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Hasil FFQ Formulir Food Frequency Questioinaire (FFQ)

1. The documents contain the results of Food Frequency Questionnaires (FFQ) for two subjects, Tn. S.L aged 59 and Nikson L aged 26. 2. The FFQs include a list of various food items and the subjects' frequency of consuming each item. 3. The frequency of consumption is categorized as over 1 time per day, 1 time per day, 4-6 times per week, 1-3 times per week, 1-3 times per month, or never.

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Klara Latarima
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31 views14 pages

Hasil FFQ Formulir Food Frequency Questioinaire (FFQ)

1. The documents contain the results of Food Frequency Questionnaires (FFQ) for two subjects, Tn. S.L aged 59 and Nikson L aged 26. 2. The FFQs include a list of various food items and the subjects' frequency of consuming each item. 3. The frequency of consumption is categorized as over 1 time per day, 1 time per day, 4-6 times per week, 1-3 times per week, 1-3 times per month, or never.

Uploaded by

Klara Latarima
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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1.

Hasil FFQ
Formulir Food Frequency Questioinaire (FFQ)
Nama Subjek : Tn. S.L Tanggal Wawancaa : 30/September/2021
Umur : 59 thn Pewawancara : Klara Latarima
Jenis Kelamin : Laki-laki Alamat : Kel. Mongkonai
Barat

No Bahan Makanan Frequensi Konsumsi (skor Konsumsi Pangan)

>1kali 1 4-6kali/ 1-3kali/ 1- Tidak


/hari kali minggu minggu 3kali/ pernah
/hari bulan
A Makanan Pokok

1 Nasi ✔
2 Jagung ✔
3 Singkong ✔
4 Sagu ✔
5 Kentang ✔
6 Roti ✔
B Lauk Hewani

7 Daging sapi ✔
8 Sosis ✔
9 Udang basah ✔
10 Cumi cumi ✔
11 Kepiting ✔
12 Bandeng ✔
13 Kakap ✔
14 Ayam ✔
15 Hati ayam ✔
16 Telur ayam ✔
17 Telur itik ✔
18 Telur puyuh ✔
19 Belut ✔
20 Ikan asin ✔
21 Ikan kering ✔
C Lauk Nabati

22 Tahu ✔
23 Tempe ✔
24 Kacang Merah ✔
25 Kacang Mete ✔
26 Kacang Hijau ✔
27 Kacang Kedele ✔
28 Kacang tanah ✔
29 Petai ✔
D Sayur-Sayuran

29 Pokcoy ✔
30 Kangkung ✔
31 Daun singkong ✔
32 Sawi hijau ✔
33 Gambas ✔
34 Selada ✔
35 Jamur kuping ✔
36 Lobak ✔
37 Oyong ✔
39 Ketimun ✔
40 Daun Bawang ✔
41 Labu Air ✔
42 Selada air ✔
43 Daun Kecipir ✔
44 Sawi ✔
45 Terong ✔
46 Labu Siam ✔
47 Wortel ✔
48 Kol ✔
49 Labu waluh ✔
50 Brokoli ✔
51 Buncis ✔
52 Daun Kacang ✔
53 Pare ✔
54 Rebung ✔
55 Bayam merah ✔
56 Bunga Kol ✔
57 Daun Katuk ✔
58 Daun melinjo ✔
59 Nangka muda ✔
60 Daun pepaya ✔
E Buah-Buahan

61 Alpukat ✔
62 Pisang ✔
63 Dukuh ✔
64 Pepaya ✔
65 Jambu air ✔
66 Jeruk garut ✔
67 Kedongdong ✔
68 Mangga ✔
69 Melon ✔
70 Markisa ✔
71 Apel ✔
F Susu dan hasil olahannya

72 Yoghurt ✔
73 Keju ✔
74 Ice cream ✔
75 Lainnya,
sebutkan..........
G Makanan Jajanan

76 Humburger ✔
76 Hotdog ✔
77 Pizza ✔
78 Fried Chicken ✔
79 Spaghetti ✔
80 Fench Fries ✔
81 Donat ✔
82 Bakso ✔
83 Siomay ✔
84 Batagor ✔
85 Pempek ✔
86 Roti ✔
87 Cake ✔
88 puding/agar- ✔
agar
89 Coklat ✔
90 Lainnya,
Sebutkan........
H Soft Drink

