Food Diary Instructions for Parent_MOM 20110621 - LOI2-QUEX-14

LOI2-QUEX-14 FOOD DIARY INSTRUCTIONS ATTACHMENT C.4.6

OMB#: 0925-0593

OMB Expiration Date: 07/31/13

Food Diary Instructions for Participant

1. Fill out one the food diary form once per month. You will have to enter the ASA24 the next day. It would be good to complete two weekdays (green forms, Monday-Friday) and one weekend day (blue forms, Saturday or Sunday).

2. Complete a food record one time per month.

3. Start each new day on a new page. Fill out the day’s date at the top of each page.

4. Complete Time, Place Prepared, and Meal columns for each meal or snack you ate. Remember to include everything you eat and drink (including water).

5. Bring these records in the envelope you submit to the study coordinator. *See Sample Food Diary attached.*

6. If the amount of food you ate on the day you filled out the food record form does not reflect your child’s normal eating patterns, please describe why in the comments section at the bottom of the page for that day. For example: I was sick or holiday party and ate more than usual amount.

Food and Beverages

• Please be as specific as possible with food types and dish ingredients.

• List each food or beverage on a new line.

• If a mixed dish is eaten, such as a casserole or stew, please include the recipe if known. Please include the number of servings the recipe makes and the amount (or number) of servings you ate, even if it is a part of a serving.

• Include preparation methods such as fried, baked, boiled, etc. in the Food and Beverages category.

• Include brand names where possible in the Food and Beverage category (McDonald’s , Michelina’s frozen dinners).

• List ingredients of mixed dish on separate lines. For example Spaghetti and Meatballs:

1 cup Spaghetti noodles cooked in salt water

1/2 cup store brand tomato sauce

2 meatballs- 1 inch each 80% lean beef

* Also see Sample Food Diary *

Amounts of Food Eaten

• Please record the amount you ate not the amount of food/drink served.

• For food eaten in pieces, like apples, cheese, etc., please record the size of the piece consumed (small, medium, large) and record dimensions when possible (i.e. 1”x1” block of cheese; or 2”x½” slice of apple)

• Please be specific when recording amount or portion size (¼ cup, 2 tsp., 1 small slice).

Before returning food diary, please check that the following are filled out for each day:

• Time of day

• Meal

• Place prepared

• Food and beverages

• Amount

When you are ready to return the completed food diary, put the following items in the white envelope:

• The completed Food Diary Forms for three days – two week days and one weekend day.

• The Food Diary the day care provider completed and any relevant menus for the day(s) recorded.

Thank you for participating in this study. If you have any questions about this diary please contact (Place SITE Coordinator Information HERE).