non whole grain breads, chicken, sweetened beverages and pizza.

Question 12

Which of these is not a shortfall nutrient?

A. Calcium
B. Magnesium
C. Potassium
D. Selenium

Answer 12

D. Shortfall nutrients are Calcium, fibre, Mg, K, Vit A,C,D, E , K

Question 13

Which of these foods does not have a high fibre content ie. >20% DV in a serving?

A. Raspberries
B. Mushrooms
C. Flaxseeds
D. Papaya

Answer 13

B. Mushrooms fall into the mod high fibre 5-20% DV category

Question 14

A nutritional assessment should NOT include

A. Biochemical data
B. Clinical assessment
C. Dietary assessment
D. Exercise prescription

Answer 14

Includes- ABCD

Anthropometric data( weight, BMI,WC) , Biochemical data (lab work), Clinical assessment ( age, gender, PMSHx, activity levels, nutritional hx, physical examination), Dietary assessment- (daily intakes liquids/solids, 24 hr recall, 3 day food record, nutrition calculators)

Question 15

Which of these diets or interventions has no demonstrated evidence for a positive effect of the nutrition based approach in modifying disease outcomes?

A. Portfolio diet
B. DASH diet
C. CHIP program
D. Flexitarian diet

Answer 15

D Flexitarian diet has no supporting data in the board review book

Question 16

Which of these is the least helpful nutrition prescription format?

A. Consume 1 cup of cooked broccoli three times a week at dinner for 3 months
B. Limit consumption to 1 cup of a sugar sweetened beverage once per week
C. Consume 5 brazil nuts every day for 1 month
D. Consume cruciferous vegetables every day

Answer 16

D prescriptions should follow TAF- Type (be specific), Amount (exact) and Frequency. Generally better to be a positive prescriptions- consume more of as more accepted by patients

Question 17

Which of these is not routinely recommended to assist patients with developing healthy eating habits?

A. Keep a food and exercise journal
B. Develop a consistent meal schedule
C. Discuss intermittent fasting
D. Avoid eating in the car

Answer 17

C . Not covered in this material

Question 18

Which of these plant foods is not rich in protein?

A. Tofu
B. Lentils
C. Pumpkin seeds
D. Broccoli

Answer 18

D soy beans, tofu, lentils, pinto beans, hempseed, whole wheat bagel, pumpkin seeds are all > 9 g/protein per serve

Question 19

Which of these is not a saturated fat?

A. Stearic acid
B. Lauric acid
C. Palmitic acid
D. Trans fat

Answer 19

D.

Question 20

Which of these is not a good source of mono unsaturated fats?

A. Peanut oil
B. Canola Oil
C. Olives
D. Sunflower seeds

Answer 20

D mainly composed polyunsaturated fat

Foods that contain healthy monounsaturated fats include:
Avocados
Unsalted nuts such as almonds, cashews and peanuts
Olives
Cooking oils made from plants or seeds, including: olive, canola, peanut, sunflower, soybean, sesame and safflower.

Foods that contain healthy polyunsaturated fats (omega-3 and omega-6) include:
Fish
Tahini (sesame seed spread)
Linseed (flaxseed) and chia seeds
Soybean, sunflower, safflower, canola oil and margarine spreads made from these oils
Pine nuts, walnuts and brazil nuts.

Question 21

Which of these is an essential fatty acid?

A. gamma-Linolenic acid (GLA)
B. α-Linolenic acid (ALA)
C. Arachidonic acid (AA)
D. Docosahexaenoic acid (DHA)

Answer 21

B Only two fatty acids are known to be essential for humans: alpha-linolenic acid (an omega-3 fatty acid) and linoleic acid (an omega-6 fatty acid)

Question 22

To reduce AGE consumption it is recommended to do all of these except which of these statements?

A. Increase unprocessed whole foods
B. Prepare food by moist heat cooking eg boiling or stewing
C. Choose full fat dairy products
D. Avoid frying and grilling

Answer 22

C . AGE’s are higher in full fat dairy

Question 23

Which of these statements is not true?

A. Oxalates in beet greens, spinach and chard inhibit the absorption of calcium contained in these foods
B. Potatoes and sweet potatoes are potassium rich foods
C. Adequate calcium intake can only be achieved by eating dairy foods
D. Magnesium is found in nuts and black beans

Answer 23

C. greens, tofu, beans, fortified non dairy drinks are all good sources to meet daily requirements

Question 24

Which of these recommendations are not suggested to lower cancer risk?

A. Increase antioxidant foods such as carrots, spinach, berries
B. Reduce fibre to 20g/day
C. Reduce red meat and highly processed foods
D. Avoid increased AGE from thermal processing

Answer 24

B recommended to increase fibre to 40- 45 mg/day

Question 25

Which of these is optimal LDL?

