Cm
Umur : .............................................................. BB................Kg
IMT (Indeks Masa Tubuh) :............................................................
Kebutuhan Gizi Sehari :
Kalori : Kkal Lemak : gram
DIET
Protein: gram Karbohidrat : gram
Nasi /pengganti :
Berat(gr) * URT
...................... .......................
HIPERTENSI
Hewani/nabati : ...................... ....................... Contoh Menu
Sayuran : ...................... .......................
Minyak : ...................... ....................... Pagi Siang Malam
Gula pasir : ...................... ....................... Nasi NasiNasi
Telur bumbu Ikan pepesAyam bakar Sambal goreng
Selingan Jam 10.00 : balado keringOseng-oseng tahu tempedan cabe
................................................................................................................ Tumis buncis hijau Sayur bening bayamCah sayuran
Buah: pepayaBuah: jeruk manis
Siang Jam 12.00 – 13.00 :
Nasi /pengganti: ...................... .......................
Hewani: ...................... ....................... Jam 10.00
Nabati: ...................... ....................... (Selingan) Pukul 21.00
....................... Jus buah
Sayuran: ...................... ....................... Crackers tawar
Buah: ...................... ....................... atau buah
Minyak: ......................