Midterm Review Material

Question 1

Low weight for height is called […], while low height for weight is called […].

Answer 1

Low weight for height is called wasting, while low height for weight is called stunting.

Question 2

What anthropometric measurement can be used to detect wasting in children who are between the ages of 6 months and 5 years?

Answer 2

Mid-upper arm circumference (MUAC)

Question 3

Marasmus is mainly due to […] deficiency and kwashiorkor is mainly due to […] deficiency.

Answer 3

Marasmus is mainly due to energy deficiency and kwashiorkor is mainly due to protein deficiency.

Question 4

Moon face, “flaky paint” dermatosis, and/or loss of appetite may be present in which condition(s)?

Answer 4

Kwashiorkor

Question 5

[…] is an indicator of chronic malnutrition, while […] is an indicator of acute malnutrition.

Answer 5

Stunting is an indicator of chronic malnutrition, while wasting is an indicator of acute malnutrition.

Question 6

Cases of kwashiorkor can be classified as moderate or severe.
True or False?

Answer 6

False.
All cases are severe.

Question 7

Children 2 years old or younger who have growth failure are referred to as “stunting” while children over the age of 2 with growth failure are referred to as having “stunted” growth.
True or False?

Answer 7

True.

Question 8

List two factors that are protective and lower children’s risk for malnutrition.

Answer 8

1. Mother was educated for at least 5 years
2. Participation in nutrition supplementation programs

Question 9

Bilateral pitting edema is an indicator of kwashiorkor. This is a less serious condition than marasmus/wasting.
True or False?

Answer 9

False.
Bilateral pitting edema is an indicator of kwashiorkor. This is a more serious condition than marasmus/wasting.

Question 10

What explains a relatively SMALL amount of the differences in children’s growth?

Answer 10

Race/ethnicity

Question 11

For each of A and B, indicate:

1) What test is being demonstrated? (1 point)

2) How would you advise a mother to do this test? (3 points; your answer should be in the words you would use to train a mother to do the test)

Answer 11

A:

1) testing for bilateral pitting edema

2) Use your thumbs to press down on the tops of both of your child’s feet. Press gently with a little bit of pressure and count out 3 seconds. Then, remove your fingers and look to see if there is a little dent (or “pit”) where your fingers were. If you can still see a dent in both feet after you have removed your fingers, that is a sign of malnutrition and your child should be brought to the clinic for treatment.

B:

1) **Mid-upper arm circumference **(MUAC)

2) Remove any clothing from your child’s arm, and have their arm by their side (not up in the air). Put the band halfway between your child’s shoulder and elbow, and insert the tip of the long end into the little slit so that it forms a loop around your child’s arm. Gently tighten the band so that it lies flat on your child’s skin (not too tight, not too loose). Look at where the arrow is pointing - if it points to a number in the yellow or red areas of the band, that is a sign of malnutrition and your child should be brought to the clinic for treatment.

Question 12

Dietary iron requirements are […] times higher in people who are consuming primarily plant-based diets.

Answer 12

Dietary iron requirements are 1.8 times higher in people who are consuming primarily plant-based diets.

This higher target is to account for the reduced bioavailability of iron in plant-based diets. A person consuming a plant-based diet will absorb a sufficient quantity or iron if they consume 1.8 X the target daily intake for a person who consumes meat. (For example, a woman of child-bearing age is advised to consume 18 mg of iron daily; for women consuming a plant-based diet, the target would be 32 mg per day).

Question 13

Vitamin A is a fat-soluble vitamin, so we must consume it as often as possible to prevent deficiencies.
True or False?

Answer 13

False.
Fat-soluble vitamins have toxicity risk.

Question 14

[…] can occur in children due to maternal hypothyroidism. This is caused by lack of […] in the mother during pregnancy.

Answer 14

Cretinism can occur in children due to maternal hypothyroidism. This is caused by lack of iodine in the mother during pregnancy.

Question 15

Zinc deficiency can cause weakened immunity.
True or False?

Answer 15

True.

Question 16

Zinc deficiency can cause pallor.
True or False?

Answer 16

False.

