Nutrition and Health — MCQs

Which is/are the correct statements regarding the cut off points for the diagnosis of anaemia? 1. Haemoglobin for adult males is 13 g/dl 2. Haemoglobin for adult non-pregnant female is 12 g/dl 3. Haemoglobin for adult pregnant female is 11 g/dl 4. Haemoglobin for children six months to six years of age is 11 g/dl Select the correct answer using the code given below:

Q560

The most important indicator for assessment of impact in Salt Iodization Programme is:

Nutrition and Health Indian Medical PG Practice Questions and MCQs

Question 551: In India, the most widely prevalent stage of iron deficiency is

A. decreased iron stores without any other detectable abnormalities (Correct Answer)
B. fall in percentage saturation of transferrin
C. decrease in the concentration of circulating haemoglobin
D. overt iron deficiency with impaired haemoglobin synthesis

Explanation: ***decreased iron stores without any other detectable abnormalities*** - This stage represents **latent iron deficiency (Stage 1)**, where the body's iron reserves are depleted (↓ serum ferritin), but hemoglobin and transferrin saturation remain normal. - According to the **epidemiological "iceberg" principle**, subclinical deficiency is always more prevalent than clinically apparent disease in populations. - This is the **most widely prevalent stage** in India, as many individuals with depleted iron stores have not yet progressed to frank anemia, representing the largest segment of the iron deficiency spectrum. - Seen commonly in **nutritionally vulnerable groups** due to inadequate dietary iron intake and chronic blood loss. *fall in percentage saturation of transferrin* - A fall in **transferrin saturation** (<16%) indicates **Stage 2: iron deficient erythropoiesis**, where iron availability for red blood cell production becomes limited. - This occurs after iron stores have been significantly depleted and represents a more advanced stage than simple store depletion. - While common, it is less prevalent than Stage 1 as not all individuals with depleted stores progress to this stage. *decrease in the concentration of circulating haemoglobin* - This signifies **Stage 3: iron deficiency anemia**, where iron deficiency is severe enough to impair hemoglobin synthesis, leading to clinical anemia (Hb <12 g/dL in women, <13 g/dL in men). - Although highly prevalent in India (NFHS-5 data shows 57% anemia in women), it represents a later manifestation that affects fewer individuals than the earlier subclinical stages. - This is the most **commonly detected** stage due to routine Hb screening, but not the most **prevalent** stage overall. *overt iron deficiency with impaired haemoglobin synthesis* - This also describes **Stage 3: iron deficiency anemia**, characterized by microcytic, hypochromic red blood cells due to insufficient iron for heme synthesis. - This is a clinically diagnosable stage with functional impairment, representing the "tip of the iceberg" of the total iron deficiency burden in the population.

Question 552: With reference to Indian men, who can be categorized as carrying out 'moderate work', what is the Recommended Dietary Allowance (RDA) of thiamine (in mg/day)?

A. 1.2
B. 1.8
C. 1.0
D. 1.4 (Correct Answer)

Explanation: ***1.4*** - The **Recommended Dietary Allowance (RDA) of thiamine** for Indian men performing **moderate work** is established at **1.4 mg/day** as per **ICMR 2020 guidelines**. - This recommendation is based on metabolic needs considering average physical activity levels, energy expenditure, and preventing deficiency symptoms. - The RDA ensures adequate thiamine intake for carbohydrate metabolism and nervous system function. *1.2* - This value represents the older RDA from previous ICMR guidelines. - While this was the recommended allowance in earlier versions, the current ICMR 2020 guidelines have updated the requirement to 1.4 mg/day for men with moderate activity. - This lower value may not fully meet the metabolic demands as per current recommendations. *1.8* - This value significantly exceeds the standard RDA for moderate work and might be recommended for individuals with higher energy expenditure or heavy physical activity. - For most Indian men performing moderate work, this intake would be considered higher than necessary. *1.0* - This value is below the recommended allowance for Indian men with moderate work. - This intake would not fully meet the metabolic demands, increasing the risk of suboptimal thiamine status and potential deficiency symptoms over time, especially during periods of increased carbohydrate intake.

