Nutritional Assessment Questions and Answers

Answer: A

The normal BMI range for adult Asians in the WHO Asia-Pacific classification is about 18.5 to 22.9 kg/m\(^{2}\), which the question rounds to 18 – 23 kg/m\(^{2}\). Asian populations carry more body fat and more metabolic risk at a given BMI, so the cut-offs sit lower than the 18.5 to 24.9 range used for Western adults. The other ranges (19 – 24, 20 – 25 and 21 – 26) all start and stop too high, so they would count people who are already overweight for an Asian build as normal.

Answer: D

A dietary survey uses a food frequency questionnaire (FFQ), anthropometry uses mid-upper arm circumference (MUAC), biochemical assessment measures haemoglobin (Hb) and clinical assessment looks for signs such as Bitot spots. So the match is (a)-(iii), (b)-(v), (c)-(i), (d)-(ii). A bomb calorimeter measures the energy value of food, and HPLC analyses vitamins and other compounds in the laboratory, so these two are distractors.

Answer: A

Serum vitamin D levels below 20 ng/dl, the keyed value, are taken to indicate sub-clinical vitamin D deficiency.

Sub-clinical deficiency is the stage at which the biochemical level is low although there are no visible signs yet, so the cut-off is a laboratory threshold. The keyed value is 20, and the options of 10 and 5 describe lower and more severe levels, while 30 is a higher threshold that is usually taken as the lower limit of the sufficient range, not the line for deficiency.

Answer: D

The item that is not a biochemical method of nutritional assessment is blood pressure.

Biochemical methods measure a nutrient or its metabolite in blood or urine: urinary iodine shows iodine status, haemoglobin estimation shows iron and anaemia status, and serum retinol shows vitamin A status. Blood pressure is a clinical measurement made with an instrument on the body and is not a laboratory estimation of a nutrient, so it is the odd one out.

Answer: D

Both statements are correct and (R) is the correct explanation of (A).

Biochemical tests detect a change in the level of a nutrient in blood or urine before symptoms appear, so they allow early detection of deficiency. The reason says that these tests confirm the sub-clinical form, which is exactly why they are useful at the early stage. The codes that call either statement wrong or that deny the link are not accepted.

Answer: C

The correct matching is a-ii, b-i, c-vi, d-v, e-vii, f-iii, the third code.

Normal systolic pressure is below 120 mmHg and normal diastolic pressure below 80 mmHg. The normal adult BMI is 18.5 to 24.9 kg/m\(^{2}\), HbA1c should be below 7 percent in a controlled diabetic, the fasting blood sugar cut-off is below 100 to 120 mg/dl and serum cholesterol is wanted at about 200 mg/dl. The other codes swap the two blood pressures or give BMI the cholesterol value.

Answer: A

The methods are II, III and V: dietary survey, anthropometry and clinical examination.

Nutritional status is assessed by the dietary, anthropometric, biochemical and clinical methods (the ABCD of nutritional assessment). A dietary survey shows what is eaten, anthropometry measures height, weight and skinfolds, and clinical examination looks for signs of deficiency.

An IQ test and psychological tests measure intelligence and behaviour, so any option that includes statement I or IV is wrong.

Answer: B

Both statements are false, so the answer is both (A) and (R) are false.

The 24 hour recall depends on the memory of the person, who may forget or misstate what was eaten, so it is not the most accurate method of diet survey; weighment methods are more exact. It records what was eaten, not what was thrown away, so it cannot measure food wastage; that needs plate waste or kitchen waste records.

The options that accept either statement as true are therefore wrong.

Answer: B

Creatinine is a test of kidney function (iii), bilirubin is a test of liver function (i), T3 and T4 are thyroid hormones (iv) and LDL cholesterol relates to the heart (ii). So the code is iii, i, iv, ii.

Options A, C and D link creatinine with the heart, the thyroid or the pancreas, which is wrong. Pancreas is a distractor here, and none of the tests matches it. The creatinine level in blood rises when the kidneys fail to filter waste, whereas bilirubin rises in jaundice and liver disease.

Answer: B

Protein energy malnutrition in children is assessed at an early stage by anthropometry, which means measuring weight, height or length, mid-upper arm circumference and head circumference and comparing them with reference standards. These changes in growth show up before clinical or laboratory signs. Biochemical and pathological tests detect established deficiency and are costly, so they are not used for early screening. Hence anthropometry is the correct answer, and 'none of the above' is wrong.