Food Diary

NAME:

HOW TO RECORD YOUR FOOD INTAKE	Day 1: Date:              Day of week:			Day 2: Date:              Day of week:
Please write down everything you eat and drink for five days in the coming week.  Make sure that you include at least one weekend day. Write down the time at the start of each meal of drink or snack.  A bar of chocolate eaten at the bus-stop is a snack. Describe the food as accurately as possible-for instance, a sandwich is actually three foods: bread, butter, and eg cheese. Give clear descriptions of the type of food eaten, eg: Bread - wholemeal, white, thick or thin sliced. Milk - whole, semi-skimmed, skimmed, evaporated Sausages, - beef or pork, fried or grilled. Describe the portion in household measures, eg slices, tablespoons, mugs or cups. EXAMPLE	Time	Description of food or drink	How much	Time	Description of food or drink	How much
Time Description of food or drink How much 7:30am Boiled egg 1   White toast 1 slice medium   Butter (thickly spread)     Marmalade 2 teaspoons   Tea (whole milk, no sugar) 2 cups       9:30 am Coffee (semi-skimmed milk) 1 cup   Sugar 1 teaspoon       12:00 Brown bread 1 slice medium   Cheese 1 oz   Tomato 1   Butter (thinly spread)     Tea (semi-skimmed milk no sugar) 1 cup       3:30pm Tea (semi-skimmed milk no sugar) 1 cup       6:00pm Beef 2 slices   Potatoes (new boiled) 3   Peas 2 tablespoons   Gravy     Tinned peaches 3 halves

If the spaces in the columns are too small for you, please copy the form onto larger paper. (Ref: Leeds A., Judd P., Lewis B., (1990) Nutrition Matters for Practice Nurses: A Handbook of Dietary Advice for use in the Community.  John Libbey.)

Day 3: Date:                   Day of Week:			Day 4: Date:                Day of Week:			Day 5: Date:                Day of Week:
Time	Description of food or drink	How much	Time	Description of food or drink	How much	Time	Description of food or drink	How much

(Ref: Leeds A., Judd P., Lewis B., (1990) Nutrition Matters for Practice Nurses: A Handbook of Dietary Advice for use in the Community.  John Libbey.)

Click here to be taken to Nutrition Checklist