Nutrition: Nutrients, ICMR-NIN Requirements, Deficiency Diseases & Therapeutic Diets
Key Takeaways
Carbohydrate and protein each supply 4 kcal per gram, fat supplies 9 kcal per gram and alcohol 7 kcal per gram.
ICMR-NIN 2020 sets energy needs at 2,110 kcal/day for a sedentary 65 kg man and 1,660 kcal/day for a sedentary 55 kg woman, plus 350 kcal/day in pregnancy.
The ICMR-NIN 2020 protein RDA for healthy adults is 0.83 g/kg/day, about 54 g for the reference man and 46 g for the reference woman.
The ICMR-NIN 2020 iron RDA is 19 mg/day for adult men and 29 mg/day for adult women; adult calcium is 1,000 mg/day.
Indian adult BMI cut-offs classify 23.0–24.9 kg/m² as overweight and 25 kg/m² or more as obese, lower than the WHO global cut-offs.
Nutrition questions in nursing recruitment exams test three things: the energy and nutrient values you must calculate, the deficiency disease that matches a sign, and the right diet for a disease. This section uses the ICMR-National Institute of Nutrition (NIN) reference values that Indian textbooks follow.
1. Classes of Nutrients and Energy Values
| Nutrient | Main functions | Energy (kcal/g) | Rich Indian sources |
|---|---|---|---|
| Carbohydrate | Main fuel; spares protein | 4 | Rice, wheat, millets (ragi, jowar), potatoes |
| Protein | Growth, tissue repair, enzymes, antibodies | 4 | Pulses (dal), milk, eggs, fish, meat, soybean |
| Fat | Concentrated energy; carries vitamins A, D, E, K; essential fatty acids | 9 | Oils, ghee, nuts, oilseeds |
| Vitamins | Regulate metabolism | 0 | Fruits, vegetables, milk, whole grains |
| Minerals | Bones, blood, nerve and muscle function | 0 | Milk (calcium), green leafy vegetables, jaggery (iron) |
| Water | Medium for all reactions; temperature control | 0 | Drinking water, beverages, food moisture |
| Fibre | Bowel regularity; lowers cholesterol and glycaemic load | ~0 | Whole grains, vegetables, fruits, pulses |
Alcohol provides 7 kcal/g but no nutrients ("empty calories").
Worked example: a meal containing 60 g carbohydrate, 15 g protein and 10 g fat provides (60 × 4) + (15 × 4) + (10 × 9) = 240 + 60 + 90 = 390 kcal.
Protein quality: cereals are low in lysine; pulses are low in methionine. Eating them together (rice with dal, roti with dal) gives mutual supplementation. Egg protein is the classic reference protein of high biological value.
2. ICMR-NIN 2020 Requirements for Indians
The 2020 ICMR-NIN expert committee revised the Recommended Dietary Allowances (RDAs). Reference body weights are 65 kg for an adult man and 55 kg for an adult woman.
| Group | Energy (kcal/day) | Protein |
|---|---|---|
| Man, sedentary | 2,110 | 0.83 g/kg/day (about 54 g/day) |
| Man, moderate work | 2,710 | 0.83 g/kg/day |
| Man, heavy work | 3,470 | 0.83 g/kg/day |
| Woman, sedentary | 1,660 | 0.83 g/kg/day (about 46 g/day) |
| Woman, moderate work | 2,130 | 0.83 g/kg/day |
| Pregnancy | +350 | +9.5 g (2nd trimester); +22 g (3rd trimester) |
| Lactation, 0–6 months | +600 | +16.9 g |
| Lactation, 7–12 months | +520 | +13.2 g |
Selected micronutrient RDAs (ICMR-NIN 2020) for adults:
| Nutrient | Men | Women |
|---|---|---|
| Iron (mg/day) | 19 | 29 |
| Calcium (mg/day) | 1,000 | 1,000 |
| Iodine (µg/day) | 150 | 150 |
| Folate (µg/day, DFE) | 300 | 220 |
| Vitamin C (mg/day) | 80 | 65 |
| Vitamin A (µg/day) | 1,000 | 840 |
| Vitamin D (IU/day) | 600 | 600 |
The ICMR-NIN Dietary Guidelines for Indians (2024) recommend iodized salt limited to 5 g a day, and a person should limit visible fat (cooking oil) to roughly 20–50 g a day depending on energy needs. For people eating cereal-based diets with lower-quality protein, NIN suggests about 1 g protein/kg/day.
