Completing a CPSP Nutrition Dietary Assessment

CPSP requires that all nutrition assessments, trimester reassessments and postpartum
assessments include a dietary intake to compare the womans food intake to a science
based standard for pregnancy. The US! MyPyramid Plan for Moms is an on"line,
personali#ed, and interacti$e dietary guideline tool for pregnant, breastfeeding and
formula feeding women %www.mypryamid.go$ &. Specific dietary guidance is not
a$ailable in an on"line format for obese pregnant and postpartum women with gestational
diabetes. ietary guidelines are a$ailable on MyPyramid Plan for Moms for diet patterns
from '((( to )((( calories. *f using the on"line tool is not an option, use the standardi#ed
food intake guideline for pregnant and breastfeeding women, What Should I Eat? My
Pyramid Plan for Moms %see appendi+&.
http,--www.mypyramid.go$-downloads-resource-pregnancyposter.pdf &.
There is no one required method or form you must use to assess a womans diet at her
initial, reassessment and postpartum $isit. The 24-Hour Perinatal Dietary Recall and the
Perinatal Food rou! Recall are dietary intake assessment forms pro$ided in the
appendi+. ! complete CPSP nutrition assessment includes a Dietary Inta"e #ssessment
and an Initial $om%ined #ssessment
%http,--www.cdph.ca.go$-pubsforms-forms-Ctrld.orms-cdph//00.pdf& or Prenatal
&utrition #ssessment
%http,--www.cdph.ca.go$-pubsforms-forms-Ctrld.orms-cdph//1'c.pdf & and a weight
gain grid. %see !ppendi+.& The dietary assessment and inter$ention pro$ides an
opportunity to,
2& !ssess strengths and gaps in a womans typical eating habits and food choices by
comparing her diet to the MyPyramid Plans for Moms'
'& !ssess a womans food insecurity and refer her to needed supplemental food and
financial resources.
)& !ssess and address any food safety concerns.
/& 3elp a woman de$elop a healthy eating plan, keeping in mind her food habits,
culture, family, weight, health status and lifestyle.
0& 4ducate a woman on the healthiest food choices from e$ery food group and get
the most nutrition from the food she eats.
5& Stress how important 6*C education and food checks are in helping a woman
achie$e a healthy diet. 4ncourage her to consume the foods 6*C offers.
1& iscuss the balance between food intake and physical acti$ity.
7& Pro$ide referrals for comple+ medical-nutrition conditions. Steps to Take offers
referral criteria under most nutrition guidelines.
8& Celebrate healthy food and acti$ity habits and changes. 9ffer guidance and
support for on"going impro$ement.
How to Assess Food Intake
Steps to Take includes two methods to assess the food intake of pregnant, breastfeeding,
and postpartum women. The first is the 24 Hour-Perinatal Dietary Recall and the second
is the Perinatal Food rou! Recall. :o dietary intake method completely reflects the
food intake of the client, but either tool pro$ides a basis for educating and encouraging a
woman to make healthy eating choices based on MyPyramid Plan for Moms' 9ther food
intake methods that ha$e been re$iewed and appro$ed by state designated staff are
allowed.
The 24 Hour Perinatal Dietary e!all
Conducting a '/"hour dietary recall takes practice. !s you learn the steps and complete
se$eral recalls you will feel more comfortable and you will get better results. 4+perts
ha$e found the best results come from using a step by step method. ;ecord the results of
the womans food intake on the Perinatal 24-Hour Dietary Recall. <efore you begin,
always e+plain what you are going to do.
=I am (oin( to as" you to tell me e)erythin( you ate and dran" durin( the last 24 hours'
I *ill as" +uestions to (et the most accurate food inta"e !ossi%le' I *ill com!are your
food inta"e *ith a food (uide that includes all the nutrients and ener(y you need for a
healthy !re(nancy ,or for !ost!artum and %reastfeedin( needs-' Please %e sure you tell
me e)erythin( you ate or dran". e)en the small thin(s li"e %utter. salad dressin(s. cream.
and candies. so I can (i)e you the %est healthy eatin( information !ossi%le'/
Step "# $ake a %ui!k &ist of e$erything the woman ate or drank during the '/ hour
period. 6rite the food down on the 24-Hour Perinatal Recall in the =.ood> column.
6rite down one main food item per line. o not worry about ser$ing si#es or the time the
food was eaten during Step 2.
'ey Points(
<egin in the morning after the woman woke up and go through the day step by step
until the last thing she ate.
!$oid using words like breakfast, lunch or dinner. People ha$e different meanings for
these words and you also may miss the foods eaten in"between meal times.