Question 553: According to the WHO guidelines, the Body Mass Index cut off for overweight is:

A. ≥ 25 (Correct Answer)
B. ≥ 18
C. ≥ 35
D. ≥ 30

Explanation: ***≥ 25*** - A **Body Mass Index (BMI)** of **25.0 to 29.9 kg/m²** is classified as **overweight** according to **WHO international guidelines**. - This classification indicates a higher risk of developing various health problems. - **Note:** For Asian populations including India, modified cutoffs are used where **overweight is ≥23 kg/m²**. *≥ 18* - A BMI of **less than 18.5 kg/m²** is classified as **underweight**, indicating potential nutritional deficiencies. - A BMI between **18.5 and 24.9 kg/m²** is considered **normal weight** per WHO standards. *≥ 35* - A BMI of **≥ 35 kg/m²** falls into the category of **Obesity Class II or III**, representing a severe level of obesity. - This signifies a significantly elevated risk for severe health complications. *≥ 30* - A BMI of **≥ 30 kg/m²** is classified as **obese**, specifically **Obesity Class I**. - This threshold indicates a clear need for weight management interventions to reduce health risks.

Question 554: Which one of the following indicators includes the value of a person's height squared in its formula?

A. Quetelet's index (Correct Answer)
B. Waist-to-hip ratio
C. Ponderal index
D. Waist circumference

Explanation: ***Quetelet's index*** - **Quetelet's index**, also known as **Body Mass Index (BMI)**, is calculated as **weight (kg) / height (m)²**, thus directly incorporating height squared. - It is widely used to classify individuals as underweight, normal weight, overweight, or obese. - BMI is the most commonly used anthropometric indicator in clinical and public health settings. *Waist-to-hip ratio* - This ratio is calculated by dividing **waist circumference** by **hip circumference**. - It is an indicator of abdominal adiposity and does not use height in its formula. *Ponderal index* - The **Ponderal index** is calculated as **weight (kg) / height (m)³**, which uses height cubed, not squared. - It is often used to assess proportionality in infants and children. - While it includes height, the power is different from Quetelet's index. *Waist circumference* - **Waist circumference** is a direct measurement of the circumference of the abdomen. - It is an indicator of visceral fat and does not include height in its measurement or interpretation.

Question 555: Consider the following indices : 1. Chandelier index 2. Sullivan's index 3. Waist-hip index 4. Ponderal index Which of the above is/are used for measuring obesity?

A. 1 and 3
B. 3 and 4 (Correct Answer)
C. 2 and 4
D. 3 only

Explanation: ***3 and 4*** - The **waist-hip index** is a measure of **central obesity**, an important risk factor for metabolic diseases, indicating fat distribution. - The **Ponderal index** (or Rohrer's index) takes into account height and weight, similar to **BMI**, and is used to assess **overall adiposity**. *1 and 3* - The **Chandelier index** is not a standard or recognized index for measuring obesity. - While the **waist-hip index** is used, this option incorrectly includes an irrelevant index. *2 and 4* - **Sullivan's index** is related to **disability-free life expectancy** and is not used for measuring obesity. - While the **Ponderal index** is relevant, this option incorrectly includes an irrelevant index. *3 only* - While the **waist-hip index** is indeed used for measuring obesity, limiting the answer to only this index is incorrect because the **Ponderal index** is also a valid measure of obesity. - The question asks for all relevant indices among the given choices, making this option incomplete.

Question 556: What is the Body Mass Index of a person 150 cm tall and weighing 67.5 kg?

