RESEARCH RECHERCHE

Impact of Nutrition Education

On University Students Fat Consumption
TERI E. EMRICH, MHSc, M.J. PATRICIA MAZIER, PhD, Department of Human Nutrition, St. Francis Xavier University, Antigonish, NS

Abstract
Purpose: University science students who have taken a nutrition course possess greater knowledge of fats than do those who have not; whether students apply this knowledge to their diet is unknown. We measured and compared science students' total and saturated fat intake in the first and fourth years, and evaluated whether taking a nutrition course influenced fat consumption. Methods: A sample of 269 first- and fourth-year science students at a small undergraduate university completed a survey with both demographic questions and a semi-quantitative food frequency questionnaire about fats in the diet. Data were analyzed using chi-square tests and independent-sample t -tests. Results: Fourth-year science students consumed fewer grams of total and saturated fat than did first-year science students (p<0.001). Science students who had taken a nutrition course consumed fewer grams of total and saturated fat than did those who had not (p<0.001). Conclusions: Taking a nutrition course may decrease firstyear students fat consumption, which may improve diet quality and decrease the risk of chronic disease related to fat consumption. (Can J Diet Prac Res 2009;70:187-192) (DOI: 10.3148/70.4.2009.187)

Rsum
Objectif. Les tudiants universitaires en sciences qui ont suivi un cours de nutrition possdent de meilleures connaissances sur les matires grasses que ceux qui ne lont pas fait; on ne sait pas si les tudiants mettent ces connaissances en pratique dans leur alimentation. Nous avons mesur et compar lapport en matires grasses totales et satures en premire et en quatrime anne, et valu si le fait de suivre un cours de nutrition influence la consommation de matires grasses. Mthodes. Un chantillon de 269 tudiants de premire et de quatrime anne en sciences dans une petite universit de premier cycle ont particip une enqute comportant une section de donnes dmographiques et un questionnaire semiquantitatif de frquence de consommation alimentaire des matires grasses. Les donnes ont t analyses au moyen de tests du chi carr et de tests t pour chantillon indpendant. Rsultats. Les tudiants de quatrime anne en sciences consommaient moins de grammes de matires grasses totales et satures que les tudiants de premire anne (p<0,001). Les tudiants qui avaient suivi un cours de nutrition consommaient moins de grammes de matires grasses totales et satures que ceux qui ne lavaient pas fait (p<0,001). Conclusions. Suivre un cours de nutrition peut rduire la consommation de matires grasses chez les tudiants de premire anne, habitude qui peut amliorer la qualit de lalimentation et diminuer le risque de maladies chroniques lies la consommation de matires grasses. (Rev can prat rech ditt 2009;70:187-192) (DOI: 10.3148/70.4.2009.187)

INTRODUCTION
Much research has been conducted to examine the relationship between dietary fat and certain chronic diseases. Intake of dietary fat, especially saturated fat, has been established as a contributing factor in the development of atherosclerosis and cardiovascular disease risk (1-3). Furthermore, animal fat and saturated fat have been tentatively linked to several persistent diseases, which include diabetes, sex-hormone-related cancers, and decreased bone mineral density (1,4-6). Current recommendations are that, for optimal health, the populaCanadian Journal of Dietetic Practice and Research Vol 70 No 4, Winter 2009

tion should limit total fat intake to 20% to 35% and saturated fat intake to less than 10% of total energy intake (79). According to the 2004 Canadian Community Health Survey, Canadians 19 and older consume, on average, just over 31% of their daily calories in the form of fat, with significant proportions of the population exceeding this average (9). A limited number of investigators have looked at university students dietary habits. Many individuals in this period of transition resort to unhealthy dietary behav187

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Table 1
First- and fourth-year students responses to demographic questions
First yeara (n=130) Characteristic Live on campusb Purchase groceries Prepare meals Have taken a nutrition course
a b

Yes 106 (82.2%) 73 (56.1%) 30 (23.1%) 16 (12.3%)

No 23 (17.8%) 57 (43.8%) 100 (76.9%) 114 (87.7%)

Fourth yeara (n=139) Yes No 31 (22.3%) 133 (95.6%) 134 (96.4%) 72 (51.8%) 108 (77.7%) 6 (4.3%) 5 (3.6%) 67 (48.2%)

