A pediatrician reviewing global health data defines malnutrition as which process?
A. Excess adiposity impairing mobility
B. Deficient nutrient supply impairing health
C. Appetite loss after infection
D. Weight loss from dehydration

B. Deficient nutrient supply impairing health

An adult with chronic illness has a BMI of 18.2. Which threshold defines being underweight and at risk for malnutrition?
A. BMI below 20.0
B. BMI below 17.0
C. BMI below 19.0
D. BMI below 18.5

D. BMI below 18.5

A toddler’s weight-for-age and BMI-for-age fall below which percentile, prompting closer evaluation for malnutrition?
A. 5th percentile
B. 10th percentile
C. 15th percentile
D. 25th percentile

A. 5th percentile

Marasmus most directly reflects failure to meet which dietary requirement?
A. Iron and folate
B. Water and sodium
C. Fat and vitamins
D. Calories and protein

D. Calories and protein

Which finding best supports marasmus rather than kwashiorkor?
A. Generalized edema and apathy
B. Dermatitis with hair changes
C. Marked wasting with fat loss
D. Hypoalbuminemia with edema

C. Marked wasting with fat loss

Kwashiorkor is best described as which nutritional deficit?
A. Predominant protein deficiency
B. Exclusive vitamin deficiency
C. Total caloric deficiency
D. Isolated carbohydrate deficiency

A. Predominant protein deficiency

A child has edema, irritability, dermatitis, hypopigmented hair, and low albumin. What is the most likely diagnosis?
A. Marasmus
B. Kwashiorkor
C. Cachexia
D. Food insecurity

B. Kwashiorkor

Both marasmus and kwashiorkor commonly lead to which consequence?
A. Enhanced immune surveillance
B. Preserved daily functioning
C. Reduced infection risk
D. Functional decline with weakness

D. Functional decline with weakness

Which group is particularly prone to malnutrition?
A. Children, older adults, hospitalized patients
B. Athletes, students, commuters
C. Travelers, teachers, executives
D. Adolescents, smokers, laborers

A. Children, older adults, hospitalized patients

In developing countries, malnutrition is associated with approximately what share of deaths among children under 5?
A. 20%
B. 35%
C. 50%
D. 70%

C. 50%

In 2011, roughly how many under-5 children in developing countries were underweight?
A. 75 million
B. 99 million
C. 120 million
D. 150 million

B. 99 million

Underweight prevalence in children under 5 in developing countries changed from which 1990 value to which 2011 value?
A. 25% to 15%
B. 20% to 10%
C. 17% to 28%
D. 28% to 17%

D. 28% to 17%

Worldwide, vitamin and mineral deficiencies affect approximately:
A. One in three
B. One in eight
C. One in six
D. One in ten

A. One in three

Malnutrition affects what proportion of preschool children?
A. One in eight
B. One in six
C. One in four
D. One in two

C. One in four

In developing countries, approximately what proportion of infants are born at low birth weight?
A. One in ten
B. One in six
C. One in three
D. One in two

B. One in six

Malnutrition has been reported in up to what proportion of nursing home residents?
A. 15%
B. 30%
C. 40%
D. 50%

D. 50%

Which patient profile carries the greatest malnutrition risk?
A. Chronic disease, polypharmacy, poverty
B. Exercise, full pantry, employment
C. Good mobility, family meals
D. Adequate income, no disease

A. Chronic disease, polypharmacy, poverty

Food insecurity is best defined as:
A. Poor diet quality without hunger
B. Voluntary restriction for finances
C. Financially limited access to food
D. Inadequate vitamins despite satiety

C. Financially limited access to food

Hungry households are best characterized by:
A. Temporary shortages without hunger
B. High food costs, normal intake
C. Child pickiness causing skipped meals
D. Regular hunger with adult restriction

D. Regular hunger with adult restriction

In 2011, about what percentage of American households experienced food insecurity?
A. 12%
B. 15%
C. 20%
D. 8%

B. 15%

Which household best fits a high-risk pattern for food insecurity?
A. Married professionals, no children
B. Retired couple above poverty line
C. Minority single parent
D. Dual-income suburban homeowners

