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FNH 398 Practice Final Exam

This exam is designed to help you prepare for your FNH 398 Final Exam. The exam does not include an exhaustive list of all topics – you are still responsible for knowing everything covered in class, including topics not assessed here.

The exam has 45 possible marks with

25 Multiple choice questions

20 Short answer questions

To practice timing for the final exam, you should be able to complete this within 1 hr & 50 min.

Multiple Choice Questions (25 marks)

Choose the best answer for each of the questions below.

1. Janet is a graduate student who just started work in her new lab. During her orientation she notices that the lab has labelled study samples with participants names instead of study codes. She asks about this and her supervisor said that they find it simpler to just label samples with names rather than anonymous identifiers.

The ethical principle that is violated here is:

A. Justice

B. Concern for welfare

C. Informed consent

D. Respect for persons

E. Coercion

2. In which of the following studies would it be most appropriate to use an animal study?

A. Investigating the association between social meal-time interactions and number of calories consumed

B. Investigating whether Vitamin D supplementation can promote healthy sleep patterns

C. Investigating the impact of dietary fibre in preventing diarrhea in patients with irritable bowel disease

D. Investigating the effects of plasmalogens from mother’s milk on neonatal brain and liver development

3. When conducting animal research, ethical considerations are important. Which is NOT one of the “3 Rs” associated with use of animals in research?

A. Replacement of animal research with other methods when possible

B. Reduction of number of animals used

C. Re-using the same animals in multiple studies to reduce costs and risks to humans before conducting epidemiological human trials

D. Refining methods to minimize distress to animals

Study for questions 4-7

A hypothetical study was done to assess calcium and vitamin D intakes of UBC students. Students were randomly selected from a list of all UBC student numbers and invited to participate. Of 3000 students contacted, 1000 agreed to participate and signed informed consent. These students were asked to self-report intake through three 24 hour dietary recalls including use of supplements. The results are provided below:

All students

(n = 1000)

Non-supplement users (n = 600)

Supplement users

(n= 400)

Calcium

760± 100 mg

600 ± 90 mg

1000 ± 200 mg*

Vitamin D

10.2 mcg ± 10 mcg

7 mcg ± 10 mcg

15 mcg ± 10 mcg

All values are mean ± standard deviation. *Significantly different from non-supplement users, P<0.05.

4. What type of study is described above?

A. Qualitative

B. Cross sectional

C. Cohort

D. Case control

E. Experimental

5. What type of sampling was done?

A. Simple random

B. Systematic

C. Cluster

D. Convenience

E. Quota

6. What statistical test was used to determine differences in calcium intake between non-supplement and supplement users?

A. Paired t-test

B. Unpaired t-test

C. One-way ANOVA

D. Chi-squared

E. Pearson correlation

7. The main limitation of this study was:

A. Recalls are not a valid method for assessing intakes

B. Interviewer bias may have influenced the results

C. Recall bias

D. Publication bias

E. Non-response bias

8. Why do participants in research studies need to sign or verbally give informed consent?

A. To follow the principle of concern for welfare, which states that participation in a research study must be voluntary

B. To follow the Tri-Council Policy Statement, which states that records providing demographic information must be maintained for all research participants

C. To follow the principle of respect for persons, which states people can make their own decisions when given full information about the benefits and risks of a study

Study for questions 9-11

A study was done to assess the association between persistent dieting and bone mineral density.

150 patients that had recently been diagnosed with low bone mineral density were compared to 150 age and sex matched controls. Of those with low bone mineral density, 80 claimed to be persistent dieters. Of those without low bone mineral density, 45 claimed to be persistent dieters.

9. What type of study was done in the example above?

A. Qualitative

B. Case control

C. Cohort

D. Retrospective cohort

E. Experimental

10. Why were controls matched for age and sex?

A. To ensure blinding of researchers

B. To ensure adequate sample size

C. To ensure randomization was successful

D. To ensure groups were comparable on potential confounding factors

E. To ensure adequate representation of all ages and sexes

11. What is the odds ratio for odds of low bone mineral density among persistent dieters compared to non-dieters?

A. 0.375

B. 0.562

C. 1.78

D. 2.67

Results for questions 12 – 13

The following results are results from a meta-analysis that compared the effects of dietary coconut oil compared to other edible oils on LDL cholesterol levels.

