Nutrition Knowledge and Attitude Survey       Brown University School of Medicine has received a Nutrition Academic Award from the Heart, Lung, and Blood Institute of the National Institutes of Health (NIH), which will allow us to assess an improve the teaching of nutrition-related topics within the medical curriculum. This survey is intended to assess the nutrition knowledge and attitude of medical students at different points in their education and training. Your responses will as a baseline against which will be able to evaluate the effectiveness of various components of the curriculum and of our project.       We also ask that you supply some background information about yourself. Your ID number is necessary for statistical purposes only. Please be assured that your responses will remain entirely confidential and known only to project-related researchers in the Center for Primary Care and Prevention. NAA ID number: Gender: Male Female Race/Ethnicity: Age: Height: feet    inches Weight: pounds Current Year of Training: Medical School,  year Resident,  year Other, please specify: Do you currently smoke or use tobacco products? Yes No    If yes, please list them:     Do you regularly take vitamins, minerals, and/ or dietary supplements? Yes No    If yes, please list them:   Within the past seven days, how often did you engage in 20-minute sessions of exercise or physical activity that made you sweat and breathe hard (e.g., basketball, jogging, fast dancing, swimming, tennis, bicycling or similar aerobic activities)? None         1-2 times          3-4 times          5 or more times Nutrition Knowledge Survey Please click on the oval indicating your answer to each of the following questions. 1. Which of the following is not associated with the others?   a. Abdominal obesity b. Hypertriglyceridemia c. Hypertension d. Elevated plasma high density lipoprotein e. Hyperinsulinemia 2. A 56-year-old man presents with complaints of constipation, and is concerned about eating "too much fat". He underwent successful pancreatectomy for pancreatic cancer one year previously. His appetite is good and his weight is stabilized ~ 12 pounds below his preoperative weight. He takes insulin daily and pancreatic digestive enzymes whenever he feels he needs them. He has a bowel movement every few days. You suggest a high fiber diet because ingestion of dietary fiber promotes all but which of the following:   a. bowel integrity b. diarrhea c. chelation with dietary toxins d. metabolism of colonic bacteria e. decreases in serum cholesterol 3. Which of the following are confirmed dietary carcinogens?   a. Fats b. Animal protein c. Nitrites and aflatoxin d. Dairy products e. Artificial sweetners 4. Which of the following does NOT contribute to the quality of dietary proteins?   a. overall amino acid composition b. content of lysine c. digestibility d. protein conformation e. content of tryptophan Questions 5-6: Mr. Z is a 37-year-old man who is concerned about his weight. He weighs 200 pounds and is 5'6" tall. 5. What is his body mass index (BMI)? Weight in kg (pounds divided by 2.2)/Height in meters2 (inches x 2.54 x .01)2   a. 20 b. 26 c. 32 d. 38 e. 44 6. You would classify this patient as:   a. overweight b. average weight c. underweight d. obese e. markedly cahectic 7. Consumption of which one of the following fatty acids predisposes an individual to atherosclerosis?   a. oleic acid b. linoleic acid c. stearic acid d. palmitic acid e. linolenic acid 8. Which of the following is not a potential cause of a vitamin B12 deficiency?   a. Antibodies to intrinsic factor b. Achlorhydria c. Type II diabetes d. Crohn's disease e. Pancreatic insufficiency 9. Malignancies may affect nutritional status by which of the following mechanism(s)?   a. Impaired assimilation of nutrients b. Increased energy expenditure c. Impaired appetite d. Treatment for the malignancy e. All of the above, depending on type of malignancy Questions 10-11: Mr. Binks is is drivung on an Interstate highway at a rate of 65 mph. He is engrossed listening to a story on nutrition fads on NPR and hits a car stalled at the side of the road. After transfer to a regional trauma unit, it is found that he has suffered major musculoskeletal trauma. Enteral support is initiated as soon as possible. His nutrient intake includes 100 grams of protein/day. A 24 hour urine collection shows a total nitrogen content of 39 grams. He has no diarrhea at this time. 10. What is his nitrogen balance? (Nitrogen in gms = protein in gms/6.25)   a. + 25 gms b. + 10 gms c. - 0 gms d. - 10 gms e. - 25 gms 11. This suggests that Mr. Binks may:   a. lose muscle mass b. maintain muscle mass c. gain muscle mass d. be eating too much protein e. be eating too little protein 12. Which of the following vitamins is NOT an antioxidant?   