Start
hcs_2_clinic_1
HERTFORDSHIRE DIETARY QUESTIONNAIRE

Name:

Generic text

Address:

Long text

Telephone:

Generic text

Transport:

Generic text

Clinic Appointment:

Generic text

Interviewer

Generic text

Date of Interview:

Generic date
Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).
AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Beef: eg. roast, steak, mince or casserole
Beefburgers
Pork: eg. roast, chops or stew
Lamb: eg. roast, chops or stew
Chicken and Turkey
Bacon and Gammon
Ham
Corned beef, Spam and luncheon meat
Sausages
Meat pies, eg. pork pie, pasties, steak and kidney pie or sausage rolls
Liver
Liver paté and liver sausage
White fish in batter or crumbs
Fish fingers and fish cakes
Other white fish, eg. cod, haddock, plaice, sole, halibut
Smoked white fish, eg. cod, haddock,
Oily fish, eg. mackerel, tuna or salmon
Smoked oily fish, eg. kippers .
Shellfish, eg. scampi or prawns
Fish roe and taramasalata
Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).
AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

White bread (one slice)
Brown and wholemeal bread (one slice)
Crackers and cheese biscuits (one cracker)
Crispbread, eg. Ryvita (one crispbread)
Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).
AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Porridge, (one bowl)
Breakfast cereals (one bowl)
Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).
AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Boiled, mashed and jacket potatoes (one egg size potato)
Chips
Roast potatoes (one egg size potato)
Potato salad
White rice
Brown rice
White or green pasta, eg. spaghetti, macaroni, noodles
Wholemeal pasta
Pizza
Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).
FOOD AND AMOUNTS: DAIRY PRODUCTS AND FATS Other salad dressing (tablespoon) cs_AUIP3M cs_N_ltom_13pm_Oaw_24pw_56pw_Oad_23pd_45pd_6pd

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Single cream (tablespoon) 1 AVERAGE USE IN PAST 3 MONTHS
Single cream (tablespoon) 2 AVERAGE USE IN PAST 3 MONTHS
Double cream (tablespoon) 1 AVERAGE USE IN PAST 3 MONTHS
Double cream (tablespoon) 2 AVERAGE USE IN PAST 3 MONTHS
Low fat yoghurt and fromage frais (125g pot) 1 AVERAGE USE IN PAST 3 MONTHS
Low fat yoghurt and fromage frais (125g pot) 2 AVERAGE USE IN PAST 3 MONTHS
Full fat or Greek yoghurt (125g pot) 1 AVERAGE USE IN PAST 3 MONTHS
Full fat or Greek yoghurt (125g pot) 2 AVERAGE USE IN PAST 3 MONTHS
Other ready made desserts (125g pot) 1 AVERAGE USE IN PAST 3 MONTHS
Other ready made desserts (125g pot) 2 AVERAGE USE IN PAST 3 MONTHS
Cheese, eg. Cheddar, Brie, Edam (medium serving) 1 AVERAGE USE IN PAST 3 MONTHS
Cheese, eg. Cheddar, Brie, Edam (medium serving) 2 AVERAGE USE IN PAST 3 MONTHS
Cottage cheese, (medium serving) 1 AVERAGE USE IN PAST 3 MONTHS
Cottage cheese, (medium serving) 2 AVERAGE USE IN PAST 3 MONTHS
Eggs as boiled, fried, scrambled etc. (one egg)) 1 AVERAGE USE IN PAST 3 MONTHS
Eggs as boiled, fried, scrambled etc. (one egg)) 2 AVERAGE USE IN PAST 3 MONTHS
Quiche and cheese flans (medium serving) 1 AVERAGE USE IN PAST 3 MONTHS
Quiche and cheese flans (medium serving) 2 AVERAGE USE IN PAST 3 MONTHS
Low calorie salad cream and mayonnaise (tablespoon) 1 AVERAGE USE IN PAST 3 MONTHS
Low calorie salad cream and mayonnaise (tablespoon) 2 AVERAGE USE IN PAST 3 MONTHS
Salad cream and mayonnaise (tablespoon) 1 AVERAGE USE IN PAST 3 MONTHS
Salad cream and mayonnaise (tablespoon) 2 AVERAGE USE IN PAST 3 MONTHS
French dressing (tablespoon) 1 AVERAGE USE IN PAST 3 MONTHS
French dressing (tablespoon) 2 AVERAGE USE IN PAST 3 MONTHS
Which spreading fats have you used for example on bread or vegetables?
-

