JOURNAL OF COMMUNITY HEALTH NURSING, 2000, 17(4), 247–262

Copyright © 2000, Lawrence Erlbaum Associates, Inc.

Program of Care for Young Women With Iron

Deficiency Anemia: A Pilot
Bonnie L. Callen, RN, MS
Department of Nursing
University of Wisconsin–Madison

Iron deficiency anemia is the most widespread nutritional deficiency in the United States; it
affects 3.3 million women and is associated with preterm births, low birth weight babies, and
cognitive delays in infant and child development. Many young women are rarely screened
for iron deficiency anemia, but plasma donors are routinely screened, affording an excellent
opportunity to target an at-risk population seldom seen by primary health care providers.
Many of these donors are economically disadvantaged young adults.
The purpose of this program was to improve the knowledge, diets, and subsequently the
hematocrits of young women who cannot give plasma due to low hematocrits. An educa-
tional intervention was piloted. The results were an improvement in hematocrit levels and di-
etary consumption of iron, but no gain in dietary knowledge. This unique, cost-effective
health promotion program targets young women before they become pregnant to address the
problem of diets low in iron.

Iron deficiency anemia is the most widespread nutritional deficiency in the United States
and worldwide (Johnson-Spear & Yip, 1994). Although the incidence of iron deficiency
anemia in children has declined since the 1970s, the rate of anemia among low-income
women during pregnancy is high, and no improvement has been noted since the 1970s
(Centers for Disease Control and Prevention [CDC], 1998). Iron deficiency is reportedly
the most common cause of anemia in general medical practice and is alleged to be the
most common organic disorder seen in clinical medicine (Lee, Bithell, Foerster, Athens,
& Lukens, 1993). In young women, iron deficiency anemia is associated with preterm
births, low birth weight babies, and cognitive delays in infant and child development
(CDC, 1998). Due to this continuing prevalence, Healthy People 2000 included in its ob-
jectives a reduction of iron deficiency among women of childbearing age from 5% at
baseline in the period from 1976 to 1980 to less than 3% in 2000 (U. S. Department of
Health and Human Services, 1990).

Requests for reprints should be sent to Bonnie L. Callen, 4242 Mandan Crescent, Madison, WI 53711.
E-mail: blcallen@students.wisc.edu
248 Callen

In this population it is important to correct iron deficiency for several reasons. First,
identifying and correcting anemia prior to pregnancy increases the chances of a healthy
pregnancy for both mother and baby (CDC, 1998). Teens often delay prenatal care and
receive too few prenatal visits. Minority women, especially African Americans, are less
likely to get first trimester prenatal care regardless of age (Wisconsin Department of
Health and Social Services, 1990). According to Healthy People 2000, a reduction in iron
deficiency among women of childbearing age can be achieved by nutrition education to
encourage selection of iron-rich foods and by adequate supplementation with iron during
pregnancy (CDC, 1998). Second, making wise food choices and establishing sound eat-
ing habits early are critical to developing healthier people (Wisconsin Department of
Health and Social Services, 1990).
A number of programs, such as school lunch programs, target low-income or in-
ner-city children with improved nutrition (Childs, Aukett, Darbyshire, Ilett, & Livera,
1997). Other programs such as Women, Infants, and Children include both pregnant and
lactating women as well as infants and children for nutritional supplementation (Com-
mittee on the Prevention, Detection, and Management of Iron Deficiency Anemia
Among U.S. Children and Women of Childbearing Age, 1993). A search of recent litera-
ture reveals a lack of programs targeting young women of childbearing age before they
become pregnant. This is a missed opportunity.
To target this at-risk aggregate, a program of care was started in a Madison, Wiscon-
sin, plasma donation center. More than 350 plasma centers in the United States currently
screen adults for hematocrits on a regular basis. These sites presently do not provide
health promotion or disease prevention programs, yet they serve a population that may
go for years without seeing a health care provider.
This program was designed to be very economical. No additional personnel or space is
needed. The nurses implementing the intervention are already on staff and are able to incor-
porate the intervention into their daily schedules without requiring an extension of their
shifts. Data collection and analysis are done by existing staff. The tools were designed on a
home computer and can be reproduced at work, avoiding printing costs. No additions to the
current budget are needed to incorporate this cost-effective program of care.
This nutritional program is an innovative way of promoting health among a portion of
an at-risk population. Nutritional counseling and education emphasize the importance of
eating a varied diet. The purpose of this program is to improve the knowledge, diets, and
subsequently the hematocrits of women of childbearing age who cannot give plasma due
to low hematocrits, thereby targeting young women before they become pregnant to ad-
dress the problem of inadequate diets.

