A.

General Information
1. Description of the individual
Toddler/Preschooler
Lifecycle Stage
January 15th, 2012
Date of Birth
2 years
Age
Female
Gender
33 inches
Height
a
28 lbs
Weight
b
N/A
Weight Gain and # Weeks Pregnant
Breastfeeding and # Months Postpartumc N/A
18.2 (Overweight)
BMI (actual value and weight category)
a
Use pre-pregnancy weight for a pregnant woman.
b
This row is filled out only if you are interviewing a pregnant woman.
c
This row is filled out only if you are interviewing a woman who is breastfeeding her child.
2. Plot height and weight on the appropriate growth chart (infant/child/young adult), weight
gain chart (pregnant woman), or BMI chart (adult/older adult) and attach the chart as the
second page of your report. Find a copy of the appropriate chart from a website or
textbook.

3. List any medical and/or nutritional issues and describe the treatment(s) being sought or
completed, including a history of the dietary education received for the condition(s). If
none, enter none; if many issues, insert additional rows as needed.
Medical or Nutritional Issuesa
NONE

Treatment(s)
NONE

Examples include anorexia, binge eating disorder, bulimia, diabetes, dysphasia, food allergies,
hypertension, morning sickness, obesity, pica, etc. Describe any drug-nutrient interactions. For
example, if the individual is taking warfarin, he/she needs to monitor vitamin K intake.

4. Describe living situation, eating patterns, food security issues.

Living Situationa
Lives with Parents
a

Frequency/Week Eating Out

Once every other week

Food Security Issuesb

No food security issues

Living with parents, friends, spouse/partner, alone, etc.

Receives SNAP, WIC, free/reduced price school meals, etc.

5. Exercise level, any sports played regularly, your evaluation of activity level
1

Time Spent Exercising/Daya

(include type of exercise)
.5 hours (light running)

Time Spent Exercising/Week Activity Levelb

3hr

Light

You may enter different type of exercise in separate rows

Estimate the level of activity and enter Light, Moderate, Hard, or Extra Hard:
Light exercise: 1-3 days/week
Moderate exercise: 3-5 days/week
Hard exercise: 6-7 days/week
Extra hard exercise or athletic training: 2 days/week

B. Dietary Information
1. Conduct a 24-hour recall using the multi-pass method. Add rows to the table as needed.
Food/Beverage List
Amount Consumeda
Plum Jammy Sammy
1 bar
Pancake and Sausage
2 mini sandwiches
Sandwich
Breakfast: 8:00am , home
Water
8 oz
Snack: 8:15am, home
Apple Juice
8 oz
Snack: 10:00am, home
Slice of Yellow American
1 slice
Cheese
Lunch: 2:00pm, home
Plum Jammy Sammy
1 bar
Lunch: 2:00pm, home
Mixed Fruit Cup
4 oz
Lunch: 2:00pm, home
Milk
8 oz
Dinner: 5:00pm, home
Macaroni and Cheese with 1 cup macaroni, 1/4 cup
Broccoli
veggies
Dinner: 5:00pm, home
Water
8 oz
Snack: 7:00pm, home
Apple Juice
8 oz
Snack: 7:00pm, home
Fruit snack
1 small package
a
Describe the amount as accurately as possible by using cups, tsp, tbsp, and sizes (small,
medium, large). Please read FFQ questions before you prepare for the 24-hour recall because
you will need to compare responses between the two assessment tools.
Meal/Snack, Time, Place Eaten
Breakfast: 8:00am, home
Breakfast: 8:00am, home

2. Conduct the FFQ and attach the completed form as a part of your report, after your 24hour recall information. You can find sample FFQs for children and adults on Canvas.
Compare the results between the 24-hour recall and FFQ, and describe how usual food and
beverage intake (responses to FFQ) are different or similar to responses from the 24-hour
recall.
3. Analysis of the individuals daily needs and intake
i. Caloric needs: 1138 calories/day
Little to no exercise: 1.2
a) For children under 11 years old, use this website to calculate the needs:
http://www.bcm.edu/cnrc/healthyeatingcalculator/eatingCal.html

