- When nutrition advocates became concerned that recommendations did not do enough to address prevention of chronic diet related diseases, what policy change were made?
RDA’s (Recommended Daily Allowances) expanded into several DRI (Daily Reference Intakes) - What is true of dietary reference intake? choose two.
a. They are used to establish taxation rates and food costs
**b. Food labeling must include information about them.
**c. They differ depending on age and gender
d. They are dependent on foodborne illness risks - What is always found on a nutrition label in the US?
Serving size - A healthful diet contains nutrient intake near what amount?
Recommended daily allowance - What is an appropriate use of AMDR (Acceptable Macronutrient Dietary Range) when evaluating the appropriateness of a snack food?
50% calories from fat is too much.
(There is an AMDR for fats, carbs, and proteins only. It is a range of percentages of calories that you should get from that nutrient per day. i.e. 45-65% of calories from carbs per day.
50% of calories from fat is too much.
)
- What is meant by Tolerable Upper Intake Level?
The highest level of daily consumption that current data has shown to cause no side effects in humans; ensures people do not take harmful amounts.
(More for supplements; No side effects in humans)
- How is estimated average requirement commonly used?
To guide recommendations and menu planning for communities in combinations with upper intake levels. - What is true of choose my plate .gov recommendations as presented by their setting place graphic?
Half of the plate should be fruits and vegetables. - What is the nutritional benefit of fruits and vegetables?
They provide nutrients that reduce the risk some type of cancer.
(They are high in fiber/bulk, vitamins and minerals, low in calories.)
- What is false regarding fruits and vegetables in the diet?
Fruits and vegetables are rich in vitamin B12
(Watch for the negative/false/incorrect questions!!)
- What strategy might be avoided due to expense for patients looking to eat more healthfully on a budget?
Buying frozen meals - Which statement is true about planning a balanced meal?
Skim milk has roughly the same amount of calcium and protein as whole milk.
(Always stick with reduced or no fat)
- What is true about dietary recommendation for whole grain intake?
Half of all grains consumed should be whole grain products. - Fritz is hosting a brunch and prepares for each of his friends
Omelet with cheese
Toasted English muffin
1t all fruit preserves
½ large grapefruit
1c whole milk
How can his menu be improved to follow the dietary guidelines for Americans? Choose all that apply
Use egg whites for the omelets
Replace cheese with vegetables in the omelets
Replace English muffin with whole wheat English muffin
Replace whole milk with fat free milk
(Adding juice will never be an answer because it is sugar water.)
- What is true of recommendations concerning trans fat and added sugar intake?
Trans fat and added sugar intake should be minimized. There is no DRI value. - What is recommended daily amount of protein intake?
60g/ day. - Which list contains all examples of protein?
Garbanzo beans (Chickpeas), egg, chicken breast, yogurt, cheese, ground beef, peanut butter, tofu - What is the best choice for a combination of plant-based foods to maximize healthy diet in a vegetarian diet?
Legume+ whole grain - There is a current initiative for more transparent labeling of sugars on nutrition fact labels. In the coming years, which of these might be more obviously labeled sugars? Choose all that apply. Anything ending in-ose, honey
Anything ending in-ose, honey
(Most things ending in ose are sugars like glucose, fructose, etc. Not -ase which are enzymes)
- Which carbohydrate will cause a quick return to hunger?
One with a higher glycemic index
(Measures how the body responds to a sugar, low index would mean it raises BG slower.)
- Which is the reason that seafood can be considered a healthful diet?
Some seafood is high in healthy omega 3 oils - What are generally considered sources of healthy fat?
Fish, nuts, olive oil - What is not a common source of high levels of sodium?
Spices and herbs
(Manufactured breads, processed food and canned soup/broth tend to have lots of sodium)
- Which foods are relatively rich in iron? Choose all that apply
Dark leafy greens, legumes, red meat, nuts
(Root vegetables, eggs and dairy are not.)
- What is the best vegetarian source of iron from the options provided?
Beans - Which of these are protective against heart disease?
Fiber, HDL cholesterol
(Not protein, LDL, trans fat, or saturated fat. Protein is neutral, but doesn’t increase risk.)
- Which are linked to increase heart disease risk? Choose all that apply.
LDL, trans fat, saturated fats - Reducing heart disease/ stroke
LDL levels below 120mg/dl
Limit cholesterol intake to less than 30mg per day
Saturated fats-less than 7% of total daily calories
At least 30 minutes of activity in daily routine
Sodium levels-below 1600mg per day
Increase intake of fiber, especially insoluble fiber, although most will be soluble.
Limit alcohol to 1-2 drinks per day. - What is an appropriate dietary intervention to address a patient’s low albumin level?
High protein diet. - Select foods that would be inappropriate for a patient with kidney disease?