3. Vitamins and Their Deficiencies
| Vitamin | Deficiency disease / key sign | Notes for nurses |
|---|---|---|
| A (retinol) | Night blindness, Bitot's spots, keratomalacia | National prophylaxis: 9 doses from 9 months to 5 years |
| D | Rickets (children), osteomalacia (adults) | Synthesised in skin with sunlight |
| E | Hemolysis in premature infants | Antioxidant |
| K | Bleeding (Vitamin K Deficiency Bleeding of the newborn) | 1 mg IM at birth for term babies |
| B1 (thiamine) | Beriberi (wet: heart failure; dry: neuropathy); Wernicke's encephalopathy | Give thiamine before IV glucose in alcoholics |
| B2 (riboflavin) | Angular stomatitis, cheilosis, glossitis | Milk, eggs |
| B3 (niacin) | Pellagra: the "3 Ds"—dermatitis, diarrhoea, dementia (death if untreated) | Seen with maize-based or jowar-based diets |
| B6 (pyridoxine) | Peripheral neuropathy, convulsions | Given with isoniazid |
| B9 (folate) | Megaloblastic anemia; neural tube defects | 400 µg periconceptionally |
| B12 | Megaloblastic anemia + neuropathy | Vegans and pernicious anemia |
| C | Scurvy: bleeding gums, perifollicular hemorrhage | Destroyed by prolonged cooking |
Fat-soluble vitamins (A, D, E, K) are stored and can be toxic in excess; water-soluble vitamins (B group, C) are excreted and needed daily.
4. Minerals of Public-Health Importance
- Iron: iron-deficiency anemia is the commonest nutritional deficiency in India. Absorption improves with vitamin C and falls with tea, coffee, calcium and phytates.
- Iodine: deficiency causes goitre, cretinism and cognitive impairment. Under the National Iodine Deficiency Disorders Control Programme, iodized salt should contain 30 ppm at production and at least 15 ppm at consumer level.
- Calcium: bones and teeth, clotting, muscle contraction; milk and ragi are rich sources.
- Fluorine: small amounts prevent caries; excess in drinking water causes dental and skeletal fluorosis.
- Zinc: wound healing and immunity; zinc is given for 14 days in childhood diarrhoea.
- Sodium: excess raises blood pressure, hence the 5 g/day salt limit.
5. Assessing Nutritional Status
- Anthropometry: weight, height, BMI, mid-upper arm circumference (MUAC), waist circumference.
- Body Mass Index: BMI = weight (kg) ÷ height (m)². Example: 70 kg and 1.65 m gives 70 ÷ 2.7225 = 25.7 kg/m².
| Category | WHO (global) | Asian-Indian consensus |
|---|---|---|
| Underweight | < 18.5 | < 18.5 |
| Normal | 18.5–24.9 | 18.5–22.9 |
| Overweight | 25.0–29.9 | 23.0–24.9 |
| Obese | ≥ 30.0 | ≥ 25.0 |
A BMI of 25.7 is therefore "overweight" by WHO global cut-offs but "obese" by the Indian cut-off. Abdominal obesity is suggested by a waist circumference above about 90 cm in Indian men and 80 cm in Indian women.
- Clinical signs, biochemical tests (hemoglobin, serum albumin) and diet surveys (24-hour recall, food frequency) complete the assessment.
6. Therapeutic Diets
| Diet | Key features | Typical use |
|---|---|---|
| Clear liquid | Water, clear juices, broth, ORS | First diet after surgery; before procedures |
| Full liquid | Adds milk, curd-lassi, custard, strained soups | Transition diet; difficulty chewing |
| Soft diet | Low fibre, easily chewed (khichdi, idli, porridge) | Post-operative, GI upset, weakness |
| Low sodium | Salt restricted; avoid pickles, papad, processed foods | Hypertension, heart failure, cirrhosis with ascites, renal disease |
| Diabetic | Controlled carbohydrate, high fibre, regular meal timing, low simple sugar | Diabetes mellitus |
| High-calorie, high-protein | Extra energy and protein | Burns, TB, malnutrition, wound healing |
| Renal | Controlled protein, potassium, phosphorus, sodium and fluid | Chronic kidney disease |
| Low fat | Avoid fried food, ghee, organ meat | Gallbladder disease, pancreatitis, hyperlipidemia |
| Gluten-free | No wheat, barley, rye | Celiac disease |
| Low residue | Limited fibre | Before bowel surgery; acute inflammatory bowel flare |
Feeding methods: oral, enteral (nasogastric, gastrostomy, jejunostomy), and parenteral (total parenteral nutrition through a central line).
7. National Nutrition Programmes
- ICDS (1975): supplementary nutrition, growth monitoring and preschool education at Anganwadi centres.
- POSHAN Abhiyaan (2018): national nutrition mission targeting stunting, undernutrition, anemia and low birth weight.
- PM POSHAN (formerly the Mid-Day Meal scheme): hot cooked meals in government schools.
- Anemia Mukt Bharat (2018): life-cycle IFA supplementation, deworming and testing using the "6×6×6" strategy.
- Vitamin A prophylaxis and the iodine deficiency programme.
A snack contains 30 g carbohydrate, 8 g protein and 6 g fat. How many kilocalories does it provide?
152 kcal
176 kcal
206 kcal
264 kcal
According to the ICMR-NIN 2020 recommendations, what is the recommended dietary allowance of iron for an adult Indian woman?
19 mg/day
21 mg/day
29 mg/day
35 mg/day
A patient presents with dermatitis on sun-exposed skin, chronic diarrhoea and memory loss. Deficiency of which vitamin is most likely?
Niacin (vitamin B3)
Riboflavin (vitamin B2)
Thiamine (vitamin B1)
Ascorbic acid (vitamin C)
Sections you finish are checked off in the contents.