Human Nutrition

Daily Food Record Name (print):____Jane Doe_____________________ Day & Date of Intake: ____Tuesday 1/25/11_____ Male______ Female __X__ Age ___20__

Meal Date Time

Of Day Food Item Amount

Description

(Brand or restaurant) How Prepared (if applicable)

12/23 8:30am Cheerios 1 ½ cup General Mills sugar 2 tsp 2% milk 1 cup Purity Fresh blueberries ¾ cup Orange juice ½ cup Water 1 cup

Breakfast

12/23 12:45pm Turkey sub 6 in Subway

including shredded lettuce ¼ cup Shredded and tomato ¼ cup Sliced on wheat bread with Cheddar Cheese Slices 2 oz with light mayonnaise 1 Tbsp Baked Lays Orig. Potato Crisps 1 oz Frito-Lay

Lunch

Diet Coke 16 fl oz 12/23 7:00pm Salmon fillet 5 oz baked

with Diced Raw Tomato ½ cup and Diced Raw Onion ½ cup and White Wine for Cooking ½ cup and Ground Black Pepper ¼ tsp Long Grain Brown Rice ¾ cup Cooked Salad Tossed Romaine Lettuce 2 cups Shredded Raw Carrots 1/3 cup Sliced Raw Tomatoes ½ cup Diced with Diet Italian Dressing 2 Tbsp

Dinner

White wine 5 fl oz 12/23 3:00pm Apple 1 medium

Peanut butter 1 tbsp Peter Pan creamy Bottled water 12 fl oz 8:00pm Peanut M and M’s 10 Shared pkg with friend Water with lemon 2 cups 10:00pm Popcorn Light Natural Flavor 2 cups Orville Microwaved

Snacks

Green tea 1 cup • Record food items as completely as possible, listing separate ingredients when indicated (e.g., don’t just write “sandwich”, but

include type of bread, filling, vegetables added, sauces and condiments). • Don’t forget beverages, including alcoholic beverages, sodas, juice, milk, and water. • Estimate the amounts or serving size you consume as closely as possible in units, such as cups, ounces, tablespoons, and teaspoons.

(NOTE: “one serving”, “one bowl”, or “one piece” are not acceptable units as they are subjective measures and don’t relay quantifiable amounts.) You may want to measure foods to obtain a more accurate estimate of quantity.

• When indicated, include preparation method or other details that may help describe the food, for example: indicate whether a chicken breast is baked, grilled, breaded, fried, etc. or whether vegetables are raw, steamed, “Southern style”, sautéed, fried, etc.