What is the leading modifiable disease in older adults?
heart disease
What dietary guideline is part of the 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk?
Reduce salt intake to 2300 mg.
A review of dietary patterns resulting in reduced risk of stroke found increasing consumption of ______ to be an effective strategy of primary stroke prevention.
cruciferous vegetables
To normalize blood pressure, limit _____ intake while maintaining adequate ______ intakes.
sodium; calcium, potassium, and magnesium
The majority of older Americans have one or more chronic diseases.
TRUE
Diabetes diagnosis criteria and management goals for older adults are different from those for younger adults.
FALSE
Shrinking in height due to osteoporosis happens quickly and with sharp, jabbing pains in the spinal column.
FALSE
Weight maintenance requires lifelong behavioral strategies.
TRUE
The rate of death from CHD in African-American men is nearly double that of Asian or Pacific Islander men.
TRUE
Viscous fiber escorts water in the gut, forming a liquid gel that increases absorption of cholesterol-rich bile acids and carries them throughout the body.
FALSE
Severe obesity is defined as a BMI ? 40
TRUE
African Americans with very high BMIs can be underdiagnosed for metabolic syndrome.
TRUE
Screening for cardiovascular disease should occur about every ____ years beginning at age ____.
5; 20
What combination of symptoms would be diagnosed as metabolic syndrome?
male waist circumference of 42 inches, systolic blood pressure of 140 mmHg, and HDL of 30 mg/dL
Type 1 diabetes is an autoimmune disorder in which the ______ of the pancreas that produce ______ are destroyed by the body's own immune system.
beta cells; insulin
What is the number one cause of death among people with diabetes?
heart disease
What serving of food counts as a single carbohydrate serving and will provide about 15 grams of carbohydrate?
� cup cooked cereal
What is the correct order of the stages of cancer development?
activation, initiation, promotion, progression, invasion and metastasis
Mortality for bulimia nervosa appears to be higher than for anorexia nervosa.
FALSE
The risk of persistence of obesity from childhood into adulthood increases if at least one parent is overweight.
TRUE
Weight status among adolescents should be assessed by measuring body composition.
FALSE
Orlistat is currently the only weight-loss medication that has been FDA-approved for use by adolescents.
TRUE
Type 2 diabetes constitutes the majority of cases of diabetes in people 20 years or younger.
FALSE
What stage of the national guidelines for the treatment of child and adolescent overweight and obesity involves a team of healthcare professionals who specialize in pediatric obesity management and recommends weekly visits for at least 8-12 weeks followed
Stage 3
To be considered as a candidate for bariatric surgery, adolescents must have a BMI of _____ with medical major complications or a BMI of ____ with minor co-morbidities.
>35; >40
What nutritional supplement is marketed as a means to increase lean body mass and has dose-related side effects of cramping, nausea, diarrhea, headache, and reduced renal function?
creatine
Jamie weighed 165 pounds before his workout and weighed 162 pounds after his workout. How much fluid should Jamie consume after his workout to maintain proper hydration?
48 ounces
Adolescents who use tobacco have been shown to have higher ______ requirements while adolescents who frequently consume large quantities of alcohol have higher ______ requirements.
vitamin C; thiamin
Of the following blood lipid readings, which one would indicate hyperlipidemia in an adolescent?
triglycerides at 165 mg/dL
Current data suggests that dieting is most common among ________, who also have the highest reported rates of vomiting and use of laxatives to lose weight.
Hispanic females
Mikalia refuses to maintain a normal weight for her age and height, has an intense fear of becoming fat, regularly self-induces vomiting and uses laxatives to lose weight. Based upon diagnostic criteria for eating disorders, which disorder does Mikalia ex
binge-eating/purging type anorexia nervosa
One example of a psychosocial criterion for inpatient treatment of eating disorders is ________.
social isolation
High-protein diets are recommended as a pre-performance dietary regimen among adolescent athletes.