<e gentle and kind. .ood intake is $ery personal information and negati$e comments
or gestures may decrease the accuracy of the dietary recall.
Some people eat in the middle of the night? ask the woman if ate anything after she
went to sleep.
;ecord any $itamins, minerals and other nutrition supplements like protein powder,
fish oils, herbs, etc.
Sample )uestions to ask *or Step "#
Healthy eatin( is im!ortant for you and your %a%y# Please tell me e)erythin( you
had to eat or drin" yesterday'
What *as the first thin( you are or dran" after you *o"e u! yesterday?
What *as the ne0t thin( you ate or dran" after that?
What *as the last thin( you ate in this 24 hour !eriod?
Step 2# Forgotten Food &ist+ @ook o$er the food list with the woman and ask if there is
anything else she remembers eating or drinking. !dd these foods to the recall.
'ey Points(
4asy to forget foods like butter, half and half, mayonnaise, salad dressings,
fats used in cooking and snacks may contain many calories and few nutrients.
Check to see that all be$erages are recorded, including sodas, coffee, teas,
Auices and any type of water"based be$erage.
Sample questions to help trigger memory include,
Did you ha)e any snac"s yesterday?
What %e)era(e did you drin" *ith this meal?
Do you use cream or su(ar in your drin"?
Did you s!read anythin( on your %read. %iscuit. or muffin?
Did you add %utter or mar(arine to the !otato or )e(eta%les you ate?
Did you eat tortillas. !ieces of %read or rolls *ith your meal?
Step ,# Time and -!!asion+*t is helpful to ask the woman what time she ate the food to
learn more about her food habits and to help her remember other foods she ate. ;ecord
times of food eaten in the =Time> column. Bou may want to ask,
What time did you eat this meal? When did you eat ne0t?
Was there a s!ecial occasion on this day?
Step 4# Detailed Des!ription o* Food .aten+To assess if all the food groups were eaten
in the amount needed, you will need to compare the types and amounts of food eaten to
MyPyramid Plan for Moms' The amounts in MyPyramid are described in cups %fruits,
$egetables and dairy foods&, ounces %protein foods and breads, grains and cereals& and
teaspoons %oils&.
Determine Amount .aten"*t is important to determine the amount eaten of each food
group. Use food models and pictures, measuring cups and spoons, dinner plates and
bowls to help assess the amount of each food item eaten. 6rite the amount she ate for
each food item in the =3ow Cuch> column of the dietary recall. Duestions to help
determine the amounts of food eaten include,
Do you fill a (lass that is lar(er or smaller than this one?
Was the meat !ortion you ate smaller. lar(er or the same si1e as this dec" of cards?
2oo"in( at this %o*l. can you tell me ho* much cereal you ate?
2oo"in( at the !ictures of these tortillas. tell me *hat si1e tortilla you ate'
Ho* many tortillas did you eat *ith your meal?
Web Resource(
$y Pyramid +www.mypyramid.go$ or
http,--www.mypyramid.go$-downloads-CiniPoster.pdf pro$ides ser$ing si#es for each
food group. !t the website click =*nside the Pyramid>, ne+t, click on any food group for a
description of the food group, pictures of common ser$ing si#es and information on what
counts as a ser$ing.
Che!k *or Added Fat+ Cooking methods affect the amount of fat in the diet. !sk about
added cream, butter, sauces, salad dressings, cheese, etc. Possible questions include,
Did you %a"e. %roil. %oil or fry the chic"en you ate?
Did you lea)e the s"in on or off the chic"en?
Ho* did you fla)or the %roccoli you ate?
Do you !an fry or dee! fry your !otatoes?
Ho* much %utter did you add for each !anca"e?
Which of these measurin( s!oons or cu!s %est descri%es the amount of (ra)y. salad
dressin(. sour cream. etc' you ate?
Step /+ Final e0iew o* the 24+hour Dietary e!all+ !sk the client to look at the
complete list of the food items she ate to see if she can remember anything else she ate or
drank.
N.1T+ Cal!ulate the Dietary Intake
9nce you ha$e recorded all the types and amounts of food eaten in '/ hours, it is time to
add up the total number of ser$ings eaten per day in each food group. Bou will need to,
3- De!ide whi!h *ood group the *ood or drink *its into# ;e$iew the food groups
on MyPyramid Plan website. Bou need to decide if the food fits under the Erains,
Fegetables, .ruits, 9ils, Cilk, or Ceat and <eans. ! handy page to refer to is
Inside MyPyramid at http,--www.mypyramid.go$-pyramid-printpages.html. This
web link pro$ides food group information and the amount that counts as a ser$ing
for common foods.
