Dietary Assessment MyPlate Comparison Chart 3-Day Diet Record and Food Frequency Questionnaire (DHQ)

(submit with Parts 2 & 3- so keep a copy!) Name of interviewer: Andrea Rapp _________________

Client information: Initials: ___KP___ Sex: ___F__ Age:____21___

Habitual physical activity:

Type(s): Weight Lifting, Cardio (running)

Exertion level:_Moderate Minutes per day: 30-45 Minutes

Food Group My Plate Recommended Quantity1

DRI calorie goal: 2,400

3-Day Diet Record (Average quantity/day)2

Food Frequency Questionnaire (DHQ)

(Approximate quantity/day)

grams % of total calories

grams % of total calories

grams % of total calories

Protein (total) 45.36g 10% - 35% 124.5 34% 111 33%

Carbohydrate (total) 328.81g 45% - 65% 165.1 45% 119 35.7%

Fat (total) 74.40 20% - 35% 34.4 21% 42 28%

Fruits (cups) 2 Cups 0.7 Cup 0.2 Cup

Vegetables (cups) 3 Cups 2.0 Cup 1.9 Cup

Grains (oz-eq) 8oz-eq 4.7oz-eq 2.0oz-eq

Protein foods (oz, tsp, cups) 6.5oz-eq 12.5oz-eq 16.60z-eq

Dairy (cups) 3 Cups 0.7 Cups 1.5 Cup

Added Oils/Fats (tsp)3 7tsp 7.6tsp 9.3tsp

Discretionary calories (kcals)3 330 kcal 261.8 kcal 471.2 kcal

1 The MyPlate food group recommended listings are appropriate for individuals who get less than 30 minutes per day of moderate physical activity, beyond normal daily activities. You will need to make recommendation adjustments for clients who are more physically active. 2 For 3-day diet record, total the quantity eaten over three days for each food group on a separate sheet, then divide by three to determine average daily intake. Report averages in the table above. 3 When completing the Comparison Chart, be mindful that you will need to use your professional judgment when deciding what to include in the Oils/Fats (tsp) and Discretionary/empty calories (kcals) sections.

• Examples in the Oils/Fats (tsp) category may include: salad dressing, butter, oils, etc.; there are 4.5 grams in a tsp. • Examples in the Discretionary/empty calories (kcals) section may include: energy drinks, soda, alcohol, high- octane desserts, etc.

Dietary Assessment

Part 2

FSHN 360

Andrea Rapp

Dietary Assessment Part 2: Observations Recording your intake/completing the 3-Day Diet Record: What was it like to record all food and beverages for 3 days? Easier or harder than you anticipated? Meals prepared and eaten at home vs. away? Measures and weights? Did you carry the diet record with you throughout the day/night? What was it like to see your food and beverage consumption in print? Completing the 3-Day Diet Record was slightly more difficult then I had anticipated. I realized that I was out and about doing things throughout the day and did not always have my record near me to record what I had been eating. Because of this, I did have to do some of the recall from memory, which made it hard to know exact amounts that I had eaten. I also had trouble recording the little items. For example, when I would take a sip of something to drink or just take a “handful” of something for a snack, I often forgot to write it down. I also had dinner that was made for me one night, which made things very difficult to measure out and there was a little bit of guessing involved. For example, one of the nights for dinner I had a quinoa mix, and I needed to record everything that was involved with it. However, I was not the one who made it so I had to rely on the person who had made it and use estimates for what I had actually consumed. I noticed that it was also very time consuming to measure out all of the food. The first day, I was excited to do it and become more motivated to measure and record exactly what I was having. Then, as I became busier the next two days, this motivation dropped. I did realize that I was more conscious of what I was eating when I was writing things down and viewing everything. I can see why this could lead to some inaccuracies that might not record a reliable average for someone’s food consumption.

Conducting the interview: How thorough was your client’s record? Elaborate on what it was like to conduct the interview on a peer /someone you know who is also in a health field? Do you anticipate their record was valid? Reliable?

My clients record was relatively thorough. She is used to keeping a food record through a cell phone app, which made it slightly easier on me to go through everything. The one thing that I had to double check with her however was her fluid intake. She forgot to mention anything she had drank that day so I had to go back through with her and figure out what she had. It made it easy that she had only had water to drink, but estimating the amount became a little more difficult and we had to use some water bottles in order to come up with an accurate amount. I liked that I was conducting this interview on someone else in the health field. I was worried at first I would overlook a few things or miss some items I should be asking about, so if I did that then my client was able to help me out. I do think that her record was both valid and reliable as well. She was very good at tracking her meals and using correct measurements for each food item. She was also good at listing what she used to cook with a few times. The only concern I would have had would be with the Chipotle bowl she had consumed. In order to come up with valid measurements, we had to look at the website and use their estimated normal amounts for each bowl1.

Entering and analyzing your classmate’s 3-day diet record: Were all foods available in the program? Did you need to use professional judgment or interpretation to align with available foods? Effectiveness of software program? Was it user-friendly? Easy to interpret?

1 Nutrition Calculator. Chipotle Mexican Grill. http://www.chipotle.com/en-US/menu/nutrition_calculator/nutrition_calculator.aspx. Accessed February 17, 2015.