Question 17

Zinc deficiency can cause brittle nails.
True or False?

Answer 17

False.

Question 18

Which of the following micronutrient deficiencies will show clinical symptoms first?
* Protein
* Vitamin B12
* Vitamin A
* Vitamin C

Answer 18

Vitamin C

Question 19

100g of bread contains 2.0g of iron and 100g of beef rump contains 2.4g of iron. Therefore, we can consider bread and beef as equivalent sources of iron.
True or False?

Answer 19

False.

Question 20

Zinc supplements, along with oral rehydration solutions, can reduce […] and […] of diarrheal infections in children and can reduce diarrheal mortality by 50%.

Answer 20

Zinc supplements, along with oral rehydration solutions, can reduce duration and severity of diarrheal infections in children and can reduce diarrheal mortality by 50%.

Question 21

Which symptoms of vitamin A deficiency can be reversed if detected early on? [2]

Answer 21

1. Bitot’s spots
2. Night blindness

Question 22

Identify and briefly explain 2 potential solutions to improve dietary intake of Vitamin A in young children in areas such as India or Sub-Saharan Africa. (2 marks) Which of these two options do you think would be most effective? Why? (1 mark)

Answer 22

Potential answers for the first portion of the question include 2 of the following (identifying each of the two strategies would be 0.5 mark, an appropriate brief explanation of the strategy would be 0.5 mark):

1. Increase dietary sources through dietary diversification (palm oil, greens, varieties of maize, golden rice, etc.) Improving dietary diversity will not only help improve vitamin A status, but contribute to better overall health.

2. Education and awareness for women of childbearing age. Educate women on the importance of vitamin A in preventing infection and promote breastfeeding as it contains vitamin A.

3. Distribute vitamin A supplements since the effects can last 4-6 months and 2 doses per year costs only ~$1 per child per year. This is a cost effective solution and has lasting impact.

4. Local food production like home gardens can increase dietary diversity and bring a lot of co-benefits. Studies done in Bangladesh show that night blindness was more common in families that did not have home gardens.

5. Fortification of staple foods such as sugar, oil, and margarine, keeping in mind that fortified foods should provide a minimum of 15% of daily calorie intake. This an easy way to incorporate vitamin A into food that are already being consumed by the masses.

For the second portion of the question, 0.5 mark would be for clearly identifying which of the strategies you identified would be most effective, and 0.5 mark would be for giving a very brief explanation as to why. (For example: “I think that vitamin A supplements would be most effective because they are cost-effective, you can reach a lot of people, and they have been shown to work.”)

Question 23

Optimal infant feeding can play a key role in breaking the cycle of malnutrition in women because it can prevent stunting, wasting, and micronutrient deficiencies in the infant.
True or False?

Answer 23

True.

Question 24

Breastfeeding should be “on demand” (i.e., the mother should breastfeed the infant whenever the infant shows signs of being hungry).
True or False?

Answer 24

True.

Question 25

Breastfeeding should occur alongside bottle and pacifier use.
True or False?

Answer 25

False.

Question 26

Breastfeeding should begin within an hour of birth.
True or False?

Answer 26

True.

Question 27

Breastfeeding should only occur in developing countries where there is no alternative.
True or False?

Answer 27

False.

Question 28

Complementary foods should be rich in both energy (kcal) and nutrients. With respect to the micronutrient content of foods, the highest priority is that complementary foods include foods that are very good sources of […].

Answer 28

Iron

It is very important to include iron-rich foods among the complementary foods offered to an infant (from the age of 6 months onwards) because an exclusively-breasted infant’s iron stores will no longer provide enough iron to meet the infant’s needs at that point. Breast milk is low in iron; if additional sources of iron are not introduced through complementary foods, the infant may become iron deficient.

Question 29

[…] is the phase of breast milk that is consumed by the infant during the first 2-3 days of lactation and helps the infant expel the meconium (i.e., the first bowel movement).

Answer 29

Colostrum is the phase of breast milk that is consumed by the infant during the first 2-3 days of lactation and helps the infant expel the meconium (i.e., the first bowel movement).

