College of Applied Medical Sciences
Department of Community Health Sciences
CHS 269: Nutritional Epidemiology Final Exam (Students' Model)
Please write True or False between brackets and correct the false question (s) by underlining the false word(s) and write it (them) under each question. Non corrected false
question (s) will be given zero: ( marks)
1. The difference between case report and case series report is the number of cases having unusual disease
2. Because the diet may influence the incidence of many diseases, it is preferable to use patients with another disease as controls in hospital-based studies
3. Measuring blood cholesterol level on a single occasion and associating these levels to the risk of heart disease may lead to Information bias
4. Historical cohort studies are rarely used in nutritional epidemiology.
5. During calculating the odds ratio, the result more than one means that the exposure is protective against the disease
6. Survey is a continuous process, whereas a surveillance occurs once at a particular time.
7. The advantage of representing diets as nutrients is that it can be related directly to our knowledge of biology
8. Among the advantages of biomarkers are their dependence on the memory of the subject 9. Some biomarkers are influenced by factors other than dietary intake
10. Estrogen protects women during menopause againts cardiovascular disease because it raises HDL and lowers LDL-cholesterol
Please circle the correct answer: ( marks)
1. The epidemiological study that is used to follow up diabetic patients to explore the curative effect a new anti-diabetic drug and compare them with another diabetic patients given insulin is called:
a) Case control study b) Randomized clinical trial c) Historical cohort study d) Cohort study
2. It is conducted in the early stages of the investigation of a diet-disease relationship.
a) Case Series Report b) Case control study c) Ecological study d) Cohort study
3. This type of study takes the advantages of speed and low cost of the case-control studies and
b) Nested case-control study c) Historical cohort study d) Prospective Cohort study
4. It is a biologically inactive substance given to the control group so that they think they are being treated
a) Blinding b) Placebo
c) Experimental study d) Confounding factor
5. In a case control study, women with low blood levels of ß-carotene had an odds ratio for cervical cancer of 4.5, meaning that;
a) Consumption of ß-carotene to increase its blood levels will protect against cervical cancer b) Low consumption of ß-carotene will protect against cervical cancer
c) Decreasing consumption of ß-carotene to 4.5 mg daily will protect against cervical cancer d) No relationship between the blood levels of ß-carotene and cervical cancer
6. It can distort the association between the exposure and a disease but can be avoided by analyzing data separately for subjects in different categories
a) Blinding b) Placebo
c) Confounding factor d) Study design
7. It is the reduction of the disease risk after removal of the exposure a) Plausibility
b) Reversibility c) Temporal relation d) Study design
8. Although they are relatively quick and simple, their main disadvantage is underreporting of food intake
a) Observations b) 24-hour recalls c) Dietary records d) Biomarkers
9. It is a measurement of changes over time in the nutritional status of a population with repeated comparable assessments at regular intervals.
a) Nutritional survey b) Nutritional monitoring c) Nutritional surveillance d) Nutritional assessment
10. A preventive measure aims to forestall the onset of illness during the prepathogenesis period:
a) Primordial b) Primary
Please fill the empty space with the correct word (s): ( marks) 1. The characteristics of Nutrition related problems in the past are:-
(1) --- (2) --- and (3) ---
2. There are two types of information biases in the Case-control studies which are: - (1) --- and (2) ---
3. --- and --- are used as measurements of association between exposure and outcome
4. Methods of dietary assessment are based on:- (1) --- (2) ---(3) ---
5. Among the non-modifiable risk factors for cardiovascular disease are:- (1) --- (2) --- (3) --- (4) ---
6. One of the most important secondary prevention measures is ---
The following table shows the results of a study investigating the correlation between diabetes and fat consumption
Diabetics Non Diabetic Total
High fat diet 200 100 300
Low fat diet 50 350 400
Total 250 450 700
Find the followings:
incidence of diabetes among those on high fat diet
incidence of diabetes among those on low fat diet
Relative Risk (Risk ratio)
=
Interpretation of Relative Risk
Attributable risk percent
Interpretation of
Attributable risk percent
Model answers
1. Modifiable risk factors of diabetes include:
Overweight/Obesity: 50% of diabetic men & 70% of diabetic women are obese/ Abdominal obesity is of special importance
Physical Inactivity (decrease insulin sensitivity, reduces glucose consumption as energy source).
