Vol. 34, No.1

1. The rapid growth in research and policy interest in ultra-processed foods (UPFs) has led to increased interest in what UPFs are or are not. When it comes to UPFs, there is/are:

a. Established and universally accepted definitions of UPFs.

b. A standard definition of UPFs that defines them as “junk” foods.

c. No universally accepted definition of UPFs yet.

d. A universally accepted definition of UPFs being defined as any “high” fat food.

2. Janet is a patient who wants to remove all UPFs from her routine meal plan because she views all UPFs as “bad.” Based on the most recent research, you advise her that:

a. While total UPF intake has been linked with obesity and adverse health outcomes, these associations are largely driven by specific categories of UPFs (e.g., processed meat).

b. Studies show that nutrient-adequate diets with high UPF content can still be constructed, underscoring the importance of distinguishing nutrient composition from processing.

c. She (Janet) is correct, all UPFs are bad and should be avoided because they are all linked to obesity, diabetes, and other chronic health conditions.

d. A and B

3. Product X contains flavor enhancers, sweeteners, and coloring agents. Which statement is true regarding these food constituents?

a. These constituents are found in whole foods, like fresh fruit, and are not associated with health issues.

b. These constituents are markers of UPFs and studies show some are associated with increased mortality risk, whereas others are not.

c. All of these constitutes have research strongly supporting the claim they are unhealthy and should be avoided.

d. Only meats and meat products that contain these food constituents are harmful to health.

4. Damien is a patient that is concerned about the impact of processed foods on his health and the health of his family. What counseling tips might you employ when discussing this topic with Damien?

a. Not all processed foods are alike.

b. Look at the nutrients.

c. Pace and produce and focus on overall balance.

d. All of the above

5. Legumes, such as soybeans and pulses, represent a healthy, economical, and sustainable source of plant protein. These foods are unique in that they provide both protein and fiber. Your patient asks, “What are pulses?” Two examples include:

a. Dry beans

b. Lentils

c. Sunflower seeds

d. A and B

6. Plant-based meat alternatives (PBMAs) derived from legumes offer a promising and convenient way to increase plant protein intake beyond traditional legume preparations. PBMAs are typically comprised of a concentrated protein source, usually pea, soy or wheat, along with fat, binding and flavoring agents, and colorants. What are PBMAs classified as according to Nova?

a. Unprocessed

b. Plant processed

c. Ultra-processed

d. Fresh processed

7. Observational studies consistently link total UPF intake to adverse health effects, but subgroups of UPFs differentially affect health outcomes. Much of the association between total UPF intake and adverse health is driven by a few subcategories, especially:

a. Processed meat and sugar-sweetened beverages

b. Frozen fruits and vegetables

c. Fresh produce

d. Processed meat and whole fruits

8. Paul is a dietetic intern and asks you about the conflicting research regarding PBMAs and health risks. One study from Stanford reported that compared to meat, consuming PBMAs resulted in improved cardiovascular disease risk factors. However, a study from Singapore failed to find differences in health outcomes related to PBMA intake. According to the research, what was one explanation for the discrepancy in results?

a. The sample size was too small, and the study designs were dissimilar.

b. Differences in nutrient content between the studies were noted and highlighted the importance of nutrient content vs. extent of processing.

c. The PBMAs were high in fat and sugar in the Singapore study which led to discordant results.

d. The serving sizes of the PBMAs from the Stanford study were significantly smaller than the Singapore study and the caloric content was also much lower, leading to different results.

9. PBMAs are typically not associated with increased health risks, but PBMAs can vary markedly in nutrient content. Some PBMAs may be relatively high in ___________ which is important to consider in the context of a balanced meal plan.

a. Zinc

b. Calcium

c. Sodium

d. Potassium

10. Ryan has Celiac Disease (CD) and would like to try soy products. She asks if soy foods are safe to consume. What advice might you provide to her?

a. Soybeans do not contain gluten, but some products like soy sauce, might contain wheat. It is important to read the labels.

b. Consuming soy can trigger CD symptoms in all patients because soybeans contain gluten and should be avoided.

c. It’s possible some soy flour may be contaminated with wheat flour, look for “gluten free” on the label to ensure the product meets FDA standards of gluten free, <20 parts per million gluten.

d. A and C

11. Your patient, Ryan, returns for dietary counseling after adding more soy products to her diet. She reports that after eating some bulk edamame purchased at a farmers’ market, she experienced CD symptoms; she has not experienced CD symptoms after eating tofu, tempeh, or other soy products. What are some possible explanations for why she could have experienced CD symptoms after eating the edamame?

a. Comingling of grain can occur because of the use of shared harvesting, transporting, and processing equipment leading to contamination with gluten.

b. Soybeans are typically rotated with other crops to improve soil conditions, one of which is wheat, which could have possibly contaminated the edamame with gluten.

c. The edamame was self-scooped from a bulk bin so it is possible wheat from the neighboring bin or other source could have contaminated the edamame with gluten.

d. All of the above

12. Jason is a 42-year-old patient who was recently diagnosed with CD. He started a gluten free diet but is still experiencing symptoms. Jason said, “I’ve switched to a gluten free, vegetarian diet to reduce my risk of heart disease, which runs in my family.” During his visit with you, he mentions he has “avoided soy completely because I was told by my mother that I had a soy allergy as a child.” He states, “I know my mom said I had an allergy, but I tried tofu for the first time the other day. Not long after, my GI symptoms were terrible. I felt better, then I drank some soymilk and the same thing happened. I think it’s my CD getting worse.” What does the research indicate about CD patients who may not respond well to a gluten free diet or those who experience CD symptoms after consuming soy?

a. CD patients who responded poorly to a gluten-free diet had significant anti-soya antibodies in comparison to patients with other gastrointestinal diseases.

b. CD patients may have an associated dietary soy sensitivity which could adversely influence their response to gluten withdrawal.

c. Research shows soybeans, tofu, and soy flour all have high levels of gluten and should be avoided by CD patients.

d. A and B

Continuing Professional Education Credit