FORM 1-1 TWENTY-FOUR HOUR FOOD RECALL

Name of subject ________________________________ Date________________________

Day of the week _____________ Name of interviewer _____________________________
List of foods eaten yesterday (or the last 24 hours)
Time Place eaten Dish/Food Item Description Amount
Was this food intake typical? ______ If not, why?
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How much salt and other condiments like fish sauce soy do you add to your food at the table?
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Do you take vitamin and mineral supplements? ______ What kind and how much?
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