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

Source: https://tracknation.in/story/nutrition-for-neet-pg-psm-icmr-nin-2020-rda-and-ear-dietary-guidelines-2024-anaemia-mukt-bharat-sam-ten-steps-iodine (TrackNation — free UPSC notes with PYQs)

> NEET PG Community Medicine: ICMR-NIN 2020 nutrient requirements (EAR vs RDA, energy, protein 0.83 g/kg, iron, calcium), Dietary Guidelines for Indians 2024 and My Plate for the Day, Anaemia Mukt Bharat (6x6x6, IFA doses, Hb cut-offs, deworming), facility-based management of SAM (MUAC < 115 mm, ten steps, F-75/F-100, discharge) and the iodine programme — all from official ICMR-NIN and MoHFW documents, with a ten-steps diagram, verified MCQs and cards.

## Start Here

🎯 **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.

| **Group (reference weight)**

 | **Energy (kcal/day)**

 | **Protein RDA (g/day)**

 |
| Man, sedentary (65 kg)

 | 2110

 | 54 (0.83 g/kg)

 |
| Man, moderate (65 kg)

 | 2710

 | 54

 |
| Man, heavy (65 kg)

 | 3470

 | 54

 |
| Woman, sedentary (55 kg)

 | 1660

 | 45.7

 |
| Woman, moderate (55 kg)

 | 2130

 | 45.7

 |
| Woman, heavy (55 kg)

 | 2720

 | 45.7

 |
| Pregnancy (2nd / 3rd trimester)

 | +350

 | +9.5 / +22

 |
| Lactation (0–6 / 6–12 months)

 | +600 / +520

 | +16.9 / +13.2

 |

- **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).

| **Nutrient (RDA 2020)**

 | **Men**

 | **Women**

 | **Change from 2010**

 |
| Iron (mg)

 | 19

 | 29

 | up from 17 / 21

 |
| Calcium (mg)

 | 1000

 | 1000

 | up from 600

 |
| Vitamin A (µg)

 | 1000

 | 840

 | up from 600

 |
| Folate (µg DFE)

 | 300

 | 220

 | up from 200

 |
| Vitamin B12 (µg)

 | 2.2

 | 2.2

 | up from 1

 |
| Vitamin C (mg)

 | 80

 | 65

 | up from 40

 |
| Vitamin D (IU)

 | 600

 | 600

 | up from 400

 |
| Iodine (µg)

 | 150

 | 150

 | unchanged

 |

## 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):

| **Food group (2000 kcal day)**

 | **Raw amount**

 | **% of energy**

 |
| Cereals incl. millets

 | 250 g

 | 42

 |
| Pulses (or egg/fish/meat)

 | 85 g

 | 14

 |
| Milk/curd

 | 300 ml

 | 11

 |
| Vegetables + green leafy vegetables

 | 400 g

 | 9

 |
| Fruits

 | 100 g

 | 3

 |
| Nuts and seeds

 | 35 g

 | 9

 |
| Fats and oils

 | 27 g

 | 12

 |

## 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.

| **Beneficiary**

 | **Prophylactic IFA (Anaemia Mukt Bharat)**

 | **Deworming (albendazole 400 mg)**

 |
| Children 6–59 months

 | IFA syrup 1 ml (20 mg iron + 100 µg folic acid) twice a week

 | Biannual; ½ tablet at 12–24 months, 1 tablet at 24–59 months

 |
| Children 5–9 years

 | 1 pink tablet weekly (45 mg iron + 400 µg FA)

 | Biannual, 1 tablet

 |
| Adolescents 10–19 years

 | 1 blue tablet weekly (60 mg iron + 500 µg FA)

 | Biannual, 1 tablet

 |
| Women of reproductive age (non-pregnant, non-lactating)

 | 1 red tablet weekly (60 mg iron + 500 µg FA)

 | Biannual, 1 tablet

 |
| Pregnant and lactating women

 | 1 red tablet daily from the 4th month — at least 180 days in pregnancy and 180 days post-partum