2- De!ide total amount o* ea!h *ood group eaten# !mounts or ser$ings are
counted in cups, ounces or by teaspoons, depending on the food group. The bo+
below describes how food amounts are counted in MyPyramid Plan'
Food Amounts For $yPyramid Plan
Food 2roups Amounts or Ser0ings
Erains 2rains are counted by 2 ounce equi$alents and most pregnant and
lactating women need at least 5"7 ounces of grains per day. 2 ounce
is counted as 2 ser$ing. Common 2 ounce portions, 2 slice of bread,
G large bagel, 2 5 inch corn or flour tortilla, H cup cooked rice,
pasta or hot cereal, 2 cup ready to eat cereal, H 4nglish muffin, 2
small muffin.
Fegetables 3egeta4les are counted by cups and most women need ' H cups a
day. 2 cup raw or cooked $egetables and ' cups of leafy $egetables
%like salad& count as 2 cup. '( .rench fries count as 2 cup of
$egetables and as added fat. Total up all the cups of fresh, fro#en,
and canned $egetables she eats in a day. *t is important to eat the
fi$e types of $egetables each week, dark green, orange, beans and
peas, starchy and other $egetables.
.ruits Fruits are counted by cups and most women need ' cups of fruit
each day. 2 cup fresh, fro#en, canned fruit or Auice and H cup of
dried fruit count as one cup. Cost women need ' cups of fruit each
day. CPSP suggests limiting fruit Auice to H cup per day.
9ils -ils ser$ings are counted in teaspoons and most women need 5
teaspoons of oils from plants, nuts and seeds each day. Commonly
eaten oils include dressings and plant oils to prepare and cook
foods. Use measuring spoons to help women estimate the amount of
oil eaten. 2 tablespoon oil is equal to ) teaspoons. Solid fats like
butter, cream, half and half, do not count as oils. :ote solid fats
eaten on the dietary recall and encourage the woman to eat nuts,
seeds and plant oils.
Cilk $ilk is counted by 2 cup ser$ings and most women need ) cups per
day. 9ne cup of the milk group equals, 2 cup fluid milk, 2 cup
yogurt, 2 H ounces of hard cheese, 2-) cup shredded cheese, '
ounces %' slices& processed cheese, ' cups cottage cheese and 2 H
cups ice cream.
Ceat and <eans $eat and 5eans6 the high protein foods are counted in ounces# 9ne
ounce of meat, 2 egg and G cup of cooked beans and peas count as
2 protein ser$ing. Cost women need 0 H "5 H ounces of meat and
beans per day. ! meat portion the si#e of a deck of cards is about )
ounces. Cost women eat enough protein rich foods. Fegetarian
women can get the protein they need eating legumes, soy products
like tofu, nuts and seeds. See Vegetarian Eating if the woman does
not eat meat, poultry, and fish.
4+tra or
Sometimes .oods
.7tra or Sometimes Foods+ The MyPyramid Plan for Moms
includes =e+tras> in calorie amounts. 4ncourage woman to eat more
healthy choices rather than high calorie foods with few nutrients. *t
is okay for women to ha$e food that is high in fat or sugar once in a
while as long as her weight gain is not high and the foods are
allowed in her diet.
Combination or
Ci+ed ishes
Com4ination or $i7ed Dishes+ 6hen se$eral foods are used
together like casseroles, burritos, spaghetti, lasagna, soups, stews,
etc. you may ha$e to estimate the amount of each food eaten. 9n"
line resources can help you identify the food group and count the
ser$ings si#es in mi+ed dishes. Use $yFood+a+pedia
"htt!455***'myfooda!edia'(o)5 for food group and ser$ing si#e
information for commonly eaten foods. Counting $i7ed Dishes
in $yPyramid, a tool that counts the food groups in se$eral mi+ed
dishes is found on CyPyramid =Tips and ;esources> and is also
found in the appendi+ under :utrition Tools.
.7ample(
Tuna Fish Sandwi!h
Food .aten Food 2roup Ser0ings
' o#. tuna Ceat '
' slices whole wheat bread <read-Erain '
' tsp. mayonnaise 9ils '
N.1T ST.P+ Comparing the Food Intake to MyPyramid Plan for Moms
There are two ways to compare the clients '/" 3our dietary intake with the guidelines.
