Which of the following increase the absorption of non-haem iron from a meal of millet roti and dal? Select all that apply.

Germinating and fermenting the grain before cooking

A glass of lemon water with the meal

A calcium tablet taken with the meal

Germinating and fermenting the grain before cooking

A cup of tea immediately after the meal

A glass of lemon water with the meal

Match correctly: which of these deficiency pairings are right? Select all that apply.

Riboflavin — angular stomatitis

The Recommended Dietary Allowance of a nutrient is set at:

The Estimated Average Requirement plus two standard deviations

The average intake of the population

The Estimated Average Requirement plus two standard deviations

The Estimated Average Requirement itself

The Tolerable Upper Limit minus two standard deviations

Assertion (A): ICMR-NIN 2020 set the reference Indian adult man at 65 kg and woman at 55 kg. Reason (R): ICMR-NIN 2020 was the first Indian report to set Tolerable Upper Limits for nutrients. Choose the correct option.

Both A and R are true, but R is not the correct explanation of A

Both A and R are true, and R is the correct explanation of A

Both A and R are true, but R is not the correct explanation of A

A pregnant woman's haemoglobin is 10.5 g/dL. By the WHO cut-off she is:

Anaemic, because the cut-off in pregnancy is 11 g/dL

Not anaemic, because the cut-off for women is 10 g/dL

Not anaemic, because pregnancy raises haemoglobin

Anaemic only if she is also underweight

Anaemic, because the cut-off in pregnancy is 11 g/dL

Nutrition and Dietetics I: Food Groups, the Balanced Diet and Food Guides, Macro- and Micronutrients, Deficiencies, and Nutrient Requirements for Indians

Unit II is the largest unit of this syllabus in teaching load, and it takes three chapters here: this one on nutrients and requirements (items 1 and 2), the next on public health, life-span, community, sports and emergency nutrition and nutritional assessment (items 3 to 6), and the third on programmes, clinical and therapeutic nutrition, diet counselling and research designs (items 7 to 10). This chapter starts with the food groups and food guides used to plan a balanced diet, works out energy from the macronutrients, sets out what each nutrient does and what its deficiency looks like, and ends with the way requirements are now expressed for Indians: the ICMR-NIN Nutrient Requirements for Indians of 2020, with its estimated average requirements, recommended dietary allowances and tolerable upper limits, and the ICMR-NIN Dietary Guidelines for Indians of 2024.

1. Food groups, the balanced diet and food guides

A balanced diet supplies all nutrients in the amounts and proportions needed for health, growth and activity, with a small margin for short periods of stress, from a variety of foods. Food groups make that planning practical by sorting foods by the nutrients they chiefly supply, so that choosing some food from every group every day covers most needs without calculation.

ICMR five food groups	Main nutrients
1. Cereals, grains and products (rice, wheat, millets)	Energy, protein, B vitamins, fibre, iron (millets)
2. Pulses and legumes	Protein, energy, B vitamins, fibre, folate
3. Milk and meat products (milk, curd, egg, fish, meat)	High-quality protein, calcium, riboflavin, vitamin B12
4. Fruits and vegetables	Carotenes, vitamin C, folate, minerals, fibre, phytochemicals
5. Fats and sugars	Concentrated energy; fats also supply essential fatty acids and carry fat-soluble vitamins

Food guides turn the groups into pictures. The United States moved from the Basic Seven (1943) and the Basic Four to the Food Guide Pyramid (1992) and then to MyPlate (2011), which shows proportions on a plate rather than servings in a stack. In India, the ICMR-NIN Dietary Guidelines for Indians were revised in 2024 with seventeen guidelines; they present a "My Plate for the Day" in which vegetables, greens and fruits take the largest share, with cereals and millets, pulses and flesh foods, milk and curd, nuts and oils making up the rest, and they advise limiting ultra-processed foods high in fat, sugar and salt. The World Health Organization recommends keeping free sugars below 10 per cent of energy and salt below 5 grams a day.

⚠️ A food guide is not a diet chart

Food groups and plates are tools for choosing a varied diet; they do not state an individual's requirement. Requirements are expressed as nutrient amounts (the RDA and related values below), and a diet chart for a person is planned from those values using the food groups.

