1: Introduction to Lifestyle Medicine Flashcards
Review of section 1 in the 4th Ed. ACLM Board review book
Which of the following statements are not true
A. In INTERHEART study five of the risk factors ( smoking, lipids, HT, diabetes, Obesity) identified accounted for 80% on the population attributable risk for acute MI
B. Data in INTERHEART study is from 32 countries.
C. Ten life style risk factors in INTERSTROKE study were associated with90% of the risk of stroke in men and women of all ages.
D. Data in INTERSTROKE study was from 52 countries.
4ed. p10
Answer B&D are reversed
A. In addition to the five risk factors/80% risk, all nine identified RF accounted for more than 90% of the PAR of AMI in men and 94% in women. + diet, physical inactivity, alcohol consumption and psychosocial factors ( stress, Mental health, isolation, addictions PAR 30% comparable to High BP and Abdominal obesity)
B. 52 countries
C. 10 risk factors: HT, Current smoking, abdominal obesity, unhealthy diet, physical inactivity, diabetes, alcohol intake, psychological stress, depression, cardiac causes and abnormal lipids.
D.32
In the **Chicago Heart Association Detection Project in Industry **, making six life style changes can reduce heart disease risk by 90-95%.
Which of the following are incorrect:
A. 50% decease in total cholesterol => 50% risk reduction of heart disease.
B. Smoking cessation- 50% risk reduction of sudden cardiac death
C. Maintain ideal body weight and waist size- 60% risk reduction of heart disease.
D. 150 minutes/week or more of moderate exercise- 30% risk reduction of heart disease.
E. more than 5 serving of fruit and veg per day- 20-25% risk reduction of heart disease.
F. 6mm Hg decrease in diastolic BP - 16% risk reduction of heart disease
Answer D and E
D 35-55% not 60%
E 35-55% not 30%
Also showed lower Medicare costs !
6mmHg reduction in DBP had the least contribution (16%) for heart disease - but reduced stroke risk 42%!
Note that the list is ordered from greatest to lowest impact on heart disease
Page 10-11
Which of the following statements is not true:
A. In Framingham heart study men with optimal risk had 5% life time risk of atherosclerotic CVD versus men with 2 or more risk factors who had 69% life time risk at 50
B. Multiple risk factors intervention trial ( MRFIT) study outcomes included 6-10 years greater life expectancy.
C. Nurses Heart study: 5 health factors associated with low risk of CHD were absence of smoking, BMI <25, Physically active 30 minutes per day, moderate alcohol consumption (5-30 grams or 0.2-1 ounce per day), healthy diet score.
D. Three large prospective studies
* Nurses health study
* Nurses health study 2
* Health professionals follow up study
found that higher adherence to a healthy plant based diet had positive correlation with coronary heart disease.
ANSWER: D
A.Figures for women were 8% vs. 50%. This adds about 10 years to life expectancy. (11+ years for men and 8+ years for women)
B. Low risk patients had 40-60% lower total mortality and 73-85% lower risk CVD mortality.
C. diet score were based on intake of cereal fiber, marine omega 3 fatty acids and folate.
D Healthy (whole food) PBD had an inverse relationship with CAD [HR 0.92] - while unhealthy PBD had positive relationship
Name the biological processes affected by healthy lifestyle:
A) Reduces chronic Systemic inflammation
B) Reduces insulin resistance (the underlying cause of Hyperglycemia & related metabolic dysfunction)
C) Provides Antioxidants
D) Gene expression (epigenetics)
E All of the above
Answer E
Which of the following are incorrect:
A. Adventist Health Study 2: Approx decrease in risks for vegans: Diabetes 50% (OR 0.51), metabolic syndrome 55% (OR 0.44), Hypertension 65% (OR 0.37)
B Lyons Heart Study (Med vs. AHA1) : The protective effects of the Mediterranean diet were not maintained for 4 years following a first heart attack.
C. Portfolio diet - high in plant Sterols, Soy protein, viscous fibers & Berries
D The CHIP program at Vanderbilt University for diabetics : Approximately 24% of study participants were able to eliminate one or more of their medications.
4Ed, p12
ANSWER: B & C
A. NOTE: Pesco-Vegetarian had lowest all-cause mortality!
B Protective effects of Mediterranean diet were maintained for 4 years following a first heart attack.
