Lampiran 2
Penentuan Gizi Penderita dan Jumlah Kalori Perhari
BBR % =
BB =
Berat Badan ( kg )
TB =
Tinggi Badan ( cm )
BBR =
Berat Badan Relatif
Kebutuhan kalori/hari untuk menuju berat
badan normal :
1. Berat Badan
Kurang ( BBR < 90 % ) kebutuhan kalori sehari : 40 – 60 kalori / kg BB.
2. Berat Badan
Normal ( BBR 90 – 100 % ) kebutuhan kalori sehari : 30 kalori / kg BB.
3. Berat Badan Lebih
( BBR > 110 % ) kebutuhan kalori sehari : 20 kalori / kg BB.
4. Gemuk = obesitas
( BBR > 120 % ) kebutuhan kalori sehari : 15 kalori / kg BB.
Lampiran 3
Diet G ( Diet DM B 1 untuk DM dengan Gangren )
Karbohidrat : 60 %, protein : 20 %, Lemak : 20 %
Diet G mempunyai
6 sifat yaitu : dengan kandungan :
1.
Kolestrol kurang dari 300 mg/hari dan dilengkapi
dengan,
2.
Tinggi arginin
3.
Tinggi serat ( 25 – 40 g/hari )
4.
Folat
5.
Vitamin B6
6.
Vitamin B12
Standart
|
|
Nama Bahan
|
Pagi
|
Siang
|
Sore
|
Snack
|
DM I
|
|
|
|
|
|
|
Energi
|
1087.2 kalori
|
Nasi
|
50 gr
|
50 gr
|
50 gr
|
09.30 kacang hijau 25 gr
|
Protein
|
55,1 gr
|
Daging
|
25 gr
|
25 gr
|
25 gr
|
|
Lemak
|
26.7 gr
|
Tempe
|
25 gr
|
50 gr
|
50 gr
|
|
Karbohidrat
|
160 gr
|
Sayuran A
|
100 gr
|
100 gr
|
100 gr
|
15.30 kacang hijau 25 gr
|
ARGININ
|
2423,5 mgr
|
Sayuran B
|
25 gr
|
50 gr
|
50 gr
|
|
Asam Folat
|
689,5
|
Minyak jagung
|
2,5 gr
|
2,5 gr
|
2,5 gr
|
|
Serat
|
11,9 gr
|
|
|
|
|
21.30 pisang 150 gr
|
Kolestrol
|
52,5 mgr
|
|
|
|
|
|
LTJG
|
4,8
|
|
|
|
|
|
LJ
|
5
|
|
|
|
|
|
P / S
|
1
|
|
|
|
|
|
Standart
|
|
Nama Bahan
|
Pagi
|
Siang
|
Sore
|
Snack
|
DM II
|
|
|
|
|
|
|
Energi
|
1323 kalori
|
Nasi
|
50 gr
|
75 gr
|
75 gr
|
09.30 kacang hijau 25 gr,
pisang 75 gr
|
Protein
|
63,3 gr
|
Daging
|
25 gr
|
25 gr
|
25 gr
|
|
Lemak
|
30,5 gr
|
Tempe
|
25 gr
|
50 gr
|
25 gr
|
|
Karbohidrat
|
208,1 gr
|
Sayuran A
|
100 gr
|
100 gr
|
100 gr
|
15.30 kacang hijau 25 gr,
pisang 75 gr
|
ARGININ
|
3239 mgr
|
Sayuran B
|
25 gr
|
50 gr
|
50 gr
|
|
Asam Folat
|
521
|
Minyak jagung
|
2,5 gr
|
5 gr
|
2,5 gr
|
|
Serat
|
11,9 gr
|
|
|
|
|
21.30 susu skim 25 gr,
pisang 75 gr
|
Kolestrol
|
52,5 mgr
|
|
|
|
|
|
LTJG
|
6,3
|
|
|
|
|
|
LJ
|
5,4
|
|
|
|
|
|
P / S
|
1,2
|
|
|
|
|
|
Standart
|
|
Nama Bahan
|
Pagi
|
Siang
|
Sore
|
Snack
|
DM III
|
|
|
|
|
|
|
Energi
|
1529,3 kalori
|
Nasi
|
75 gr
|
100 gr
|
100 gr
|
09.30 kacang hijau 25 gr,
pisang 75 gr
|
Protein
|
71,55 gr
|
Daging
|
25 gr
|
25 gr
|
25 gr
|
|
Lemak
|
33,7 gr
|
Tempe
|
50 gr
|
50 gr
|
50 gr
|
|
Karbohidrat
|
243,6 gr
|
Sayuran A
|
100 gr
|
100 gr
|
100 gr
|
15.30 kacang hijau 25 gr,
pisang 75 gr
|
