Date of Interview

Name of Respondent
Name of Interviewer
Time of Interview
No

Place of Eaten

Time

16-Nov-15
Fitria Nurrahmawati
Yosefin Widiyatno
13.30
Name of Dish/Menu

Age: 20 yrs
Weight of respondent: 56 kg
Height of respondent : 153 cm
Ingredients

Monday, November 16, 2015

1

RK 8 FKM Unair

2
Home
3
4

13.15

Nasi Campur

10.00

Air Mineral (ml)

09.50

Susu Anlene Actifit

Home

09.00

Jamu Kunir Asem

Home

09.00

Perkedel Jagung

6
08.00
Home
7
04.30
Sunday, November 15, 2015
1
22.30
Home

Nasi Putih
Mie Basah
Kering Tempe
Ayam Taliwang
Air
Susu Sapi Fortifikasi
Air
Kunyit
Asam
Jeruk Nipis
Gula Jawa
Jagung Kuning Pipil rebus
Tepung Terigu'
Air
Minyak Kelapa Swt

Air Mineral (ml)

Air

Air Mineral (ml)

Air

2
3
4

6
7
8

Home

21.30
20.30
19.30

Air Mineral (ml)

Home

19.00

Tahu Telor

Home

18.45
17.00
16.30

Air Mineral (ml)

Richeese Nabati Snack
Air Mineral (ml)

Air
Tahu Goreng
Telor
Kacang tnh grg
Kerupuk Kemplang Grg
Petis Udang Pasta
Kecap
Air
Wafer
Air

URT

Bahan Makanan
Banyaknya

1 mangkok
2 sendok
2 sendok
2 Sendok
3/4 gelas
3 sendok
3/4 gelas
5 sendok
5 sendok
4 sendok
4 sendok
3 sendok
1 1/2 sendok
1/5 gelas
4 sendok
3/4 gelas
3/4 gelas

100 gr
20 gr
20 gr
20 gr
200 gr
30 gr
200 gr
50gr
50gr
20gr
40 gr
30 gr
15 gr
50 gr
40 gr
200 gr
2010gr

3/4 gelas

200 gr

1 gelas
1 gelas
1 gelas
5/4 buah bsr
1 butir
2 sendok
2 sendok
2 sendok
1 sendok
1 gelas
1 bungkus
3/4 gelas

250gr
250 gr
250 gr
125 gr
50 gr
20 gr
20 gr
20 gr
10 gr
250
8.5 gr
200 gr

FOOD RECALL PERTAMA

No

Menu

1.

Nasi Campur

2.

Air Mineral

Susu Anlene Actifit

Jamu Kunir Asem

Perkedel Jagung

6
7
8
Air Mineral
9
10
11

12 Tahu Telor

13 Air Mineral
14 Richeese nabati
15 Air Mineral

Ingredients
Nasi Putih
Mie Basah
Tempe goreng
Ayam Taliwang
Minyak Kelapa Sawit
Air
Susu Sapi Fortifikasi
Air
Air
Kunyit
Asem
Gula Jawa
Jeruk Nipis
Jagung Kuning pipil rebus
Tepung Terigu
Air
Minyak Kelapa Sawit

Air

Tahu goreng
Telur Ayam
Kerupuk Kemplang Grg
Petis Udang Pasta
Kecap manis
Kacang tanah goreng
Air
Wafer
Air
TOTAL

PERSENTASE
1.
2.
3.

KARBOHIIDRAT
PROTEIN
LEMAK

38.7685809244
8.8895270745
52.341892001

Amount (gr)
100
20
10
20
30
200
30
200
200
50
50
40
20
20
15
50
40
200
200
200
200
200
200
125
50
20
20
10
20
250
8.5
200
2998.5

NORMAL
55
15
30

per 100 BDD

39.8
14
10.4
20.1
0
0
63.33
0
0
9.1
62.5
92
10
28.4
77.2
0
0
0
0
0
0
0
0
2.5
0.7
57.1
38
9
25.5
0
300
0

Karbohidrat
gr food
39.8
2.8
1.04
4.02
0
0
19
0
0
4.55
31.25
36.8
2
5.68
11.58
0
0
0
0
0
0
0
0
3.125
0.35
11.42
7.6
0.9
5.1
0
6
0
161.995

Konsumsi Air (ml)

1850
Yg dianjurkan (ml)
2300

kkal
159.2
11.2
4.16
16.08
0
0
76
0
0
18.2
125
147.2
8
22.72
46.32
0
0
0
0
0
0
0
0
12.5
1.4
45.68
30.4
3.6
20.4
0
24
0
647.98

