6. 6 Further reaDing
appendix 4: an example of dietary history
8.5 example 4: filled-out dietary history*
ID Number: 004 (Group: Chan 001) Sex: M Date of Birth: 13th July 1989 Date: 18th September 2010 Day of Week: Tuesday
table e - A dietary history record
BreaKfast
time: 8.30 am
place: home freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
Skimmed milk,
without sugar 1 cup (200ml) Hot skimmed
milk Parmalat x
Wholemeal
bread, no salt 2 slices, thin
(100g) Toasted
bread
BreaKfast
time: 8.30 am
place: home freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
+ jam 2 heaped
teaspoons, (20g)
Apricot jam Zuegg
without sugar
Yogurt, plain 1 cup(125g) Yogurt, plain, low fat, no sugar
Yomo x
+ cereals, corn
flakes, plain 6–8 heaped tablespoons, (30 g)
Cereals, ready-to-eat, corn grits, toasted plain
Carrefour
Sandwich, white bread, commercially prepared
1 sandwich, medium (80 g)
Toasted
bread x
+ omelette 2 eggs Cooked egg Ovito
+ e.v. olive oil 1 tablespoon,
(10ml) De Cecco
+ lettuce, romaine,
fresh, raw 4 leaves
(80g) Lettuce,
fresh, raw
Biscuits, dried 6–8 pieces (50g)
Dried biscuits with chocolate chips, commercially prepared
Mulino Bianco
x
+ orange juice 1 glass (200ml)
Santal
Cappuccino without sugar
1 cup (150ml)
Hot Skimmed Milk
Parlmalat x
+ coffee cup
(30ml) + coffee + espresso
(kimbo)
BreaKfast
time: 8.30 am
place: home freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
+ wholemeal croissant filled with honey
1 piece (70g)
Fruit salad, fresh 2 cups (200g) x
+ yogurt, plain, low fat, sugar free
1 cup (125g) Sterzing-
Vipiteno
English tea 1 cup (150 ml) Hot tea Twinings x
+ yogurt cake, cinnamon flavoured
2 slices, thin
(200g) Yogurt cake (homemade), prepared from recipe, fat free
mid-morning tea
time: 10.30 am
place: school freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
Banana 1 medium
(150g)
fresh banana Chiquita x
Apple 1 medium
(150g)
Fresh apple Melinda x
Cappuccino
without sugar 1 cup (150ml) + coffee cup (30ml)
Hot skimmed milk + coffee Espresso
x
+ biscuits,
buttermilk 3/4 pieces
(30g) Biscuits
buttermilk, commercially prepared
Mulino Bianco
mid-morning tea
time: 10.30 am
place: school freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
Orange 1 medium
(150g) Riberella x
+ rice crackers,
Gluten free 1 pack (30g) Galbusera
Porridge oats 3 heaped tablespoons (30g)
Rapunzel x
+ soymilk, plain 1 cup (150ml)
Isola Bio
lunch time: 13.00 pm
place: school freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
Rice, white, long-grain (basmati), raw
1 cup (100g) Boiled rice Scotti x
+ mushrooms,
fresh 1 cup (80g) + sliced,
sautéed mushrooms
+ cheese:
parmesan cheese
1 heaped tablespoon, (10g)
Bonduelle
+ e.v. olive oil 1 tablespoon,
(10ml) Monini
lunch time: 13.00 pm
place: school freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
+ salt A pinch
vEgEtABlES Lettuce, romaine, fresh, raw
4 leaves (80g)
Raw lettuce x
+ e.v. olive oil 1 tablespoon, (10ml)
Monini
+ salt A pinch
Apple Cake 1 slice (100g) Baked cake Homemade x
DriED pAStA Spaghetti,
rigatoni, fusilli 1 cup (100g)
(uncooked) Boiled pasta De Cecco x
FrESh/FillED pAStA
Lasagne 1 piece (250g) Baked pasta Barilla x
Cannelloni (filled with red meat- beef- and cheese- ricotta)
2 pieces
(200g) Baked pasta Barilla x
Tortellini (with
spinach and cheese 1 cup (125g) Boiled pasta Rana x
othErS Mashed, dehydrated, potatoes
A pack, commercially prepared (75g)
mashed, dehydrated potatoes, prepared from recipe, with whole milk + water + cheese
Buitoni x
lunch time: 13.00 pm
place: school freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
othErS
+ full cream milk 1 heaped cup (300ml)
Parmalat
+ cheese (parmesan cheese) +salt
3 heaped tablespoons (30g). A pinch
Lucini
Soup, pulses
and wheat, dried 1 cup (100g) Boiled lentils, chickpeas, spelt, oats
AlceNero x
+ e.v. olive oil 1 tablespoon (10ml)
De Cecco
+ salt A pinch
Cheese, mozzarella, whole milk
1 piece (125g) Fresh Mozzarella
Vallelata x
+ pork, cured
ham 3 oz. slices
(45g) + cured ham,
