Quality Of Diet Screening Quiz

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Quality of Diet
Screening Quiz

Quality of Diet Screening

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HOW MANY SERVINGS OF VEGETABLES DO YOU EAT EACH DAY?*
1 SERVING equals 1 cup raw leafy vegetables, 1/2 cup raw or cooked non-leafy vegetables, 1/2 cup vegetable juice. White potatoes and French Fries don't count.
- Less than 1 serving per day?
- 1 serving per day?
- 2 servings per day?
- 3 servings per day?
- 4 servings per day?
- 5 or more servings per day?

HOW MANY SERVINGS OF FRUIT DO YOU EAT EACH DAY?
1 SERVING equals 1 medium sized piece of fruit, 1 cup of cut-up fruit, 1/2 cup of fresh/frozen berries, or 1/4 cup of dried fruit. [MUST BE WHOLE FRUIT. Fruit juice does not count.]
- Less than 1 serving per day?
- 1 serving per day?
- 2 servings per day?
- 3 servings per day?
- 4 servings per day?

HOW MANY SERVINGS OF WHOLE GRAINS DO YOU EAT EACH DAY?*
One serving equals 1 cup of cold cereal or ½ cup of hot cereal, cooked grains, pasta, or corn. One slice of bread or 3 cups of popcorn are good too BUT ALL FOODS MUST BE 100% WHOLE GRAIN.
- 0 Due to food allergies and/or gluten sensitivity, I don't eat whole grains.
- Less than 1 serving per day?
- 1 servings per day?
- 2 servings per day?
- 3 servings per day?
- 4 servings per day?
- 5 servings per day?

HOW MANY SERVINGS OF BEANS, NUTS OR SEEDS DO YOU EAT EACH WEEK?*
1 SERVING equals 1/4 cup nuts or seeds, 1 tablespoon nut/seed butters, ½ cup of beans, chickpeas, lentils or tofu, 1/4 cup of hummus.
- Due to food allergies and/or digestive issues, I don't eat beans, nuts, or seeds.
- Less than 1 serving per day?
- 1 or 2 servings per WEEK?
- 3 or 4 servings per WEEK?
- 5 or 6 servings per WEEK?
- 7 or more servings per WEEK?

HOW MANY SERVINGS OF FATTY FISH DO YOU EAT EACH WEEK?
1 SERVING equals 4oz (1/4 pound) of fatty fish like salmon, anchovies, mackerel or herring.
- Due to seafood allergies, I don't eat fish or shellfish.
- Less than 1 serving per WEEK?
- 1 serving per WEEK?
- 2 serving per WEEK?
- 3 or more servings per WEEK?

HOW MANY SERVINGS OF RED OR PROCESSED MEAT DO YOU EAT EACH WEEK?*
1 SERVING equals 1½ oz. processed meat (bacon, ham, sausage, hot dogs, deli meats) or 4 oz. [1/4 pound] of red meat (steak, hamburger, pork, lamb etc.).
- NO servings each WEEK?
- 1-2 servings each WEEK?
- 3-4 servings each WEEK?
- 4+ servings each WEEK?

HOW MANY SERVINGS OF SUGARY BEVERAGES DO YOU DRINK EACH WEEK?*
1 SERVING equals 8 fluid ounces of fruit juice, sugary soda, sweet tea, coffee drinks, or energy/sports drink etc. [NOTE: A standard can of soda is 12 oz.]
- NO sugary beverages each WEEK?
- 3 to 4 sugary beverages each WEEK?
- 7 or more sugary beverages each WEEK?

ALCOHOLIC BEVERAGE CONSUMPTION
Which gender do you most closely identify with biologically?*
*Gender is important here since there are specific metabolic differences in how men and women process alcohol.
- Male
- Female
HOW MANY SERVINGS OF ALCOHOLIC BEVERAGES DO YOU DRINK EACH DAY?
1 SERVING equals 5 fluid ounces of wine, 12 oz. of beer, or 1.5 oz. of liquor.
- NO alcoholic beverages each DAY?
- 1 to 2 alcoholic beverages each DAY?
- 2 or more alcoholic beverages each DAY?
HOW MANY SERVINGS OF ALCOHOLIC BEVERAGES DO YOU DRINK EACH DAY?
1 SERVING equals 5 fluid ounces of wine, 12 oz. of beer, or 1.5 oz. of liquor.
- NO alcoholic beverages each DAY?
- 1 or less alcoholic beverages each DAY?
- 1 or more alcoholic beverages each DAY?

