Grace Kim

A) Client Information
Age: 26 Gender: Female Height: 55 Weight: 127 lb
IBW: 125 lb Weight history: Steady weight, no major loss/gain
Medications: None Alcohol intake: None Supplements: None
Food allergies/intolerances: None
Planned physical activity: Little to no planned physical activity
General activity pattern: Sedentary lifestyle as student, walks to subway 10 mins away for class
Occupation: Student
Medical/surgical history: No major medical/surgery experiences
Family medical history: Heart disease in grandparents

B) Documented 24 Hour Recall

Time Meal Food / Preparation / Other Detail Portion Size
8:00 am Breakfast Coffee - drip 1.5 cups
8:00 am Breakfast Almond milk 3 Tbsp
8:00 am Breakfast White sugar 2 tsp
11:00 am Snack Natures Path dark chocolate chip 1 bar (1.2 oz)
granola bar
11:00 am Snack Chobani Low-fat yogurt, pineapple 1 serving cup (5.3
flavor oz)
1:30 pm Lunch Wheat bread, untoasted 2 pieces
Avocado 2 Tbsp (1 oz)
Tomato, raw 2 slices
Deli turkey slice (cold cuts) 2 slices (1 oz)
Spinach, raw cup
Water 1 cup
2:30 pm Snack Chocolate chip muffin (premade 4 oz
from bodega)
6:30 pm Dinner Salmon - baked w/ dash of salt and 3 oz
pepper
6:30 pm Dinner Curry sauce cup
6:30 pm Dinner White onion (cooked w/ sauce) cup chopped
before cooking
6:30 pm Dinner White rice 1 cup after cooking
7:00 pm Snack Peppermint tea 1 cup

Observed vs. Recalled Shared Meal

Food Recalled Meal Reported meal Difference
Portion Size Portion Size Between
Portion Sizes
(Recalled
Reported)
Wheat bread 2 pieces 2 pieces 0 pieces
Avocado 1 oz 1 oz 0 oz

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Tomato, raw 2 slices 2 slices 0 slices

Deli turkey slice 2 slice (1 oz) 3 slices (1.5 oz) - 1 slices (-.5 oz)
Spinach, raw cup 1 cup - cup
Water 1.5 cup 1.5 cups 0 cups
Russian salad Not reported 1 Tbsp - 1 Tbsp
dressing
Potato chips - Not reported 0.8 oz - 0.8 oz
Sea Salt flavor

C) Observed vs. Recalled meal ?s

i. 2 items were forgotten: the Russian salad dressing and the bag of Popchip potato chips.
ii. No items were mentioned in the recall but not observed.
iii. 50% of items were remembered accurately.
iv. 2 items (turkey slice and the spinach) were underestimated in size.
v. The estimated total calories of the recalled meal is 268.75 calories, while the reported
meal is 412.75 calories. Therefore, the absolute difference in total calories is 144 calories.

Calorie Estimates
Food Portion Number & Type Estimated
of Exchange Calories
Wheat bread, 2 pieces 2 Starch 160
untoasted (80 x 2)
Avocado 1 oz 1 Fat 45
Tomato, raw 2 slices Non-starchy 6.25
Recalled Meal vegetable (25 x 0.25)
Deli turkey 2 slices (1 oz) 1 lean protein 45
slice (cold cuts)
Spinach, raw cup Non-starchy 12.5
vegetable (25 x 0.5)
Water 1.5 cups 0 0

Wheat bread 2 pieces 2 Starch 160

(80 x 2)
Avocado 1 oz 1 Fat 45
Tomato, raw 2 slices Non-starchy 6.25
vegetable (25 x 0.25)
Deli turkey 3 slices 1.5 lean protein 67.5
Reported/ slice (cold cuts) (45 x 1.5)
Observed Spinach 1 cup 1 Non-starchy 25
Meal vegetable
Water 1.5 cups 0 0
Russian salad 1 Tbsp 1 Fat 45
dressing
Potato chips - 0.8 oz 0.8 Starch 64
Sea Salt flavor (80 x 0.8)

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vi. (144 calories/412.75 = 34.9%)

The 34.9% difference in calories represents the percentage of intake that was
underestimated.

D) What did this assignment help you to understand about 24 Hour recalls?
This assignment emphasizes the large difference between recalled intake and actual
intake. Food items and beverages can be easily forgotten. Sizes of portions can also be over or
underestimated, especially if the client is not too familiar with cups, tablespoons, and weight
measurements of average portions. Over many meals, this difference can be substantial. If
possible, a food diary would most likely be a closer representation of a clients diet.

E) Summary of nutrition-related concerns & recommendations

Client eats breakfast sporadically (when she has time), so I would first recommend
planning in advanced to consistently eat a balanced breakfast, as breakfast could be an ideal meal
to incorporate more fruits and vegetables. She also tends to snack on high-sugar snacks, so to
start, I would recommend swapping at least one of these snacks with fruit or vegetables. Grains
(bread and rice) can be substituted for whole grains. I would also ask if the patient is willing to
incorporate more planned physical activity into her daily life.