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).
AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Chocolate biscuits-wrapped, eg. penguin (one)
Other biscuits, eg. sandwich, digestive (one)
Sponge cakes and gateaux
Fruit cakes
Buns
Pastries
Fruit puddings eg pies, tarts, crumbles
Milk based puddings eg rice pudding
Other puddings
Sweet white sauce eg custard
Ice cream
Chocolate eg. Mars, Crunchie (one standard bar)
Other sweets
Cereal and chewy bars (one bar)
Crisps and savoury snacks (one bag)
Nuts eg peanuts
Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).
AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Soups tinned and packet (one bowl)
Soups home made (one bowl)
Savoury white sauces, eg. parsley and cheese sauce, (tablespoon)
Gravy (tablespoon)
Tomato ketchup and brown sauce (tablespoon)
Pickles, chutney (tablespoon)
Meat and yeast extract eg Marmite, Bovril (teaspoon)
Jam, marmalade, honey (teaspoon)
Peanut butter (teaspoon)
Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).
AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Tea (one cup)
Coffee (one cup)
Decaffeinated coffee (one cup)
Cocoa and hot chocolate (one cup)
Malted milk drinks (one cup)
Low calorie fizzy drinks (one glass)
Fizzy drinks, eg. coca cola, lemonade (one glass)
Pure fruit juices eg. orange, apple juice (one glass)
Low calorie or diet fruit squash or cordial (one glass)
Fruit squash or cordial (one glass)
Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).
AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Apples (one fruit)
Pears (one fruit)
Oranges, (one fruit)
Grapefruit (one half)
Bananas (one fruit)
Grapes (medium serving)
Melon, pineapple, kiwi and other tropical fruits (medium serving)
Peaches, plums, cherries and apricots (medium serving)
Strawberries and raspberries (medium serving)
Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).
AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Tinned fruit (medium serving)
Cooked fruit (medium serving)
Dried fruit, eg. raisins, prunes (medium serving)
Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).
AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Tinned vegetables eg peas, carrots, mixed veg. (medium serving)
Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).
AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Carrots
Spinach
Broccoli, spring greens and kale
Brussels sprouts
Cabbage
Peas
Green beans, broad beans, runner beans
Marrow and courgettes
Cauliflower
Parsnips, swede and turnips,
Leeks
Onions
Garlic
Mushrooms
Peppers
Beansprouts
Green salad eg lettuce, cucumber, celery
Watercress
Tomatoes
Sweetcorn
Beetroot
Coleslaw
Avocados
Baked beans and other tinned beans
Dried beans and pulses eg lentils, red kidney beans
Vegetarian foods
Other vegetable dishes
ADDITIONAL DIETARY QUESTIONS
Now I would like to ask in detail about some other foods

Which types of milk have you used regularly in drinks and added to breakfast cereals over the past three months? Milk A Other (specify)

1
Whole pasteurised
2
Semi-skimmed pasteurised
3
Skimmed pasteurised
4
Whole UHT
5
Semi-skimmed UHT
6
Skimmed UHT
7
Other
9
None
Other

Which types of milk have you used regularly in drinks and added to breakfast cereals over the past three months? Milk B Other (specify)

1
Whole pasteurised
2
Semi-skimmed pasteurised
3
Skimmed pasteurised
4
Whole UHT
5
Semi-skimmed UHT
6
Skimmed UHT
7
Other
9
None
Other

Which types of milk have you used regularly in drinks and added to breakfast cereals over the past three months? Milk C Other (specify)

1
Whole pasteurised
2
Semi-skimmed pasteurised
3
Skimmed pasteurised
4
Whole UHT
5
Semi-skimmed UHT
6
Skimmed UHT
7
Other
9
None
Other
If None to question 1.1 (go to Q2.1)
(qc_1_1_a == NULL || qc_1_1_a == 9) && (qc_1_1_b == NULL || qc_1_1_b == 9) && (qc_1_1_c == NULL || qc_1_1_c == 9)
Else
On average over the past 3 months how much of each milk have you consumed per day?
pints
pints
Milk A
Milk B
Milk C

Were there any OTHER foods or drinks which you ate or drank once a week or more over the past 3 months?

0
No
1
Yes
If No to question 2.1 (go to Q3.1)
qc_2_1 == 0
Else
Please describe these
Number of times eaten each week

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Did you eat breakfast cereal in the past 3 months?