FALSE
Most define a chronic condition in a child as one expected to last ____ or more.
12 months
Scoliosis is a secondary condition that interferes with accurate measurement of stature.
TRUE
U.S. educators consider asthma, learning disabilities, ADHD, and speech problems the most prevalent chronic conditions in children.
TRUE
The 2010 Institute of Medicine Food and Nutrition Board increased the RDA for _____ and _____ for all children, including those with chronic conditions.
calcium; vitamin D
What chronic condition has a special growth chart used in conjunction with the CDC 2000 growth chart for assessment of growth and development?
e. Cystic fibrosis
A child with PKU will only have to follow a special diet until adolescence, after which she or he will be able to consume a normal diet.
FALSE
Galactosemia and cerebral palsy are two conditions affecting _____, thus affecting bone growth.
calcium
Children with a gastrostomy can't eat anything orally.
FALSE
The major nutrient-related consequence of cystic fibrosis is the malabsorption of various nutrients due to the lack of ______.
pancreatic enzymes
Currently, type 2 diabetes is most prevalent in _______ youth.
American Indian
Utilized for children with uncontrolled seizures, a ketogenic diet severely limits ______ and increases ______ content.
carbohydrates; fat
What natural source of protein, in limited amounts, would be allowed in the diet of a child with PKU?
potatoes
What is a side effect of psychostimulant medications that causes nutritional concern?
decreased appetite
Energy needs in children with special health care needs are related to activity level and _____.
frequency of illnesses
What program or law ensures that school cafeteria lines accommodate wheelchairs?
Americans with Disabilities Act
What are the three most common chronic conditions affecting men over age 65?
Hypertension, arthritis and heart diseases.
What are the three most common chronic conditions affecting women over age 65?
Hypertension, arthritis and heart diseases, in other words, older men and women face the same chronic diseases.
BMI is a less effective predictor of morbidity and mortality in older than younger adults. Why is BMI a less reliable tool in older adults?
The BMI is calculated using height and weight. Getting an accurate height may be more difficult in older adults who have compressed vertebrae or kyphosis which has reduced normal height. On average, older adults have lost muscle tissue which has been repl
The DASH diet has been shown to reduce HBP; additional sodium restrictions have led to further reductions in blood pressure.
True- adherence to the DASH diet reduces blood pressure. An additional dose-response effect on blood pressure reduction results from sodium restriction.
Even a small loss of body weight can improve osteoarthritis.
TRUE
Vitamin K levels present in dark green vegetables may interfere with warfarin (anti-coagulant) therapy.
True-Approximately 11% of men above age 65 and 4.5% of women over age 65 take warfarin and must keep their vitamin K levels stable for effective blood-thinning effect.
Eating a Mediterranean-style diet is associated with lower CVD mortality in older adults
TRUE
Older adults who suffer from sarcopenia may benefit from high-protein diets. High protein intake will also help to keep their bones strong.
TRUE
Vitamin B12 deficiency can cause irreversible neurological damage. List at least three reasons why an older adult might have low vitamin levels.
B12 deficiency may result from malabsorption due to atrophic gastritis, GI infections such as H. pylori, lack of animal products in the diet, family history of pernicious anemia, and medications.
Dehydration can result in confusion. List three or more strategies that can help to restore hydration and provide nutrients an older adult might be missing.
Push fluids by structuring reminders to drink (such as a water jug in the refrigerator that should be empty at day's end), drinking liberal amounts of water when taking medications, offering nutritious beverages to increase nutrients, observing "happy hou
Older adults have proportionately more illness than younger adults, and the two leading causes of death are heart disease and cancer.
TRUE
The CDC suggests that longevity depends more on lifestyle factors than on genetics.
True - lifestyle factors are estimated to account for 51% of longevity compared to a 19% contribution from genetics.
U.S. life expectancy at birth is the highest in the world.
