Cm
Umur : .............................................................. BB ............... Kg
IMT (Indeks Masa Tubuh) :............................................................
Kebutuhan Gizi Sehari :
DIET
Kalori : Kkal Lemak : gram TINGGI KALORI
Protein: gram Karbohidrat : gram TINGGI PROTEIN
PEMBAGIAN MAKANAN SEHARI (TKTP)
Malam
SelinganJam Jam18.00 16.00– :19.00
Nasi /pengganti : ...................... .......................
................................................................................................................
Hewani : ...................... .......................
Nabati : ...................... .......................
Sayuran : ...................... .......................
Buah : ...................... .......................
Minyak : ...................... .......................