LITERATURE REVIEW

Data from the third National Health and Nutrition Examination Survey (NHANES III)
have shown that iron deficiency anemia is still relatively common in U.S. women of child-
 Iron Deficiency Anemia 249

bearing age. This study, conducted between 1988 and 1994, revealed that 7.8 million ado-
lescent girls and women of childbearing age were iron deficient and 3.3 million have iron
deficiency anemia (Looker, Dalman, Caroll, & Gunter, 1997).
Women of childbearing age require additional iron to compensate for menstrual blood
loss of 0.3 to 0.5 mg per day (CDC, 1998). Women in this age group need 15 mg of iron
daily due to their increased needs compared to 10 mg per day for men in the same age
group (Christian, 1994). This increased need comes at a time when many young women
are preoccupied with body image. Dissatisfaction with body image has led approxi-
mately two thirds of adolescents to try reducing diets (Wisconsin Department of Health
and Social Services, 1990). Some young women become vegetarians, eliminating the
heme iron source of iron in their diets without substituting a sufficient quantity of
nonheme iron. Only one fourth of adolescent girls and women of childbearing age meet
the recommended daily allowance (RDA) for iron through diet (CDC, 1998). The combi-
nation of inadequate diet and menstrual blood loss is a common combination contribut-
ing to iron deficiency in young women (Lee et al., 1993).
The NHANES III study found that iron deficiency anemia is twice as common in mi-
nority women as compared to White women (Looker et al., 1997). Iron deficiency was
also more common among poor women, those with less education, and those who had
more children (Looker et al., 1997).
Iron store depletion and iron deficient erythropoiesis are not associated with any dis-
tinct clinical findings (Hillman & Ault, 1995; Hoffman et al., 1995). Some of the signs
and symptoms of iron deficiency anemia (e.g., fatigue, headaches, or irritability) are non-
specific and easily attributed to lifestyle (Hoffman et al., 1995). Therefore, these young
women are not likely to seek medical attention. The CDC (1998) currently recommends
screening nonpregnant women of childbearing age for anemia every 5 to 10 years and
targeting this aggregate for nutritional education.

METHOD

Participants

A 6-month record audit at this plasma donation center revealed that 4% of the women try-
ing to donate plasma failed to meet the minimum Food and Drug Administration (FDA)
standard of 38% hematocrit. Women were 24% of those trying to donate plasma, but 95%
of the donors deferred for low hematocrits were women. Blacks comprise 3.8% of the
population in Wisconsin (U.S. Department of Health and Human Services, 1997), but
32% of the donors with low hematocrits were African American.
Retrospective chart audits revealed that 75% of deferred donors are less than 30 years
of age. About one half of the donors at this center are students. The other half are commu-
nity-dwelling residents, primarily those of lower socioeconomic status using plasma do-
250 Callen

nations to supplement their income. This latter group is a subgroup that is at higher risk
for poor health (Schorr, 1998; U.S. Department of Health and Human Services, 1997).
The economically deprived have an increased prevalence of iron deficiency anemia, ex-
plained in part by the fact that heme iron is almost totally absent from their diets (Lee et
al., 1993).
Inclusion criteria for donating plasma are age between 18 and 65 years, proof of a cur-
rent local address, and weight of 110 pounds. Donors are excluded for high-risk behav-
ior; out-of-range health parameters (as determined by FDA standards) such as blood
pressure, serum protein, hematocrit, positive test for glucose in the urine, or positive drug
test; or other health problems.

