Cm
Umur : .............................................................. BB : ................ Kg
IMT (Indeks Masa Tubuh) :............................................................
RS Bhayangkara Padang
Kebutuhan Gizi Sehari :
DIET
Kalori : Kkal Lemak : gram
Protein: gram Karbohidrat : gram
Nasi /penggant :
Berat(gr)
......................
* URT
.......................
RENDA
Hewani/nabat
Sayuran
Minyak
:
:
:
......................
......................
......................
.......................
.......................
.......................
Pagi
Contoh Menu
Siang Malam
H
PURIN
Gula pasir : ...................... .......................
Nasi Nasi Nasi
Selingan Jam 10.00 : Telur dadar isi Ikan bakar saos kecap Semur daging
................................................................................................................ wortel dan (1/2 potong) Pepes tahu
tomat Tempe bacem Tumis sawi dan
Teh manis (1 potong kecil) tomat
Siang Jam 12.00 – 13.00 :
Sayur sop Buah pisang
Nasi /penggant : ...................... .......................
Buah jeruk ambon
Hewani : ...................... ....................... Jam 10.00
Nabat : ...................... ....................... (Selingan)
Sayuran : ...................... ....................... Semangka
Buah : ...................... .......................
Minyak : ...................... .......................