A. 24
B. 30 (Correct Answer)
C. 27
D. 33

Explanation: ***30*** - The Body Mass Index (BMI) is calculated using the formula: **weight (kg) / [height (m)]²**. - For a person weighing **67.5 kg** and standing **1.5 m (150 cm)** tall, the calculation is **67.5 / (1.5)² = 67.5 / 2.25 = 30**. - A BMI of **30** represents the threshold for **Obesity Class I** according to WHO classification (BMI ≥30). *24* - This value falls in the **normal to overweight range** (BMI 18.5-24.9 is normal) but is incorrect for the given measurements. - To achieve a BMI of 24 at 150 cm height, the person would need to weigh approximately **54 kg**, not 67.5 kg. *27* - This BMI would indicate **overweight** (BMI 25-29.9), but it is not the accurate calculation for the provided weight and height. - To achieve a BMI of 27 at 150 cm height, the person would need to weigh approximately **60.75 kg**, not 67.5 kg. *33* - A BMI of 33 indicates **Obesity Class I** (BMI 30-34.9), but it is higher than the correct calculation for the given parameters. - To achieve a BMI of 33 at 150 cm height, the person would need to weigh approximately **74.25 kg**, not 67.5 kg.

Question 557: For a child aged four years, an Anganwadi Worker detects that the weight is lower than expected. What should the Anganwadi Worker do first regarding the malnutrition detected in the child?

A. Give nutritional counselling to the mother (Correct Answer)
B. Refer the child to the nearby Health Centre
C. Start fortnightly deworming
D. Refer the child to a nearby nutritional rehabilitation centre

Explanation: ***Give nutritional counselling to the mother*** - As an Anganwadi Worker, the **first and most immediate action** for detected malnutrition in a four-year-old child is to provide **nutritional counseling** to the mother. This empowers the caregiver with knowledge and practical advice on improving the child's diet and feeding practices at home. - Counseling can address issues such as **appropriate food choices**, frequency of feeding, overcoming feeding difficulties, and hygiene, which are often at the root of mild to moderate malnutrition. *Refer the child to the nearby Health Centre* - Referring to a health center is essential if the malnutrition is **severe** or if there are **associated medical complications** requiring clinical evaluation and treatment. - However, for initial detection, especially in cases that might be mild, basic nutritional guidance from an Anganwadi Worker is the primary step before escalating to a medical referral. *Start fortnightly deworming* - Deworming is an important public health measure to reduce parasitic load, which can contribute to malnutrition, but it is not the **first and most direct intervention** for managing detected low weight. - While beneficial as part of a comprehensive strategy, deworming alone does not address immediate dietary deficiencies or feeding practices contributing to low weight. *Refer the child a nearby nutritional rehabilitation centre* - Referral to a nutritional rehabilitation center (NRC) is typically reserved for children with **severe acute malnutrition (SAM)** who require intensive, structured feeding and medical management. - For a child whose weight is simply detected as "lower than expected" (which could be moderate or even mild malnutrition), an NRC is usually not the initial or immediate course of action.

Question 558: Which of the following is/are the methods of assessment of nutritional status? 1. Clinical examination 2. Anthropometry 3. Biochemical evaluation 4. Orthotolidine test Select the correct answer using the code given below:

A. 1 only
B. 1 and 3 only
C. 1, 2, 3 and 4
D. 1, 2 and 3 only (Correct Answer)

Explanation: ***1, 2 and 3 only*** - **Clinical examination** involves assessing physical signs of nutrient deficiencies or excesses. This includes inspecting for signs like **pallor** (iron deficiency), **cheilosis** (riboflavin deficiency), or **edema** (protein-energy malnutrition). - **Anthropometry** uses body measurements like **height, weight, body mass index (BMI), and skinfold thickness** to assess body composition and identify abnormalities such as **underweight, overweight, obesity, and stunting**. - **Biochemical evaluation** involves laboratory tests on blood or urine samples to measure nutrient levels (e.g., **serum albumin, ferritin, vitamin D**) or metabolic markers indicative of nutritional status. *1 only* - While **clinical examination** is a crucial component of nutritional assessment, it alone does not provide a comprehensive picture. - It may miss subclinical deficiencies or excesses that require further investigation through other methods. *1 and 3 only* - This option correctly identifies **clinical examination** and **biochemical evaluation** as assessment methods, but it incorrectly excludes **anthropometry**. - **Anthropometry** is fundamental for assessing growth, body composition, and identifying specific nutritional problems like **underweight, obesity, and stunting**. *1, 2, 3 and 4* - This option includes methods 1, 2, and 3, which are indeed correct methods for nutritional assessment. - However, the **Orthotolidine test** (method 4) is used to detect **blood in urine or feces**, specifically for investigating conditions like **gastrointestinal bleeding**, and is not a direct method for assessing general nutritional status.