Setting

More than 350 plasma centers in 44 states screen donors for serum hematocrit each time
they come in to donate. Donors may donate plasma two times in a 7-day period with 2 days
separating any two donations. Hematocrit is measured before each donation to ensure the
good health of donors. Because lab tests reveal low hemoglobin or hematocrit only after
iron stores in the body have been depleted, anyone identified with low hematocrit already
has significantly insufficient iron intake for needs (Hillman & Ault, 1995). These centers
afford an ideal opportunity to identify and target an at-risk population for health promo-
tion and disease prevention. The pilot was conducted in a Midwestern center that screens
between 40 and 100 plasma donors a day.

Instruments

Lack of simple, easy-to-read tools made it necessary to create the tools used in this pro-
gram. These tools underwent multiple changes and were tested for several months on ap-
proximately 30 individuals. Changes to the tools were made based on feedback from do-
nors and staff. Reading level was calculated using a simplified measure of gobbledook
readability formula at the fifth-grade level (McLaughlin, 1969). The tools consisted of the
following:

1. A 10-item quiz to measure knowledge of the sources and function of dietary iron.
The 10 questions are multiple-choice or true–false questions intended to take little time to
complete (see Appendix A; answers given in Appendix B).
2. A 24-hr recall diet diary measures actual intake of iron (see Appendix C). This tool
helps the donor find out how many milligrams of iron are being consumed on a typical
day. The diet diary provides a quantifiable measure of change in eating habits.
 Iron Deficiency Anemia 251

3. An educational handout gives basic information on the purpose and importance of

iron in the diet. Side 2 of the handout includes a list of foods commonly eaten by this
at-risk aggregate, such as fast foods, bagels, or instant noodle packets. Food items in-
cluded in the handout are the foods most often eaten by the donors at this center, plus a few
food items, such as oysters, that illustrate foods especially high in iron content. The hand-
out also lists the iron content of typical portions. This handout can be taken home and used
by the donor to calculate dietary intake of iron on a regular basis (see Appendix D).

Although multipage brochures are available in some health care settings, they are
costly to purchase or reproduce. The tools for this nutritional program were designed on a
home computer and can be reproduced on a photocopier, avoiding printing or purchasing
costs. The tools are written at a fifth-grade level to make them easily read by all but the
most illiterate. They are also adaptable to diverse cultures, making them useful in many
settings.

Procedure

Through routine screening of this aggregate, donors are identified for inclusion in this
program when they fail to meet the required minimum hematocrit level of 38%. The indi-
viduals processing the donors (screeners) then refer these donors to the staff nurses for nu-
tritional counseling. Participation was voluntary and subject to availability of a nurse to
provide the intervention. Two registered nurses work 92% of the hours the plasma center
is open. Their primary function is to screen donors for health and high-risk behavior to
protect the plasma supply. When health assessment reveals no other obvious reason for
the low hematocrit than inadequate diet, an intervention is implemented.
Donors are asked to write down everything eaten the previous day. If the day was not
typical, they list the food items that are eaten on a typical day. Donors either fill in the diary
themselves, including portion sizes, or the nurse fills in the diary based on oral information
obtained from the donor. The nurse then calculates total dietary iron intake using Bowes &
Church’s Food Values of Portions Commonly Used (Pennington, 1994) as a guide.
The next step is informational dietary counseling, including assessment of economic,
social, and cultural factors. The importance of iron in the diet, the reason why iron is im-
portant in the body, and some symptoms of low iron levels are discussed. The RDA of 15
mg of iron for women between the ages of 11 and 50 and 10 mg for men in the same age
category is compared to the individual donor’s actual intake calculated from the diet di-
ary. Counseling includes a nutritional assessment of food availability to tailor the inter-
vention to specific situations, needs, and dietary preferences. For example, a student
living in a dormitory without individual cooking facilities can choose nonperishable
foods such as fortified cereals or dried fruits to increase iron consumption. The single
mother of three small children may not have enough money for large portions of red
meat. This woman can learn how to combine inexpensive cuts of meat, fish, and poultry
252 Callen