Question 30

According to the WHO guidelines : “Exclusive breastfeeding is recommended up to […] of age, with continued breastfeeding along with appropriate complementary foods up to […] of age or beyond”.

Answer 30

According to the WHO guidelines : “Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to 2 years of age or beyond”.

Question 31

Breast milk composition changes throughout various stages of lactation as the infant gets older (e.g., first colostrum is produced, then transitional milk, then mature breast milk). However, there is no difference in breast milk composition during a single breastfeeding session.
True or False?

Answer 31

False.
Foremilk is less energy dense and contains less fat-soluble vitamins than hind milk.

Question 32

List 3 benefits of breastfeeding for mother and child.

Answer 32

1. Reduced infant mortality
2. Reduced risk of postpartum bleeding
3. Increased lactational amenorrhea (i.e., birth spacing)

Question 33

The prevalence of HIV has increased because many more people are becoming newly infected with the disease every year.
True or False?

Answer 33

False.

Question 34

Give four factors that decrease the number of children born per woman.

Answer 34

1. Higher level of education
2. Women are able to join the workforce
3. Family planning (i.e., contraception) is accessible
4. Children are not needed for work

Question 35

List 3 reasons why breastfeeding rates may be low in a population.

Answer 35

1. Effective marketing from formula companies
2. Lack of education among healthcare providers
3. Lack of social support for breastfeeding

Question 36

Should HIV+ women breastfeed their infants if there are no safe alternatives to breast milk available? Answer yes or no and provide a justification for your response. (3marks)

Answer 36

Each of the following points could count for 0.5 marks, to a maximum of 3 marks.

• Yes, HIV+ women should breastfeed their infants if no safe alternative available
• Breastfeeding is particularly important in areas where diarrhea and pneumonia are common among children
• Mother should also receive ARV treatment
• Risk of transmitting HIV is lowered to ~1% when the mother is on ARV therapy
• Should breastfeed exclusively for 6 months
• Should continue breastfeeding along with providing complimentary foods for at least 12 months, or up to 24 months or more
• Breastfeeding should stop when a safe, nutritionally-adequate diet can be provided without breast milk
• Breastfeeding has many benefits for infant that outweigh the relatively small risk of HIV infection via breast milk
• If a mother passes HIV to her child, this is called “Mother-to-Child transmission” or “vertical transmission”
• Risk of death from other causes if infant is not breastfed is greater than risk of HIV infection if infant is breastfed
• Benefits of breastfeeding include increased birth spacing, reduced infant mortality, reduced risk of postpartum hemorrhage – mentioning any one of the benefits of breastfeeding could count for 0.5 mark
• If safe alternative (safe donor milk or infant formula prepared with safe water) became available and there was confidence that the safe alternative would continue to be available throughout the months the infant would require it, it would be appropriate to switch to the safe alternative

Question 37

People with less iron stored in their body absorb less iron from their diet.
True or False?

Answer 37

False.
People with less iron stored in their body absorb more iron from their diet.

Question 38

Non-heme iron is present only in plant-based foods.
True or False?

Answer 38

False.
Non-heme iron is present in both plant- and animal-based foods.

Question 39

[…] iron is only found in hemoglobin and myoglobin in animal-based foods.

Answer 39

Heme iron is only found in hemoglobin and myoglobin in animal-based foods.

Question 40

Tannic acid binds to iron, thereby increasing the bioavailability of the iron.
True or False?

Answer 40

False.
Tannic acid binds to iron, thereby decreasing the bioavailability of the iron.

Question 41

List 4 things that inhibit iron absorption.

Answer 41

1. Phytates and oxalates
2. Zinc
3. Calcium
4. Tannic acid

Question 42

List 2 things that boosts iron absorption.

Answer 42

1. Vitamin C
2. MFP (found in meat)

Question 43

Non-heme iron accounts for 60% of the iron found in animal tissues (i.e., muscle). The absorption of this iron is increased by the presence of MFP factor.
True or False?

Answer 43

True.

Question 44

How could you increase the absorption of dietary iron?

Answer 44

Have a glass of orange juice with your meal

Question 45

List 4 factors that affect iron absorption.

