Nutrient Requirements and Recommended Dietary Allowances for Indians (A Report of The Expert Group of The Indian Council of Medical Research)

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In India, the first attempt to define nutrient requirements and desirable dietary intakes of nutrients for Indians to maintain good health was made by the Nutrition Advisory Committee of the Indian Research Fund Association [Now Indian Council of Medical Research (ICMR)] in 1944 (1.1). This followed the recommendations made by the Technical Committee of the Health Committee, League of Nations in 1936 (1.2), Food and Nutrition Board of the National Research Council, USA, 1944 (1.3) and Report of the Committee of Nutrition, British Medical Association 1933 (1.4). At that time, requirements and allowances of only energy, protein, iron, calcium, vitamin A, thiamine, riboflavin, ascorbic acid and vitamin 0 for Indians were considered. Considering these recommendations, a typical balanced diet based on habitual Indian dietary habits was formulated to provide all the nutrients for a normal adult man of 55 kg and a normal adult woman of 45 kg body weight (1.5). This was used to demonstrate that the diet then consumed by Indians, particularly by the poor, was deficient in several nutrients and could be improved by inclusion of some protective foods.

The Current Nutrition Scenario In India

India, being a country in developmental transition, faces the dual burden of pre-transition diseases like undernutrition and infectious diseases as well as post-transition, lifestyle-related degenerative diseases such as obesity, diabetes, hypertension, cardiovascular diseases and cancers. According to recent National Family Health Survey (1.6) and UNICEF reports (1.7), 46% of preschool children and 30% of adults in India suffer from moderate and severe grades of protein-calorie malnutrition as judged by anthropometric indicators. Currently, India is in nutrition transition with 10% rural adults and 20% urban adults suffering from overnutrition, leading to an emerging double burden of malnutrition (1.8).

Though severe clinical forms of PCM - kwashiorkor and marasmus have become rare, they persist in some less developed states like Uttar Pradesh and Orissa. Over 50% women (particularly pregnant women) and children suffer from iron deficiency anaemia (IDA), aggravated by helminthic infections. Though blindness due to vitamin A deficiency has become rare, a recent survey shows that milder grades of deficiency as judged by clinical signs like night blindness and Bitot spots and low serum vitamin A levels, are common (1.9). Deficiencies of other micronutrients like some B-complex vitamins particularly riboflavin, folic acid and perhaps vitamin B12 are also common. Rickets has become rare, but recent studies from North and South India show that vitamin D deficiency as judged by serum levels of 25-hydroxy vitamin O2 exists in adults. This, besides low intake of calcium, may be responsible for the high prevalence of osteoporosis particularly in women. Recently, ICMR conducted a Task Force Study on prevalence of osteoporosis in India. The problem of severe forms of Iodine Deficiency Disorders (IDD) (an environmental problem) has been considerably reduced after universalization of Iodized salt. However due to implementation infirmities, milder forms of IDD persist in many districts. For every frank case of nutrition deficiency, there are dozens of others who suffer from sub-clinical malnutrition.

Revision of Human Nutrient Requirements

In the wake of reports by the Food and Agriculture Organization (FAO) on calorie (1.10, 1.11) and protein (1.12) in 1950 and 1957 respectively, an attempt was made by the ICMR in 1958 through its Nutrition Advisory Committee (NAC) to revise protein and calorie requirements of Indians, based on data available at that time (1.13). In 1968, the requirements of all nutrients except energy were reviewed by an Expert Committee constituted by ICMR (1.14). In arriving at these new recommendations, the international data provided by the FAO/WHO Expert Group and those generated by then in India, were used. In 1978, the Recommended Dietary Allowances (RDA) for Indians were again reviewed by another Expert Group of the ICMR and RDAs of several nutrients were revised (1.15). In the recommendations made by the ICMR Expert Group in 1968 and 1978, a wide range of balanced diets for different age and sex groups were formulated which, if consumed, could ensure a daily intake of all nutrients at the recommended levels.

The recommendations on human protein and energy requirements were again revised by a Joint Expert Group of FAO, WHO and United Nations University (UNU) in 1985 (1.16). In arriving at human energy requirement, this International Expert Group followed an entirely new set of guidelines.

Energy allowances for Indians, which were recommended in 1958, had not been revised till 1988. In 1988, an Expert Group was constituted by the ICMR. This Indian Expert Group, while following the new guidelines of the Joint FAO/WHO/UNU Consultative Group of 1985(1.16), also considered the updated data on Indians that had accumulated after 1973 (1.17), to define the energy and protein requirements of Indians. This Expert Group also defined the requirement of other nutrients like fat, vitamin D and vitamin A. No changes were, however, made in the recommendations on the requirement of B-complex vitamins, iron and calcium. This Expert Group included in its recommendations, several additional nutrients such as dietary fiber, electrolytes, phosphorus, vitamin E and vitamin K or dietary factors not considered by the earlier ICMR Expert Committees and made provisional recommendations on their desirable intakes to maintain good health. Dietary fat requirements were examined in greater detail and recommendations regarding the requirement in terms of invisible and visible fat were made (1.18). The reference body weights of normal healthy adult man, woman and children were also altered based on body weight data on healthy normal adults and children then obtained by National Institute of Nutrition (NIN) (1.19, 1.20).

The FAO/WHO/UNU Expert Consultation considered the revision of human nutrient requirements again after 2000. One Committee revised the requirement of micronutrients in 2001 (1.21), energy in 2004 (1.22) and protein in 2007 (1.23). In its revision, the international expert group considered several other micronutrient requirements of humans. The energy requirement, particularly of children 1-10 years was based on stable oxygen use and energy requirement of adults was guided by widespread prevalence of overweight and obesity in the west. In case of proteins, requirement of indispensable amino acids (IAA) was discussed in greater detail and RDA for IAA were also included.

It is more than 15 years since nutrient requirements and RDA was recommended for Indians. In the meantime, there has been much change in the concept of human energy requirements based on actual measurements (double isotopic ratio methods) and the requirement of several micronutrients has also been reconsidered in the recent past. In view of these international developments, ICMR constituted an Expert Group to revise and upgrade the earlier RDA of nutrients for Indians.