Chapter 25 — Self-Check Quiz

20 questions. Answers with explanations at the end. Aim for 16+.

Questions

1. In older age, the pattern of requirements is:

• a) Energy up, protein down
• b) Energy down, protein up, micronutrients same or up — so required nutrient density is the highest of adult life
• c) Everything down proportionally
• d) Everything up

2. Folic acid is recommended preconception because:

• a) It takes months to absorb
• b) The neural tube closes at around four weeks — often before pregnancy is known
• c) It is depleted by pregnancy tests
• d) It only works before conception

3. The energy increase in pregnancy is approximately:

• a) Double
• b) Essentially nothing in T1, ~+340 kcal/day in T2, ~+450 in T3
• c) +1,000 kcal/day throughout
• d) Zero throughout

4. Which nutrient does the chapter call genuinely under-taught in pregnancy, and often absent from prenatal supplements?

• a) Vitamin C
• b) Choline
• c) Magnesium
• d) Vitamin K

5. The real food-safety dangers in pregnancy are:

• a) Pesticide residues
• b) Listeria and Toxoplasma — unpasteurized dairy, deli meats, undercooked meat, unwashed produce
• c) Food additives
• d) Non-organic produce

6. Compared with pregnancy, lactation requires:

• a) Less energy and less iodine
• b) More energy than any trimester, and higher iodine than pregnancy
• c) The same as the third trimester
• d) No change from pre-pregnancy

7. The strongest causal evidence on breastfeeding comes from PROBIT, which found:

• a) Large effects on IQ and adult obesity
• b) Clear reductions in GI infection and eczema, with much more modest or absent effects on many long-term outcomes
• c) No benefits of any kind
• d) That formula is superior

8. Complementary feeding is recommended at around six months mainly because:

• a) Teeth appear
• b) In-utero iron stores deplete around then, and milk alone no longer supplies enough
• c) Milk becomes indigestible
• d) It is a cultural convention

9. Which complementary-feeding rule does the chapter describe as absolute?

• a) No cow's milk as a main drink before 12 months
• b) No honey before 12 months, because of infant botulism
• c) Purées before finger foods
• d) No salt

10. The LEAP trial found that early peanut introduction in high-risk infants:

• a) Increased allergy risk
• b) Substantially reduced peanut allergy, changing guidelines internationally
• c) Had no effect
• d) Was unsafe

11. Under the division of responsibility:

• a) The parent decides what, when and where; the child decides whether and how much
• b) The child decides everything
• c) The parent decides how much
• d) Neither decides; the schedule does

12. Pressuring a child to eat a food is associated with:

• a) Increased liking of that food
• b) REDUCED liking of that food, and poorer self-regulation
• c) No effect
• d) Improved nutrient intake only

13. Restricting a food from a child is associated with:

• a) Reduced desire for it
• b) INCREASED desire for it, and eating in the absence of hunger
• c) No effect
• d) Improved self-regulation

14. Parental weight-related talk with adolescents is associated with:

• a) Weight loss
• b) Disordered eating, lower self-esteem, and weight GAIN
• c) Improved body image
• d) No measurable effect

15. Peak bone mass is largely accrued by:

• a) Age 8
• b) The late teens to early twenties
• c) Age 40
• d) The menopause transition

16. Regarding weight and the menopause transition, the accurate position is:

• a) Menopause causes all the weight gain
• b) The scale change is largely age-related; the fat redistribution toward the abdomen is menopause-related, and that is what matters metabolically
• c) Nothing changes
• d) Metabolism crashes

17. In older adults, which of these inverts?

• a) Unintended weight loss becomes a red flag rather than a success
• b) "Eat enough" replaces "eat less"
• c) Sarcopenia overtakes adiposity as the dominant risk
• d) All of the above

18. Protein recommendations for healthy older adults are commonly around:

• a) 0.8 g/kg/day, as for all adults
• b) 1.0–1.2 g/kg/day with roughly 0.4 g/kg per meal, because of anabolic resistance
• c) 3 g/kg/day
• d) There is no recommendation

19. The two most cost-effective interventions in §25.14 are:

• a) Protein powder and multivitamins
• b) A dental review and a medication review — neither of which is a nutrition intervention
• c) Oral nutritional supplements and fortified drinks
• d) Meal delivery and vitamin D

20. Recurrent chest infections in an older person should prompt:

• a) Antibiotic prophylaxis only
• b) A swallowing assessment — aspiration is a leading cause of death in advanced dementia and Parkinson's
• c) A weight-loss plan
• d) Nothing specific

Answers

1. b) Energy down, protein up, micronutrients same or up. ⚠️ Required nutrient density is highest at 80 — arriving exactly when appetite, taste, dentition, cooking capacity, income and company are all declining. That mismatch is the chapter's central problem. §25.1, §25.12.

