Diet History

8/9/2019 Diet History

1/36

NATIONAL INSTITUTES OF HEALTH

DIET HISTORY QUESTIONNAIRE

GENERAL INSTRUCTIONS

Answer each question as best you can. Estimate if you are not sure. A guess is bettethan leaving a blank.

Use only a No. 2 pencil.

Be certain to completely blacken in each of the answers. Erase completely if you make any changes.

Do not make any stray marks on this form.

If you blacken NEVER or NO for a question, please follow any arrows or instructionsthat direct you to the next question.

BEFORE TURNING THE PAGE, PLEASE COMPLETE THE FOLLOWING QUESTIONS.

Todays date

MONTH DAY YEAR

In what month were youborn?

In what year wereyou born?

Are you male orfemale?

O JAN 0 0 O 1998O FEB 1 1 O 1999O MAR 2 2 O 2000O APR 3 3 O 2001O MAY 4 O 2002O JUN 5O JUL 6O AUG 7O SEP 8O OCT 9O NOVO DEC

O JANO FEBO MARO APRO MAYO JUNO JULO AUGO SEPO OCTO NOVO DEC

19_ _0 01 12 23 34 45 56 67 78 89 9

O MALE

O FEMALE

1


2/36

1. Over the past 12 months, how often did you drinktomato juice orvegetable juice?

O NEVER (GO TO QUESTION 2)

O 1 time per month or less O 1 time per dayO 2-3 times per month O 2-3 times per dayO 1-2 times per week O 4-5 times per day

O 3-4 times per week O 6 or more times per dayO 5-6 times per week

1a. Each time you drank tomato juice orvegetablejuice, how much did you usually drink?

O Less than cup (6 ounces)O to 1 cups (6 to 10 ounces)O More than 1 cups (10 ounces)

2. Over the past 12 months, how often did you drinkorange juice orgrapefruit juice?


O 1 time per month or less O 1 time per dayO 2-3 times per month O 2-3 times per dayO 1-2 times per week O 4-5 times per dayO 3-4 times per week O 6 or more times per dayO 5-6 times per week

2a. Each time you drank orange juice orgrapefruitjuice, how much did you usually drink?


3. Over the past 12 months, how often did you drink other100% fruit juice or100% fruit juice mixtures (such asapple, grape, pineapple, or others)?



3a. Each time you drank other fruit juice orfruit juicemixtures, how much did you usually drink?


Question 4 appears in the next column.

Over the past 12 months...

4. How often did you drink otherfruit drinks (such ascranberry cocktail, Hi-C, lemonade, or Kool-Aid, diet regular)?


O 1 time per month or less O 1 time per day

O 2-3 times per month O 2-3 times per dayO 1-2 times per week O 4-5 times per dayO 3-4 times per week O 6 or more times per dayO 5-6 times per week

4a. Each time you drank fruit drinks, how much didyou usually drink?

O Less than 1 cup (8 ounces)O 1 to 2 cups (8 to 16 ounces)O More than 2 cups (16 ounces)

4b. How often were your fruit drinks diet or sugar-fdrinks?

O Almost never or neverO About of the timeO About of the timeO About of the timeO Almost always or always

5. How often did you drink milk as a beverage (NOT incoffee, NOT in cereal)? (Please include chocolate mand hot chocolate.)


O 1 time per month or less O 1 time per dayO 2-3 times per month O 2-3 times per day

O 1-2 times per week O 4-5 times per dayO 3-4 times per week O 6 or more times per dayO 5-6 times per week

5a. Each time you drank milk as a beverage, howmuch did you usually drink?


5b. What kind ofmilk did you usually drink?

O Whole milkO 2% fat milkO 1% fat milkO Skim, nonfat, or % fat milkO Soy milkO Rice milkO Other

Question 6 appears on the next page.

2


3/36


6. How often did you drink meal replacement, energy, orhigh-protein beverages such as Instant Breakfast,Ensure, Slimfast, Sustacal or others?


O 1 time per month or less O 1 time per dayO 2-3 times per month O 2-3 times per day

O 1-2 times per week O 4-5 times per dayO 3-4 times per week O 6 or more times per dayO 5-6 times per week

6a. Each time you drank meal replacementbeverages, how much did you usually drink?


7. Over the past 12 months, did you drink soft drinks,soda, orpop?

O NO (GO TO QUESTION 8)

O YES

7a. How often did you drink soft drinks, soda, orpopIN THE SUMMER?

O NEVER


7b. How often did you drink soft drinks, soda, orpopDURING THE REST OF THE YEAR?

O NEVER


7c. Each time you drank soft drinks, soda, orpop,how much did you usually drink?

O Less than 12 ounces or less than 1 can or bottleO 12 to 16 ounces or 1 can or bottleO More than 16 ounces or more than 1 can or bottle

Question 8 appears on the next column.

7d. How often were these soft drinks, soda, or pop dorsugar-free?


7e. How often were these soft drinks, soda, or pop

caffeine-free?O Almost never or neverO About of the timeO About of the timeO About of the timeO Almost always or always

8. Over the past 12 months, did you drink beer?


O YES

8a. How often did you drink beerIN THE SUMMER

O NEVER

O 1 time per month or less O 1 time per dayO 2-3 times per month O 2-3 times per dayO 1-2 times per week O 4-5 times per dayO 3-4 times per week O 6 or more times per daO 5-6 times per week

8b. How often did you drink beerDURING THE RESOF THE YEAR?

O NEVER

O 1 time per month or less O 1 time per dayO 2-3 times per month O 2-3 times per dayO 1-2 times per week O 4-5 times per dayO 3-4 times per week O 6 or more times per daO 5-6 times per week

8c. Each time you drank beer, how much did youusually drink?

O Less than 12 ounces or less than 1 can or bottleO 12 to 16 ounces or 1 can or bottleO More than 16 ounces or more than 1 can or bottle



4/36


9. How often did you drink wine orwine coolers?


O 1 time per month or less O 1 time per dayO 2-3 times per month O 2-3 times per dayO 1-2 times per week O 4-5 times per dayO 3-4 times per week O 6 or more times per day

O 5-6 times per week

9a. Each time you drank wine orwine coolers, howmuch did you usually drink?

