Professional Documents
Culture Documents
I.
Name
TIME
SEX
AGE DATE:
M/F
____/_____/____
FOOD OR BEVERAGE
Specific Names, Preparations, Ingredients
DAY OF WEEK:
M T W TH F SA SU
PORTION SIZE
Breakfast
A. Complete the top line of the FOOD INTAKE FORM provided with your name,
sex (gender), age, date, and day of the week
B. Record all foods and beverages and amounts consumed for 3 days. (One food
intake sheet per day please make copies from original)
1. Record types food items and beverages in column labeled Food or Beverage: (1
food / beverage per line)
a) Specify:
(1) Type of food
(a) Oatbran muffin, white bread
(2) How the food was prepared
(a) Baked, pan or deep fried, steamed, broiled stir fried, braised,
stewed
(3) Whether food was fresh or processed in some way?
(a) Frozen, dried, canned
(b) Specify brand name if possible
(4) Seasonings
(a) Salt, ketchup, mustard
(5) Type of oil /fat/ spray used for cooking
(a) Pam, olive oil, butter
(6) Cut of meat, poultry, lamb, pork eaten:
(a) Loin, round, chuck, blade, ground,
(b) White meat, breast, drumstick, thigh, dark meat
(7) Type of fish
(a) Salmon, Orange Roughy, Trout
TIME
Breakfast
FOOD OR BEVERAGE
Specific Names, Preparations, Ingredients
Large scrambled eggs (in butter)
Butter (with salt)
Whole milk
Doughnut (3 in)
Fresh, large peach
Coffee (with sugar and cream)
Half and half
Granulated sugar
PORTION SIZE
FOOD OR BEVERAGE
Specific Names, Preparations, Ingredients
Large scrambled eggs (in butter )
Butter (with salt)
Whole milk
Doughnut (3 in)
Fresh, large peach
Coffee (with sugar and cream)
Half and half
Granulated sugar
PORTION SIZE
2
1 tsp.
1 cup
1
1
2 cups
2 tbsp.
1 tbsp.
1 Tablespoon = 3 teaspoons
1 cup = 16 tablespoons
1 pint = 2 cups
1 quart = 4 cups
1 pound = 16 ounces
II.
Dietary Analysis
A. Once you have completed your 3-day food diary, you are ready to enter the data
into the computer. Please consult the software directions for specifics on
installing the software and entering / analyzing foods and beverages.
1. Set up a Profile.
a) Enter your personal information.
Please staple project materials in the following order and hand in:
Grade Sheet
Food Intake Sheets (handwritten)
Daily Food Logs for Day 1, 2, and 3 printouts
Profile DRI Goals Report
Intake vs. Goals Report (average over 3 days)
Source Analysis for saturated fat and fiber (1 day of each)
Worksheet for Dietary Analysis
If your project materials are not in the correct order, 2 points will be deducted from
your grade.
If your project materials are not stapled, 2 points will be deducted from your grade.
SEX
M/F
AGE
DATE:
____/_____/____
FOOD OR BEVERAGE
Specific Names, Preparations, Ingredients
DAY OF WEEK:
M T W TH F SA SU
PORTION SIZE
Breakfast
Lunch
Dinner
Snacks
SEX
M/F
AGE
DATE:
____/_____/____
FOOD OR BEVERAGE
Specific Names, Preparations, Ingredients
DAY OF WEEK:
M T W TH F SA SU
PORTION SIZE
Breakfast
Lunch
Dinner
Snacks
SEX
M/F
AGE
DATE:
____/_____/____
FOOD OR BEVERAGE
Specific Names, Preparations, Ingredients
DAY OF WEEK:
M T W TH F SA SU
PORTION SIZE
Breakfast
Lunch
Dinner
Snacks
If you continued to consume the same number of kilocalories as your current daily intake,
would you gain, lose, or maintain your weight? (1/2 pt.)
42%
Does your intake meet the DRI for carbohydrates? (1/2 pt)
No, under by 3%
Calculate your daily starch intake (in grams). (1/2 pt)
(Subtract grams of sugars + dietary fiber intake from total carbohydrate)
113 g
Record your daily fiber intake and the DRI for fiber below. (1/2 pt)
Your intake 13 grams
DRI 25 grams
If your fiber intake is lower than the DRI, what 3 foods (that you enjoy) could you
incorporate into your diet to increase your fiber?
