Lampiran 1

MENU IX
Nama : Ny.D
Diagnosa : DM + Sepsis + Ulkus pedis

Protein (g) Vit. Natriu

Energi Lemak H A Ca Fosfor Fe Vit. A Vit. C
Waktu Menu Bahan Makanan Berat B1 m
(Kcal) Hewani Nabati (g) (g) (mg) (mg) (mg) (SI) (mg)
(mg) (mg)
makan pagi Bubur Beras giling 60 216.0 0.0 4.1 0.4 47.3 3.6 84.0 0.5 0.0 0.1 0.0 3.0
Ayam pelalah Ayam 60 181.2 12.0 0.0 15.0 0.0 8.4 120.0 0.9 486.0 0.0 0.0 60.0
Tempe bb woku Tempe kedele murni 30 44.7 0.0 5.5 1.2 3.8 38.7 46.2 3.0 15.0 0.1 0.0 0.0
Extra Putel Telur ayam bagian put 40 20.0 4.3 0.0 0.0 0.3 2.4 6.8 0.1 0.0 0.0 0.0 0.0
Oseng kacang panjangKacang panjang 65 28.6 0.0 4.5 0.5 5.1 31.9 225.6 0.5 217.8 0.1 13.7 3.4
Wortel 65 27.3 0.0 1.2 0.5 6.0 25.4 24.1 0.5 7800.0 0.0 3.9 45.5
Minyak kelapa sawit 5 45.1 0.0 0.0 5.0 0.0 0.0 0.0 0.0 3000.0 0.0 0.0 0.0

Snack Pagi Talam labu kuning Labu waluh 40 11.6 0.0 0.6 0.1 2.6 18.0 25.6 0.6 72.0 0.0 20.8 0.0
Tepung terigu 10 36.5 0.0 1.0 0.1 7.7 1.6 10.6 0.1 0.0 0.0 0.0 0.2
Tepung beras 10 36.4 0.0 0.8 0.1 8.0 0.5 14.0 0.1 0.0 0.0 0.0 0.0
Susu Diabetasol 25 108.3 4.2 0.0 2.9 16.3 45.0 35.0 22.0 234.0 23.0 4.0 5.0

Makan Siang Bubur Beras giling 70 252.0 0.0 4.8 0.5 55.2 4.2 98.0 0.6 0.0 0.1 0.0 3.5
Fuyunghai + saos Telur ayam 50 81.0 6.4 0.0 4.8 0.4 27.0 90.0 1.4 450.0 0.1 0.0 79.0
Tomat masak 10 2.0 0.0 0.2 0.0 0.4 0.5 2.7 0.1 150.0 0.0 4.0 0.4
Noodle tahu kukus Mie basah 40 34.4 0.0 0.5 0.8 5.6 5.6 5.2 0.3 0.0 0.0 0.0 0.0
Tahu 40 27.2 0.0 3.1 1.0 0.6 49.6 25.2 0.3 0.0 0.0 0.0 4.8
Cap cay Wortel 50 21.0 0.0 1.0 0.2 4.7 19.5 18.5 0.4 6000.0 0.0 3.0 35.0
Kol kembang 50 12.5 0.0 2.5 0.1 2.5 11.0 36.0 0.6 45.0 0.1 34.5 15.0
Kacang kapri ( biji seg 50 49.0 0.0 4.4 0.1 8.9 11.0 61.0 1.0 340.0 0.2 13.0 5.5
Minyak kelapa sawit 8 72.2 0.0 0.0 8.0 0.0 0.0 0.0 0.0 4800.0 0.0 0.0 0.0
 Buah Pisang ambon 150 148.5 0.0 1.8 0.3 38.7 12.0 42.0 0.8 219.0 0.1 4.5 27.0

Sanck Sore Buah Apel 150 87.0 0.0 0.7 0.4 22.4 9.0 15.0 15.5 135.0 0.1 7.5 3.0
Susu Diabetasol 25 108.3 4.2 0.0 2.9 16.3 45.0 35.0 22.0 234.0 23.0 4.0 5.0

