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Are you a vegetarian? |
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Yes
No
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How many times per day do you eat lean sources of protein such as fish, grains and legumes, low-fat dairy products or eggs? |
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Rarely or never
Less than once per day
1 to 2 times per day
3 or more times per day
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How many times per week do you eat red meat, such as hamburgers, steak and other beef products? |
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Rarely or never
1 to 2 times per week
3 to 5 times per week
6 or more times per week
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How many times per week do you eat lean meats such as turkey, chicken or fish? |
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Rarely or never
1 to 2 times per week
3 to 5 times per week
6 or more times per week
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How many times per day do you usually eat fried foods or foods containing a lot of fat or cholesterol, such as fatty meats, eggs, organ meats or cheese? |
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Rarely or never
Less than once per day
1 to 2 times per day
3 or more times per day
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How many servings of butter or cream do you usually eat each day?(serving size: one pat of butter or one tablespoon of cream) |
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None
Less than one per day
1 to 2 times per day
3 or more times per day
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How many times per day do you eat high fiber foods, such as fresh fruits and vegetables or whole grains? |
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3 or more times per day
Once or twice per day
A few times per week
One or less times per week
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How often do you eat salty foods, cook with salt or add salt to food at the table? |
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3 or more times per day
Once or twice per day
A few times per week
One or less times per week
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How often do you eat sweets, foods containing a lot of sugar, or soft drinks with sugar? |
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3 or more times per day
Once or twice per day
A few times per week
One or less times per week
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How many caffeine drinks (such as coffee, tea, or soft drinks) do you drink per day? |
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None
1 to 2 drinks
3 to 6 drinks
More than 6 drinks
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How often do you eat breakfast? |
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Almost always
Sometimes
Never
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How often do you skip meals? (breakfast, lunch or dinner) |
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Almost always
Sometimes
Never
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