pork Beretta
+ tomatoes, red, fresh
3 pieces (200g)
+ fresh tomatoes
Cirio
+ e.v. olive oil 1 tablespoon,
(10ml) De Cecco
+ salt A pinch
vEgEtABlES Zucchini, with skin, fresh
2–3 pieces (200g)
Sliced, grilled x
Eggplant, raw 1 piece
(250g) Sliced, grilled x
lunch time: 13.00 pm
place: school freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
vEgEtABlES Mushrooms, white, fresh, raw
1 cup (80g) Sliced,
cooked x
Pepper, red, fresh, (uncooked)
1 piece (200g)
Sliced, grilled x
+ e.v. olive oil 1 tablespoon,
(10ml) Monini x
+ salt A pinch x
Water 2 glasses
(400ml) Natural water x
afternoon tea
time: 4.00 pm
place: home freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
English Tea 1 cup
(200ml) Hot Tea Sainsbury’s
brand x
+ sugar, brown, unpacked
1 teaspoon sugar (5g) + dried,
chocolate biscuits
2 pieces (20g)
Dried, chocolate, biscuits, commercially prepared
Mulino Bianco
afternoon tea
time: 4.00 pm
place: home freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
Pear juice 1 medium
glass (200ml) Fresh pear
juice Yoga x
+ yogurt, plain,
low fat 1 cup (125g) + yogurt,
plain, low fat, sugar free
Danone, Vitasnella
Banana 1 medium
(150g) Fresh fruit,
raw Chiquita x
+ cappuccino 1 cup (150ml) + coffee cup (30 ml)
Whole milk + coffee, espresso, (Illy)
Illy
Apple 1 medium
(150g)
Fresh fruit, apple, raw, with skin
x
+ multigrain crackers, (with rice, buckwheat and spelt)
1 pack (30g) Misura
Fruit salad, fresh 1 big cup
(200g) Fresh mixed fruits (orange, apple, banana, kiwi)
x
dinner time: 8.30 pm
place: outside/home freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
FiSh
Sogliola, fillet,
fresh (uncooked) 1 piece
(150g) Baked x
dinner time: 8.30 pm
place: outside/home freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
FiSh
Codfish, frozen, fillet (uncooked)
1 piece (150g)
Baked x
Salmon, pink, fillet, fresh (uncooked)
1 piece
(150g) Cooked in
the pan x
+e.v. olive oil 1 tablespoon
(10ml) x
+ salt A pinch x
+ lemon A few drops
of lemon juice
x
mEAt
Chicken, breast, fillet, boneless, skinless (uncooked)
2 slices, thin (200g)
Grilled chicken
Amadori x
Chicken, legs, with bone without skin (uncooked)
2 pieces, small (200g)
Grilled chicken
Aia x
Turkey, breast, fillet, without skin (uncooked)
2 slices, thin
(200g) Baked turkey Amadori x
Beef, steak
(uncooked) 1 slice (130g) Grilled Beef x
Beef, meatballs,
(cooked) 2 pieces
(120g) x
+salt A pinch x
dinner time: 8.30 pm
place: outside/home freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
tuBErS
Potatoes, peeled 1 cup (200g) French Fries x
vEgEtABlES, CookED
Spinach, fresh 1 cup (200g) boiled x
Chicory, fresh 1 cup (200g) sautéed x
Chard, fresh 1 cup (200g) boiled x
+ e.v. olive oil 1 tablespoon, (10 ml)
Monini x
+ salt A pinch x
othErS Eggs, whole, raw
2 eggs, hen (100g)
Boiled egg Ovito x
Bread, oatmeal 2 slices, thin
(100g) Fresh bread x
Cheese cake 1 slice, (100g) Homemade x
Water 2 glasses
(400ml) Natural water Lete x
Alcoholic beverage, wine, red, Pinot Noir
½ glass
(75ml) Red wine Antinori x
others time: 11.30 pm
place: outside/home freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
Dark chocolate 2 pieces, (square) thin (20g)
Lindt x
Muffin 1 piece (80g) Yogurt
Muffin, com-mercially prepared
OrGran x
DriED NutS
walnuts 3 pieces
(12g) x
almonds 5 pieces (5g) x
pistachios 10
pieces(10g) x
BiSCuitS dried biscuits, cinnamon flavoured
4/5 pieces (30g)
Commercial-ly prepared
Gentilini x
Chocolate wafer 2 pieces (20g) Commercial-ly prepared
Loacher x
Coca-cola 1 can (330 ml) Coca-cola x
FrESh FruitS Apple, fresh,
raw, with skin 1 medium
(150g) x
Orange, fresh, raw 1 medium (150g)
x
Pineapple, raw 2 slices,
thick, (150g) x
others time: 11.30 pm
place: outside/home freQuency
food/drinK amount preparation
method remarKs
1 per mo 2 - 3 per mo 1 - 2 per wk 3 - 4 per wk 5- 6 per wk daily
iCE-CrEAm
Fruit flavours Small cone (60g)
Commercial-ly prepared
Algida x
Cream flavours Small cone
(60g)
Commercial-ly prepared Algida x
*Note: record adapted using Italian food habits