Nutrition lesson 1 quiz & Chapter 1 Overview of nutrition
Why might someone choose food out of habit?
-comforting -time of day (juice) -Its what they've always done
A mineral is what?
A chemical element; its atoms are all alike, so its identity never changes
Nutrient Density
A measure of nutrients a food provides relative to the energy content of that food
Scientific Method
A series of steps and protocols that researchers use to determine if there is a relationship between two or more variables
What are the three energy yielding nutrients?
Carbohydrates fat protein
Macronutrients
Energy-yielding nutrients (carbohydrate, protein and fat) that are needed in large amounts
Nutrients that must be obtained through the diet because the body doesn't make enough of them to meet needs are known as a(n): Essential nutrients Organic nutrients Macronutrients Micronutrients
Essential nutrients
Nutrients that must be obtained through the diet because the body doesn't make enough of them to meet needs are known as a(n): Essential nutrients Organic nutrients Macronutrients Micronutrients
Essential nutrients
Recommendations in this category in the Dietary Reference Intakes meet the needs of 50% of healthy people. Adequate Intake Recommended Daily Allowance Estimated Average Requirement Tolerable Upper Limit
Estimated Average Requirement
The energy yielding nutrients are carbohydrate, protein and vitamins. True False
False
Gram for gram, which of the following nutrients provides the most energy? Vitamins Fat Minerals Protein
Fat
Statements that characterize the relationship between a nutrient and disease condition is a: Nutrient claim Health claim Structure-Function claim
Health Claim
A kcalorie is the measure of what type of energy?
Heat energy
What are some values that direct some peoples food choices?
Religious beliefs political views Environmental concerns
Which of the following claims is a red flag for nutrition quackery? (Select all that apply) Satisfaction guaranteed Good source of fiber Natural Based on ancient herbal remedies
Satisfaction guaranteed Natural Based on ancient herbal remedies
Are minerals and water organic or inorganic?
Inorganic because they do not contain carbon
What is the international unit for measuring food energy?
Joule
How does marketing influence people to eat more?
Just by persuading them; building brand loyalty; promises of convenience
Energy from food is measure in units of energy called: Kilocalories Calories Units Grams
Kilocalories
Following is the list of ingredients on a food label for cereal: Milled corn, sugar, malt flavoring, high fructose corn syrup, salt. The cereal contains the most of which ingredient by weight? Milled corn Sugar Malt flavoring High fructose corn syrup Salt
Milled corn
Which of the following nutrients is inorganic? Protein Minerals Vitamins Fat
Minerals
How do you convert energy measures from kcal to kilojoules?
Multiply kcal by 4.2
Do water, vitamins, and minerals yield energy in the human body?
No
Are the other four classes of nutrients simple?
No, they are complex because they contain both hydrogen and oxygen as well as carbon
Essential Nutrients
Nutrients that must be obtained from food because the body either can't make them or can't make them in sufficient amounts to meet needs
"Supports colon health" is an example of which type of claim? Health claim Nutrient content claim Structure-Function claim Consumer claim
Structure-Function claim
Which nutrient yields 4 kcalories/gram in energy? Vitamins Fat Minerals Protein
Protein
What types of foods do most people eat?
foods that are quick, easy to prepare, and are within thier financial means
What does developing cultural competence do?
honors individual professionals who help others plan healthy diets
Observation and Question
Terrence reviews the supplement ingredient list and searches for research on the supplement or ingredients that could explain the claims of reducing body fat.
Experimental Studies
Test cause-and-effect relationships between variables. Includes laboratory animal and in vitro studies and human clinical trials.
Tolerable Upper Limit (UL)
The maximum daily amount of a nutrient that appears safe for most healthy people
What does eating traditional ethnic foods provide?
The opportunity to celebrate a person's cultural heritage
Nutrition
The science of how nutrients and other substances in food interact with the human body
Epidemiological Studies
The study of the distribution of diseases and other health-related conditions in populations. Includes cross-sectional, case-control and cohort studies.
Conclusion
The supplement does not increase body fat losses.
What values does a vegetarian have that makes them choose to not eat certain foods?
Their support for animal rights
Which diet planning guide groups foods according to their nutrient content? USDA Food Patterns MyPlate The Dietary Guidelines for Americans Food Lists
USDA Food Patterns
What are the 6 classes of nutrients?
