Nutrition and Health — MCQs

Nutrition and Health Indian Medical PG Practice Questions and MCQs

Question 121: Which of the following is NOT suggestive of obesity or overweight?

A. Quetelet's index of 26
B. Corpulence index of 1.4
C. Waist to hip ratio of 0.86 in a male (Correct Answer)
D. Sum of skinfold thickness at all sites is 50 mm in a male

Explanation: This question tests the knowledge of anthropometric indicators used to define overweight and obesity. ### **Explanation of the Correct Answer** **Option C (Waist to Hip Ratio of 0.86 in a male)** is the correct answer because it falls within the **normal range**. For males, a Waist-to-Hip Ratio (WHR) is considered indicative of abdominal obesity only when it is **>0.90**. In females, the cutoff is **>0.85**. A ratio of 0.86 in a male suggests a healthy distribution of body fat and is not suggestive of obesity. ### **Analysis of Incorrect Options** * **Option A: Quetelet's Index of 26.** Quetelet's Index is another name for **Body Mass Index (BMI)** ($weight/height^2$). According to WHO classification, a BMI between 25.0–29.9 $kg/m^2$ defines **overweight**. Thus, 26 is suggestive of being overweight. * **Option B: Corpulence Index of 1.4.** Also known as Rohrer's Index ($weight/height^3$), it is used to measure body build. A value **>1.2** is generally considered suggestive of obesity. * **Option C: Sum of skinfold thickness of 50 mm.** Skinfold thickness (measured using Harpenden calipers) is a proxy for subcutaneous fat. In males, a sum of skinfold thickness (typically measured at triceps, biceps, subscapular, and suprailiac sites) **>40 mm** is indicative of obesity. ### **High-Yield Clinical Pearls for NEET-PG** * **Best indicator of abdominal (central) obesity:** Waist Circumference (Males >90 cm, Females >80 cm in Asians). * **Ponderal Index:** $Height / \sqrt[3]{Weight}$. * **Broca’s Index:** $Height (cm) - 100$. (Ideal weight in kg). * **Gold Standard for body fat estimation:** Hydrostatic (underwater) weighing. * **WHO BMI Cut-offs:** * Normal: 18.5–24.9 * Overweight: 25–29.9 * Obese: $\ge 30$

Question 122: Which vitamin is lost on exposure to sunlight?

A. Vitamin A
B. Vitamin B1
C. Vitamin B6
D. Vitamin C (Correct Answer)

Explanation: **Explanation:** **Vitamin C (Ascorbic Acid)** is the correct answer because it is the most heat-labile and chemically unstable of all vitamins. It is highly sensitive to oxidation, which is accelerated by exposure to **sunlight (UV radiation)**, heat, and alkaline mediums. In the context of food preparation, significant amounts of Vitamin C are lost during drying in the sun, prolonged storage, or open-pan cooking. **Analysis of Incorrect Options:** * **Vitamin A (Retinol):** While Vitamin A is sensitive to oxidation and high temperatures, it is relatively stable compared to Vitamin C. It is primarily lost through rancidification of fats rather than direct sunlight exposure during routine handling. * **Vitamin B1 (Thiamine):** Thiamine is very sensitive to heat (thermolabile) and alkaline pH (e.g., adding baking soda to pulses), but it is not specifically characterized by loss due to sunlight exposure. * **Vitamin B6 (Pyridoxine):** Pyridoxine is fairly stable to heat and acids, though it can be sensitive to light in its pure liquid form; however, in the hierarchy of "vitamins lost on exposure," Vitamin C is the classic medical teaching and the most significant. **Clinical Pearls for NEET-PG:** * **Most Heat-Labile Vitamin:** Vitamin C (destroyed by boiling/canning). * **Scurvy:** The clinical manifestation of Vitamin C deficiency, characterized by "corkscrew hair," petechiae, and bleeding gums. * **Biological Function:** Essential for the post-translational modification of collagen (hydroxylation of proline and lysine). * **Enhancer:** Vitamin C significantly increases the absorption of **non-heme iron** from the gut by reducing it from the ferric ($Fe^{3+}$) to the ferrous ($Fe^{2+}$) state.

