Date of Interview 16-Nov-15 Age: 20 yrsName of Respondent Fitria Nurrahmawati Weight of respondent: 56 kgName of Interviewer Yosefin Widiyatno Height of respondent : 153 cmTime of Interview 13.30

No Place of Eaten TimeName of Dish/Menu Ingredients

Monday, November 16, 2015

1 RK 8 FKM Unair 13.15 Nasi Campur

Nasi PutihMie BasahKering TempeAyam Taliwang

2Home

10.00 Air Mineral (ml) Air

309.50

Susu Anlene Actifit Susu Sapi FortifikasiAir

4 Home 09.00 Jamu Kunir Asem

KunyitAsam Jeruk NipisGula Jawa

5 Home 09.00 Perkedel Jagung

Jagung Kuning Pipil rebusTepung Terigu'AirMinyak Kelapa Swt

6Home

08.00Air Mineral (ml) Air

7 04.30Sunday, November 15, 20151

Home

22.30

Air Mineral (ml) Air

2Home

21.30Air Mineral (ml) Air

3 20.304 19.30

5 Home 19.00 Tahu Telor

Tahu GorengTelorKacang tnh grgKerupuk Kemplang GrgPetis Udang PastaKecap

6Home

18.45 Air Mineral (ml) Air7 17.00 Richeese Nabati Snack Wafer8 16.30 Air Mineral (ml) Air

Bahan MakananURT Banyaknya

Monday, November 16, 20151 mangkok 100 gr2 sendok 20 gr2 sendok 20 gr2 Sendok 20 gr3/4 gelas 200 gr3 sendok 30 gr3/4 gelas 200 gr5 sendok 50gr5 sendok 50gr4 sendok 20gr4 sendok 40 gr3 sendok 30 gr1 1/2 sendok 15 gr1/5 gelas 50 gr4 sendok 40 gr3/4 gelas 200 gr3/4 gelas 2010gr

Sunday, November 15, 20153/4 gelas 200 gr

1 gelas 250gr1 gelas 250 gr1 gelas 250 gr5/4 buah bsr 125 gr1 butir 50 gr2 sendok 20 gr2 sendok 20 gr2 sendok 20 gr1 sendok 10 gr1 gelas 2501 bungkus 8.5 gr3/4 gelas 200 gr

FOOD RECALL PERTAMA

No Menu Ingredients Amount (gr)Karbohidrat Protein Lemak

Total kkalper 100 BDD gr food kkal per 100 BDD gr food kkal per 100 BDD gr food kkal

1. Nasi Campur

Nasi Putih 100 39.8 39.8 159.2 3 3 12 0.3 0.3 2.7 173.9

Mie Basah 20 14 2.8 11.2 0.6 0.12 0.48 3.3 0.66 5.94 17.62Tempe goreng 10 10.4 1.04 4.16 24.5 2.45 9.8 26.6 2.66 23.94 37.9Ayam Taliwang 20 20.1 4.02 16.08 18.2 3.64 14.56 20.1 4.02 36.18 66.82Minyak Kelapa Sawit 30 0 0 0 0 0 0 100 30 270 270

2. Air Mineral Air 200 0 0 0 0 0 0 0 0 0 0

3 Susu Anlene ActifitSusu Sapi Fortifikasi 30 63.33 19 76 16.67 5 20 3.33 1 9 105Air 200 0 0 0 0 0 0 0 0 0 0

4 Jamu Kunir Asem

Air 200 0 0 0 0 0 0 0 0 0 0Kunyit 50 9.1 4.55 18.2 2 1 4 2.7 1.35 12.15 34.35Asem 50 62.5 31.25 125 2.8 1.4 5.6 0.6 0.3 2.7 133.3Gula Jawa 40 92 36.8 147.2 0 0 0 0 0 0 147.2Jeruk Nipis 20 10 2 8 0.5 0.1 0.4 0.2 0.04 0.36 8.76

5 Perkedel Jagung

Jagung Kuning pipil rebus 20 28.4 5.68 22.72 3.8 0.76 3.04 3.5 0.7 6.3 32.06Tepung Terigu 15 77.2 11.58 46.32 9 1.35 5.4 1 0.15 1.35 53.07Air 50 0 0 0 0 0 0 0 0 0 0Minyak Kelapa Sawit 40 0 0 0 0 0 0 100 40 360 360