Makan Malam Bubur Beras giling 60 216.0 0.0 4.1 0.4 47.3 3.6 84.0 0.5 0.0 0.1 0.0 3.0
Daging bistik Daging sapi 50 103.5 10.0 0.0 5.0 0.0 5.5 85.0 1.4 15.0 0.0 0.0 46.5
Tempe bb kemiri Tempe kedele murni 50 74.5 0.0 9.2 2.0 6.4 64.5 77.0 5.0 25.0 0.1 0.0 0.0
Extra Putel Telur ayam bagian put 40 20.0 4.3 0.0 0.0 0.3 2.4 6.8 0.1 0.0 0.0 0.0 0.0
Cah wortel, gambas Wortel 75 31.5 0.0 1.2 0.2 7.0 29.3 27.8 0.6 9000.0 0.0 4.5 52.5
Gambas/oyong 75 13.5 0.0 0.8 0.2 3.1 14.3 24.8 0.7 285.0 0.0 6.0 33.2
Minyak kelapa sawit 8 72.2 0.0 0.0 8.0 0.0 0.0 0.0 0.0 4800.0 0.0 0.0 0.0
Buah Pepaya 100 46.0 0.0 0.5 0.0 12.2 23.0 12.0 1.7 365.0 0.0 78.0 4.0

Snack Malam Schutel makaroni Makaroni 40 145.2 0.0 5.5 0.2 31.5 8.0 32.0 0.1 0.0 0.0 0.0 1.2
Susu sapi 10 6.1 0.3 0.0 0.4 0.4 14.3 6.0 0.2 13.0 0.0 0.1 0.0
Keju 10 32.6 4.3 0.0 0.6 1.3 77.7 33.8 0.2 75.0 0.0 0.1 0.0
Susu Susu skim 25 9.0 0.9 0.0 0.0 1.3 30.8 24.3 0.0 0.0 0.0 0.3 9.5
Total Asupan 2082.0 106.5 45.6 312.6 608.1 1379.8 78.8 28591.8 47.1 119.3 414.2
makan pagi Bubur Beras giling 60 216.0 0.0 4.1 0.4 47.3 3.6 84.0 0.5 0.0 0.1 0.0 3.0
ke X Telur ayam bb sarden Telur ayam 60 97.2 6.4 0.0 5.8 0.4 32.4 108.0 1.6 540.0 0.1 0.0 94.8
Tomat masak 10 2.0 0.0 0.5 0.0 0.4 0.5 2.7 0.1 150.0 0.0 4.0 0.4
Sarang lebah tahu kukuTahu 30 20.4 0.0 2.3 1.4 0.5 37.2 18.9 0.2 0.0 0.0 0.0 3.6
Wortel 5 2.1 0.0 0.1 0.0 0.5 2.0 1.9 0.0 600.0 0.0 0.3 3.5
Tumis kangkung Kangkung 70 20.3 0.0 2.1 0.2 3.8 51.1 35.0 1.8 4410.0 0.0 2.1 45.5
Taoge Kacang Hijau 60 36.5 0.0 4.0 3.0 2.9 20.4 49.2 0.7 0.6 1.8 0.1 4.8
Minyak kelapa sawit 10 90.2 0.0 0.0 10.0 0.0 0.0 0.0 0.0 6000.0 0.0 0.0 0.0

Snack Pagi Nagasari mutiara Tepung hunkkwe 10 36.4 0.0 0.5 0.1 8.4 5.0 10.0 0.1 0.0 0.0 0.0 0.0
ke X Tepung sagu 40 141.2 0.0 0.2 0.1 33.9 4.4 5.2 0.6 0.0 0.0 0.0 0.0
Susu Diabetasol 25 108.3 4.2 0.0 2.9 16.3 45.0 35.0 22.0 234.0 23.0 4.0 5.0
NU IX
Jenis Kelamin : Perempuan
Umur : 40 tahun

Kalium Coles Serat AIR

(mg) (mg) (mg) (ml)

60.0 0.0 1.2 7.8

210.0 36.0 0.0 33.5
0.0 0.0 2.1 19.2
0.0 0.0 0.0 35.1
36.0 0.0 4.4 57.5
159.3 0.0 3.3 57.3
0.0 0.0 0.0 0.0