Question 123: What is known as 'poor man's meat'?

A. Milk
B. Pulses (Correct Answer)
C. Fish
D. Egg

Explanation: **Explanation:** **Why Pulses are the Correct Answer:** In the context of public health and nutrition, **pulses** are famously referred to as **"poor man’s meat"** because they are a concentrated, low-cost source of dietary protein. For populations in developing countries where animal protein is economically inaccessible, pulses provide the primary protein source. They contain approximately **20-25% protein by weight**, which is double the protein content of wheat and triple that of rice. **Analysis of Incorrect Options:** * **Milk (A):** Known as a "complete food" (except for Vitamin C and Iron), but it is relatively more expensive and has lower protein density per gram compared to dried pulses. * **Fish (C) & Egg (D):** These are sources of **First-Class Proteins** (containing all essential amino acids in the right proportions). While nutritionally superior due to higher biological value, their higher cost makes them inaccessible as a staple for the poor, thus they do not carry this specific moniker. **High-Yield Clinical Pearls for NEET-PG:** * **Limiting Amino Acids:** Pulses are deficient in **Methionine** but rich in **Lysine**. Conversely, cereals are deficient in Lysine but rich in Methionine. * **Synergistic Effect:** When cereals and pulses are eaten together (e.g., Khichdi), they achieve a **"supplementary action of proteins,"** providing a complete amino acid profile comparable to animal protein. * **Reference Protein:** The **Egg** is considered the "standard/reference protein" (Biological Value = 96) against which other proteins are compared. * **Net Protein Utilization (NPU):** Pulses have an NPU of approximately 45-60, whereas Egg has an NPU of 100.

Question 124: What are the components of nutrition surveillance?

A. Policy maker (Correct Answer)
B. National survey
C. AFP surveillance
D. DOTS

Explanation: ### Explanation **Nutrition Surveillance** is the continuous monitoring of the nutritional status of a population to provide data for making decisions regarding policy, planning, and management of nutrition programs. **1. Why "Policy Maker" is the Correct Answer:** Nutrition surveillance is not just about data collection; it is a **functional system** designed to trigger action. According to the WHO, the primary objective of surveillance is to provide information to **policy makers** and planners so they can initiate timely interventions. The components of a surveillance system include: * **Data collection** (from various sectors like health, agriculture, and economics). * **Analysis and interpretation.** * **Communication to decision-makers (Policy Makers).** * **Implementation of corrective actions.** **2. Analysis of Incorrect Options:** * **B. National Survey:** While surveys (like NFHS in India) provide cross-sectional data on nutrition, they are periodic and not continuous. Surveillance is an ongoing process, whereas a survey is a "snapshot" in time. * **C. AFP Surveillance:** Acute Flaccid Paralysis (AFP) surveillance is a specific strategy used for the **Polio Eradication Program**. It is unrelated to nutritional monitoring. * **D. DOTS:** Directly Observed Treatment Short-course (DOTS) is the operational strategy for the **National Tuberculosis Elimination Program (NTEP)**. **3. High-Yield Clinical Pearls for NEET-PG:** * **Surveillance vs. Monitoring:** Monitoring is the day-to-day measurement of performance (e.g., growth monitoring in an Anganwadi), while surveillance is the long-term, large-scale continuous scrutiny of trends to guide policy. * **Key Indicators:** Nutrition surveillance often tracks "Sentinel" sites and uses indicators like birth weight, height-for-age (stunting), and weight-for-height (wasting). * **Triple Burden of Malnutrition:** Modern surveillance now tracks undernutrition, micronutrient deficiencies, and overweight/obesity simultaneously.

Question 125: What is the Body Mass Index (BMI) range for pre-obesity?