Daily Calorie Needs

1138

Macronutrient

Actual Calorie Intake

% Daily Needs Met 71.6%

Actual % of Calories
Consumed
21.21%
3.65%
38% of calories
15% of calories

Actual Intake

Carbohydrates
Protein
Total Fat
Saturated Fat

1589

194g
58g

Micronutrient

Actual intake/day
(use correct unit)

DRI/daya
(use correct unit)

Vitamin A

493 g

300 g/day

Actual %
of DRI
Consumed
164.33%

Vitamin B6

1.3 mg

.5mg/day

260%

Vitamin B12

3.2 g

.9g/day

355.56%

Vitamin C

240 mg

15mg/day

1600%

Vitamin D

5 g

15g/day

33.33%

Folate

402 g

150g/day

268%

Riboflavin

1.8 mg

.5mg/day

360%

Calcium

830 mg

700mg/day

118.57%

AMDR
(healthy person)
45-65
5-20
30-40

List top 3 food

sources from 24hour recallb
1. Broccoli
2. 2% milk
3. Mac and
Cheese
1. Sausage
2. Broccoli
3. Peanut Butter
& Jelly
Sandwich
1. Sausage
2. 2% milk
3. Mac and
Cheese
1. Broccoli
2. Fruit Snacks
3. Apple Juice
1. 2% milk
2. Sausage
3. Mac and
Cheese
1. Broccoli
2. PB&J
sandwich
3. Mac and
Cheese
1. 2% milk
2. Mac and
Cheese
3. Pancakes
1. 2% milk
2. Mac and
Cheese

Iron

8 mg

7mg/day

114.29%

Potassium

2268 mg

3000mg/day

75.6%

Sodium

2472 mg

1000mg/day

247.2%

Zinc

7 mg

3mg/day

233.33%

Cholesterol

171 mg

< 300mg/day

57%

Fiber

13 g

19g/day

68.42%

3. American
Cheese
1. PB&J
Sandwich
2. Sausage
3. Broccoli
1. Broccoli
2. Apple Juice
3. 2% milk
1. Sausage
2. Mac and
Cheese
3. PB&J
Sandwich
1. Sausage
2. 2% milk
3. Mac and
Cheese
1. Sausage
2. Mac and
Cheese
3. 2% milk
1. Broccoli
2. PB&J
Sandwich
3. Mac and
Cheeese

DRI values can be found on the inside cover of your textbook.

In the Nutrients Report from the SuperTracker, click on the expansion box to the left of the
nutrient to get this information.
b

Question: LL was over on Zinc which was 233% of her daily intake, Sodium (247% of her daily
intake), Riboflavin (360% of her daily intake), Folate (268% of her daily intake), Vitamin C
(1600% of her daily intake), B6 (260%), and B12 (355%)). This could be because she eats a lot
of protein (sausage) and broccoli which would contribute to the folate, vitamin C and vitamin A.
For her macronutrients, LL is over on both her carbohydrates and protein. Her diet is highly carb
loaded which would explain why she is so over in her CHOs.

C. Recommendation
1.

After assessing the 24 hour recall and the Food Frequency Questionnaire, I can
conclude that LL is getting both too many and too little nutrients, specifically being over
on Vitamins C and B12, and Riboflavin and being under on Vitamin D and Potassium.
The 24-hour recall is representative of LLs diet, as listed in the Food Frequency
Questionnaire. All of the foods she ate during those 24 hours were almost exactly the
same as how her parents listed what she eats normally.
I interpret that while LLs diet may be okay for right now, she will eventually
become malnourished. She does not have a wide variety of foods in her diet, like other
types meat rather than chicken nuggets and consumes too much pasta during the week, 4
times a week, which ups her carbohydrate intake greatly. LL also does not eat real
meals. Her meals are made up of frozen foods and snacks to get her by. Once she starts
having a real peanut butter and jelly sandwich, rather than a frozen snack one, she would
become fuller longer and her sodium intake would go down.

