20 | How do you estimate your salt consumption? 1 = very heavy 2 = heavy 3 = normal 4 = low 5 = very low |
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21 | What type of oil or fat do you use most for your meals? 1 = palm oil 2 = refined palm oil 3 = soy oil 4 = olive oil 5 = margarine |
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22 | How often to you consume fatty products? 1 = always 2 = often 3 = sometimes 4 = rarely 5 = never |
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23 | Do you nibble between meals 1 = yes 2 = no |
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| Physical activity |
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24 | Do you practice physical activity at your workplace, during moment of leisure or sports that makes you sweat or breathe actively? 1 = yes 2 = no |
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25 | If yes, for how many hours do you practice every day? ………………. |
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26 | How many times a week? ………………. |
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| Personal past medical history |
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27 | Are you hypertensive? 1 = yes 2 = no 3 = don’t know |
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28 | If yes, what treatment do you follow actually for hypertension? Lifestyle changes: 1 = yes 2 = no BP lowering drugs: 1 = yes 2 = no |
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29 | If you are taking BP lowering drugs, please precise the classes ACE inhibitors: 1 = yes 2 = no ARBs: 1 = yes 2 = no Calcium channel inhibitor: 1 = yes 2 = no Thiazide diuretics: 1 = yes 2 = no Beta blocquer: 1 = yes 2 = no Others: 1 = yes 2 = no |
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30 | Are you diabetic? 1 = yes 2 = no 3 = don’t know |
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31 | If yes, are you taking a treatment? 1 = yes 2 = no |
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32 | If you are taking a treatment, please precise 1 = Oral antidiabetics 2 = insulin |
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| Family past medical history |
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34 | Is there somebody with obesity in your family? 1 = yes 2 = no If yes, precise the relationship ……………………. |
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35 | Is there somebody having hypertension in your family? 1 = yes 2 = no If yes, precise the relationship …………………… |
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36 | Is there somebody having type 2 diabetes in your family? 1 = yes 2 = no If yes, precise the relationship……………………… |
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STEPS 2: PHYSICAL MEASURMENTS | ||
37 | Weight (Kg) ……………… |
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