Exam 1

Take Home Exam Instructions:

Provide your answers to the 14 questions below.  Use your own words (copy and pasting from the notes and other class content will not earn points for a correct answer) and work independently. Additionally, please show your work where indicated.

 

Kansas State University has an Honor and Integrity System based on personal integrity, which is presumed to be sufficient assurance that, in academic matters, one’s work is performed honestly and without unauthorized assistance. Undergraduate and graduate students, by registration, acknowledge the jurisdiction of the Honor and Integrity System. The policies and procedures of the Honor and Integrity System apply to all full and part-time students enrolled in undergraduate and graduate courses on-campus, off-campus, and via distance learning. A component vital to the Honor and Integrity System is the inclusion of the Honor Pledge which applies to all assignments, examinations, or other course work undertaken by students. The Honor Pledge is implied, whether or not it is stated: “On my honor, as a student, I have neither given nor received unauthorized aid on this academic work.” A grade of XF can result from a breach of academic honesty. The F indicates failure in the course; the X indicates the reason is an Honor Pledge violation.

 

  • As a nutrition professional, what aspects would you weigh when guiding an individual or a group of people on what a healthy diet is? In other words, list at least two things that should be taken into consideration when trying to balance different sources of nutrition information (3.5 pts).

 

  • There is no perfect dietary assessment tool. Of the subjective tools we have discussed (listed below), please discuss the biases that come with each method and what each bias means.  Examples of this include reactivity, recall bias and flat slope response (3 pts).
  1. 24-hour recall
  2. Food frequency questionnaire
  3. Food record

 

  • For the following research designs, list the dietary assessment method most commonly used in each design. Additionally, please explain why (hint: what is the tool meant to measure?) (3 pts).
  1. Cross-sectional
  2. Longitudinal (cohort)
  3. Case-control

 

  • Select the FALSE statement regarding nutritional assessment and edit the false statement to make it true (3 pts).
  1. Nutritional assessment is a complex process and individuals and/or populations need to be assessed repeatedly over time.
  2. Nutritional assessment involves four main types of assessment but using dietary assessment methods alone can adequately assess a person’s nutritional status.
  3. Nutritional assessment is critical and often mandated for groups at high risk for malnutrition.
  4. Nutritional assessment is used by nutrition professionals in a variety of healthcare settings.
  • When conducting an interviewer-based 24-hour recall, list three tips for how to gather the most accurate data from your client (3 pts).

 

  • Read the following case study. As you read it, please categorize statements/information into the following assessment types: anthropometric, biochemical, clinical, or dietary.  In the table below please list two examples for each type of assessment.  You do not need to infer meaning about what the information may or may not tell you about the client’s nutritional status (10 pts).

Dale Cooper is an 84-year-old man who lives in Punxsutawney, Pennsylvania where he worked in the coal mines until he retired at the age of 67. He and his wife, Annie, lived there all their lives till she passed away 6 months ago. Annie was the homemaker and did all the cleaning, cooking, and chores around the home. Now that she’s gone, Dale has to cook and clean for himself because he refuses to leave his home to go to some “retirement home where people just go to die”. Prior to losing his wife, Dale weighed 200lbs at six feet tall at his last doctor’s appointment and had blood drawn for standard lab panels and gave a urine sample. He now weighs 175lbs and claims it’s because he hasn’t been eating any pie and ice cream since his sweetheart left his side. They used to go to the local café to have slice with a scoop of ice cream and a hot cup of black coffee. When asked about his diet he states that he doesn’t feel hungry very often and eats because he knows that if Annie was alive, she’d pester him till he ate something.  He started to take a daily multivitamin knowing Annie would approve.

His typical day is as follows:

10 am: 1c black coffee, sometimes a small bowl of raisin brain with whole milk while he reads the paper

2 pm: bowl of Great Value beefy stew and 2 slices of white bread with butter, tall glass of milk

6 pm: white bread sandwich with bologna, mayo, cheddar cheese; handful of chips; 1 can Pepsi

Labs: Complete blood count (CBC), basic metabolic and panels, urinary analysis (UA). All non-remarkable.

During your session with Dale, you notice that he keeps coughing and has some dyspnea (trouble/labored breathing). You ask him about it and he laughs. He tells you that because he worked in the coal mines for so long, he got the ‘black lung’ but wasn’t diagnosed with it until after he retired. Sometimes he feels completely fine, and others, his chest feels tight, and he has shortness of breath. His doctor prescribed him an inhaler and told him to carry it around at all times. At night, he wears an oxygen mask to help him breathe better.

 

Anthropometric

1.

2.

 Biochemical

1.

2.
Clinical

1.

2.

 Dietary

1.

2.

 

6b) What else would you consider to be important information when assessing Dale’s nutritional status that does not fall “cleanly” into A, B, C or D? ist at least one piece of information and explain why you think it would be important.

 

  • List one benefit and one limitation of each dietary assessment method below (13.5 pts). ADDITIONALLY, please offer one feasible scenario or client, where you think this dietary assessment method would work best and please explain why for each.
  1. 24-hour recall (interview-based)

Benefit:

Limitation:

Scenario/client:

Why?

 

  1. 24-hour recall (automated [ASA24])

Benefit:

Limitation:

Scenario/client:

Why?

 

  1. Food record

Benefit:

Limitation:

Scenario/client:

Why?

 

  1. Food frequency questionnaire

Benefit:

Limitation:

Scenario/client:

Why?

 

  1. Diet history

Benefit:

Limitation:

Scenario/client:

Why?

  • Explain, in your own words, what each of the following Dietary Reference Intake terms mean. Your explanations can involve how one DRI relates to another, how they are established, how they should be interpreted in terms of meeting the needs of average, healthy individuals for a given nutrient, and any examples or scenarios you think appropriate reflect the meaning (6 pts).
  1. Adequate Intake (AI)
  2. Tolerable Upper Intake Level (UL)
  3. Estimated Average Requirement (EAR)
  4. Recommended Daily Allowance (RDA)

 

  • Below are the DRIs for iron for a 19–30-year-old female.  What is the range – i.e. pick two of the numbers below – (in mg) of adequate and safe intake for this population (2 pts)?

EAR = 8.1 mg/day

RDA = 18 mg/day

UL = 45 mg/day

  • Rank the following types of assessment in level of depletion severity that the type is able to detect (1 = least severe, 2 = moderate, 3 = most severe). Please explain your rankings (4.5 pts).

Clinical

Dietary

Anthropometric or Biochemical

 

  • What is wrong with the statement below (3 pts)?

Omar has scheduled his annual check-up with his physician.  The physician notes that Omar has gained weight since his last check-up and his BMI now classifies him as obese.  Omar is given a referral for a nutrition consultation.  At the first appointment a 24-hour recall is collected and the nutrition professional formally diagnoses him as being malnourished because his recall analysis shows he is not getting adequate amounts of many micronutrients.  No plans are made for a follow up.

  • A female has the following intake: 1600 total kcal/day, 65g protein/day, 45g fat/day, 225g carbohydrate/day. What percent of her daily total kcal came from protein, fat, and carbohydrate respectively (4.5 pts)? PLEASE SHOW YOUR WORK.

Percent kcal from protein:

Percent kcal from fat:

Percent kcal from carbohydrate:

  • List four factors/conditions which increase the risk of malnutrition. For each factor, explain why the risk for malnutrition is increased (8 pts)

1.

2.

3.

4.

  • List and describe in a few words three sources of error related to food composition databases (3 pts).

1.

2.

3.