O Less than 5 ounces or less than 1 glassO 5 to 12 ounces or 1 to 2 glassesO More than 12 ounces or more than 2 glasses

10. How often did you drink liquorormixed drinks?



10a. Each time you drank liquorormixed drinks, howmuch did you usually drink?

O Less than 1 shot of liquorO 1 to 3 shots of liquorO More than 3 shots of liquor

11. Over the past 12 months, did you eat oatmeal, grits, orothercooked cereal?


O YES

11a. How often did you eat oatmeal, grits, orothercooked cereal IN THE WINTER?

O NEVER

O 1-6 times per winter O 2 times per weekO 7-11 times per winter O 3-4 times per weekO 1 time per month O 5-6 times per weekO 2-3 times per month O 1 time per dayO 1 time per week O 2 or more times per day


11b. How often did you eat oatmeal, grits, orothercooked cereal DURING THE REST OF THE

YEAR?

O NEVER

O 1-6 times per year O 2 times per weekO 7-11 times per year O 3-4 times per weekO 1 time per month O 5-6 times per weekO 2-3 times per month O 1 time per day

O 1 time per week O 2 or more times per day

11c. Each time you ate oatmeal, grits, or othercooked cereal, how much did you usually eat?

O Less than cupO to 1 cupsO More than 1 cups

12. How often did you eat cold cereal?


O 1-6 times per year O 2 times per week

O 7-11 times per year O 3-4 times per weekO 1 time per month O 5-6 times per weekO 2-3 times per month O 1 time per dayO 1 time per week O 2 or more times per day

12a. Each time you ate cold cereal, how much did yusually eat?

O Less than 1 cupO 1 to 2 cupsO More than 2 cups

12b. How often was the cold cereal you ate Total,Product 19, or Right Start?


12c. How often was the cold cereal you ate All BranFiber One, 100% Bran, orBran Buds?




5/36


12d. How often was the cold cereal you ate some otherbran orfiber cereal (such as Cheerios, ShreddedWheat, Raisin Bran, Bran Flakes, Grape-Nuts,Granola, Wheaties, or Healthy Choice)?

O Almost never or neverO About of the timeO About of the time

O About of the timeO Almost always or always

12e. How often was the cold cereal you ate any othertype of cold cereal (such as Corn Flakes, RiceKrispies, Frosted Flakes, Special K, Froot Loops,Cap'n Crunch, or others)?


12f. Was milk added to your cold cereal?O NO (GO TO QUESTION 13)

O YES

12g. What kind ofmilk was usually added?

O Whole milkO 2% fat milkO 1% fat milkO Skim, nonfat, or % fat milkO Soy milkO Rice milkO Other

12h. Each time milk was added to your cold cereal,how much was usually added?

O Less than cupO to 1 cupO More than 1 cup

13. How often did you eat applesauce?


O 1-6 times per year O 2 times per weekO 7-11 times per year O 3-4 times per week

O 1 time per month O 5-6 times per weekO 2-3 times per month O 1 time per dayO 1 time per week O 2 or more times per day


13a. Each time you ate applesauce, how much didyou usually eat?


14. How often did you eat apples?


O 1-6 times per year O 2 times per weekO 7-11 times per year O 3-4 times per weekO 1 time per month O 5-6 times per weekO 2-3 times per month O 1 time per dayO 1 time per week O 2 or more times per day

14a. Each time you ate apples, how many did youusually eat?

O Less than 1 appleO 1 appleO More than 1 apple

15. How often did you eat pears (fresh, canned, or froze



15a. Each time you ate pears, how much did youusually eat?

O Less than 1 pearO 1 pear

O More than 1 pear

16. How often did you eat bananas?





6/36


16a. Each time you ate bananas, how many did youusually eat?

O Less than 1 bananaO 1 bananaO More than 1 banana

17. How often did you eat dried fruit, such as prunes or

raisins (not including dried apricots)?



17a. Each time you ate dried fruit, how much did youusually eat (not including dried apricots)?

O Less than 2 tablespoonsO 2 to 5 tablespoonsO More than 5 tablespoons

18. Over the past 12 months, did you eat peaches,nectarines, orplums?


O YES

18a. How often did you eat fresh peaches, nectarines,orplums WHEN IN SEASON?

O NEVER

O 1-6 times per season O 2 times per weekO 7-11 times per season O 3-4 times per weekO 1 time per month O 5-6 times per weekO 2-3 times per month O 1 time per dayO 1 time per week O 2 or more times per day

18b. How often did you eat peaches, nectarines, orplums (fresh, canned, or frozen) DURING THEREST OF THE YEAR?

O NEVER




18c. Each time you ate peaches, nectarines, orplumhow much did you usually eat?

O Less than 1 piece of fruit or less than cupO 1 to 2 pieces of fruit or to cupO More than 2 pieces of fruit or more than cup

19. How often did you eat grapes?



19a. Each time you ate grapes, how much did youusually eat?

O Less than cup or less than 10 grapesO to 1 cup or 10 to 30 grapesO More than 1 cup or more than 30 grapes

20. Over the past 12 months, did you eat cantaloupe?


O YES

20a. How often did you eat fresh cantaloupeWHENSEASON?

O NEVER


20b. How often did you eat fresh or frozen cantalouDURING THE REST OF THE YEAR?

O NEVER




7/36


20c. Each time you ate cantaloupe, how much did youusually eat?

O Less than melon or less than cupO melon or to 1 cupO More than melon or more than 1 cup

21. Over the past 12 months, did you eat melon, other

than cantaloupe (such as watermelon or honeydew)?O NO (GO TO QUESTION 22)

O YES

21a. How often did you eat fresh melon, other thancantaloupe, (such as watermelon or honeydew)WHEN IN SEASON?

O NEVER


21b. How often did you eat fresh orfrozen melon,other than cantaloupe (such as watermelon orhoneydew) DURING THE REST OF THE YEAR?

