ACBN Case Studies & Practical Application 4 — Questions and Answers
Question 1: A nutritionist is reviewing a 3-day food record for a 35-year-old woman trying to conceive. Her folate intake averages 250 mcg DFE/day. What recommendation is most appropriate?
- Her intake is sufficient; no changes needed
- Recommend 400 mcg folic acid supplement daily in addition to dietary folate (Correct answer)
- Recommend 4,000 mcg folic acid daily as a precaution
- Advise fortified foods will fully compensate without supplementation
Correct answer: Recommend 400 mcg folic acid supplement daily in addition to dietary folate
The CDC recommends all women of childbearing age supplement with 400 mcg folic acid daily to prevent neural tube defects, regardless of dietary folate intake.
Question 2: A 5-year-old child is brought in with night blindness, dry skin, and poor growth. Parents report a diet very low in animal foods and no fortified products. Which deficiency best explains all three symptoms?
- Zinc deficiency
- Vitamin A deficiency (Correct answer)
- Essential fatty acid deficiency
- Vitamin E deficiency
Correct answer: Vitamin A deficiency
Vitamin A deficiency causes xerophthalmia (night blindness, dry eyes), hyperkeratosis (dry skin), and impairs growth, particularly in children in developing regions.
Question 3: An 80-year-old nursing home resident is assessed for malnutrition. BMI is 18.5, unintentional weight loss is 8% in 3 months, and she eats <50% of meals. Using the ASPEN criteria, how is her nutritional status classified?
- At risk for malnutrition only
- Malnutrition (moderate to severe) (Correct answer)
- Normal nutrition status
- Sarcopenic obesity
Correct answer: Malnutrition (moderate to severe)
Meeting at least two of ASPEN/AND's malnutrition indicators (significant weight loss, inadequate intake) in the context of chronic illness qualifies as moderate-to-severe malnutrition.
Question 4: A client with irritable bowel syndrome (IBS-D) reports worsening symptoms after consuming apples, onions, wheat bread, and milk. Which dietary approach is most evidence-based for managing her symptoms?
- Gluten-free diet indefinitely
- Low-FODMAP elimination diet followed by systematic reintroduction (Correct answer)
- Lactose-free diet only
- High-fiber diet with >35 g/day
Correct answer: Low-FODMAP elimination diet followed by systematic reintroduction
The low-FODMAP diet has the strongest clinical evidence for reducing IBS symptoms, with systematic reintroduction identifying individual triggers rather than permanent elimination.
Question 5: A competitive marathon runner complains of GI distress and fatigue during long runs despite adequate training. A 24-hour recall shows very low carbohydrate intake. What is the most likely performance and GI issue?
- Fat malabsorption syndrome
- Glycogen depletion causing GI blood flow shunting and cramping (Correct answer)
- Overhydration-induced hyponatremia
- Iron-deficiency anemia from footstrike hemolysis
Correct answer: Glycogen depletion causing GI blood flow shunting and cramping
Insufficient carbohydrate intake depletes glycogen stores; the body shunts blood away from the GI tract during high-intensity exercise, exacerbating GI symptoms and causing fatigue.
Question 6: A dietitian counsels a newly diagnosed HIV-positive client on 1,200 mg/day of the antiretroviral ritonavir. The client asks about grapefruit juice. What is the primary concern?
- Grapefruit increases vitamin absorption competing with the drug
- Grapefruit inhibits CYP3A4 enzymes, increasing drug plasma levels to potentially toxic concentrations (Correct answer)
- Grapefruit contains compounds that reduce drug efficacy
- Grapefruit has no interaction with HIV medications
Correct answer: Grapefruit inhibits CYP3A4 enzymes, increasing drug plasma levels to potentially toxic concentrations
Grapefruit furanocoumarins irreversibly inhibit CYP3A4 in the gut wall, dramatically increasing plasma concentrations of ritonavir and many other drugs to toxic levels.
Question 7: A nutritionist is creating a meal plan for a patient with phenylketonuria (PKU). What is the primary dietary goal?
- Eliminate all protein from the diet
- Restrict phenylalanine intake while ensuring adequate tyrosine and total protein from medical formula (Correct answer)
- Supplement with high-dose branched-chain amino acids
- Follow a ketogenic diet to manage neurological symptoms
Correct answer: Restrict phenylalanine intake while ensuring adequate tyrosine and total protein from medical formula
PKU management requires strict phenylalanine restriction (it cannot be metabolized) while providing tyrosine (now essential) and sufficient total protein through phenylalanine-free medical formula.
ACBN Case Studies & Practical Application 4
A nutritionist is reviewing a 3-day food record for a 35-year-old woman trying to conceive.
Her folate intake averages 250 mcg DFE/day.
What recommendation is most appropriate?