ACBN Case Studies & Practical Application 5 — Questions and Answers
Question 1: A 40-year-old woman with non-alcoholic fatty liver disease (NAFLD) and a BMI of 33 asks about dietary strategies. Which approach has the strongest evidence for reducing hepatic fat content?
- Complete elimination of dietary fat
- 5-10% body weight loss through caloric restriction with reduced refined carbohydrates and saturated fat (Correct answer)
- High-dose omega-3 supplementation alone
- Fasting for 3 days per week only
Correct answer: 5-10% body weight loss through caloric restriction with reduced refined carbohydrates and saturated fat
A 5-10% reduction in body weight through caloric restriction targeting refined carbohydrates and saturated fat is the most evidence-based intervention for reducing hepatic steatosis in NAFLD.
Question 2: An infant born at 28 weeks gestation is in the NICU. The nutritionist calculates energy needs. Which factor primarily distinguishes preterm infant nutrition needs from full-term infant needs?
- Preterm infants need less protein per kilogram
- Preterm infants need higher energy (110-135 kcal/kg/day) and protein (3.5-4.5 g/kg/day) for catch-up growth (Correct answer)
- Preterm infants should be started on solid foods at 4 months corrected age
- Preterm infants have better fat absorption than full-term infants
Correct answer: Preterm infants need higher energy (110-135 kcal/kg/day) and protein (3.5-4.5 g/kg/day) for catch-up growth
Preterm infants missed the third-trimester nutrient deposition period and have immature digestive function, requiring higher energy and protein density to support accelerated catch-up growth.
Question 3: A school nutritionist is evaluating a 10-year-old with attention difficulties and frequent afternoon energy crashes. The 24-hour recall shows skipped breakfast and a high-sugar lunch. What intervention should be recommended first?
- Recommend omega-3 supplementation for cognition
- Establish consistent balanced breakfast with protein, complex carbohydrates, and fat to stabilize blood glucose (Correct answer)
- Eliminate all sugar from the school lunch
- Refer directly to a pediatric endocrinologist
Correct answer: Establish consistent balanced breakfast with protein, complex carbohydrates, and fat to stabilize blood glucose
Breakfast consumption stabilizes blood glucose throughout the morning, improving attention span and reducing the energy crashes associated with glycemic variability from high-sugar meals.
Question 4: A client with Crohn's disease in remission asks about nutrition during a flare. Which approach is most appropriate during an active flare to minimize GI symptoms while maintaining nutrition?
- High-fiber, raw vegetable diet to promote bowel health
- Low-residue, low-fiber diet with easily digestible foods and adequate hydration (Correct answer)
- Prolonged clear liquid diet for 2 weeks
- Elimination of all fats due to malabsorption risk
Correct answer: Low-residue, low-fiber diet with easily digestible foods and adequate hydration
During active Crohn's flares, a low-residue, low-fiber diet reduces mechanical irritation of inflamed intestinal tissue while maintaining caloric and nutrient intake.
Question 5: A nutritionist is counseling a client on warfarin therapy who eats variable amounts of leafy greens. The client's INR is unstable. What is the most clinically sound advice?
- Eliminate all vitamin K-containing foods from the diet
- Maintain a consistent daily vitamin K intake rather than eliminating vitamin K foods (Correct answer)
- Increase leafy green intake to maximum to stabilize INR
- Switch to a vitamin K supplement to replace food sources
Correct answer: Maintain a consistent daily vitamin K intake rather than eliminating vitamin K foods
Consistency in vitamin K intake allows the warfarin dose to be calibrated accurately; drastic daily variation is what causes INR instability, not the presence of vitamin K itself.
Question 6: A 25-year-old male presents for sports nutrition counseling. He trains 2 hours daily and wants to maximize muscle hypertrophy. What is the evidence-based protein recommendation?
- 0.8 g/kg/day (standard DRI)
- 1.6-2.2 g/kg/day distributed in 4-5 feedings throughout the day (Correct answer)
- 3.5 g/kg/day for maximum gains
- Protein timing is the only factor that matters, not total intake
Correct answer: 1.6-2.2 g/kg/day distributed in 4-5 feedings throughout the day
Current evidence supports 1.6-2.2 g/kg/day for maximizing muscle protein synthesis in resistance-trained athletes, with distribution across multiple feedings optimizing leucine-stimulated anabolism.
Question 7: A food service nutritionist is updating menus for a senior center. Which nutrient is most commonly under-consumed by adults over 70, contributing to falls and fractures?
- Vitamin B12
- Vitamin D (Correct answer)
- Potassium
- Selenium
Correct answer: Vitamin D
Vitamin D deficiency is highly prevalent in older adults due to reduced skin synthesis, decreased dietary intake, and impaired hydroxylation; deficiency contributes to muscle weakness and fall-related fractures.
ACBN Case Studies & Practical Application 5
A 40-year-old woman with non-alcoholic fatty liver disease (NAFLD) and a BMI of 33 asks about dietary strategies.
Which approach has the strongest evidence for reducing hepatic fat content?