Lifestyle Questionnaire
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STUDY ON DIET, LIFESTYLE AND HEALTH Use a black or blue ball-point pen. If you want to change your answer, fill in the wrong box completely and mark the correct box. Personal number – PHYSICAL ACTIVITY AND EXERCISE SUN HABITS 1. Your level of physical activity during the past year: 4. Do you travel to sunny resorts during winter time? Walking/cycling No Yes, sometimes Yes, every year Hardly ever 40-60 min/day 5. How does your skin react when you are in the sun? Less than 20 min/day 1-1,5 hours/day Always red/never tanned Sometimes red/always tanned 20-40 min/day More than 1-1,5 hours/day Always red/sometimes tanned Never red/always tanned Daily occupation/work 6. When it is sunny, you prefer: Mostly sitting down Mostly walking, min. lifting/carrying The sun at all the time Sitting down half the time Mostly walking, sig. lifting/carrying Both the sun and the shade Mostly standing up Heavy manual labour Seeking shade at all the time Home/household work 7. Do you use sunblock? Less than 1 hour/day 5-6 hours/day Yes, always Most of the time Sometimes Never 1-2 hours/day 7-8 hours/day 3-4 hours/day More than 8 hours/day EATING HABITS Watching TV/reading 8. Which meals do you usually eat? Less than 1 hour/day 5-6 hours/day Breakfast Lunch Dinner 1-2 hours/day 7-8 hours/day Mid-morning snack Afternoon snack Evening snack 3-4 hours/day More than 6 hours/day 9. On average, how often do you eat the following? Exercise (examples: gym and calisthenics) Times per month Per week Per day Almost never 2-3 hours/week 0 1-3 1-2 3-4 5-6 1 2 3+ Less than 1 hour/week 4-5 hours/week Cooked meal 1 hour/week More than 5 hours/week Meals outside home 2. How far can you walk outdoors? Frozen meals Cannot walk outdoors Almost as far as I want Canned food Only short distances Unlimited distances Ready-made food 3. Do you usually perform any physical activity (that (retirement home, home makes you short of breath) for more than two hours help, relative) per week? E.g.: gardening, brisk walks or similar Fish Yes No Meat 10. How big are your portion sizes? Even Even Mark the image that best describes smaller larger your portion size (volume). portions portions 11. What is your main type of diet? Mixed Vegetarian Vegan 12. Do you exclude/avoid anything in your diet? Gluten Lactose Milk protein Nuts Other:_____________________ Nothing 13. During childhood, did you eat more sweets (such as cakes, cookies, sweets, puddings, fruit fool or soup) compared to your peers? Yes, much more Yes, some more No, same No, some less No, ate none at all 14. How often did you eat these sweets? times/week or times/month Do not know DIETARY HABITS IND THE LAST YEAR 15. How much did you usually drink/eat of the following? 17. On average, how often you eat each of the If you do not eat/drink the specific food item, mark ”0”. following. Mark only one mark on each row 1 glass, 1 cup= 2 dl (enter only whole numbers). If you seldom or never eat that specific item, mark “0”. Per day or Per week Times per month per week per day Milk, skimmed (<0,5% fat) glass/d glass/w CEREALS 0 1-3 1-2 3-4 5-6 1 2 3+ Oatmeal/rye porridge Milk, semi-skimmed (1,5% fat) glass/d glass/w Other porridge/gruel Milk, whole (3% fat) glass/d glass/w Müesli Fruit yoghurt/sour milk glass/d glass/w Breakfast cereals Bran of wheat or oats Yoghurt/sour milk, low-fat glass/d glass/w (<0,5% fat) Linseed glass/d glass/w Sour milk, reduced fat (1,5% fat) Sesame seeds glass/d glass/w Sunflower/pumpkin seeds, etc. Sour milk/yoghurt (3% fat) Wholemeal macaroni/spaghetti glass/d glass/w Water (including mineral) Spaghetti/macaroni/pasta glass/d glass/w Coca Cola/Pepsi, light Pancakes/crepes glass/d glass/w Couscous/bulgur Coca Cola/Pepsi Wholegrain rice glass/d glass/w Other soft drinks/soda, light Other rice glass/d glass/w Other soft drinks/soda Times per month per week per day 0 1-3 1-2 3-4 5-6 1 2 3+ cup/d cups/w MEAT Green tea Minced meat (meatballs, hamburger, cup/d cups/w mincemeat sauce) Herbal tea/ red tea Pork (steak/casserole) cup/d cups/w Tea (black) Beef/veal (steak/casserole) cup/d cups/w Bacon Coffee (filtered) Other meat cup/d cups/w Coffee (unfiltered) Lean sausage Tsp/d Tsp/d Balogna sausage/Falukorv Sugar Other sausage Tbsp/d Tbsp/w Honey Blood pudding/sausage