Water, carbohydrates (including fibers), lipids, proteins, vitamins, minerals
What is energy released from carbs, fat, and protein measured in?
calories/kcalories
What is a substance that contributes energy, but is not a nutrient?
alcohol
What is health history?
an account of a client's current and past health status and disease risks.
What does negative correlation mean?
as one variable increases, the other decreases
What does positive correlation mean?
as one variable increases, the other increases
What do news updates on nutrition often do that can be negative?
- Biases influence choices and perspectives. Usually, the reports present findings from a single, recently released study, making the news current and controversial. - Reporters may twist inconclusive findings into "meaningful discoveries" when pressured to write catchy headlines and sensational stories. -
What does a healthy 150-pound body contain?
- about 90 pounds of water and about 20 to 45 pounds of fat. - The remaining pounds are mostly protein, carbohydrate, and the major minerals of the bones. - Vitamins and other minerals constitute a fraction of a pound
When you hear nutrition news, what should you ask yourself and consider?
- consider its source - Is the person providing the information qualified to speak on nutrition? - Is the information based on valid scientific research?
What is included in a physical examination?
- looking for clues to poor nutrition status - Visual inspection of the hair, eyes, skin, posture, tongue, and fingernails can provide such clues - reveal possible imbalances that must be confirmed by other assessment techniques, or they confirm results from other assessment measures.
What are the red flags of nutrition quackery?
- natural -Quick and easy fix -satisfaction guaranteed -one product does it all -time tested/ newfound treatment
What does it mean if a food is ultra processed?
- no longer resemble whole foods; they are made from substances that are typically used in food preparation, but not consumed as foods themselves (such as oils, fats, flours, refined starches, and sugars) - undergo further processing by adding a little, if any, processed foods, salt and other preservatives, and additives such as flavors and colors - Foods that cannot be made at home with common grocery ingredients
How many vitamins are there?
13
How many minerals are known to be essential in human nutrition?
16
What are some poor health behaviors of the US?
35 percent of US adults consume more than moderate amounts of alcohol; 20 percent smoke cigarettes; 50 percent are physically inactive; 60 percent are either overweight or obese; and 30 percent obtain 7 hours or less of sleep per day
Experiment
40 subjects are randomly placed into two groups and are unaware of whether they're receiving a placebo or treatment. Subjects will eat a specific diet for a period of six weeks and follow a specific exercise program. Body weight, measurements and composition are taken prior to the program and will be tracked each week.
What is the determined composition of a diet from the DRI committee that provides adequate energy and nutrients and reduces the risk of chronic diseases?
45 to 65 percent kcalories from carbohydrate 20 to 35 percent kcalories from fat 10 to 35 percent kcalories from protein
Jack had two eggs, a slice of toast with three pats of butter and two slices of bacon, washed down with black coffee for breakfast. He consumed 25g of carbohydrate, 21g of protein and 35g of fat. How many kcalories were in Jack's breakfast? 449 kcalories 429 kcalories 509 kcalories 499 kcalories
499 kcalories
For a mid-day snack, Theresa had one of her mother's fresh peanut butter cookies with a glass of whole milk. This snack has 400 kcalories, of which 234 kcalories came from fat. What percentage of total calories came from fat in Theresa's snack? 58% 47% 32% 75%
58%
For a mid-day snack, Theresa had one of her mother's fresh peanut butter cookies with a glass of whole milk. This snack has 400 kcalories, of which 234 kcalories came from fat. What percentage of total calories came from fat in Theresa's snack? 58% 47% 32% 75%
58%
How much energy does alcohol contain per gram?
7 kcal/g
Recommendations in this category of the Dietary Reference Intakes are not based on scientific evidence. Adequate Intake Recommended Daily Allowance Estimated Average Requirement Tolerable Upper Limit
Adequate Intake
Your sister takes a daily supplement of 500mg of vitamin C and claims that she hasn't has a cold in five years because of the supplement. Her experience is best described as a(n): Case-control study Anecdote Experiment Clinical study
Anecdote
Recommended Daily Amount (RDA)
Based upon the EAR, the RDA is the intake level of a nutrient at which the needs of 98% of a healthy population will be met
Why are carbs, fats, and proteins sometimes called macronutrients?
Because the body requires them in relatively large amounts (many grams daily)
Why are vitamins and minerals micronutrients?