Analyzing the 3-Day Diet record was one of the more difficult parts of this project. I think that NutritionCalcPlus is an excellent program and gives good information regarding food intake. But, it is a little hard to find all of the specific foods listed. My client had foods that had special brands, like Kirtland, that were not available in the program. Surprisingly, there was not any Kroger brands either that I could find. This made it slightly more difficult because, yes, there are food items that closely matched it but I was not sure which ones. I definitely had to use my best judgments on the eggs and some of the vegetables. Since these food items are still very basic, I went for the USDA listed brands, as they closely matched that of the eggs found in the brands my client had listed2. I also had a lot of trouble marking down what she had eaten at Chipotle. I did notice that NutritionCalcPlus had some foods from restaurants, but I think it would be great if they had a few more. I had to look up some of the ingredients that were in the certain food items that came with the bowl my client ordered, and to the best of my ability, matched them with certain items already listed in the database. Other then that, I did think the results were easy to interpret and overall, it is a user-friendly program.

Challenges: Did you need to make any adjustments to MyPlate recommendations based on an activity level? If supplements were consumed, how did you handle this? Other logistics and/or challenges not mentioned in one of the other reflection areas?

I did have some challenges regarding the recommendations. I contemplated hard whether or not I should have changed the recommendations that were given. My client did get slightly over the 30 minutes of recommended activity, but there are a lot of food items she is deficient in, so I made the decision not to make any changes to the recommendations. On days she lifts weights, she is expending roughly 130-150 calories, which I think is appropriately accounted for in these recommendations. I went off of the recommendations that were listed for the 2400 calorie plan due to the fact that her DRI recommended somewhere around this amount. My client did not take any supplements, which meant that everything she was taking in was coming from her food. She did a good job at meeting many of her micronutrient needs but there are some that still should have been increased. The most challenging part of this whole project is making the recommendations. I can give an opinion but I definitely would like to increase my knowledge on these subjects to more accurately give food intake advice to clients.

Dietary recommendations to client based on results. Discuss any changes you made to MyPlate recommendations and why in addition to reflecting on their 3-day diet record intake average. Make comparisons between the two for each food group/row of the chart. What are they doing well? Areas for improvement? How to achieve, etc.

I did not end up making any changes to the existing recommendations from MyPlate for this client. I think it is important to at least be hitting all of these goals, and for macronutrients, my client is doing fairly well. However, she is very below her recommendations regarding fruit, vegetables, grains, dairy and overall calorie consumption. Here are some of the observations and recommendations that I would make for each group:

Protein: My client is easily meeting and exceeding her recommended protein requirements. I understand that I am not an expert in deciding what is best for my client protein wise, but I do not think that exceeding this

2 Nutrition Benefits of Egglands Best Eggs. Egglands Best Eggs. http://www.egglandsbest.com/superior-nutrition/nutritional-benefits-eb-eggs/ . Accessed February 17, 2015.

amount is doing any harm. I think protein is one of the most important macronutrients to achieve and I have been told that requirements can range anywhere from 0.5g to 1g per pound of body weight3.

Carbohydrate/Grains: My client is well under her carbohydrate goal, which I would recommend to her to increase. I would recommend that she includes more whole grains in her diet that will provide these carbohydrates and well as allow her to meet her recommended grains goal. Some food items I might suggest would be maybe trying to incorporate a brown rice or whole-wheat pasta dish.

Fruits and Vegetables: These categories are definitely something that my client needs to increase. She is not meeting her recommended needs, especially for fruits. For this, I would recommend maybe trying to add a piece of fruit at all of her larger meals, or possibly even as a snack item. This would also increase her overall caloric intake. If this is not able to be met due to fullness, time constraints, etc.. I would recommend trying a 100% fruit juice drink, or possibly some sort of smoothie. For vegetables, increasing the amount that she has been eating at every meal might help. Also combining some with other foods could help increase her amount. For example, mixing a vegetable of choice with the tuna she eats could be an option. Salads and some fruit drinks/smoothies can also increase your vegetable intake.

Dairy: My client also needs to increase her dairy intake. It is shown in the table that she is well under this recommendation as well. Low fat dairy items in milk, yogurt and cheese could improve this and also help increase her calcium amount. She is doing well with calcium, but is not hitting the recommended goal by about 20%.

Fats/Oils and Discretionary Calories: I think my client is doing well with these categories. I know she is under the recommended amount for discretionary calories, but I would rather her get her calories from more nutrient dense items that her body could utilize. I calculated the fats by using the conversion factor provided and the discretionary calories by the calories provided by saturated fat and sugar consumed.

Micronutrients: Overall, I think my client is doing very well with hitting her micronutrient goals, but there are a few that she should increase. Her vitamin A intake is a bit low, so adding in some foods high in this such as sweet potatoes or dark leafy greens could improve this. Her vitamin E intake should also increase and foods high in this would be nuts, spinach and some fish. Finally, her potassium intake should increase as well. For this I would recommend her getting it from either the dark leafy greens or yogurt so she can increase these food items as well.

3 Campbell, W. W., Johnson, C. A., McCabe, G. P., Carnell, N. S.. American Journal of Clinical Nutrition. Vol. 88 (5), 2008. 1322–1329.