C. Minority single parent

Many eligible low-income working families do not use federal assistance primarily because of:
A. Shift from welfare to work
B. Excess program availability
C. Universal employer meal coverage
D. Decreased food prices nationwide

A. Shift from welfare to work

Obesity-related conditions account for more than what share of preventable deaths yearly?
A. 25%
B. 33%
C. 40%
D. 50%

D. 50%

A malnourished child first shows falling weight-for-age, later stunted height, and eventually plateaued head growth. Which progression is most accurate?
A. Height → weight → head size
B. Weight → height → head size
C. Head size → BMI → height
D. BMI → head size → weight

B. Weight → height → head size

In an older adult, which added feature further increases malnutrition risk?
A. Homebound, poor support, depression
B. Employed with meal delivery
C. Ambulatory with exercise group
D. Strong cooking skills, transportation

A. Homebound, poor support, depression

Which household pattern is also associated with especially high food insecurity rates?
A. Married couple above poverty line
B. Single adults without children
C. Minority family near poverty line
D. Retired homeowners with savings

C. Minority family near poverty line

Which social or behavioral factor also raises malnutrition risk?
A. Formal nutrition counseling
B. Alcohol misuse, poor nutrition knowledge
C. Daily shared family meals
D. Reliable grocery assistance

B. Alcohol misuse, poor nutrition knowledge

A cohort study compares BMI categories with normal-weight adults. Which group is not associated with excess mortality?
A. Overweight and Class I obesity
B. Underweight and overweight
C. Class II and Class III obesity
D. Central obesity and sarcopenia

A. Overweight and Class I obesity

Severe obesity is associated with significantly increased mortality relative to normal BMI. In that comparison, which group has the larger relative increase?
A. Females
B. Adolescents
C. Males
D. Older children

C. Males

Which is considered a biological factor contributing to obesity?
A. Restaurant meal frequency
B. Resting energy expenditure
C. Sedentary commuting patterns
D. Sugary beverage access

B. Resting energy expenditure

Which pair best represents environmental contributors to obesity?
A. High intake, low activity
B. FTO variant, diabetes risk
C. Large adipocytes, low REE
D. Pregnancy, adolescence

A. High intake, low activity

The FTO gene may account for up to what proportion of obesity cases?
A. 10 percent
B. 15 percent
C. 30 percent
D. 22 percent

D. 22 percent

The FTO gene shows a strong association with which condition?
A. Hypertension
B. Diabetes
C. Asthma
D. Osteoporosis

B. Diabetes

A child has one overweight parent. What is the approximate chance of becoming overweight in adulthood?
A. 20 percent
B. 40 percent
C. 60 percent
D. 80 percent

B. 40 percent

If both parents are overweight, that child’s approximate adult overweight risk becomes:
A. 80 percent
B. 50 percent
C. 60 percent
D. 30 percent

A. 80 percent

During infancy, adolescence, and pregnancy, adipose tissue normally increases primarily in:
A. Density
B. Size
C. Number
D. Distribution

C. Number

With modest weight gain, adipocytes typically increase in:
A. Number only
B. Size only
C. Surface tension
D. Lipase activity

B. Size only

With significant weight gain, adipocytes generally increase in:
A. Size and number
B. Number only
C. Size only
D. Insulin response

A. Size and number

After weight loss, adipocytes typically decrease in:
A. Number, not size
B. Size, not number
C. Neither size nor number
D. Number and size

B. Size, not number

Rising calorie consumption in many populations is partly attributed to:
A. Fewer snacks and fasting
B. Smaller meals at home
C. More activity and commuting
D. Larger portions and dining out

D. Larger portions and dining out

Which populations are less likely to meet physical activity guidelines?
A. Men and retirees
B. Women and minorities
C. Children and athletes
D. Smokers and immigrants

B. Women and minorities

In overweight or obese patients who have already lost weight, the single best predictor of long-term weight control is:
A. Daily calorie counting
B. Regular physical activity
C. Intermittent fasting
D. Low-carbohydrate dieting

B. Regular physical activity

In 2009–2010, what proportion of U.S. adults were obese?
A. About one sixth
B. About one fourth
C. More than one third
D. More than one half