Because they are only required in small amounts (milligrams or micrograms daily)
How does randomization help?
By eliminating bias and ensures that the two groups are "equal" and that observed differences reflect the treatment and not other factors.
How much energy in grams does a Carb, fat, and protein contain?
Carb: 4kcal/g Fat: 9 kcal/g Protein: 4 kCal/G
What is the definition of "organic" in relation to nutrients? Raised without the use of fertilizers, pesticides or hormones Meat, poultry and eggs from livestock allow to graze freely Compounds that contain the element carbon Occurs naturally
Compounds that contain the element carbon
The ___ meets the needs of about half the population, whereas the ____ meets the needs of about 98% of the population.
EAR RDA
What are the four categories of the DRI?
Estimated Average Requirements (EAR) Recommended Dietary Allowances (RDA) Adequate Intakes (AI) Tolerable Upper Intake Levels (UL)
What is the energy recommendation called?
Estimated energy requirement (EER)
Every year Maria's mother prepares tamales during the holiday season. When she eats the tamales, Maria is being influenced by: Habit Personal preference Ethnic heritage or tradition Nutrition
Ethnic heritage or tradition
Every year Maria's mother prepares tamales during the holiday season. When she eats the tamales, Maria is being influenced by: Habit Personal preference Ethnic heritage or tradition Nutrition
Ethnic heritage or tradition
How do you calculate the percentage of kcalories each of the energy nutrients contributes to the total?
Ex) divide 81 fat kcal by the total 173 kcal = .468 = 47%
Phytochemicals are nutrients. True False
False
The energy-yielding nutrients are carbohydrate, protein and vitamins. True False
False
The ingredient list on a food label must only include the food ingredients used to make the product.
False
The ingredient list on a food label must only include the food ingredients used to make the product. True False
False
Statements that characterize the relationship between a nutrient and disease condition is a: Nutrient claim Health claim Structure-Function claim
Health claim
What does a trained health care professional use to prepare a nutrition assessment?
Historical information Anthropometric measurements Physical examinations Laboratory tests
What is a systematic review?
It provides a qualitative summary of the evidence
What is a meta-analysis?
It provides quantitative summary
How do you convert kilojoules to kcals?
Multiply by .24
Do small amounts greater than the daily requirements do harm to the body?
No
Does a positive or negative correlation always reflect a desired outcome?
No
Do the causes of death often occur singly?
No, they often occur as a mixture
when a new finding is published or released to the media is it meaningful?
No. It is still only preliminary and not very meaningful by itself. Other scientists will need to confirm or disprove the findings through replication and reanalysis.
Statements that characterize the quantity of a nutrient in a food is a: Nutrient claim Health claim Structure-Function claim
Nutrient claim
"50% less fat" on a product package is an example of which type of claim? Health claim Nutrient content claim Structure-Function claim Consumer claim
Nutrient content claim
Micronutrients
Nutrients that are needed in small or trace amounts (vitamins and minerals)
What are essential nutrients?
Nutrients that the body cannot make and that need to be supplied from foods
What is the first step that scientists take when using scientific method? Hypothesis and prediction Experiment Observation and question Results and interpretation
Observation and question
What does correlational evidence prove?
Only that variables are associated, not that one causes the other
Nutrient density refers to foods that: Provide more nutrients relative to kcalories Provide more energy per gram Provide few nutrients relative to kcalories Are organic
Provide more nutrients relative to kcalories
Recommendations in this category of the Dietary Reference Intakes meet the needs of 98% of a healthy population. Adequate Intake Recommended Daily Allowance Estimated Average Requirement Tolerable Upper Limit
Recommended Daily Allowance
Which of the following is an example of a strength of an epidemiological study? Researchers can control conditions of the study Researchers can determine the effects of a variable Researchers can narrow down the list of possible causes Researchers can't prove cause and effect
Researchers can narrow down the list of possible causes
Hypothesis and Prediction
Review of research reveals that one ingredient stimulates release and use of stored fat, so Terrence believes that the supplement will result in body fat loss.
Results and Interpretation
Subjects using the supplement after six weeks have a slightly lower percentage of body fat as compared to original measurements than those getting the placebo, but results of statistical analysis reveal that the fat loss is not scientifically significant
What is the number one reason most people choose a food? Convenience Taste Habit Nutrition
Taste
What does a strong association between risk factor and a disease mean?
