Fill out one the food diary form for three non-consecutive days – two weekdays (green forms, Monday-Friday) and one weekend day (blue forms, Saturday or Sunday). The days should not follow each other.
Start each new day on a new page. Fill out the day’s date at the top of each page.
For weekday food diaries and if the child attends day care or school, please ask the day care provider or teacher to inform you of what your child has eaten.. You will be expected to enter any additional food/drinks your child has before/after school.
Complete Time, Place Prepared, and Meal columns for each meal or snack your child ate. Remember to include everything your child eats and drinks (including water). For week days, you do not have to list the foods eaten while your child was at school or day care if the teacher or provider gave you a completed diary for the meals eaten while away from you. Remember to include these records in the envelope you submit to the study coordinator. *See Sample Food Diary attached.*
If the amount your child ate does not reflect your child’s normal eating patterns, please indicate why in the comments section at the bottom of the page for that day. For example: Child 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 your child ate, even if it is a partial 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 , Kraft Macaroni & Cheese).
List ingredients of mixed dish on separate lines. For example Spaghetti and Meatballs:
1 cup Spaghetti noodles cooked in salt water
1/2 cup Harris Teeter brand tomato sauce
2 meatballs- 1 inch each 80% lean beef
* Also see Sample Food Diary *
Amounts of Food Eaten
Please record the amount your child ate not the amount of food 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. child at 1”x1” block of cheese; or child ate 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.
Thank you for participating in this study. If you have any questions about this diary please contact (Place SITE Coordinator Information HERE).
| File Type | application/msword |
| Author | UNC |
| Last Modified By | hashemip |
| File Modified | 2012-10-17 |
| File Created | 2012-09-03 |