Nutrition and Health Practice Questions

Q: What is the recommended dietary allowance of calcium for pregnant females?

1000 mg. **Explanation:** The correct answer is **1000 mg/day**. This value is based on the **ICMR-NIN (2020) guidelines**, which are the current gold standard for NEET-PG. **1. Why 1000 mg is correct:** During pregnancy, there is a significant transfer of calcium to the fetus (approximately 30g), primarily during the third trimester for skeletal mineralization. According to the **ICMR-NIN 2020 RDA**, the calcium requirement for a pregnant woman is **1000 mg/day**. Notably, this is the **same** as the requirement for a non-pregnant, non-lactating adult woman. The body compensates for the increased fetal demand by increasing intestinal calcium absorption efficiency, rather than requiring a massive increase in dietary intake. **2. Why other options are incorrect:** * **1200 mg:** This was the RDA in the older **ICMR 2010** guidelines. Many older textbooks still carry this value, but for current exams, the 2020 update (1000 mg) is preferred. * **1300 mg:** This is the RDA recommended by some international bodies (like the IOM) specifically for **pregnant adolescents** (14–18 years) to support both fetal growth and the mother’s own continuing bone maturation. * **1500 mg:** This value is not a standard RDA but is sometimes used in clinical practice for women at high risk of gestational hypertension or pre-eclampsia. **High-Yield Clinical Pearls for NEET-PG:** * **Lactation RDA:** The calcium requirement remains **1000 mg/day** (ICMR 2020). * **Post-menopausal women:** The RDA increases to **1200 mg/day** to prevent osteoporosis. * **Iron & Calcium:** Never advise taking Iron and Calcium tablets together; calcium inhibits the absorption of non-heme iron. * **WHO Recommendation:** In areas with low dietary calcium intake, WHO suggests 1.5g–2.0g daily to reduce the risk of **pre-eclampsia**.

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

Waist to hip ratio of 0.86 in a male. 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: $\ge 30$

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

25-29.9. **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).

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

Selenium. **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.

Q: Skimmed milk is devoid of:

Fat. **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.

Q: What is the prophylactic dose of vitamin A given to children aged 1-6 years?

200,000 IU. ### Explanation The correct answer is **200,000 IU**. This dose is part of the **National Vitamin A Prophylaxis Programme**, which aims to prevent nutritional blindness due to Vitamin A Deficiency (VAD). **1. Why 200,000 IU is correct:** Vitamin A is a fat-soluble vitamin stored in the liver. In children aged **1 to 6 years**, the liver capacity is sufficient to store a large bolus dose that can be utilized over several months. Under the current guidelines, children in this age group receive **200,000 IU orally every 6 months** until their 5th birthday (totaling 9 doses starting from infancy). **2. Why the other options are incorrect:** * **100,000 IU (Option D):** This is the specific dose for infants aged **6 to 11 months**. Because infants have smaller liver storage capacity and a lower body weight, a half-dose is administered to prevent toxicity while ensuring adequate protection. * **2,000 IU (Option A):** This is closer to the Recommended Dietary Allowance (RDA) for daily intake, not a periodic prophylactic bolus. * **20,000 IU (Option B):** This dose does not correspond to any standard prophylactic or therapeutic protocol in the national program. **3. High-Yield Clinical Pearls for NEET-PG:** * **Schedule:** The 1st dose (1 lakh IU) is given at **9 months** with the Measles/MR vaccine. Subsequent doses (2 lakh IU) are given every 6 months up to **5 years** of age. * **Total Dosage:** A child receives a total of **17,00,000 IU** (17 lakh IU) across 9 doses by age five. * **Treatment of Xerophthalmia:** If a child has clinical signs (e.g., Bitot's spots), the schedule is: One dose on **Day 0**, one dose on **Day 1**, and one dose on **Day 28**. * **Oil-based:** Vitamin A is administered using a 2ml spoon (where 1ml = 1 lakh IU).

Q: What is true about lathyrism?

Prevented by parboiling. **Explanation:** Lathyrism is a form of permanent spastic paraplegia caused by the excessive consumption of **Khesari Dal (*Lathyrus sativus*)**. It is primarily seen in central India among socio-economically disadvantaged populations who use this pulse as a staple during droughts. **Why Option B is Correct:** The toxic principle in *Lathyrus sativus* is **BOAA** (Beta-oxalyl-amino-alanine), which is water-soluble. **Parboiling** (steeping the pulse in hot water and then drying it) effectively leaches out the toxin, reducing its concentration to safe levels. Another method for toxin removal is sun-drying followed by roasting. **Why Other Options are Incorrect:** * **Option A:** *Aspergillus flavus* is a fungus that produces **Aflatoxins**, which are associated with groundnuts and maize, leading to acute hepatitis and hepatocellular carcinoma, not lathyrism. * **Option C:** **Sanguinarine** is the toxic alkaloid found in Argemone oil (Mexican poppy). Its consumption leads to **Epidemic Dropsy**, characterized by bilateral edema, cardiac failure, and glaucoma. **NEET-PG High-Yield Pearls:** 1. **Toxic Principle:** BOAA (also known as ODAP). It acts as a neurotoxin by mimicking glutamate. 2. **Clinical Stages:** Lathyrism progresses through four stages: **Latent** (positive stick sign), **No-stick** (clumsy gait), **One-stick**, and **Two-stick** (permanent disability). 3. **Prevention:** The most effective long-term strategy is the replacement of *Lathyrus sativus* with safer crops like Bengal gram or the use of low-BOAA varieties. 4. **Target Population:** Typically affects young adult males (15–45 years) due to higher consumption levels.