That when the factor is present, the likelihood of developing the disease increases
Which of these diet planning guides translates nutrient recommendations in the Dietary Reference Intakes to food recommendations?
The Dietary Guidelines for Americans
Which of these diet planning guides translates nutrient recommendations in the Dietary Reference Intakes to food recommendations? USDA Food Patterns MyPlate The Dietary Guidelines for Americans Food Lists
The Dietary Guidelines for Americans
What two international groups do many countries use the recommendations of?
The Food and Agriculture Organization (FOA) World Health Organization (WHO)
What does an adequate intake (AI) reflect?
The average amount of a nutrient that a group of healthy people consumes (like the RDA, it may be used as a nutrient intake goal for individuals
How do nutrients release energy into the body?
The bonds break between the nutrient's atoms and as they break, they release energy. Some as heat and some is used to send electrical impulses through the brain and nerves to synthesize the body compounds and to move muscles
What is established if there is insufficient scientific evidence to determine and EAR?
The committee establishes an adequate intake (AI) instead of an RDA
What happens when the contribution of any of the energy nutrients increases or decreases?
The contribution of the others shift as well
What is a peer review?
The findings from a research study are submitted to a board of reviewers composed of other scientists who rigorously evaluate the study to ensure that the scientific method was followed
What is a control group?
The group that does not receive the experimental treatment in an experiment.
Adequate Intake (AI)
The intake level of a nutrient assumed to be adequate to prevent deficiency when there is an insufficient amount of scientific evidence available to set an RDA
Estimated Average Requirement (EAR)
The intake level of a nutrient at which the needs of 50% of a healthy population will be met based on scientific evidence
In order to prove that one variable causes another variable, what do scientists need to find evidence of?
The mechanism; or an explanation of how a variable might cause another
What guides researchers in their work?
The scientific method
How does the RDA meet the needs of as many people as possible?
They are set near the top end of the range of the population's estimated requirements
How can minerals disappear form the body?
They can be bound by substances that interfere with the body's ability to absorb them They can be lost during food processing or during cooking when they leach into water that is discarded
What is the role of vitamins in the body?
They facilitate the release of energy from carbs, fat, and protein and participate in numerous other activities
How do social customs influence social interactions?
They invite people to accept food or drink offered by a host or shared by a group regardless of hunger signals
Who tends to make healthier food choices; those who eat out or those who frequently cook at home?
Those at home
Why are recommendations set greater than the EAR?
To meet the needs of most healthy people because approximately half the population would develop deficiencies of a nutrient if they consumed the AVERAGE requirement of a given nutrient each day
Food group plans help people eat an adequate, balanced, moderate and varied diet. True False
True
The Dietary Reference Intakes include four categories known as EAR, RDA, AI and UL.
True
The basic steps of scientific method are observation, hypothesis, experiment and results/conclusions. True False
True
Paying attention to what is useful in guarding against the overconsumption of nutrients, which may occur when people use large dose dietary supplements and fortified foods regularly?
Upper Limit (UL)
What is a primary deficiency?
When a person is missing a nutrient in their diet
What is a double blind experiment?
When both the subjects and the researches do not know which subjects are in which group
What is a second deficiency?
When the body doesn't absorb enough, excretes too much, or uses the nutrient insufficiently
How must research findings be analyzed and interpreted?
With an awareness of each study's limitations
Can dietitians order therapeutic diets and nutrition-related lab tests without the supervision or approval of a physician?
Yes
Is it more likely for a young adult to have persisting risk factors that follow them through aging?
Yes
What is a subclinical deficiency?
a deficiency in the early stages, before the outward signs have appeared.
What is energy density?
a measure of the energy a food provides relative to the weight of the food (kcalories per gram).
What is the Healthy People Program?
a national public health initiative under the jurisdiction of the US Department of Health and Human Services (DHHS) that identifies the most significant preventable threats to health and focuses efforts to eliminate them.
What is a registered dietitian nutritionist (RDN)?
a person who has completed a minimum of a bachelor's degree from an accredited university or college, has completed approved course work and a supervised practice program, has passed a national examination, and maintains registration through continuing professional education; also called registered dietitian (RD).