O NEVER


21c. Each time you ate melon other than cantaloupe,how much did you usually eat?

O Less than cup or 1 small wedgeO to 2 cups or 1 medium wedgeO More than 2 cups or 1 large wedge


22. Over the past 12 months, did you eat strawberries?


O YES

22a. How often did you eat fresh strawberries WHEIN SEASON?

O NEVER


22b. How often did you eat fresh orfrozenstrawberriesDURING THE REST OF THE YEA

O NEVER

O 1-6 times per season O 2 times per weekO 7-11 times per season O 3-4 times per weekO 1 time per month O 5-6 times per week

O 2-3 times per month O 1 time per dayO 1 time per week O 2 or more times per day

22c. Each time you ate strawberries, how much did yusually eat?

O Less than cup or less than 3 strawberriesO to cup or 3 to 8 strawberriesO More than cup or more than 8 strawberries

23. Over the past 12 months, did you eat oranges,tangerines, ortangelos?


O YES

23a. How often did you eat fresh oranges, tangerineortangelos WHEN IN SEASON?

O NEVER




8/36


23b. How often did you eat oranges, tangerines, ortangelos (fresh or canned) DURING THE RESTOF THE YEAR?

O NEVER



23c. Each time you ate oranges, tangerines, ortangelos, how many did you usually eat?

O Less than 1 piece of fruit or less than cupO 1 piece of fruit or to 1 cupO More than 1 piece of fruit or more than 1 cup

24. Over the past 12 months, did you eat grapefruit?


O YES

24a. How often did you eat fresh grapefruit WHEN INSEASON?

O NEVER


24b. How often did you eat grapefruit (fresh or canned)

DURING THE REST OF THE YEAR?

O NEVER


24c. Each time you ate grapefruit, how much did youusually eat?

O Less than grapefruit or less than cupO grapefruit or to 1 cupO More than grapefruit or more than 1 cup


25. How often did you eat other kinds of fruit?



25a. Each time you ate other kinds of fruit, how mucdid you usually eat?

O Less than cupO to cupO More than cup

26. How often did you eat COOKED greens (such asspinach, turnip, collard, mustard, chard, or kale)?


O 1-6 times per year O 2 times per weekO 7-11 times per year O 3-4 times per weekO 1 time per month O 5-6 times per week


26a. Each time you ate COOKED greens, how muchyou usually eat?


27. How often did you eat RAW greens (such as spinacturnip, collard, mustard, chard, or kale)? (We will askabout lettuce later.)



27a. Each time you ate RAW greens, how much didyou usually eat?



8


9/36


28. How often did you eat coleslaw?



O 1 time per week O 2 or more times per day28a. Each time you ate coleslaw, how much did you

usually eat?


29. How often did you eat sauerkraut orcabbage (otherthan coleslaw)?




29a. Each time you ate cabbage orsauerkraut, howmuch did you usually eat?


30. How often did you eat carrots (fresh, canned, orfrozen)?



30a. Each time you ate carrots, how much did youusually eat?

O Less than cup or less than 2 baby carrotsO to cup or 2 to 5 baby carrotsO More than cup or more than 5 baby carrots


31. How often did you eat stringbeans orgreenbean(fresh, canned, or frozen)?



31a. Each time you ate stringbeans orgreenbeanhow much did you usually eat?


32. How often did you eat peas (fresh, canned, or frozen




32a. Each time you ate peas, how much did you usuaeat?


33. Over the past 12 months, did you eat corn?


O YES

33a. How often did you eat fresh corn WHENINSEASON?

O NEVER



9


10/36

Over the past 12 months

33b. How often did you eat corn (fresh, canned, orfrozen) DURING THE REST OF THE YEAR?

O NEVER



33c. Each time you ate corn, how much did you usuallyeat?

O Less than 1 ear or less than cupO 1 ear or to 1 cupO More than 1 ear or more than 1 cup

34. Over the past 12 months, how often did you eat broccoli(fresh or frozen)?



34a. Each time you ate broccoli, how much did youusually eat?


35. How often did you eat cauliflower or Brussels sprouts

(fresh or frozen)?



35a. Each time you ate cauliflowerorBrusselssprouts, how much did you usually eat?



36. How often did you eat mixedvegetables?



36a. Each time you ate mixedvegetables, how muchdid you usually eat?


37. How often did you eat onions?




37a. Each time you ate onions, how much did youusually eat?

O Less than 1 slice or less than 1 tablespoonO 1 slice or 1 to 4 tablespoonsO More than 1 slice or more than 4 tablespoons

38. Now think about all the cookedvegetables you atethe past 12 months and how they were prepared. Hooften were your vegetables COOKEDWITH some soffat, including oil spray? (Please do not includepotatoes.)




10


11/36


38a. Which fats were usually added to your vegetablesDURINGCOOKING? (Please do not includepotatoes. Mark as many as apply.)

O Margarine (including O Corn oillow-fat) O Canola or rapeseed oil

O Butter (including O Oil spray, such aslow-fat) Pam or others

O Lard, fatback, or O Other kinds of oilsbacon fat O None of the aboveO Olive oil

39. Now, thinking again about all the cookedvegetablesyou ate in the past 12 months, how often was somesort of fat, sauce, or dressing added AFTERCOOKINGORATTHETABLE? (Please do notinclude potatoes.)




39a. Which fats, sauces, or dressings were usuallyadded AFTER COOKING OR AT THE TABLE?(Please do not include potatoes. Mark as many;as apply.)

O Margarine (including O Salad dressinglow-fat) O Cheese sauce

O Butter (including O White saucelow-fat) O Other

O Lard, fatback, orbacon fat

39b. If margarine, butter, lard, fatback, or bacon fat wasadded to your cooked vegetables AFTERCOOKING OR AT THE TABLE, how much did youusually add?

O Did not usually add theseO Less than 1 teaspoonO 1 to 3 teaspoonsO More than 3 teaspoons

39c. If salad dressing, cheese sauce, or white saucewas added to your cooked vegetables AFTERCOOKING OR AT THE TABLE, how much did youusually add?

