CODE#_________________
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 DIET  RECORD

 SUMMARY SHEET
 
 
 
 
 
 
 
 
 
 
 

 NAME ________________________________________





















 
 

          CODE #_____________

Energy Use:

1. Calculate resting energy expenditure (REE) using the Harris Benedict Equation:

 REE for a female (kcal/day) = 655 +  9.7(W) + 1.8(H)  - 4.7(A)

 REE for a male (kcal/day)   =  66 + 13.7(W) + 5(H) - 6.8(A)
  where,
    W = weight in Kg
    H = height in cm
    A = age in years
 

 BEE _____________________________________

2. Estimate the calories used for daily physical activity.________

Sedentary Activity (mostly sitting):  20% -40% of REE
Light Activity (Sedentary activity plus daily walking program):  55%-65% of REE
Moderate Activity ( more active profession plus moderate exercise program):  70%-75% of BMR
Heavy Activity  ( Mail carrier who walks a route or daily vigorous exercise program): 80%-100% of BMR

3. Estimate the calories used for the thermic effect of food.  _______________

Approximately 10% of the sum of REE +physical activity

4.  Calculate estimated total daily energy use (1+2+3).__________________

5. From the diet analysis, what is the average daily caloric intake?_________

6. Subtract the daily caloric intake (5) from the daily energy use (4).   (4)-(5)=_________

7. If the number calculated in 6 is positive the individual should be losing weight.  If the number is negative the individual should be gaining weight.  Is the calculation consistent with this person's experience?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 



 

Composition of the diet: Fill in the table using averages for the three days you recorded.  
 

Nutrient
Recommended Diet
Your Diet
% kcal from Protein
15
 
% kcal from Carbohydrate
55
 
% kcal from Fat
30
 
% kcal from Saturated Fat
<10
 
% kcal from Monounsaturated Fat
>10
 
% kcal from Polyunsaturated Fat
10
 
Dietary Fiber (grams)
20-35
 
Protein (grams)
50 (women), 63 (men)
 
Calcium (mg)
1000
 
Vitamin C (mg)
60
 
Iron (mg)
15 (women), 10 (men)
 
Sodium (mg)
<2000
 

Based on the values in the table, would you make any recommendations for dietary changes?
 
 
 

What recommendations would you suggest?