0.0 0.0 0.0 36.5

40.0 0.0 0.2 1.2
0.0 0.0 0.0 1.2
142.0 0.0 2.0 0.0

70.0 0.0 1.4 9.1

89.0 275.0 0.0 37.0
23.5 0.0 0.8 9.4
0.0 0.0 0.0 32.0
60.4 0.0 0.2 33.9
122.5 0.0 2.5 44.1
174.5 0.0 3.3 45.9
147.5 0.0 2.5 37.2
0.0 0.0 0.0 0.0
651.0 0.0 4.5 108.0

195.0 0.0 1.1 126.2

142.0 0.0 2.0 0.0

60.0 0.0 1.2 7.8

244.5 35.0 0.0 33.0
0.0 0.0 3.5 32.0
0.0 0.0 0.0 35.1
183.8 0.0 3.8 66.2
106.1 0.0 2.3 70.9
0.0 0.0 0.0 0.0
221.0 0.0 2.5 86.7

52.8 0.0 0.2 4.7

0.0 0.0 0.0 8.8
0.0 10.0 0.0 3.9
37.3 0.0 0.0 22.6
2356.0 356.0 37.7 909.0
60.0 0.0 1.2 7.8
106.8 330.0 0.0 44.4
23.5 0.0 0.8 9.4
45.3 0.0 0.2 25.4
12.3 0.0 0.3 4.4
54.6 0.0 0.8 62.8
4.2 145.2 0.0 0.2
0.0 0.0 0.0 0.0

0.0 0.0 0.0 1.0

0.0 0.0 0.2 5.6
142.0 0.0 2.0 0.0
Lampiran 1
MENU IX
Nama : Ny.D Jenis Kelamin : Perempuan
Diagnosa : DM + Sepsis + Ulkus pedis Umur : 40 tahun

Protein (g) Vit.

Energi Lemak H A Ca Fosfor Fe Vit. A Vit. C Natriu Kalium Coles Serat AIR
Waktu Menu Bahan Makanan Berat B1
(Kcal) Hewani Nabati (g) (g) (mg) (mg) (mg) (SI) (mg) m (mg) (mg) (mg) (mg) (ml)
(mg)
Makan Siang Bubur Beras giling 70 252.0 0.0 4.8 0.5 55.2 4.2 98.0 0.6 0.0 0.1 0.0 3.5 70.0 0.0 1.4 9.1
Fuyunghai + saos Telur ayam 50 81.0 6.4 0.0 4.8 0.4 27.0 90.0 1.4 450.0 0.1 0.0 79.0 89.0 50.0 0.0 37.0
Tomat masak 10 2.0 0.0 0.2 0.0 0.4 0.5 2.7 0.1 150.0 0.0 4.0 0.4 23.5 0.0 0.8 9.4
Noodle tahu kukus Mie basah 40 34.4 0.0 0.5 2.0 5.6 5.6 5.2 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 32.0
Tahu 40 27.2 0.0 3.1 1.0 0.6 49.6 25.2 0.3 0.0 0.0 0.0 4.8 60.4 0.0 0.2 33.9
Cap cay Wortel 50 21.0 0.0 2.0 0.2 4.7 19.5 18.5 0.4 6000.0 0.0 3.0 35.0 122.5 0.0 2.5 44.1
Kol kembang 50 12.5 0.0 4.0 0.5 2.5 11.0 36.0 0.6 45.0 0.1 34.5 15.0 174.5 0.0 3.3 45.9
Kacang kapri ( biji segar ) 50 49.0 0.0 4.4 0.6 8.9 11.0 61.0 1.0 340.0 0.2 13.0 5.5 147.5 0.0 2.5 37.2
Minyak kelapa sawit 10 90.2 0.0 0.0 10.0 0.0 0.0 0.0 0.0 6000.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Snack Sore Buah Apel 150 87.0 0.0 0.7 0.8 22.4 9.0 15.0 15.5 135.0 0.1 7.5 3.0 195.0 0.0 1.1 126.2
Susu Diabetasol 25 108.3 4.2 0.0 2.9 16.3 45.0 35.0 22.0 234.0 23.0 4.0 5.0 142.0 0.0 2.0 0.0