2.
a) Nutrition Assessment
Food History: Formula only until 6 months where rice cereal was then added. Softer
finger foods were introduced at 10 months.
LL currently weighs 33lbs and is 30 inches tall.

b) Nutrition Diagnosis
(Problem)

Excessive energy intake

(Etiology)

An over consumption of calories

related to
as evidenced by

(Signs/Symptoms) The patients nutrient report and description of being slightly

overweight

c) Nutrition Intervention

Have LL eat more whole foods and meals instead of having snacks all day long.
Also have LL start exercising more regularly outside than playing around the
house.

d) Nutrition Monitoring and Evaluation

Following the intervention, monitor LLs daily diet using a food frequency
questionnaire for 2 weeks and a 24 hour recall to evaluate the most recent caloric
intake. Weigh LL to see if there is any weight loss or gain and adjust the
intervention if needed.
6

LL's Nutrients Report 04/01/14 - 04/01/14

Your plan is based on a 1000 Calorie allowance for a preschooler.
Nutrients

Target

Average Eaten

Status

Total Calories

1000 Calories

1589 Calories

Over

Protein (g)***

13 g

58 g

OK

Protein (% Calories)***

5 - 20% Calories 15% Calories

OK

Carbohydrate (g)***

130 g

194 g

OK

Carbohydrate (% Calories)*** 45 - 65%

Calories

49% Calories

OK

Dietary Fiber

19 g

13 g

Under

Total Fat

30 - 40%
Calories

38% Calories

OK

Saturated Fat

< 10% Calories

15% Calories

Over

Monounsaturated Fat

No Daily Target 14% Calories

or Limit

No Daily
Target or Limit

Polyunsaturated Fat

No Daily Target 5% Calories

or Limit

No Daily
Target or Limit

Linoleic Acid (g)***

7g

OK

Linoleic Acid (% Calories)***

5 - 10% Calories 5% Calories

OK

-Linolenic Acid (g)***

0.7 g

0.5 g

Under

-Linolenic Acid (%
Calories)***

0.6 - 1.2%
Calories

0.3% Calories

Under

Omega 3 - EPA

No Daily Target 0 mg
or Limit

No Daily
Target or Limit

Omega 3 - DHA

No Daily Target 1 mg
or Limit

No Daily
Target or Limit

Cholesterol

< 300 mg

171 mg

OK

Minerals

Target

Average Eaten

Status

Calcium

700 mg

830 mg

OK

Potassium

3000 mg

2268 mg

Under

Sodium**

< 2300 mg

2472 mg

Over

8g

Copper

340 g

747 g

OK

Iron

7 mg

8 mg

OK

Magnesium

80 mg

193 mg

OK

Phosphorus

460 mg

1122 mg

OK

Selenium

20 g

45 g

OK

Zinc

3 mg

7 mg

OK

Vitamins

Target

Average Eaten

Status

Vitamin A

300 g RAE

493 g RAE

OK

Vitamin B6

0.5 mg

1.3 mg

OK

Vitamin B12

0.9 g

3.2 g

OK

Vitamin C

15 mg

240 mg

OK

Vitamin D

15 g

5 g

Under

Vitamin E

6 mg AT

6 mg AT

OK

Vitamin K

30 g

273 g

OK

Folate

150 g DFE

402 g DFE

Over

Thiamin

0.5 mg

1.2 mg

OK

Riboflavin

0.5 mg

1.8 mg

OK

Niacin

6 mg

16 mg

OK

Choline

200 mg

260 mg

OK

Information about dietary supplements.

** If you are African American, hypertensive, diabetic, or have chronic kidney disease, reduce your sodium to 1500 mg a day. In
addition, people who are age 51 and
older need to reduce sodium to 1500 mg a day. All others need to reduce sodium to less than 2300 mg a day.
*** Nutrients that appear twice (protein, carbohydrate, linoleic acid, and -linolenic acid) have two separate
recommendations:
1) Amount eaten (in grams) compared to your minimum recommended intake.
2) Percent of Calories eaten from that nutrient compared to the recommended range.
You may see different messages in the status column for these 2 different recommendations.