Significant difference between first- and fourth-year students for all questions asked (chi-square test, p<0.001) One first-year student failed to complete the place of residence field in the demographic portion of the survey, and therefore information on place of residence was available for only 129 first-year students.

iours, which may include consuming high levels of fat (10). In particular, university students may eat excessive amounts of fast food and fried foods, and thus may exceed recommendations for both total and saturated fat intake (10-14). Several authors propose that an individuals nutrition knowledge may have an impact on healthy eating, and that diet improves with increasing nutrition knowledge (15-18). Skinner, for example, examined university students enrolled in a three-credit nutrition course (19). Students decreased their total caloric and fat intake following an assignment in which they used their acquired nutritional knowledge to suggest improvements in their own diet. However, the difficulty lies in determining if dietary change was brought on by the assignment or by increased nutrition knowledge.

already participated in another class or those who identified themselves as outside the participant selection criteria. A total of 189 (35.3%) students were excluded for failing to meet the selection criteria because they identified themselves either as not in first or fourth year or not in a degree program offered by the Faculty of Science. An additional 76 (14.2%) students were excluded for failure to complete the questionnaire correctly or entirely, and two (0.4%) did not sign the consent forms. The final sample (269 of the original 536 students) included 130 (24.3%) first-year and 139 (25.9%) fourth-year science students. Data collection A two-part, self-administered questionnaire was used for data collection. The first part was used to collect demographic information and included a question that determined current or prior enrollment in a universitylevel nutrition course (Table 1). The second part was a 15-item semi-quantitative food frequency questionnaire (FFQ) that measured daily total and saturated fat intake (Appendix 1). The FFQ was adapted from a previously validated 13-item FFQ of commonly consumed high-fat foods; we added pizza and peanut butter (21). The adapted questionnaire was rechecked for validity by two faculty members in the Department of Human Nutrition, who made sure that the two added ingredients did not detract from the original questionnaires purpose. This adapted questionnaire was pilot tested with five nutrition majors, who completed it on two separate occasions to test for reliability. When they were ranked according to total and saturated fat intake, the members of the pilot test group maintained the same rank on both the first and second testing occasions. The study and the questionnaire were approved by the St. Francis Xavier University Research Ethics Committee. Data were collected before course lectures between November 2006 and January 2007 (i.e., late in the first semester and early in the second semester). Introductory nutrition courses are offered in the first semester; science students who were completing a three-credit nutrition course were grouped with those who had previously completed a nutrition course. All students in the class were invited to participate before the questionnaire was distribRevue canadienne de la pratique et de la recherche en dittique Vol 70 n 4, hiver 2009

PURPOSE
In a previous study of university science students, we found that students knowledge of fats increased between first and fourth year (20). That study also showed that taking a nutrition course increased a students general knowledge of fats and nutrition terms related to the purchase of dietary fats. In the current study, we wanted to determine whether taking a nutrition course, and the subsequent increased knowledge of fat, decrease the consumption of dietary fat. Our hypothesis was twofold: first, science students with a higher level of education would consume less dietary fat than those with a lower level of education; second, science students who were taking or who previously had taken at least one course in nutrition would consume less fat than those who had not.

METHODS
Sample A convenience sample was taken from the 2771 students registered in a bachelor of science program at St. Francis Xavier University, Nova Scotia. Only first-year (n=563) and fourth-year (n=479) science students were included in the final sample. Of the 27 professors who were asked, 16 agreed to let their classes participate in the study. All students present in class on the day of the survey (n=536) participated, except those who had
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uted. Students were given a package that included a letter explaining the project and what was expected of them, along with a consent form. Students who did not wish to participate were asked to accept the questionnaire and hand it in uncompleted, at the same time that consenting participants submitted theirs. These uncompleted questionnaires were not included in the final count of questionnaires. Before completing the questionnaire, participants were given a visual demonstration of common measurements of one cup and one tablespoon. They were asked to respond to eight demographic questions, and then to record their usual serving size of the 15 foods listed in the questionnaire. They also were asked to assign a numerical value to how often they consumed these food items daily, weekly, monthly, yearly, or rarely/never (Appendix 1). Students were given 15 minutes to complete the questionnaire, as the pilot test indicated this was ample time for completion. Data analysis The average grams of total and saturated fat consumed per day by each participant were calculated using the raw data. Data were analyzed using version 13 of SPSS (SPSS Inc., Chicago, IL, 2004). The major area of study, year of study, age, place of residence, and grocery shopping and meal preparation habits were described using descriptive statistics. Chi-square tests were used to test for relationships between variables such as year of study and grocery shopping. Data were tested for normality using a one-sample Kolmogorov-Smirnov test, and were found to be non-normal. Then the data were transformed using a logarithmic function, retested for normality, and found to be normal. Independent-sample t- tests were used to test the relationship between fat consumption and year of study, age, gender, place of residence, and grocery shopping and meal preparation habits (22).

