CDN Clinical Nutrition & Assessment 4 — Questions and Answers
Question 1: A patient with type 2 diabetes is counseled on the glycemic index (GI). Which statement about GI is most accurate?
- GI measures the fat content of a food
- GI compares blood glucose response to a reference food like white bread or glucose (Correct answer)
- High-GI foods always contain more carbohydrates
- GI is not affected by cooking methods
Correct answer: GI compares blood glucose response to a reference food like white bread or glucose
The glycemic index ranks foods based on their postprandial blood glucose response relative to a reference food (pure glucose or white bread = 100), independent of portion size.
Question 2: Which dietary pattern has the strongest evidence for reducing cardiovascular mortality and is recommended by major US health organizations?
- Ketogenic diet
- Mediterranean diet (Correct answer)
- Carnivore diet
- Low-FODMAP diet
Correct answer: Mediterranean diet
The Mediterranean diet, rich in olive oil, fish, whole grains, legumes, fruits, and vegetables, has the strongest evidence from large RCTs (e.g., PREDIMED) for reducing cardiovascular mortality.
Question 3: A dietitian calculates a patient's nitrogen balance as negative. This finding indicates the patient is in a state of:
- Anabolism and muscle building
- Nitrogen equilibrium
- Net protein catabolism (Correct answer)
- Positive energy balance
Correct answer: Net protein catabolism
Negative nitrogen balance means nitrogen (protein) losses exceed intake, indicating net catabolism where the body is breaking down more protein than it is synthesizing.
Question 4: Which vitamin deficiency is most commonly associated with peripheral neuropathy, macrocytic anemia, and neurological deterioration in elderly patients?
- Vitamin B6 (pyridoxine)
- Vitamin B12 (cobalamin) (Correct answer)
- Folate
- Vitamin E
Correct answer: Vitamin B12 (cobalamin)
Vitamin B12 deficiency causes subacute combined degeneration of the spinal cord, peripheral neuropathy, and megaloblastic anemia; it is common in elderly due to reduced gastric acid and intrinsic factor.
Question 5: The MUST (Malnutrition Universal Screening Tool) scores patients based on which three components?
- BMI, serum albumin, and recent weight loss
- BMI, unplanned weight loss, and acute disease effect (Correct answer)
- Age, dietary intake, and functional status
- Waist circumference, appetite, and lab values
Correct answer: BMI, unplanned weight loss, and acute disease effect
MUST uses BMI score, unplanned weight loss percentage score, and an acute disease effect score to categorize patients as low, medium, or high malnutrition risk.
Question 6: In a patient with liver cirrhosis, which dietary modification is most important to prevent hepatic encephalopathy?
- Eliminate all protein from the diet
- Provide adequate protein (1.2–1.5 g/kg/day) with preference for branched-chain amino acids (Correct answer)
- Restrict carbohydrate intake to <20% of calories
- Increase saturated fat to spare protein
Correct answer: Provide adequate protein (1.2–1.5 g/kg/day) with preference for branched-chain amino acids
Adequate protein intake (1.2–1.5 g/kg/day) is essential in cirrhosis to prevent sarcopenia; branched-chain amino acids (BCAAs) are preferred as they are metabolized peripherally rather than hepatically.
Question 7: Which assessment tool uses a structured questionnaire to evaluate nutritional status and is specifically validated for use in hospitalized and community-dwelling elderly patients?
- Malnutrition Universal Screening Tool (MUST)
- Nutritional Risk Screening 2002 (NRS-2002)
- Mini Nutritional Assessment (MNA) (Correct answer)
- Subjective Global Assessment (SGA)
Correct answer: Mini Nutritional Assessment (MNA)
The Mini Nutritional Assessment (MNA) is validated specifically for geriatric populations in both hospital and community settings, assessing anthropometrics, dietary intake, mobility, and cognition.
CDN Clinical Nutrition & Assessment 4
A patient with type 2 diabetes is counseled on the glycemic index (GI).
Which statement about GI is most accurate?