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Diet History Questionnaire III
Questionnaire
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Welcome
Instructions
About you
Beverages
What
beverages
did you drink?
Tomato or vegetable juice
Orange or grapefruit juice
Grape juice
Other 100% fruit juice
Fruit or vegetable smoothies
Other fruit drinks
Milk as a beverage
Chocolate milk as a beverage
Milkshakes
Meal replacement or high-protein beverages
Soda or pop
Sports drinks
Energy drinks
Water
Vitamin water
Beer
Wine or wine cooler
Liquor or mixed drinks
Coffee, plain
Espresso drink mixtures
ICED tea
HOT tea
Green tea
Herbal or fruit tea
Additions to coffee and tea
What did you add to your coffee and tea?
Sugar, honey, or other sweeteners
Cream, milk, or non-dairy creamer
Fruits
What
fruits
have you eaten?
Applesauce
Apples
Bananas
Pineapple
Pears
Peaches, nectarines, or plums
Dried fruit
Grapes
Cantaloupe
Other melons
Strawberries
Blueberries
Oranges, tangerines, or clementines
Grapefruit
Avocado or guacamole
Other fruits
Vegetables, potatoes, beans
What
vegetables, potatoes,
and
beans
did you eat?
COOKED greens
RAW greens
Coleslaw
Sauerkraut or cabbage
COOKED carrots
RAW carrots
String beans or green beans
Peas
Corn
Broccoli
Cauliflower or Brussels sprouts
Sweet peppers
Onions
Garlic
Mixed vegetables
Additions to cooked vegetables
Fat during cooking
Fat after cooking
Lettuce salads
Salad dressing on salads
Mayonnaise on salads
Fresh tomatoes
Salsa
Catsup or ketchup
Sweet potatoes or yams
French fries, home fries, hash browned potatoes, or Tater Tots
Potato salad
Baked, boiled, or mashed potatoes
Cooked dried or canned beans
Other kinds of vegetables
Soups, chili, tacos, burritos, tortillas, etc.
What
soups, chili, tacos, burritos, tortillas, etc.
have you eaten?
Soups
Chili
Tacos, tostados, burritos, tamales, fajitas, enchiladas, quesadillas, or chimichangas
Corn or wheat tortillas
Rice, pasta, pizza
What
rice, pasta,
and
pizza
have you eaten?
Rice or other cooked grains
Sushi
Lasagna, stuffed shells, stuffed manicotti, ravioli, or tortellini
Macaroni and cheese
Pasta salad or macaroni salad
Pasta, spaghetti, or other noodles
Pizza
Cereal, pancakes, breads
What
cereal, pancakes,
and
breads
have you eaten?
Oatmeal, grits, or other cooked cereals
Cold cereal
Pancakes, waffles, or French toast
Bagels or English muffins
Breads or rolls AS PART OF SANDWICHES
Breads or rolls NOT AS PART OF SANDWICHES
Cornbread or corn muffins
Biscuits
Jam, jelly, or honey
Peanut butter or other nut butter
Hummus
Cold cuts, luncheon meats, hot dogs
What
cold cuts, luncheon meats,
and
hot dogs
have you eaten?
Roast beef or steak IN SANDWICHES
Luncheon or deli-style ham
Turkey or chicken COLD CUTS
Bologna
Other cold cuts or luncheon meat
Hot dogs or frankfurters
Meat, poultry, fish
What
meat, poultry,
and
fish
have you eaten?
Ground chicken or turkey
Baked, broiled, roasted, stewed, grilled, pan-fried, or fried chicken
Chicken in mixed dishes
Turkey
Beef hamburgers or cheeseburgers from a FAST FOOD RESTAURANT
Beef hamburgers or cheeseburgers NOT from a FAST FOOD RESTAURANT
Ground beef in mixtures
Beef mixtures
Roast beef or pot roast
Steak
Pork or beef spareribs
Baked ham or ham steak
Pork
Gravy
Liver or liverwurst
Bacon
Sausage
Canned tuna or tuna salad
Fresh tuna, trout, anchovy, mackerel, herring, sardine
Salmon
Fried shellfish
Shellfish that was NOT FRIED
Fish sticks or other fried fish
Other fish that was NOT FRIED
Eggs, meat alternatives
What
eggs
and
meat alternatives
have you eaten?
Tofu, soy burgers, or soy meat-substitutes
Eggs, egg whites, or egg substitutes
Chips, pretzels, other snacks
What
chips, pretzels,
and
other snacks
have you eaten?
Crackers
Potato chips
Corn chips or tortilla chips
Popcorn
Pretzels
Whole nuts
High-protein or breakfast bars
Protein powder
Granola bars
Yogurt and cheese
What
yogurt
and
cheese
have you eaten?
Yogurt
Cottage cheese or ricotta cheese
Cheese
Whipped cream
Sweets, baked goods, desserts
What
sweets, baked goods,
or
desserts
have you eaten?
Frozen yogurt, sorbet, or ices
Ice cream, ice cream bars, or sherbet
Cake
Pie
Cookies
Brownies
Doughnuts, sweet rolls, Danish, or Pop-Tarts
Sweet muffins or dessert breads
Pudding or custard
Chocolate
Other candy
Spreads and dressings
What
spreads
and
dressings
have you eaten?
Margarine
Mayonnaise or mayonnaise-type dressing
Salad dressing
Summary questions
Vitamins and supplements
What
vitamins
and
dietary supplements
did you take?
Multivitamin/minerals
Eye health supplement
B-complex
Antacid
B-12
B-6
Biotin
Calcium
Coenzyme Q
Fiber supplement
Folate or folic acid
Garlic supplement
Joint supplement
Iron
Magnesium
Melatonin
Niacin
Omega-3 or fish oil
Potassium
Probiotics
Saw palmetto
Vitamin C
Vitamin D
Vitamin E
Zinc
Other supplements
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