Q: If ASHA finds any child lies in the yellow area according to the ICDS growth chart, what action should be taken?

Child is referred to the Primary Health Centre (PHC). ### Explanation The ICDS (Integrated Child Development Services) growth chart, based on WHO Growth Standards, uses a color-coded system to monitor a child's nutritional status based on **Weight-for-Age**. **1. Why Option B is Correct:** The growth chart is divided into three zones: * **Green Zone:** Normal nutritional status (Above -2SD). * **Yellow Zone:** Moderately underweight (Between -2SD and -3SD). * **Orange Zone:** Severely underweight (Below -3SD). When an ASHA or Anganwadi Worker identifies a child in the **Yellow Zone**, it indicates **Moderate Acute Malnutrition (MAM)**. According to ICDS guidelines, these children must be referred to the **Primary Health Centre (PHC)** for a medical check-up to rule out underlying infections and to receive targeted nutritional supplementation (Double Ration). **2. Why Other Options are Incorrect:** * **Option A:** Referral to a higher center (NRC or District Hospital) is reserved for children in the **Orange Zone** (Severe Acute Malnutrition) or those with medical complications. * **Option C:** While community-based management is part of the strategy, the immediate protocol-driven action for an ASHA is a formal referral to the PHC for assessment. * **Option D:** "Only follow-up" is insufficient. While follow-up is necessary, the child requires an initial clinical evaluation and supplementary nutrition. ### High-Yield Clinical Pearls for NEET-PG: * **Growth Chart Type:** The ICDS uses the **WHO Growth Standards (2006)**. * **Reference Parameters:** The ICDS chart specifically monitors **Weight-for-Age**. * **Growth Curve Trends:** A flat curve (stagnant weight) or a falling curve is a more sensitive indicator of malnutrition than a single point in the yellow zone. * **SAM Criteria:** Weight-for-height < -3SD, Mid-Upper Arm Circumference (MUAC) < 11.5 cm, or presence of bilateral pitting edema.

Question 1

What is the recommended dietary allowance of calcium for pregnant females?

Accepted Answer

1000 mg

Answer

1200 mg

Answer

1500 mg

Answer

1300 mg

Question 2

Which of the following is NOT suggestive of obesity or overweight?

Accepted Answer

Waist to hip ratio of 0.86 in a male

Answer

Quetelet's index of 26

Answer

Corpulence index of 1.4

Answer

Sum of skinfold thickness at all sites is 50 mm in a male

Question 3

What are the components of nutrition surveillance?

Accepted Answer

Policy maker

Answer

National survey

Answer

AFP surveillance

Answer

DOTS

Question 4

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

Accepted Answer

25-29.9

Answer

Less than 18.5

Answer

18.5-24.9

Answer

Greater than or equal to 30

Question 5

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

Accepted Answer

The focus is on health and nutrition in the first 1000 days of life.

Answer

Launched by the Prime Minister in March 2018.

Answer

It is the Prime Minister's overarching scheme for holistic nutrition.

Answer

Goals for this program include reduction in stunting, undernutrition, low birth weight, and anemia.

Question 6

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

Accepted Answer

Selenium

Answer

Copper

Answer

Iron

Answer

Zinc

Question 7

Skimmed milk is devoid of:

Accepted Answer

Fat

Answer

Carbohydrate

Answer

Protein

Answer

Vitamin B12

Question 8

What is the prophylactic dose of vitamin A given to children aged 1-6 years?

Accepted Answer

200,000 IU

Answer

2,000 IU

Answer

20,000 IU

Answer

100,000 IU

Question 9

What is true about lathyrism?

Accepted Answer

Prevented by parboiling

Answer

Caused by Aspergillus flavus

Answer

Sanguinarine is the toxic principle

Answer

All of the above

Question 10

If ASHA finds any child lies in the yellow area according to the ICDS growth chart, what action should be taken?

Accepted Answer

Child is referred to the Primary Health Centre (PHC)

Answer

Child is referred to a higher center

Answer

Community-based management of malnutrition

Answer

Only follow-up

Nutrition and Health — MCQs

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