A. Less than 18.5
B. 18.5-24.9
C. 25-29.9 (Correct Answer)
D. Greater than or equal to 30

Explanation: **Explanation:** Body Mass Index (BMI), or Quetelet’s Index, is a standard epidemiological tool used to classify nutritional status in adults. It is calculated as weight in kilograms divided by the square of height in meters ($kg/m^2$). **1. Why Option C is Correct:** According to the **WHO Classification of Weight Status**, the range **25.0–29.9 $kg/m^2$** is specifically designated as **Pre-obesity** (also commonly referred to as Overweight). At this stage, there is an increased risk of co-morbidities, serving as a critical window for lifestyle intervention before reaching clinical obesity. **2. Analysis of Incorrect Options:** * **Option A (< 18.5):** This range defines **Underweight** status. * **Option B (18.5–24.9):** This is the **Normal (Healthy) range**, associated with the lowest statistical risk of chronic diseases. * **Option D (≥ 30):** This defines **Obesity**. It is further subdivided into Class I (30–34.9), Class II (35–39.9), and Class III (≥ 40). **High-Yield Clinical Pearls for NEET-PG:** * **Asian-Indian Specific Criteria:** Due to a higher risk of metabolic syndrome at lower BMIs, the cut-offs for Indians are lower: * Normal: 18.5–22.9 $kg/m^2$ * Overweight/Pre-obese: **23.0–24.9 $kg/m^2$** * Obese: **≥ 25 $kg/m^2$** * **Ponderal Index:** Another measure of thinness ($Weight/Height^3$). * **Corpulence Index:** Used for children ($Weight/Height^{2.98}$). * **Best Indicator of Abdominal Obesity:** Waist-to-hip ratio (Significant if > 0.9 in men; > 0.85 in women).

Question 126: All of the following are true about 'POSHAN' Abhiyaan except?

A. Launched by the Prime Minister in March 2018.
B. It is the Prime Minister's overarching scheme for holistic nutrition.
C. The focus is on health and nutrition in the first 1000 days of life. (Correct Answer)
D. Goals for this program include reduction in stunting, undernutrition, low birth weight, and anemia.

Explanation: **Explanation:** The **POSHAN Abhiyaan** (Prime Minister’s Overarching Scheme for Holistic Nourishment) is a flagship program aimed at improving nutritional outcomes for children, pregnant women, and lactating mothers. **Why Option C is the correct answer (the "Except" statement):** While the "first 1000 days" (from conception to a child's second birthday) is a critical window for intervention in many nutrition programs, the POSHAN Abhiyaan has a **broader target age group**. It focuses on children from **0 to 6 years**, adolescent girls, pregnant women, and lactating mothers. Therefore, limiting its focus strictly to the first 1000 days is technically incorrect in the context of this scheme's official mandate. **Analysis of other options:** * **Option A:** Correct. It was launched by the Prime Minister on **March 8, 2018** (International Women's Day) from Jhunjhunu, Rajasthan. * **Option B:** Correct. It is the apex body/scheme designed to converge various nutrition-related schemes (like ICDS, PMMVY, and NHM) to ensure holistic nutrition. * **Option D:** Correct. The mission has specific quantitative targets (per annum): * Reduction in **Stunting**: 2% * Reduction in **Undernutrition** (underweight): 2% * Reduction in **Anemia** (among young children, women, and adolescent girls): 3% * Reduction in **Low Birth Weight (LBW)**: 2% **High-Yield Clinical Pearls for NEET-PG:** * **Mission 2.0:** POSHAN 2.0 was launched in 2021, merging POSHAN Abhiyaan with the Supplementary Nutrition Programme to strengthen delivery and outreach. * **Poshan Maah:** September is celebrated as the National Nutrition Month. * **Target for Stunting:** The ultimate goal was to reduce stunting from 38.4% (NFHS-4) to **25% by 2022**. * **Key Strategy:** The use of **ICT-based Real-Time Monitoring** (ICDS-CAS) and Jan Andolan (social mobilization).

Question 127: The Nalgonda technique is related to which content in water?