Question 559: Which is/are the correct statements regarding the cut off points for the diagnosis of anaemia? 1. Haemoglobin for adult males is 13 g/dl 2. Haemoglobin for adult non-pregnant female is 12 g/dl 3. Haemoglobin for adult pregnant female is 11 g/dl 4. Haemoglobin for children six months to six years of age is 11 g/dl Select the correct answer using the code given below:

A. 1 and 3 only
B. 1, 2, 3 and 4 (Correct Answer)
C. 1 only
D. 2 and 4 only

Explanation: ***1, 2, 3 and 4*** - All four statements correctly represent the **World Health Organization (WHO) hemoglobin cut-off points** for diagnosing **anemia** across different population groups. - These standardized values are used globally for **screening, diagnosis, and public health surveillance** of anemia. - **Adult males: <13 g/dL**, **non-pregnant females: <12 g/dL**, **pregnant females: <11 g/dL**, and **children (6 months-6 years): <11 g/dL** are the accepted thresholds. *1 and 3 only* - This option incorrectly excludes statements 2 and 4, which are also valid WHO criteria. - Missing the cut-offs for non-pregnant women (12 g/dL) and young children (11 g/dL) would result in incomplete anemia assessment. *1 only* - This option is far too restrictive, acknowledging only the hemoglobin threshold for adult males. - It ignores the correct and distinct criteria for **women (pregnant and non-pregnant)** and **children**, which are essential for comprehensive anemia diagnosis. *2 and 4 only* - This option incorrectly omits statements 1 and 3, which are equally valid. - Excluding the hemoglobin cut-offs for adult males (13 g/dL) and pregnant women (11 g/dL) provides an incomplete picture of WHO anemia criteria.

Question 560: The most important indicator for assessment of impact in Salt Iodization Programme is:

A. Testing median urinary iodine excretion (Correct Answer)
B. Testing Iodine content of salt at consumer level
C. Testing iodine content of salt at production level
D. Testing serum iodine levels

Explanation: ***Testing median urinary iodine excretion*** - **Urinary iodine excretion** is the most reliable biochemical indicator of recent **iodine intake** and is considered the best measure for assessing the iodine status of a population. - The **median urinary iodine concentration** is used to categorize a population's iodine nutrition status as deficient, adequate, or in excess, providing a direct measure of programme impact. *Testing iodine content of salt at consumer level* - While important for monitoring **salt iodization efforts**, this only reflects the availability of iodized salt, not necessarily the actual **iodine intake** or nutritional status of the consumers. - Salt content can degrade over time due to improper storage, heat, and humidity, leading to discrepancies between the salt's iodine content and the iodine actually consumed. *Testing iodine content of salt at production level* - This is crucial for **quality control** and ensuring compliance with iodization standards at the source. - However, it does not account for potential **iodine loss** during transport, storage, and household use, nor does it directly reflect the population's actual iodine status. *Testing serum iodine levels* - **Serum iodine levels** are primarily regulated by the thyroid gland and are not a sensitive indicator of a population's *recent iodine intake* or overall iodine nutrition status. - These levels are often maintained within a narrow range even with varying intake, making them less useful for monitoring large-scale intervention programmes like **salt iodization**.

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

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Nutrition in Emergencies

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Food Fortification and Supplementation

Practice Questions

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