Table 2
Students daily mean total fat and saturated fat intakea
Characteristic (n=130) First Fourth yearb (n=139) Menb (n=93) Womenb (n=176) On campusb (n=137) Off campusb (n=131) Purchases groceries (n=206) Does not purchase groceries (n=63) Prepares mealsb (n=164) Does not prepare mealsb (n=105)
a

Total fat (g) 57.35 37.16 40.60 24.65 66.05 44.01 40.94 27.12 53.72 35.76 42.50 25.42

Saturated fat (g) 22.25 16.19 14.90 10.80 25.45 18.33 15.31 12.14 20.88 15.73 15.61 11.21

yearb

46.94 31.69 54.41 34.08 42.23 26.97 58.82 37.29

17.71 13.91 20.89 14.67 15.60 11.84 22.92 16.19

By year of study, gender, place of residence, grocery shopping habits, and meal preparation habits _ + standard deviation b Results of an independent-sample t -test were statistically significant (p<0.05).

RESULTS
Results are expressed in terms of grams of fat consumed each day. Without information on height, weight, and daily caloric intake, students adherence to recommendations cannot be determined. Students fat intake therefore is discussed in grams per day. The final sample included 130 (48.3%) first-year science students and 139 (51.6%) fourth-year science students, with ages ranging from 17 to 34. The mean age standard deviation of first-year science students was 18.6 1.5, while the mean age of fourth-year science students was 21.7 3.3. Ninety-three (34.6%) men and 176 women (65.4%) were included in the study. The sample represented students majoring in biology (n=49), chemistry (n=19), computer science (n=1), engineering (n=23), human kinetics (n=46), mathematics (n=8), nursing (n=53), nutrition (n=30), physics (n=1), psychology (n=1), and joint science (n=12); also represented were 26 students with undecided majors. Year of study proved significant in terms of place of residence and lifestyle factors; more fourth-year science
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students lived off campus, purchased their own groceries, and prepared their own meals (p<0.001) (Table 1). Furthermore, the proportion of science students who had previously attended a nutrition course was also significantly larger in fourth year than in first year (p<0.001) (Table 1). Data from the FFQ (Appendix 1) showed the mean mass of total fat that respondents consumed daily was 49.6 35.9 g (input-output 7.3 to 305.9 g) while the mean mass of saturated fat was 18.8 15.3 g (input-output 2.9 to 117.2 g). For both total and saturated fat, intake was significantly less in fourth year than in first year (p<0.001) (Table 2). Gender also was significant; men consumed more total and saturated fat than did women (p<0.001) (Table 2). Off-campus science students consumed significantly less total fat (p<0.010) and saturated fat (p<0.003) than did on-campus science students. Similarly, those who prepared their own meals ate significantly less total and saturated fat (p<0.001) (Table 2). These differences disappeared, however, when data were separated by year of study and independent-sample t -tests were reapplied to test for differences in fat consumption associated with place of residence and meal preparation habits. Science students who had attended a nutrition course consumed significantly less fat and saturated fat than did those who had not (p<0.001). When years of study were examined separately, and independentsample t -tests were re-administered, significant differences were found in both total and saturated fat consumption between first-year science students who had attended a nutrition course and those who had not (p<0.001)
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Table 3
Students daily mean total and saturated fat intake, by enrollment in a nutrition course, year of study, and major area of study
Nutrition course/major Currently or previously enrolled in a nutrition coursea (n=88) Never enrolled in a nutrition coursea (n=181) First year, currently or previously enrolled in a nutrition coursea (n=16) First year, never enrolled in a nutrition coursea (n=114) Fourth year, currently or previously enrolled in a nutrition course (n=72) Fourth year, never enrolled in a nutrition course (n=67) Total fat (g) Saturated fat (g)

