Nutrition and Health

Macronutrients and requirements

• Atwater: carbohydrate 4, protein 4, fat 9, alcohol 7 kcal/g.
• ICMR‑NIN 2020: reference man 65 kg, woman 55 kg; EAR vs RDA (EAR + 2 SD); energy as EER. Protein ≈ 0.83 g/kg/day. Pregnancy +350 kcal (2nd/3rd trimester); lactation +600 (0–6 months).
• Protein complementation: cereals lack lysine, pulses lack methionine. Egg = reference protein (BV ≈ 94).
• Dietary Guidelines for Indians 2024: "My Plate" (half vegetables/fruits), cereals ≤ 45% energy, salt < 5 g, added sugar < 5% energy, trans fat ≤ 2% in oils (FSSAI).

Micronutrients

• Vitamin A: XN, X1A, X1B (Bitot's), X2, X3A, X3B, XS, XF. Public‑health problem: XN > 1%, X1B > 0.5%. 9 doses (1 lakh IU at 9 months, then 2 lakh IU 6‑monthly to 5 years). Treatment: days 1, 2, 14.
• B1 beriberi (polished rice, alcohol); B2 angular stomatitis; B3 pellagra (maize, jowar: leucine); B6 with INH; folate NTDs; B12 vegetarians; C scurvy; D rickets.
• Anaemia (WHO 2024, g/dL): 6–23 months < 10.5; 24–59 months < 11; 5–11 years < 11.5; 12–14 years < 12; women < 12; men < 13; pregnancy < 11 (1st/3rd), < 10.5 (2nd). NFHS‑5: children 67.1%, women 57%, men 25%.
• Anaemia Mukt Bharat (2018), 6 × 6 × 6: syrup 20 mg + 100 µg biweekly (6–59 months); pink 45 mg + 400 µg weekly (5–9 years); blue 60 mg + 500 µg weekly (10–19); red 60 mg + 500 µg weekly (WRA), daily × 180 days (pregnant, lactating).
• Iodine: 150 µg/day (250 in pregnancy). TGR ≥ 5% = problem; median UIC < 100 µg/L insufficient. Salt ≥ 30 ppm production, ≥ 15 ppm consumer; > 90% households adequate. NGCP 1962 → NIDDCP 1992. 21 October.
• Fluoride: 0.5–1 mg/L optimal; > 1.5 dental, > 3–4 skeletal fluorosis; BIS acceptable 1.0, permissible 1.5. Nalgonda technique. NPPCF 2008–09.

Undernutrition and assessment

• SAM: WHZ < −3, MUAC < 11.5 cm, or bilateral pitting oedema. MAM: WHZ −3 to −2 or MUAC 11.5–12.5.
• Complicated SAM → NRC: 10 steps; F‑75 (stabilisation) → F‑100 (rehabilitation); ReSoMal; antibiotics for all; no iron in stabilisation. Good weight gain > 10 g/kg/day; discharge at 15% gain. CMAM protocol 2023.
• Kwashiorkor: oedema, flaky‑paint skin, flag sign, fatty liver, apathy.
• ABCD assessment; 24‑h recall (group means), weighment (most accurate). Consumption unit: adult man sedentary work = 1 (moderate 1.2, heavy 1.6).

Food safety and programmes

• Pasteurisation: holder 63 °C × 30 min; HTST 72 °C × 15 s; UHT 135–150 °C. Phosphatase test = adequacy; methylene blue = bacterial load.
• FSS Act 2006 (replaced PFA 1954); FSSAI 2008; Schedule 4; FoSTaC; Eat Right India.
• Adulterants: metanil yellow (turmeric, dal; HCl pink), argemone (mustard oil; nitric acid test), starch/water in milk.
• Toxins: lathyrism (BOAA/ODAP, khesari dal, spastic paraplegia, steeping/parboiling); aflatoxin (A. flavus, groundnut, HCC); epidemic dropsy (sanguinarine, argemone, Delhi 1998); ergotism (Claviceps, bajra); pyrrolizidine (veno‑occlusive disease).
• ICDS (2 October 1975; 6 services); Poshan 2.0 norms: children 500 kcal + 12–15 g; SAM 800 kcal + 20–25 g; P&L 600 kcal + 18–20 g. POSHAN Abhiyaan (8 March 2018, Jhunjhunu; Poshan Maah September). PM POSHAN: primary 450 kcal + 12 g; upper primary 700 kcal + 20 g. NFSA 2013: 5 kg/person/month; AAY 35 kg. Fortified rice universal (2024).