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Part II Nutrition Assessment, Consequences, and Implications Figure 7.3 Council of Nutrition Appetite Questionnaire Name: __________________________________________________________ Sex (circle): Male

Age: ____________________ Weight: ____________________ Height: ____________________ Date: ___________________

Administration Instructions: Ask the subject to complete the questionnaire by circling the correct answers, and then tally the results based upon the following numerical scale: a = 1, b = 2, c = 3, d = 4, e = 5. The sum of the scores for the individual items constitutes the CNAQ score. A

. 1. My appetite is

a. very poor b. poor c. average d. good e. very good

2. When I eat

a. I feel full after eating only a few mouthfuls b. I feel full after eating about a third of a meal c. I feel full after eating over half a meal d. I feel full after eating most of the meal e. I hardly ever feel full

3. I feel hungry

a. rarely b. occasionally c. some of the time d. most of the time e. all of the time

4. Food tastes

a. very bad b. bad c. average d. good e. very good

5. Compared to when I was younger, food tastes

a. much worse b. worse c. just as good d. better e. much better

6. Normally I eat

a. less than one meal a day b. one meal a day c. two meals a day d. three meals a day e. more than three meals a day

7. I feel sick or nauseated when I eat

a. most times b. often c. sometimes d. rarely e. never

8. Most of the time my mood is

a. very sad b. sad c. neither sad nor happy d. happy e. very happy

Source: Reprinted with permission from Wilson MG, Thomas DR, Rubenstein LZ, Chibnal JT, Anderso S, Baxi A, Diebold MR, Morley JE. Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr. 2005; 82:1074-1081. http://ajcn.nutrition.org/content/82/5/1074/T5.expansion.html.

Female