a. Vitamin A b. Vitamin C c. Vitamin D d. Vitamin E e. Vitamin K 13. The nutritional status of which of the following pairs of B vitamins should often be evaluated simultaneously in elderly individuals?   a. B12 and niacin b. Niacin and ribofavin c. B6 and folate d. B12 and folate e. Thiamine and pyridoxine 14. What distinquishes the STEP I American Heart Association diet from the STEP II American Heart Association diet?   a. Total % calories from fat b. Total % calories from saturated fat c. Total % calories from carbohydrate d. Total % calories from polyunsaturated fat e. Total % calories from protein 15. A 45-year-old woman presents to clinic with a history of polyuria and polydipsia and is found to have a fasting blood glucose level of 246 mg/dl. She has a history of gestational diabetes. She is 5'5", weighs 223 pounds, and has a blood pressure of 140/92. The patient is at highest risk for death from which of the following:   a. diabetic nephropathy b. breast cancer c. infectious complications from diabetes d. coronary artery disease e. cerebral hemorrhage 16. Lactating women:   a. require 110-120% of calories and protein compared to their non-lactating counterparts. b. should return to their pre-pregnant diet and set a goal of returning to their pre-pregnant weight by 6-8 weeks post-partum. c. have no additional nutritional needs compared to non-lactating adults. d. should, in all cases, provide fluoride supplements to their infant from two months of age. e. should always supplement their infants with bottled water. 17. Which of the following dietary components have been proven to decreasehuman cancer?   a. Low fat b. Fruits and vegetables c. Vitamin C d. Vitamin A e. Restricted calories 18. The recommended dietary allowances (RDA) for mironutrients:   a. are based on the average needs of all Americans. b. provide a standard that is used for both healthy and ill individuals. c. provide a maximum level above which toxicity may occur. d. include the mean + 2SD (standard deviations) for almost all healthy individuals. e. are the minimum micronutrient needs necessary to prevent deficiency. 19. In humans, the greatest determinant of % body fat is:   a. dietary habits b. metabolic rate c. level of self control or will power d. genetic factors e. psychosocial factors 20. The most common nutritionally related problem in American children is:   a. iron-deficiency anemia b. lactose intolerance c. rickets d. obesity e. dental caries 21. Which of the following is NOT associated with elevated serum potassium levels?   a. renal failure b. trauma c. extrcellular potassium losses d. excess administration e. excess intake of potassium-rich foods 22. When assess energy needs, the following parameter(s) need NOT be considered:   a. height and weight b. lean body mass c. stress and activity level d. preganacy and lactation e. age 23. Advantages of enteral feeding over TPN include all but which of the following:   a. Cost b. Provides superior nutrition c. Reduction in length of hospital stay d. Less complications e. Promotion of gut integrity 24. Which of the following conditions would NOT merit multivitamin supplementation?   a. Avoidance of one of the food groups (e.g., dairy items) b. Pregnancy c. Smoking d. Alcoholism e. Childhood 25. Which of the following vitamins is a potential teratogen (an agent that may cause birth defects) when consumed in excess?   a. Vitamin A b. Vitamin C c. Vitamin D d. Vitamin E e. Vitamin K 26. While the extensiveness of a Nutritional Assessment will vary from patient to patient and the specific diagnosis involved, some level of Nutritional Assessment should be included as part of every patient's History and Physical Exam. This involves a review of all but which one of the following?   a. Anthropometric measures (e.g., height, weight, etc.) b. Serum nutrient levels (e.g., amino acid levels, acetoacetate levels, etc.) c. Evaluation of unusual dietary practices d. Use of vitamin and/or mineral supplements e. General clinical tests (e.g., blood, serum proteins, ions, etc.) Nutrition Attitude Survey This survey is intended to assess the views of medical students about working with patients who may have problems with nutrition. We estimate that it will take five minutes to answer all the items in Part I. There are no right or wrong answers, so respond to all items with complete candor and treat each statement seperately. Part I Please click on the oval indicating your response to each of the following statements.     