Appendix VI - Food Diary Sample

Time	Meal or Snack Place	Amount	Food – Method of preparation and amount of fat added	Calories	Fat, grams

7:00 AM	Breakfast, Home	1 cup	Orange juice	112	0
		1 cup	Bran flakes with raisins	156	1
		1 cup	½% milk	92	1
		2 slices	Wheat toast	139	2
		1 teaspoon	Margarine	34	4
		1 tablespoon	Jam	48	0

12:00 Noon	Lunch, Deli	1 sandwich	Grilled chicken breast on Kaiser roll with mayonnaise (2 teaspoons), lettuce, tomato	427	14
		1	Dill pickle spear	5	0
		½ cup	Baked beans	124	1
		1 ½ cup	Watermelon cubes	77	1

6:00 PM	Dinner, Home	4 ounces	Grilled salmon	179	7
		¾ cup	Rice pilaf	215	4
		3 spears	Steamed broccoli	29	0
		1 cup	Fresh fruit salad	92	1
		1 medium	Wheat roll	86	2
		1 teaspoon	Margarine	34	4
		¾ cup	Low-fat frozen yogurt	147	2

8:30 PM	Snack, Home	8 cups	Light microwave popcorn	206	7
		1 cup	Apple cider	117	0

		TOTAL		2321	51

Sample Food / Dairy Calary Calculation Sheet

Time	Meal or Snack Place	Amount	Food – Method of preparation and amount of fat added	Calories	Fat, grams