Dietary Intake forms
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School
York University *
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Course
100
Subject
Health Science
Date
Dec 6, 2023
Type
Pages
8
Uploaded by MatePelican32
DAILY INTAKE FORM
Complete a separate form for each day. Use >1 form per day if needed.
Read your assignment instructions carefully before completing this form.
See important footnotes below.
Column A:
Detailed Food Description
1
Column B:
Amount
consumed
(Volume
–
e.g. cup, tsp,
etc)
Column C:
Added fats and
oils (in ml)
2
Column D:
Record
volumes (mL)
consumed for water
6
and other beverages
that don’t fit in
columns C or D
Column E:
Chronometer Substitution
(if exact food is not found).
Green tea:
one bag of green tea from the brand
Lipton
Boiled water.
1 tbs of tea
1 cup of water
N/A
N/A
2 Avocado toast:
B
read from the brand D’italiano
Toasted with butter
Sliced avocado
Cherry tomatoes (3 per toast)
Pinch of salt, pepper, chill flakes.
Accompanied by a cup of water.
245mL of bread
¼ cup of avocado
½ cup of cherry
tomatoes
1/8 tsp of salt,
pepper and chili
flakes
15mL of butter
237mL of water
IHOP avocado toast
Spicy chicken ramen: made with one
package of the brand Samyang buldak and
one cup of water.
Accompanied by a cup of water
1 cup of ramen
1 cup of water
N/A
237mL of water
Tap water drank during the day
2000mL of water
N/A
DAILY INTAKE FORM
Complete a separate form for each day. Use >1 form per day if needed.
Read your assignment instructions carefully before completing this form.
See important footnotes below.
DAY #1
Date: October 9, 2023
Was this a weekday?
❑
or a weekend day?
❑
NAME: Sofia Bedoya
DAY # 2
Date: October 11, 2023
Was this a weekday?
❑
or a weekend day?
❑
NAME: Sofia Bedoya
Column A:
Detailed Food Description
1
Column B:
Amount
consumed
(Volume
–
e.g. cup, tsp,
etc)
Column C:
Added fats and
oils (in ml)
2
Column D:
Record
volumes (mL)
consumed for water
6
and other beverages
that don’t fit in
columns C or D
Column E:
Chronometer Substitution
(if exact food is not found).
Green tea:
one bag of green tea from the brand
Lipton
Boiled water.
1tbsp of green tea
1 cup of water
N/A
N/A
Lipton chicken noodle soup:
one package of Lipton chicken noodle
soup
Boiled water.
Accompanied by a glass of water
120mL of soup mix
1 cup of water
N/A
237mL of water
Green tea:
one bag of green tea from the brand
Lipton
Boiled water.
1tbsp of green tea
1 cup of water
N/A
N/A
pork chop with rice and corn:
Porkchop:
Seasoned with salt, pepper, and paprika
and it was cooked with a little olive oil.
Rice:
Seasoned with salt and pepper and it was
cooked with water and a little vegetable
oil.
The corn was boiled.
118 mL porkchop
1/8 tsp of salt,
pepper and
paprika
1 cup of rice
1/8 tsp of salt and
pepper
½ cup of boiled
corn
7mL of Olive oil
15mL of vegetable oil
355mL of
sparkling water
Pork chops loin
Rice white long-grain
Corn yellow canned
Accompanied by a glass of sparkling water
2 bottles of tap water each of 1L, drank in
the day
2000mL of water
N/A
DAILY INTAKE FORM
Complete a separate form for each day. Use >1 form per day if needed.
Read your assignment instructions carefully before completing this form.
See important footnotes below.
Column A:
Detailed Food Description
1
Column B:
Amount
consumed
(Volume
–
e.g. cup, tsp,
etc)
Column C:
Added fats and
oils (in ml)
2
Column D:
Record
volumes (mL)
consumed for water
6
and other beverages
that don’t fit in
columns C or D
Column E:
Chronometer Substitution
(if exact food is not found).
Matcha milk tea
Water,
Green tea from the brand Lipton,
Milk powder from the brand no name.
2 cups of water
2 tbsp of green tea
1 tbsp of milk
powder.
N/A
N/A
Matcha latte
McCain egg, potato, and bacon breakfast
bowl.
Accompanied by a glass of orange juice
209mL of breakfast
bowl.
N/A
250mL of
orange juice
McCain 5 minutes breakfast
bowl
10-
piece McDonald’s chicken nuggets
meal10 chicken nuggets with large-size
fries and a medium iced coffee with milk
and sugar-free syrup.
No sauces.
177mL of chicken
nuggets
157mL of fries
N/A
485mL of sugar-
free syrup iced
coffee
McDonald's chicken nuggets
McDonald’s large fries
Iced coffee with milk flavored
sugar-free.
EXTRA
DAY #3
Date: October 14, 2023
Was this a weekday?
❑
or a weekend day?
❑
NAME: Sofia Bedoya
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