2. Macronutrients and energy

Carbohydrates, proteins and fats supply energy; alcohol does too, though it is not a nutrient. The physiological fuel values are 4 kilocalories per gram of carbohydrate, 4 per gram of protein, 9 per gram of fat and 7 per gram of alcohol. Dietary fibre, the carbohydrate that escapes digestion in the small intestine, supplies little energy but adds bulk, slows glucose absorption and feeds the gut microbiota.

Worked example: a snack with	Grams	Energy (kcal)
Protein	12	12 × 4 = 48
Fat	10	10 × 9 = 90
Carbohydrate	60	60 × 4 = 240
Total	82	378
Share of energy from fat	-	90 / 378 × 100 = 23.8 per cent

Protein quality depends on the essential amino acids, which the body cannot make: histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine. Cereals are limited in lysine and pulses in the sulphur amino acids (methionine and cysteine), so a cereal-pulse combination such as khichdi, idli or dal-roti supplies a better amino acid pattern than either alone; this is mutual supplementation. Fats are classed by their fatty acids: saturated (ghee, coconut oil, palm oil), monounsaturated (groundnut, mustard, olive), and polyunsaturated, including the essential omega-6 linoleic acid (sunflower, safflower, soybean) and omega-3 alpha-linolenic acid (mustard, soybean, flaxseed, and long-chain forms in fish). Industrial trans fats from partial hydrogenation raise LDL cholesterol and lower HDL, and the WHO recommends keeping them below 1 per cent of energy.

🧠 Four, four, nine, seven

Carbohydrate 4, protein 4, fat 9, alcohol 7. To find what share of a diet's energy comes from one nutrient, convert every gram figure to kilocalories first, add them, then divide. Percentages of grams and percentages of energy are different numbers because fat is more than twice as energy-dense.

3. Micronutrients: roles, sources and deficiencies

Nutrient	Key roles	Good sources	Deficiency
Vitamin A	Vision in dim light, epithelial integrity, immunity	Liver, milk fat; beta-carotene in green leafy and yellow-orange foods	Night blindness, Bitot's spots, xerophthalmia, keratomalacia
Vitamin D	Calcium absorption, bone mineralisation	Sunlight on skin; fish liver oils, egg yolk	Rickets in children, osteomalacia in adults
Thiamine (B1)	Carbohydrate metabolism, nerve function	Whole grains, pulses, parboiled rice	Beriberi (wet: cardiac; dry: neuritic)
Riboflavin (B2)	Energy metabolism (FAD, FMN)	Milk, eggs, green leafy vegetables	Angular stomatitis, cheilosis, glossitis
Niacin	Energy metabolism (NAD, NADP)	Groundnuts, meat, whole grains; made from tryptophan	Pellagra: dermatitis, diarrhoea, dementia
Folate and vitamin B12	DNA synthesis, red cell formation; B12 also nerve myelin	Folate: greens, pulses; B12: only animal foods	Megaloblastic anaemia; neural tube defects in the foetus (folate)
Vitamin C	Collagen synthesis, antioxidant, enhances non-haem iron absorption	Amla, guava, citrus, sprouts	Scurvy: bleeding gums, poor wound healing
Iron	Haemoglobin and myoglobin, enzymes	Haem: meat, fish; non-haem: greens, millets, pulses, jaggery	Microcytic hypochromic anaemia
Iodine	Thyroid hormones	Iodised salt, seafood	Goitre, cretinism, lowered IQ in children
Calcium and zinc	Bones and teeth, clotting; zinc for growth, immunity, wound healing	Milk, ragi, sesame; zinc in meat, pulses, nuts	Rickets and osteoporosis risk; zinc deficiency causes growth failure

Iron is the nutrient whose absorption depends most on the meal. Haem iron from flesh foods is well absorbed; non-haem iron from plant foods is absorbed poorly, and its absorption is raised by vitamin C and by small amounts of meat or fish in the same meal, and lowered by phytates (whole grains, pulses), tannins (tea, coffee) and calcium taken at the same time. Advising tea an hour away from meals, and lemon or amla with an iron-rich meal, is sound practice.