FALSE
Fat-free mass or lean body mass tends to shrink in old age. This results in significantly decreased need for calories, vitamins, and minerals.
False - [It's a trick question] While energy needs decrease with age, some vitamins (Vitamins , C, D) and minerals (Mg, Ca) increase with age while iron and chromium decrease.
The OAANP serves individuals aged 60 and older. The congregate meal program was established to increase socialization as well as to improve nutritional intakes of older adults.
TRUE
DETERMINE, MUST, and the MNA are three tools to screen for nutritional risk. List five factors that place older adults at risk of malnutrition.
ere are seven factors that put older adults at risk of malnutrition:
1)food insecurity or low income
2)eating fewer than two meals per day
3)illness or a condition that has affected dietary intake
4)lost or gained more than 10 pounds in the last 6 months
Food guidance for older adults is different from that for the general public. Cite two adjustments in food guidance that are particularly important for older adults.
Here are three adjustments of generic food-guides to make for older adults:
1)Greater risk of dehydration requires fluid assessment and recommendations
2)lower caloric intake needs to be balanced with greater nutrient density, especially when activity lev
The AMDR for protein is 10-35 percent of calories, and the RDA is 0.8 gm/kg body weight. If the average older adult meets the RDA, why is protein a nutrient of concern for older adults?
Reasons might include: Lack of money may affect ability to buy high quality protein, compromised ability to chew, inability to cut meats once cooked, cognitive impairment that leads to forgetting to eat.
Using information from Question 8, how would you determine the protein needs of JT in Case Study 18.1? Hint: He weighs 235 pounds (107 kg).
Multiply 107 kg by 0.8-1.3 gm protein per kg body weight; distribute the 86-139 gm of protein that would be adequate for JT throughout the day in a way that he would consume as food and beverages; use heart-healthy protein sources.
How would you design a lifestyle-change program based on cognitive behavioral therapy?
Essential components of cognitive behavioral change programs include:
Long duration�programs are 12-16 weeks long to build knowledge, modify beliefs and attitude, and integrate new behaviors.
Combination of skills training and analysis of behavior and tho
What three things differentiate population recommendations to minimize cardiovascular disease risk from therapeutic lifestyle changes for individuals at high risk?
Differences between recommendations to reduce risk of the population and treatment of high risk individuals:
Population messages vs. individualized behavioral counseling and on-going intervention with health care providers to help make therapeutic lifesty
List the metabolic changes that characterize metabolic syndrome. How many are required for a diagnosis of metabolic syndrome? What is the easiest way to screen for metabolic syndrome?
Abdominal obesity, high blood pressure, elevated fasting glucose, dyslipidemia with elevated LDL cholesterol, low HDL and high triglycerides. Three are needed for a diagnosis of metabolic syndrome. Waist circumference is a simple screening method.
Why is it better to start intervention in the prediabetic state rather than waiting for the diagnosis of diabetes?
There is a long pre-symptomatic phase with marginally elevated glucose during which vascular changes occur. Intervention in the prediabetes phase can prevent conversion to diabetes and reduce cardiovascular risk factors.
List the main considerations in developing a diet plan (nutrition prescription) for an individual with diabetes.
Diet flexibility within an individualized plan. This includes a target calorie level based on current weight and weight goal, with a defined distribution of calories among carbohydrate, protein and fat. A meal plan including snacks that provides relativel
What are a dietitian's priorities for nutrition intervention in each of the four stages of cancer care?
Prevention�Healthy diet with caloric intake adjusted to achieve or maintain weight within normal ranges.
Treatment�Medical nutrition therapy to restore nutrient shortages, maintain nutritional health, and prevent or manage complications of cancer and the
What nutrition-related concerns develop as a result of having HIV?