C Portfolio diet included Almonds not Berries
Which ONE is INCORRECT regarding the five competencies for Physicians
prescribing Lifestyle medicine?
A. Leadership such as promoting healthy personal behaviours at school, work and home.
B. Knowledge of the available evidence supporting lifestyle interventions and positive patient engagement
C. Assessment skills including lifestyle
“vital signs” like tobacco use, alcohol
consumption, diet, physical activity, BMI,
stress level, sleep and emotional wellbeing.
D. Prescribe medications for the patient’s
chronic diseases as well as counselling and
psychotherapy.
E. Use of office and community support
F. A, B, and C.
ANSWER: D
Management Skills is the 4th competency
Includes lifestyle prescriptions, establishing effective relationships and referring when needed
Field of Lifestyle Medicine refers to all
the following except:
A)Holistic approaches to balance core
functional processes, control oxidative
stresses at a cellular level and promote
detoxification.
B) Evidence-based treatment and
prevention of chronic diseases related to
lifestyle and behaviours.
C) Reversal of certain lifestyle-related
diseases.
D) Assisting the patient in enhancing his diet
with whole foods, incorporating physical
activity and emotional well-being practices
and avoiding risky substances. Medications
are used as an adjunct.
Answer A.
Regarding adverse drug reactions, which
one of the following is incorrect?
A) They often occur despite appropriate
use.
B) They are the 3rd leading cause of
death in the US, ranking higher than
pulmonary disease, diabetes, AIDS,
pneumonia, accidents and motor vehicle
accidents.
C) There are more than two million serious
reactions per year.
D) The total cost of adverse drug reactions
is more than that of cardiovascular disease or
diabetes
Answer:
B 4th leading cause
which is the following is not true
A. Ideally, a ITLC includes an INDUCTION phase which precedes the MAINTENANCE and SUPPORT phases in lifestyle change
- outpatient programs have visits ~ 60 minutes 1-3x/week for 8-18 weeks
- Residential programs are generally 7-21 days long
- Shorter ITLC immersions can last 3-10 days.
B examples of 3 ITLC programs
1) Pritkin program 1970s
2) Ornish program - 1980s
3) Diehl CHIP program - 1990s
C A whole food plant based diet (WFPB diet):
1) Consists of mostly foods from plants (eg whole grains, vegetables, fruits, beans & legumes)
2) Little or no animal products (eg dairy, meat, eggs)
D LM approach include
Feet, fingers, forks, sleep stress love (Mnemonic)
Feet - REGULAR physical activity
Fingers - avoid risky substances (eg tobacco, drugs)
Forks - PREDOMINANTLY whole food plant-based diet
Sleep - ADEQUATE sleep
Stress - stress MANAGEMENT
Love - non-drug modalities to PROMOTE health & PREVENT disease
E All true
Answer E
With respect to lifestyle medicine and its impact on disease pathophysiology, the following are true except:
A. Change gene expression in men with low risk prostate cancer
B. Beta cell regeneration via fasting mimicking diet.
C. Normalisation of beta cell function.
D. Improved Oxygen uptake at peak exercise.
E. Acute systemic inflammation.
F. Increase in LDL-C
G. Change telomerase activity and telomere length.
Answer
E: its chronic systemic inflammation
F. Decrease in LDL-C
Physical inactivity is the ______ leading risk factor for global mortality. It is the cause of 1:______ premature deaths.
4th
10
Which risk factors differed between InterHeart vs InterStroke Study?
9 in IH: psychosocial factors
10 in IS: psychological stress and depression were identified separately
Name 3 programs that have demonstrated lower healthcare costs through lifestyle modification?
Chicago Heart Association Detection Project in Industry
(low risk CAD men had less than 2/3 Medicare costs of controls, low risk women less than 1/2)
Diabetes Prevention Program
CHIP Lifestyle program - Vanderbilt
Community Weight-loss program for obese patients
What is the prevalence of obesity in children and adolescents?
A. 10%
B. 20%
C. 30%
D. 40%
B. 20% (21% in adolescents)
Which countries have the best performance compared to spending?
United Kingdom
New Zealand
(USA is the worst in both - 17% of GDP)
