Attach 4. Newest Vital Sign Food Label

ATTACHMENT 4 NEWEST VITAL SIGN

Newest Vital Sign Test

Study Site:

PID:

Today’s Date:

Answer Sheet for the Newest Vital Sign Questions
THIS INFORMATION IS ON THE BACK OF A CONTAINER OF A PINT
OF ICE CREAM. PLEASE READ THE INFORMATION AND ANSWER
THE FOLLOWING QUESTIONS.
1. If you eat the entire container, how many calories will you eat?

2. If you are allowed to eat 60 grams of carbohydrates as a snack, how much ice
cream could you have?

3. Your doctor advises you to reduce the amount of saturated fat in your diet. You
usually have 42 g of saturated fat each day, which includes one serving of ice
cream. If you stop eating ice cream, how many grams of saturated fat would you
be consuming each day?

4. If you usually eat 2500 calories in a day, what percentage of your daily
value of calories will you be eating if you eat one serving?

PRETEND THAT YOU ARE ALLERGIC TO THE FOLLOWING SUBSTANCES:
PENECILLIN, PEANUTS, LATEX GLOVES, AND BEE STINGS
5. Is it safe for you to eat this ice cream?

6. If your answer to Question 5 is “No,” please explain why you chose this answer. If
your answer to Question 5 is “Yes,” please skip this question?