A. Fluorine (Correct Answer)
B. Chlorine
C. Nitrate
D. Nitrites

Explanation: The **Nalgonda technique** is a method specifically designed for the **defluoridation** of water (removal of excess Fluorine). Developed by the National Environmental Engineering Research Institute (NEERI) in Nagpur, it is a cost-effective, community-level process widely used in India to combat endemic fluorosis. ### Why Fluorine is Correct The technique involves the sequential addition of **Alum** (Aluminum sulfate), **Lime** (Calcium oxide), and **Bleaching powder** to water, followed by rapid mixing, flocculation, sedimentation, and filtration. * **Alum** acts as the coagulant that removes fluoride ions. * **Lime** ensures the correct pH for the reaction. * **Bleaching powder** provides simultaneous disinfection. ### Why Other Options are Incorrect * **Chlorine:** While chlorine is used for disinfection (to kill pathogens), the Nalgonda technique is not its primary removal or application method. Chlorine is actually *added* during the process as bleaching powder. * **Nitrate/Nitrites:** Excess nitrates in water cause **Methemoglobinemia (Blue Baby Syndrome)**. Removal typically requires ion exchange or reverse osmosis, not the Nalgonda process. ### High-Yield Clinical Pearls for NEET-PG * **Optimal Fluoride Level:** 0.5 to 0.8 mg/L (prevents dental caries). * **Dental Fluorosis:** Occurs when levels exceed **1.5 mg/L** (mottling of enamel). * **Skeletal Fluorosis:** Occurs with long-term exposure to levels > **3.0–6.0 mg/L**. * **Alternative Method:** The **Activated Alumina** method is another way to remove fluoride, but Nalgonda remains the most high-yield "Indian" technique for exams. * **Sequence Memory Tool:** Remember **"ALB"** (Alum, Lime, Bleaching powder) for the Nalgonda process.

Question 128: Which of the following trace elements is associated with hypothyroidism in the Himalayan region?

A. Copper
B. Iron
C. Zinc
D. Selenium (Correct Answer)

Explanation: **Explanation:** The correct answer is **Selenium (D)**. While Iodine deficiency is the primary cause of endemic goiter and hypothyroidism in the Himalayan region (the "Goiter Belt"), Selenium plays a critical role as a co-factor for the enzyme **Type 1 iodothyronine deiodinase**. This enzyme is responsible for converting the pro-hormone Thyroxine (T4) into its active form, Triiodothyronine (T3). In the Himalayan region, the soil is often deficient in both Iodine and Selenium. A concurrent deficiency of Selenium exacerbates hypothyroidism because, even if some T4 is produced, it cannot be efficiently converted to active T3. **Analysis of Incorrect Options:** * **Copper (A):** Copper is essential for iron metabolism (via ceruloplasmin) and collagen synthesis. Its deficiency leads to Menkes disease or microcytic anemia, but it is not a primary driver of Himalayan hypothyroidism. * **Iron (B):** While Iron is a cofactor for *Thyroid Peroxidase* (TPO), and its deficiency can impair thyroid function, it is not the specific trace element classically associated with the geographical endemicity of the Himalayan belt in the context of this specific biochemical synergy. * **Zinc (C):** Zinc is involved in the synthesis of TRH and the binding of T3 to its nuclear receptor. However, its epidemiological link to the Himalayan endemic goiter is less significant than Selenium. **High-Yield NEET-PG Pearls:** * **Glutathione Peroxidase:** Selenium is also a key component of this antioxidant enzyme, which protects the thyroid gland from oxidative damage during hormone synthesis. * **Keshan Disease:** Remember that severe Selenium deficiency is also linked to Keshan disease (endemic cardiomyopathy). * **Double Deficiency:** In the Himalayan region, "Endemic Myxedematous Cretinism" is often attributed to the combined deficiency of Iodine and Selenium.