Protein
per 100 BDD
gr food
3
3
0.6
0.12
24.5
2.45
3.64
18.2
0
0
0
0
16.67
5
0
0
0
0
2
1
2.8
1.4
0
0
0.5
0.1
3.8
0.76
9
1.35
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
9.7
12.125
12.4
6.2
5.6
1.12
15
3
5.7
0.57
25.5
5.1
0
0
100
1
0
0
37.145

kkal
12
0.48
9.8
14.56
0
0
20
0
0
4
5.6
0
0.4
3.04
5.4
0
0
0
0
0
0
0
0
48.5
24.8
4.48
12
2.28
20.4
0
4
0
148.58

Lemak
per 100 BDD
gr food
0.3
0.3
3.3
0.66
26.6
2.66
4.02
20.1
100
30
0
0
3.33
1
0
0
0
0
2.7
1.35
0.6
0.3
0
0
0.2
0.04
3.5
0.7
1
0.15
0
0
100
40
0
0
0
0
0
0
0
0
0
0
0
0
8.5
10.625
10.8
5.4
28.1
5.62
0.9
0.18
1.3
0.13
44.4
8.88
0
0
50
1.5
0
0
97.205

kkal
2.7
5.94
23.94
36.18
270
0
9
0
0
12.15
2.7
0
0.36
6.3
1.35
0
360
0
0
0
0
0
0
95.625
48.6
50.58
1.62
1.17
79.92
0
13.5
0
874.845

Total kkal
173.9
17.62
37.9
66.82
270
0
105
0
0
34.35
133.3
147.2
8.76
32.06
53.07
0
360
0
0
0
0
0
0
156.625
74.8
100.74
44.02
7.05
120.72
0
41.5
0
1671.405

PERSENTASE ENERGI YANG TELAH DIKONSU

KARBOHIID
39%
52%

9%

PROTEIN
LEMAK

FOOD RECALL PERTAMA

Ca

Ca food

25
14
202
94
0
0
1666.67
0
0
24
74
76
18
7
22
0
0
0
0
0
0
0
0
200
86
50
37
123
106
0
0
0

25
2.8
20.2
18.8
0
0
500
0
0
12
37
30.4
3.6
1.4
3.3
0
0
0
0
0
0
0
0
250
43
10
7.4
12.3
21.2
0
0
0
947.5

Fe

Fe food
0.4
6.8
4.9
2
0
0
0
0
0
3.3
0.6
3
0.2
0.5
1.3
0
0
0
0
0
0
0
0
4.1
3
2.9
2.8
5.7
4.1
0
0
0

YANG TELAH DIKONSUMSI RECALL 1

KARBOHIIDRAT
PROTEIN

0.4
1.36
0.49
0.4
0
0
0
0
0
1.65
0.3
1.2
0.04
0.1
0.195
0
0
0
0
0
0
0
0
5.125
1.5
0.58
0.56
0.57
0.82
0
0
0
12.76

Zn

zn food

0
0
0
12.3
0
0
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
2.46
0
0
1.2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3.66

karoten total

karoten total food

0
0
78
0
0
0
246.67
0
0
0
30
0
4
234
0
0
0
0
0
0
0
0
0
0
104
280
0
0
0
0
15
0

0
0
7.8
0
0
0
74
0
0
0
15
0
0.8
46.8
0
0
0
0
0
0
0
0
0
0
52
56
0
0
0
0
0.15
0
196.4

thiamin

thiamin food

0.05
0
0.24
0
0
0
0
0
0
0.03
0.34
0
0.01
0.08
0.1
0
0
0
0
0
0
0
0
0.01
0.12
0.31
0
0
0.4
0
15
0

0.05
0
0.024
0
0
0
0
0
0
0.015
0.17
0
0.002
0.016
0.015
0
0
0
0
0
0
0
0
0.0125
0.06
0.062
0
0
0.08
0
0.15
0
0.3645

PERSENTASE KONSUMSI ENERGI YANG DIANJURKAN

KARBOHIIDRAT

30%

LEMAK

PROTEIN
55%

15%

LEMAK

riboflavin
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0.07
0
0
0
0
0
0
0
0
0
0.38
0
0
0
0
0
15
0

riboflavin food
0
0
0
0
0
0
0.3
0
0
0
0
0
0
0
0.0105
0
0
0
0
0
0
0
0
0
0.19
0
0
0
0
0
0.15
0
0.5005

niacin

niacin food
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Vit. C
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.15
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.15

0
0
0
0
0
0
0
0
0
1
2
0
19.7
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

vit. C food
0
0
0
0
0
0
0
0
0
0.5
1
0
3.94
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5.44

