Nutrition for NEET PG PSM: ICMR-NIN 2020 RDA and EAR, Dietary Guidelines 2024, Anaemia Mukt Bharat, SAM Ten Steps, Iodine

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🎯 Exam priority: High-yield (Tier 1). Nutrition questions test numbers: RDA values (which changed in 2020), IFA doses and tablet colours, Hb cut-offs, SAM criteria and the ten steps, and iodised-salt levels. Everything here is from the ICMR-NIN 2020 requirements and 2024 dietary guidelines and from MoHFW programme guidelines. Older textbooks still carry the 2010 RDAs (e.g. protein 1 g/kg) — learn the 2020 figures.

CBME mapping: CM 5 (nutrition).

EAR and RDA: The 2020 Shift

• The Estimated Average Requirement (EAR) is the median of the distribution of requirements; the RDA sits at the upper end of that distribution. EARs are usually about 80% of the RDA.

• The 2020 committee recommends using the EAR for population adequacy and for diet/menu planning — using the RDA for everyone shifts intakes too high, pushing some people towards the tolerable upper limit (TUL).

• Total energy expenditure = BMR × PAL. Indian PAL for sedentary work was revised down from 1.53 (2010) to 1.40, and adult BMR was reduced by a further 5% — so adult energy needs fell by 3–8 kcal/kg/day.

• Protein: EAR 0.66 and RDA 0.83 g/kg/day (down from 1 g/kg in 2010); for cereal-based diets with low-quality protein, 1 g/kg. Protein quality is now judged by DIAAS (based on true ileal digestibility) rather than PDCAAS.

• The ideal cereal : legume : milk ratio is 3 : 1 : 2.5 (earlier 11 : 1 : 3).

• Fats: limit visible fat (cooking oil) to 20–50 g/day — not more than 27 g on a 2000 kcal diet; the essential fatty acids are linoleic (n-6, about 6.6 g/day) and alpha-linolenic (n-3, about 2.2 g/day).

Dietary Guidelines for Indians 2024 and My Plate

ICMR-NIN's 2024 dietary guidelines give 17 guidelines. The most-tested points:

• Sugar under 5% of total energy for adults; no added sugar under 2 years.

• Breastfeeding within one hour of birth; colostrum is the milk of the first 3–4 days; exclusive breastfeeding for 6 months; complementary feeding soon after 6 months, with breastfeeding up to 2 years and beyond.

• Pregnancy: a woman should be at least 21 years at her first pregnancy; IFA and calcium after 12 weeks, continued in lactation.

• At least 400 g of vegetables a day; combine cereals and pulses 3 : 1 for better protein quality.

• Added salt at most 5 g/day, and it should be iodised.

• Avoid vanaspati (partially hydrogenated fat — trans fats) and repeated heating of cooking oil.

• Activity: 30–45 minutes of brisk walking for adults; 60 minutes a day for children.

My Plate for the Day (about 1.2 kg of raw food, 2000 kcal; protein ≈ 15% and fat ≈ 30% of energy; sugar 25–30 g at most):

Anaemia Mukt Bharat

• Launched with a 6 × 6 × 6 strategy: six target beneficiary groups, six interventions and six institutional mechanisms.

• The six interventions: (1) prophylactic IFA, (2) deworming, (3) year-round behaviour-change campaign "Solid Body, Smart Mind" — including delayed cord clamping (by 3 minutes), (4) testing and treatment with digital haemoglobinometers, (5) IFA-fortified foods in public programmes, (6) addressing non-nutritional causes (malaria, haemoglobinopathies, fluorosis) in endemic pockets.

Withhold prophylactic iron during acute illness (fever, diarrhoea, pneumonia) and in thalassaemia major or repeated transfusions.

Hb cut-offs (WHO, used by the programme):

Severe Acute Malnutrition (SAM)

SAM in children 6–59 months = any one of: weight-for-height below −3 SD of the WHO standards, MUAC < 115 mm, or bilateral pitting oedema.

SAM with a medical complication — anorexia, fever ≥ 39 °C or hypothermia < 35 °C, persistent vomiting, severe dehydration, lethargy or convulsions, hypoglycaemia, severe anaemia, severe pneumonia — needs admission to a Nutrition Rehabilitation Centre (NRC); grade +++ oedema always needs in-patient care.

The ten steps: hypoglycaemia, hypothermia and dehydration are tackled in days 1–2; iron is withheld until the rehabilitation phase.

• Starter diet (F-75): 75 kcal and 0.9 g protein per 100 ml, 8–12 feeds a day — low protein and sodium, high carbohydrate.

• Catch-up diet (F-100): 100 kcal and 2.9 g protein per 100 ml, for rapid weight gain once appetite returns.

