Food Frequency Survey
Tailored Nutrition LLC
Name
Date of Birth
Please indicate the number of servings you consumed from each of the following food groups in the last 24 hours or other specific 24 hour period.
Keep a food record for a typical day before completing this survey.
Write down everything you ate in one 24 hour period. Then estimate the number of servings you consumed from each of the following food groups.
Please consider the serving size. For example, if you ate one cup of steamed green beans, then count that as two servings of a non-startchy vegetable. A single serving of a non-starchy vegetable is 1/2 cup cooked or 1 cup raw. Consequently, one cup of cooked string beans will be 2 servings.
Consider the examples below of single serving sizes as you complete this survey.
Date of 24 Hour Period
Grains and Starches
Refined Grains, Cereals and Breads
Example: 1 slice white bread, 1/2 cup cooked white rice or regular pasta, 1/4 bagel or 1/2 English muffin, hamburger bun or pita bread, 3 cups (G and S)
Whole Grains, Cereals and Breads
Example: 1 slice whole grain bread, 1/2 cup cooked oatmeal, whole grain pasta, or cooked brown rice (G and S)
Fruits
Fruits
Example: 1 whole small or medium fresh fruit, 1/2 cup chopped, cooked, or canned fruit, 1/4 cantaloupe melon, 1/2 grapefruit, 3/4 cup (6oz) fruit juice, 2 tbsp raisins or diced dried fruit pieces (Fruit)
Vegetables
Non-Starchy Vegetables
Example: 1 cup raw, leafy salad greens such as lettuce, endice, escarole, 1/2 cup cooked vegetables, 1 cup chopped raw vegetables, 3/4 cup vegetable juice, 1/2 cup spaghetti sauce (NSV)
Starchy Vegetables
Example: 1/2 medium or 1/4 large baked potato with skin, 10 French fried potatoes (add 1/2 fat), 1/4 cup homemade potato salad, 1 cup squash, 1/2 cup yam or sweet potato pieces, 1/2 cup green peas (G and S)
Milk
Milk, Whole
Example: 1 cup (8 oz) 4.5% fat whole milk, 3/4 cup plain or artificially sweeted whole milk yogurt, 1 cup kefir, 1/2 cup whole evaporated, milk
Milk, Low Fat / 2%
1 cup (8 oz) 2% low-fat milk, 1 cup fortified soy milk, 3/4 cup (6 oz) plain or artificially sweetened low-fat, yogurt
Milk, Non-Fat / 1%
1 cup (8 oz) nonfat or 1% milk, 1 cup fortified reduced-fat soy milk, 2/3 cup (6 oz) plain or artificially sweetened nonfat yogurt
Cheese
Cheese, Regular
Example: 1 oz, 1/4 cup shredded or 1 slice of American, cheddar, Monterey Jack, or Swiss Cheese
Cheese, Part-Skim
Example: 1 slice or 1 oz or 1/4 cup shredded Mozzerella, Feta, or 2 oz Ricotta cheese
Meats
Meat, High-Fat
Example: 3 oz pork spareribs, 3 oz Polish sausage, pork, 3 oz cooked turkey bacon, 1 (4.5 oz) large hot dog
Meat, Medium Fat
Example: 3 oz cooked boneless pork chops, 3 oz cooked ground lamb, 3 oz cooked turkey bacon
Meat, Lean Fat
Example: 3 oz cooked ground turkey meat, 3 oz cooked beef tenderloin, 3 oz cooked lean boneless pork chops, 3/4 cup 4.5% fat cottage cheese, 3 oz of flank steak or lean ham
Meat Very Lean Fat
Example: 3 oz steamed, boiled or baked shrimp, 3 oz steamed, boiled or baked crab, 3 oz boneless chicken breast without skin, 3 oz boneless light turkey meat roasted, without skin, 3 oz sliced lean lucheon meat
Meat, Organs
Example: 3 oz grilled, baked or broiled liver
Fish High Fat
Example: 3 oz of higher fat fish such as mackerel or salmon
Fish, Other
Example: 3 oz of lean fish such as flounder, haddok, halibut, perch, pike, pollock, sea bass, sole, trout, tuna (fresh or canned in water)
Meat, Replacements or Analogue
Example: 1 vegeburger patty such as Griller or Garden burger (VLM)
Eggs
Eggs
Example: 1 whole egg
Egg Substitute
Example: 1/4 cup egg substitute, such as Egg Beaters Brand
Beans
Beans or Lentils
Example: 3/4 cup cooked beans such as pinto beans, black beans, and lentils
Soy
Example: 4 oz or 1/2 cup tofu, 3 tbsp cooked soybeans or edamame (green soybeans)
Nuts and Fats
Nuts
Example: 2 tbsp peanut butter, 1 oz nuts such as almonds, walnut halves, or peanuts
Mono Oil
Example: 2 tbsp or 1/8 slice of a medium avocado, 1 tsp canola, olive or peanut oils, 8 large ripe black olives, 10 green stuffed olives
Other Oil
Example: 1 tbsp regular mayonnaise or 2 tsp Miracle Whip salad dressing, 1 tsp corn, safflower, or other salad oils, 1 tbsp regular or 2 tbsp reduced-fat salad dressing, 1 tbsp sunflower or pumpkin seeds
Butter or Lard
Example: 1 tsp, pat or 2 tsp whipped butter, 1 slice bacon or 1 tsp lard, 1 tbsp regular cream cheese or sour cream
Margarine, Regular
Example: 1 tsp stick margarine
Margarine, Soft
Example: 1 tsp soft tub margarine or 1 tbsp light (reduced-fat) margarine
Sweets
Sweets or Regular Soda
Example: 6 oz sugar sweetened soft drink or soda (1, 12 oz. can is equal to 2 servings), 0.3 oz candy such as jelly beans Skittles, 1 oz brownie square, 1 tbsp sugar (Sugar)
Liquids
Alcohol
Example: 12 oz can of beer, 4.5 oz glass of wine, 1.5 oz hard liquor
Caffeinated Beverages
Example: 12 oz can of cola, 1 cup coffee, and 1/2 serving energy drink
Water
Example: 8 oz or 1 cup of water