Avocado, strawberries, and green peas
If your diet meets the DRI for fiber, list the 3 highest fiber foods you consumed.
____________________________________________________
Name a common GI health problem that results from a low fiber diet? (1 pt)
Constipation
Protein:
What percentage of your daily kilocalories comes from protein? (1/2 pt)
24%
Does your daily protein intake meet (and/or exceed) the DRI? (1/2 pt)
Yes
No
Lipids:
Compare your average dietary intake of fat, saturated fat, and cholesterol to the
recommendations listed below:
What percentage of your daily kilocalories comes from fat? Show calculations (1/2 pt)
% Total fat 34%
Does your total fat (%) intake meet the DRI recommendations stated above? (1/2 pt)
Yes
No
What percentage of your daily kilocalories comes from saturated fat? (1/2 point)
% Saturated fat 14%
Does your saturated fat intake meet the DRI recommendations stated above? (1/2 pt.)
Yes
No
What 3 foods in your diet contribute the most saturated fat? (from Source Analysis) (1 pt)
Macaroni and cheese, Swiss cheese, and butter
What is your daily cholesterol intake (1/2 pt)?
Cholesterol 294 mg
Does your cholesterol (mg) intake meet the guidelines stated above? (1/2 pt.)
Yes
No
C. Vitamins (5 points)
Record your daily intake of vitamins, your DRI, and % DRI for the vitamins listed in the
table below. (2 pt.)
Vitamin
Vitamin A (gRAE)
Vitamin E (mg-alphaTE)
Vitamin C (mg)
Thiamin (mg)
Riboflavin (mg)
Niacin (mg NE)
Vitamin B-6 (mg)
Folate (g DFE)
Vitamin B-12 (g)
Vitamin D (g)
Your Intake
272
4
70
1.1
1.1
21
1.2
398
2.3
2
DRI
700
75
75
1.1
1.1
14
1.3
400
2.4
15
% DRI
38.86%
26.67%
93.33%
100%
100%
150%
92.31%
99.5%
95.83%
13.33%
Vitamins (continued)
Answer one of the following 2 questions from the vitamin table above (2 pts):
If your intake of one or more vitamins is lower than the DRI what 2 foods (per vitamin) could
you add to your diet to boost your levels? (List vitamins and respective foods)
Vitamin A Low: sweet potatoes and kale
Vitamin E Low: spinach and almonds
If your intake of vitamins meets / exceeds the DRI what three (3) foods in your diet are
good sources of the vitamins listed above. (List vitamins and respective foods)
______________________________________________________________________
D. Minerals (5 points)
Record your daily intake, DRI, and % DRI for the minerals listed in the table below. (2pt.)
Mineral
Your Intake
DRI
% DRI
Calcium (mg)
598
1000
Iron (mg)
18
44.44%
Magnesium (mg)
172
310
55.48
Zinc (mg)
75%
Sodium (mg)
2825
<2300
122.83%
Potassium (mg)
1410
4700
30%
59.8%
Answer one of the following 2 questions from data in the minerals table above:
If your intake of one or more minerals is lower than the DRI what 2 foods (per mineral)
could you add to your diet to boost your levels? (List minerals and respective foods)
Potassium Low: bananas and sweet potatoes
Iron Low: spinach and pumpkin seeds
If your intake of minerals meets / exceeds the DRI what foods (name at least 3) in your diet
that are good sources of minerals. (List minerals and respective foods)
______________________________________________________________________
________________________________________________________________________
10
Name _______________________________________
Grade Sheet
Food Intake Sheets (handwritten)
Daily Food Log (printouts)
Profile DRI Report
Intake vs. Goals Report
Source Analysis for Fiber and Saturated Fat (1day)
Worksheet for Dietary Analysis
If your project materials are not in the correct order, 2 points will be deducted
from your grade.
If your project materials are not stapled, 2 points will be deducted from your
grade.
Day 1
Description of food/beverage (4 pts.)
________
Portions (2 pts.)
_______
Day 2
Description of food/beverage (4 pts.)
Portions (2 pts.)
________
_______
Day 3
Description of food/beverage (4 pts.)
Portions (2pts.)
________
_______
________
________
________
________
________
Macronutrients (9 pts.)
________
Vitamins (5 pts.)
________
Minerals (5 pts.)
________
Total Points
______
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