ℹ️ WHO haemoglobin cut-offs for anaemia

Anaemia is diagnosed when haemoglobin falls below 13 grams per decilitre in men, 12 in non-pregnant women, and 11 in pregnant women and in children aged 6 to 59 months.

4. Nutrient requirements for Indians

The ICMR-National Institute of Nutrition report Nutrient Requirements for Indians (2020) was the first Indian revision to set Estimated Average Requirements and Tolerable Upper Limits alongside the Recommended Dietary Allowances. It also raised the reference body weights to 65 kilograms for an adult man and 55 kilograms for an adult woman, reflecting healthy Indian adults of normal BMI, and it sets energy requirements by activity level rather than by occupation labels alone.

Term	Meaning
EAR (Estimated Average Requirement)	Intake meeting the need of half the healthy individuals in a group; used to assess the adequacy of a population's intake
RDA (Recommended Dietary Allowance)	EAR plus two standard deviations; meets the need of about 97 to 98 per cent of individuals; a goal for planning an individual's diet
AI (Adequate Intake)	Used where evidence is too thin to set an EAR
TUL (Tolerable Upper Limit)	The highest daily intake unlikely to cause harm; relevant for supplements and fortification

Pregnancy adds about 350 kcal a day in the second and third trimesters; lactation adds about 600 kcal a day in the first six months
Adult energy requirement, ICMR-NIN 2020 (kcal per day)	Man, 65 kg	Woman, 55 kg
Sedentary	2110	1660
Moderate activity	2710	2130
Heavy activity	3470	2720

The protein allowance for healthy adults is 0.83 grams per kilogram of body weight a day, which for the 65-kilogram reference man is about 54 grams (65 × 0.83 = 53.95) and for the 55-kilogram reference woman about 46 grams. Allowances rise in pregnancy, lactation and growth, and are set higher for protein of lower digestibility and quality, which is why the cereal-pulse combination matters in largely vegetarian Indian diets.

⚠️ EAR assesses groups, RDA plans for individuals

Comparing a population's intakes with the RDA overstates inadequacy, because the RDA is set above almost everyone's need. The proportion of a population eating below the EAR is the better estimate of the prevalence of inadequate intake.

Key takeaways

ICMR's five food groups are cereals, pulses, milk and meat products, fruits and vegetables, and fats and sugars; the 2024 ICMR-NIN Dietary Guidelines for Indians give seventeen guidelines and a "My Plate for the Day".
Energy values are 4 kcal per gram of carbohydrate and protein, 9 of fat and 7 of alcohol; convert grams to energy before computing any energy share.
Cereals lack lysine and pulses lack sulphur amino acids, so cereal-pulse combinations supplement each other.
Non-haem iron absorption rises with vitamin C and falls with phytates, tannins and calcium; WHO anaemia cut-offs are 13, 12 and 11 g/dL for men, non-pregnant women and pregnant women.
ICMR-NIN 2020 introduced EAR and TUL beside the RDA, with reference weights of 65 kg and 55 kg and a protein allowance of 0.83 g/kg a day.

Practice questions (10)

Attempt each one before opening the answer. Every explanation names the tempting wrong option as well as the right one, because that is where marks are lost.