HOW CONFIDENT ARE YOU IN YOUR ABILITY TO MAINTAIN OR CHANGE YOUR CURRENT DIET AND EATING PATTERNS?
- Very confident.
- Somewhat confident but it's difficult to maintain changes.
- Not so confident, it's challenging to change my diet.

HOW USEFUL IS THE DIETARY CHANGE INFORMATION YOU'VE RECEIVED FROM YOUR HEALTHCARE TEAM, OR FOUND ON YOUR OWN?
- I have not received any information from my healthcare team.
- The information I have has not been very helpful.
- The information I have has been somewhat helpful.
- The information I have has been very helpful.
Hidden
Male Score
Hidden
Female Score

WOULD YOU BE INTERESTED IN LEARNING ABOUT TOOLS & TECHNIQUES THAT HAVE BEEN SHOWN TO BE EFFECTIVE IN CHANGING UNHEALTHY DIET & EXERCISE PATTERNS?
- Yes
- No
- Later, not now

Full Name*
Email Address*
Terms of service*
CANCER NUTRITION CARE (CNC) STRONGLY SUGGESTS ALL PATIENTS AND CLIENTS SHARE THEIR SCREENING RESULTS WITH THEIR MEDICAL TEAMS. THIS IS ESPECIALLY IMPORTANT IF YOU HAVE EXPERIENCED ANY WEIGHT LOSS OR MADE SIGNIFICANT CHANGES TO YOUR DIET. IF YOU ARE UNSURE OF YOUR RESULTS OR WOULD LIKE A MORE COMPREHENSIVE SCREENING AND/OR ASSESSMENT, PLEASE CONTACT A CNC ONCOLOGY DIETITIAN.
Screening Disclaimer
Cancer Nutrition Care (CNC) is providing this Quality of Diet screening tool as a service to the cancer community as even small changes in diet and/or losses in weight are correlated with less than optimal treatment outcomes. Providing this screening tool and related information is not intended to take the place of medical care or the advice of your doctor. CNC strongly suggests consulting your doctor or other health professionals about any information obtained here including your results obtained through our screening tool.
Website Content Disclaimer Policy
All written materials on the CNC website, including screening surveys and survey results as well as any other information provided to you are not intended to replace medical advice. Our staff is largely comprised of oncology certified Registered Dietitians. We do not have any Oncologists, Oncology Nurses, or Medical Doctor’s on our staff. With that said, our Registered Dietitians are board-certified specialists in oncology nutrition and provide both general guidance on nutrition and specific guidance related to cancer nutrition.
Our Commitment to Information Privacy
CNC respects the privacy of every individual who visits our website, those who take our FREE screenings or seek us out for any of our other services or products.
Screening Privacy Policy
Information collected during the FREE screenings may be used as follows: as part of the process of doing the screening, improving the screening experience and any related services, and communicating results to you via the email you provide.
CNC does not provide any of the screening information to third parties or any other individuals or entities. We may use your personal information (name and email address) to provide services to you, respond to your inquiries, provide information on products and services you request or have a dietitian or other representative contact you regarding our products or services.
Unless you have otherwise opted out of receiving any email communication from us, you agree, by using our services, to allow us to use your email for personal communication and communication related to any services we are engaged in. You have the ability to cancel any email-related correspondence from us. Finally, we may contact you to gather customer service information to help us determine how we can improve our services and products to better meet your needs.
Website Privacy Policy
We do not share any of your information with anyone, including any third-party companies. We do not disclose any information collected during your use of our website, information collected as part of our screenings, or other information provided by you during the course of your interactions on our website.
- I agree to the Terms of Service

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