Bou may use What Should I Eat? My Pyramid Plan for Moms %found on page II& and
online at http,--www.mypyramid.go$-downloads-resource-pregnancyposter.pdf &.
for a standardi#ed guideline or you may use the on"line MyPyramid Plan for Moms for an
indi$iduali#ed plan
%http,--www.mypyramid.go$-mypyramidmoms-pyramidmomsJplan.asp+& . 4nter the
womans height, pre"pregnant weight, due date and acti$ity le$el for an indi$iduali#ed
food intake eating plan. :ote that MyPyramid Plan for Moms will not calculate an eating
plan for obese women and should not be used for women with diabetes or other comple+
health conditions requiring the skills of a registered dietitian.
Steps(
2. !dd up the amounts eaten for each food group and record the number under
=Total Ser$ings> column on the '/" hour Perinatal ietary ;ecall *ntake .orm.
'. Compare the number of ser$ings of each food group eaten with the minimum
number of recommended ser$ings on MyPyramid Plan for Moms'
). Compliment the woman for the strengths of her food intake.
/. Circle or underline all foods eaten that pro$ide calories and few nutrients, e.g.,
soda, chips, candy, and sweet drinks.
0. ;e$iew the food groups what are missing or eaten in inadequate amounts. !sk the
woman about these food groups. Can she afford these foodsK oes she dislike
these foodsK !sk her what she is willing to do to impro$e her food intake.
5. ;e$iew the handout 6What Should I Eat?/ and help the woman set healthy eating
goals.
1. Complete the dietary assessment and nutrition indi$iduali#ed care plan? include a
plan for follow up nutrition assessment and education and make needed referrals.
7. ;ecord the total number of minutes to complete the entire CPSP nutrition
assessment, including plotting the weight gain grid, a dietary intake assessment
and a nutrition assessment questionnaire.
8e4 and Print esour!es+ These resources are pro$ided to help CPSP
practitioners assess dietary intake and pro$ide nutrition counseling and education.
CyPyramid .ood Eallery
%http,--www.okstate.edu-hes-nsci-nutrition-:SC*'22/-foodgallery.htm& " 9klahoma State
Uni$ersity, epartment of :utritional Sciences
This is an e+cellent resource to help assess dietary intake. The food gallery contains
actual pictures of food and was de$eloped to help people recogni#e the appearance of
$arious amounts of foods on a plate. The plates are standard 2("inch diameter plates.
Intera!ti0e Fast Food $enu with Fitness Cal!ulator 9 -regon State :ni0ersity6
Cooperati0e .7tension+.ast food information is a$ailable for Cconalds, <urger Ling,
Subway, Chick .il"!, ominos and Taco <ell and includes calories, fat, sodium, fiber,
protein and carbohydrate. The interacti$e tool allows clients to choose food and then
make better choices based on nutrition information presented. The fitness calculator
includes many forms of physical acti$ity, from casual walking to $igorous e+ercise.
htt!455***'e0tension'or(5!a(es5Interacti)e7Fast7Food7Menu7*ith7Fitness
$yFood+a+pedia" ! data base that breaks food down into food groups and ser$ings, and
calculates calories from fats and sugars. 8SD#' $enter for &utrition Policy and
Promotion' htt!455***'myfooda!edia'(o)5
Calorie 'ing+ ! food data base for o$er 0(,((( generic and brand name foods, including
fast foods.+ htt!455***'calorie"in('com5foods5
Fast Food 2uide :utrition information for fast foods including burgers, pi##a, and
coffee drinks. Contains printable charts.
9D Medical - Dia%etes $are-htt!455***'%d'com5resource'as!0?ID:;42<4
MyPyramid Plan for Moms esour!es
$y Pyramid in A!tion+Tips *or Pregnant $oms+ Printable handouts for weight gain
and diet intake guidance for pregnant and breastfeeding women in 4nglish and Spanish.
.nglish+
Pregnancy" http,--www.nal.usda.go$-wicworks-Topics-Pregnancy.actSheet.pdf
@actation" http,--www.nal.usda.go$-wicworks-Topics-<reastfeeding.actSheet.pdf
Spanish
Pregnan!y http,--www.nal.usda.go$-wicworks-Topics-SpanishPregnancy.actSheet.pdf
&a!tation http,--www.nal.usda.go$-wicworks-Topics-Spanish<reastfeeding.actSheet.pdf
$yPyramid *or Pregnan!y and 5reast*eeding Poster"
.nglish" http,--www.mypyramid.go$-downloads-resource-pregnancyposter.pdf

The Perinatal Food 2roup e!all $ethod
The Perinatal .ood Eroup ;ecall %see appendi+& is an alternati$e to the traditional 24-
Hour Dietary Recall. This method pro$ides an o$er$iew of the womans diet but does not
pro$ide the le$el of detail of a carefully completed '/" hour dietary recall. ;egardless of
the dietary assessment method used, what is most important is that the woman makes
healthy food selections. The Perinatal Food rou! Recall asks questions about a
womans usual daily intake, it does not ask about her specific intake for one day. Shading
on the forms bo+es indicates a nutritional concern to address with the client. The
=!d$ise Patient to> column pro$ides brief nutrition guidance for each food group.