HIV raises energy requirements by 10%. Macro and micro nutrient needs increase during periods of high viral load, decline of immune function, secondary infections and altered absorption and metabolism. Changes in gut and gastrointestinal pathogens can lea
What are the differences between individual and external or environmental factors that determine nutrition status and health? Give examples for how each type is monitored.
ndividual factors�Things individuals are primarily responsible for, including food and nutrient intake and nutritional adequacy, physical activity and other lifestyle habits; and the results of individual behavior on weight status and chronic disease risk
Describe the physiological changes that occur during the adult years. How do those changes relate to the continuum of health? Which changes have implications for development of chronic diseases?
Bone density and muscular strength peak by age 30. By middle adulthood there is a loss in muscle mass and an increase and redistribution of body fat. With the decline of estrogen production bone loss is accelerated, abdominal fat increases and blood chole
How many calories do you need? Use three methods discussed in the chapter to estimate daily energy requirement. What factors would increase or decrease the number of calories you need to eat in a day?
Caloric needs can be determined by using reference tables (Table 16.4), measured through indirect calorimetry, and calculated using the Mifflin-St. Jeor formula or the simple method of 15 calories per pound of body weight. Factors that decrease calorie ne
If you are a typical male or female as represented in Table 16.5, what nutrient shortfalls and excesses should you be worried about and why?
ales consume too much total and saturated fat, cholesterol, sugar and sodium and not enough fiber, vitamins A, D, E, K (for young men), choline, magnesium and potassium. Females have too much total and saturated fat, and sodium and low intakes of fiber, v
You have been appointed to the Campus Dietary Guidelines Committee. What things do you need to consider when developing dietary guidelines for the campus community?
Considerations include: Priority health issues and nutrient needs of young adults and older faculty and staff, and current Dietary Guidelines for Americans. The challenge on college campuses is to provide nutrient-dense foods, minimize solid fats and adde
What do you need to do to meet the Physical Activity Guidelines for Americans? What are the benefits if you do? What are the consequences if you don't?
Compare your current level of activity with the national guidelines on Table 16.9. Being more physically active increases muscle strength, balance and endurance, support physical and mental health, improves cognitive function, helps manage weight and comb
Make a table of different types of strategies for helping adults achieve good nutritional health.
Answer
Individuals�Education and counseling to increase knowledge and encourage behavior change, primary care providers assessing and talking about BMI, eating habits, and physical activity.
Organizations�Health promotion programs, sponsored events, community ga
Stage 2 treatment for adolescent obesity can be offered by a single provider.
TRUE
At which state of obesity treatment is a structured eating plan designed to create a caloric deficit?
Stage 3
Which of the following nutrients may be required in greater amounts by adolescents who use alcohol and tobacco?
Thiamin
Iron
Vitamin C
Which is not a criterion for inpatient treatment of eating disorders?
Weight loss of more than 10 lb in 3 months
All of the following criteria are required for adolescent bariatric surgery, except:
amily history of obesity-related deaths
How does binge-eating disorder differ from bulimia nervosa?
While both conditions include eating large amounts of food in a short period of time, a diagnosis of bulimia nervosa requires frequent purging methods to compensate for the calories consumed while the diagnosis of binge-eating disorder does not include a
How does the use of substances such as alcohol, tobacco, and recreational drugs affect the nutritional status of adolescents?
Energy intake that results from the consumption of alcohol may displace energy intake from food. Because alcohol does not provide micronutrients, the overall dietary quality would be reduced in an individual who consumed alcohol frequently. The use of tob
Why don't adolescent BMI charts use a single cutoff point for determining obesity in the same way adult BMI charts do?
Adolescent BMI charts use multiple cutoff points because they allow for continued development and growth by age.
Which of the following is NOT part of national guidelines for physical activity for adolescents?
Engage in at least 60 minutes of strenuous aerobic physical activity at least 5 days a week.
Which of the following is considered a risk factor for low vitamin D status?
Dark skin pigmentation
Sexual maturation rating is a method of determining when adolescents have completed menarche or spermarche.