6

Air Mineral Air

200 0 0 0 0 0 0 0 0 0 07 200 0 0 0 0 0 0 0 0 0 08 200 0 0 0 0 0 0 0 0 0 09 200 0 0 0 0 0 0 0 0 0 010 200 0 0 0 0 0 0 0 0 0 011 200 0 0 0 0 0 0 0 0 0 0

12 Tahu Telor

Tahu goreng 125 2.5 3.125 12.5 9.7 12.125 48.5 8.5 10.625 95.625 156.625Telur Ayam 50 0.7 0.35 1.4 12.4 6.2 24.8 10.8 5.4 48.6 74.8Kerupuk Kemplang Grg 20 57.1 11.42 45.68 5.6 1.12 4.48 28.1 5.62 50.58 100.74Petis Udang Pasta 20 38 7.6 30.4 15 3 12 0.9 0.18 1.62 44.02Kecap manis 10 9 0.9 3.6 5.7 0.57 2.28 1.3 0.13 1.17 7.05Kacang tanah goreng 20 25.5 5.1 20.4 25.5 5.1 20.4 44.4 8.88 79.92 120.72

13 Air Mineral Air 250 0 0 0 0 0 0 0 0 0 014 Richeese nabati Wafer 8.5 300 6 24 100 1 4 50 1.5 13.5 41.515 Air Mineral Air 200 0 0 0 0 0 0 0 0 0 0

TOTAL 2998.5 161.995 647.98 37.145 148.58 97.205 874.845 1671.405

PERSENTASE NORMAL Konsumsi Air (ml)1. KARBOHIIDRAT 38.7685809244 55 18502. PROTEIN 8.8895270745 15 Yg dianjurkan (ml)3. LEMAK 52.341892001 30 2300

39%

9%

52%

PERSENTASE ENERGI YANG TELAH DIKONSUMSI RECALL 1

KARBOHIIDRAT

PROTEIN

LEMAK

FOOD RECALL PERTAMA

Ca Ca food Fe Fe food Zn zn food karoten total karoten total food thiamin thiamin food riboflavin riboflavin food niacin niacin food Vit. C vit. C food

25 25 0.4 0.4 0 0 0 0 0.05 0.05 0 0 0 0 0 0

14 2.8 6.8 1.36 0 0 0 0 0 0 0 0 0 0 0 0202 20.2 4.9 0.49 0 0 78 7.8 0.24 0.024 0 0 0 0 0 0

94 18.8 2 0.4 12.3 2.46 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1666.67 500 0 0 4 1.2 246.67 74 0 0 1 0.3 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

24 12 3.3 1.65 0 0 0 0 0.03 0.015 0 0 0 0 1 0.574 37 0.6 0.3 0 0 30 15 0.34 0.17 0 0 0 0 2 176 30.4 3 1.2 0 0 0 0 0 0 0 0 0 0 0 018 3.6 0.2 0.04 0 0 4 0.8 0.01 0.002 0 0 0 0 19.7 3.94

7 1.4 0.5 0.1 0 0 234 46.8 0.08 0.016 0 0 0 0 0 022 3.3 1.3 0.195 0 0 0 0 0.1 0.015 0.07 0.0105 1 0.15 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

200 250 4.1 5.125 0 0 0 0 0.01 0.0125 0 0 0 0 0 086 43 3 1.5 0 0 104 52 0.12 0.06 0.38 0.19 0 0 0 050 10 2.9 0.58 0 0 280 56 0.31 0.062 0 0 0 0 0 037 7.4 2.8 0.56 0 0 0 0 0 0 0 0 0 0 0 0

123 12.3 5.7 0.57 0 0 0 0 0 0 0 0 0 0 0 0106 21.2 4.1 0.82 0 0 0 0 0.4 0.08 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 15 0.15 15 0.15 15 0.15 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