supports previous studies linking healthy eating to education level (23,24). While these students would have acquired nutritional knowledge from other sources, such as the media, social and physical environments, buying groceries, cooking meals, and a small increase in age (20), a significant difference still was seen between first-year students who had taken a nutrition course and those who had not. Place of residence Differences in fat consumption existed between oncampus and off-campus science students and those who prepared their own meals versus those who did not, but these differences disappeared when separated by year of study. These results provide further support for a relationship between increasing education level and decreasing dietary fat intake. Changes in dietary fat intake therefore may have resulted from differences between first-year and fourth-year science students, rather than from differences in place of residence and meal preparation habits. Purchasing groceries Purchasing their own groceries made no difference to students fat consumption. Grocery shoppers have access to a greater variety of low-fat and nutritious foods, as well as to accurate nutrition-label information on fat content, but this alone did not lead to decreased fat intake in science students who bought groceries. This observation strengthens previous results showing that the mere act of selecting and purchasing food has little impact on the selection of lower-fat foods, a finding that implies some other factors must be at play when someone chooses a low-fat diet (25,26). Physiological state, psychological factors, food preferences, and perceptions of healthy eating have been suggested as factors influencing personal food choice (27). Nutrition knowledge and education also may be among the factors influencing the selection of lowerfat food, because they encourage the use of nutritional information on food labels (25,26,28). Nutrition education University science students who had taken a nutrition course consumed less fat than did those with no nutrition education (Table 3), a finding consistent with results of a previous study of university students (19). This implies that students were able to translate the knowledge they acquired into action to reduce fat intake. This effect is further supported by results showing that science students majoring in nutrition consumed, on average, far less fat than did all other science majors (Table 3). Unfortunately, we were not able to measure total energy intake or carbohydrate and protein intake, and thus we cannot determine with certainty whether nutrition students may have been suffering from restrictive eating (29) or simply consuming a healthy diet that was low in fat (30). A smaller, in-depth study is warranted. Our study showed that differences in fat intake appeared between first-year science students with some nutrition education and those without, but not between
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37.59 22.86 54.08 34.88

13.25 8.90 20.99 15.47

34.62 22.97

12.82 10.28

60.57 37.72

23.60 16.46

38.25 22.95 43.14 26.30

13.34 8.65 16.58 12.57

Non-nutrition science majorsa (n=239) 52.46 36.82 Nutrition majorsa (n=30) 26.98 13.45

20.02 15.72 9.19 6.07

First-year nutrition majors (n=9) Fourth-year nutrition majors (n=22)

a

29.61 16.73 25.85 12.08

11.07 9.19 8.38 4.16

Results of an independent-sample t -test were statistically significant (p<0.05).

(Table 3). No such difference was found among fourthyear science students. Finally, nutrition majors were found to eat significantly less total fat and saturated fat than were all other science majors (p<0.001). No difference was found, however, between first- and fourth-year nutrition majors (Table 3).

DISCUSSION
Previous and current studies Previously we have shown that fourth-year undergraduate science students, who had taken at least one nutrition course, had greater knowledge of fats than did first-year students (20)a finding that confirms the role of nutrition education. At the time, we were not able to confirm whether greater knowledge translates into better food choices. We now know that, in comparison with first-year students, fourth-year science students do consume less total fat and saturated fat (Table 2). This
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fourth-year students, whether or not they had taken a nutrition course. This, combined with the fact that fourth-year science students had greater knowledge of fats than did first-year students, regardless of whether they had taken a nutrition course (20), suggests that increasing nutrition knowledge decreases fat intake only to a certain extent. Increasing nutrition knowledge may fail to affect consumption as other factors, such as taste preference, social and physical environment, and simply attaining a higher level of education, begin to interact with knowledge to affect food choice (31). Further evidence is provided by the lack of a difference between first-year and fourth-year nutrition majors (Table 3). Nutrition education and the subsequent increase in nutrition knowledge clearly have an impact on individual fat ingestion, but education obviously is not the sole influence on consumption. Nutrition knowledge is just one contributor among many in the process of food selection and the adoption of healthful dietary patterns. Study limitations We chose a convenience sample of science students for this study, because we felt confident that a reasonable number had taken a nutrition course. While a sample of all undergraduates would have been more representative, very few non-science majors have taken a nutrition course. Thus, our results may not apply to all university students. In addition, the questionnaire was too brief to mention all sources of dietary fat, and it may not have reflected high-fat foods consumed with alternative diets, such as vegetarian, vegan, or kosher diets. The brevity of the questionnaire may also explain why reported total fat consumption was low. Finally, the survey was limited by students ability to recall and describe their intake accurately, which required averaging serving sizes and consumption over time (21). who kindly cooperated in the data collection. Thank you to Dr. Barry Taylor for his help with statistical analysis. This study was funded by the Department of Human Nutrition, St. Francis Xavier University.