Fried eggs, hot dogs, steak
(Watch proteins because they are broken down to ketones which are difficult for the kidneys)
- What is the dash diet designed to address?
Hypertension
(Dietary Approaches to Stop Hypertension)
- Which factors are important in controlling hypertension? Select all that apply
Sodium below 1600mg daily
Daily exercise such as a half hour walk
Maintaining a healthy weight-BMI below 25 - Because obesity affects many organ systems and hormones impairing body functions, which is true/
It is now considered a disease by AMA - What BMI is considered obese, requiring counseling about a weight loss dietary plan?
BMI> 30
(BMI>25 is overweight, >40 is morbidly obese) - What is the BMI calculation for a patient that measures 5’4″ in height and 175lbs in weight?
30
(BMI is square the height in inches (6464=4096) then divide the weight in lbs by that number (175/4096= 0.043) then multiply by 703 to change to metric units (0.043703=30).)
- What describes a diet least likely to result in obesity?
A diet with a variety of fruits, whole grains and vegetables. - Identify which heart disease risk factors are modifiable?
Sedentary lifestyle
BMI 32kg/m2
Diet high in trans fat - Which statement is true?
Obese children and teenagers are at increased risk of coronary heart disease - You are working in a family medicine clinic with a 22 yr old patient. You note a BMI of 17. What counseling might you give this patient?
“At this BMI you are at an increased risk of infertility, osteoporosis and premature death. Let’s find solutions.” - What health risks clearly increase along with BMI? Select all that apply.
Heart Disease
Type 2 diabetes,
Premature death
Osteoarthritis
Sleep apnea - What is true regarding genetic influence on body weight?
Body weights of parents are often predictive of children even when they do not raise him. - To maintain weight in the long term, patients should:
Balance energy expenditure with energy intake; eat just enough calories for activity level. - You can only draft five pieces of advice for weight loss. Which do you choose?
Reduce processed foods
Increase activity
When you want food, ask yourself, “am I hungry?”
Eat 5 small meals to maintain energy throughout the day,
Limit sugary drinks.
(Pick the top 5, more may be good, but pick the Best)
- Which person is most likely to lose weight and keep it off?
One who sticks to their diet long term. - Which is true about weight loss?
10% reduction in total weight has consistently been shown to improve health and decrease risk. - Which is likely not an appropriate, sustainable weight goal?
To lose 20 pounds in a month and be envied by friends - What is true of water intake and weight loss?
There is evidence to support that drinking 48oz of water or more supports weight loss. - Which foods are likely appropriate for consistent inclusion on a weight reduction dietary plan? Choose all that apply.
Baked fish
Seasoned green vegetables
Skinless chicken breast - Which are thought to societal factors in the obesity epidemic? Choose all that apply.
More desk based, low activity jobs.
Increasing size of food portions at restaurants and at home.
Increased consumption of processed foods. - Obesity messages to adolescents:
Focus on a healthy diet, not weight loss diets.
Reinforce healthy behavior
Don’t reward with food
Watch consumption of media messages determine content, credibility, etc. - What is inappropriate advice to a family of a 14-year-old with anorexia?
Serve separate meals to different family members.
(Everyone should eat a well-balanced meal together) - What is true of physical activity, in conjunction with diet, to support weight loss?
Patients should strive for 90 minutes of moderate physical activity at least 3 times a week. - What is a legal supplement body builder take in an effort to increase muscle mass and increase nitrogen retention? (an Ergogenic aid)
Protein powder - What does the term anthropometrics refer to?
Weight management assessment tools including weight, height, and waist size
(Anthro=human, metrics=measurements)
- How do you calculate physical activity level (PAL)?
Total Energy Expenditure/Body Mass Rate
(Basal Metabolic Rate = Basal Energy Expenditure)
- You are in the family medicine clinic and are working with a patient with a BMI of 52 and a sedentary lifestyle. He is wondering about bariatric surgery. Which pieces of advice are appropriate? Choose all that apply.
“Increase your physical activity now, but do it gradually, to reduce strain on your heart and increase your likelihood of keeping with it.”
“Even after surgery, you will need to continue to exercise.”
“After surgery, you may lose weight rapidly.”
“You will need to take specific vitamin supplements after surgery.” - What is true nutrition for infants?
Human milk contains immune factors that infant formula does not. - Why is juice not recommended for infants? Choose all that apply.
Contributes to dental decay
Lacks fiber and may contribute to diarrhea
It is a high calorie source of fluid - Which behavior may contribute to dental carries (cavities) in infancy?
Sharing utensils - What parent behavior may put a child in a risk of developing poor relationship with food? Choose all that apply.
Never involve children in meal planning
Avoiding offering children choices - How does the CDC define overweight in children?
BMI for the age over 85th percentile. - When teaching kindergarteners (5-6yrs old) about Choose My Plate, what would an appropriate educational strategy be?