12. An appropriate conclusion for the study is that:

A. Coconut oil consumption was associated with 10.47 mg/L higher LDL cholesterol compared to other oils

B. Coconut oil consumption was associated with 10.47 mg/L lower LDL cholesterol compared to other oils

C. Coconut oil consumption was associated with 10.47 times higher risk of high LDL cholesterol compared to other oils

D. Coconut oil consumption was associated with 47% times increased risk of high LDL cholesterol compared to other oils

E. Coconut oil was not associated with LDL cholesterol levels

13. Which of the following is true in this study?

A. There was very low heterogeneity among the studies, therefore, it may not have been appropriate to combine them

B. There was very low heterogeneity among the studies, therefore, it was appropriate to combine them

C. There was significant heterogeneity among the studies, therefore, it may not have been appropriate to combine them

D. There was significant heterogeneity among the studies, therefore, it was appropriate to combine them

14. When making evidence based decisions, which would you put most weight on?

A. A double blind placebo controlled randomized controlled trial

B. A meta-analysis of randomized trials

C. A cohort study

D. A case control study

E. A narrative review

15. Which of the following is TRUE regarding animal research?

A. A chow diet is preferred in nutrition studies using animals, as it is easier to control

the nutrient composition of chow diets than purified diets

B. It is important to monitor weight gain in animal studies

C. Ethics approval is not required for most types of animal studies

D. Animal studies in human nutrition typically follow an observational study design

E. Most animals used in research at UBC are birds and large mammals

16. A Cochrane Systematic Review differs from other systematic reviews because in a Cochrane review the authors agree to:

A. Use a systematic approach to finding and selecting studies for inclusion

B. Assess the risk of bias in included studies

C. Update the study every two years

D. Disclose any conflicts of interest

E. Search a minimum of three databases

17. To assess the effects of vitamin D supplements on risk of severe COVID 19, researchers randomly assigned participants to receive vitamin D supplements or placebo for five years. Risk of severe COVID 19 was compared in those who received supplements compared to those who did not.

Which of the following best describes the study design above?

R X O

R O

R O X O

R O O

R O X O

R O

R X O

Abstract for questions 18-20

AJCN. 2019: 109(1), 109–116.https://doi.org/10.1093/ajcn/nqy254

Objective: This study aimed to examine the association between iron intake and cognitive function in Chinese adults and tested the interaction effect of iron intake and BMI on cognition.

Design: Longitudinal study data from a nationwide sample (n = 4852; age ≥55 y) from the China Health and Nutrition Survey during 1991–2006 were used. Of the participants, 3302 had completed cognitive screening tests in ≥2 surveys. Cognitive function was assessed in 1997, 2000, 2004, and 2006. Dietary iron intake was obtained from a 3-d food record during home visits in 1991, 1993, 1997, 2000, 2004, and 2006. Multivariable mixed linear regression and logistic regression were used.

Results: The cumulative mean ± SD iron intake in 1997 of tested subjects was 23.7 ± 11.3 mg/d (25.4 mg/d in men and 22.2 mg/d in women). High iron intake was associated with poor cognition. …The association between high iron intake and poor cognition was stronger among those with a high BMI than those with a low BMI. Among those with a BMI (kg/m²) >24, across quartiles of iron intake the ORs (95% CIs) for poor cognitive function were 1.00, 1.27 (0.91, 1.78), 1.41 (0.97, 2.04), and 2.04 (1.38, 3.01), respectively.

18. What type of study was done in the abstract above?

A. Cross sectional

B. Case control

C. Nested case control

D. Prospective cohort

E. Retrospective cohort

19. Among adults with a BMI >24, consumption of iron in the highest compared to lowest quartile was associated with :

A. Lower risk of poor cognition and this was statistically significant

B. Higher risk of poor cognition and this was statistically significant

C. Lower risk of poor cognition but this was not statistically significant

D. Higher risk of poor cognition but this was not statistically significant

20. Why was diet intake measured in 1991, 1993, 1997, 2000, 2004, and 2006?

A. To ensure validity of the measurement

B. To ensure reliability of the measurement

C. To assess for changes in the diet

D. To ensure compliance with the intervention

21. Animal studies are lower on the hierarchy of evidence than human studies. This is because:

A. Most animal studies use an observational design

B. Blinding is not possible in animal studies

C. Animal diets cannot be designed to be similar to human diets

D. Animal biology differs from human biology

E. Animals, especially rodents and mice, and genetically very different from humans

22. Which of the following threats to internal validity can be minimized by using a control group?

A. Selection

B. Experimental mortality

C. Regression to the mean

D. History

23. Which of the following statistical tests is most appropriate for assessing results of an experimental study?

A. Parametric tests including t-test, ANOVA and correlation

B. Odds ratio

C. Relative risks

D. Two of the above

E. All of the above may be used in experimental studies

24. Why is justice an important ethical principle?

A. It allows for the distribution of the burdens and benefits of research

B. It allows participants to make their own decisions about whether or not to participate in research

C. It ensures that the benefits outweigh the risks of research

D. It ensures appropriate consent for people with diminished capacity

Abstract for question 25

From: Atazadegan MA et al. J Trace Elem Med Biol. 2021 Nov 18;69:126903.