Makan Malam Bubur Beras giling 60 216.0 0.0 4.1 0.4 47.3 3.6 84.0 0.5 0.0 0.1 0.0 3.0 60.0 0.0 1.2 7.8
Daging bistik Daging sapi 50 103.5 10.0 0.0 5.0 0.0 5.5 85.0 1.4 15.0 0.0 0.0 46.5 244.5 12.0 0.0 33.0
Tempe bb kemiri Tempe kedele murni 50 74.5 0.0 10.0 2.0 6.4 64.5 77.0 5.0 25.0 0.1 0.0 0.0 0.0 0.0 3.5 32.0
Extra Putel Telur ayam bagian putih 40 20.0 4.3 0.0 0.0 0.3 2.4 6.8 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 35.1
Cah wortel, gambas Wortel 75 31.5 0.0 2.0 0.2 7.0 29.3 27.8 0.6 9000.0 0.0 4.5 52.5 183.8 0.0 3.8 66.2
Gambas/oyong 75 13.5 0.0 0.8 0.2 3.1 14.3 24.8 0.7 285.0 0.0 6.0 33.2 106.1 0.0 2.3 70.9
Minyak kelapa sawit 10 90.2 0.0 0.0 10.0 0.0 0.0 0.0 0.0 6000.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Snack Malam Schutel makaroni Makaroni 40 145.2 0.0 5.5 0.2 31.5 8.0 32.0 0.1 0.0 0.0 0.0 1.2 52.8 0.0 0.2 4.7
Susu sapi 10 6.1 0.5 0.0 0.4 0.4 14.3 6.0 0.2 13.0 0.0 0.1 0.0 0.0 0.0 0.0 8.8
Keju 10 38.6 8.3 0.0 0.6 1.3 77.7 33.8 0.2 75.0 0.0 0.1 0.0 0.0 10.0 0.0 3.9
Susu Susu skim 25 9.0 0.9 0.0 0.0 1.3 30.8 24.3 0.0 0.0 0.0 0.3 9.5 37.3 0.0 0.0 22.6

Makan pagi Bubur Beras giling 60 216.0 0.0 4.1 0.4 47.3 3.6 84.0 0.5 0.0 0.1 0.0 3.0 60.0 0.0 1.2 7.8
Menu ke X Telur ayam bb sarden Telur ayam 60 97.2 6.4 0.0 5.8 0.4 32.4 108.0 1.6 540.0 0.1 0.0 94.8 106.8 60.0 0.0 44.4
Tomat masak 10 2.0 0.0 0.5 0.0 0.4 0.5 2.7 0.1 150.0 0.0 4.0 0.4 23.5 0.0 0.8 9.4
Sarang lebah tahu kukus Tahu 30 20.4 0.0 2.3 1.4 0.5 37.2 18.9 0.2 0.0 0.0 0.0 3.6 45.3 0.0 0.2 25.4
Wortel 5 2.1 0.0 0.1 0.0 0.5 2.0 1.9 0.0 600.0 0.0 0.3 3.5 12.3 0.0 0.3 4.4
Tumis kangkung Kangkung 70 20.3 0.0 2.1 0.2 3.8 51.1 35.0 1.8 4410.0 0.0 2.1 45.5 54.6 0.0 0.8 62.8
Taoge Kacang Hijau 60 36.5 0.0 4.0 3.0 2.9 20.4 49.2 0.7 0.6 1.8 0.1 4.8 4.2 50.0 0.0 0.2
Minyak kelapa sawit 10 90.2 0.0 0.0 10.0 0.0 0.0 0.0 0.0 6000.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Snack Pagi Nagasari mutiara Tepung hunkkwe 10 36.4 0.0 0.5 0.1 8.4 5.0 10.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0
Menu ke X Sagu mutiara 40 141.2 0.0 0.2 0.1 33.9 4.4 5.2 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.2 5.6
Susu Diabetasol 25 108.3 4.2 0.0 2.9 16.3 45.0 35.0 22.0 234.0 23.0 4.0 5.0 142.0 0.0 2.0 0.0
Total Asupan 2102.9 101.0 46.2 329.6 636.6 1144.6 78.3 40701.6 48.8 87.5 457.7 2157.4 182.0 29.9 855.8
40 141.2 0.0 0.2 0.1 33.9 4.4 5.2 0.6 0.0
0.0 0.0 0.0 0.0 0.0 0.2 5.6