Answer 45

1. An individual’s iron status
2. The amount of iron in the diet
3. The type of iron present in the foods consumed
4. The amount of acid present in the stomach

Question 46

[…] is an example of a staple food that is commonly fortified with iron.

Answer 46

Flour is an example of a staple food that is commonly fortified with iron.

Question 47

If the same meal was given to a person with iron deficiency anemia (IDA) and a person without IDA, the person with IDA would absorb […] iron than the person without IDA, because iron absorption […] if iron status is low.

Answer 47

If the same meal was given to a person with iron deficiency anemia (IDA) and a person without IDA, the person with IDA would absorb more iron than the person without IDA, because iron absorption increases if iron status is low.

Question 48

Iron deficiency is the leading cause of preventable blindness in the world.
True or False?

Answer 48

False.
Vitamin A deficiency is the leading cause of preventable blindness in the world.

Question 49

Heme iron is only found in […]

Answer 49

Hemoglobin
Myoglobin

Question 50

Eggs and dairy products contain heme iron.
True or False?

Answer 50

False.
Heme iron is found only in animal tissues (i.e., meat) and blood. Eggs and dairy products contain only non-heme iron.

Question 51

What are the advantages of using “Sprinkles” (micronutient powder packets) in preventing iron deficiency? [4]

Answer 51

1. Easy to use
2. Highly acceptable
3. Can be added to any cooked food
4. Imparts no discernable taste to food

Question 52

Why does the daily iron requirement vary between adult males and adult females?
What is the requirement for each?
Why would a vegetarian’s requirement be different?

Answer 52

• Women lose iron every month in their period.
• Males = 8.7 mg/day
• Females = 14.8 mg/day
• Plant-based iron (i.e. non-heme iron) is less bioavailable

Question 53

What is/are probably true for this child?
* He has marasmus
* He has kwashiorkor
* He will probably be stunted

Answer 53

He has marasmus and he will probably be stunted.

Question 54

This photo shows a UNICEF doctor measuring the mid upper arm circumference (MUAC) of a young boy in an internally displaced persons (IDP) camp in north-west Yemen in 2009. Identify and briefly describe 2 signs of severe malnutrition can you observe in this boy.

Answer 54

• His MUAC measurement is in the red zone, signalling severe acute malnutrition
• His hair is an orange colour, reflecting depigmentation, which is due to severe protein undernutrition
• He is very thin. The loss of muscle mass and adipose (or fat) tissue is clearly visible and reflects severe kcal (or energy) restriction and wasting.

Question 55

Very few of the people with Type 2 Diabetes in the world live in low- or middle-income countries.
True or False?

Answer 55

False.
The majority of the people with Type 2 Diabetes in the world live in low- or middle-income countries.

Question 56

Basal metabolism typically accounts for 30% of a person’s total energy (kcal) needs.
True or False?

Answer 56

False.
Basal metabolism typically accounts for 60-75% of a person’s total energy (kcal) needs.

Question 57

A deficiency in which of the following micronutrients may lead to blindness?

Answer 57

Vitamin A

Question 58

Digestion is the process by which nutrients and other substances are transferred from the digestive system into body fluids for transport throughout the body.
True or False?

Answer 58

False.
Absorption is the process by which nutrients and other substances are transferred from the digestive system into body fluids for transport throughout the body.

Question 59

Bilateral pitting edema is a clinical sign of kwashiorkor.
True or False?

Answer 59

True.

Question 60

Famine foods are eaten during extreme food scarcity because they are a good source of energy.
True or False?

Answer 60

False.
* Famine foods may not actually provide much energy (kcal), but they do provide satiety (a feeling of fullness).
* Famine foods tend to be high in fibre, which humans cannot break down for energy, so they are not a good source of energy.
* Famine foods are not typically a good source of energy, but they are eaten as a “last resort” when nothing else is available.