0
No
1
Yes
If No to question 3.1 (go to Q4.1)
qc_3_1 == 0
Else
_cereal < 5

BRAND eg. Kellogg's

Generic text

TYPE eg. Frosties

Generic text

Have you added sugar to tea and coffee or breakfast cereals in the past 3 months?

0
No
1
Yes
If No to question 4.1 (go to Q5)
qc_4_1 == 0
Else

Approximately how many teaspoons of sugar have you added each day?

How many
In the past 3 months what kind of fat or oil did you most often use for frying or roasting?
-

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

What did you do with the visible fat on your meat including chicken skin?

1
Ate most of the fat
2
Ate some of the fat
3
Ate as little as possible
4
Did not eat meat

How often was salt or a salt substitute added to your food during cooking?

1
Always
2
Usually
3
Sometimes
4
Rarely
5
Never
If Never to question 7.1 (go to Q7.3)
qc_7_1 == 5
Else

Was this salt or a salt substitute?

1
Salt
2
Lo Salt
3
Sainsbury's salt substitute
4
Other
Other

How often did you add salt or a salt substitute to your food at the table?

1
Always
2
Usually
3
Sometimes
4
Rarely
5
Never
If Never to question 7.3 (go to Q8)
qc_7_3 == 5
Else

Was this salt or a salt substitute?

1
Salt
2
Lo Salt
3
Sainsbury's salt substitute
4
Other
Other
During the past 3 months, on average, how many times a week did you eat the following foods?
Times/week
How many
Vegetables (not including potatoes) Portion size: Medium serving
Fruit and fruit products (not including fruit juice) Portion size: Medium serving or 1 fruit
Fish and fish products Portion size: Medium serving
Meat, meat products and meat dishes (including bacon, ham and chicken) Portion size: Medium serving

Are the past 3 months typical of the way you generally eat?

0
No
1
Yes
2
Reasonably

Have you taken any vitamins, minerals, fish oils, fibre or other food supplements during the past 3 months?

0
No
1
Yes
_supplements < 6

NAME AND BRAND Please list full name, brand and strength

Generic text

DOSE Please state number of pills capsules or teaspoons consumed per day

How many

NUMBER of days in the past 90

Days out of last 90

Did you start taking this

1
less than 1 month
2
1-3 months ago,
3
More than 3 months ago?

Are you still taking this now?

0
No
1
Yes

Comments

Generic text
End

hcs_2_clinic_1

HERTFORDSHIRE DIETARY QUESTIONNAIRE
Name:
Generic text
Address:
Long text
Telephone:
Generic text
Transport:
Generic text
Clinic Appointment:
Generic text
Interviewer
Generic text
Date of Interview:
Generic date

Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).

AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Beef: eg. roast, steak, mince or casserole
Beefburgers
Pork: eg. roast, chops or stew
Lamb: eg. roast, chops or stew
Chicken and Turkey
Bacon and Gammon
Ham
Corned beef, Spam and luncheon meat
Sausages
Meat pies, eg. pork pie, pasties, steak and kidney pie or sausage rolls
Liver
Liver paté and liver sausage
White fish in batter or crumbs
Fish fingers and fish cakes
Other white fish, eg. cod, haddock, plaice, sole, halibut
Smoked white fish, eg. cod, haddock,
Oily fish, eg. mackerel, tuna or salmon
Smoked oily fish, eg. kippers .
Shellfish, eg. scampi or prawns
Fish roe and taramasalata

Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).

AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

White bread (one slice)
Brown and wholemeal bread (one slice)
Crackers and cheese biscuits (one cracker)
Crispbread, eg. Ryvita (one crispbread)

Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).

AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Porridge, (one bowl)
Breakfast cereals (one bowl)

Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).

AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Boiled, mashed and jacket potatoes (one egg size potato)
Chips
Roast potatoes (one egg size potato)
Potato salad
White rice
Brown rice
White or green pasta, eg. spaghetti, macaroni, noodles
Wholemeal pasta
Pizza

Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).