Teach them a rhyme with the concepts
Teach them a rhyme with the concepts
Have them write out a description of a healthy menu with different food groups
- You are working in a pediatrics practice and have an appointment with an obese 9-year-old boy and his parents. What are some pieces of advice you might give the family?
High levels of stress can cause poor eating habits
Limit portion sizes and avoid frequent restaurant meals
Encourage the child to help choose and prepare meals
Encourage physical active play and not just desk-based study
Provide and model choices of healthy plant-based snacks and colorful fruits and vegetables at meals - What are some strategies to avoid when teaching high school students about nutrition? Choose all that apply.
Focus on how good nutrition will make them pretty
Explain ways to skip or replace meals. - A healthy 17-year-old girl is reading a nutrition label and sees that a product contains 13%DV of calcium per serving. How many servings of this product would this girl need to have that day to get the recommended amount of calcium from that product alone?
10
(Recommended DV of 130% for adolescents instead of 100% like adults.)
- A nurse is evaluating a 16-year-old boy with short stature (stunted linear growth), poor bone development, and cognitive development delays. What might be a dietary cause of this boy’s condition?
Malnutrition. - What nutrient do young adolescent have an increased need for relative to adults?
Thiamine - What is appropriate advice to give a newly pregnant mother?
Alcohol should be avoided during all trimesters of pregnancy - What is a possible effect of alcohol consumption during pregnancy on the fetus?
Permanent developmental disability - What nutrient reduces the risk of neural tube defects?
Folate/Folic acid - What are some good dietary sources of folate?
Lentils, spinach, oats - How can a pregnant mother minimize the risk of preterm delivery? Select all that apply.
Abstain from tobacco and drugs prior to conception and through pregnancy
Discontinue use of alcohol
Maintain a healthy weight
Maintain healthy diet to prevent gestational diabetes - What is false about breastfeeding?
It is a reliable form of birth control - Why are adults over 70 years of age more vulnerable to inadequacy of one or more dietary nutrients?
Different GI physiology interferes with absorption - What are some potential benefits of prebiotics and probiotics for an older adult? Choose all that apply.
Decreased total cholesterol
Control of IBS – yogurt/cultured products
Support immune system function
Rebuild bone density - How might you advise a patient about adapting to older adulthood?
“To avoid obesity, remain active, and realize your overall caloric needs may decrease.” - A patient is considering adding a dietary supplement and wants to know more. What should they do first?
Discuss it with their healthcare provider - To which patient represented by a quote in a meeting with the nurse, should the nurse recommend a dietary supplement?
“The doctor said my labs showed that I have iron-deficiency anemia. - The phrase “Not intended to diagnose, treat, cure or prevent any disease”:
Is required to appear on the label of all supplements. - Which vitamins can be flushed out in the urine stream if they are in moderate excess? Select all that apply.
B vitamins
Vitamin C
(Water soluble vs fat soluble (K, A, D, E)
- Match the supplement with what it aims to improve.
Ergogenic aid- athletic performance
Nootropic- cognition
Probiotic- digestive system
Galactagogue- breastmilk production. - Supplements may or may not contain an active ingredient. What else may they contain?
Extra ingredients that are unlisted and are similar to fillers in Rx drugs - How should you counsel a patient about providing information about the supplements they take to the healthcare team?
“Supplements can interact with medicine and make the medicine’s effect too strong. This can cause a life-threatening event.” - Match the nutrient to its deficiency:
Thiamine- beriberi
Iodine- brain damage, intellectual impairment, goiter
Vitamin A- blindness
Vitamin D- rickets - Why do many women take calcium supplements?
To reduce the risk of osteoporosis - Vitamin k:
Should be avoided while on warfarin (Coumadin) - What is unavailable in plant foods, and therefore may need to be consumed as a supplement to a vegetarian diet?
Vitamin B12. - What nutrients are available in plant foods but may require special consideration in a vegetarian diet? Select all that apply.
Iron
Vitamin D
Protein (can be very difficult on a vegetarian diet)
Calcium (must be a bioavailable form) - A limited ability to acquire nutritionally adequate foods in socially acceptable ways is called?
Food insecurity - What is true of food waste and overpopulation?
They are contributing factors to global hunger - What are natural causes of famine?
Pests, draught, and flood - What does the Economic Research Service do?
Assists in providing research and analysis on food security issues in developing countries. - Food deserts are often characterized by their lack of:
Availability and accessibility of healthful foods
(Food deserts are places w/ many people who are food insecure because of accessibility)
- What are characteristics of food deserts? Choose all that apply.
Fast foods are more affordable in the area
Markets in the area do not have fresh produce - What are some public health strategies to reduce food deserts? Choose all that apply.
Implement urban farmer’s market
Supporting public policy to reduce costs of fresh foods - Financial limitations to adequate nutrition are a main focus of what diagnostic tool?
