Nora is a 41-year-old African American single mother of two young boys, ages 8 and 10. She and her sons recently evacuated from their home ahead of a major hurricane. They stayed w

FORM D – for 3 Day Diet Log Average Daily Nutrient Intake Name: ______________
DRI A B C
*leave grey boxes empty; transfer DRIs from Pt 1 NUTRIENT DAY 1 DAY 2 DAY 3 Daily AVERAGE (TOTAL??3)
Day of Week
DATE (Month/Day/Year)
MACRONUTRIENTS
TOTAL ENERGY INTAKE (kcal)
TOTAL ENERGY EXPENDITURE (kcal)
SWEET DRINKS (liquid calories) (kcal)
JUNK FOOD CALORIES (kcal)
RAW VEG (kcal)
ALCOHOL (g list kcals)
MICRONUTRIENTS – MINERALS
(mg) CALCIUM (mg)
(mg) TOTAL IRON (mg)
HEME IRON of Total Iron (mg)
NonHEME IRON of Total Iron (mg)
% Animal of Total Iron
% Plant of Total Iron
(mg) SODIUM (mg)
(mg) POTASSIUM (mg)
(mg) MAGNESIUM (mg)
MICRONUTRIENTS – VITAMINS
(ug) VITAMIN K (ug)
(ug) FOLATE (ug)
(mg) VITAMIN C (mg)
AMDR % = MACRONUTRIENTS – CARBS
(g to g) CARBOHYDRATE (g)
(kcal to kcal) CARBOHYDRATE (kcal)
(g) DIETARY FIBER (g)
AMDR % = MACRONUTRIENTS – FAT
(g to g) TOTAL FAT (g)
(kcal to kcal) TOTAL FAT (kcal)
DRI% SATURATED FAT (g)
(g) TRANS FAT (g)
(g) MONO-UNSATURATED FAT (g)
(g) POLY-UNSATURATED FAT (g)
(mg) CHOLESTEROL (mg)
(g) OMEGA 6 (g)
(g) OMEGA 3 (g)
AMDR % = MACRONUTRIENTS – PROTEIN
(g to g) TOTAL PROTEIN (g)
(kcal to kcal) TOTAL PROTEIN (kcal)
ANIMAL PROTEIN of Total Protein (g)
PLANT PROTEIN of Total Protein (g)
% Animal of Total Protein
% Plant of Total Protein
RDA based on weight Your ESSENTIAL AMINO ACID intake
(g) Trytophan (g)
Trytophan (% of rec in Crono)
(g) Valine (g)
Valine (% of rec on Crono)
(g) Threonine (g)
Threonine (% of rec)
(g) Isoleucine (g)
Isoleucine (% of rec)
(g) Leucine (g)
Leucine (% of rec)
(g) Lysine (g)
Lysine (% of rec)
(g) Phenylalanine (g)
Phenylalanine (% of rec)
(g) Methionine (g)
Methionine (% of rec)
(g) Histidine (g)
Histidine (% of rec)
Q1. Would you consider these days to be representative of your ‘usual’ food intake? If not, explain why.