 | One dose after the first trimester

 |

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

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

| **Group**

 | **Anaemia if Hb below (g/dl)**

 | **Mild**

 | **Moderate**

 | **Severe**

 |
| Children 6–59 months

 | 11

 | 10–10.9

 | 7–9.9

 | < 7

 |
| Children 5–11 years

 | 11.5

 | 11–11.4

 | 8–10.9

 | < 8

 |
| Children 12–14 years

 | 12

 | 11–11.9

 | 8–10.9

 | < 8

 |
| Non-pregnant women (≥ 15 y)

 | 12

 | 11–11.9

 | 8–10.9

 | < 8

 |
| Pregnant women

 | 11

 | 10–10.9

 | 7–9.9

 | < 7

 |
| Men (≥ 15 y)

 | 13

 | 11–12.9

 | 8–10.9

 | < 8

 |

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

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

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

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

- Men 19 mg, women 29 mg.

- 1000 mg (was 600).

- 3 : 1 : 2.5.

- 20–50 g/day; ≤ 27 g on 2000 kcal.

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

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

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

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

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

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

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

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

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

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

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

- 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

**Answer: (d)** — RDA 0.83 g/kg/day (EAR 0.66); the 2010 value was 1 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

**Answer: (c)** — EAR is the median requirement; EARs are usually about 80% of the RDA.

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

- (a) RDA

- (b) EAR

- (c) Adequate intake

- (d) TUL

**Answer: (b)** — Using the RDA as the target shifts intakes too high; the EAR is recommended for population adequacy and diet planning.

**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

**Answer: (b)** — 2110 kcal/day (2320 in 2010); 2710 is moderate work; 1660 is a sedentary woman.

**Q5.** The additional energy recommended during pregnancy is

- (a) +600 kcal/day

- (b) +350 kcal/day

- (c) +150 kcal/day

- (d) +520 kcal/day

**Answer: (b)** — Pregnancy +350 kcal/day; lactation +600 (0–6 months) and +520 (6–12 months).

**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

**Answer: (b)** — Women 29 mg (21 in 2010); men 19 mg (17 in 2010).

**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

**Answer: (c)** — 3 : 1 : 2.5 (2020); 11 : 1 : 3 was the 2010 composition.

**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

**Answer: (a)** — Visible fat 20–50 g/day by energy level; not more than 27 g for a 2000 kcal diet.

**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

**Answer: (a)** — Restrict added salt to a maximum of 5 g/day and use iodised salt.

**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

**Answer: (d)** — Biweekly 1 ml IFA syrup (20 mg elemental iron + 100 µg folic acid per ml).

**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

**Answer: (a)** — Blue tablet weekly for adolescents; pink (45 mg + 400 µg) for 5–9 years; red for women.

**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

**Answer: (b)** — Daily IFA (60 mg iron + 500 µg FA) from the second trimester, minimum 180 days in pregnancy and 180 days post-partum.

**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

**Answer: (d)** — Pregnant women: mild 10–10.9, moderate 7–9.9, severe < 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

**Answer: (d)** — The BCC campaign includes ensuring delayed cord clamping (by 3 minutes) after delivery in facilities.

**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

**Answer: (d)** — SAM: WFH < −3 SD, MUAC < 115 mm, or bilateral pitting oedema. Height-for-age reflects stunting, weight-for-age underweight.

**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

**Answer: (d)** — Micronutrients are corrected throughout, but with no iron in stabilisation and with iron 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

**Answer: (a)** — F-75: 75 kcal, 0.9 g protein /100 ml; catch-up F-100: 100 kcal, 2.9 g protein /100 ml.

**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

**Answer: (a)** — Discharge: 15% weight gain, no oedema, > 5 g/kg/day gain for 3 consecutive days, and no illness.

**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

**Answer: (b)** — At least 30 ppm at manufacture and 15 ppm at consumption.

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

- (a) 1992

- (b) 2002

- (c) 1985

- (d) 1975

**Answer: (a)** — NGCP (1962) became NIDDCP in August 1992.

### 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.