A. DRINKS
1. Do you drink COFFEE?    Yes ☐   No, never. ☐
	How many times per day? ………
2. Do you drink ALCOHOL DRINKS?    Yes ☐   No, never. ☐
	How much?	Wine:	0.15 L ☐	0.20 L ☐	0.25 L ☐
		Beer:	0.23 L ☐	0.33 L ☐	0.45 L ☐	0.66 L ☐
		Strong alcohol:	0.03 L ☐	0.13 L ☐	0.20 L ☐	0.30 L ☐
	How many times per week? ………   Less than once a week. ☐
3. Do you drink SOFT DRINKS (coke, soda…) ?    Yes ☐   No, never. ☐
	How many times per day? ………
B. MILK and DAIRY PRODUCTS
4. Do you drink MILK?    Yes ☐   No, never. ☐
	Which kind?	Whole ☐	Semi-skimmed ☐	Skimmed ☐
	How much?	Small (120 mL) ☐	Medium (200 mL) ☐	Large (300 mL) ☐
	How many times per week? ………   Less than once a week. ☐
5. Do you eat Yogurt?    Yes ☐   No, never. ☐
	How much?	Small (125 g) ☐	Medium (150 g) ☐	Large (180 g) ☐
	How many times per week? ………   Less than once a week. ☐
6. Do you eat CHEESE?    Yes ☐   No, never. ☐
	How many times per week? ………   Less than once a week.
	6.1. HARD CHEESE(e.g., parmesan, sheep’s milk, Swiss) ?    Yes ☐   No, never. ☐
	How much?	Small serving (30 g) ☐	Medium serving (50 g) ☐	Large serving (70 g) ☐
	How many times per week? ………   Less than once a week. ☐
	6.2. SOFT CHEESE?    Yes ☐   No, never. ☐
	How much?	Small serving (50 g) ☐	Medium serving (70 g) ☐	Large serving (100 g) ☐
	How many times per week? ………   Less than once a week. ☐
	6.3. MOZZARELLA?    Yes ☐   No, never. ☐
	How much?	Small serving (60 g) ☐	Medium serving (125 g) ☐	Large serving (200 g) ☐
	How many times per week? ………   Less than once a week. ☐
	6.4. COTTAGE CHEESE?    Yes ☐   No, never. ☐
	How much?	Small serving (100 g) ☐	Medium serving (150 g) ☐	Large serving (200 g) ☐
	How many times per week? ………   Less than once a week. ☐
C. MEAT, FISH and EGGS
7. Do you eat RED MEAT?    Yes ☐   No, never. ☐
	How much?	Small serving (80 g) ☐	Medium serving (120 g) ☐	Large serving (200 g) ☐
	How many times per week? ………   Less than once a week. ☐
8. Do you eat POULTRY?    Yes ☐   No, never. ☐
	How much?	Small serving (80 g) ☐	Medium serving (120 g) ☐	Large serving (160 g) ☐
	How many times per week? ………   Less than once a week. ☐
9. Do you eat PORK?    Yes ☐   No, never. ☐
	How much?	Small serving (50 g) ☐	Medium serving (100 g) ☐	Large serving (150 g) ☐
	How many times per week? ………   Less than once a week. ☐
10. Do you eat FISH?    Yes ☐   No, never. ☐
	How much?	Small serving (100 g) ☐	Medium serving (150 g) ☐	Large serving (200 g) ☐
	How many times per week? ………   Less than once a week. ☐
11. Do you eat CURED MEATS AND SALAMI?    Yes ☐   No, never. ☐
	How much?