with vegetables for a diet rich in iron. She can also learn how to enhance iron absorption
by including ascorbic acid as well as meat in the diet. Foods rich in iron are discussed to
find those that meet individual preferences. The individualized counseling allows for ad-
aptation to cultural and socioeconomic diversity.
Donors are encouraged to use the handout to calculate iron intake on their own, keep-
ing track of their progress in reaching their RDA based on age and gender. The interven-
tion applies the concept of self-efficacy, the judgment of one’s ability to carry out a
particular course of action, from Pender’s (1996) health promotion model.
To measure outcomes, the nurse flags the chart of each donor receiving the intervention.
When that donor returns, the following reassessments are made: (a) readministration of the
quiz to measure change in knowledge, (b) repeat of the 24-hr recall diet diary to measure
change in behavior, and (c) repeat hematocrit to measure physiological change. Not all do-
nors receive follow-up measurement for several reasons. Some choose not to participate.
The donor may choose not to wait until the nurse is available or no nurse may be present.
Donors with repeated low hematocrits receive additional educational counseling to rein-
force information given at the initial intervention. Donors with three consecutive low
hematocrits are deferred from donating until they have been seen by a health care provider
and have obtained medical clearance. They still must meet the 38% hematocrit minimum
donation standard.

Data Analysis

Descriptive summary data are presented in Tables 1 through 3.

RESULTS

A 3-month pilot study of this program was conducted. There were 18 donors eligible for
the intervention. A total of 9 donors chose to participate in the program, receiving the in-

TABLE 1
Demographics

Intervention Nonintervention

Demographics N % N %

Gender
Male 1 11 1 11
Female 8 89 8 89
Total 9 100 9 100
Race
White 8 89 7 78
Black 1 11 2 22
Total 9 100 9 100
 Iron Deficiency Anemia 253
TABLE 2
Age of Donors

Category M SD Mdn Range

Intervention 26 13.00 20 18–57

Nonintervention 27 7.23 26 19–36

TABLE 3
Results of Intervention

Intervention Follow-Up

Outcome N M SD % RDAa N M SD % RDA

a

Knowledge 9 82.00 17.9 — 4 87.5 9.6 —

Hematocrit 9 36.00 6.0 — 7 38.0 2.6 —
Iron intake 9 7.58 — 51 5 — — 61

a% Recommended Daily Allowance for iron in women between 11 and 50 years of age.

tervention. Another 9 donors did not receive the intervention. One of the donors not re-
ceiving the intervention was unable to read, therefore the nurse excluded him from the in-
tervention group. Other reasons for nonintervention were donor refusal or lack of avail-
ability of a staff nurse.
The intervention group was considered a convenience sample and the nonintervention
group was considered a comparison group for this pilot study.
Of the 9 participants receiving the intervention, 5 returned a second time for fol-
low-up measurement. Two donors did not return. Two donors, for reasons un-
known, were not measured when they returned. Eight participants (89%) were
White; one (11%) was African American. One participant (11%) was male and 8
(89%) were female. The nonintervention group also consisted of 8 (89%) women
and 1 (11%) man. In this group, 7 were White (78%) and 2 (22%) were African
American (see Table 1). The mean age for program participants was 27 with a
range of 18 to 57. The mean age in the nonintervention group was 27 with a range
of 19 to 37 (see Table 2).
Of the 7 donors who received the intervention and returned, 1 showed no improve-
ment in hematocrit and was deferred from donating plasma a second time. The remaining
6 improved enough to donate plasma on their return to the center (see Table 3).
Knowledge, as measured by the quiz, decreased for 1 donor, remained the same for the
remaining donors, and improved for none of the donors. The donor with the lowest score
at intervention (40%) was not measured on return (see Table 3).
Mean iron intake at time of intervention was 7.58 mg for all donors completing the
intervention (n = 9), with a range of 3.1 mg to 11.2 mg. This mean is 51% of the RDA
of iron for young women. At the time of repeated measurement, the mean iron intake
254 Callen