References
1. Kuller LH. Dietary fat and chronic diseases: epidemiologic overview. J Am Diet Assoc. 1997;97:S9-S15. 2. Griel AE, Kris-Etherton PM. Beyond saturated fat: the importance of the dietary fatty acid profile on cardiovascular disease. Nutr Rev. 2006;64(5):257-262. 3. Nettleton JA, Steffen LM, Mayer-Davis EJ, Jenny NS, Jiang R, Herrington DM, et al. Dietary patterns are associated with biochemical markers of inflammation and endothelial activation in the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr. 2006;83(6):1369-1378. 4. Franz MJ, Bantle JP, Beebe CA, Brunzell JD, Chiasson JL, Garg A, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care. 2002;25:48-98. 5. Costacou T, Mayer-Davie EJ. Nutrition and prevention of type 2 diabetes. Ann Rev Nutr. 2003;23:147-170. 6. Corwin RL, Hartman TJ, Maczuga SA, Graubard BI. Dietary saturated fat intake is inversely associated with bone density in humans: analysis of NHANES III. J Nutr. 2006;136(1):159-165. 7. Whitney EN, Cataldo CB, Rolfes SR. Understanding normal and clinical nutrition. 6th ed. Belmont, CA: Wadsworth; 2002. 8. Health Canada. Dietary reference intakes tables. Food and nutrition; 2006 [cited 2007 1 Mar]. Available from: http://www.hcsc.gc.ca/fnan/nutrition/reference/table/index_e.html 9. Garriguet D. Overview of Canadians eating habits. Nutrition: findings from the Canadian Community Health Survey. Ottawa: Statistics Canada; 2004. 10. Brevard PB, Ricketts CD. Residence of college students affects dietary intake, physical activity, and serum lipid levels. J Am Diet Assoc. 1996;96(1):35-38. 11. Douglas KA, Collins JL, Warren C, Kann L, Gold R, Clayton S, et al. Results from the 1995 National College Health Risk Behavior Survey. J Am Coll Health. 1997;46(2):55-66. 12. Anding JD, Suminski RR, Boss L. Dietary intake, body mass index, exercise, and alcohol: are college women following the dietary guidelines for Americans? J Am Coll Health. 2001;49(4):167-171. 13. DeBate RG, Topping M, Sargent RG. Racial and gender differences in weight status and dietary practices among college students. Adolescence. 2001;36(144):819-833. 14. Racette SB, Deusinger SS, Strube MJ, Highstein GR, Deusinger RH. Weight changes, exercise, and dietary patterns during freshman and sophomore years of college. J Am Coll Health. 2005;53(6):245-251. 15. Variyam JN, Blaylock J. Unlocking the mystery between nutrition knowledge and diet quality. Food Rev. 1998;21(2):21-29. 16. Siero FW, Broer J, Bemelmans WJE, Meyboom-de Jong BM. Impact of group nutrition education and surplus value of Prochaska-based stage matched information on health related cognitions and on Mediterranean nutrition behavior. Health Educ Res. 2000;15(5):635-647. 17. Bogue J, Coleman T, Sorenson D. Determinants of consumers dietary behaviour for health enhancing foods. Br Food J. 2005;107(1):4-16. 18. McDonell GE, Roberts DCK, Lee C. Stages of change and reduction of dietary fat: effect of knowledge and attitudes in an Australian university population. J Nutr Educ. 1998;30(1):37-44.
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RELEVANCE TO PRACTICE
Elevated total and saturated fat consumption among university students may affect future health and the development of chronic disease (1). The results of this study suggest that taking a nutrition course may decrease fat consumption and that first-year science students may derive the most benefit from a nutrition course. Past studies have shown that a nutrition course teaching first-year students about energy balance, food composition, diet, and serving sizes successfully reduced calorie intake and fat consumption (32,33). Interventions directed at decreasing fat consumption among first-year students will put them on the path to healthier dietary patterns earlier in life (1). All students could benefit from at least one three-credit course that provides basic instruction in nutrition. Health professionals, as well as university officials, could see the benefit of nutrition instruction in improving diet quality and reducing the risk for chronic disease. Acknowledgements We thank Jensen Lutes for assisting with data collection, and the professors at St. Francis Xavier University