947.5 12.76 3.66 196.4 0.3645 0.5005 0.15 5.44

`39%

9%

52%

PERSENTASE ENERGI YANG TELAH DIKONSUMSI RECALL 1

KARBOHIIDRAT

PROTEIN

LEMAK 55%

15%

30%

PERSENTASE KONSUMSI ENERGI YANG DIANJURKAN

KARBOHIIDRAT

PROTEIN

LEMAK

No Place of Eaten Time

20-Nov1

Home07.45

2 04.153 00.3019-Nov

4Home

23.00

5 21.006 19.30

7 Home 19.00

8 Home 18.30

9 Home 16.30

10 RK08 12.30

11 RK08 12.15

12 Kantin FKM Unair 11.15

13 Home 10.30

14 Home 09.00

Name of Dish/MenuIngredients Bahan Makanan

URT20-Nov

Air mineral Air1 gelas3/5 gelas2/5 gelas

19-Nov

Teh HijauDaun teh kering 3 sendokAir 3/4 gelas

Air Mineral Air1 gelas3/4 gelas

Fuyung Hai

Telur 1 butirTepung Terigu 3/2 sendokAyam 3/5 potongWortel 5 sendok

Jus NanasNanas 1/2 buahSusu Kental Mns 2 sendokAir 1 gelas

Air Mineral (ml) Air 1 gelasCorovit Kaplet - 1 tabletVitacimin C - 1 tabletNatur E 100 IU - 1 tabletAir mineral Air 1 gelas

Nasi Campur

Nasi Putih 1 mangkokBuncis 1/5 ikatTahu 1 bh kecilTelur 1 butirmie 1 sendokwortel 1 /10 buahMinyak Klp swt 3 sendok

Good day Carebian NutKopi 1 sachetAir 1 gelas

Jamu Kunir Asem

Kunyit 1 buahAsam 5 sendokJeruk Nipis 4 sendokGula Jawa 4 sendok

Air Mineral Air 3/4 gelas

Bahan MakananBanyaknya

20-Nov250gr150 gr100 gr

19-Nov30 gr200 gr250 gr200 gr50 gr15 gr30 gr50 gr50 gr20 gr250 gr25010 gr10 gr10 gr250 gr100 gr10 gr10 gr50 gr10 gr10 gr30 gr30 gr250 gr50gr50gr20gr40 gr200 gr

FOOD RECALL KEDUA

No Menu Ingredients Amount (gr)Karbohidrat Protein

per 100 BDD gr food kkal per 100 BDD gr food kkal1

Minum Air mineral Air250 0 0 0 0 0 0

2 150 0 0 0 0 0 03 100 0 0 0 0 0

4 Teh Hijaudaun teh krg 30 53.6 16.08 64.32 28.3 8.49 33.96Air 200 0 0 0 0 0 0

5 Minum Air mineral Air 250 0 0 0 0 0 06 200 0 0 0 0 0 0

7 Fuyung Hai

Tepung Terigu 15 77.2 11.58 46.32 9 1.35 5.4Telur Ayam 50 0.7 0.35 1.4 12.4 6.2 24.8Ayam 30 0 0 0 18.2 5.46 21.84Wortel 50 7.9 3.95 15.8 1 0.5 2

8 Jus NanasNanas 50 9.9 4.95 19.8 0.6 0.3 1.2Susu Kental Manis 20 55 11 44 8.2 1.64 6.56Air 250 0 0 0 0 0 0

9 Minum Air mineral Air 250 0 0 0 0 0 010 Suplemen Multivit 1 kaplet salut gula 10 - - - - - -11 Suplemen Vit C - 0 0 0 0 0 0 012 Natur E 100 IU - 0 0 0 0 0 0 0

13 Air Mineral Air 250 0 0 0 0 0 0

14 Nasi Campur

Nasi Putih 100 39.8 39.8 159.2 3 3 12Buncis 10 7.2 0.72 2.88 0.3 0.03 0.12Tahu 150 0 0 0 18.7 28.05 112.2Telur Ayam 50 0.7 0.35 1.4 12.4 6.2 24.8Minyak klp swt 30 0 0 0 0 0 0

