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 Table of Contents  
SHORT COMMUNICATION
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 216-220

Changes in decade-old reference standards by the national institute of nutrition 2020


1 Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
2 Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission18-Dec-2020
Date of Decision20-Apr-2021
Date of Acceptance11-Jun-2021
Date of Web Publication04-Mar-2022

Correspondence Address:
Lalithambigai Chellamuthu
Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry - 607 402
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_176_20

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  Abstract 


The National Institute of Nutrition (NIN), Hyderabad, a prime research body under the apex body for biomedical research, Indian Council of Medical Research has been recognized globally for its eminent studies on diverse subjects of nutrition, with a special focus on protein–energy malnutrition. The first edition of “Dietary Guidelines for Indians-Manual” was published by NIN in 1998 and since then has undergone many changes till the year 2011. A decade later, the updated version of “Dietary Guidelines for Indians-Manual” has been introduced by NIN in 2020 that revised the decade-old standards on reference body weight, height, age, and recommended dietary allowances for an Indian adult which will be serving as a valuable source of information for all.

Keywords: Ideal bodyweight, National Institute of Nutrition, recommended dietary allowances, reference height


How to cite this article:
Chellamuthu L, Boratne AV, Bahurupi YA. Changes in decade-old reference standards by the national institute of nutrition 2020. CHRISMED J Health Res 2021;8:216-20

How to cite this URL:
Chellamuthu L, Boratne AV, Bahurupi YA. Changes in decade-old reference standards by the national institute of nutrition 2020. CHRISMED J Health Res [serial online] 2021 [cited 2022 May 28];8:216-20. Available from: https://www.cjhr.org/text.asp?2021/8/3/216/339046




  Introduction Top


The National Institute of Nutrition (NIN), Hyderabad, a prime research body under the apex body for biomedical research, Indian Council of Medical Research (ICMR) has been recognized globally for its eminent studies on diverse subjects of nutrition, with a special focus on protein–energy malnutrition.[1],[2],[3],[4],[5],[6] The first edition of “Dietary Guidelines for Indians-Manual” was published by NIN in 1998 and since then has undergone many changes till the year 2011.[7] A decade later, the updated version of “Dietary Guidelines for Indians-Manual” has been introduced by NIN in 2020 that revised the decade-old standards on reference body weight, height, age, and recommended dietary allowances (RDAs) from the NIN for an Indian adult.[8],[9],[10],[11],[12]

Background

In 1989, an expert committee constituted by NIN decided on what should be a nutritious diet, by observing body weights and heights of well-to-do Indian children and adolescents. Reference weights for a man and woman were fixed at 60 and 55 kg, respectively, based on that data.[7],[13] However, there was lack of representativeness from the entire nation in that data.[9],[12]

Another panel in 2010 viewed the anthropometry measurements gathered by the National Nutrition Monitoring Bureau (NNMB), employing nutrition profiles from only ten Indian states for estimating reference body weights, and they figured reference weights for various age groups.[9],[12]

The 2020 expert panel of ICMR-NIN followed a different process than the earlier panels. They derived acceptable reference body weight values through the lifespan and average height by utilizing the data covering the whole of India, including various nationally representative data from the National Family Health Survey-4 (2015–2016), NNMB (2015–2016), WHO report (2006–2007), and Indian Academy of Pediatrics (2016).

The latest revision in “ideal” weight and height will be considered for the estimation of body mass index (BMI) in India. The choice to modify average height and weight for Indians was actualized because of the increased nutritional food intake. To arrive at this decision, data from both rural and urban areas were utilized, unlike in 2010, where only urban data were applied.[8],[9],[12]


  Upward Revision on Reference Values of Adult Age, Body Weight, and Height Top


NIN has come up with updated cutoff values for the decade-old standards on reference body weight, height, age, and RDA for an Indian adult in September 2020 [Table 1].[8],[9],[10],[11],[12]
Table 1: Upward revision on reference values of adult age, body weight, and height

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  Updates of Norms on Recommended Dietary Allowance Top


NIN has also modified the RDA and estimated average requirement (EAR) of nutrition for Indians in the latest report. For the first-time ever, nutrient requirements incorporate EAR and the tolerable upper limit of nutrients alongside suggested RDA. Furthermore, the intake of ideal amount of carbohydrates, minerals, fats and oils, protein, dietary fiber, and even water by an individual is provided in the new guidelines.[8],[9]

The ICMR-NIN committee has considered recommendations for fiber-based energy intake for the first time. A safe limit has been suggested as 40 g of dietary fiber per 2000 kilocalories of food intake. Recommendations for visible fat intake for individuals with sedentary, moderate, and heavy activities have been set at 25, 30, and 40 g/day for men and 20, 25, and 30 g/day for women. The cutoff for dietary intake of carbohydrates was decided by considering estimated energy requirement at 100 g a day for >1 year of age with a RDA of 130 g/day.[8],[9],[12]

Recommended daily allowance of calcium for an adult was 600 mg/day in 2010 while increased to 1000 mg/day in 2020 with an addition of 200 mg for a pregnant and lactating mother. For postmenopausal females, the required amount of calcium is 1200 mg/day [Table 2].[7],[9],[13]
Table 2: Recommended dietary allowances for Indians in 2011 and 2020[7],[13]

Click here to view


Recommended salt consumption for an individual has been 5 g/day, with sodium intake limited to 2 g/day and consumption of potassium fixed at 3,510 MG/day.[8],[9],[12] Water intake recommended for an adult male ranges from 32 to 58 ml/kg, and for a female, it ranges from 27 to 52 ml/kg.[12] The recommended water intake for children has been prescribed to be >60 ml/kg body mass and for adolescent age group ranging from 47 to 60 ml/kg among boys and 39–49 ml/kg in case of girls. Based on working intensity, water required for a pregnant woman ranges from 2.1 to 3.2 l/day. A minimum of 400 g/day of fruits and vegetables are essential in gaining adequate antioxidants which has protective action against chronic diseases and cancers. Furthermore, it is advisable to supplement with vegetable oil to obtain Vitamin E in sufficient amounts.[12]


  Possible Impacts of these Updates on Reference Standards Top


How will be the comparison of Indians with International standards?

