Dietary Interview - Total Nutrient Intak
Respondent sequence number
Dietary day one sample weight
Dietary two-day sample weight
Dietary recall status
Interviewer ID code
Breast-fed infant (either day)
Number of days of intake
# of days b/w intake and HH interview
Intake day of the week
Language respondent used mostly
Main respondent for this interview
Helped in responding for this interview
Type of table salt used
How often add salt to food at table
Salt used in preparation?
Salt used at table yesterday?
Type of salt used yesterday
On special diet?
Weight loss/Low calorie diet
Low fat/Low cholesterol diet
Low salt/Low sodium diet
Sugar free/Low sugar diet
Low fiber diet
High fiber diet
Diabetic diet
Weight gain/Muscle building diet
Low carbohydrate diet
High protein diet
Gluten-free/Celiac diet
Renal/Kidney diet
Other special diet
Number of foods/beverages reported
Energy (kcal)
Protein (gm)
Carbohydrate (gm)
Total sugars (gm)
Dietary fiber (gm)
Total fat (gm)
Total saturated fatty acids (gm)
Total monounsaturated fatty acids (gm)
Total polyunsaturated fatty acids (gm)
Cholesterol (mg)
Vitamin E as alpha-tocopherol (mg)
Added alpha-tocopherol (Vitamin E) (mg)
Retinol (mcg)
Vitamin A, RAE (mcg)
Alpha-carotene (mcg)
Beta-carotene (mcg)
Beta-cryptoxanthin (mcg)
Lycopene (mcg)
Lutein + zeaxanthin (mcg)
Thiamin (Vitamin B1) (mg)
Riboflavin (Vitamin B2) (mg)
Niacin (mg)
Vitamin B6 (mg)
Total folate (mcg)
Folic acid (mcg)
Food folate (mcg)
Folate, DFE (mcg)
Total choline (mg)
Vitamin B12 (mcg)
Added vitamin B12 (mcg)
Vitamin C (mg)
Vitamin D (D2 + D3) (mcg)
Vitamin K (mcg)
Calcium (mg)
Phosphorus (mg)
Magnesium (mg)
Iron (mg)
Zinc (mg)
Copper (mg)
Sodium (mg)
Potassium (mg)
Selenium (mcg)
Caffeine (mg)
Theobromine (mg)
Alcohol (gm)
Moisture (gm)
SFA 4:0 (Butanoic) (gm)
SFA 6:0 (Hexanoic) (gm)
SFA 8:0 (Octanoic) (gm)
SFA 10:0 (Decanoic) (gm)
SFA 12:0 (Dodecanoic) (gm)
SFA 14:0 (Tetradecanoic) (gm)
SFA 16:0 (Hexadecanoic) (gm)
SFA 18:0 (Octadecanoic) (gm)
MFA 16:1 (Hexadecenoic) (gm)
MFA 18:1 (Octadecenoic) (gm)
MFA 20:1 (Eicosenoic) (gm)
MFA 22:1 (Docosenoic) (gm)
PFA 18:2 (Octadecadienoic) (gm)
PFA 18:3 (Octadecatrienoic) (gm)
PFA 18:4 (Octadecatetraenoic) (gm)
PFA 20:4 (Eicosatetraenoic) (gm)
PFA 20:5 (Eicosapentaenoic) (gm)
PFA 22:5 (Docosapentaenoic) (gm)
PFA 22:6 (Docosahexaenoic) (gm)
Compare food consumed yesterday to usual
Total plain water drank yesterday (gm)
Total tap water drank yesterday (gm)
Total bottled water drank yesterday (gm)
Tap water source
Shellfish eaten during past 30 days
Clams eaten during past 30 days
# of times clams eaten in past 30 days
Crabs eaten during past 30 days
# of times crabs eaten in past 30 days
Crayfish eaten during past 30 days
# of times crayfish eaten past 30 days
Lobsters eaten during past 30 days
# of times lobsters eaten past 30 days
Mussels eaten during past 30 days
# of times mussels eaten in past 30 days
Oysters eaten during past 30 days
# of times oysters eaten in past 30 days
Scallops eaten during past 30 days
# of times scallops eaten past 30 days
Shrimp eaten during past 30 days
# of times shrimp eaten in past 30 days
Other shellfish eaten past 30 days
# of times other shellfish eaten
Other unknown shellfish eaten past 30 d
# of times other unknown shellfish eaten
Refused on shellfish eaten past 30 days
Fish eaten during past 30 days
Breaded fish products eaten past 30 days
# of times breaded fish products eaten
Tuna eaten during past 30 days
# of times tuna eaten in past 30 days
Bass eaten during past 30 days
# of times bass eaten in past 30 days
Catfish eaten during past 30 days
# of times catfish eaten in past 30 days
Cod eaten during past 30 days
# of times cod eaten in past 30 days
Flatfish eaten during past 30 days
# of times flatfish eaten past 30 days
Haddock eaten during past 30 days
# of times haddock eaten in past 30 days
Mackerel eaten during past 30 days
# of times mackerel eaten past 30 days
Perch eaten during past 30 days
# of times perch eaten in past 30 days
Pike eaten during past 30 days
# of times pike eaten in past 30 days
Pollock eaten during past 30 days
# of times pollock eaten in past 30 days
Porgy eaten during past 30 days
# of times porgy eaten in past 30 days
Salmon eaten during past 30 days
# of times salmon eaten in past 30 days
Sardines eaten during past 30 days
# of times sardines eaten past 30 days
Sea bass eaten during past 30 days
# of times sea bass eaten past 30 days
Shark eaten during past 30 days
# of times shark eaten in past 30 days
Swordfish eaten during past 30 days
# of times swordfish eaten past 30 days
Trout eaten during past 30 days
# of times trout eaten in past 30 days
Walleye eaten during past 30 days
# of times walleye eaten in past 30 days
Other fish eaten during past 30 days
# of times other fish eaten past 30 days
Other unknown fish eaten in past 30 days
# of times other unknown fish eaten
Refused on fish eaten past 30 days