📊 Nutritional Requirements and Malnutrition

This lesson builds core elective concepts in BSc Agriculture with practical applications and exam-oriented clarity.

---

Nutritional Requirements and Malnutrition

Recommended Dietary Allowance (RDA)

RDA is defined as the amount of a nutrient sufficient to meet the requirements of nearly all (97.5%) healthy individuals in a defined group. RDA = EAR + 2 SD (where EAR = Estimated Average Requirement).

India follows the ICMR (Indian Council of Medical Research) 2020 guidelines — an update from the earlier ICMR 2010 report. The 2020 revision incorporated improved body of evidence, updated body weight references, and revised physical activity levels for Indian population.

Factors Affecting Nutritional Requirements

• Age: infants and adolescents have higher nutrient density needs per kg body weight
• Sex: males have higher energy/iron-independent needs; females have higher iron needs (menstruation)
• Physiological status: pregnancy (+energy, +protein, +iron, +folate, +Ca); lactation (+protein, +Ca, +Vitamin A)
• Physical activity level (PAL): sedentary (PAL 1.4–1.6), moderate (PAL 1.7–1.9), heavy (PAL 2.0–2.4)
• Climate: hot climate slightly reduces energy needs; cold climate increases
• Disease: fever, infection, malabsorption increase requirements

---

ICMR 2020 RDA — Key Values

Energy (kcal/day)

Group	Sedentary	Moderate Activity	Heavy Activity
Adult Male (60 kg)	2,110	2,710	3,490
Adult Female (55 kg)	1,660	2,130	2,720
Pregnancy (2nd trimester)	+350 kcal/day	—	—
Lactation (0–6 months)	+600 kcal/day	—	—

Protein (g/day)

• Reference adult: 0.83 g/kg/day (safe intake level)
• Adult male (60 kg): 50 g/day
• Adult female (55 kg): 46 g/day
• Pregnancy: +8.5 g/day above normal
• Lactation (0–6 months): +19.9 g/day above normal

Micronutrients — Selected ICMR 2020 RDA

Nutrient	Adult Male	Adult Female	Pregnancy	Lactation
Iron (mg/day)	17	21	35	21
Calcium (mg/day)	600	600	1,200	1,200
Vitamin C (mg/day)	65	65	80	95
Vitamin A (µg RE/day)	750	750	800	1,200
Zinc (mg/day)	17.0	13.2	18.2	17.0
Folate (µg DFE/day)	220	220	520	340
Iodine (µg/day)	150	150	220	250

Note: ICMR 2020 values differ from ICMR 2010 in several areas — notably, protein requirement was revised downward from 0.96 g/kg to 0.83 g/kg based on updated factorial method studies.

---

Malnutrition in India

India faces a double burden of malnutrition — coexistence of undernutrition and overnutrition, sometimes within the same community or household.

Undernutrition Indicators (NFHS-5, 2019–21)

Indicator	National Prevalence
Stunting (low height-for-age; HAZ <−2 SD)	35.5% children <5 years
Wasting (low weight-for-height; WHZ <−2 SD)	19.3% children <5 years
Underweight (low weight-for-age; WAZ <−2 SD)	32.1% children <5 years
Anaemia in children 6–59 months	67.1%
Anaemia in women 15–49 years	57.0%
Anaemia in men 15–49 years	25.0%

Protein-Energy Malnutrition (PEM)

PEM is caused by inadequate intake of energy and/or protein, primarily affecting children under 5 years in developing countries.

Feature	Marasmus	Kwashiorkor
Primary deficiency	Energy (calories)	Protein (adequate energy)
Clinical signs	Severe wasting, "old man" face, skin and bones	Oedema (pitting), pot belly, dermatitis, depigmented hair
Serum albumin	Normal or slightly low	Markedly low
Onset	Gradual	May be rapid (after weaning)
Management	Gradual refeeding; F-75 then F-100	Same; plus treat oedema

MUAC (Mid-Upper Arm Circumference): field tool for acute malnutrition screening:

• <11.5 cm → severe acute malnutrition (SAM)
• 11.5–12.5 cm → moderate acute malnutrition (MAM)

• 12.5 cm → normal

Micronutrient Deficiencies

Iron Deficiency Anaemia (IDA)