• Vitamin A on admission: 50,000 IU under 6 months; 1 lakh IU at 6–12 months (or weight < 8 kg); 2 lakh IU over 12 months — repeated on days 2 and 14 if there are eye signs.

• Discharge: 15% weight gain, oedema resolved, weight gain > 5 g/kg/day for 3 consecutive days, and no illness.

Iodine Deficiency Disorders

• The National Goitre Control Programme (1962) was renamed the NIDDCP in August 1992.

• Iodised salt must contain at least 30 ppm iodine at manufacture and 15 ppm at consumer level.

• Goals: IDD prevalence below 5% and 100% household use of adequately iodised salt (15 ppm); districts are resurveyed every 5 years; urinary iodine excretion and salt iodine are monitored in laboratories.

• The adult RDA for iodine is 150 µg/day.

Traps the Examiner Sets

• Protein RDA is now 0.83 g/kg, not 1 g/kg; iron RDA is 19 mg (men) and 29 mg (women); calcium 1000 mg.

• EAR = median requirement (≈ 80% of the RDA) and is the figure to use for population adequacy.

• IFA tablet colours: pink 5–9 years, blue adolescents, red women (weekly) and pregnancy (daily).

• Under-fives get IFA syrup twice a week, not daily.

• Anaemia in pregnancy: Hb < 11; severe < 7 (not < 8).

• SAM: MUAC < 115 mm (not 125 mm); no iron during stabilisation.

• Salt iodine: 30 ppm at production, 15 ppm at the household.

Rapid-Revision Cards

• EAR vs RDA

  EAR = median requirement (≈ 80% of RDA), used for population adequacy; RDA at the upper end of the distribution.

• Protein RDA 2020

  0.83 g/kg/day (EAR 0.66); was 1 g/kg in 2010.

• Energy, sedentary man / woman

  2110 / 1660 kcal/day (65 / 55 kg).

• Extra energy, pregnancy / lactation

  +350 / +600 (0–6 m), +520 (6–12 m) kcal/day.

• Iron RDA 2020

  Men 19 mg, women 29 mg.

• Calcium RDA 2020

  1000 mg (was 600).

• Cereal : legume : milk

  3 : 1 : 2.5.

• Visible fat

  20–50 g/day; ≤ 27 g on 2000 kcal.

• Salt / sugar limits (DGI 2024)

  Salt ≤ 5 g/day; sugar < 5% energy; no added sugar < 2 years.

• My Plate (2000 kcal)

  Cereals 250 g, pulses 85 g, milk 300 ml, veg 400 g, fruit 100 g, nuts 35 g, oil 27 g.

• AMB strategy

  6 × 6 × 6: beneficiaries, interventions, institutional mechanisms.

• IFA under-fives

  1 ml syrup twice weekly (20 mg Fe + 100 µg FA per ml).

• IFA tablet colours

  Pink 5–9 y (45 mg); blue adolescents (60 mg); red women and pregnancy (60 mg).

• IFA in pregnancy

  Daily from 4th month, ≥ 180 days + 180 days post-partum.

• Severe anaemia

  Hb < 7 (under-fives, pregnancy); < 8 (others).

• SAM definition

  WFH < −3 SD or MUAC < 115 mm or bilateral pitting oedema.

• F-75 / F-100

  75 kcal + 0.9 g protein / 100 kcal + 2.9 g protein per 100 ml.

• SAM discharge

  15% weight gain, no oedema, > 5 g/kg/day × 3 days.

• Iodised salt

  ≥ 30 ppm at manufacture; ≥ 15 ppm at consumer.

• NGCP → NIDDCP

  1962 → August 1992.

Sources

Sources

Facts in this article were checked against these documents.

• A Brief Note on Nutrient Requirements for Indians, the RDA and EAR (ICMR-NIN 2020) — ICMR-National Institute of Nutrition, 2020 (link)

• Dietary Guidelines for Indians — booklet — ICMR-National Institute of Nutrition, 2024 (link)

• My Plate for the Day — ICMR-National Institute of Nutrition, 2018 (link)

• Anemia Mukt Bharat: Intensified National Iron Plus Initiative — Operational Guidelines — MoHFW, 2018 (link)

• Operational Guidelines on Facility Based Management of Children with Severe Acute Malnutrition — MoHFW, 2011 (link)

• National Iodine Deficiency Disorders Control Programme — Dte.GHS, MoHFW, n.d. (link)

• IDD & Nutrition Cell — MoHFW, n.d. (link)

Test Yourself: Practice Questions

Twenty questions in NEET PG style.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. According to ICMR-NIN 2020, the RDA for protein for a healthy Indian adult is

