Respondent sequence number
Total # of Dietary Supplements Taken
Total # of Antacids Taken
Any Dietary Supplements Taken?
Any Antacids Taken?
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)
Lycopene (mcg)
Lutein + zeaxanthin (mcg)
Thiamin (Vitamin B1) (mg)
Riboflavin (Vitamin B2) (mg)
Niacin (mg)
Vitamin B6 (mg)
Folic acid (mcg)
Folate, DFE (mcg)
Total choline (mg)
Vitamin B12 (mcg)
Vitamin C (mg)
Vitamin K (mcg)
Vitamin D (D2 + D3) (mcg)
Calcium (mg)
Phosphorus (mg)
Magnesium (mg)
Iron (mg)
Zinc (mg)
Copper (mg)
Sodium (mg)
Potassium (mg)
Selenium (mcg)
Caffeine (mg)