had improved to 9.1 mg, with a range of 5.9 mg to 15.0 mg. Follow-up mean iron in-
take was 61% of the RDA. The male participant had improved from 4.9 mg (49% of
RDA) to 5.9 mg (59% of RDA; see Table 3). The donor with the lowest intake (3.1
mg) did not return for follow-up measurement. Only 1 donor improved to 100% of
RDA for iron.
Limitations of this pilot are the small sample size and lack of randomization to inter-
vention. It is possible that there are important differences between intervention and
nonintervention groups.

DISCUSSION

This pilot confirms that dietary intake of iron for young women of childbearing age is
far short of nutritional needs among young women trying to donate plasma. Although
average iron intake improved from 51% to 61% of the RDA for young women receiv-
ing the nutritional intervention, long-term intakes at this level deplete iron stores and
result in iron deficiency anemia. One brief intervention is not a quick fix, but a start in
the right direction. This program provides that start for a population seldom targeted
for nutritional health promotion. The 24-hr diet diary has proved to be a powerful tool,
giving empirical evidence to my clinical experience that many young plasma donors,
primarily students and community-dwelling women of lower socioeconomic status,
have diets deficient in iron. Even after dietary counseling and efforts to improve their
diets, these young women fell far short of their daily needs for iron and quite probably
for other nutrients not measured in this study. This is a lower percentage than that re-
ported by the CDC (1998), possibly because this program targets women of low socio-
economic status.
Although those donors who received the educational intervention of this program
showed improvement in both hematocrit levels and dietary intake of iron, none showed
an increase in knowledge. This may suggest that knowledge is only one factor involved
in behavior changes or the limitation of this tool. The quiz was the part of the intervention
that donors expressed reluctance to participate in. These young people are in a hurry. If
they cannot donate, they want to leave. However, they are motivated to donate, usually
for monetary reasons. By capitalizing on this motivating factor, these young women are
willing to take the time to learn about how they can improve their diets. Many donors ex-
pect to be able to eat one meal rich in iron and have their hematocrit improve the next day.
An important part of this program is improving knowledge of the long-term role of iron
in the body.
Further research should replicate this study with a larger sample size over a greater pe-
riod of time. The implications for nursing practice are that nurses in varied settings can
create and implement tools to assess the health of their clinical population for health pro-
motional programs targeted to specific population needs. Changing behavior continues
 Iron Deficiency Anemia 255

to be a challenge in young people, but this program capitalizes on the motivation to do-
nate plasma to provide nutritional education. This program of care emphasizes individual
responsibility for nutritional health, recognizing that the desire for well-being may be
more effective than fear arousal based on a future threat of illness in young people (Pen-
der, Walker, Sechrist, & Frank-Stromborg, 1990).
If “preventing illness from advancing is the essence of quality medicine” (Goldstein,
1998, p. 100), then this program demonstrates the opportunity for nurses working in the
community to provide health promotion and contribute to disease prevention.