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19. Skinner JD. Changes in students dietary behavior during a college nutrition course. J Nutr Educ. 1991;23(2):72-75. 20. Mazier MJP, McLeod SL. University science students knowledge of fats. Can J Diet Prac Res. 2007;68:154-159. 21. Lee RD, Neiman DC. Nutritional assessment. 3rd ed. Boston: McGraw Hill; 2005. 22. Zar JH. Biostatistical analysis. 3rd ed. Upper Saddle River, NJ: Prentice Hall; 1996. 23. Groth MV, Fagt S, Brondsted L. Social determinants of dietary habits in Denmark. Eur J Clin Nutr. 2001;55(11):959-966. 24. Hart A Jr, Tinker L, Bowen DJ, Longton Beresford SAA. Correlates of fat intake behaviors in participants in the Healthy Eating for a Healthy Life study. J Am Diet Assoc. 2006;106(10):1605-1613. 25. Larson NI, Story M, Eisenberg ME, Neumark-Sztainer D. Food preparation and purchasing roles among adolescents: associations with sociodemographic characteristics and diet quality. J Am Diet Assoc. 2006;106(2):211-218. 26. Drichoutis AC, Lazaridis P, Nayga RM Jr. Consumers use of nutritional labels: a review of research studies and issues. Acad Mark Sci Rev. 2006 [cited 2007 1 Mar];10(9):1-22. Available from: http://www.amsreview.org/articles/drichoutis09-2006.pdf 27. Raine KD. Determinants of healthy eating in Canada: an overview and synthesis. Can J Public Health. 2005;96(Suppl 3):S8-S14. 28. Russo France K, Fitzgerald Bone P. Policy makers paradigms and evidence from consumer interpretations of dietary supplement labels. J Consum Aff. 2005;39(1):27-52. 29. Worobey J, Schoenfeld D. Eating disordered behavior in dietetics students and students in other majors. J Am Diet Assoc. 1999;99(9):1100-1102. 30. House J, Su J, Levy-Milne R. Definitions of healthy eating among university students. Can J Diet Prac Res. 2006;67:4-18. 31. Eertmans A, Baeyens F, Van den Bergh O. Food likes and their relative importance in human eating behavior: review and preliminary suggestions for health promotion. Health Educ Res. 2001;16(4):443456. 32. Matvienko O, Lewis DS, Schafer E. A college nutrition science course as an intervention to prevent weight gain in female college freshmen. J Nutr Educ. 2001;33(2):95-101. 33. Georgiou CC, Betts NM, Hoerr SL, Keim K, Peters PK, Stewart B, et al. Among young adults, college students and graduates practiced more healthful habits and made more healthful food choices than did nonstudents. J Am Diet Assoc. 1997;97(7):754-759.

Appendix 1 Screening questionnaire for fat intakea

Complete the following questionnaire to the best of your ability. Using the example of a medium sample size given, indicate if you usually consume a small, medium, or large serving of the food item. Next indicate how often you consume that food item (e.g., two times a week or one time a month).

Medium serving
Food product Hamburgers, cheeseburgers, meat loaf Beefsteaks, roasts Pork, including chops, roast Hot dogs Ham, lunch meats Whole milk Cheese, excluding cottage Doughnuts, cookies, cake, pastries Eggs Bread, rolls, bagels, etc. Margarine or butter Salad dressing or mayonnaise French fries, fried potatoes Cheese pizza Peanut butter Example of a medium serving

Your serving size

S M L Day Week

How often?
Month Year Rarely/never

Size of a pack of cards Size of a pack of cards Size of a pack of cards 2 regular hot dogs 2 slices 1 cup 4 dominoes 1 piece or 3 cookies 2 eggs 2 slices, 3 crackers 2 tsp 2 tbsp 3/4 cup 1/12 of a 12 pizza 2 tbsp

tbsp = tablespoon; tsp = teaspoon a Adapted with permission from Dr. Gladys Block, National Cancer Institute (21)

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