FORM FFQs

Food Questionnaire

PLEASE DO NOT WRITE IN THIS AREA

This form asks about your usual food intake during ________________________________ .

Please use pencil.

Do not make any othermarks on the form. Pleaseuse a separate piece ofpaper to make comments.

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MO DAY YEARTODAY'S DATE IDENTIFICATION

NUMBER

Answer by filling in the correct oval.Yes No

1

1 1

MSEL

SERIAL #

2YesNo

When you ate chicken orturkey, how often did you eatthe skin?

1. Did you eat chicken or turkey?

Almost alwaysOftenSometimesRarelyNever

Part I: Usual Food Choices

These questions are about the types of foods you ate during ____________________________________.

YesNo

2. Did you eat beef, pork, ham or lamb?

When you ate beef, pork, hamor lamb, how often did you eatthe fat?

Almost alwaysOftenSometimesRarelyNever

YesNo

When you ate hamburger orother ground meat, was itusually... Mark one or two.

3. Did you eat hamburger or otherground meat?

RegularLeanExtra leanGround chicken or turkeyDont know

YesNo

Were any of these vitamins orminerals added (speciallyfortified) to the juices youdrank? Mark all that apply.

4. Did you drink orange, grapefruit orother fruit juices?

Extra Vitamin CVitamin ECalciumNoneDont know

YesNo

6. Did you put milk (all types), cream orcreamer on cereal?

When you put milk, cream orcreamer on cereal, what typedid you usually use? Mark one or two.

Cream or half and halfWhole milk2% milk1% milk or buttermilkNonfat or skim milkSoy milkNon-dairy creamerDont know

YesNo

When you ate cold cereal,what type did you usually eat?Mark one or two.

5. Did you eat cold cereals?

Highly fortified cereals (100% ofDaily Values) such as Total,Smart Start and Product 19High fiber or bran cereals suchas Raisin Branand All BranRegular granola (not lowfat)All other cereals such as lowfatgranola, Cheerios, CornFlakes and Frosted Flakes

YesNo

When you drank milk orbeverages made with milk,was it usually Mark one or two.

8. Did you drink milk (all types)? Also includebeverages made with milk, such as lattes,cappuccinos, mochas or hot chocolate.

Whole milk2% milk1% milk or buttermilkNonfat or skim milkSoy milkDont know

YesNo

When you used mayonnaise,what type did you usuallyuse? Mark one or two.

10. Did you use mayonnaise?

RegularLow or reduced fatFat free or nonfat

YesNo

When you ate cookies orcakes, how often were theyfig bars, SnackWells, angelfood cakes, or other types oflow or nonfat cookiesor cakes?

11. Did you eat cookies or cakes?

Almost alwaysOftenSometimesRarelyNever

YesNo

When you used saladdressing, what type did youusually use? Mark one or two.

9. Did you use salad dressing?

Regular, including oiland vinegarLow or reduced fatFat free or nonfat

ButterStick margarineTub or liquid margarineLowfat margarineOlive oilSour creamDidnt use fat

13. What kinds of fat did you use at the table,for example on breads, vegetables or potatoes? Mark up to four.

ButterStick margarineTub or liquid margarineLowfat margarineOlive oilCanola oilOther oils such as corn, soybean, peanutand safflowerLard, bacon fat or meat drippingsDidnt use fat or used non-stick spray(such as Pam)

12. In your household, what kinds of fat wereusually used when cooking, for example toflavor vegetables or fry meat? Mark up to four.

YesNo

7. Did you put milk (all types), cream orcreamer in coffee or tea?

When you put milk, cream or creamer in coffee or tea,what type did you usuallyuse? Mark one or two.

Cream or half and halfWhole milk2% milk1% milk or buttermilkNonfat or skim milkSoy milkNon-dairy creamerDont know

SERIAL #PLEASE DO NOT WRITE IN THIS AREA

3

4Part II: Usual Food UseThese questions are about foods you ate during ______________________________________________.

Mediumserving

size M LS

HOW OFTEN DID YOU EAT THESE FOODS? AMOUNT?

14. Mark the column to show how often, on average, you ate the following foods.Mark your usual serving size as small, medium or large.

Cold cereals

CEREALS, BREADS, SNACKS

A small serving is about one-half (1/2 ) the medium serving size or less. A large serving is about one-and-a-half (11/2 ) times the medium serving size or more.

