Cm
Umur : .............................................................. BB : ................ Kg
IMT (Indeks Masa Tubuh) :............................................................
Kebutuhan Gizi Sehari :
Kalori : Kkal Lemak : gram
Protein: gram Karbohidrat : gram
DIET
PEMBAGIAN MAKANAN SEHARI
Siang Malam
LAMBUNG
Gula pasir : ...................... .......................
Nasi Tim Nasi Tim Nasi Tim
Telur Dadar Semur daging Ikan panggang
Selingan Jam 10.00 :
Setup Wortel Tim Tahu bumbu tomat
................................................................................................................
Teh manis encer Sayur Bening Tumis Tempe
Pepaya Setup Buncis
Siang Jam 12.00 – 13.00 : Pisang
Nasi /pengganti : ...................... ....................... Selingan Selingan
Hewani : ...................... ....................... Snack Snack Selingan
Nabati : ...................... ....................... Biskuit Poeding Susu
Sayuran : ...................... ....................... Susu rendah - Susu
Buah : ...................... ....................... lemak
Minyak : ...................... .......................