FOOD AND AMOUNTS: DAIRY PRODUCTS AND FATS Other salad dressing (tablespoon) cs_AUIP3M cs_N_ltom_13pm_Oaw_24pw_56pw_Oad_23pd_45pd_6pd

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Single cream (tablespoon) 1 AVERAGE USE IN PAST 3 MONTHS
Single cream (tablespoon) 2 AVERAGE USE IN PAST 3 MONTHS
Double cream (tablespoon) 1 AVERAGE USE IN PAST 3 MONTHS
Double cream (tablespoon) 2 AVERAGE USE IN PAST 3 MONTHS
Low fat yoghurt and fromage frais (125g pot) 1 AVERAGE USE IN PAST 3 MONTHS
Low fat yoghurt and fromage frais (125g pot) 2 AVERAGE USE IN PAST 3 MONTHS
Full fat or Greek yoghurt (125g pot) 1 AVERAGE USE IN PAST 3 MONTHS
Full fat or Greek yoghurt (125g pot) 2 AVERAGE USE IN PAST 3 MONTHS
Other ready made desserts (125g pot) 1 AVERAGE USE IN PAST 3 MONTHS
Other ready made desserts (125g pot) 2 AVERAGE USE IN PAST 3 MONTHS
Cheese, eg. Cheddar, Brie, Edam (medium serving) 1 AVERAGE USE IN PAST 3 MONTHS
Cheese, eg. Cheddar, Brie, Edam (medium serving) 2 AVERAGE USE IN PAST 3 MONTHS
Cottage cheese, (medium serving) 1 AVERAGE USE IN PAST 3 MONTHS
Cottage cheese, (medium serving) 2 AVERAGE USE IN PAST 3 MONTHS
Eggs as boiled, fried, scrambled etc. (one egg)) 1 AVERAGE USE IN PAST 3 MONTHS
Eggs as boiled, fried, scrambled etc. (one egg)) 2 AVERAGE USE IN PAST 3 MONTHS
Quiche and cheese flans (medium serving) 1 AVERAGE USE IN PAST 3 MONTHS
Quiche and cheese flans (medium serving) 2 AVERAGE USE IN PAST 3 MONTHS
Low calorie salad cream and mayonnaise (tablespoon) 1 AVERAGE USE IN PAST 3 MONTHS
Low calorie salad cream and mayonnaise (tablespoon) 2 AVERAGE USE IN PAST 3 MONTHS
Salad cream and mayonnaise (tablespoon) 1 AVERAGE USE IN PAST 3 MONTHS
Salad cream and mayonnaise (tablespoon) 2 AVERAGE USE IN PAST 3 MONTHS
French dressing (tablespoon) 1 AVERAGE USE IN PAST 3 MONTHS
French dressing (tablespoon) 2 AVERAGE USE IN PAST 3 MONTHS

Which spreading fats have you used for example on bread or vegetables?

-

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).

AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Chocolate biscuits-wrapped, eg. penguin (one)
Other biscuits, eg. sandwich, digestive (one)
Sponge cakes and gateaux
Fruit cakes
Buns
Pastries
Fruit puddings eg pies, tarts, crumbles
Milk based puddings eg rice pudding
Other puddings
Sweet white sauce eg custard
Ice cream
Chocolate eg. Mars, Crunchie (one standard bar)
Other sweets
Cereal and chewy bars (one bar)
Crisps and savoury snacks (one bag)
Nuts eg peanuts

Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).

AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Soups tinned and packet (one bowl)
Soups home made (one bowl)
Savoury white sauces, eg. parsley and cheese sauce, (tablespoon)
Gravy (tablespoon)
Tomato ketchup and brown sauce (tablespoon)
Pickles, chutney (tablespoon)
Meat and yeast extract eg Marmite, Bovril (teaspoon)
Jam, marmalade, honey (teaspoon)
Peanut butter (teaspoon)

Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).

AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Tea (one cup)
Coffee (one cup)
Decaffeinated coffee (one cup)
Cocoa and hot chocolate (one cup)
Malted milk drinks (one cup)
Low calorie fizzy drinks (one glass)
Fizzy drinks, eg. coca cola, lemonade (one glass)
Pure fruit juices eg. orange, apple juice (one glass)
Low calorie or diet fruit squash or cordial (one glass)
Fruit squash or cordial (one glass)

Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).

AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Apples (one fruit)
Pears (one fruit)
Oranges, (one fruit)
Grapefruit (one half)
Bananas (one fruit)
Grapes (medium serving)
Melon, pineapple, kiwi and other tropical fruits (medium serving)
Peaches, plums, cherries and apricots (medium serving)
Strawberries and raspberries (medium serving)

Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).

AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Tinned fruit (medium serving)
Cooked fruit (medium serving)
Dried fruit, eg. raisins, prunes (medium serving)

Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).

AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Tinned vegetables eg peas, carrots, mixed veg. (medium serving)

Now I am going to ask you about the foods you have eaten over the past 3 months. The list may include foods you never ate or you may find that foods which you ate a lot are missing. These can be added on at the end (define the 3-month period).