11/2 cups

2 piecesPancakes, French toast and waffles

EXAMPLE: This man ate spaghetti with meat sauce every Saturday. He usually ate about 21/2 cups.

Spaghetti, lasagna, and otherpasta with tomato with meat sauce 1

1/2 cups

Mediumserving

size M LS

AMOUNT?

2-3per

month

1per

week

2per

week

3-4per

week

5-6per

week

1perday

2+perday

NEVER orless thanonce per

month

1per

month

HOW OFTEN DID YOU EAT THESE FOODS?

2-3per

month

1per

week

2per

week

3-4per

week

5-6per

week

1perday

2+perday

NEVER orless thanonce per

month

1per

month

2 pats or 2teaspoons

Butter or margarine on breads, cereals, pancakes, etc.

2 slices or1 mediumCornbread and corn muffins

2 slices or1 medium

White breads, including bagels,rolls and English muffins

2 slices or1 medium

Dark breads, including darkbagels and rolls

1 mediumMuffins, scones, croissantsand biscuits

2 Tbsp.

1 bar

1 bar

Jam, jelly, honey, syrup and sugar(including in coffee, tea and cereal)Granola bars and cereal barssuch as Nutri-Grain BarsSports or meal replacementbars such as Power Bars andClif Bars

Cooked cereals and grits

Milk on cereals

11/2 cups

3/4 cup

MEAT, FISH, EGGS

4 handfuls or 1 med.bag

12medium

2 Tbsp.(spreads) or1/2 cup (nuts)

12medium

Peanut butter, peanuts andother nuts and seeds

Low or nonfat potato chips, tortillachips, corn chips and pretzelsRegular potato chips, tortillachips, corn chips and puffs

Low or nonfat crackers, such assaltines and SnackWellsRegular crackers such as Ritzand Wheat Thins

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5

2-3per

month

1per

week

2per

week

3-4per

week

5-6per

week

1perday

2+perday

Mediumserving

size M LS

HOW OFTEN DID YOU EAT THESE FOODS? AMOUNT?NEVER orless thanonce per

month

4 handfuls or 1 med.bag

Plain popcorn (no butter) or lowfatmicrowave popcorn 8 handfuls

Buttered or regular microwavepopcorn 8 handfuls

Mediumserving

size M LS

AMOUNT?

2 eggs

3 strips or2 links

2 hot dogsor 4 ounces

Low or reduced fat hot dogsand sausage

Eggs (egg substitute,mark NEVER)Bacon and breakfast sausage

1per

month

2-3per

month

1per

week

2per

week

3-4per

week

5-6per

week

1perday

2+perday

HOW OFTEN DID YOU EAT THESE FOODS?NEVER orless thanonce per

month

1per

month

CEREALS, BREADS, SNACKS (continued)

1 medium pattyor 4 ounces

Ground meat, includinghamburgers and meatloaf

6 ouncesBeef, pork, ham and lamb

1 can tunaor 2 cupscasserole

Canned tuna, tuna salad andtuna casserole

2 hot dogsor 4 ounces

Regular hot dogs and sausagesuch as bratwurst and chorizo

2 slices

2 slicesAll other lunch meat such asbologna, salami and Spam

Lunch meats such as ham, turkeyand lowfat bologna

6 ounces

Fried chicken, includingnuggets and tenders

Liver, chicken liver andorgan meats

2 large piecesor 9 nuggets

62 large or4 smallpieces

4 ounces or 1 sandwich4 ouncesor 1 cup

6 ounces

6 ounces

Chicken and turkey (roasted,stewed, grilled or broiled)

Shellfish, not fried (shrimp,lobster, crab and oysters)

Dark fish (broiled or baked)such as salmon, mackereland bluefish

Mediumserving

size M LS

AMOUNT?

White fish (broiled or baked) suchas sole, halibut, snapper and cod

Fried fish, fish sandwich and friedshellfish (shrimp and oysters)

2-3per

month

1per

week

2per

week

3-4per

week

5-6per

week

1perday

2+perday

NEVER orless thanonce per

month

1per

month

HOW OFTEN DID YOU EAT THESE FOODS?MEAT, FISH, EGGS (continued)

Mediumserving

size M LS

AMOUNT?