O Did not usually add theseO Less than 1 tablespoonO 1 to 3 tablespoonsO More than 3 tablespoons


40. Over the past 12 months, how often did you eat swepeppers (green, red, or yellow)?



40a. Each time you ate sweetpeppers, how much dyou usually eat?

O Less than 1/8 pepperO 1/8 to 1/4 pepperO More than 1/4 pepper

41. Over the past 12 months, did you eat freshtomatoe(including those in salads)?


O YES

41a. How often did you eat fresh tomatoes (includingthose in salads) WHEN IN SEASON?

O NEVER


41b. How often did you eat fresh tomatoes (includingthose in salads) DURING THE REST OF THE

YEAR?

O NEVER


41c. Each time you ate fresh tomatoes, how much dyou usually eat?

O Less than tomatoO to tomatoO More than tomato


11


12/36


42. How often did you eat lettuce salads (with or withoutother vegetables)?




42a. Each time you ate lettuce salads, how much didyou usually eat?


43. How often did you eat salad dressing (includinglow-fat) on salads?



43a. Each time you ate salad dressing on salads, howmuch did you usually eat?

O Less than 2 tablespoonsO 2 to 4 tablespoonsO More than 4 tablespoons

44. How often did you eat sweet potatoes oryams?



44a. Each time you ate sweet potatoes oryams, howmuch did you usually eat?

O 1 small potato or less than cupO 1 medium potato or to cupO 1 large potato or more than cup


45. How often did you eat French fries, home fries, hasbrowned potatoes, ortater tots?



45a. Each time you ate French fries, home fries, habrowned potatoes, ortater tots how much didyou usually eat?

Less than 10 fries or less than cupO 10 to 25 fries or to 1 cupO More than 25 fries or more than 1 cup

46. How often did you eat potato salad?




46a. Each time you ate potatosalad, how much did yusually eat?

O Less than cupO to 1 cupO More than 1cup

47. How often did you eat baked, boiled, ormashedpotatoes?



47a. Each time you ate baked, boiled, ormashedpotatoes, how much did you usually eat?

O 1 small potato or less than cupO 1 medium potato or to 1 cupO 1 large potato or more than 1 cup


12


13/36


47b. How often was sour cream (including low-fat)added to your potatoes, EITHER IN COOKING ORAT THE TABLE?

O Almost never or never (GO TO QUESTION 47d)O About of the timeO About of the timeO About of the time

O Almost always or always

47c. Each time sour cream was added to yourpotatoes, how much was usually added?

O Less than 1 tablespoonO 1 to 3 tablespoonsO More than 3 tablespoons

47d. How often was margarine (including low-fat)added to your potatoes, EITHER IN COOKING ORAT THE TABLE?

O Almost never or never

O About of the timeO About of the timeO About of the timeO Almost always or always

47e. How often was butter(including low-fat) added toyour potatoes, EITHER IN COOKING OR AT THETABLE?


47f. Each time margarine orbutterwas added to yourpotatoes, how much was usually added?

O Never addedO Less than 1 teaspoonO 1 to 3 teaspoonsO More than 3 teaspoons

47g. How often was cheese orcheese sauce added toyour potatoes, EITHER IN COOKING OR AT THETABLE?

O Almost never or never (GO TO QUESTION 48)O About of the time

O About of the timeO About of the timeO Almost always or always


47h. Each time cheese orcheese sauce was added your potatoes, how much was usually added?


48. How often did you eat salsa?

O NEVER (GO TO QUESTION 49)O 1-6 times per year O 2 times per weekO 7-11 times per year O 3-4 times per weekO 1 time per month O 5-6 times per weekO 2-3 times per month O 1 time per dayO 1 time per week O 2 or more times per day

48a. Each time you ate salsa, how much did you usueat?


49. How often did you eat catsup?



49a. Each time you ate catsup, how much did youusually eat?

O Less than 1 teaspoonO 1 to 6 teaspoonsO More than 6 teaspoons

50. How often did you eat stuffing, dressing, ordumplings?



50a. Each time you ate stuffing, dressing, or

dumplings, how much did you usually eat?



13


14/36


51. How often did you eat chili?



O 1 time per week O 2 or more times per day51a. Each time you ate chili, how much did you usually

eat?


52. How often did you eat Mexican foods (such as tacos,tostados, burritos, tamales, fajitas, enchiladas,quesadillas, and chimichangas)?



52a. Each time you ate Mexican foods, how much didyou usually eat?

O Less than 1 taco, burrito, etc.O 1 to 2 tacos, burritos, etc.O More than 2 tacos, burritos, etc.

53. How often did you eat cooked dried beans (such as

baked beans, pintos, kidney, blackeyed peas, lima,lentils, soybeans, or refried beans)? (Please dontinclude bean soups or chili.)



53a. Each time you ate beans, how much did youusually eat?



53b. How often were the beans you ate refried beansor beans prepared with any type of fat orwithmeat added?


54. How often did you eat other kinds of vegetables?



54a. Each time you ate other kinds of vegetables, hmuch did you usually eat?

O Less than cup

O to cupO More than cup

55. How often did you eat rice orother cooked grains(such as buIgur, cracked wheat, or millet)?



55a. Each time you ate rice or other cooked grainshow much did you usually eat?


55b. How often was butter, margarine, oroil addedyour rice IN COOKING OR AT THE TABLE?



14


15/36


56. How often did you eat pancakes, waffles, orFrenchtoast?




56a. Each time you ate pancakes, waffles, orFrenchtoast, how much did you usually eat?

O Less than 1 medium pieceO 1 to 3 medium piecesO More than 3 medium pieces

56b. How often was margarine (including low-fat)added to your pancakes, waffles, or French toastAFTER COOKING OR AT THE TABLE?


56c. How often was butter(including low-fat) added toyour pancakes, waffles, or French toast AFTERCOOKING OR AT THE TABLE?


56d. Each time margarine orbutterwas added to yourpancakes, waffles, or French toast, how much wasusually added?