C. More than one third

Over the past decade in the United States, obesity prevalence increased significantly among:
A. Women and girls
B. Men and boys
C. Girls only
D. Women only

B. Men and boys

For children and adolescents, overweight is defined as BMI above which percentile?
A. 75th percentile
B. 95th percentile
C. 90th percentile
D. 85th percentile

D. 85th percentile

For children and adolescents, obesity is defined as BMI:
A. Above the 90th percentile
B. Below the 5th percentile
C. Greater than 95th percentile
D. At the 85th percentile

C. Greater than 95th percentile

A patient with obesity loses 10% of body weight. Which improvement is expected?
A. Lower pressure, glucose, lipids
B. Higher HDL, lower calcium
C. Lower albumin, lower insulin
D. Higher hemoglobin, lower LDL

A. Lower pressure, glucose, lipids

Which additional outcome may also improve after 10% weight loss?
A. Lower fracture risk
B. Reduced cancer risk
C. Reduced anemia risk
D. Lower infection risk

B. Reduced cancer risk

Intensive treatment is particularly important for an obese patient with three or more accompanying risk factors. Which option lists qualifying risk factors?
A. Smoking, hypertension, dyslipidemia
B. Asthma, eczema, myopia
C. Gallstones, gout, migraine
D. Arthritis, GERD, insomnia

A. Smoking, hypertension, dyslipidemia

Which additional factor also counts among those obesity-related treatment risk factors?
A. High ferritin level
B. Family history of diabetes
C. Vegetarian diet history
D. Normal fasting glucose

B. Family history of diabetes

A clinician asks a patient to list everything consumed during the previous day. Which dietary tool is being used?
A. Food frequency questionnaire
B. Prospective food record
C. Usual intake history
D. Twenty-four-hour recall

D. Twenty-four-hour recall

Which dietary assessment method is retrospective and asks about normal intake patterns, including amounts eaten?
A. Food record
B. Twenty-four-hour recall
C. Usual intake history
D. Calorie expenditure log

C. Usual intake history

Which dietary assessment method is best for identifying trends in usual consumption of specific foods?
A. Food frequency questionnaire
B. Twenty-four-hour recall
C. Seven-day weighed record
D. Prospective meal diary

A. Food frequency questionnaire

Which dietary assessment tool is completed prospectively?
A. Diet history
B. Food record
C. Intake recall
D. Frequency survey

B. Food record

On exam, which site should be checked closely for muscle wasting?
A. Deltoid insertion
B. Patellar tendon
C. Temporalis muscle
D. Parotid gland

C. Temporalis muscle

Which hand muscle region is specifically examined for wasting in nutritional assessment?
A. Lumbricals
B. Thenar eminence
C. Flexor retinaculum
D. Palmar fascia

B. Thenar eminence

Serum albumin has which approximate half-life?
A. 2–3 days
B. 8–9 days
C. 12–14 days
D. 18–20 days

D. 18–20 days

Serum transferrin has which approximate half-life?
A. 8–9 days
B. 18–20 days
C. 2–3 days
D. 30–40 days

A. 8–9 days

Serum prealbumin has which approximate half-life?
A. 18–20 days
B. 8–9 days
C. 5–6 days
D. 2–3 days

D. 2–3 days

Evidence of a nutrition disorder should be labeled primary when it occurs in a patient with:
A. Severe organ failure
B. No other etiology
C. Chronic inflammation
D. Multiple comorbid causes

B. No other etiology

A child with cystic fibrosis develops weight loss from pancreatic insufficiency and fat malabsorption. This is best classified as:
A. Primary nutrition disorder
B. Starvation-related marasmus
C. Secondary nutrition problem
D. Isolated protein deficiency

C. Secondary nutrition problem

Resting energy expenditure is best defined as the energy required to:
A. Maintain vital function at rest
B. Digest food after a meal
C. Sustain exercise over hours
D. Build new adipose tissue

A. Maintain vital function at rest

Basal metabolic rate is the minimum calorie requirement measured under which condition?
A. Fasting, controlled environment
B. Exercise, thermoneutral environment
C. Feeding, room temperature
D. Stress, postabsorptive state