Reference body mass is a proxy indicator for the nutritional status of people in a country. When compared internationally, it was noticed that the average Indian is lighter than his or her counterparts living across the world. For instance, an average Dutch male is 87.4 kg and a woman 72.3 kg while the average body weight in the United Kingdom is 86.8 kg for men and 72.9 kg for women.[12] Indians are closer to typical weights prevalent in Asian countries but rank lower in comparison with countries like Sri Lanka and Japan. The weight of an average Sri Lankan male is 61.3 kg and woman 56.2 kg, and an average Japanese man is 69 kg and woman 54.7 kg.[12] However, it was based on 2010 estimates, but now the latest NIN modifications on average weight will push Indians up a few ranks among other countries in the Asian region.

Are Indians growing taller and heavier?

Have you ever wondered how children of this generation are taller than their parents? This rise in height could be attributed to multiple reasons such as access to clean water, intake of nutritious food, a decrease in the prevalence of childhood infections, proper perinatal care, and prompt interventions to address infections. Measurement of height of men and women has been happening at regular intervals since 1975. In the last decades, the average height of Indian men increased by 3 cm and of women by 5 cm.[10] NIN has revised the average height of men and women by increasing two and three inches, respectively, keeping 2010 data as baseline. For these recent revisions on height and weight, should there be a review on anthropometric reference standards (height and weight) of under-five children? If in future, similar changes apply to anthropometric reference standards of under-five children, what about the impact on the categorization of under-five children based on indicators such as height-for-age, weight-for-age, and weight-for-height?

How do we estimate the poverty line by calorie norms in India?

The poverty line is computed based on a fixed consumption basket of 1973–1974, which satisfied the minimum requirement of 2400 and 2100 calories per person per day in rural and urban areas, respectively.[14]

The minimum wage calculation for a family is based on the consumer unit. A consumption unit is comparable to a “standard” male aged 20–39 years and doing sedentary work. The nutritional requirements of a consumer unit in Indian condition are fixed as 2700 Kcal/day. Per capita nutritional standards are determined by fixing the number of consumer units to household members based on age–sex specifications.[15]

What will happen to the minimum requirement of calories for an individual per day due to these modifications in “ideal body weight” and “standard age?” Will this alter the estimation of the below poverty line based on calorie norms and minimum wage calculation in India?

How will be the categorization of body mass index in India?

BMI, earlier called the Quetelet index, is a measure for nutritional status in adults and moreover a good proxy for adiposity and overweight-related problems.[16] The World Health Organization has designed different BMI cutoff points for the Asian population and rest other population [Table 3].[17],[18],[19]
Table 3: Classification of body mass index

Click here to view


Reference weight and height of Indians were different when BMI cutoff points were fixed for the Asian-Pacific population in the previous years which is still being in use. At present, with an amendment in reference weight and height of Indians by NIN, is it suitable to utilize the previously defined BMI cutoff points for Asians? Is there a need for redefining the BMI cutoff points for Indians?

Can we expect a reduction in common nutritional problems in India?

Undernutrition begins as early as during conception. As a result of extensive maternal undernutrition (underweight, poor weight gain during pregnancy, nutritional anemia, and vitamin deficiencies), infants are born with low birth weight (<2500 g).[20] Both clinical and subclinical undernutrition are widely prevalent even during early childhood and adolescence in our nation. Persistent undernutrition throughout the growing phase of childhood leads to short stature and obesity in adults.[21]

The Government of India has initiated several strategies to curb common nutritional problems and aid in improving the nutritional status of people, namely Integrated Child Development Services, Mid-Day Meal Scheme, National Food Security Act, and Mahatma Gandhi National Rural Employment Guarantee Act.[22],[23],[24],[25],[26],[27],[28] Recently introduced Government of India's flagship program in 2018, “The Prime Minister's Overarching Scheme for Holistic Nutrition or POSHAN Abhiyaan or National Nutrition Mission,” aims to build a people's movement (Jan Andolan) around malnutrition intending to significantly reduce malnutrition in the next 3 years.[29] Besides these initiatives, is it possible for all Indian citizens to consume the recommended daily allowance of nutrients to achieve the revised ideal weight and reference height?


  Conclusion Top


More clarity is mandated in all aspects of these present-day standards, its implementation, and evaluation. These recommendations should be widely used to estimate or assess the nutritional requirement for an Indian adult. These novel norms should set out as an effective source of accurate and accessible information substantiating the modifications, both for the general public and those who are involved in disseminating nutrition and health education. The Government of India needs to restructure all the nutritional programs and initiatives in the limelight of these new nutritional yardsticks.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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