56e. How often was syrup added to your pancakes,waffles, or French toast?

O Almost never or never (GO TO QUESTION 57)



56f. Each time syrup was added to your pancakes,waffles, or French toast, how much was usuallyadded?


57. How often did you eat lasagna, stuffed shells, stuff

manicotti, ravioli, ortortellini? (Please do not incluspaghetti or other pasta.)



57a. Each time you ate lasagna, stuffed shells,stuffed manicotti, ravioli, ortortellini, how mudid you usually eat?


58. How often did you eat macaroni and cheese?



58a. Each time you ate macaroni and cheese, howmuch did you usually eat?


59. How often did you eat pasta salad ormacaroni sala




15


16/36


59a. Each time you ate pasta salad ormacaroni salad,how much did you usually eat?


60. Other than the pastas listed in Questions 57, 58, and

59, how often did you eat pasta, spaghetti, orothernoodles?



60a. Each time you ate pasta, spaghetti, orothernoodles, how much did you usually eat?


60b. How often did you eat your pasta, spaghetti, orother noodles with tomato sauce orspaghettisauce made WITH meat?


60c. How often did you eat your pasta, spaghetti, or

other noodles with tomato sauce orspaghettisauce made WITHOUT meat?


60d. How often did you eat your pasta, spaghetti, orother noodles with margarine, butter, oil, orcream sauce?




61. How often did you eat bagels orEnglish muffins?

O NEVER (GO TO INTRODUCTION TO QUESTION 62)


61a. Each time you ate bagels orEnglish muffins, hmany did you usually eat?

O Less than 1 bagel or English muffinO 1 bagel or English muffinO More than 1 bagel or English muffin

61b. How often was margarine (including low-fat)spread on your bagels or English muffins?


61c. How often was butter(including low-fat) spread your bagels or English muffins?


61d. Each time margarine orbutterwas spread onyour bagels or English muffins, how much wasusually used?


61e. How often was creamcheese (including low-fatspread on your bagels or English muffins?

O Almost never or never (GO TO INTRODUCTION TQUESTION 62)



16


17/36


61f. Each time cream cheese was spread on yourbagels or English muffins, how much was usuallyused?


The next questions ask about your intake of breadsother than bagels or English muffins. First, we will askabout bread you ate as part of sandwiches only. Thenwe will ask about all other bread you ate.

62. How often did you eat breads orrolls AS PART OFSANDWICHES (including burger and hot dog rolls)?




62a. Each time you ate breads orrolls AS PART OFSANDWICHES, how many did you usually eat?

O 1 slice or rollO 2 slices or 1 rollO More than 2 slices or more than 1 roll

62b. How often were the breads or rolls that you usedfor your sandwiches white bread (including burgerand hot dog rolls)?



62c. How often was mayonnaise or mayonnaise-typedressing (including low-fat) spread on yoursandwich bread or rolls?

O Almost never or never (GO TO QUESTION 62e)O About of the timeO About of the timeO About of the timeO Almost always or always


62d. Each time mayonnaise or mayonnaise-typedressing was spread on your sandwich breads rolls, how much was usually used?


62e. How often was margarine (including low-fat)

spread on to your sandwich bread or rolls?O Almost never or neverO About of the timeO About of the timeO About of the timeO Almost always or always

62f. How often was butter(including low-fat) spread your sandwich bread or rolls?

O Almost never or neverO About of the timeO About of the timeO About of the time


62g. Each time margarine orbutterwas spread onyour sandwich breads or rolls, how much wasusually used?


63. How often did you eat breads ordinnerrolls, NOT PART OF SANDWICHES?



63a. Each time you ate breads ordinner rolls, NOTAS PART OF SANDWICHES, how much did yousually eat?

O 1 slice or 1 dinner rollO 2 slices or 2 dinner rolls

O More than 2 slices or 2 dinner rolls


17


18/36


63b. How often were the breads or rolls you ate whitebread?


63c. How often was margarine (including low-fat)spread on your breads or rolls?


63d. How often was butter(including low-fat) spread onyour breads or rolls?


63e. Each time margarine orbutterwas spread onyour breads or rolls, how much was usually used?


63f. How often was cream cheese (including low-fat)spread on your breads or rolls?

O Almost never or never (GO TO QUESTION 64)O About of the timeO About of the timeO About of the timeO Almost always or always

63g. Each time cream cheese was spread on yourbreads or rolls, how much was usually used?



64. How often did you eatjam, jelly, orhoney on bagelsmuffins, bread, rolls, or crackers?



64a. Each time you atejam, jelly, orhoney, how mudid you usually eat?


65. How often did you eat peanut butterorother nutbutter?




65a. Each time you ate peanut butterorother nutbutter, how much did you usually eat?


66. How often did you eat roast beeforsteak INSANDWICHES?

O NEVER (GO TO QUESTION 67);


66a. Each time you ate roast beeforsteak INSANDWICHES, how much did you usually eat?

O Less than 1 slice or less than 2 ouncesO 1 to 2 slices or 2 to 4 ouncesO More than 2 slices or more than 4 ounces


18


19/36


67. How often did you eat turkey orchicken COLD CUTS(such as loaf, luncheon meat, turkey ham, turkeysalami, or turkey pastrami)? (We will ask about otherturkey or chicken later.)




67a. Each time you ate turkey orchicken COLDCUTS, how much did you usually eat?

O Less than 1 sliceO 1 to 3 slicesO More than 3 slices

68. How often did you eat luncheon ordeli-style ham?(We will ask about other ham later.)



68a. Each time you ate luncheon ordeli-style ham,how much did you usually eat?


68b. How often was the luncheon or deli-style ham youate light, low-fat, orfat-free?



69. How often did you eat other cold cutsor luncheonmeats (such as bologna, salami, corned beef, pastraor others, including low-fat)? (Please do not includeham, turkey, or chicken cold cuts.)




69a. Each time you ate other cold cuts orluncheonmeats, how much did you usually eat?