2-3per

month

1per

week

2per

week

3-4per

week

5-6per

week

1perday

2+perday

NEVER orless thanonce per

month

1per

month

HOW OFTEN DID YOU EAT THESE FOODS?SPAGHETTI, MIXED DISHES, SOUPS

11/2 cupsStew, pot pie, curries andcasseroles with meat or chicken

Chili with meat and beans

Spaghetti, lasagna and other pasta with tomato and meat sauceSpaghetti and other pasta withtomato sauce (no meat)

3 slicesPizza

Tofu, tempeh and productssuch as tofu hot dogs, soyburgers and tofu cheese

Spaghetti and other pasta withoil, cheese or cream sauce,including macaroni and cheeseAsian-style (stir-fried) noodlesand rice such as chow mein,fried rice and Pad Thai

4 ounces,2 hot dogsor 1 burger

2 mediumBurritos, tacos, tostadasand quesadillas

Enchiladas and tamales 2 medium

Vegetable, minestrone andtomato soup

11/2 cups

11/2 cups

11/2 cups

11/2 cups

11/2 cups

11/2 cups

Cream soups such as chowders,potato and cheese 1

1/2 cups

Mediumserving

size M LS

AMOUNT?

Miso soup

Bean soups such as pea,lentil and black bean

2-3per

month

1per

week

2per

week

3-4per

week

5-6per

week

1perday

2+perday

NEVER orless thanonce per

month

1per

month

HOW OFTEN DID YOU EAT THESE FOODS?SPAGHETTI, MIXED DISHES, SOUPS (continued)

Other soups such aschicken noodle

DAIRY PRODUCTS

Cottage cheese andricotta cheese

2 slices or1/2 cup

shredded

1 cup

2 slices, 1/2cup shredded

or 2 Tbsp.cream

All other cheese (American,cheddar or cream), includingcheese used in cooking

Low or reduced fat cheese,including cheese used in cooking

Yogurt, all types except frozen

Mediumserving

size M LS

AMOUNT?

2-3per

month

1per

week

2per

week

3-4per

week

5-6per

week

1perday

2+perday

NEVER orless thanonce per

month

1per

month

HOW OFTEN DID YOU EAT THESE FOODS?

Mediumserving

size M LS

AMOUNT?VEGETABLES and GRAINS

Mark all vegetables you ate, including in salads, mixed dishes, sandwiches and stir-fries.

2-3per

month

1per

week

2per

week

3-4per

week

5-6per

week

1perday

2+perday

NEVER orless thanonce per

month

1per

month

HOW OFTEN DID YOU EAT THESE FOODS?

Green salad (lettuce or spinach) 2 cups

1/4 cup

1 mediumor 4 slicesFresh tomatoes

Carrots

1/2 cupGreen peppers and green chilies

11/2 cups

11/2 cups

11/2 cups

11/2 cups

3/4 cup

3/4 cup

Ramen noodle soup

Salad dressing (all types)

1/2 cupRed peppers and red chilies

7

Mediumserving

size M LS

AMOUNT?

Cauliflower, cabbage andBrussels sprouts

Green or string beans

Broccoli

VEGETABLES and GRAINS (continued)

Mark all vegetables you ate, including in salads, mixed dishes, sandwiches and stir-fries.

2-3per

month

1per

week

2per

week

3-4per

week

5-6per

week

1perday

2+perday

NEVER orless thanonce per

month

1per

month

HOW OFTEN DID YOU EAT THESE FOODS?

Corn and hominy

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8

1/2 cup

Cooked greens such as spinach,mustard greens and collards

Onions and leeks

Yams and sweet potatoes 1 medium

Winter squash such as acorn, butternut and pumpkin

Summer squash and zucchini

1 cupFrench fries, fried potatoesand hash browns

1/2 mediumor 1/2 cup

1 clove

Avocado and guacamole

Fresh garlic, including in cooking

1 mediumor 1 cup

Potatoes (boiled, baked ormashed)Refried beans

Coleslaw

All other beans (baked, lima or chili without meat)

Potato, macaroni and pasta saladsmade with mayonnaise or oilRice, noodles and othergrains (as a side dish)

3/4 cup

3/4 cup

3/4 cup

3/4 cup

3/4 cup

3/4 cup

3/4 cup

3/4 cup

3/4 cup

3/4 cup

3/4 cup

3/4 cup

3/4 cup

Green peas

2 pats or 2teaspoons

Butter, margarine, sour creamand other fat added tovegetables, potatoes and rice

9

Mediumserving

size M LS

AMOUNT?