A. Fasting, controlled environment

Clinically, REE is mainly used to estimate:
A. Lean body mass
B. Basal metabolic rate
C. Activity thermogenesis
D. Respiratory quotient

B. Basal metabolic rate

Approximately what fraction of daily energy expenditure is due to REE?
A. 35%
B. 50%
C. 80%
D. 65%

D. 65%

Total energy expenditure is best estimated by:
A. REE plus nitrogen balance
B. REE times activity factor
C. BMR minus exercise losses
D. Protein intake times BMI

B. REE times activity factor

Average protein requirement for a healthy adult is closest to:
A. 0.3–0.5 g/kg
B. 0.8–1.0 g/kg
C. 1.8–2.0 g/kg
D. 2.5–3.0 g/kg

B. 0.8–1.0 g/kg

Malnutrition is best defined as a nutrient supply that is:
A. Excessive and growth-promoting
B. Deficient but asymptomatic
C. Suboptimal and health-impairing
D. Protein-poor but calorie-rich

C. Suboptimal and health-impairing

Genetics accounts for no more than what proportion of body-weight variance?
A. One half
B. One quarter
C. Two thirds
D. One third

D. One third

A hospitalist teaching interns about nutrition says nearly all hospitalized patients are what, to some degree?
A. Obese
B. Cachectic
C. Malnourished
D. Sarcopenic

C. Malnourished

The major biochemical consequence of excessive alcohol consumption is:
A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis

B. Metabolic acidosis

Alcohol-induced metabolic acidosis occurs largely because alcohol interferes with:
A. Glycolysis in erythrocytes
B. Acetyl-CoA oxidation in TCA
C. Ketone use in muscle
D. Urea synthesis in liver

B. Acetyl-CoA oxidation in TCA

In the Western world, the most common cause of malnutrition is:
A. Chronic alcoholism
B. Crohn disease
C. Chronic pancreatitis
D. Poverty alone

A. Chronic alcoholism

Alcohol provides how many kilocalories per gram?

7

High alcohol concentrations can directly disrupt which mucosal surfaces?
A. Esophageal and colonic
B. Jejunal and ileal
C. Gastric and duodenal
D. Oral and rectal

C. Gastric and duodenal

Which vitamin is routinely supplemented in patients with alcoholism?
A. Niacin
B. Pyridoxine
C. Folate
D. Thiamin

D. Thiamin

Thiamin is especially important in:
A. Fatty acid transport
B. Carbohydrate metabolism
C. Cholesterol esterification
D. Bile acid conjugation

B. Carbohydrate metabolism

Which symptom cluster best suggests thiamin deficiency?
A. Jaundice, edema, ascites
B. Hematuria, rash, fever
C. Anorexia, fatigue, irritability
D. Tremor, diarrhea, pruritus

C. Anorexia, fatigue, irritability

Chronic alcohol use is also associated with deficiency of:
A. Vitamin D
B. Vitamin B12
C. Folate
D. Vitamin E

C. Folate

Folate is required for normal biosynthesis of:
A. Purines and pyrimidines
B. Heme and globin
C. Ketones and bile salts
D. Glycogen and lactate

A. Purines and pyrimidines

A patient with vitamin B12 deficiency is mistakenly treated only with folate. Which abnormality is least likely to improve?
A. Neurologic dysfunction
B. Megaloblastic anemia
C. Low hemoglobin
D. Macrocytosis

A. Neurologic dysfunction

In chronic liver disease, hepatic production of which protein is usually preserved until end-stage disease?
A. Transferrin
B. Albumin
C. Fibrinogen
D. Prealbumin

B. Albumin

Which abnormality can respond to either folate or vitamin B12 replacement?
A. Posterior column loss
B. Paresthesias
C. Hematologic changes
D. Cognitive decline

C. Hematologic changes

A clinician asks a diabetic patient to list everything consumed yesterday. Which dietary tool is being used?
A. Three-day food record
B. Food frequency survey
C. Usual intake history
D. Twenty-four-hour recall

D. Twenty-four-hour recall

Which dietary assessment is best suited to evaluating long-term eating habits?
A. Three-day food record
B. Usual intake history
C. Calorie count sheet
D. Single-meal recall