• Most common micronutrient deficiency globally and in India
• 57% women of reproductive age are anaemic (NFHS-5)
• Stages: iron depletion → iron-deficient erythropoiesis → iron deficiency anaemia
• Biochemical markers: serum ferritin (best indicator of stores), transferrin saturation, haemoglobin
• Causes: low dietary iron intake, poor bioavailability (phytates, tea), menstrual losses, parasitic infections, repeated pregnancies

Vitamin A Deficiency (VAD)

• 18.8% sub-clinical VAD in children (NFHS)
• Clinical progression: night blindness → Bitot's spots → xerophthalmia → keratomalacia (corneal ulceration → blindness)
• Leading preventable cause of childhood blindness
• National Programme: Vitamin A supplementation for children 9 months–5 years; 1 lakh IU (9–11 months), 2 lakh IU (1–5 years) every 6 months

Iodine Deficiency Disorders (IDD)

• Goitre belt: Himalayan foothills, sub-Himalayan regions, Gangetic plains, North-East India
• Deficiency spectrum: goitre → hypothyroidism → cretinism (severe, irreversible — foetal iodine deficiency)
• Universal Salt Iodization (USI): mandatory iodization of salt at 30 ppm at production level; 15 ppm at consumer level
• India declared IDD control achieved (goitre rate <5%) in most states after USI

Zinc Deficiency

• Widespread but underreported due to lack of sensitive biomarkers
• Effects: growth stunting, impaired immunity, poor wound healing, reproductive failure, loss of taste (hypogeusia)
• Global estimate: ~17% of world population at risk (IZiNCG)

Overnutrition — The Rising Problem

• 22.9% women and 22.5% men are overweight (BMI ≥25) — NFHS-5
• 5.4% women and 4.0% men are obese (BMI ≥30)
• Diabetes: 101 million adults with diabetes in India (ICMR-INDIAB 2023)
• Hypertension: 315 million adults — India is "hypertension capital"
• Urban areas, higher socioeconomic groups, and South India disproportionately affected
• Driven by: dietary transition (processed foods, refined carbohydrates, saturated fats), sedentary lifestyles, nutrition transition

---

Nutritional Assessment — ABCD Method

Method	Components	Examples
A — Anthropometric	Growth and body composition measurements	Weight, height, BMI, MUAC, skinfold thickness, waist circumference
B — Biochemical	Laboratory tests of nutritional status	Serum ferritin, haemoglobin, serum retinol, plasma zinc, urinary iodine
C — Clinical	Physical examination for signs of deficiency	Bitot's spots (VAD), glossitis (riboflavin), Cheilosis (B2), Dermatitis (niacin)
D — Dietary	Food consumption assessment	24-hour dietary recall, Food Frequency Questionnaire (FFQ), diet history, food weighment

WHO Growth Standards (2006): based on healthy children in 6 countries; Z-score (SD) system:

• HAZ <−2 SD = stunting; <−3 SD = severe stunting
• WHZ <−2 SD = wasting; <−3 SD = severe wasting

---

Government Nutrition Programmes in India

Programme	Target Group	Key Intervention	Ministry
ICDS (Integrated Child Development Services)	0–6 year children, pregnant/lactating women	Supplementary nutrition, immunisation, health check, ECCE	WCD
PM POSHAN (Mid-Day Meal)	School children 6–14 years (Class I–VIII)	Hot cooked meal; ~9.6 crore beneficiaries	Education
POSHAN Abhiyaan (Mission POSHAN 2.0)	Children, adolescents, pregnant/lactating women	Convergence to reduce stunting, wasting, anaemia, LBW	WCD
NFSA 2013	BPL and eligible households	Subsidized foodgrains (PDS); 5 kg/person/month	Food & PD
NMHP / National Anaemia Control	Adolescent girls, pregnant women, children	Weekly iron-folic acid supplementation (WIFS)	Health
Vitamin A Supplementation	Children 9 months–5 years	Megadose Vitamin A every 6 months	Health

POSHAN Abhiyaan targets (2022 from 2017 baseline):

• Reduce stunting by 2% per year
• Reduce wasting by 2% per year
• Reduce anaemia by 3% per year
• Reduce LBW (low birth weight) by 2% per year

---

Summary Cheat Sheet

Topic	Key takeaway
Main focus	ICMR 2020 RDA values, malnutrition in India (PEM, anaemia, VAD, iodine deficiency, overnutrition), nutritional assessment, and government nutrition programmes.
Section context	Revise this lesson with the rest of Human Nutrition for stronger conceptual continuity.