69b. How often were the other cold cuts or luncheonmeats you ate light, low-fat, orfat-free cold cuor luncheon meats? (Please do not include ham

turkey, or chicken cold cuts.)O Almost never or neverO About of the timeO About of the timeO About of the timeO Almost always or always

70. How often did you eat canned tuna (including insalads, sandwiches, or casseroles)?




70a. Each time you ate canned tuna, how much did yusually eat?

O Less than cup or less than 2 ouncesO to cup or 2 to 3 ouncesO More than cup or more than 3 ounces

70b. How often was the canned tuna you atewater-packed tuna?



19


20/36


70c. How often was the canned tuna you ate preparedwith mayonnaise orother dressing (includinglow-fat)?



71. How often did you eat GROUND chicken orturkey?(We will ask about other chicken and turkey later.)



71a. Each time you ate GROUND chicken orturkey,how much did you usually eat?

O Less than 2 ounces or less than cupO 2 to 4 ounces or to 1 cupO More than 4 ounces or more than 1 cup

72. How often did you eat beef hamburgers orcheeseburgers?




72a. Each time you, ate beef hamburgers orcheeseburgers, how much did you usually eat?

O Less than 1 patty or less than 2 ouncesO 1 patty or 2 to 4 ouncesO More than 1 patty or more than 4 ounces

72b. How often were the beef hamburgers orcheeseburgers you ate made with lean groundbeef?




73. How often did you eat ground beef in mixtures (sucas meatballs, casseroles, chili, or meatloaf)?



73a. Each time you ate ground beef in mixtures, homuch did you usually eat?

O Less than 3 ounces or less than cupO 3 to 8 ounces or to 1 cupO More than 8 ounces or more than 1 cup

74. How often did you eat hot dogs orfrankfurters?(Please do not include sausages or vegetarian hotdogs.)



74a. Each time you ate hot dogs orfrankfurters, howmany did you usually eat?

O Less than 1 hot dogO 1 to 2 hot dogsO More than 2 hot dogs

74b. How often were the hot dogs orfrankfurters yo

ate light or low-fat hot dogs?



20


21/36


75. How often did you eat beef mixtures such as beefstew, beef pot pie, beef and noodles, orbeef andvegetables?




75a. Each time you ate beef stew, beef pot pie, beefand noodles, orbeef and vegetables, how muchdid you usually eat?


76. How often did you eat roast beeforpot roast?(Please do not include roast beef or pot roast in

sandwiches.)O NEVER (GO TO QUESTION 77)


76a. Each time you ate roast beeforpot roast(including in mixtures), how much did you usuallyeat?

O Less than 2 ounces

O 2 to 5 ouncesO More than 5 ounces

77. How often did you eat steak (beef)? (Do not includesteak in sandwiches)



77a. Each time you ate steak (beef), how much did youusually eat?

O Less than 3 ouncesO 3 to 7 ouncesO More than 7 ounces


77b. How often was the steak you ate lean steak?


78. How often did you eat pork orbeef spareribs?



78a. Each time you ate pork orbeef spareribs, howmuch did you usually eat?

O Less than 4 ribsO 4 to 12 ribsO More than 12 ribs

79. How often did you eat roast turkey, turkey cutletsturkey nuggets (including in sandwiches)?



79a. Each time you ate roast turkey, turkey cutletsturkey nuggets, how much did you usually eat?

(Please note: 4-8 turkey nuggets = 3 ounces.)O Less than 2 ouncesO 2 to 4 ouncesO More than 4 ounces

80. How often did you eat chicken as part ofsalads,sandwiches, casseroles, stews, orother mixture





21


22/36


80a. Each time you ate chicken as part ofsalads,sandwiches, casseroles, stews, orothermixtures, how much did you usually eat?


81. How often did you eat baked, broiled, roasted,stewed, orfried chicken (including nuggets)? (Pleasedo not include chicken in mixtures.)



81a. Each time you ate baked, broiled, roasted,stewed, orfried chicken (including nuggets), how

much did you usually eat?O Less than 2 drumsticks or wings, less than 1 breast or

thigh, or less than 4 nuggetsO 2 drumsticks or wings, 1 breast or thigh, or 4 to 8

nuggetsO More than 2 drumsticks or wings, more than 1 breast or

thigh, or more than 8 nuggets

81b. How often was the chicken you ate fried chicken(including deep fried) orchicken nuggets?



81c. How often was the chicken you ate WHITE meat?


81d. How often did you eat chicken WITH skin?




82. How often did you eat baked ham orham steak?



82a. Each time you ate baked ham orham steak, homuch did you usually eat?

O Less than 1 ounceO 1 to 3 ouncesO More than 3 ounces

83. How often did you eat pork (including chops, roastsand in mixed dishes)? (Please do not include ham,ham steak, or sausage.)




83a. Each time you ate pork, how much did you usuaeat?

O Less than 2 ounces or less than 1 chopO 2 to 5 ounces or 1 chopO More than 5 ounces or more than 1 chop

84. How often did you eat gravy on meat, chicken,potatoes, rice, etc.?



84a. Each time you ate gravy on meat, chicken,potatoes, or rice, etc., how much did you usuallyeat?

O Less than 1/8 cupO 1/8 to 1/2 cupO More than 1/2 cup


22


23/36


85. How often did you eat liver (all kinds) orliverwurst?



O 1 time per week O 2 or more times per day85a. Each time you ate liverorliverwurst, how much

did you usually eat?

O Less than 1 ounceO 1 to 4 ouncesO More than 4 ounces

86. How often did you eat bacon (including low-fat)?




86a. Each time you ate bacon, how much did youusually eat?

O Fewer than 2 slicesO 2 to 3 slicesO More than 3 slices

86b. How often was the bacon you ate light, low-fat, orlean bacon?


87. How often did you eat sausage (including low-fat)?




87a. Each time you ate sausage, how much did youusually eat?

O Less than 1 patty or 2 linksO 1 to 3 patties or 2 to 5 linksO More than 3 patties or 5 links

87b. How often was the sausage you ate light, low-forlean sausage?


88. How often did you eat fish sticks orfried fish(including fried seafood or shellfish)?




88a. Each time you ate fish sticksor fried fish, howmuch did you usually eat?

