LMNA lifestyle surveyLifestyle questionnairePlease help us by filling out the LMNA Lifestyle questionnaire.What is your date of birth?* What is your date of birth?*2. What is your gender?* 2. What is your gender?*ManWomenOtherI prefer not to sayHave you been diagnosed with laminopathy? (If you answer is no, continue with the family members questionnaire starting at question 17)* Have you been diagnosed with laminopathy? (If you answer is no, continue with the family members questionnaire starting at question 17)*YesNo (I am a family member of a laminopathy patient. I don’t have the disease)In what year were you diagnosed with laminopathy? In what year were you diagnosed with laminopathy?Lifestyle questionnaire for patients (family members: please start at section 4)The questions below refer to the last 5 years before your diagnosis (For example, if you were diagnosed in 2020, these questions refer to the period 2015-2020). How would you describe your diet in the period before your diagnosis? How would you describe your diet in the period before your diagnosis?UnhealthyModerately healthyVery healthyWith regard to your diet, did you have a greater preference for: With regard to your diet, did you have a greater preference for:Sugary foodFatty foodBothOther:Did you exercise before your diagnosis? Did you exercise before your diagnosis?YesNoHow many hours did you exercise per week on average? How many hours did you exercise per week on average?Less than 1 hourBetween 1 and 2 hours3 hours or moreDid you have a job before your diagnosis? Did you have a job before your diagnosis?YesNoIf yes, what was your job title? If yes, what was your job title?If yes, how many hours per week did you work? If yes, how many hours per week did you work?If yes, how did you get to work? If yes, how did you get to work?WalkingBikingCarPublic transportIn the 5 years before your diagnosis, have you experienced mental stress, for example at work or at home? In the 5 years before your diagnosis, have you experienced mental stress, for example at work or at home?Little to no stressModerate stressA lot of stressIf you have experienced moderate or high stress, how long did this period last? If you have experienced moderate or high stress, how long did this period last?Food groups for patientsFor each food group, please indicate whether you ate a lot or a little of these in the period before your diagnosis:Fruit FruitA littleModerateA lotVegetables VegetablesA littleModerateA lotCereals (bread, pasta, rice, etc.) Cereals (bread, pasta, rice, etc.)A littleModerateA lotMeat and poultry Meat and poultryA littleModerateA lotSweets (chocolade, cookies, candy, etc) Sweets (chocolade, cookies, candy, etc)A littleModerateA lotFatty foods (fries, chips) Fatty foods (fries, chips)A littleModerateA lotLifestyle questionnaire for family membersThe following questions are only for family members without a laminopathy diagnosis. The questiones relate to you (not to the patients). What is your relationship to the family member with laminopathy? I am the: What is your relationship to the family member with laminopathy? I am the:Brother/sisterFather/motherSon/daughterGrandfather/motherGrandson/daughterCousinUncle/AuntOther:How would you describe your diet? How would you describe your diet?UnhealthyModerately healthyVery healthyWith regard to your diet, do you have a greater preference for: With regard to your diet, do you have a greater preference for:Sugary foodFatty foodBothOther:Do you exercise? Do you exercise?YesNoIf yes, which sport(s)? If yes, which sport(s)?How many hours do you exercise per week on average? How many hours do you exercise per week on average?Less than 1 hourBetween 1 and 2 hours3 hours or moreQuestion QuestionOption 1Do you have a job? Do you have a job?YesNoIf yes, what is your job title? If yes, what is your job title?If yes, how many hours per week do you work? If yes, how many hours per week do you work?If yes, how do you get to work? If yes, how do you get to work?WalkingBikingCarPublic transportDo you experience mental stress, for example at work or at home? Do you experience mental stress, for example at work or at home?Little to no stressModerate to no stressA lot of stressIf you experience or have experienced moderate or high stress, how long did this period last? If you experience or have experienced moderate or high stress, how long did this period last?Food groups for family membersFor each food group, please indicate whether you ate a lot or a little of these in the period before your diagnosis:Fruit FruitA littleModerateA lotVegetables VegetablesA littleModerateA lotCereals (bread, pasta, rice, etc.) Cereals (bread, pasta, rice, etc.)A littleModerateA lotMeat and poultry Meat and poultryA littleModerateA lotSweets (chocolade, cookies, candy, etc) Sweets (chocolade, cookies, candy, etc)A littleModerateA lotFatty foods (fries, chips) Fatty foods (fries, chips)A littleModerateA lot
