Cm
Um ur : .............................................................. BB : ................ Kg
IMT (Inde ks Masa Tubuh) :............................................................
Kementerian Kesehatan RI
Ke butuhan Gizi Se hari : 2011
Kalori : Kkal Le m ak : gram
Prote in: gram Karbohidrat : gram
Nasi / pe ngganti
Be rat(gr)
: ......................
* URT
.......................
PENYAKIT
He wani/ nabati : ...................... .......................
Sayuran
Minyak
Gula pasir
: ......................
: ......................
: ......................
.......................
.......................
.......................
Pagi
Contoh Me nu Se hari
Siang Malam
LAMBUNG
Nasi Tim Nasi Tim Nasi Tim
Se lingan Jam 10.00 : Te lur Dadar Se m ur daging Ikan panggang
................................................................................................................ Se tup Worte l Tim Tahu bum bu tom at
Te h m anis e nce r Sayur Be ning Tum is Te m pe
Siang Jam 12.00 – 13.00 : Pe paya Se tup Buncis
Nasi / pe ngganti : ...................... ....................... Pisang
He wani : ...................... ....................... Se lingan Se lingan
Nabati : ...................... ....................... Snack Snack Se lingan
Sayuran : ...................... ....................... Biskuit Poeding Susu
Buah : ...................... ....................... Susu re ndah - Susu
Minyak : ...................... ....................... le m ak
SUMBER LEMAK Margarin, minyak, santan encer Santan kental, lemak hewan, minyak untuk
m e nggore ng