No
20-Nov
1
2
3
19-Nov

Place of Eaten

Time

Home

07.45
04.15
00.30

23.00
Home

5
6
7

21.00
19.30

Home

19.00

Home

18.30

Home

16.30

10

RK08

12.30

11

RK08

12.15

12

Kantin FKM Unair

11.15

13

Home

10.30

14

Home

09.00

Name of Dish/Menu

Ingredients
URT

Air mineral

Air

Teh Hijau

Daun teh kering

Air

Air Mineral

Air

Fuyung Hai

Jus Nanas
Air Mineral (ml)
Corovit Kaplet
Vitacimin C
Natur E 100 IU
Air mineral

Nasi Campur

Good day Carebian Nut

Jamu Kunir Asem

Air Mineral

Bahan Makanan

Telur
Tepung Terigu
Ayam
Wortel
Nanas
Susu Kental Mns
Air
Air
Air
Nasi Putih
Buncis
Tahu
Telur
mie
wortel
Minyak Klp swt
Kopi
Air
Kunyit
Asam
Jeruk Nipis
Gula Jawa
Air

1 gelas
3/5 gelas
2/5 gelas
3 sendok
3/4 gelas
1 gelas
3/4 gelas
1 butir
3/2 sendok
3/5 potong
5 sendok
1/2 buah
2 sendok
1 gelas
1 gelas
1 tablet
1 tablet
1 tablet
1 gelas
1 mangkok
1/5 ikat
1 bh kecil
1 butir
1 sendok
1 /10 buah
3 sendok
1 sachet
1 gelas
1 buah
5 sendok
4 sendok
4 sendok
3/4 gelas

Bahan Makanan
Banyaknya
250gr
150 gr
100 gr
30 gr
200 gr
250 gr
200 gr
50 gr
15 gr
30 gr
50 gr
50 gr
20 gr
250 gr
250
10 gr
10 gr
10 gr
250 gr
100 gr
10 gr
10 gr
50 gr
10 gr
10 gr
30 gr
30 gr
250 gr
50gr
50gr
20gr
40 gr
200 gr

No

Menu

Ingredients

1
2
3

Minum Air mineral

Air

Teh Hijau

daun teh krg

Air

5
6

Minum Air mineral

Air

Fuyung Hai

Jus Nanas

9 Minum Air mineral

10 Suplemen Multivit
11 Suplemen Vit C
12 Natur E 100 IU
13 Air Mineral
14

Nasi Campur

14

GoodDay Carebian N

15

Jamu Kunir Asem

16 Minum Air mineral

TOTAL

1.
2.
3.
4

Tepung Terigu
Telur Ayam
Ayam
Wortel
Nanas
Susu Kental Manis
Air
Air
1 kaplet salut gula
Air
Nasi Putih
Buncis
Tahu
Telur Ayam
Minyak klp swt
Kopi
gula
Air
Air
Kunyit
Asem
Gula Jawa
Jeruk Nipis
Air

PERSENTASE Konsumsi
KARBOHIIDRAT
44.4211655571
PROTEIN
16.134793172
LEMAK
39.4440412709
Konsumsi Air
1650

Amount (gr)
250
150
100
30
200
250
200
15
50
30
50
50
20
250
250

Karbohidrat
per 100 BDD
gr food
0
0
0
0
0
0
53.6
16.08
0
0
0
0
0
0
77.2
11.58
0.7
0.35
0
0
7.9
3.95
9.9
4.95
55
11
0
0
0
0

10

0
0
250
100
10
150
50
30
20
10
200
200
50
50
40
20
200
3285

0
0
0
39.8
7.2
0
0.7
0
16
94
0
0
9.1
62.5
92
10
0

Yang dianjurkan
55
15
30
2300

0
0
0
39.8
0.72
0
0.35
0
3.2
9.4
0
0
4.55
31.25
36.8
2
0
175.98

kkal

Protein
gr food
0
0
0
0
0
28.3
8.49
0
0
0
0
0
0
9
1.35
12.4
6.2
18.2
5.46
1
0.5
0.6
0.3
8.2
1.64
0
0
0
0

per 100 BDD

0
0
0
64.32
0
0
0
46.32
1.4
0
15.8
19.8
44
0
0
-

0
0
0
159.2
2.88
0
1.4
0
12.8
37.6
0
0
18.2
125
147.2
8
0
703.92

0
0
0
3
0.3
18.7
12.4
0
1
0
0
0
2
2.8
0
0.5
0

0
0
0
3
0.03
28.05
6.2
0
0.2
0
0
0
1
1.4
0
0.1
0
63.92

kkal
0
0
0
33.96
0
0
0
5.4
24.8
21.84
2
1.2
6.56
0
0
-

0
0
0
12
0.12
112.2
24.8
0
0.8
0
0
0
4
5.6
0
0.4
0
255.68

* suplemen multivitamin yang dikonsumsi adalah Corovit Kaplet

*Suplemen Vitamin C yang dikonsumsi bermerek Vitacimin C
*Natur E 100 IU merupakan suplemen vitamin E

