Date Sex M F Age Work Education level Middle school High school University degree 1. Medical history Diseases Surgery Familiarity 2. Lifestyle Smoke Drugs NO YES Cigarette n. 3. Anthropometrics Weight (kg) Height(m) Waist circumference (cm) 4. Blood pressure SBP (mm Hg) DBP (mm Hg) 5. Diaries Food Physical activity Filled Filled
A- What do you know about nutrition? 1- Breakfast is a very important meal, and often underestimated. What happens if people skips breakfast regularly? It is most likely that you gain weight You can eat more at lunch Your performance is reduced at school orat work All three answers are true 2- How much should you drink during the day? (Without considering fluids contained in foods- e.g.fruit, vegetables, soups)? About half a liter About 1 liter About 2 liters About 3 liters 3- How many meals you should eat a day? 3 meals 4 meals 5 meals It doesn't matter. It depends on the calories consumed 4- How many calories should an adult female (F) or male (M), with a rather sedentary work, consume more or less a day? 3000/4000 (F/M) 2500/3000 (F/M) 1800/2200 (F/M) 1200/1500 (F/M) 5- How many calories provides 1 gram of fat? About 1 About 4 About 7 About 9
6- Which foods are rich in fiber among the following? Fruit, vegetables and whole grains Lean meat, especially poultry Milk, full fat Olive oil How much salt you should consume in the day? Less than 1 gram (tip of a knife) No more than 2-3 grams (half a teaspoon) No more than 5-6 grams (a teaspoon) At least 10-12 grams (two teaspoons) 8- How many grams are 5 servings of fruits and vegetables you should consume in the day? At least 150 grams At least 300 grams At least 400 grams At least 800-850 grams 9-Which food among these contains calcium, helpful for bones? Milk and dairies Lean meat Leafy vegetables Fruit 10- Which of these foods is the most rich in protein? Foods made from whole grains Butter Ripe fruit Lean meat
B- What do you do in your everyday life? 1- Do you have breakfast? Seldom or never 2-3 times a week Often or nearly always, but I just have a coffee with something sweet Often or nearly always, and I try to have a plenty breakfast Other (specify): 2- How much do you drink on average during the day (at the table and between meals), including water, soft drinks, fruit juices, etc. (excluding spirits, wine and beer)? Less than half a liter (less than 2 drinking glasses) From half a liter to one liter (from two to four glasses) From a liter to a liter and a half (from four to six glasses) A liter and a half or more (six glasses or more) 3- Which meals do you have per day on a regular basis Lunch and dinner Breakfast, lunch and dinner Breakfast, lunch, dinner, mid-afternoon snack Breakfast, lunch, dinner, mid-morning and mid-afternoon snacks 4- Do you pay attention to the calories you consume trough the day? No, never Only when I see I'm gaining weight Only if I had some important meal in the earlier days in the days before I always try to avoid hypercaloric foods 5- Which type of fat you usually consume? Few or very few At home we mainly use extra virgin olive oil At home we mainly use butter At home we mainly use plant oils and spreads Other (specify)
6- What do you do with sugar? I use few or very few, I do not like the sweet taste I eat a lot of sweets (cakes, pastries, candies or chocolates) I like to drink sweetened beverages I try to substitute sugar with low-calorie sweeteners, such as aspartame 7- In your household, do you pay attention to salt? No special attention, we use salt according to taste We try to add a little salt to dishes We just choose slightly salted foods (we pay attention to cheese, sausages, bread, etc.) We use spices to reduce salt intake 8- How much fruit and vegetables you consume in the day? Little fruit and vegetables (I don't like them) Little vegetable, but I try tu consume a lot of fruit Little fruit, but I try to consume a lot of vegetables I eat plenty of fruit and vegetables 9- Do you eat meat? Or are you vegetarian? I don't like meat and I eat little or very little I don't eat meat for personal choice (I'm vegetarian or vegan) I prefer eating poultry and little red meat I eat much red meat because I like it and I know it is good for health (it contains proteins and iron) 10-Do you consume wholegrain foods? No, I don't like them No, I dont' see any usefulness I try to eat them, but I don't like their taste Yes, I regularly consume wholegrain foods
Day 1: Beverages Water (glass) <2 3-4 5-6 7-8 9 o + Tea or herb tea (glass or cup) 0 1 2 3 4 o + Coffee (cup) 0 1 2 3 4 o + Milk (glass) 0 1 2 3 4 o + Cappuccino/milk and coffee (cup) 0 1 2 3 4 o + Soft drinks like Cola (glass) 0 1 2 3 4 o + Low calorie soft drinks (glass) 0 1 2 3 4 o + Juices (glass) 0 1 2 3 4 o + Wine (glass) 0 1 2 3 4 o + Beer (can) 0 1 2 3 4 o + Aperitifs, digestivs, spirits (small glass) 0 1 2 3 4 o + Foods Fresh fruit(portions)** 0 1 2 3 4 o + Biscuits (number) 0 1-2 3-5 6-9 10 o + Pastry/Croissant without filling 0 1 2 3 4 o + Filled pastry/croissant 0 1 2 3 4 o + Ready to eat breakfast cerels (30 g = 1 spoon) 0 1 2 3 4 o + Ice cream (scoop or spoon) 0 1 2 3 4 o + Yogurt (pot) 0 1 2 3 4 o + Low calorie yogurt (pot) 0 1 2 3 4 o + Honey (little spoon) 0 1 2 3 4 o + Jam (spoon) 0 1 2 3 4 o + Spreadable cream chocolate / hazelnut 0 1 2 3 4 o + (spoon) S*LCS* * S or LCS: for S, please report the number fo little spoons or sachets of sucrose and for LCS the number of doses of low calorie sweeteners added day to the beverage (for example 2 sugar little spoons per coffee cup and 3 cups per day: 6 ). ** fresh fruit: 1 portion corresponds to an apple, pear, orange, grapefruit, peach, banana or 2 apricots, plums, tangerines, and a bunch of grapes, a slice of melon or watermelon; also as juice or smoothie. Candy, chocolate in tablets or in the cup, chocolates, desserts, cakes and other sweet foods, dried fruits: please indicate each food specifying the amount consumed per day. Example: chocolate cake a slice, 5 nuts, 4 squares of chocolate, etc..