ARGININ
|
3981 mgr
|
Sayuran B
|
25 gr
|
50 gr
|
50 gr
|
|
Asam Folat
|
756,3
|
Minyak jagung
|
2,5 gr
|
5 gr
|
2,5 gr
|
|
Serat
|
13,05 gr
|
|
|
|
|
21.30 susu skim 25 gr,
pisang 75 gr
|
Kolestrol
|
52,5 mgr
|
|
|
|
|
|
LTJG
|
6,5
|
|
|
|
|
|
LJ
|
5,6
|
|
|
|
|
|
P / S
|
1,2
|
|
|
|
|
|
Standart
|
|
Nama Bahan
|
Pagi
|
Siang
|
Sore
|
Snack
|
DM IV
|
|
|
|
|
|
|
Energi
|
1701.75 kalori
|
Nasi
|
75 gr
|
100 gr
|
100 gr
|
09.30 kacang hijau 25 gr,
pisang 100gr
|
Protein
|
81,7 gr
|
Daging
|
25 gr
|
50 gr
|
50 gr
|
|
Lemak
|
40,8 gr
|
Tempe
|
50 gr
|
50 gr
|
50 gr
|
|
Karbohidrat
|
261,6gr
|
Sayuran A
|
100 gr
|
100 gr
|
100 gr
|
15.30 kacang hijau 25 gr,
pisang 100 gr
|
ARGININ
|
4549 mgr
|
Sayuran B
|
25 gr
|
50 gr
|
50 gr
|
|
Asam Folat
|
787,8
|
Minyak jagung
|
2,5 gr
|
5 gr
|
2,5 gr
|
|
Serat
|
13,5 gr
|
|
|
|
|
21.30 susu skim 25 gr,
pisang 100 gr
|
Kolestrol
|
87,5 mgr
|
|
|
|
|
|
LTJG
|
6,7
|
|
|
|
|
|
LJ
|
8,1
|
|
|
|
|
|
P / S
|
0,8
|
|
|
|
|
|
Standart
|
|
Nama Bahan
|
Pagi
|
Siang
|
Sore
|
Snack
|
DM V
|
|
|
|
|
|
|
Energi
|
1978 kalori
|
Nasi
|
100 gr
|
150 gr
|
150 gr
|
09.30 kacang hijau 25 gr,
pisang 100gr
|
Protein
|
90,1gr
|
Daging
|
50 gr
|
50 gr
|
50 gr
|
|
Lemak
|
42,7 gr
|
Tempe
|
50 gr
|
50 gr
|
50 gr
|
|
Karbohidrat
|
311,4 gr
|
Sayuran A
|
100 gr
|
100 gr
|
100 gr
|
15.30 kacang hijau 25 gr,
pisang 100 gr
|
ARGININ
|
5119 mgr
|
Sayuran B
|
25 gr
|
50 gr
|
50 gr
|
|
Asam Folat
|
803,3
|
Minyak jagung
|
2,5 gr
|
5 gr
|
2,5 gr
|
|
Serat
|
13,7 gr
|
|
|
|
|
21.30 susu skim 25 gr,
pisang 100 gr
|
Kolestrol
|
105 mgr
|
|
|
|
|
|
LTJG
|
6,7
|
|
|
|
|
|
LJ
|
9,5
|
|
|
|
|
|
P / S
|
0,7
|
|
|
|
|
|
Standart
|
|
Nama Bahan
|
Pagi
|
Siang
|
Sore
|
Snack
|
DM VI
|
|
|
|
|
|
|
Energi
|
2151,3 kalori
|
Nasi
|
100 gr
|
150 gr
|
150 gr
|
09.30 kacang hijau 25 gr,
pisang 125gr
|
Protein
|
100,3 gr
|
Daging
|
50 gr
|
75 gr
|
75 gr
|
|
Lemak
|
56,3 gr
|
Tempe
|
50 gr
|
50 gr
|
50 gr
|
|
Karbohidrat
|
329,4 gr
|
Sayuran A
|
100 gr
|
100 gr
|
100 gr
|
15.30 kacang hijau 25 gr,
pisang 125 gr
|
ARGININ
|
5687 mgr
|
Sayuran B
|
25 gr
|
50 gr
|
50 gr
|
|
Asam Folat
|
855,8
|
Minyak jagung
|
2,5 gr
|
5 gr
|
2,5 gr
|
|
Serat
|
14,2 gr
|
|
|
|
|
21.30 susu skim 25 gr,
pisang 125 gr
|
Kolestrol
|
140 mgr
|
|
|
|
|
|
LTJG
|
9,7
|
|
|
|
|
|
LJ
|
12,6
|
|
|
|
|
|
P / S
|
0,8
|
|
|
|
|
|
Standart
|
|
Nama Bahan
|
Pagi
|
Siang
|
Sore
|
Snack
|
DM VII
|
|
|
|
|
|
|
Energi
|
2333,3 kalori
|
Nasi
|
100 gr
|
175 gr
|
175 gr
|
09.30 kacang hijau 25 gr,
pisang 150gr
|
Protein
|
109,3gr
|
Daging
|
50 gr
|
