Please choose which language you would like use for this survey.
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English 英文
Chinese 中文
What does this study involve? Two-week stay at the University of Auckland's Human Nutrition Unit in Mount Eden (You may continue to work during the day) - All of your meals, snacks and drinks will be provided during this time. - We will assess how our study diet influences your risk of diabetes. - Find out a wide range of information about your health. - You will be compensated for your time. - In the Auckland area - Between 18-60 years old - European Caucasian OR Asian Chinese (inc. Mainland China, Singapore, Malaysia, Hong Kong and Taiwan) - Happy to eat a wide range of foods (you cannot be vegetarian, vegan or gluten-free)
这项研究会涉及什么 在伊甸山的奥克兰大学人类营养学研究所居住两周。 您可以继续日常的工作或上课。 在居住两周的这段期间将提供您所有的食物、点心和饮料。 我们将评估我们准备的饮食对与糖尿病风险相关的不同代谢健康指标的影响。 您将会发觉有关您目前健康状况的广泛信息。 您参与研究的这段时间将会得到补偿。
我怎么知道我是否符合资格？ 如果您符合以下条件，您可能有资格： 在奥克兰地区 18-60岁之间 欧洲高加索裔或亚洲华人（包括中国大陆、新加坡、马来西亚、香港和台湾） 超重或肥胖（根据 BMI）。这是运用您的身高和体重计算的公式：体重 (kg) / [身高 (m) x 身高 (m)] 乐意吃各种各样的食物（你不能是素食主义者、纯素食者或无麸质者） 您完成调查后，我们其中一位研究人员将与您联系（如果您符合条件)。 非常感谢您抽出宝贵时间完成这份预筛查调查！ Where did you see our advert?
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Facebook WeChat Clinics Word of mouth Poster advert Community noticeboards (roadside) Other Newspaper (Eastern Courier) Newspaper (East & Bays Courier) Newspaper (Mandarin Pages) Skykiwi Forum Channel 28 Channel 33 Skykiwi Little Red Book
你在哪里看到我的研究广告？
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Facebook脸书 微信 家庭医生诊所 朋友介绍 橱窗海报 告示板（路旁） 其他 报纸 (Eastern Courier) 报纸 (East & Bays Courier) 报纸 (华页） 新西兰天维网 新西兰华人电视台 TV28 新西兰中文电视媒体 Channel 33 新西兰天维网 - 小红书
First name:
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Last name:
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Gender:
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Male
Female
Please select your gender first to complete the following questions.
男性
女性
请先选择你的性别以便回答接下来的问题。
Date of birth:
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Today Y-M-D Please provide your date of birth first to complete the following questions.
Today Y-M-D 请先输入你的生日以便完成下面的问题。
View equation View equation Address:
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Please provide a valid physical address for us to contact you in the future.
Contact telephone number (Home):
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If you don't have a landline, please enter None.
联系电话（家庭）：
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Contact mobile number:
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Please provide a valid mobile number for us to contact you.
手机电话：
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Contact telephone number (Work):
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If you don't have a landline, please enter None.
联系电话（工作）：
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E-mail address:
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Please provide a valid e-mail address for us to contact you.
电子邮箱：
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Your ethnic background is:
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Mainland Chinese
Taiwan Chinese
Hong Kong Chinese
Korean
Malaysia Chinese
Singapore Chinese
NZ European
Caucasian
Other
Mainland Chinese
Taiwan Chinese
Hong Kong Chinese
Korean
Malaysia Chinese
Singapore Chinese
NZ European
Caucasian
Other
If other, please specify.
Please specify your ethnic group.
Your mother's ethnic background is:
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Mainland Chinese
Taiwan Chinese
Hong Kong Chinese
Korean
Malaysia Chinese
Singapore Chinese
NZ European
Caucasian
Other
Mainland Chinese
Taiwan Chinese
Hong Kong Chinese
Korean
Malaysia Chinese
Singapore Chinese
NZ European
Caucasian
Other
If other, please specify.
Please specify your mother's ethnic group.
