Formulir Food Frequency Dan Interpretasi
Formulir Food Frequency Dan Interpretasi
Formulir Food Frequency Dan Interpretasi
Date of Interview
: 17 desember 2014
Name of Respondent
Name of Interviewer
Please mark the number of portion for the visual daily, weekly, or monthly intake of the following foods.
You can sum up food in one meal e.g all beverages in the brake. If you dont find some food please enter
them with the common portions and frequency in empty lines between the meals.
For calculation of the energy requirement we need the following data :
Food Items
Daily
Sumber Fe
Telur ayam
Daging sapi
Ikan segar
Udang segar
Daging ayam
Tempe
Sawi
Daun katuk
Bayam
Kangkung
Sumber Yodium
Ikan salmon
Ikan tuna
Garam
Tiram
Sumber Vitamin A
Hati sapi
Wortel
Daun singkong
Daun pepaya
Daun melinjo
Pepaya
Mangga
Melon
Minyak ikan
Tomat
Weekly
Frequency
Monthly
Yearly
Never
2
1
1
v
1
2
2
v
2
2
v
v
3
v
v
2
V
V
V
4
3
3
v
2
Food Items
Daily
Sumber kalsium
Susu sapi
Susu kedelai
Tepung susu
Teri kering
Udang kering
Brokoli
Selada air
Tahu
Yoghurt
Keju
Oatmeal
Weekly
Frequency
Monthly
Never
v
v
v
v
v
1
1
2
v
v
v
Sumber kolesterol
Otak sapi
Iga sapi
Telur puyuh
Jeroan sapi
Jeroan ayam
Kerang
Daging kambing
Mentega/margarine
Sumber serat
Jagung
Beras merah
Roti gandum
Havermut
Buncis
Alpukat
Apel
Raspberry
Blueberry
Jeruk
Pir
Pisang
Kacang almond
Kacang polong
Kacang hitam
Yearly
v
v
v
v
v
v
v
1
v
v
v
v
4
3
3
v
v
2
v
4
v
v
v
Weekly
(25)
Frequency
Monthly
(10)
Yearly
(5)
Never
(0)
2
1
1
v
1
2
2
v
2
2
v
v
3
v
v
2
V
V
V
4
3
3
v
2
v
v
v
v
v
1
1
2
v
Total Skor
50
10
25
0
25
100
50
0
50
50
0
0
150
0
0
100
0
0
0
100
15
15
0
20
0
0
0
0
0
5
5
100
0
Keju
Oatmeal
v
v
0
0
Sumber kolesterol
Otak sapi
Iga sapi
Telur puyuh
Jeroan sapi
Jeroan ayam
Kerang
Daging kambing
Mentega/margarine
v
v
v
v
v
v
v
0
0
0
0
0
0
0
5
v
v
v
v
0
0
0
0
100
15
15
0
0
20
0
100
0
0
0
1125
Sumber serat
Jagung
Beras merah
Roti gandum
Havermut
Buncis
Alpukat
Apel
Raspberry
Blueberry
Jeruk
Pir
Pisang
Kacang almond
Kacang polong
Kacang hitam
4
3
3
v
v
2
v
4
v
v
v
Total Skor
1. Sumber Fe
Yang sering dikonsumsi : tempe, telur ayam, sawi, bayam, kangkung
Yang jarang dikonsumsi : ikan dan ayam
2. Sumber Yodium
Yang sering dikonsumsi : garam
3. Sumber Vitamin A
Yang sering dikonsumsi : wortel dan papaya
Yang jarang dikonsumsi : tomat, mangga, melon
4. Sumber Kalsium