75 gr
|
75 gr
|
|
Lemak
|
53,1 gr
|
Tempe
|
50 gr
|
50 gr
|
50 gr
|
|
Karbohidrat
|
343,7 gr
|
Sayuran A
|
100 gr
|
100 gr
|
100 gr
|
15.30 kacang hijau 25 gr,
pisang 150 gr
|
ARGININ
|
5851 mgr
|
Sayuran B
|
25 gr
|
50 gr
|
50 gr
|
|
Asam Folat
|
861,25
|
Minyak jagung
|
2,5 gr
|
5 gr
|
2,5 gr
|
|
Serat
|
14,9 gr
|
|
|
|
|
21.30 susu skim 25 gr,
pisang 175 gr
|
Kolestrol
|
140 mgr
|
|
|
|
|
|
LTJG
|
6,91
|
|
|
|
|
|
LJ
|
11,8
|
|
|
|
|
|
P / S
|
1,7
|
|
|
|
|
|
Standart
|
|
Nama Bahan
|
Pagi
|
Siang
|
Sore
|
Snack
|
DM VIII
|
|
|
|
|
|
|
Energi
|
2547,5 kalori
|
Nasi
|
175 gr
|
200 gr
|
200 gr
|
09.30 kacang hijau 25 gr,
pisang 150gr
|
Protein
|
118,25gr
|
Daging
|
50 gr
|
75 gr
|
75 gr
|
|
Lemak
|
61,5 gr
|
Tempe
|
50 gr
|
75 gr
|
75 gr
|
|
Karbohidrat
|
391 gr
|
Sayuran A
|
100 gr
|
100 gr
|
100 gr
|
15.30 kacang hijau 25 gr,
pisang 150 gr
|
ARGININ
|
6685,4 mgr
|
Sayuran B
|
25 gr
|
50 gr
|
50 gr
|
|
Asam Folat
|
953
|
Minyak jagung
|
5 gr
|
5 gr
|
5 gr
|
|
Serat
|
21,43 gr
|
|
|
|
|
21.30 susu skim 25 gr,
pisang 175 gr
|
Kolestrol
|
140 mgr
|
|
|
|
|
|
LTJG
|
10,18
|
|
|
|
|
|
LJ
|
12,97
|
|
|
|
|
|
P / S
|
0,8
|
|
|
|
|
|
.
Standart
|
|
Nama Bahan
|
Pagi
|
Siang
|
Sore
|
Snack
|
DM IX
|
|
|
|
|
|
|
Energi
|
2702,9 kalori
|
Nasi
|
175 gr
|
225 gr
|
225 gr
|
09.30 kacang hijau 25 gr,
pisang 150gr
|
Protein
|
83,7gr
|
Daging
|
25 gr
|
50 gr
|
50 gr
|
|
Lemak
|
63,6 gr
|
Tempe
|
25 gr
|
50 gr
|
50 gr
|
|
Karbohidrat
|
466,1 gr
|
Sayuran A
|
100 gr
|
100 gr
|
100 gr
|
15.30 kacang hijau 25 gr,
pisang 150 gr
|
ARGININ
|
5211,5 mgr
|
Sayuran B
|
25 gr
|
50 gr
|
50 gr
|
|
Asam Folat
|
706,3
|
Minyak jagung
|
10 gr
|
12,5 gr
|
10 gr
|
|
Serat
|
15,7 gr
|
|
|
|
|
21.30 pisang 325 gr
|
Kolestrol
|
87,5mgr
|
|
|
|
|
|
LTJG
|
19,9
|
|
|
|
|
|
LJ
|
11,4
|
|
|
|
|
|
P / S
|
1,7
|
|
|
|
|
|
Standart
|
|
Nama Bahan
|
Pagi
|
Siang
|
Sore
|
Snack
|
DM X
|
|
|
|
|
|
|
Energi
|
2925,1 kalori
|
Nasi
|
175 gr
|
250 gr
|
250 gr
|
09.30 kacang hijau 25 gr,
pisang 175gr
|
Protein
|
89,7 gr
|
Daging
|
50 gr
|
50 gr
|
50 gr
|
|
Lemak
|
67,5 gr
|
Tempe
|
25 gr
|
50 gr
|
50 gr
|
|
Karbohidrat
|
500,98 gr
|
Sayuran A
|
100 gr
|
100 gr
|
100 gr
|
15.30 kacang hijau 25 gr,
pisang 175 gr
|
ARGININ
|
5619,5 mgr
|
Sayuran B
|
25 gr
|
50 gr
|
50 gr
|
|
Asam Folat
|
713,5
|
Minyak jagung
|
10 gr
|
12,5 gr
|
10 gr
|
|
Serat
|
16,21 gr
|
|
|
|
|
21.30 pisang 350 gr
|
Kolestrol
|
105 mgr
|
|
|
|
|
|
LTJG
|
20,8
|
|
|
|
|
|
LJ
|
12,8
|
|
|
|
|
|
P / S
|
1,6
|
|
|
|
|
|
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