CSP Nutritional Care & Intervention 3 — Questions and Answers
Question 1: A dietitian is counseling an adolescent athlete with relative energy deficiency in sport (RED-S). Which finding most directly confirms inadequate energy availability?
- Low serum ferritin
- Amenorrhea lasting >3 months (Correct answer)
- Stress fracture on imaging
- Low 25-hydroxyvitamin D
Correct answer: Amenorrhea lasting >3 months
Functional hypothalamic amenorrhea resulting from low energy availability is a hallmark clinical indicator of RED-S in female athletes.
Question 2: A 6-month-old infant with cow's milk protein allergy requires a substitute formula. Which option is most appropriate for infants who fail soy formula?
- Goat milk-based formula
- Partially hydrolyzed whey formula
- Extensively hydrolyzed casein formula (Correct answer)
- Rice milk
Correct answer: Extensively hydrolyzed casein formula
Extensively hydrolyzed casein formulas are recommended for infants with cow's milk protein allergy who cannot tolerate soy, as the proteins are broken down to reduce allergenicity.
Question 3: Which method best estimates resting energy expenditure in critically ill children when indirect calorimetry is unavailable?
- Schofield equation (Correct answer)
- Harris-Benedict equation
- Mifflin-St Jeor equation
- WHO 1985 equations for adults
Correct answer: Schofield equation
The Schofield equation is the most validated predictive equation for estimating resting energy expenditure in pediatric patients.
Question 4: A 10-year-old with Crohn's disease is started on exclusive enteral nutrition (EEN). What is the primary mechanism by which EEN induces remission?
- Bowel rest alone
- Modulation of gut microbiome and mucosal healing (Correct answer)
- High-dose steroid effect of the formula
- Elimination of dietary antigens via elemental formula
Correct answer: Modulation of gut microbiome and mucosal healing
EEN induces remission primarily by altering gut microbiota composition and promoting intestinal mucosal healing rather than simply resting the bowel.
Question 5: When counseling a family about introducing allergenic foods to a high-risk infant, current evidence supports:
- Delaying peanut introduction until 2-3 years of age
- Introducing peanut-containing foods between 4-6 months in high-risk infants (Correct answer)
- Avoiding all allergenic foods until 12 months
- Introducing one new food every 4 weeks
Correct answer: Introducing peanut-containing foods between 4-6 months in high-risk infants
Current guidelines (LEAP trial evidence) recommend early introduction of peanut-containing foods between 4-6 months in high-risk infants to reduce peanut allergy risk.
Question 6: A 14-year-old with anorexia nervosa at 75% ideal body weight is medically unstable. What is the appropriate initial refeeding calorie target?
- Start at 1800-2000 kcal/day immediately
- Start at 1000-1200 kcal/day and advance by 200 kcal every 1-2 days
- Start at 500-800 kcal/day and advance slowly (Correct answer)
- Match estimated full caloric needs on day one
Correct answer: Start at 500-800 kcal/day and advance slowly
Severely malnourished patients require cautious refeeding starting at 500-800 kcal/day with slow advancement to prevent refeeding syndrome.
Question 7: Which iron supplementation regimen is currently recommended for exclusively breastfed full-term infants?
- No supplementation needed until 12 months
- 1 mg/kg/day starting at 4 months until iron-rich foods are established (Correct answer)
- 2 mg/kg/day starting at birth
- Iron drops beginning at 6 months when solids are introduced
Correct answer: 1 mg/kg/day starting at 4 months until iron-rich foods are established
The AAP recommends 1 mg/kg/day of oral iron supplementation for exclusively breastfed full-term infants starting at 4 months of age.
CSP Nutritional Care & Intervention 3
A dietitian is counseling an adolescent athlete with relative energy deficiency in sport (RED-S).
Which finding most directly confirms inadequate energy availability?