What is a dietetic technician?
a person who has completed a minimum of an associate's degree from an accredited university or college and an approved dietetic technician program that includes a supervised practice experience. See also, dietetic technician, registered (DTR).
What is an anecdote?
a personal account of an experience or event; not reliable scientific information.
What does research always begin with?
a problem or question
The % Daily Value column on a food label is an estimate of how individual foods contribute to the total diet based upon a reference diet of: a. 1,500 kcalories/day b. 2,000 kcalories/day c. 2,500 kcalories/day d. Both b and c
b. 2,000 kcalories/day
The % Daily Value column on a food label is an estimate of how individual foods contribute to the total diet based upon a reference diet of: a. 1,500 kcalories/day b. 2,000 kcalories/day c. 2,500 kcalories/day d. Both b and c
b. 2,000 kcalories/day
Why has no upper limit (UP) been determined for energy needs?
because any amount of excess results in weight gain
Why can vitamins only function if they're intact?
because they are complex organic molecules
Why are minerals inorganic and need not be handled with special care?
because they are inorganic
Where are minerals found in the body?
bones teeth some are found in the fluids of the body and can influence the fluids by balancing and distributing
How can factors that increase or reduce the risk of developing chronic diseases be identified?
by analyzing statistical data
What are some terms used that sound authoritative when talking about dietitian, but actually lack the credentials of an RDN?
certified nutritionist, certified nutritional consultant, or certified nutrition therapist
What helps to preserve vitamins in vegitables while cooking them?
cooking at moderate temperatures for short times using small amounts of water
What are vitamins vulnerable to?
destruction by heat, light, and chemical agents
What is the one choice that can influence chronic disease risks for those who do not smoke or drink?
diet
What do the dietary reference intakes and other major reports do?
examine the relationships between diet and health depend on the info collected from the nutrition surveys
What are the two groups that scientists typically divide subjects into?
experimental group control group
What is the placebo effect?
experimental results caused by expectations alone; any effect on behavior caused by the administration of an inert substance or condition, which the recipient assumes is an active agent.
What provides more energy per gram, fat, carbs, protein?
fat; it is more energy dense
What are some examples of minimally processed foods?
frozen vegetables, fruit juices, smoked salmon, cheeses, and breads
Foods that have high energy density contribute to weight ____, while foods with low energy density contribute to weight _____.
gain loss
What are risk factors that a person cannot control?
genetics, gender, and age
Who do the DRI recommendations apply to?
healthy people and may not be appropriate for people with diseases that increase or decrease nutrient needs.
What are the leading causes of death in the US?
heart disease cancers chronic lung diseases accidents strokes
What are some roles of public health dietitians?
help plan, coordinate, and evaluate food assistance programs; act as consultants to other agencies; manage finances; and much more.
What does the DRI committee consist of?
highly qualified scientists who base their estimates of nutrient needs on careful examination and interpretation of scientific evidence
How does the estimated average requirements (EAR) committee cluster its recommendations?
into groups based on gender and age; even when grouped like this, the exact requirements for people of the same gender and age are likely to be different
Sample sizes in an experiment must be ______.
large
What is the simplest of the nutrients?
minerals
How do you calculate the energy available from a food?
multiply the number of grams of carbohydrate, protein, and fat by 4, 4, and 9, respectively. Then add the results together. For example, 1 slice of bread with 1 tablespoon of peanut butter on it contains 16 grams carbohydrate, 7 grams protein, and 9 grams fat: 16g carb x 4 kcal/g = 64kcal 7g protein x 4 kcal/g = 28 kcal 9 g fat x 9 kcal - 81 kcal Total = 173 kcal
Is the recommendation for energy (food) generously given?
no, excess energy cannot be readily excreted and is eventually stored as body fat
What are some decisions a person can choose that can improve the likelihood of good health?
not smoke, to eat a well-balanced diet, to engage in regular physical activity, and to drink alcohol in moderation
What must researches be able to do while conducting an experiment?
observe, measure, or verify the variables selected
To be meaningful, what does a conclusion of any study need to be?
presented cautiously within the context of other research findings
How do scientists sort subjects to ensure that each person has an equal chance of being assigned to either the experimental group of the control group?
randomization
What are acceptable Macronutrient Distribution Ranges (AMDR)?
ranges of intakes for the energy nutrients that provide adequate energy and nutrients and reduce the risk of chronic diseases.
what is anthropometric?
relating to measurement of the physical characteristics of the body, such as height and weight.