91 Coca-cola ✔
92 Fanta ✔
93 Sprite ✔
94 Pepsi ✔
95 Pop Ice ✔
96 Lainnya, ✔
Sebutkan.......

2. Hasil FFQ
Formulir Food Frequency Questioinaire (FFQ)
Nama Subjek : Nikson L Tanggal Wawancaa : 30/September/2021
Umur : 26 thn Pewawancara : Klara Latarima
Jenis Kelamin : Laki-laki Alamat : Kel. Mongkonai
Barat

No Bahan Makanan Frequensi Konsumsi (skor Konsumsi Pangan)

>1kali 1 4-6kali/ 1-3kali/ 1- Tidak


/hari kali minggu minggu 3kali/ pernah
/hari bulan
A Makanan Pokok

1 Nasi ✔
2 Jagung ✔
3 Singkong
4 Sagu ✔
5 Kentang ✔
6 Roti ✔
B Lauk Hewani

7 Daging sapi ✔
8 Sosis ✔
9 Udang basah ✔
10 Cumi cumi ✔
11 Kepiting ✔
12 Bandeng ✔
13 Kakap ✔
14 Ayam ✔
15 Hati ayam ✔
16 Telur ayam ✔
17 Telur itik ✔
18 Telur puyuh ✔
19 Belut ✔
20 Ikan asin ✔
21 Ikan kering ✔
C Lauk Nabati

22 Tahu ✔
23 Tempe ✔
24 Kacang Merah ✔
25 Kacang Mete ✔
26 Kacang Hijau ✔
27 Kacang Kedele ✔
28 Kacang tanah ✔
29 Petai ✔
D Sayur-Sayuran

29 Pokcoy ✔
30 Kangkung ✔
31 Daun singkong ✔
32 Sawi hijau ✔
33 Gambas ✔
34 Selada ✔
35 Jamur kuping ✔
36 Lobak ✔
37 Oyong ✔
39 Ketimun ✔
40 Daun Bawang ✔
41 Labu Air ✔
42 Selada air ✔
43 Daun Kecipir ✔
44 Sawi ✔
45 Terong ✔
46 Labu Siam ✔
47 Wortel ✔
48 Kol ✔
49 Labu waluh ✔
50 Brokoli ✔
51 Buncis ✔
52 Daun Kacang ✔
53 Pare ✔
54 Rebung ✔
55 Bayam merah ✔
56 Bunga Kol ✔
57 Daun Katuk ✔
58 Daun melinjo ✔
59 Nangka muda ✔
60 Daun pepaya ✔
E Buah-Buahan

61 Alpukat ✔
62 Pisang ✔
63 Dukuh ✔
64 Pepaya ✔
65 Jambu air ✔
66 Jeruk garut ✔
67 Kedongdong ✔
68 Mangga ✔
69 Melon ✔
70 Markisa ✔
71 Apel ✔
F Susu dan hasil olahannya

72 Yoghurt ✔
73 Keju ✔
74 Ice cream ✔
75 Lainnya,
sebutkan..........
G Makanan Jajanan

76 Humburger ✔
76 Hotdog ✔
77 Pizza ✔
78 Fried Chicken ✔
79 Spaghetti ✔
80 Fench Fries ✔
81 Donat ✔
82 Bakso ✔
83 Siomay ✔
84 Batagor ✔
85 Pempek ✔
86 Roti ✔
87 Cake ✔
88 puding/agar- ✔
agar
89 Coklat ✔
90 Lainnya,
Sebutkan........
H Soft Drink