Strongly Disagree Disagree Uncertain Agree Strongly Agree 1. A change toward a healthier lifestyle is important at any stage in life. 2. Nutritional assessment and counseling should be included in any routine appointment, just like diagnosis and treatment. 3. I have an obligation to improve the health of my patients, including discussing nutrition with them. 4. Patients will rarely change their behavior if they do not have active symptoms of a disease. 5. Patients need specific instructions about how to change their eating behavior. 6. All physicians, regardless of specialty, should counsel high-risk patients about dietary change. 7. Most obese patients want to lose weight but feel frustrated and confused about how to do it. 8. Patients need good tasting alternatives in order to change their eating patterns. 9. Nutrition counseling should be part of routine care by all physicians, regardless of specialty. 10. Most physicians are not adequately trained to discuss nutrition with patients. 11. Specific advice about how to make dietary changes could help some patients improve their eating habits. 12. After receiving nutrition counseling, patients with poor eating patterns will make major changes in their eating behavior. 13. Patients need ongoing counseling following my initial instruction to maintain behavior changes consistent with a healthier diet. 14. Patients will only change their eating patterns if faced with a significant health problem (e.g., a heart attack). 15. Most patients will try to change their lifestyle if I advise them to do so. 16. Physicians can have an effect on a patient's dietary behavior if they take the time to discuss the problem. 17. Patient motivation is essential to achieving dietary change. 18. My patient education efforts will be effective in increasing patient's compliance with nutrition recommendations. 19. Nutrition counseling is not an effective use of my professional time. 20. Individual physicians can have little impact on a patient's ability to lose weight. 21. It is not worth the time to counsel patients with poor dietary patterns about nutrition. 22. For most patients, health education does little to promote adherence to healthy lifestyle. 23. Preventive healthcare is boring. 24. Patients are not motivated to change unless they are sick. 25. After receiving nutrition counseling, patients with poor eating patterns will make moderate changes in their eating behavior. Part II Please click a Yes or No response oval to the following statements. It is important that I: Yes No 26. Address the importance of diet whenever I care for a patient. 27. Identify dietary risk factors in pediatric patients by assessing diet and energy balance. 28. Assess each patient's intake of vitamin, mineral and dietary supplements. 29. Counsel patients regarding their use of supplements and emphasize when they are contraindicated. 30. Whenever possible recommend dietary changes prior to initiating drug therapy. 31. Assess each patient's fat, fiber, and fruit and vegetable intake as a preventive strategy. 32. Request that patients bring a food record or perform another diet assessment measure when they come in for routine visits. 33. Encourage patients to ask diet-related questions and refer them for additional assistance when warranted. 34. Perform at least some level of nutritional assessment with every patient. 35. Follow the National Cholesterol Education Program guidelines for prevention and treatment of high blood cholesterol, such as advocating the Step One or Step Two diet. 36. Assess each patient's weight status in accordance with the national (NIH) guidelines on the identification, evaluation, and treatmnet of obesity in adults. 37. Refer patients with diet-related problems to registered dietitians or other qualified nutrition staff. 38. Evaluate patients' alcohol intake as part of their overall nutritional status. 39. Assess each patient's stage of change prior to initiating dietary intervention. 40. Assess dietary sodium, potassium, and calcium intake especially among patients at risk for hypertension, osteoporosis, or stroke. 41. Refer diabetic patients for detailed dietary counseling. 42. Advocate diet and activity balance to promote weight control. 43. Assess my patient's ability to read a food label. 44. Advocate a low fat diet for weight control. 45. Assist pediatric patients to establish healthy eating habits early to prevent risk for chronic diseases.