Question 129: Skimmed milk is devoid of:

A. Fat (Correct Answer)
B. Carbohydrate
C. Protein
D. Vitamin B12

Explanation: **Explanation:** The correct answer is **Fat**. Skimmed milk is produced by the mechanical removal of cream from whole milk. By definition, skimmed milk must contain less than **0.5% fat** (usually 0.1%). During this process, almost all the fat-soluble components are removed, while the water-soluble components remain intact. * **Why Fat is correct:** The skimming process specifically targets the lipid content. Along with the fat, fat-soluble vitamins (A, D, E, and K) are also significantly reduced or lost, which is why skimmed milk is often fortified with Vitamin A and D. * **Why Carbohydrates (Lactose) are incorrect:** Lactose is water-soluble and remains in the serum (whey) portion of the milk. Skimmed milk actually has a slightly higher percentage of carbohydrate per volume compared to whole milk. * **Why Protein is incorrect:** The proteins (casein and whey) are not removed during skimming. In fact, skimmed milk is an excellent source of high-biological value protein. * **Why Vitamin B12 is incorrect:** Vitamin B12 is a water-soluble vitamin. It remains preserved in the aqueous phase of the milk after the fat is removed. **NEET-PG High-Yield Pearls:** * **Caloric Value:** Skimmed milk provides approximately **35-38 kcal/100g**, whereas whole cow's milk provides about 65-67 kcal/100g. * **Toned Milk:** Contains 3.0% fat and 8.5% SNF (Solids-Not-Fat). * **Double Toned Milk:** Contains 1.5% fat and 9.0% SNF. * **Nutritional Utility:** Skimmed milk is the preparation of choice for patients with obesity, cardiovascular diseases, or those requiring high-protein, low-calorie diets.

Question 130: What percentage of the egg's total weight does the egg white contribute?

A. 58% (Correct Answer)
B. 50%
C. 30%
D. 70%

Explanation: **Explanation:** The composition of a whole chicken egg is a frequently tested topic in Community Medicine and Nutrition. A standard egg (approx. 60g) is structurally divided into three main components: the **Egg White (Albumen)**, the **Egg Yolk**, and the **Shell**. 1. **Egg White (58%):** This is the largest component by weight. It consists primarily of water (approx. 88%) and high-quality proteins like ovalbumin. It contains negligible fat. 2. **Egg Yolk (30-32%):** The yolk accounts for nearly one-third of the weight. It is the nutrient powerhouse, containing all the fat, cholesterol, and fat-soluble vitamins (A, D, E, K). 3. **Egg Shell (10-12%):** The protective outer layer made of calcium carbonate makes up the remaining small fraction of the total weight. **Analysis of Options:** * **Option A (58%):** Correct. This is the standard physiological distribution of the albumen in a poultry egg. * **Option B (50%):** Incorrect. This underestimates the white and overestimates the yolk; they are not equal in weight. * **Option C (30%):** Incorrect. This value represents the weight of the **Egg Yolk**, not the white. * **Option D (70%):** Incorrect. While the white is the majority, it does not reach 70% of the total weight including the shell. **High-Yield Facts for NEET-PG:** * **Reference Protein:** Egg protein is considered the "Gold Standard" or Reference Protein due to its high Biological Value (94) and Net Protein Utilization (96). * **Nutritional Content:** One average egg provides approx. 6g of protein and 70 kcal of energy. * **Limiting Amino Acids:** Eggs are notably rich in essential amino acids, particularly leucine and sulfur-containing amino acids. * **The "Perfect" Food:** It contains all nutrients except **Vitamin C and Carbohydrates**.

Practice by Chapter

Basic Nutritional Requirements

Practice Questions

Assessment of Nutritional Status

Practice Questions

Protein-Energy Malnutrition

Practice Questions

Micronutrient Deficiencies

Practice Questions

Nutritional Programs in India

Practice Questions

Dietary Guidelines

Practice Questions

Food Safety and Security

Practice Questions

Diet and Non-Communicable Diseases

Practice Questions

Nutrition in Pregnancy and Lactation

Practice Questions

Infant and Young Child Nutrition

Practice Questions

Nutrition in Emergencies

Practice Questions

Food Fortification and Supplementation

Practice Questions

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