Formulir Food Record 24 jam

Kode sampel : 0 0 3

Nama Responden : Amalia Azizah

Umur : 20
Jenis kelamin : Perempuan

Waktu Hari /tanggal :

maka Hidangan Nama bahan URT Estimasi Berat Ket
n makanan (gram) bersih
Nama Porsi Estimasi
(URT) (gram)
06.00 Air putih ½ gls 100 ml Air putih ½ gls 100 ml 100 ml
besar besar
06.15 Susu 1 gls 200 ml Susu 3 sdm 39 39
Dancow besar dancow
cokelat cokelat
bubuk
Air putih 5/6 gls 170 ml 170 ml
besar
06.15 Malkist 3 kpg 27 Malkist 3 Kpg 27 27
Cream Cream
Crackers Crackers
06.35 Air putih ½ gls 100 ml Air putih ½ gls 100 ml 100 ml
besar besar
07.30 Air putih 1 gls 220 ml Air putih 1 gls 220 ml 220ml
kemasan kemasan
12.20 Nasi Putih 3 ctg 150 Nasi putih 3 ctg 150 150
ceper ceper
Telur Ceplok 1 butir Telur ayam 1 butir 50 45 Fk =
0.9
Margarin 1 sdt 3.6 3.6 8%
Kecap ½ sdm 7.5 kecap ½ sdm 7.5 7.5
12.30 Air putih 1 gls 200 ml Air putih 1 gls 220 ml 220 ml
besar besar
15.30 Malkist 3 kpg 27 Malkist 3 kpg 27 27
Cream cream
Crackers crackers
15.40 Air putih 1 gls 200 ml Air putih 1 gls 200 ml 200 ml
besar besar
16.30 Pisang 1 buah 70 Pisang 1 buah 70 49 70%
ambon ambon
16.35 Air putih ½ gls 100 ml Air putih ½ gls 100 ml 100 ml
besar besar
17.20 Nasi 3 ctg 300 gr Nasi 3 ctg 300 gr 300 gr
penuh penuh
Ayam 1 potong 30 Daging 1 ptg 30 48 Fk =
goreng ayam paha 1,6
 bawah
Minyak 1 sdt 3,6 3,6 10 %
Tempe 2 potong 50 Tempe 2 potong 50 50 Fk = 1
Goreng
Minyak 1 sdt 5 5 10%
Tumis 6 sdm 60 Kangkung 6 sdm 60 60 Fk = 1
kangkung
Minyak 1 sdm 12,78 12,78 21,3%
17.30 Air putih 1 gls 200 ml Air putih 1 gls 200 200
besar besar
21.00 Pisang 1 buah 70 Pisang 1 buah 70 49 70%
ambon ambon
21.05 Air putih 1 gls 200 ml air putih 1 gls 200 ml 200 ml
besar besar

Golongan Makanan Berat

Karbohidrat
Nasi Putih 450
Malkist Cream Crackers 54
Protein Hewani
Telur Ayam 45
Paha Ayam 48
Protein Nabati
Tempe 50
Sayuran
Kangkung 60
Buah
Pisang Ambon 98

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===
Analysis of the food record
==================================================================
===
Food Amount energy carbohydr.
___________________________________________________________________________
___

Drinking water 100 g 0.0 kcal 0.0 g

susu dancow coklat 39 g 168.9 kcal 27.7 g
Drinking water 170 g 0.0 kcal 0.0 g
Roma Cream Crackers 27 g 130.0 kcal 18.0 g
Drinking water 100 g 0.0 kcal 0.0 g
Drinking water 220 g 0.0 kcal 0.0 g

Meal analysis: energy 298.9 kcal (19 %), carbohydrate 45.7 g (20 %)

nasi putih 150 g 195.0 kcal 42.9 g

telur ayam 45 g 69.8 kcal 0.5 g
Margarine for cooking 3.6 g 25.6 kcal 0.0 g
kecap 7.5 g 4.5 kcal 0.4 g
Drinking water 200 g 0.0 kcal 0.0 g
Roma Cream Crackers 27 g 130.0 kcal 18.0 g
Drinking water 200 g 0.0 kcal 0.0 g
pisang ambon 49 g 45.1 kcal 11.5 g
Drinking water 100 g 0.0 kcal 0.0 g

Meal analysis: energy 470.0 kcal (29 %), carbohydrate 73.3 g (32 %)

nasi putih 300 g 390.1 kcal 85.8 g

daging ayam bagian paha 48 g 102.7 kcal 0.0 g
minyak kelapa sawit 3.6 g 31.0 kcal 0.0 g
tempe kedele murni 50 g 99.5 kcal 8.5 g
minyak kelapa sawit 5g 43.1 kcal 0.0 g
kangkung 60 g 9.0 kcal 1.3 g
minyak kelapa sawit 12.78 g 110.2 kcal 0.0 g
Drinking water 200 g 0.0 kcal 0.0 g
pisang ambon 49 g 45.1 kcal 11.5 g
Drinking water 200 g 0.0 kcal 0.0 g

Meal analysis: energy 830.7 kcal (52 %), carbohydrate 107.0 g (47 %)

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===
Result
==================================================================
===
Nutrient analysed recommended percentage
content value value/day fulfillment
___________________________________________________________________________
___
energy 1599.6 kcal 2036.3 kcal 79 %
water 1490.4 g - -
protein 47.9 g(12%) 60.1 g(12 %) 80 %
fat 54.7 g(30%) 69.1 g(< 30 %) 79 %
carbohydr. 226.0 g(58%) 290.7 g(> 55 %) 78 %
dietary fiber 5.7 g - -
alcohol 0.0 g - -
PUFA 5.9 g - -
cholesterol 225.2 mg - -
Vit. A 1556.7 µg 800.0 µg 195 %
carotene 0.0 mg - -
Vit. E (eq.) 4.8 mg 8.0 mg 60 %
Vit. B1 0.4 mg 1.1 mg 34 %
Vit. B2 0.8 mg 1.3 mg 58 %
Vit. B6 1.2 mg 1.6 mg 77 %
tot. fol.acid 130.3 µg - -
Vit. C 32.4 mg 60.0 mg 54 %
sodium 608.1 mg - -
potassium 1189.3 mg - -
calcium 395.4 mg 1200.0 mg 33 %
magnesium 177.4 mg 280.0 mg 63 %
phosphorus 608.3 mg 1200.0 mg 51 %
iron 6.3 mg 15.0 mg 42 %
zinc 6.5 mg 12.0 mg 54 %