REFERENCES

Centers for Disease Control and Prevention. (1998). Recommendations to prevent and control iron deficiency
in the United States. Morbidity and Mortality Weekly Report, 47(RR–3), 1–30.
Childs, F., Aukett, A., Darbyshire, P., Ilett, S., & Livera, L. N. (1997). Dietary education and iron deficiency
anemia in the inner city. Archives of Disease in Childhood, 76, 144–147.
Christian, J. L. (1994). Nutrition for daily living (4th ed.). Redwood City, CA: Benjamin Cummings.
Committee on the Prevention, Detection, and Management of Iron Deficiency Anemia Among U.S. Children
and Women of Childbearing Age. (1993). Iron deficiency anemia: Recommended guidelines for the pre-
vention, detection and management among U.S. children and women of childbearing age. Washington,
DC: National Academy Press.
Goldstein, R. (1998). The disease management approach to cost containment. Nursing Case Management,
3(3), 99–103.
Hillman, R. S., & Ault, K. A. (1995). Hematology in clinical practice. New York: McGraw-Hill.
Hoffman, R., Benz, E. J., Shattil, S. J., Furie, B., Cohen, H. J., & Silberstein, L. E. (1995). Hematology basic
principles and practice (4th ed.). New York: Churchill Livingstone.
Johnson-Spear, M. A., & Yip, R. (1994), Hemoglobin differences between Black and White women with
comparable iron status: Justification for race-specific anemia criteria. American Journal of Clinical Nutri-
tion, 60, 117–121.
Lee, C. R., Bithell, T. C., Foerster, J., Athens, J. W., & Lukens, J. N. (1993). Wintrobe’s clinical hematology
(9th ed). Malvern, PA: Lea & Febiger.
Looker, A. C., Dalman, P. R., Caroll, M. D., & Gunter, E. W. (1997). Prevalence of iron deficiency anemia in
America. Journal of the American Medical Association, 277, 973–976.
McLaughlin, G. H. (1969). SMOG grading: A new reliability formula. Journal of Reading, 12, 639–644.
Pender, N. (1996). The health promotion model: Health promotion in nursing practice (3rd ed.). Stamford,
CT: Appleton-Lange.
Pender, N., Walker, S., Sechrist, A., & Frank-Stromborg, M. (1990). Predicting health promoting lifestyles in
the workplace. Nursing Research, 39, 326–332.
Pennington, A. T. (1994). Bowes & Church’s food values of portions commonly used (16th ed.). Philadelphia:
Lippincott.
Schorr, L. B. (1998). Within our reach: Breaking the cycle of disadvantage. New York: Doubleday.
U.S. Department of Health and Human Services. (1997). Healthy people 2000: Review 1997. Washington,
DC: Public Health Service.
Wisconsin Department of Health and Social Services. (1990). Healthy people in Wisconsin. Madison, WI:
Author.
256 Callen

APPENDIX A
Test Your Iron Knowledge

1. The reason I need iron in my blood is to:

a. Build hemoglobin, the oxygen carrying protein in red blood cells.
b. Build strong muscles.
c. Make my blood thicker.
2. Iron deficiency is common in all the following groups except:
a. Toddlers.
b. Adolescent girls.
c. Women of childbearing age.
d. Adult men.
3. Men need more iron each day than women do.
True
False
4. Lack of iron in my blood may:
a. Make me feel tired.
b. Cause difficulty in concentrating.
c. Lower resistance to infections.
d. Cause headaches.
e. All of the above.
5. Iron in meat, vegetables, grains, or iron pills is all absorbed equally.
True
False
6. Good vegetarian sources of iron are:
a. Dark, leafy greens.
b. Beans.
c. Dried fruits.
d. All of the above.
7. Vitamin C helps the body absorb nonheme (plant) iron.
True
False
8. The best source of iron is:
a. Fruit.
b. Vegetables.
c. Animal products (meat).
d. Grains.
9. A food that is frequently iron fortified is:
a. Milk.
b. Breakfast cereal.
c. Candy bars.
 Iron Deficiency Anemia 257

10. Eating a diet high in iron today will improve my hematocrit tomorrow.
True
False

Name
Date

APPENDIX B
Answers to Anemia Quiz

1. (a) Build hemoglobin

2. (d) Adult men
3. False
4. (e) All of the above
5. False
6. (d) All of the above
7. True
8. (c) Animal products
9. (b) Cereal
10. False
258 Callen

APPENDIX C
 Iron Deficiency Anemia 259

APPENDIX D
260 Callen

IRON CONTENT OF FOODS (in mg)