FOOD RECALL KEDUA

Lemak
gr food

per 100 BDD

0
0

0
0
0
14.4
0
0
0
0.15
5.4
7.5
0.3
0.15
2
0
0

48
0
0
0
1
10.8
25
0.6
0.3
10
0
0
-

0
0
0
0.3
2.6
1
10.8
100
2
0
0
0
2.7
0.6
0
0.2
0

0
0
0
0.3
0.26
1.5
5.4
30
0.4
0
0
0
1.35
0.3
0
0.04
0
69.45

FOOD RECALL KEDUA

Lemak
kkal

Total kkal

0
0
0
129.6
0
0
0
1.35
48.6
67.5
2.7
1.35
18
0
0

0
0
0
227.88
0
0
0
53.07
74.8
89.34
20.5
22.35
68.56
0
0

0
0
0
2.7
2.34
13.5
48.6
270
3.6
0
0
0
12.15
2.7
0
0.36
0
625.05

0
0
0
173.9
5.34
125.7
74.8
270
17.2
37.6
0
0
34.35
133.3
147.2
8.76
0
1584.65

Ca

Ca food
0
0
0
245
0
0
0
22
86
14
45
22
275
0
0
5
0
0
0
25
101
96
86
0
0
5
0
0
24
74
76
18
0

0
0
0
73.5
0
0
0
3.3
43
4.2
22.5
11
55
0
0
5
0
0
0
25
10.1
144
43
0
0
0.5
0
0
12
37
30.4
3.6
0
523.1

Fe
0
0
0
18.9
0
0
0
1.3
3
1.5
1
0.9
0.2
0
0
0
0
0
0.4
1.1
1.5
3
0
0
0.1
0
0
3.3
0.6
3
0.2
0

Fe food
0
0
0
5.67
0
0
0
0.195
1.5
0.45
0.5
0.45
0.04
0
0
0
0
0
0.4
0.11
2.25
1.5
0
0
0.01
0
0
1.65
0.3
1.2
0.04
0
16.265

Zn

zn food

karoten total

karoten total food

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
104
0
7125
90

0
0
0
0
0
0
0
0
52
0
3562.5
45

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
550
5
104
0
0
0
0
0
0
30
0
4
0

0
0
1800
0
0
0
0
55
7.5
52
0
0
0
0
0
0
15
0
0.8
0
5589.8

thiamin
0
0
0
0.38
0
0
0
0.1
0.12
0.08
0.04
0.02
0.05
0
0
0
0
0
0.05
0.05
0.03
0.12
0
0
0
0
0
0.03
0.34
0
0.01
0

thiamin food
0
0
0
0.114
0
0
0
0.015
0.06
0.024
0.02
0.01
0.01
0
0
3
0
0
0
0.05
0.005
0.045
0.06
0
0
0
0
0
0.015
0.17
0
0.002
0
3.6

riboflavin

riboflavin food
0
0
0
1.24
0
0
0
0.07
0.38
0
0.04
0
0
0
0
0
0
0
0
0.4
0
0.38
0
0
0
0
0
0
0
0
0
0

0
0
0
0.372
0
0
0
0.0105
0.19
0
0.02
0
0
0
0
3
0
0
0
0
0.04
0
0.19
0
0
0
0
0
0
0
0
0
0
3.8225

niacin
0
0
0
4.6
0
0
0
1
0
0
1
0
0
0
0
0
0
0
0
2.8
0
0
0
0
0
0
0
0
0
0
0
0

niacin food
0
0
0
1.38
0
0
0
0.15
0
0
0.5
0
0
0
0
20
0
0
0
0
0.28
0
0
0
0
0
0
0
0
0
0
0
0
22.31

Vitamin C
0
0
0
230
0
0
0
0
0
0
18
22
0
0
0
500
0
0
0
11
0
0
0
0
0
0
0
1
2
0
19.7
0

vitamin C food
0
0
0
69
0
0
0
0
0
0
9
11
0
0
0
75
500
0
0
0
1.1
0
0
0
0
0
0
0
0.5
1
0
3.94
0
670.54