A snack contains 12 g protein, 10 g fat and 60 g carbohydrate. How many kilocalories does it supply? Type the number.
Numerical answer — type the value.
Show answer
Answer: 378
Protein 12 × 4 = 48, fat 10 × 9 = 90 and carbohydrate 60 × 4 = 240 kcal; the total is 48 + 90 + 240 = 378 kcal.
A diet provides 60 g protein, 50 g fat and 300 g carbohydrate. What percentage of its energy comes from fat, to the nearest whole number?
1. 30 per cent
2. 18 per cent
3. 24 per cent
4. 12 per cent
Show answer
Answer: C — 24 per cent
Energy is 60 × 4 = 240, 50 × 9 = 450 and 300 × 4 = 1200, a total of 1890 kcal. Fat gives 450 / 1890 = 23.8 per cent, about 24. The 12 per cent option is the share of grams (50 of 410), the classic error of skipping the conversion.
Which amino acid is the limiting amino acid in most cereals?
1. Leucine
2. Methionine
3. Glycine
4. Lysine
Show answer
Answer: D — Lysine
Cereals are low in lysine, while pulses are low in the sulphur amino acids methionine and cysteine, which is why the two complement each other. Glycine is not even an essential amino acid.
Which of the following increase the absorption of non-haem iron from a meal of millet roti and dal? Select all that apply.
1. A calcium tablet taken with the meal
2. Germinating and fermenting the grain before cooking
3. A cup of tea immediately after the meal
4. A glass of lemon water with the meal
Show answer
Answer: B — Germinating and fermenting the grain before cooking; D — A glass of lemon water with the meal
Vitamin C enhances non-haem iron absorption, and germination and fermentation reduce phytate. Tannins in tea and calcium taken at the same time both reduce absorption.
Match correctly: which of these deficiency pairings are right? Select all that apply.
1. Vitamin A — Bitot's spots
2. Riboflavin — angular stomatitis
3. Niacin — pellagra
4. Thiamine — scurvy
Show answer
Answer: A — Vitamin A — Bitot's spots; B — Riboflavin — angular stomatitis; C — Niacin — pellagra
Pellagra is niacin deficiency, angular stomatitis a sign of riboflavin deficiency and Bitot's spots a sign of vitamin A deficiency. Scurvy is vitamin C deficiency; thiamine deficiency causes beriberi.
Using the ICMR-NIN 2020 protein allowance of 0.83 g per kg body weight per day, what is the daily protein allowance of the 65 kg reference man, rounded to the nearest gram? Type the number.
Numerical answer — type the value.
Show answer
Answer: 54
65 × 0.83 = 53.95 g, which rounds to 54 g a day. For the 55 kg reference woman the same allowance gives 55 × 0.83 = 45.65, about 46 g.
The Recommended Dietary Allowance of a nutrient is set at:
1. The average intake of the population
2. The Estimated Average Requirement plus two standard deviations
3. The Estimated Average Requirement itself
4. The Tolerable Upper Limit minus two standard deviations
Show answer
Answer: B — The Estimated Average Requirement plus two standard deviations
The RDA is the EAR plus two standard deviations of the requirement, so it covers about 97 to 98 per cent of healthy individuals. The EAR covers half, and the TUL is a ceiling for safety, not a basis for the RDA.
Assertion (A): ICMR-NIN 2020 set the reference Indian adult man at 65 kg and woman at 55 kg. Reason (R): ICMR-NIN 2020 was the first Indian report to set Tolerable Upper Limits for nutrients. Choose the correct option.
1. Both A and R are true, and R is the correct explanation of A
2. Both A and R are true, but R is not the correct explanation of A
3. A is true, but R is false
4. A is false, but R is true
Show answer
Answer: B — Both A and R are true, but R is not the correct explanation of A
Both are true, but R does not explain A. The reference weights were raised because requirements should describe healthy adults of normal BMI; the introduction of TULs is a separate innovation of the same report and has nothing to do with the choice of body weight.
Which of these oils is a notable plant source of the omega-3 fatty acid alpha-linolenic acid?
1. Mustard oil
2. Palm oil
3. Ghee
4. Coconut oil
Show answer
Answer: A — Mustard oil
Mustard, soybean and flaxseed oils supply alpha-linolenic acid. Coconut oil, palm oil and ghee are rich in saturated fatty acids and supply little omega-3.
A pregnant woman's haemoglobin is 10.5 g/dL. By the WHO cut-off she is:
1. Not anaemic, because the cut-off for women is 10 g/dL
2. Not anaemic, because pregnancy raises haemoglobin
3. Anaemic only if she is also underweight
4. Anaemic, because the cut-off in pregnancy is 11 g/dL
Show answer
Answer: D — Anaemic, because the cut-off in pregnancy is 11 g/dL
WHO defines anaemia in pregnancy as haemoglobin below 11 g/dL, so 10.5 g/dL is anaemia. Pregnancy expands plasma volume faster than red cell mass, which lowers haemoglobin concentration rather than raising it.