1 orange or1/2 grapefruit

Oranges, grapefruit andtangerines (not juice)Berries such as strawberriesand blueberries

1/2 cupDried fruit (other than apricots)such as raisins and prunes

2 mediumor 4 halvesApricots (fresh, canned or dried)

1 medium

1 mediumor 1/2 cup

FRUITS

1 mediumor 1/2 cup

Apples, applesauceand pears

Bananas

Peaches, nectarines and plums

2-3per

month

1per

week

2per

week

3-4per

week

5-6per

week

1perday

2+perday

NEVER orless thanonce per

month

1per

month

HOW OFTEN DID YOU EAT THESE FOODS?

Meat gravies 1/2 cup

1/2 cupSalsa (as dip or on foods)

Ketchup

Mayonnaise andmayonnaise-type spreads 2 Tbsp.

1/4 cup

SAUCES and CONDIMENTS

Mediumserving

size M LS

AMOUNT?

Cheese sauce and cream sauce 1/2 cup

2-3per

month

1per

week

2per

week

3-4per

week

5-6per

week

1perday

2+perday

NEVER orless thanonce per

month

1per

month

HOW OFTEN DID YOU EAT THESE FOODS?

1/4 melon or1/2 mango

Cantaloupe, orange melonand mango (in season)

3/4 cup

Watermelon and red melon 1 large slice

3/4 cupAny other fruit such as grapes, fruitcocktail, pineapple and cherries

2 scoops or1 shake

3 med.cookies or 1 piece of

cake

SWEETS

1 regular baror

4 pieces

2 scoops

1 mediumpiece or slice

Cookies and cakes

Chocolate, candy barsand toffee

1 cup

Ice cream and milkshakes

Low or nonfat frozen dessertssuch as lowfat ice cream, frozenyogurt and sherbet

Pudding, custard and flan

Mediumserving

size M LS

AMOUNT?

Other candy such asLifesavers, licorice andjelly beans

6 pieces or25 jelly beans

2-3per

month

1per

week

2per

week

3-4per

week

5-6per

week

1perday

2+perday

NEVER orless thanonce per

month

1per

month

HOW OFTEN DID YOU EAT THESE FOODS?

Doughnuts, pies and pastries

How often did you eat a servingof fruit? Do not count juices.

How often did you eat a servingof vegetables? Do not countpotatoes, salad or beans.

PLEASE ANSWER THESE THREE IMPORTANT QUESTIONS!

3-4per

week

5-6per

week

1perday

2perday

3perday

4perday

5+perday

NEVER orless thanonce per

week

1-2per

week

Note that the frequency headings are different.How often did you eat foods that werecooked in fat (pan-fried, sauted, ordeep-fried)? Count all fat such asmargarine, butter, oil or lard.

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11

Milk (all types) as a beverage

Coffee (not lattes or mochas)

Tea (all types)

1 cup

1 Tbsp.

BEVERAGES and ALCOHOL

1 cup

1 cup

1 cup

1 cup

1 cup

1 cup

Milk, cream or creameradded to tea and coffeeTomato juice, V-8 and othervegetable juicesOrange juice and grapefruit juiceOther 100% fruit juice such asapple, grape and cranberryFruit drinks fortified with Vitamin Csuch as Hi-C, Fruitopia andKool-Aid

Mediumserving

size M LS

AMOUNT?

Note that the frequency headings are different.

1 cup

Meal replacement drinks andshakes such as SlimFast, Ensureand Carnation Instant Breakfast

1 cup

2-4per

week

1perday

6+perday

NEVER orless thanonce per

month

1-3per

month

HOW OFTEN DID YOU DRINK THESE BEVERAGES?

Latte, cappuccino, mochaor hot chocolate

Red wine

Beer (all types)

White or ros wine

Regular soft drinks

Diet soft drinks

Water (tap, bottled or sparkling)12 ounce

can or bottle

1 mediumglass (6 oz)

1 shot(11/2 oz) or

1 mixed drink

1 mediumglass (6 oz)

12 ouncesor 1 can

12 ouncesor 1 can

1 cup

Liquor and mixed drinks

1per

week

5-6per

week

2-3perday

4-5perday

THANK YOU!Please take a moment to fill in any questions you may have skipped.

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