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Enter Name :
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Date of Birth :
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Sex :
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Select Yes/No, if you have eaten the list of food under per category within 24 hours (yesterday) during day or night |
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Q1. Do you Eat Food Group - Grains, white roots, tubers and plantains ?
- Wheat, corn(maize), Young/baby maize, rice, Macaroni, Chinese noodles, Bread, long sized corn, dry corn, young/baby maize
- Breadfruit, cassava, jicama/ yambean, potatoes, sweet potato, tannia, water chestnut, Taro, cassava flour(tapioka), Palm power, Kontas, Kumbili
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Q2. Do you Eat Food Group - Pulses (beans, peas and lentils) ?
- Adzuki bean, common bean, kidney beans, Wild Beans, Balck beasn, mung bean(green gram), pigeon pea, Rice bean, soybean(soya bean), sweet pea, urad bean(black gram), Bush and pole beans, soy bean, Black beans
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Q3. Do you Eat Food Group - Nuts and seeds ?
- Nuts, pea nut, candlenut, nuts, Jac k fruit seed, pumpkin seed, Cashew nuts, Bush and pole beans, Wilid beans, Soy bean tofu, Fermented soybean, soy milk, cashew , pumpkin seed
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Q4. Do you Eat Food Group - Dairy ?
- Fresh whole, low-fat skim milk when drunk consumed as such
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Q5. Do you Eat Food Group - Meat, poultry and fish ?
- Gizzard, heart, kidney, liver
- Beef, lamb, pork, deer, horse
- Tripe or other pale organ meats
- Dog
- Chicken, duck, pigeon
- Beef tripe
- Beef pork intestine
- Fresh, frozen or dried fish, lar or small all species
- Canned fish
-Mussels, oysters and scallots
- Shrimp, crabs
- Octopus, squid and cuttlefish
- Shark
- Whale
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Q6. Do you Eat Food Group - Eggs ?
- Chicken eggs
- Duck eggs
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Q7. Do you Eat Food Group - Dark green leafy vegetables ?
- Bean greens
- Spinach
- Broccoli
- Broccoli rabe (rappi, broccoletti, turnip greens)
- Carrot greens
- Cassava leaves
- Chili greens
- Chinese cabage(bok choy, pak choy)
- Chinese Kale(Chinese broccoli, kai-lan, gailan)
- Drumstick greens
- Lettuce(bib, romaine)
- Mustard greens
- Okra (lady’s finger, gumbo)
- Pumpkin greens
- Spinach
- Sweet potato leaves
- Tannia greens
- Taro greens
- Water cress
- Water spinach(kang kung)
- Yau choy
- Pumpkin leaves
- Papaya leaves
- Leaf of long strangle green bean
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Q8. Do you Eat Food Group - Other vitamin A-rich fruits and vegetables ?
- Carrot, pumpkin, red pepper, squash, sweet potato
- Mango (ripe fresh and dried), papaya(ripe, fresh and dried), passion fruit(ripe), melon
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Q9. Do you Eat Food Group - Other vegetables ?
- Asparagus
- Bamboo shoot
- Beans(various) when eaten as fresh pods
- Bitter melon
- Brussels sprouts
- Cabbage(common and red varieties)
- Cauliflower
- Celery
- Chayote(sayote, tayota, choko, chocho, chowchow, christophine)
- Corn(freshm not dried/flour/meal)(green maize)
- Cucumbers
- Eggplant(aubergine, brinjal)
- Green pepper
- Jicama(yam bean)
- Lettuce(light green)
- Luffa(nigged gourd)
- Mushroom
- Okra
- Onion
- Peas, green, when eaten as fresh pod
- Radish
- Squash(Summer and other light colored squash)
- Tomato(red, yellow, green, not orange)
- Zucchini
- Green beans
- Baby young papaya fruit
- Papaya flower
- Long beans
- Banana heart
- Flowering Fern(warabi)
- Ipmoea Aquatica(kankun)
- Pimpinela Bio
- Patola/Sponge Gourd
- Snap peas
- Mung bean sprouts
- Sugar peas
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Q10. Do you Eat Food Group - Other fruits ?
- Apple
- Avocado
- Banana
- Coconut flesh
- Cashew
- Grape fruit
- Grapes
- Guava
- Jackfruit(kathal)
- Lemon
- Lime
- Peaches(dried raw only)
- Pear
- Pineapple
- Plum
- Pomegranate(anar)
- Pomerac(Malay apple)
- Rambutan
- Soursop(guanabana, graviola)
- Star fruit(kamrakh)
- Strawberry
- Sweetsop(sugara apple, custard apple)
- Tamarind
- Tangerine
- Watermelon
- Rambutan
- Orange
- Tamarind
- Mandarine orange
- Guava bol
- Grapes
- Durian
- Sour star fruit
- Sugar-apple
- Mamoncillo
- Ambarella
- Dragon fruit
- Rose apple
- Citrus Bali
- Duwet
- Sour Carambola
- Cocoa
- Mangosteen
- Star Gooseberry
- Salak
- Bengkoang
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