What is randomization?
subjects are chosen randomly from the same population by flipping a coin or some other method involving chance
What foods do not contain a mixture of nutrients?
sugar (pure carb) and oil (pure fat)
What can blood and urine laboratory tests confirm?
suspicions raised by other assessment methods
What is Recommended Dietary Allowance (RDA)?
the average daily amount of a nutrient considered adequate to meet the known nutrient needs of practically all healthy people; a goal for dietary intake by individuals.
What is the Estimated Average Requirement (EAR)?
the average daily amount of a nutrient that will maintain a specific biochemical or physiological function in half the healthy people of a given age and gender group.
What does the estimated energy requirement (EER) represent?
the average dietary energy intake that maintains energy balance and good health in a person of a given age, gender, weight, height, and level of physical activity.
What is a blind experiment?
the experimental subjects do not know which treatment (if any) they are receiving
What is the experimental group?
the group that receives the treatment
What does the requirement of a nutrient mean according to the estimated average requirements (EAR)
the lowest continuing intake of a nutrient that will maintain a specified criterion of adequacy.
What do foods rich in energy-yielding nutrients provide?
the major materials for building the body's tissues and yield energy for the body's use or storage
What is the tolerable upper intake level?
the maximum daily amount of a nutrient that appears safe for most healthy people and beyond which there is an increased risk of adverse health effects.
What do the national nutrition surveys gather information on?
the population's dietary, nutritional, and health related status -foods people eat - anthropometric measurements, physical exams, and lab tests
What does a theory integrate?
the various findings and explains the complex relationships in the evidence
What does having no correlation mean?
there is nothing linking the variables
What are some examples of ultra processed foods?
soft drinks, corn chips, fruit gummies, chicken nuggets, canned cheese spreads, and toaster pastries.
What nutrients does bread contain?
water, a trace of fat, a little protein, and some vitamins and minerals in addition to its carbohydrate
What nutrients does mean contain?
water, fat, vitamins, and minerals as well as protein
What provides the environment in which nearly all the body's activities take place?
water; It participates in many metabolic reactions and supplies the medium for transporting vital materials to cells and carrying waste products away from them.
What does it mean for research to have validity?
when reviewers consider the conclusion to be well supported by evidence
Can our bodies derive all the energy, structural materials, and regulating agents we need from the foods we eat?
yes
Do children learn to like and dislike certain foods when their parents use them for rewards or punishments?
yes
Should scientists use various types of research designs when conducting an expriment?
yes
Do less amounts than the daily requirement fo harm?
yes, it could lead to health problems
Can some minerals be harmful to the body?
yes, such as lead
Jane is an animal lover and decided to become vegan after learning about how calves are raised for veal. Which of the following is influencing her decision? Personal preference Values Positive and negative associations with food Marketing
values
What are some examples of whole foods?
vegetables and legumes; fruits; seafood, meats, poultry, eggs, nuts, and seeds; milk; and whole grains
What is the second most simple nutrient?
water, because it's made up of 2 elements
can negative experiences with foods have long-lasting influences on food preferences?
yes
Organic
Chemical compounds that contain carbon
Nutrients
Chemical substances obtained from food that the body uses for energy, growth, repair and maintenance of body tissues
Convenience is the number one reason most people choose a food. True False
False
Phytochemicals
Nonnutritive compounds found in plants that are biologically active in the body
What is a joule?
The amount of energy expended when 1 kilogram is moved 1 meter by force of 1 newton (it is a measure of work energy)
Recommendations in this category of the Dietary Reference Intakes are the maximum daily amount of a nutrient that appears safe for most healthy people. Adequate Intake Recommended Daily Allowance Estimated Average Requirement Tolerable Upper Limit
Tolerable Upper Limit
Can processed foods be nutritious?
When the changes are minimal it can provide an abundant, safe, convenient, affordable, and nutritious product
What type of food choice is made if a person chooses to boycott fruit picked by migrant workers who have been exploited?
a value
What are some strategies to help consumers improve their diet quality?
by reducing the prices of fruits and vegetables, taxing processed foods, placing healthy options in strategic locations, and limiting discounts on less healthy foods.
How does a dietetic technician become a dietetic technician registered (DTR)
by passing a national exam