Your father's ethnic background is:
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Mainland Chinese
Taiwan Chinese
Hong Kong Chinese
Korean
Malaysia Chinese
Singapore Chinese
NZ European
Caucasian
Other
Mainland Chinese
Taiwan Chinese
Hong Kong Chinese
Korean
Malaysia Chinese
Singapore Chinese
NZ European
Caucasian
Other
If other, please specify.
Please specify your father's ethnic group.
你的族裔：
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中国大陆华人
台湾华人
香港华人
韩国人
马来西亚华人
新加坡华人
新西兰欧裔
高加索裔
其他
中国大陆华人
台湾华人
香港华人
韩国人
马来西亚华人
新加坡华人
新西兰欧裔
高加索裔
其他
请写下你的族裔：
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你的父亲的族裔：
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中国大陆华人
台湾华人
香港华人
韩国人
马来西亚华人
新加坡华人
新西兰欧裔
高加索裔
其他
中国大陆华人
台湾华人
香港华人
韩国人
马来西亚华人
新加坡华人
新西兰欧裔
高加索裔
其他
请写下你的父亲的族裔：
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你的母亲的族裔：
* must provide value
中国大陆华人
台湾华人
香港华人
韩国人
马来西亚华人
新加坡华人
新西兰欧裔
高加索裔
其他
中国大陆华人
台湾华人
香港华人
韩国人
马来西亚华人
新加坡华人
新西兰欧裔
高加索裔
其他
请写下你的母亲的族裔：
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Body weight (kg):
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For example: If you weight 60 kg, enter 60
体重（公斤）：
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例子: 如果你的体重是60公斤（120斤），输入60
Height (m):
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For example: If you are 1.60 meter tall, enter 1.60
身高（m）：
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例子：如果你的身高是1米60，输入1.60
View equation View equation Have you been diagnosed with type 1 or type 2 diabetes?
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Yes
No
你有1型或2型糖尿病吗？
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是
否
Are you taking medications controlling glycaemia (blood glucose)?
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Yes
No
你是否在服用控制血糖的药物？
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是
否
Do you currently or previously have significant diseases, such as cardiovascular disease, pancreatic disease, or digestive diseases including inflammatory bowel syndrome/disease, ulcerative colitis, Crohn's disease, or cancer?
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Yes
No
现在或曾经患有重大疾病，比如心血管疾病，胰腺疾病，或者消化道疾病（包括肠易激症状，溃疡性结肠炎，克罗恩氏病，或癌症？
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是
否
Have you been diagnosed with any other medical condition?
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Yes
No
你被确诊患有其他疾病吗？
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是
否
Are you on any long-term medication?
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Yes
No
你在长期服用任何药物吗？
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是
否
Participated in another clinical study, currently or in previous 6 month?
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Yes
No
是否在过去的6个月中或者现在正在参加其他的临床研究？
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是
否
If yes, please provide the details.
Did you lose or gain over > 10% of body weight in the past 3 months, or taking part in an active diet program; or current medications for weight loss?
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Yes
No
在过去的3个月中，你是否减去或者增加超过10%的体重，或者参加饮食计划，或者服用减重的药物？
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Yes
No
Did you receive bariatric (weight loss) surgery?
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Yes
No
是否做过缩胃手术（减肥手术）？
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Yes
No
Are you a smoker, currently or in previous 6 month?
* must provide value
Yes
No
目前是否吸烟，或者在过去的6个月内吸烟？
* must provide value
Yes
No
Are you a recreational drug user, currently or in previous 6 month?
* must provide value
Yes
No
你是否正在使用毒品，或者在过去的6个月内使用过毒品？
* must provide value
Yes
No
If you are female, are you pregnant or current breastfeeding?
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Yes
No
如果你是女性，你是否怀孕，或者正在哺乳期？
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Yes
No
Have you been treated with an implantable pacemaker, defibrillator, or any other active implantable device such as a nerve stimulator?
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Yes
No
你是否有心脏起搏器，心脏除颤器，或者其他植入设备比如神经刺激设备？
* must provide value
Yes
No
Have you had a recent blood donation in the past 3 months?
