Cm
Umur : .............................................................. BB : ................ Kg
IMT (Indeks Masa Tubuh) :............................................................
Kebutuhan Gizi Sehari :
Kalori : Kkal Lemak : gram
Protein: gram
Nasi /penggant :
Berat(gr)
......................
* URT
.......................
HIPERTEN
Hewani/nabat : ...................... ....................... Contoh Menu
Sayuran : ...................... .......................
Minyak :
Pagi Malam
...................... ....................... Siang
Gula pasir : ...................... .......................
Nasi Nasi Nasi
Selingan Jam 10.00 : Telur bumbu Ikan pepes Ayam bakar
................................................................................................................ balado Sambal goreng kering Oseng-oseng
Tumis buncis tahu tempe dan cabe hijau
Siang Jam 12.00 – 13.00 : Sayur bening bayam Cah sayuran
Nasi /penggant : ...................... ....................... Buah: pepaya Buah: jeruk
: ...................... Jam 10.00 manis
Hewani .......................
(Selingan)
Nabat : ...................... ....................... Pukul 21.00
Jus buah
Sayuran : ...................... ....................... Crackers tawar
Buah : ...................... ....................... atau buah
Minyak : ...................... .......................
Selingan Jam 16.00 :
................................................................................................................