• (a) 1.2 g/kg/day

• (b) 1.0 g/kg/day

• (c) 0.66 g/kg/day

• (d) 0.83 g/kg/day

Q2. The Estimated Average Requirement (EAR) of a nutrient is

• (a) the average intake of the population

• (b) the 97.5th percentile of requirements

• (c) the median of the distribution of requirements

• (d) the tolerable upper limit

Q3. For assessing the adequacy of a population's diet, ICMR-NIN 2020 recommends using

• (a) RDA

• (b) EAR

• (c) Adequate intake

• (d) TUL

Q4. The energy requirement of a sedentary Indian man (65 kg) under ICMR-NIN 2020 is

• (a) 1660 kcal/day

• (b) 2110 kcal/day

• (c) 2710 kcal/day

• (d) 2320 kcal/day

Q5. The additional energy recommended during pregnancy is

• (a) +600 kcal/day

• (b) +350 kcal/day

• (c) +150 kcal/day

• (d) +520 kcal/day

Q6. The RDA of iron for an adult Indian woman (ICMR-NIN 2020) is

• (a) 35 mg/day

• (b) 29 mg/day

• (c) 19 mg/day

• (d) 21 mg/day

Q7. The cereal : legume : milk ratio recommended for good protein quality is

• (a) 11 : 1 : 3

• (b) 2 : 1 : 1

• (c) 3 : 1 : 2.5

• (d) 4 : 1 : 1

Q8. On a 2000 kcal diet, ICMR-NIN advises visible fat (cooking oil) of not more than

• (a) 27 g/day

• (b) 50 g/day

• (c) 60 g/day

• (d) 10 g/day

Q9. The Dietary Guidelines for Indians (2024) limit added salt to a maximum of

• (a) 5 g/day

• (b) 10 g/day

• (c) 2 g/day

• (d) 8 g/day

Q10. Under Anaemia Mukt Bharat, children aged 6–59 months receive

• (a) one pink tablet weekly

• (b) 1 ml IFA syrup daily

• (c) one blue tablet weekly

• (d) 1 ml IFA syrup twice a week

Q11. The weekly IFA tablet for school-going adolescents (10–19 years) under Anaemia Mukt Bharat is

• (a) blue, 60 mg iron + 500 µg folic acid

• (b) pink, 45 mg iron + 400 µg folic acid

• (c) white, 20 mg iron + 100 µg folic acid

• (d) red, 100 mg iron + 500 µg folic acid

Q12. Prophylactic IFA for a pregnant woman under Anaemia Mukt Bharat is

• (a) one tablet weekly throughout pregnancy

• (b) one tablet daily from the 4th month, for at least 180 days, continued 180 days post-partum

• (c) one tablet daily for 100 days only

• (d) two tablets daily from the first trimester

Q13. Severe anaemia in a pregnant woman is defined as haemoglobin below

• (a) 8 g/dl

• (b) 10 g/dl

• (c) 9 g/dl

• (d) 7 g/dl

Q14. Which behaviour is promoted under Anaemia Mukt Bharat to improve infants' iron stores?

• (a) Routine iron drops from birth

• (b) Cow's milk from 6 months

• (c) Early cord clamping within 30 seconds

• (d) Delayed cord clamping by 3 minutes

Q15. A 2-year-old is admitted to an NRC. Which finding alone defines severe acute malnutrition?

• (a) MUAC of 120 mm

• (b) Height-for-age below −3 SD

• (c) Weight-for-age below −2 SD

• (d) MUAC of 110 mm

Q16. In the ten steps of SAM management, iron is

• (a) never given

• (b) given only at discharge

• (c) started on day 1

• (d) withheld during stabilisation and started in rehabilitation

Q17. The starter diet (F-75) for SAM provides per 100 ml

• (a) 75 kcal and 0.9 g protein

• (b) 100 kcal and 2.9 g protein

• (c) 75 kcal and 2.9 g protein

• (d) 100 kcal and 0.9 g protein

Q18. A child with SAM is discharged from the NRC after achieving

• (a) 15% weight gain with oedema resolved

• (b) 5% weight gain

• (c) two weeks of stay regardless of weight

• (d) MUAC of 115 mm

Q19. The minimum iodine content of iodised salt at the consumer level is

• (a) 5 ppm

• (b) 15 ppm

• (c) 50 ppm

• (d) 30 ppm

Q20. The National Goitre Control Programme, launched in 1962, was renamed NIDDCP in

• (a) 1992

• (b) 2002

• (c) 1985

• (d) 1975

Active Recall

From memory: define EAR and RDA and give the 2020 protein RDA, energy for a sedentary man and the extra energy in pregnancy; state the iron RDAs; list Anaemia Mukt Bharat IFA doses by age group with tablet colours and the Hb cut-offs for severe anaemia; define SAM, name the ten steps and the starter and catch-up diets with discharge criteria; and give the iodised-salt standards.