Therapeutic Diets Questions and Answers

Answer: A

An alkaline ash diet includes fruits, vegetables and milk.

When food is burned, the minerals left as ash are either base-forming (sodium, potassium, calcium, magnesium) or acid-forming (sulphur, phosphorus, chlorine). Fruits, vegetables and milk are rich in the base-forming minerals and leave an alkaline ash, even sour fruits whose organic acids are oxidised in the body.

Meat, egg, fish, poultry and cereals are rich in sulphur and phosphorus and leave an acid ash, so every option that includes them describes an acid ash diet. Pulses also lean towards acid ash.

Answer: C

Hyperuricemia can lead to gout.

Hyperuricemia means a raised level of uric acid in the blood, the end product of purine breakdown. When uric acid exceeds its solubility, monosodium urate crystals deposit in joints, classically the big toe, causing the acute inflammatory arthritis called gout. Dietary management limits purine-rich foods such as organ meats and some seafood, and alcohol.

Protein energy malnutrition (PEM), cancer and diabetes are not caused by high uric acid, although obesity and diabetes often occur alongside gout.

Answer: D

Sarcopenia is observed in old age.

Sarcopenia is the progressive loss of skeletal muscle mass, strength and function that comes with ageing. It begins gradually from middle age and accelerates after about 65, contributing to weakness, falls and loss of independence. Adequate protein and resistance exercise are the main means of slowing it.

Infancy, childhood and pregnancy are periods of tissue building, when muscle mass is normally increasing, so age-related muscle wasting does not belong to them.

Answer: A

Sepsis, fever, infection and trauma accelerate the loss of nitrogen.

These are catabolic stresses. Stress hormones break down muscle protein to supply amino acids for glucose production and for the immune response, and the nitrogen from the amino acids is excreted as urea. The patient goes into negative nitrogen balance, which is why protein needs rise sharply after injury, burns and severe infection.

Zinc, calcium and iron can also be affected by illness, but the characteristic, measurable loss in these states is the nitrogen of body protein.

Answer: D

Ketoacidosis is associated with diabetes.

In uncontrolled type 1 diabetes, lack of insulin means cells cannot use glucose, so the body breaks down fat at a high rate. The liver turns the fatty acids into ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone), which accumulate and make the blood acidic. Diabetic ketoacidosis is a medical emergency.

Liver disease, burns and cancer cause other metabolic problems, but ketoacidosis is the classic acute complication of diabetes.

Answer: C

Damage to liver cells leads to an increase in bilirubin.

Bilirubin, formed from the breakdown of haemoglobin, is taken up by liver cells, conjugated and excreted in bile. When liver cells are damaged, as in hepatitis or cirrhosis, they cannot process it, so bilirubin builds up in the blood and causes jaundice. Raised liver enzymes (ALT, AST) are the other classic sign.

Blood sugar, serum cholesterol and sodium do not rise as a direct marker of liver cell damage; in severe liver disease blood sugar may in fact fall.

Answer: C

A very low residue diet is given in diarrhoea.

A low residue diet restricts fibre and other foods that leave undigested material in the bowel, so it reduces the volume and frequency of stools and rests the intestine. It is used in diarrhoea, in inflammatory bowel conditions during flare-ups and before and after bowel surgery.

Diabetes and atherosclerosis are managed with diets that are high, not low, in fibre, and burns call for a high-energy, high-protein diet.

Answer: C

The hypoglycaemic compound in fenugreek is trigonelline.

Fenugreek (methi) seeds lower blood glucose through several components: the alkaloid trigonelline, the amino acid 4-hydroxyisoleucine, which stimulates insulin release, and their high content of soluble fibre (galactomannan), which slows sugar absorption. Trigonelline is the one listed here.

The others come from different sources and are known for other actions. Bromelain is a protein-digesting enzyme from pineapple, curcumin is the yellow pigment and antioxidant of turmeric, and tannins are astringent polyphenols in tea and many plants.

Answer: D

Of these foods, watermelon has the highest glycaemic index.

The glycaemic index (GI) ranks foods by how fast their carbohydrate raises blood glucose compared with pure glucose (100). Watermelon has a high GI, around 72 to 76 in the standard tables, because its carbohydrate is mostly free sugars in water with almost no fat, protein or fibre to slow absorption. Its glycaemic load is low, though, because a serving holds little carbohydrate.

Bread also has a high GI, about 70 for white bread, so it is close but lower. Ice cream is low to medium (about 50 to 60), because its fat slows digestion, and cucumber has very little carbohydrate and a low GI.

Answer: A

Refeeding syndrome causes dangerous shifts in electrolytes.

When a starved or severely malnourished person is fed, especially with carbohydrate, insulin rises and drives phosphate, potassium and magnesium into the cells. Blood levels of these electrolytes fall sharply; hypophosphataemia is the hallmark, and it can lead to heart failure, arrhythmia and respiratory failure. Feeding is therefore started slowly with electrolyte and thiamine replacement.

Liver enzymes, triglycerides and ketone bodies may change during refeeding, but they are not what makes the syndrome dangerous or defines it.