O Less than 2 ounces or less than 1 filletO 2 to 7 ounces or 1 filletO More than 7 ounces or more than 1 fillet

89. How often did you eat fish orseafood that was NOFRIED (including shellfish)?

O NEVER (GO TO THE INTRODUCTION TO QUESTION


89a. Each time you ate fish orseafood that was notfried, how much did you usually eat?

O Less than 2 ounces or less than 1 filletO 2 to 5 ounces or 1 filletO More than 5 ounces or more than 1 fillet


23


24/36


Now think about all the meat, poultry, and fish you ate in thepast 12 months and how they were prepared.

90. How often was oil, butter, margarine, orother fatused to FRY, SAUTE, BASTE, OR MARINATE anymeat, poultry, or fish you ate? (Please do not includedeep frying.)



90a. Which of the following fats were regularly used toprepare your meat, poultry, or fish? (Mark all thatapply.)

O Margarine (including O Corn oillow-fat) O Canola or rapeseed oil

O Butter (including O Oil spray, such as Pamlow-fat) or othersO Lard, fatback, or O Other kinds of oils

bacon fat O None of the aboveO Olive oil

91. How often did you eat tofu, soy burgers, orsoymeat-substitutes?




91a. Each time you ate tofu, soy burgers, orsoymeat-substitutes, how much did you usually eat?

O Less than cup or less than 2 ouncesO to cup or 2 to 4 ouncesO More than cup or more than 4 ounces


92. Over the past 12 months, did you eat soups?


O YES

92a. How often did you eat soup DURING THEWINTER?

O NEVER


92b. How often did you eat soup DURING THE RESTOF THE YEAR?

O NEVER



92c. Each time you ate soup, how much did you usuaeat?


92d. How often were the soups you ate bean soups?

O Almost never or neverO About of the time


92e. How often were the soups you ate cream soups(including chowders)?



24


25/36


92f. How often were the soups you ate tomato orvegetable soups?


92g. How often were the soups you ate broth soups(including chicken) with orwithout noodles orrice?


93. How often did you eat pizza?



93a. Each time you ate pizza, how much did you usuallyeat?

O Less than 1 slice or less than 1 mini pizzaO 1 to 3 slices or 1 mini pizzaO More than 3 slices or more than 1 mini pizza

93b. How often did you eat pizza with pepperoni,

sausage, orother meat?


94. How often did you eat crackers?




94a. Each time you ate crackers, how many did youusually eat?

O Fewer than 4 crackersO 4 to 10 crackersO More than 10 crackers

95. How often did you eat corn bread orcorn muffins?

O NEVER (GO TO QUESTION 96)O 1-6 times per year O 2 times per weekO 7-11 times per year O 3-4 times per weekO 1 time per month O 5-6 times per weekO 2-3 times per month O 1 time per dayO 1 time per week O 2 or more times per day

95a. Each time you ate corn bread orcorn muffins,how much did you usually eat?

O Less than 1 piece or muffinO 1 to 2 pieces or muffinsO More than 2 pieces or muffins

96. How often did you eat biscuits?



96a. Each time you ate biscuits, how many did youusually eat?

O Fewer than 1 biscuit

O 1 to 2 biscuitsO More than 2 biscuits

97. How often did you eat potato chips, tortilla chips, ocorn chips (including low-fat, fat-free, or low-salt)?




25


26/36


97a. Each time you ate potato chips, tortilla chips, orcorn chips, how much did you usually eat?

O Fewer than 10 chips or less than 1 cupO 10 to 25 chips or 1 to 2 cupsO More than 25 chips or more than 2 cups

97b. How often were the chips you ate Wow chips or

other chips made with fat substitute (Olean orOlestra)?


97c. How often were the chips you ate otherlow-fat orfat-free chips?


98. How often did you eat popcorn (including low-fat)?



98a. Each time you ate popcorn, how much did you

usually eat?

O Less than 2 cups, poppedO 2 to 5 cups, poppedO More than 5 cups, popped

99. How often did you eat pretzels?




99a. Each time you ate pretzels how many did youusually eat?

O Fewer than 5 average twistsO 5 to 20 average twistsO More than 20 average twists

100. How often did you eat peanuts, walnuts, seeds, oother nuts?



100a. Each time you ate peanuts, walnuts, seeds, orother nuts, how much did you usually eat?


101. How often did you eat energy, high-protein, orbreakfast bars such as Power Bars, Balance, Clifothers?



101a. Each time you ate energy, high-protein, or

breakfast bars, how much did you usually eat?

O Less than 1 barO 1 barO More than 1 bar

102. How often did you eat yogurt (NOT including frozenyogurt)?




26


27/36


102a. Each time you ate yogurt, how much did youusually eat?

O Less than cup or less than 1 containerO to 1 cup or 1 containerO More than 1 cup or more than 1 container

103. How often did you eat cottage cheese (including low-

fat)?O NEVER (GO TO QUESTION 104)


103a. Each time you ate cottage cheese, how much didyou usually eat?


104. How often did you eat cheese (including low-fat,including on cheeseburgers or in sandwiches orsubs)?



104a. Each time you ate cheese, how much did youusually eat?

O Less than ounce or less than 1 sliceO to 1 ounces or 1 sliceO More than 1 ounces or more than 1 slice

104b. How often was the cheese you ate light or low-fatcheese?


O Almost always or alwaysQuestion 105 appears in the next column.

104c. How often was the cheese you ate fat-freecheese?


105. How often did you eat frozen yogurt, sorbet, oric(including low-fat or fat-free)?



105a. Each time you ate frozen yogurt, sorbet, oricehow much did you usually eat?

O Less than cup or less than 1 scoop

O to 1 cup or 1 to 2 scoopsO More than 1 cup or more than 2 scoops

106. How often did you eat ice cream, ice cream bars, osherbet (including low-fat or fat-free)?



106a. Each time you ate ice cream, ice cream bars, osherbet, how much did you usually eat?