A. 50-70 mg/DL ( 1.293-1.810 mmol/L)
B. 40-60 mg/DL ( 1.193-1.610 mmol/L)
C. 50-80 mg/DL ( 1.293-1.910 mmol/L)

Answer 25

A

Optimal LDL is 50-70 mg/DL (1.293-1.810 mmol/L)

Question 26

Which of the following statements is TRUE regarding food sources of calcium?

a. Calcium is a shortfall nutrient along with magnesium and phosphate
b. 40-60% of the calcium from high oxalate dark greens can be absorbed, compared to 32-34% from dairy
c. The calcium available in greens such as spinach, swiss chard and beet greens is readily absorbed
d. Food groups which are high in calcium (>20% DV per serve) include dairy, poppy seeds, calcium-fortified non-dairy beverages and tofu

Answer 26

D

High calcium: dairy, seeds (chia, poppy, sesame), calcium fortified non-dairy veg and tofu

Moderately high: almonds, beans, low oxalate dark greens (kale, bok choi) and okra

Calcium, magnesium and POTASSIUM are all shortfall nutrients

40-60% of calcium from LOW oxalate dark greens can be absorbed. The greens mentioned in d. are all high in calcium but also high in oxalates which limits absorption.

Question 27

Which of the following is an accurate list of the shortfall nutrients (those that Americans are failing to consume at recommended levels)?

a. Calcium, magnesium, potassium, vitamins A, B, C, D, E and K, fiber
b. Calcium, magnesium, phosphate, Vitamins A, B, C, D, E and K, fiber
c. Calcium, magnesium, potassium, Vitamins A, C, D, E and K, fiber
d. Calcium, magnesium, phosphate, Vitamins A, C, D, E and K, fiber

Answer 27

C

Question 28

You see Joe, 67yo, who has been referred by a colleague with a wish to lose weight for health reasons. In your first appointment to address this your basic nutrition assessment should include:

a. Anthropometric data - weight, height and BMI; BMI is especially valid for Joe as he is over 65yo
b. A clinical assessment, including age, gender, medical and surgical history, activity level, nutritional and weight history, vital signs and physical examination
c. A dietary assessment; the best choice for this appointment would be a 3 day food recall as it gives you the most information
d. All of the above in addition to biochemical data

Answer 28

B

BMI is less valid for people under 20yo or over 65yo. Anthropometric data includes a waist circumference. A dietary assessment can be completed using a variety of tools (eg daily intake of solids/liquids, 24 hour recall, 3 day food record (usually given as an assignment for the next appointment), mini nutritional ax for the elderly, a variety of online tools, calculators and apps, or a dietician in-depth assessment). A basic nutrition assessment includes ABC and D – anthropometric data, biochemical data, clinical data and dietary assessment.

Question 29

Sandra is a lady of 50. She is a non-smoker with no family history of CVD, cancer or diabetes. She sees you for a general check. . You establish that she currently drinks 1-2 glasses of wine once a week, and that she walks at a moderate intensity for 20 minutes 3 times a week. She has a total cholesterol of 4.3mmol/L, a BP of 118/78 and no evidence of diabetes or pre-diabetes. She does not enjoy vegetables and eats approximately 1 serve a day. Her BMI is 24.2. Which of the following is CORRECT regarding her management?

a. The US preventative services taskforce (USPSTF) would recommend intensive behavioural health nutrition counselling and physical activity counselling for Sandra
b. As per the USPSTF, nutrition and physical activity counselling should be based on Sandra’s readiness for change.
c. There is strong evidence which exists for nutrition prescriptions
d. If a nutrition prescription was written for Sandra, the format TAF (type of food, amount to be eaten and frequency that the food should be eaten) should be used – it is generally very accepted to ‘deprescribe’ first, ie decrease the frequency of foods such as processed meats and sweets rather than first specifying foods to eat more of such as leafy greens

Answer 29

B

As she has no chronic disease and no risk factors, USPSTF recommends counselling be based on readiness for change (Grade C recommendation – service should be offered in a selective manner). Nutrition prescriptions are not well documented in the literature, but there is reason to believe they would be helpful given they are similar to exercise prescriptions, for which there is strong evidence. “Positive” prescriptions (consume more of a certain food) are generally more acceptable to patients than “negative” (consume less of a type of food).

Question 30

In diabetes, B-cell death can occur due to multiple genetic, environmental and lifestyle factors, including which of the following?

i. Oxidative stress from hyperglycaemia or from free fatty acids
ii. Leptin, which can induce apoptosis via stimulation of cytokine pathways
iii. Dyslipidaemia – VLDL and LDL are pro-apoptotic
iv. Sustained moderate-high alcohol intake stimulates pancreatic cell death

a. All of the above are correct
b. i, ii and iii are correct
c. i and iii are correct
d. None of the above are correct

Answer 30

B (BR manual, p. 150)