91 Coca-cola ✔
92 Fanta ✔
93 Sprite ✔
94 Pepsi ✔
95 Pop Ice ✔
96 Lainnya, ✔
Sebutkan.......
1. Quisioner

I Pengenalan Tempat

1. Kabupaten/Kota Kotamobagu
Barat/Kota
Kotamobagu

2. Kecamatan Kotamobagu Barat

3. Desa /Kelurahan Mongkonai Barat


4. Nomor kode sample

5. Alamat rumah tangga Mongkonai Barat


Lingkungan I

II Keterangan Rumah Tangga

1. Nama kepala rumah tangga Tn. Nikson L

2. Nama ibu rumah tangga Ny. Siti L

3. Jumlah anggota rumah tangga


5

4. Agama (1. Kr. Protestan 2. Katolik 3. Islam 4. Hindu/Budha)


3

III Keterangan Pengumpul Data

1. Nama pengumpul data Wulandari


Kalengkongan

2. Tanggal pengumpulan data (tgl-


bln-thn) 3 0 0 9 2 1 3 0 1 0 2 1

3. Tanda tangan pengumpul data

5. Supervisor

6. Tanggal pengecekan
7. Tanda tangan supervisor

IV Keterangan Anggota Rumah Tangga

1. Umur kepala rumah tangga


2 6

2. Umur ibu rumah tangga


3 0
0
3. Pendidikan tertinggi kepala rumah tangga
1. Tidak pernah sekolah 4. Tamat SLTP
2. Tidak tamat SD 5. Tamat SLTA 5
3. Tamat SD 6. Tamat Perguruan Tinggi

4. Pendidikan tertinggi ibu rumah tangga


1. Tidak pernah sekolah 4. Tamat SLTP
2. Tidak tamat SD 5. Tamat SLTA
5
3. Tamat SD 6. Tamat Perguruan Tinggi

5. Pekerjaan utama kepala rumah tangga


1
1. Petani 5. Wiraswasta/Pedagang
2. Pegawai 6. Nelayan
3. Buruh/Tukang 7. Tidak Bekerja
4. Pegawai Swasta 8. Lainnya.

6. Pekerjaan utama ibu rumah tannga


1. Ibu rumah tangga 5. Wiraswasta/Pedagang
2. Petani 6. Lainnya.
1
3. Pegawai negeri
4. Pegawai swasta
2. Quisioner

I Pengenalan Tempat

1. Kabupaten/Kota Kotamobagu
Barat/Kota
Kotamobagu

2. Kecamatan Kotamobagu Barat

3. Desa /Kelurahan Mongkonai Barat

4. Nomor kode sample

5. Alamat rumah tangga Mongkonai Barat


Lingkungan I

II Keterangan Rumah Tangga

1. Nama kepala rumah tangga Tn. Samsuri L

2. Nama ibu rumah tangga Ny. Rahma D

3. Jumlah anggota rumah tangga


3

4. Agama (1. Kr. Protestan 2. Katolik 3. Islam 4. Hindu/Budha)


3

III Keterangan Pengumpul Data


1. Nama pengumpul data Wulandari
Kalengkongan

2. Tanggal pengumpulan data (tgl-


bln-thn) 3 0 0 9 2 1 3 0 1 0 2 1

3. Tanda tangan pengumpul data

5. Supervisor

6. Tanggal pengecekan

7. Tanda tangan supervisor

IV Keterangan Anggota Rumah Tangga

1. Umur kepala rumah tangga


5 9

2. Umur ibu rumah tangga


6 0

3. Pendidikan tertinggi kepala rumah tangga


4. Tidak pernah sekolah 4. Tamat SLTP
5. Tidak tamat SD 5. Tamat SLTA 5
6. Tamat SD 6. Tamat Perguruan Tinggi

4. Pendidikan tertinggi ibu rumah tangga


4. Tidak pernah sekolah 4. Tamat SLTP
5. Tidak tamat SD 5. Tamat SLTA
5
6. Tamat SD 6. Tamat Perguruan Tinggi
5. Pekerjaan utama kepala rumah tangga
5
5. Petani 5. Wiraswasta/Pedagang
6. Pegawai 6. Nelayan
7. Buruh/Tukang 7. Tidak Bekerja
8. Pegawai Swasta 8. Lainnya.

6. Pekerjaan utama ibu rumah tannga


5. Ibu rumah tangga 5. Wiraswasta/Pedagang
6. Petani 6. Lainnya.
5
7. Pegawai negeri
8. Pegawai swasta

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