O Less than cup or less than 1 scoopO to 1 cups or 1 to 2 scoopsO More than 1 cups or more than 2 scoops

106b. How often was the ice cream you ate light, low-orfat-free ice cream or sherbet?



27


28/36


107. How often did you eat cake (including low-fat orfat-free)?




107a. Each time you ate cake, how much did you usuallyeat?

O Less than 1 medium pieceO 1 medium pieceO More than 1 medium piece

107b. How often was the cake you ate light, low-fat, orfat-free cake?



108. How often did you eat cookies orbrownies(including low-fat or fat-free)?



108a. Each time you ate cookies orbrownies, how muchdid you usually eat?

O Less than 2 cookies or 1 small brownieO 2 to 4 cookies or 1 medium brownieO More than 4 cookies or 1 large brownie

108b. How often were the cookies or brownies you atelight, low-fat, orfat-free cookies or brownies?



109. How often did you eat doughnuts, sweet rolls,Danish, orpop-tarts?



109a. Each time you ate doughnuts, sweet rolls,Danish, orpop-tarts, how much did you usuallyeat?

O Less than 1 pieceO 1 to 2 piecesO More than 2 pieces

110. How often did you eat sweet muffins ordessertbreads (including low-fat or fat-free)?



110a. Each time you ate sweet muffins ordessertbreads, how much did you usually eat?

O Less than 1 medium pieceO 1 medium pieceO More than 1 medium piece

110b. How often were the sweet muffins or dessert

breads you ate light, low-fat, or fat-free sweetmuffins ordessert breads?


111. How often did you eat fruit crisp, cobbler, orstrudel?




28


29/36


111a. Each time you ate fruit crisp, cobbler, orstrudel,how much did you usually eat?

O Less than cupO to 1 cup More than 1 cup

112. How often did you eat pie?



112a. Each time you ate pie, how much did you usuallyeat?

O Less than 1/8 of a pieO About 1/8 of a pieO More than 1/8 of a pie

The next four questions ask about the kinds of pie youate. Please read all four questions before answering.

112b. How often were the pies you ate fruit pie (such asapple, blueberry, others)?


112c. How often were the pies you ate cream, pudding,custard, ormeringue pie?


112d. How often were the pies you ate pumpkin orsweetpotato pie?




112e. How often were the pies you ate pecan pie?


113. How often did you eat chocolate candy?



113a. Each time you ate chocolate candy, how much you usually eat?

O Less than 1 average bar or less than 1 ounceO 1 average bar or 1 to 2 ouncesO More than 1 average bar or more than 2 ounces

114. How often did you eat other candy?



114a. Each time you ate other candy, how much did yusually eat?

O Fewer than 2 piecesO 2 to 9 piecesO More than 9 pieces

115. How often did you eat eggs, egg whites, or eggsubstitutes (NOT counting eggs in baked goods andesserts)? (Please include eggs in salads, quiche, asouffles.)




29


30/36


115a. Each time you ate eggs, how many did you usuallyeat?

O 1 eggO 2 eggsO 3 or more eggs

115b. How often were the eggs you ate egg substitutes?


115c. How often were the eggs you ate egg whites only?


115d. How often were the eggs you ate regular wholeeggs?


115e. How often were the eggs you ate cooked in oil,butter, ormargarine?



115f. How often were the eggs you ate part ofeggsalad?



116. How many cups ofcoffee, caffeinated ordecaffeinated, did you drink?

O NONE (GO TO QUESTION 117)

O Less than 1 cup per O 5-6 cups per weekmonth O 1 cup per day

O 1-3 cups per month O 2-3 cups per dayO 1 cup per week O 4-5 cups per dayO 2-4 cups per week O 6 or more cups per day

116a. How often was the coffee you drankdecaffeinated?


117. How many glasses ofICED tea, caffeinated ordecaffeinated, did you drink?


O Less than 1 glass per O 5-6 glasses per weekmonth O 1 glass per day

O 1-3 glasses per month O 2-3 glasses per dayO 1 glass per week O 4-5 glasses per dayO 2-4 glasses per week O 6 or more glasses per da

117a. How often was the iced tea you drankdecaffeinated or herbal tea?


O Almost always or always118. How many cups ofHOT tea, caffeinated or

decaffeinated, did you drink?


O Less than 1 cup per O 5-6 cups per weekmonth O 1 cup per day

O 1-3 cups per month O 2-3 cups per dayO 1 cup per week O 4-5 cups per dayO 2-4 cups per week O 6 or more cups per day

118a. How often was the hot tea you drank decaffeinaorherbal tea?



30


31/36


119. How often did you add sugarorhoney to your coffeeor tea?


O Less than 1 time per O 5-6 times per weekmonth O 1 time per day

O 1-3 times per month O 2-3 times per day

O 1 time per week O 4-5 times per dayO 2-4 times per week O 6 or more times per day

119a. Each time sugarorhoney was added to yourcoffee or tea, how much was usually added?


120. How often did you add artificial sweetenerto yourcoffee or tea?



O 1-3 times per month O 2-3 times per dayO 1 time per week O 4-5 times per dayO 2-4 times per week O 6 or more times per day

120a. What kind ofartificial sweetenerdo you usuallyuse?

O Equal or aspartameO Sweet N Low or saccharin

121. How often was non-dairy creameradded to yourcoffee or tea?




121a. Each time non-dairy creamerwas added to yourcoffee or tea, how much was usually used?



121b. What kind ofnon-dairy creamerdid you usuallyuse?

O Regular powderedO Low-fat or fat-free powderedO Regular liquidO Low-fat or fat-free liquid

122. How often was cream orhalf and halfadded to yo

coffee or tea?O NEVER (GO TO QUESTION 123)



122a. Each time cream orhalf and halfwas added toyour coffee or tea, how much was usually added

O Less than 1 tablespoonO 1 to 2 tablespoons

O More than 2 tablespoons

123. How often was milk added to your coffee or tea?




123a. Each time milk was added to your coffee or tea,how much was usually added?

O Less than 1 tablespoonO 1 to

Diet History

Documents

Transcript of Diet History