Background: Normal fetal growth is associated with maternal nutrition. Trace elements play important roles in fetus growth. This study aims to evaluate the relation between selenium, zinc and copper levels during pregnancy with birth weight.

Method: A literature search was conducted in Medline database (PubMed), Scopus, Web of science and Google scholar up to September 2020. Fifty observational studies were included in the final analyses. The desired pooled effect size was considered as standardized mean differences with 95 % CI or correlation. Cochran's Q statistic was used to test the heterogeneity between the included studies (I²).

Result: A significant differences were found between pooled standardized mean differences (SMD) of umbilical cord blood copper levels in small-for-gestational age birth weight (SGA) and appropriate-for-gestational age birth weight (AGA) (SMD: 0.34 μg/L, 95 % CI: 0.13 to 0.56). There was a significant pooled correlation between umbilical cord blood selenium concentrations and birth weight (r: 0.08, 95 % CI: 0.01 to 0.16). A significant pooled correlation was found between umbilical cord blood zinc concentrations and birth weight (r: 0.09, 95 % CI: 0.04 to 0.15), with significant heterogeneity (I² % = 0.63). There was significant positive association between maternal blood zinc concentrations and birth weight.

Conclusion: Findings showed the association of trace elements including selenium, zinc and copper during pregnancy with birth weight. There was significant correlation between umbilical cord and maternal blood selenium and zinc levels with birth weight. The umbilical cord blood copper levels in SGA birth weight was higher than copper levels in AGA birth weight.

25. What type of study is described above?

A. Narrative review

B. Systematic review

C. Systematic review with meta-analysis

D. Cohort study

E. Observational study

Short Answer Questions (20 marks)

Answer all of the questions below. Ensure your answers are clear and concise. Point form is fine.

Abstract for questions 1-4

From: AJCN 2021; 114(5): 1612-1624 https://doi.org/10.1093/ajcn/nqab235

Objectives:We investigated prospectively the associations between unrestrained eating behavior and digestive system cancer risk.

Methods: Participants in the Nurses’ Health Study who were free of cancer and reported dietary information in 1994 were followed for ≤18 y. Cox models were used to estimate HRs and 95% CIs for unrestrained eating (eating anything at any time) and risk of digestive system cancers.

Results are provided below:

TABLE 2

Self-reported unrestrained eating and digestive system cancer risk

	Eating anything at any time
	No (n= 54, 320)	Yes (n= 16 130)
Digestive Cancer	1507	557
Age-adjusted	1 [Reference]	1.32 (1.20, 1.46)
Multivariable	1	1.22 (1.10, 1.35)

1. What type of study was done? (1 mark)

2. What is the crude RR for unrestrained eating and digestive cancer? (1 mark)

3. What could be a confounder in the study above? Explain. (1 mark)

4. Describe two limitations of the study design above. (2 marks)

Scenario for questions 5-6

A researcher aims to determine whether wearing sunscreen influences endogenous synthesis of vitamin D during the fall months. Their comparison groups would be wearing SPF 30 or nothing while outdoors for 15 minutes. Their outcome variable is vitamin D levels in blood.

5. Describe an appropriate study design to answer the question above. Justify your choice.(2 marks)

6. Is blinding possible in this study? How might this be accomplished? (1 mark)

Study for questions 7-8:

To determine whether higher intakes of omega-3 fatty acids decreases risk of long-term COVID 19, a researcher asks a group of volunteers to take omega-3 fatty acid supplements daily for five years. These subjects will be followed for the duration of the study to determine whether omega-3 fatty acid supplementation reduces their risk of developing COVID 19.

7. What type of study design is described above. Be specific. (1 mark)

8. Describe one threat to the internal validity of this study, and explain how you could improve the study to minimize this. (2 marks)

Results for questions 9-13

From: Antioxidants (Basel). 2021 Oct 29;10(11):1731. doi: 10.3390/antiox10111731.

Below are the results from a meta-analysis on green tea consumption and total antioxidant capacity (TAC). Results are presented as a weighted mean difference (WMD) in TAC in mmol/L.