Apricots (dried), 5 whole 1.9

Apple 0.2
Applesauce, 6 oz. 0.2
Apple pie, 1/8 pie 0.2
Bagel 1.8
Baked beans, canned, 1/2 cup 0.4
Banana, 1 medium 0.4
Beans
Green, 1/2 cup 1.4
Dried, cooked 1/2 cup 2.0
Kidney beans, 1/2 cup 2.6
Lima, 1 cup 2.9
Beef, 3 oz. 3.0
Bread, wheat or enriched, 1 slice 0.7
Broccoli, raw, 1/2 cup 0.4
Burrito w/beans (2) 4.5
w/beef (2) 6.1
Cabbage (raw), 1 cup 0.4
Carrots, 1 medium 0.4
Cereals, 1 oz
Bran flakes, 3/4 cup (Kellogg’s) 18.0
Cheerios, 1 1/4 cups 4.4
Corn flakes, 1 cup 1.8
Cream of Wheat, 1/2 cup 7.8
Oatmeal, cooked, 1/2 cup 0.8
Oatmeal, instant, 1 pkt 8.1
Product 19, 3/4 cup 18.0
Raisin bran, 1/2 cup 4.5
Shredded wheat, 1 oz. 1.2
Total, 1 cup 18.0
Cheese, cheddar, 1 oz. 0.2
Chicken, 3 oz. (1/2 breast) 1.2
Corn, 1/2 cup 0.3
Cottage cheese, 1 cup 0.4
Egg, 1 medium 1.0
English muffin 1.7
Fruit cocktail, 1/2 cup 0.4
Grapes, 1 cup 0.3
Ham, 3 oz. 2.2
 Iron Deficiency Anemia 261

Hot dog 2.3

Lentils, 1 cup 4.2
Lettuce, iceberg, 1 cup 0.3
Liver (beef), pan fried, 3 oz. 5.3
Macaroni & cheese, 1 cup 1.0
Milk, 1 cup 0.1
Molasses, blackstrap, 1 tbsp. 3.2
Muffin 0.6
Nachos with cheese, 6–7 1.7
Nuts
Cashews, 1 cup 5.3
Peanuts, 1 cup 3.0
Orange 0.1
Orange juice, 4 oz. 0.1
Oysters (raw), 1 cup 13.2
Pancakes w/butter & syrup (3) 2.6
Peas, 1/2 cup 2.0
Peas, blackeye, 1 cup 3.5
Pasta, 1/2 cup 0.7
Peanut butter, 2 tbsp. 0.6
Pickle, 1 med dill 0.7
Pizza, cheese, 1/8 of 12" pizza 1.1
Popcorn, 3 cups 0.4
Pork, 3 oz. 2.7
Pork & beans (canned), 1 cup 5.9
Potato, 1/2 cup 0.7
Potato, baked w/skin, medium 2.8
Prunes, 5 medium 1.2
Prune juice, 1/2 cup 5.2
Raisins, 2 tbsp. 0.6
Ramen noodles, 1 cup 0.0
Rice, 1/2 cup 0.7
Roast beef sandwich 4.2
Shrimp (canned), 3 oz. 2.6
Soup
Split pea, 1 cup 1.0
Chicken noodle, 1 cup 0.5
Tomato, 1 cup 0.7
Spaghetti sauce (canned), 1 cup 3.3
Spinach (cooked), 1/2 cup 2.0
Sweet potato, 1 baked 1.0
262 Callen

Taco, small (6 oz.) 2.4

Tofu, 2 1/2 × 2 3/4 × 1 in. 2.3
Tuna, 1/2 cup 1.6
Turkey, 3 oz. 2.0
Yogurt, low fat, 1 cup 0.2
Yogurt, frozen, 1/2 cup 0.2

FAST FOODS

Big Mac (McDonald’s) 4.0

Biscuit w/egg & bacon 3.7
Chicken filet sandwich 4.7
Chicken (fried), breast & wing 1.4
Chicken McNuggets (1 serving) 1.0
French fries (regular order) 1.0
Hamburger, regular 2.4
Shake (chocolate), med 1.6
Submarine sandwich
(w/cheese, salami, ham) 2.5
Whopper (Burger King) 4.9