Question 61

Identify and briefly describe one factor that puts children at risk for malnutrition and one factor that can be protective. (2 points)

Answer 61

Factors that would put children at risk (as mentioned in class) include:
* Low weight (BMI) of mother
* Child’s age
* Higher birth order
* Lower standard of living

Factors that would be protective include:
* Mother’s education ≥ 5 years
* Participation in vitamin A or nutrition program

For full marks, also have to briefly explain/describe the factor (or how it would increase or decrease a child’s risk for malnutrition).

Question 62

The presence of bilateral pitting edema may indicate a child has either “moderate” or “severe” acute malnutrition.
True or False?

Answer 62

False.
All cases of bilateral pitting edema (kwashiorkor) are considered “severe” acute malnutrition

Question 63

The red zone on a mid upper arm circumference (MUAC) band indicates moderate acute malnutrition.
True or False?

Answer 63

False.
The yellow zone on a mid upper arm circumference (MUAC) band indicates moderate acute malnutrition.

Question 64

Healthy adults can regularly consume up to […]% of their total energy (kcal) intake from protein without adverse effects.

Answer 64

Healthy adults can regularly consume up to 35% of their total energy (kcal) intake from protein without adverse effects.

Question 65

Which simple sugar can the body use for energy?

Answer 65

Glucose

Question 66

What is the AMDR for CHO?

Answer 66

45-65% of total energy (kcal)

Question 67

All protein from plant souces is “incomplete”
True or False?

Answer 67

False.
Soy for example is a complete protein.

Question 68

A 24-hour recall may not be an appropriate method for assessing dietary intake in particular circumstances. Which of the following is a limitation of its use?

Answer 68

It relies on memory

Question 69

When the Pima Indians of Arizona shifted from a traditional diet (largely based on wild foods) to a modern diet (based on foods made from ingredients such as wheat flour, lard, and sugar) the prevalence of obesity and type 2 diabetes increased substantially.
True or False?

Answer 69

True.

Question 70

Wasting (i.e., marasmus) is more easily treated than nutritional edema (i.e., kwashiorkor).
True or False?

Answer 70

True.

Question 71

Based on the information provided, identify one macronutrient you think might be lacking in the diet of these children and clearly justify your response.

Answer 71

It is highly likely that the dietary intake of these children would be lacking in protein, because the majority (59%) of their kcal are coming from cassava, which is very rich in carbohydrate but has hardly any protein (or fat).

Question 72

Are you surprised that children under the age of 5 years are most at risk for malnutrition in the context of drought? Explain your response.

Answer 72

No, not surprised.
Children are usually at greater risk for malnutrition (compared to adults) because they have higher needs relative to their body size because of the increased requirements associated with growth and development.

Question 73

Identify and briefly describe two (2) clinical signs of malnutrition that might be observed among children under 5 years of age experiencing malnutrition. In your description, clearly indicate how one would interpret each sign (e.g., what type of malnutrition does it suggest?).

Answer 73

• Depigmentation of hair: indicates protein deficiency
• Dull, discoloured hair: protein deficiency
• Swollen, bleeding, red gums: vitamin C deficiency
• Bitot’s spots: white foamy plaque: vitamin A deficiency
• Pallor in conjunctiva/skin: iron deficiency
• Transverse ridging of nails: protein deficiency
• Koilonychias: spoon-shaped nails: iron deficiency
• Bilateral pitting edema: severe acute malnutrition

Question 74

What are famine foods? Define the term and include at least two examples of foods that would be considered famine foods.

Answer 74

Famine foods are foods that would otherwise be considered inedible, but they are eaten during times of extreme scarcity (they tend to be high in fibre and low in kcal).
Examples include: corn husks; banana leaves; moss; weeds; leaves; paper; tulip bulbs

Question 75

Given what you have learned so far in the course, what do you think needs to be done in this situation? Integrate the following words into your response: immediate, underlying, basic, priority, limitation, Canada.

Answer 75

Question 76

Considering what you have learned in FNH 355, what do you think needs to be done in this situation, to improve the nutritional status (and overall health and wellbeing) of people living in Yemen?

Integrate the following terms into your response: UNICEF conceptual framework, micronutrient malnutrition, education, priority, limitation, Canada. (6 marks; underline each of those 6 terms where they appear in your response)

Answer 76