:sing the Perinatal Food 2roup e!all Form
2. Tell the patient you will be asking her questions about her usual eating habits in
order to determine if she is eating the kinds of and amounts of foods that her
body needs for a healthy pregnancy.
'. To introduce each food group to the client you can use What Should I Eat?
MyPyramid Plan for Moms Plan' .ollow the form and e+plain to the woman
what the food group is and how much counts as a ser$ing. .or e+ample, you can
say,
=he first (rou! is the fruit (rou!' =he foods that ma"e u! this (rou! are fresh.
canned. fro1en and dried fruit and >uices' 352 cu! of fruit or >uice and ? cu! of
dried fruit counts as 3 ser)in(' @n a ty!ical day. ho* many cu!s of fruit do you
eat a day? Ho* many cu!s of >uice? Ho* many cu!s of dried fruit?
). etermine appro+imately how many ser$ings of each food group she eats on a
typical day. *t is important she eats at least the minimum number of ser$ings to
get the nutrients needed. Use the CyPyramid web site, pictures, measuring cups
and spoons, food models, etc to help clients identify the number of ser$ings
eaten in each food group. Say,
@n a ty!ical day. ho* many cu!s of fruit do you eat a day? Ho* many cu!s of
>uice? Ho* many cu!s of dried fruit?
/. .or most questions, you will indicate the number of food group ser$ings eaten
each day by checking the appropriate bo+ such as,
:e$er or @ess than ) ser$ings-day, etc.
in the appropriate column such as *nitial, '
nd
Tri%mester&, )
rd
Tri or Post%partum&
.or questions 5 and 1, you will check either Bes or :o.
0. .or question 7, write the total number of cups she drinks of each of the types of
be$erages on a typical day. Sugary drinks are Msometimes foods and a$oiding
caffeine is the prudent choice during pregnancy. 2' ounce cans equal 2 H cups,
25 ounces equals ' cups and '( ounce drinks equal ' H cups.
5. .or question 8, check ;es if she eats e+tra foods from each of the categories.
@ea$e blank if she does not eat these foods. *f she does eat these e+tra foods, ask
how much and how often she eats them %i.e., se$eral times a day, once daily, '")
times a week, etc.&
1. *f the patients response falls in a shaded bo+, such as she ne$er eats $egetables
or less than three ser$ings on a typical day, gi$e her the ad$ice and check off the
bo+., !im for ) or more ser$ings-day.
Initial
2
nd
Tri
,
rd
Tri Post
Ne0er
&ess than , ser0ings<day
, or more ser0ings<day
7. *f the patients response falls in an unshaded bo+, such as she eats / ser$ings of
$egetables on a typical day, tell her that she has made a good choice and check
off the bo+. !im for ) or more ser$ings-day.
8. Check other =ad$ice bo+es> as needed. .or e+ample if the only $egetables she
eats is starchy $egetables like corn, ad$ise her to
4at more dark"green and orange $egetables.
2(. .or Duestions 1, 7 and 8, help the patient make healthy substitutions for her
usual unhealthy choices if needed such as,
*f the patient uses lard in her cooking, ask her which of the healthy plant oils
she might try using instead.
*f the patient eats donuts and chips, ask her which healthy snack foods she
might eat instead.
6rite the healthy choice on the line pro$ided and check the appropriate =ad$ice
bo+es> such as !$oid foods high in fat and sugar and Choose fruits,
$egetables, nuts and seeds as snacks.
22. !fter the last question, re$iew the patients strengths and risks with her.
2'. *n the !d$ice Section, circle and date one or more items that the patient is
willing to impro$e-change by her ne+t $isit. *nclude these action items in her
indi$iduali#ed care plan. Cake notes on her copy of My Healthy Eatin( Plan that
she will take home with her.
2). !t the bottom of the form, clearly sign with your name, title and date.
2/. Since the dietary assessment is done at the same time as rest of the patients
nutrition assessment, the time spent on filling out the form should be included in
nutrition assessment minutes. .or e+ample, if it took 7 minutes to complete the
dietary assessment and '1 minutes to fill out the initial nutrition assessment form
and plot the weight gain grid, add the numbers together to get )0 minutes. 6rite
)0 minutes on the bottom of the initial nutrition assessment form.
20. Patient takes home her copy of My Healthy Eatin( Plan to reinforce the healthy
eating messages.