14 GoodDay Carebian N

Kopi 20 16 3.2 12.8 1 0.2 0.8gula 10 94 9.4 37.6 0 0 0Air 200 0 0 0 0 0 0

15 Jamu Kunir Asem

Air 200 0 0 0 0 0 0Kunyit 50 9.1 4.55 18.2 2 1 4Asem 50 62.5 31.25 125 2.8 1.4 5.6Gula Jawa 40 92 36.8 147.2 0 0 0Jeruk Nipis 20 10 2 8 0.5 0.1 0.4

16 Minum Air mineral Air 200 0 0 0 0 0 0TOTAL 3285 175.98 703.92 63.92 255.68

PERSENTASE Konsumsi Yang dianjurkan * suplemen multivitamin yang dikonsumsi adalah Corovit Kaplet1. KARBOHIIDRAT 44.4211655571 55 *Suplemen Vitamin C yang dikonsumsi bermerek Vitacimin C2. PROTEIN 16.134793172 15 *Natur E 100 IU merupakan suplemen vitamin E3. LEMAK 39.4440412709 304 Konsumsi Air 1650 2300

FOOD RECALL KEDUALemak

per 100 BDD gr food0 00 0

048 14.40 00 00 01 0.15

10.8 5.425 7.5

0.6 0.30.3 0.1510 20 00 0

- -0 00 00 0

0.3 0.32.6 0.26

1 1.510.8 5.4100 30

2 0.40 00 00 0

2.7 1.350.6 0.3

0 00.2 0.04

0 069.45

FOOD RECALL KEDUALemak

Total kkal Ca Ca food Fe Fe food Zn zn food karoten total karoten total foodkkal

0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0

129.6 227.88 245 73.5 18.9 5.67 0 0 0 00 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0

1.35 53.07 22 3.3 1.3 0.195 0 0 0 048.6 74.8 86 43 3 1.5 0 0 104 5267.5 89.34 14 4.2 1.5 0.45 0 0 0 02.7 20.5 45 22.5 1 0.5 0 0 7125 3562.5

1.35 22.35 22 11 0.9 0.45 0 0 90 4518 68.56 275 55 0.2 0.040 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0

- - 5 5 - - - - - 18000 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0

2.7 173.9 25 25 0.4 0.4 0 0 0 02.34 5.34 101 10.1 1.1 0.11 0 0 550 5513.5 125.7 96 144 1.5 2.25 0 0 5 7.548.6 74.8 86 43 3 1.5 0 0 104 52270 270 0 0 0 0 0 0 0 03.6 17.2 0 0 0 0 0 0 0 0

0 37.6 5 0.5 0.1 0.01 0 0 0 00 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0

12.15 34.35 24 12 3.3 1.65 0 0 0 02.7 133.3 74 37 0.6 0.3 0 0 30 15

0 147.2 76 30.4 3 1.2 0 0 0 00.36 8.76 18 3.6 0.2 0.04 0 0 4 0.8

0 0 0 0 0 0 0 0 0 0625.05 1584.65 523.1 16.265 0 5589.8

FOOD RECALL KEDUA

thiamin thiamin food riboflavin riboflavin food niacin niacin food Vitamin C vitamin C food

0 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 0

0.38 0.114 1.24 0.372 4.6 1.38 230 690 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 0

0.1 0.015 0.07 0.0105 1 0.15 0 00.12 0.06 0.38 0.19 0 0 0 00.08 0.024 0 0 0 0 0 00.04 0.02 0.04 0.02 1 0.5 18 90.02 0.01 0 0 0 0 22 110.05 0.01 0 0 0 0 0 0

0 0 0 0 0 0 0 00 0 0 0 0 0 0 0- 3 - 3 - 20 - 750 0 0 0 0 0 500 5000 0 0 0 0 0 0 00 0 0 0 0 0 0 0

0.05 0.05 0 0 0 0 0 00.05 0.005 0.4 0.04 2.8 0.28 11 1.10.03 0.045 0 0 0 0 0 00.12 0.06 0.38 0.19 0 0 0 0

0 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 0

0.03 0.015 0 0 0 0 1 0.50.34 0.17 0 0 0 0 2 1

0 0 0 0 0 0 0 00.01 0.002 0 0 0 0 19.7 3.94

0 0 0 0 0 0 0 03.6 3.8225 22.31 670.54