FALSE
Which of the following factors contributes to increased iron needs among adolescents?
Increased growth velocity during puberty
Low dietary intake of iron
Onset of menarche
School wellness policies are only required for schools that offer � la carte foods for sale.
FALSE
The nutrients most likely to be missing from the diets of vegan adolescents are:
Vitamins B6, D, B12, iron, and calcium
Which of the following is NOT a behavioral economics strategy to improve food choices?
Hanging MyPlate posters in the cafeteria
What is biological age (SMR) and why should it be used instead of chronological age to determine adolescent nutrient needs?
Biological age is based on sexual maturation rating. It assesses the degree of physical development, which can vary greatly among individuals of the same gender and age, thus is a better indicator of the nutrient needs of individuals as it provides a phys
Which of the following is a result of eating family meals most days of the week?
Higher intake of fruits and vegetables
Less risk of drug and alcohol use
Better academic performance
Which of the following pieces of legislation determines components of school wellness policy guidelines?
Healthy, Hunger-Free Kids Ac
Which child requires an interpretation of growth modified from the usual CDC growth chart interpretation?
A child with mild cerebral palsy with scoliosis
Which child requires in-depth nutrition assessment due to changes in body composition?
A child who appears thin and uses a wheelchair most of the time
When a child has a chronic condition that limits activity, such as spina bifida, what is the greatest long-term nutrition concern?
Excessive calorie intake further limiting mobility
An 8-year-old child with diabetes is eating birthday cake at school. What is a likely explanation?
The child has type 1 diabetes and he has adjusted his insulin pump to cover the cake.
Sue has a chronic condition with a pattern of weight gain and then loss, without growth over the last year.
Sue's condition can modify her energy needs compared to a healthy child. - True
The family may be worried about handling Sue if she grows as expected for her age. - True
Sue's nutritional intake must not be sufficient, since her growth is not as expected.
What are two examples of family support that would assist a child with a chronic condition?
Examples of support services for families are maternal and child health services, school nutrition programs, and school educational programs.
When a child with ADHD refuses to eat, what are two possible explanations?
Correct answers include medication side effects and ability to concentrate or attend to meals.
Explain why a child could need an IEP that includes nutrition services.
An IEP is a school educational plan that could include feeding or eating assistant, access to snacks or meals at set times at school, and selection of foods appropriate for the child's abilities or condition.
Timothy in Case Study 12.1 returns to his pediatrician 6 months later at years of age for a weight check. He has gained 10 kg in 6 months and now weighs 90 pounds (41 kg). His height has increased to 51 inches (130 cm).
Calculate Timothy's BMI. BMI = weight in kg divided by height in meters squared; 41 kg divided by .
What is Timothy's BMI-for-age percentile? Use CDC growth curves to determine percentile. - for his age and gender.
Which of the following classifies Timoth
Based on the staged treatment plan for pediatric obesity, describe the recommended approach to treatment for Timothy.
Timothy would enter the Prevention Plus approach to treatment for 3-6 months. If he maintains his weight or his BMI-for-age percentile is deflecting down, he would continue the Prevention Plus. If he gains weight, the next approach would be a structured w
Regarding fluid intake in school-age children, which of the following statements is most correct?
Adults who are supervising children during exercise can rely on the children to let them know when they are thirsty.
Name two strategies for increasing a school-age child's physical activity.
Find a safe route for walking or biking to school.
Encourage at least 60 minutes of active play per day.
Work within the community to maintain parks and other safe places for children to play.
Child can participate in organized sports that are appropriate
Name two strategies for decreasing a school-age child's sedentary behaviors.
Decrease "screen time" to less than 2 hours per day.
Remove televisions, video games, and computers from children's bedrooms.
Be active as a family.
Regarding child nutrition programs, which of the following statements is most correct?
Meals served as part of the School Breakfast Program must provide one-third of the Dietary Reference Intakes of key nutrients for the age of the children being served.