AVERAGE USE IN PAST 3 MONTHS

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Carrots
Spinach
Broccoli, spring greens and kale
Brussels sprouts
Cabbage
Peas
Green beans, broad beans, runner beans
Marrow and courgettes
Cauliflower
Parsnips, swede and turnips,
Leeks
Onions
Garlic
Mushrooms
Peppers
Beansprouts
Green salad eg lettuce, cucumber, celery
Watercress
Tomatoes
Sweetcorn
Beetroot
Coleslaw
Avocados
Baked beans and other tinned beans
Dried beans and pulses eg lentils, red kidney beans
Vegetarian foods
Other vegetable dishes

ADDITIONAL DIETARY QUESTIONS

Now I would like to ask in detail about some other foods
Which types of milk have you used regularly in drinks and added to breakfast cereals over the past three months? Milk A Other (specify)
1
Whole pasteurised
2
Semi-skimmed pasteurised
3
Skimmed pasteurised
4
Whole UHT
5
Semi-skimmed UHT
6
Skimmed UHT
7
Other
9
None
Other
Which types of milk have you used regularly in drinks and added to breakfast cereals over the past three months? Milk B Other (specify)
1
Whole pasteurised
2
Semi-skimmed pasteurised
3
Skimmed pasteurised
4
Whole UHT
5
Semi-skimmed UHT
6
Skimmed UHT
7
Other
9
None
Other
Which types of milk have you used regularly in drinks and added to breakfast cereals over the past three months? Milk C Other (specify)
1
Whole pasteurised
2
Semi-skimmed pasteurised
3
Skimmed pasteurised
4
Whole UHT
5
Semi-skimmed UHT
6
Skimmed UHT
7
Other
9
None
Other

On average over the past 3 months how much of each milk have you consumed per day?

pints
pints
Milk A
Milk B
Milk C
Were there any OTHER foods or drinks which you ate or drank once a week or more over the past 3 months?
0
No
1
Yes

Please describe these

Number of times eaten each week

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

Did you eat breakfast cereal in the past 3 months?
0
No
1
Yes

_cereal < 5

BRAND eg. Kellogg's
Generic text
TYPE eg. Frosties
Generic text
Have you added sugar to tea and coffee or breakfast cereals in the past 3 months?
0
No
1
Yes
Approximately how many teaspoons of sugar have you added each day?
How many

In the past 3 months what kind of fat or oil did you most often use for frying or roasting?

-

0 - Never

1 - less than once/month

2 - 1-3 per month

3 - Once a week

4 - 2-4 per week

5 - 5-6 per week

6 - Once a day

7 - 2-3 per day

8 - 4-5 per day

9 - 6+ per day

What did you do with the visible fat on your meat including chicken skin?
1
Ate most of the fat
2
Ate some of the fat
3
Ate as little as possible
4
Did not eat meat
How often was salt or a salt substitute added to your food during cooking?
1
Always
2
Usually
3
Sometimes
4
Rarely
5
Never
Was this salt or a salt substitute?
1
Salt
2
Lo Salt
3
Sainsbury's salt substitute
4
Other
Other
How often did you add salt or a salt substitute to your food at the table?
1
Always
2
Usually
3
Sometimes
4
Rarely
5
Never
Was this salt or a salt substitute?
1
Salt
2
Lo Salt
3
Sainsbury's salt substitute
4
Other
Other

During the past 3 months, on average, how many times a week did you eat the following foods?

Times/week
How many
Vegetables (not including potatoes) Portion size: Medium serving
Fruit and fruit products (not including fruit juice) Portion size: Medium serving or 1 fruit
Fish and fish products Portion size: Medium serving
Meat, meat products and meat dishes (including bacon, ham and chicken) Portion size: Medium serving
Are the past 3 months typical of the way you generally eat?
0
No
1
Yes
2
Reasonably
Have you taken any vitamins, minerals, fish oils, fibre or other food supplements during the past 3 months?
0
No
1
Yes

_supplements < 6

NAME AND BRAND Please list full name, brand and strength
Generic text
DOSE Please state number of pills capsules or teaspoons consumed per day
How many
NUMBER of days in the past 90
Days out of last 90
Did you start taking this
1
less than 1 month
2
1-3 months ago,
3
More than 3 months ago?
Are you still taking this now?
0
No
1
Yes
Comments
Generic text