	CURED MEAT:	Small serving (20 g) ☐	Medium serving (40 g) ☐	Large serving (80 g) ☐
	SALAMI:	Small serving (15 g) ☐	Medium serving (30 g) ☐	Large serving (50 g) ☐
	How many times per week? ………   Less than once a week. ☐
12. Do you eat EGGS?    Yes ☐   No, never. ☐
	How many times per week? ………   Less than once a week. ☐
D. CEREALS
13. Do you eat PASTA or RICE?    Yes ☐   No, never. ☐
	How much?	Small serving (40–50 g) ☐	Medium serving (60–80 g) ☐	Large serving (100–120 g) ☐
	How many times per week? ………   Less than once a week. ☐
14. Do you eat BREAD?    Yes ☐   No, never. ☐
	How much?	Small serving (30 g) ☐	Medium serving (50 g) ☐	Large serving (100 g) ☐
	How many times per week? ………   Less than once a week. ☐
15. Do you eat BAKERY PRODUCTS?    Yes ☐   No, never. ☐
	How much?	Small serving (15 g) ☐	Medium serving (30 g) ☐	Large serving (45 g) ☐
	How many times per week? ………   Less than once a week. ☐
16. Do you eat POTATOES?    Yes ☐   No, never. ☐
	How much?	Small serving (100 g) ☐	Medium serving (150 g) ☐	Large serving (200 g) ☐
	How many times per week? ………   Less than once a week. ☐
17. Do you eat PIZZA?    Yes ☐   No, never. ☐
	How much?	Small serving (100 g) ☐	Medium serving (150 g) ☐	Large serving (300 g) ☐
	How many times per week? ………   Less than once a week. ☐
E. VEGETABLES, LEGUMES and FRUIT
18. Do you eat VEGETABLES or GREENS?    Yes ☐   No, never. ☐
	How much?	Small serving (100 g) ☐	Medium serving (150 g) ☐	Large serving (300 g) ☐
	How many times per week? ………   Less than once a week. ☐
19. Do you eat LEGUMES (beans, peas) ?    Yes ☐   No, never. ☐
	How much?
	DRIED:	Small serving (30 g) ☐	Medium serving (50 g) ☐	Large serving (70 g) ☐
	FRESH:	Small serving (75 g) ☐	Medium serving (125g) ☐	Large serving (175 g) ☐
	How many times per week? ………   Less than once a week. ☐
20. Do you eat FRESH FRUIT?    Yes ☐   No, never. ☐
	How much?	Small serving (100 g) ☐	Medium serving (150 g) ☐	Large serving (200 g) ☐
	How many times per week? ………   Less than once a week. ☐
F. FATTY DRESSINGS
21. Do you eat OLIVE OIL?    Yes ☐   No, never. ☐
	How much?	1 teaspoon (5 g) ☐	2 teaspoons (10 g) ☐	2 teaspoons (15 g) ☐
	How many times per week? ………   Less than once a week. ☐
22. Do you eat SEED OIL?    Yes ☐   No, never. ☐
	How much?	1 teaspoon (5 g) ☐	2 teaspoons (10 g) ☐	2 teaspoons (15 g) ☐
	How many times per week? ………   Less than once a week. ☐
23. Do you eat BUTTER?    Yes ☐   No, never. ☐
	How much?	Small serving (5 g) ☐	Medium serving (10 g) ☐	Large serving (15 g) ☐
	How many times per week? ………   Less than once a week. ☐
24. Do you eat MARGARINE?    Yes ☐   No, never. ☐
	How much?	Small serving (5 g) ☐	Medium serving (10 g) ☐	Large serving (15 g) ☐
	How many times per week? ………   Less than once a week. ☐
G. OTHER
25. Do you eat SWEETS?    Yes ☐   No, never. ☐
	How much?	Small serving (30 g) ☐	Medium serving (50 g) ☐	Large serving (70 g) ☐
	How many times per week? ………   Less than once a week. ☐
26. Do you eat FRIED FOODS?    Yes ☐   No, never. ☐
	How many times per week? ………   Less than once a week. ☐
27. Do you eat FAST FOOD?    Yes ☐   No, never. ☐
	Which kind?
	HAMBERGER:	Medium serving (120 g) ☐	Large serving (210 g) ☐
	Hot Dog:	Medium serving (120 g) ☐	Large serving (210 g) ☐
	LOCAL STREET FOOD:
	Panelle sandwich	Medium serving (200 g) ☐
	Spleen sandwich	Medium serving (250 g) ☐
	How many times per week? ………   Less than once a week. ☐