DT 130

Name: Please turn in this form with your assignment for grading purposes: Assignment Title: Three Day Food Intake Record and Activity Log Goals/Objectives of this assignment: The student will: Demonstrate the ability to use a Three Day Food Intake Record and Activity Log as a nutrition assessment tool. Become familiar with food composition tables by using one to identify nutrients in the foods consumed over the three-day period. Directions: This assignment is to be completed during the first two weeks of the semester. Record ALL foods and beverages consumed during 2 weekdays and 1 weekend day on the 3-day Food Intake Record forms provided in the packet. If necessary, make additional copies of the form. Include items such as water, alcoholic beverages, seasoning and condiments in your intake record. Record the quantity of the food and beverage consumed. Use household measurements such as cups, ounces and teaspoons. Identify the quantity of the food with as much accuracy as possible. Refer to Appendix A, Food Composition Table on pages A-3 through A-101 in your text. Use this table to identify the amount of nutrients contained in the foods on the food intake record. Compare the amount that you consumed with the reference portion in the Food Composition Table and make any necessary adjustments. For example, on page A-10, the reference portion of Cheerios Cereal is listed as 1 Cup. If you consumed Cup of Cheerios cereal, you would record the nutrients as of the amounts in the Food Composition Table. Identify and record the amounts of protein, fat, carbohydrate, kilocalories, fiber, cholesterol, saturated fat, monounsaturated fat and polyunsaturated fat, adjusted for the amount that you ate, as necessary, for each food on your food intake record. Remember to enter the page number where you found the information on the Intake Record. DO NOT USE the nutrient analysis software to obtain the nutrient data. USE the food composition table found in Appendix A. There will be a five (5) point penalty if it appears that the student used a software program to obtain the nutrient data! If you are not able to locate the actual food that you ate, you may enter a similar food. Calculate the daily total intake for each nutrient by adding up each column. If you used more than 1 sheet per day, calculate subtotals, and then add the subtotals together for the daily total. If you are able, you may create an Excel spreadsheet to submit your 3-Day Food Intake. You must use the same headings as the 3-Day Food Intake Record. For the same three days, use the Activity Log to record all of your physical activity. Each day of the Activity Log has 24 sections, one section for each hour in the day, beginning at 12 midnight. In each

section, record what you were doing during those 60 minutes. For example, in the section labeled 12 midnight, if you were asleep, you would record sleeping60 minutes. If between 8 am and 9 am you were in the shower for 30 minutes and it took you an additional 15 minutes to get dressed, in the section labeled 8 am, you would record showering30 minutes; dressing15 minutes. At the end of the day, summarize your physical activity in minutes. For example, if you recorded sleeping in 7 sections, each at 60 minutes, you would record in the activity summary section sleeping420 minutes. Please refer to sample 3-Day Food Intake Record and Activity Log to see an example of how to complete the assignment. Please note that the 3-Day Food Intake Record does not have the nutrient amounts entered. You are expected to enter the nutrient amounts in the Food Intake Record that you submit. Submit the completed form, including the Assessment/Evaluation/Grading grid to the instructor by the due deadline.

Assessment/Evaluation/Grading:

DT 130 Three-Day Food Intake Record Name:

Criterion: Student Lists all food and beverages consumed over a 3 day period, with portion sizes listed. Failure to list portion sizes will result in a lower score. Accurately assigns nutrient values to the foods consumed over the 3 day period, using the food composition table and taking into consideration the amount of food consumed. Accurately calculates nutrient values for the foods consumed over the 3 day period. Records all physical activity performed over the 3 day period. Accurately summarizes the number of minutes spent in each activity each day for the 3 day period. Total

Possible Points 4.2 4.2 4.2 4.2 4.2 21

Points Earned

Day/Date:
XAnd DA+ codePage number XXXXXXXXXXXXXXXXXXXXXXXXXXXFood Name

XXFat

XXMonounsaturated Fat

XXPolyunsaturated Fat

XXEnergy in Calories

XXCarbohydrate

XXDietary Fiber

XAmount Consumed

XXSaturated Fat

XXCholesterol

XXProtein

TOTALS DT 130 Three-Day Food Intake Record Name: Day/Date:

XAnd DA+ codePage number

XXXXXXXXXXXXXXXXXXXXXXXXXXXFood Name

xXAmount Consumed

XXEnergy in Calories

XXProtein

XXCarbohydrate

XXDietary Fiber

XXFat

XXSaturated Fat

XXMonounsaturated Fat

XXPolyunsaturated Fat

XXCholesterol

XAnd DA+ codePage number

XXXXXXXXXXXXXXXXXXXXXXXXXXXFood Name

Name: TOTALS DT 130 Three-Day Food Intake Record

XXProtein XXFat XXSaturated Fat XXCholesterol

Day/Date:
xXAmount Consumed XXEnergy in Calories XXCarbohydrate XXDietary Fiber XXMonounsaturated Fat XXPolyunsaturated Fat

TOTALS

DT 130 Activity Log Name: Day/Date: 12 Midnight 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 Noon 1 PM 2 PM 3 PM 4 PM

5 PM 6 PM 7 PM 8 PM

9 PM 10 PM 11 PM

ACTIVITY SUMMARY Activity Total minutes in 24 hours

DT 130 Activity Log Name: Day/Date: 12 Midnight 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM

7 AM 8 AM 9 AM 10 AM 11 AM 12 Noon 1 PM 2 PM 3 PM 4 PM

5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM

ACTIVITY SUMMARY Activity Total minutes in 24 hours

DT 130 Activity Log Name: Day/Date: 12 Midnight 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 Noon 1 PM 2 PM 3 PM 4 PM

5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM

ACTIVITY SUMMARY Activity Total minutes in 24 hours