B. Usual intake history

A patient is asked to document meals as they are eaten over three days. This method is:
A. Retrospective
B. Cross-sectional
C. Prospective
D. Qualitative

C. Prospective

In a three-day food record, patients are specifically asked to:
A. Estimate grocery spending
B. Recall favorite foods
C. Rank meal quality
D. Record their food intake

D. Record their food intake

Excess abdominal fat is most directly assessed by measuring:
A. Hip circumference
B. Body fat percentage
C. Waist circumference
D. Mid-arm circumference

C. Waist circumference

Waist circumference should be measured at the level of the:
A. Umbilicus
B. Xiphoid process
C. Greater trochanter
D. Right iliac crest border

D. Right iliac crest border

Waist circumference is an independent predictor of morbidity particularly when which variable is not markedly increased?
A. BMI
B. LDL cholesterol
C. Age
D. Blood pressure

A. BMI

Measuring waist circumference is especially recommended when BMI is less than:
A. 25
B. 30
C. 35
D. 40

C. 35

Increased waist circumference independently predicts all of the following except:
A. Diabetes
B. Dyslipidemia
C. Hypertension
D. Hypothyroidism

D. Hypothyroidism

Compared with BMR, REE is approximately:
A. 10% lower
B. 25% higher
C. Equivalent
D. 10% higher

A. 10% lower

Daily protein needs for an unstressed, well-nourished adult are closest to:
A. 0.8-1.0 g/kg
B. 1.2-1.4 g/kg
C. 1.5-2.0 g/kg
D. >2.0 g/kg

A. 0.8-1.0 g/kg

A postoperative patient generally requires which protein intake range?
A. 0.6-0.8 g/kg
B. 0.8-1.0 g/kg
C. 1.5-2.0 g/kg
D. >3.0 g/kg

C. 1.5-2.0 g/kg

A burn patient with severe infection will often need protein intake:
A. Below 1 g/kg
B. Over 2 g/kg
C. Exactly 1.5 g/kg
D. Under 0.8 g/kg

B. Over 2 g/kg

Which is a major cause of malnutrition?
A. Reduced oral intake
B. Excessive vitamin storage
C. Increased insulin sensitivity
D. Reduced sleep duration

A. Reduced oral intake

Malabsorption-related stool losses best fit which cause of malnutrition?
A. Decreased oral intake
B. Increased nutrition loss
C. Increased fat storage
D. Reduced metabolic demand

B. Increased nutrition loss

Hypermetabolic illness causing increased calorie needs is best categorized as:
A. Increased requirements
B. Increased excretion
C. Decreased intake
D. Reduced absorption

A. Increased requirements

Which is considered part of obesity etiology?
A. Adipose cell size
B. Low stomach acid
C. Iron deficiency
D. Thyroid storm

A. Adipose cell size

Which factor is a major driver of overweight and obesity?
A. Excess caloric intake
B. Excess water intake
C. High fiber intake
D. Reduced salt intake

A. Excess caloric intake

Which lifestyle pattern promotes obesity development?
A. Increased resistance training
B. Decreased physical activity
C. Greater sleep efficiency
D. Reduced eating frequency

B. Decreased physical activity

How many kilocalories does 1 gram of protein provide?

4

How many kilocalories does 1 gram of carbohydrate provide?

4

How many kilocalories does 1 gram of fat provide?

9

In the United States, obesity most disproportionately affects:
A. Asian men
B. Black women
C. White women
D. Hispanic boys

B. Black women

A patient loses 10% of body weight. Which change is expected?
A. Higher fasting glucose
B. Lower blood pressure
C. Lower hemoglobin
D. Higher cancer risk

B. Lower blood pressure

Diet history is most commonly obtained as part of the patient’s:
A. Family history
B. Surgical history
C. Social history
D. Medication history

C. Social history

Which dietary tool is especially recommended for older adults?
A. Three-day food record
B. Usual intake history
C. Single 24-hour recall
D. Snack frequency sheet

B. Usual intake history

In the United States, obesity is most prevalent in the:
A. Northeast
B. Midwest
C. West
D. South

D. South