* must provide value
Yes
No
你是否在过去的3个月中献血？
* must provide value
Yes
No
View equation View equation Waist circumference (cm):
* must provide value
For example: If your waist circumference is 100 cm, please enter 100
腰围（厘米）：
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例子:如果你的腰围是100厘米, 输入100
Waist circumference range score:
View equation Do you usually have daily at least 30 minutes of physical activity at work or during leisure time (including normal daily activity)?
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Yes
No
Please choose one.
你是否平时在工作或休闲时间每日做至少30分钟的活动（包括正常的日常活动）？
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是
否
Please choose one.
How often do you eat vegetables, fruits or berries?
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Everyday
Not everyday
你多久吃一次蔬菜，水果或浆果？
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每天
不是每天
Have you ever taken medication for high blood pressure on the regular basis?
* must provide value
No
Yes
你有没有经常服用高血压药物？
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没有
有
Have you ever been found to have high blood glucose (eg in a health examination, during an illness, during pregnancy)?
* must provide value
No
Yes
你有没有曾经发现有高血糖（例如，在健康检查，生病期间，怀孕期间）？
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没有
有
Have any of the members of your immediate family or other relatives been diagnosed with diabetes (type 1 or type 2)?
* must provide value
No
Yes: grandparent, aunt, uncle or first cousin (but no own parent, brother, sister or child)
Yes: parent, brother, sister or own child
No
Yes: grandparent, aunt, uncle or first cousin (but no own parent, brother, sister or child)
Yes: parent, brother, sister or own child
If your parent(s) and/or other family members have diabetes, please choose "Yes: parent, brother, sister or own child".
你的直系亲属或其他任何家族成员是否被诊断患有糖尿病（1型或2型）？
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没有
有: 祖父母, 阿姨/姑姑, 叔叔/伯伯或者表亲 (但是你自己父母，亲兄弟姐妹或子女中没有糖尿病患者)
有: 父母, 亲兄弟姐妹, 或者子女
没有
有: 祖父母, 阿姨/姑姑, 叔叔/伯伯或者表亲 (但是你自己父母，亲兄弟姐妹或子女中没有糖尿病患者)
有: 父母, 亲兄弟姐妹, 或者子女
View equation 1 Would you eat this food as part of the trial?
If yes, please Tick.
Dairy items.
你是否愿意食用以下食物作为参加研究的一部分？
如果Yes，就选择。
* must provide value
2 Would you eat this food as part of the trial?
If yes, please Tick.
Breads, cereals, rice and other grains.
你是否愿意食用以下食物作为参加研究的一部分？
如果Yes，就选择。
* must provide value
3 Would you eat this food as part of the trial?
If yes, please Tick.
Fruits (Fresh, canned or pwodered)
你是否愿意食用以下食物作为参加研究的一部分？
如果Yes，就选择。
* must provide value
4 Would you eat this food as part of the trial?
If yes, please Tick.
Vegetables
你是否愿意食用以下食物作为参加研究的一部分？
如果Yes，就选择。
* must provide value
5 Would you eat this food as part of the trial?
If yes, please Tick.
Protein (meat, fish and eggs)
你是否愿意食用以下食物作为参加研究的一部分？
如果Yes，就选择。
* must provide value
6 Would you eat this food as part of the trial?
If yes, please Tick.
Nuts, seeds and legumes
你是否愿意食用以下食物作为参加研究的一部分？
如果Yes，就选择。
* must provide value
7 Would you eat this food as part of the trial?
If yes, please Tick.
Flavourings调味料
你是否愿意食用以下食物作为参加研究的一部分？
如果Yes，就选择。
* must provide value
8 Would you eat this food as part of the trial?
If yes, please Tick.
Beverages 饮料
你是否愿意食用以下食物作为参加研究的一部分？
如果Yes，就选择。
* must provide value
9 Do you have any food allergies or food intolerance?
* must provide value
Yes
No
If yes, please provide more details.
Are you happy to be contacted for future clinical studies at Human Nutrition Unit?
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Yes
No
是否同意我们联系你,讨论未来的其他Human Nutrition Unit研究项目？
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Yes
No
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