Tbsp/d Tbsp/w Liver/kidney Cottage cheese/quark Meat toppings (e.g. ham/turkey) Tbsp/d Tbsp/w Cream cheese (low-fat) Sausage toppings (e.g. salami) Tbsp/d Tbsp/w Cream cheese Times per month per week per day Slices/d Slices/w FISH/ POULTRY/EGGS 0 1-3 1-2 3-4 5-6 1 2 3+ Hard cheese (low-fat) Smoked fish Hard cheese Slices/d Slices/w Herring/mackerel Tbsp/d Tbsp/w Salmon Dessert cheese Sardines Tbsp/d Tbsp/w Liver paté (low-fat) Cod/saithe/plaice/grenadier Tbsp/d Tbsp/w Tuna Liver paté Pike/perch/bass Slices/d Slices/w Crispbread Fish fingers Slices/d Slices/w White bread/loaf Other fish Roe (e.g. Lump fish) Slices/d Slices/w Fibre enriched bread Caviar (e.g. Swedish Kalles) Granary/wholemeal bread Slices/d Slices/w Shellfish (e.g. shrimp, crayfish etc.) Chicken/other poultry 16. Do you usually have milk in your coffee or tea? Eggs/omelette Yes, in coffee Yes, in tea No Times per month per week per day Times per month per week per day POTATOES ETC 0 1-3 1-2 3-4 5-6 1 2 3+ OT HER FOODS 0 1-3 1-2 3-4 5-6 1 2 3+ Boiled potatoes Salad dressing (reduced fat/fat free) Fried potatoes Salad dressing Baked/mashed potatoes Mayonnaise (reduced fat/fat free) French fries Mayonnaise Carrots Crème fraîche (reduced fat/fat free) Beetroots Crème fraîche Times per month per week per day Double cream 0 1-3 1-2 3-4 5-6 1 2 3+ VEGETABLES/BEANS Single cream, sour cream, Lettuce/iceberg lettuce Yoghurt for cooking (8-10% fat) Cabbage (white, red, Chinese) Cauliflower Pizza Broccoli/brussels sprouts Ketchup Tomato/tomato juice Fresh herbs Peppers Dried herbs Spinach Cinnamon Green peas Pepper Onion Table salt Garlic Leek 18. Mark the type of fats you normally use Mixed frozen vegetables …in cooking Other vegetables Butter Bregott (butter/margarine) Pea soup Household margarine Liquid butter Liquid margarine Olive oil Beans/lentils/chick peas Rapeseed/canola oil Corn or sunflower oil Avocado Other None Olives …in homemade dressing Sweetcorn Olive oil Rapeseed/canola oil Times per month per week per day Corn or sunflower oil Other oil None FRUIT/BERRIES 0 1-3 1-2 3-4 5-6 1 2 3+ …bread spreads Orange/citrus fruits Butter (80% fat) Bregott (butter/margarine) Orange/grapefruit juice Margarine (80% fat) Margarine (40% fat) Apple/Pears Becel (margarine) Oil Other Banana 19.How many slices of bread with butter/margarine do Other fruit you usually eat per day or per week? Berries (fresh or frozen) Slices/day Slices/week Lingonberry jam I do not use any butter/margarine on bread Other jam Fruit fool/soups 20. How much butter/margarine do you usually spread on your bread? Prunes (incl. juice) Fairly thick Thinly Very thin Raisins Apricots/other dried fruit 21. How often do you usually eat these fried foods? Times per month per week per day Times/Month Never/Seldom 0 1-3 1-2 3-4 5-6 1 2 3+ CAKES/SWEETS ETC Sausage/steak/pork chop (fried in a pan) Buns, cakes Biscuits/wafers/rusks Fish fried in a pan Gateau/confections Chicken/fillets/casserole (fried in a pan) Chocolate Grilled/oven-baked Sweets (not chocolate) chicken Ice-cream Gravy Chips/popcorn/cheese puffs 22. To what degree of browning do you usually fry these courses? Peanuts Lightly fried (light brown) Heavily fried (dark brown) Other nuts/almonds Moderately fried (brown) Very heavily fried (charred) I don’t eat fried foods DIETARY SUPPLEMENTS AND MEDICINE 23. Do you eat vitamins, minerals or any other ALCOHOL supplements? 25. Mark how often you usually drink alcohol. Never Yes, sometimes Yes, regularly I have never had alcohol Never = None or very few Sometimes = 1-2 tablets/week or less than 100 tablets/year I stopped drinking alcohol when I was years old. Regularly= 3-7 tablets/week Times per month per week Mark: How often? For how many years? I usually drink Never 0-1 2-3 1-2 3-4 5-6 7 Beer, 2.25% alcohol 1 Beer, up to 3.5% alcohol Beer, over 3.5% alcohol 19 or more or - 4 9 - - Sometimes Regularly than Less 1 5 10 20 DIETARY SUPPLEMENTS Never Red wine Multivitamins with minerals White wine Multivitamins without minerals Liqueur/sherry/fortified wines Vitamin B complex Spirits Vitamin B12 26. On each occasion, how much do you usually drink of Vitamin B6 the following? Folic acid Beer cl Wine cl Liqueur cl Vitamin C Spirit cl Vitamin E 1 can beer =33/50 cl, bottle wine/spirit=75 cl, 1 dl=10 cl Beta-carotene Magnesium TOBACCO Calcium 27.