Smoking: increases insulin resistance/ Decreases insulin secretion/ Has direct toxic effect on pancreatic tissue
Psychosocial stress: Depression is a risk factor for type 2 diabetes
Nutrition: Low consumption of plant foods is associated with higher incidence of Obesity and type 2 diabetes/ Foods high insoluble fibers might be protective against diabetes/ High intake of fats specially saturated can lead to insulin resistance and type 2 diabetes
Infection: Strephylococci is supposed to be responsible factor for infection in pancreas.
Medications: Cortisone and contraceptives
Alcohol: Direct effect: inflammation of the pancreas/ Indirect effect: obesity or liver cirrhosis 2. Non modifiable risk factors of diabetes include:
Age: may occur at any age but 80% of type 2 diabetes occur after 50 year
Heredity or family history: The risk of developing type 2 diabetes is 40% if one parent has the disease
History of gestational diabetes
3. Screening for diabetes should be carried out in persons younger than 45 years in whom:
Are Obese
Have a first degree relative with diabetes
Are Hypertensive ≥ 140/90
Have been diagnosed with GDM or have >4.5 kgs baby
Have Dyslipidaemia (HDL< 35 mg, TG >250 mg/ dl)
Had Impaired glucose tolerance (IGT) or Impaired fasting glucose (IFG) 4. The preventive measures of Diabetes include:
Weight management. A sustained weight loss of 5 to 10 percent of body weight is recommended for overweight and obese individuals.
Active lifestyle. At least 30 minutes of moderate physical activity, such as brisk walking, is recommended daily.
Dietary modifications. An increased intake of whole grains and dietary fiber has been associated with a reduced risk for type 2 diabetes.
Regular monitoring. Individuals at risk should be monitored every one or two years to check for the possible development of type 2 diabetes.
5. The risk factors of Obesity include:
Unhealthy diet and eating habits: high in calories (oversized portions)/ lacking in fruits and vegetables,/ full of fast food/ missing breakfast,
Physical inactivity : Lack of physical activity, fewer calories will be burned thus increasing of becoming obese
Age: Obesity occurs at any age even in young children/ But the risk increases with increasing age due to: hormonal changes, less active lifestyle, decrease in the amount of muscle (decrease in metabolism).
Sex: women generally have a higher adipose tissue then men
Socio-economic conditions: Overweight and obesity were a problem of high-income countries but now; they are increasing in developing and poor countries
Lack of sleep or getting too much sleep at night, leads to hormonal changes that increase appetite and craving of carbohydrates and high calories foods
Pregnancy: Weight gain during pregnancy may contribute to the development of obesity 6. Leptin and ghrelin are hormones responsible for energy homeostasis within the body.
7. Common consequences of obesity include:
Cardiovascular diseases (mainly heart disease and stroke), which were the leading cause of death in 2008;
High blood pressure
Diabetes;
Musculoskeletal disorders (especially osteoporosis )
Some cancers (endometrial, breast, and colon).
Gallstones, 50% – 70% of patients with gallstones are obese
Sleep apnea, asthma, other respiratory
Skin complications: Bacterial infections, Fungal infections.
Poor female reproductive health
Arthritis and gout
8. Preventive measures of Obesity include:
limit energy intake (women: 1200 kcal/day, men: 1600 kcal/day)
Select a diet with nutrients comprising the following percentages from the total calories;
(Carbohydrates; 55% (not less than 130 gm daily to avoid ketosis)/ Fat; 30% or less but not less than 20% to avoid reducing HDL (reduce saturated and trans fats)/ Proteins; 15% (0.8 g protein/kg BW/day)
Eat High Fiber Foods (20-30g/day) from raw, leafy green vegetables
Eat Breakfast Every Day
Engage in regular physical activity
Drugs and surgical intervention in some cases