Day 2: Beverages Water (glass) <2 3-4 5-6 7-8 9 o + Tea or herb tea (glass or cup) 0 1 2 3 4 o + Coffee (cup) 0 1 2 3 4 o + Milk (glass) 0 1 2 3 4 o + Cappuccino/milk and coffee (cup) 0 1 2 3 4 o + Soft drinks like Cola (glass) 0 1 2 3 4 o + Low calorie soft drinks (glass) 0 1 2 3 4 o + Juices (glass) 0 1 2 3 4 o + Wine (glass) 0 1 2 3 4 o + Beer (can) 0 1 2 3 4 o + Aperitifs, digestivs, spirits (small glass) 0 1 2 3 4 o + Foods Fresh fruit(portions)** 0 1 2 3 4 o + Biscuits (number) 0 1-2 3-5 6-9 10 o + Pastry/Croissant without filling 0 1 2 3 4 o + Filled pastry/croissant 0 1 2 3 4 o + Ready to eat breakfast cerels (30 g = 1 spoon) 0 1 2 3 4 o + Ice cream (scoop or spoon) 0 1 2 3 4 o + Yogurt (pot) 0 1 2 3 4 o + Low calorie yogurt (pot) 0 1 2 3 4 o + Honey (little spoon) 0 1 2 3 4 o + Jam (spoon) 0 1 2 3 4 o + Spreadable cream chocolate / hazelnut 0 1 2 3 4 o + (spoon) S*LCS* * S or LCS: for S, please report the number fo little spoons or sachets of sucrose and for LCS the number of doses of low calorie sweeteners added day to the beverage (for example 2 sugar little spoons per coffee cup and 3 cups per day: 6 ). ** fresh fruit: 1 portion corresponds to an apple, pear, orange, grapefruit, peach, banana or 2 apricots, plums, tangerines, and a bunch of grapes, a slice of melon or watermelon; also as juice or smoothie. Candy, chocolate in tablets or in the cup, chocolates, desserts, cakes and other sweet foods, dried fruits: please indicate each food specifying the amount consumed per day. Example: chocolate cake a slice, 5 nuts, 4 squares of chocolate, etc..
Day 3: Beverages Water (glass) <2 3-4 5-6 7-8 9 o + Tea or herb tea (glass or cup) 0 1 2 3 4 o + Coffee (cup) 0 1 2 3 4 o + Milk (glass) 0 1 2 3 4 o + Cappuccino/milk and coffee (cup) 0 1 2 3 4 o + Soft drinks like Cola (glass) 0 1 2 3 4 o + Low calorie soft drinks (glass) 0 1 2 3 4 o + Juices (glass) 0 1 2 3 4 o + Wine (glass) 0 1 2 3 4 o + Beer (can) 0 1 2 3 4 o + Aperitifs, digestivs, spirits (small glass) 0 1 2 3 4 o + Foods Fresh fruit(portions)** 0 1 2 3 4 o + Biscuits (number) 0 1-2 3-5 6-9 10 o + Pastry/Croissant without filling 0 1 2 3 4 o + Filled pastry/croissant 0 1 2 3 4 o + Ready to eat breakfast cerels (30 g = 1 spoon) 0 1 2 3 4 o + Ice cream (scoop or spoon) 0 1 2 3 4 o + Yogurt (pot) 0 1 2 3 4 o + Low calorie yogurt (pot) 0 1 2 3 4 o + Honey (little spoon) 0 1 2 3 4 o + Jam (spoon) 0 1 2 3 4 o + Spreadable cream chocolate / hazelnut 0 1 2 3 4 o + (spoon) S*LCS* * S or LCS: for S, please report the number fo little spoons or sachets of sucrose and for LCS the number of doses of low calorie sweeteners added day to the beverage (for example 2 sugar little spoons per coffee cup and 3 cups per day: 6 ). ** fresh fruit: 1 portion corresponds to an apple, pear, orange, grapefruit, peach, banana or 2 apricots, plums, tangerines, and a bunch of grapes, a slice of melon or watermelon; also as juice or smoothie. Candy, chocolate in tablets or in the cup, chocolates, desserts, cakes and other sweet foods, dried fruits: please indicate each food specifying the amount consumed per day. Example: chocolate cake a slice, 5 nuts, 4 squares of chocolate, etc..
Attività fisica o sportiva (espressa in minuti) Physical activity or sports (minutes) Day 1 Date: 0 01 Morning Afternoon After dinner Moving on foot or by bicycle (to go to school, to work, to the grocery store, etc.). Brisk walking or cycling Sporting activities or training Making exercise bike, rowing machine, fitness, wii or similar Dy 2 Date: Moving on foot or by bicycle (to go to school, to work, to the grocery store, etc.). Brisk walking or cycling Morning Afternoon After dinner Sporting activities or training Making exercise bike, rowing machine, fitness, wii or similar Day 3 date: Moving on foot or by bicycle (to go to school, to work, to the grocery store, etc.). Brisk walking or cycling Morning Afternoon After dinner Sporting activities or training Making exercise bike, rowing machine, fitness, wii or similar