2. b) The neural tube closes at ~4 weeks. ⚠️ Often before pregnancy is known, which is why the recommendation attaches to anyone who could become pregnant, not to pregnant people. 400 µg/day typically; substantially higher in defined risk groups. §25.2.

3. b) ~nothing, +340, +450. ⚠️ "Eating for two" is 🟠 — the increase is about a sandwich. §25.2.

4. b) Choline. ⚠️ Requirements rise, intakes are frequently below recommendations, eggs, meat and legumes are the main sources — and many prenatal supplements contain little or none. Check yours. §25.2.

5. b) Listeria and Toxoplasma. ⚠️ Chapter 20 §20.12b's comparative risk, landing where it matters most. Far more consequential than any pesticide residue question. §25.2.

6. b) More energy than any trimester; higher iodine. ⚠️ ~+330–500 kcal/day. And this is the stage where under-eating is most likely and most consequential — a new parent is exhausted, time-poor, often trying to lose pregnancy weight, and receiving advice written for someone else. Aggressive restriction can reduce supply. §25.4.

7. b) GI infection and eczema reductions; modest or absent long-term effects. ⚠️ Long-term claims — IQ, obesity — are heavily confounded, and sibling-pair analyses find much smaller effects. Both halves of §25.4 are true: breastfeeding has real measurable benefits, principally infection reduction in infancy, AND formula is a safe adequate alternative. A reader who takes only one has been misled. §25.4.

8. b) Iron stores deplete. ⚠️ Which is why iron-rich foods matter most among first foods (Chapter 14). §25.5.

9. b) No honey before 12 months. ⚠️ Infant botulism. (Cow's milk as a main drink before 12 months and no added salt or sugar are also rules — honey is the absolute one.) §25.5.

10. b) Substantially reduced peanut allergy. Du Toit et al., NEJM, 2015. ⚠️ Guidance had previously said the OPPOSITE — delay introduction. This is Chapter 17's stale-guidance category with a child's allergy at stake, and nobody wrote to tell anyone. ⚠️ Exception: severe eczema or existing food allergy warrants assessment first (Chapter 28). §25.5.

11. a) Parent decides what/when/where; child decides whether/how much. ⚠️ It resolves most mealtime conflict by removing the thing being fought over. §25.6.

12. b) REDUCED liking. ⚠️ "Three more bites" reduces liking of the pressured food and impairs self-regulation. §25.6.

13. b) INCREASED desire. ⚠️ Pressure and restriction backfire in OPPOSITE directions — and they are the two things almost every anxious parent does. Pressure to eat vegetables reduces liking of vegetables; restricting biscuits increases desire for biscuits. The intuitive interventions have the reverse of the intended effect. §25.6.

14. b) Disordered eating, lower self-esteem, and weight GAIN. ⚠️ Chapter 24 §24.9's prospective finding in a younger population. The instruction: do not diet a child, do not comment on a child's body, and do not comment on your own in front of them. Change the household, never the child. §25.7.

15. b) Late teens to early twenties. ⚠️ "The account you have at 55 is the one you opened at 15." An adolescent who under-fuels reaches a lower peak, and nothing after fully recovers it — which is why Chapter 23's RED-S material and §25.10's bone material are the same problem thirty-five years apart. §25.8, §25.10b.

16. b) Scale change is mostly age; redistribution is menopause and matters metabolically. ⚠️ Telling a woman she's imagining it is wrong. So is telling her that her metabolism has crashed. §25.10.

17. d) All of the above. ⚠️ Plus: restriction costs more and delivers less, and a modestly higher BMI is associated with lower mortality in older age. Chapter 24 §24.14b flagged this row and §25.12 is where it lands. §25.12.

18. b) 1.0–1.2 g/kg/day, ~0.4 g/kg per meal. ⚠️ Anabolic resistance (Chapter 8 §8.6) — older muscle responds less to a given dose, so both the total and the per-meal dose must rise. Higher in illness. ⚠️ And protein without resistance training does much less: together they work. (Significant kidney disease changes this — Chapter 29.) §25.13.

19. b) A dental review and a medication review. ⚠️ Neither is a nutrition intervention. Anyone advising an older adult about diet who hasn't asked about their teeth and their tablets is guessing. And eating with other people is among the most effective things available. §25.14.

20. b) A swallowing assessment. ⚠️ Recurrent chest infections in an older person are a swallowing question until proven otherwise — and aspiration pneumonia is a leading cause of death in advanced dementia and Parkinson's. Refer to speech and language therapy; texture modification is prescribed, not improvised. ⚠️ And modified diets are frequently lower in energy and protein than the food they replace, so intake needs watching MORE closely, not less. §25.14.

Scoring

Three items worth checking regardless of score.

Questions 12 and 13. ⚠️ If you got either wrong and you feed a child, this is the highest-value correction in the chapter — and it applies today.

Question 17. ⚠️ The inversion is the thing most likely to make you give bad advice to someone you love.

Question 19. ⚠️ Two questions, thirty seconds, and they outperform anything nutritional.