Self Management/Lifestyle Interventions—Quiz With Answers:
1. US health professionals with at least one unhealthy lifestyle factor (smoking, heavy alcohol use, obesity, or physical activity) had higher all cause mortality associated with
A. Higher animal protein consumption [correct answer]
B. Lower animal protein consumption
C. Replacement of red meat with 3% of energy from plant protein
D. Replacement of eggs with 3% of energy from plant protein
ANSWER: A. The Nurses’ Health Study and Health Professionals Follow-up Study showed a dose response increase in mortality with increasing animal protein consumption (+8% per 10% energy increment) and decreased mortality with increasing plant protein consumption (-10% per 3% energy increment). Mortality was decreased 34% with 3% energy substitution of plant protein for red meat and decreased 19% when the plant protein substitution was made for egg protein.1
2. Evidence suggests cardiovascular events are NOT decreased by adherence to which diet:
A. DASH diet
B. Low carbohydrate diet [correct answer]
C. Swedish diet
D. Low fat diet
ANSWER: B. See Table on slide 11. A 23-year study on 42,327 Swedish women showed a dose responsive 6% increase in cardiovascular mortality for each decile of decreased carbohydrate consumption or increased protein intake.2 Also, the Nurses’ Health Study and Health Professionals Follow-up Study showed an animal protein- based low carbohydrate diet was associated with 14% increase in cardiovascular mortality, while a plant protein- based low carbohydrate diet was associated with 23% decrease in cardiovascular mortality.3 The low fat diet- based Pritikin program was associated with a decrease in mortality from 17% expected to 6% for patients recommended to have coronary artery bypass.4 Following a low fat diet-based Ornish program resulted in resolution of chronic angina in 74% of 1,152 patients over 12 weeks versus controls.5
3. Regarding physical exercise, which of the following is TRUE?
A. Cardiac rehabilitation programs have been shown to reduce cardiovascular mortality but not all cause mortality.
B. Walking a total of 2 miles per week can reduce all cause mortality by 39% in diabetics. [correct answer]
C. Inactive adults require thrice weekly muscle strengthening exercise to improve cardiac outcomes.
D. Sedentary adults need moderate to vigorous activity to significantly improve health outcomes.
ANSWER: B. See slide 38. A study of 2,896 diabetic adults for 8 years showed a 39% reduction in all cause mortality for those who walked at least 2 hours per week.6
4. The Medicare G0104 group diabetes self-management training code could generate reimbursement of up to $700 per 30-minute session for a group of 20 qualifying patients no more than ___ times per year
A. A randomized single blinded study shows lifestyle intervention (comprised of stress management, group support, mild to moderate exercise, and very low fat vegetarian diet) reverses myocardial PET perfusion abnormalities in atherosclerotic patients.7
B. A prospective randomized controlled trial shows lifestyle intervention (comprised of stress management, smoking cessation, moderate exercise, and low-fat vegetarian diet) reverses coronary artery stenosis on quantitative coronary angiography in atherosclerotic patients.8
C. A prospective randomized controlled trial shows transcendental meditation decreases exercise induced myocardial ischemia on stress testing in atherosclerotic patients.9
D. A prospective randomized controlled trial shows lifestyle intervention (comprised of stress management, social support, moderate exercise, and low-fat vegetarian diet) increases telomere length in biopsy proven prostate cancer patients.10
E. All of the above [correct answer]
ANSWER: E. See footnotes for study references.
6. 96% of Americans fail to consume the USDA/CDC recommended daily requirement of
A. Fiber [correct answer]
B. Water
C. Protein
D. Vitamin D
E. Calcium
ANSWER: A. See footnotes for study references, from the US Department of Agriculture’s National Health and Nutrition Examination Survey11 and the CDC.12
References—PowerPoint Slides:
American Diabetes Association website. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/checking-your-blood-glucose.html. Accessed October 4, 2016.
Demark-Wahnefried W, Rock CL, Patrick K, Byers T. Lifestyle interventions to reduce cancer risk and improve outcomes. Am Fam Physician 2008 Jun 1;77(11):1573-8
Esselstyn CB Jr, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Pract 2014 Jul;63(7):356-364b.
Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community. Circulation 2011 May 31;123(21):2344-52.
Katz DL, Meller S. Can we say what diet is best for health? Annu Rev Public Health 2014;35:83-103.
Kushi LH, Doyle C, McCullough M, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians 2012;62:30-67.
Lanier JB, Bury DC, Richardson SW. Diet and physical activity for cardiovascular disease prevention. Am Fam Physician 2016 Jun 1;93(11):919-24.
Pickering TG, Miller NH, Ogedegbe G, et al. Call to action on use and reimbursement for home blood pressure monitoring: executive summary: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension 2008;52:10-29
Ripsin CM, Kang H, Urban RJ. Management of blood glucose in type 2 diabetes mellitus. Am Fam Physician 2009 Jan 1;79(1):29-36.
Standards of Medical Care in Diabetes—2014. American Diabetes Association. Diabetes Care 2014 Jan; 37(Suppl 1):S14-S80.
