| □ | Magnesium |
| □ | Vitamin C |
| □ | Zinc |
| □ | Vitamin D |
| □ | Iron |
| □ | Calcium |
| □ | B vitamins |
| □ | Folic acid |
| □ | Vitamin A |
| □ | Selenium |
| □ | Vitamin E |
| □ | Iodine |
| □ | I do not consume any food supplements |
| □ | Others |
| □ | Magnesium |
| □ | Vitamin C |
| □ | Zinc |
| □ | Vitamin D |
| □ | Iron |
| □ | Calcium |
| □ | B vitamins |
| □ | Folic acid |
| □ | Vitamin A |
| □ | Selenium |
| □ | Vitamin E |
| □ | Iodine |
| □ | I do not consume any food supplements |
| □ | Others |