Food Security Survey Module - A situation where a person who consumes many calories, but without adequate nutrients, can be considered?
Undernutrition, which also includes the chronically hungry - What is the use of the Child Food Security Survey Module?
Determine if a child is experiencing hunger at home. - What does “Household Food Security Status” refer to?
An outcome measure to examine the public’s ability to secure adequate food. - What is a term that means all people have access, at all times, to sufficient food for an active and a healthy life?
Food security - What is true of the Food Security Survey Module?
It measures sufficiency of food and very low food security requires intervention. - Low food security is characterized by?
Reduced quality, variety, or desirability of diet - What was one effect of the National Nutrition Monitoring and Related Research Act of 1990?
Development of standardized questionnaires for measuring household food security status. - The uneasy or painful sensation caused by the lack of food is known as….
Hunger - Which factor might be a cause of a patient’s frequent ED visits for congestive heart failure?
The patient goes without medication because they cannot afford them until they are paid. - What problems of factors can be associated with food insecurity? Choose all that apply.
Poor nutrition
Trouble obtaining food
Obesity
Lower cognitive and academic performance
Poorer health status - What does SNAP (Supplemental Nutrition Assistance Program) do?
Help low income families who have trouble affording food acquire food. - What is the most appropriate referral to have home meals delivered by Meals on Wheels?
Male, age 82, limited income, mobility issues and cannot drive. - Which is the most appropriate referral to the Women, infants, and Children program?
Female, age 22, speaks limited English, 6 months pregnant, low income, difficulty obtaining prenatal care. - What is not a primary consideration when addressing nutritional needs for a homeless patient?
Is the food fair-trade certified? - What is a major barrier to nutritional education, and a strategy for overcoming that barrier?
Illiteracy, screening for problems with written materials and providing verbal or picture-based instruction. - When working with a patient who speaks limited English, what should be avoided? Choose all that apply?
Using text only to teach
Using only traditional American food to teach. - What program teaches older adults how to shop, plan, and prepare nutritious meals, as well as conducting hypertension assessments?
Elderly Nutrition Program - What is one way that programs seek to provide socialization to older adults?
Providing meals in group settings - Matching: Programs for those at risk.
Senior farmer’s market Nutrition Program:
Allows older adults to acquire fruits and vegetables
SNAP (Supplemental Nutrition Assistance Program):
Helps low income families acquire food
Special Supplementary Nutrition program- WIC:
Recognizes medical and dietary risks to women and children
- Which is an important consideration of the Meals on Wheels program?
That the meals are appealing to the patient’s taste - What is “food poisoning”?
Can be caused by either primary infection by a microbe or production of toxins by microbes. - What is true of botulism?
It is thought to be the most lethal bioterrorism agent. - Which infections are most commonly disseminated by ingestion? (Fecal-oral) Choose all that apply.
Cholera
Shigellosis - What is Food Systems Security?
A system to focus on locating the source of bioterrorism incident and notifying affected facilities. - What foods have been common sources of food contamination in recent years? Choose all that apply.
Bean sprouts
Spinach
Milk - Which home cooks have put themselves at increased risk of spreading microbial foodborne illness? Select all that apply.
Fred who didn’t wash the spinach for the salad
Francine who undercooked her chicken
Filip who put a big handful of raw sprouts on his Thai noodles
Frank, who defrosted his steak on the counter
Flo, who stores her cooked and raw vegetables together - Food safety, matching:
Campylobacter- undercooked poultry (test)
e-coli – foods contaminated with fecal matter (fecal-oral)
mycotoxins— molds/fungus (test)
glycoalkaloids- potatoes exposed to light
ciguatoxin- fish such as grouper
monosodium glutamate- flavor enhancer which can cause chest pain, edema, facial numbness, headache (test)
- Enteritis and diarrhea are commonly caused by? Select all that apply.
E-coli
Salmonella - Why should pregnant women eat cheese only if it has been pasteurized?
Listeria in unpasteurized cheese increases the risk of spontaneous abortion and congenital infection of the newborn. - Foods that require freezing, preservation techniques, or immediate use are called:
Perishable foods - True or False: pasteurized milk can be stored at room temperature?
False - True or False: Contaminated drinking water should be boiled for at least five minutes?
True - True or false: Irradiated food becomes radioactive?
False - True or false: Dented cans should be discarded?
True - True or false: Chicken should be cooked or frozen within four days of purchase?
False (2 days) - What is the term for the chemical that gives rise to obesity?
Obesogen: Bisphenol A is an example - What does the USDA organic seal indicate? Choose 2 answers.
That the food is 100% organic according to current standards
That the food is not genetically engineered, and no synthetic fungicides or insecticides were used - A bottle of pasta sauce says, “Made with organic tomatoes, onions, and basil.” What can you infer from this?
The sauce contains at least 70% certified organic content