Revised RDA for Indians 2010 (Report of the Expert Group of ICMR)

Transcription

1 Revised RDA for Indians 2010 (Report of the Expert Group of ICMR) Dr. B. Sesikeran, MD, FAMS Director National Institute of Nutrition (Indian Council Medical Research) Hyderabad

2 15 th November, 2010 New Delhi 2

3 The amount of nutrient considered adequate to meet the needs of practically all healthy people. The RDA are based on scientific knowledge. Prepared by the National Nutrition Advisory Committee (ICMR). The committee revise the RDAevery 10 years. Current RDA of Indians was set up in

4 RDA - Basis Provides a guideline for nutrient intake, adequacy, preventing deficiency or excess of a population. Basis: Nutrient intake is assumed to follow Gaussian distribution, unless itis known to be otherwise Gaussian distribution EAR RDA SUL UL Def Av Toxicity Nutrient Intake Av : Mean RDA : Mean + 2SD, 97.5% In case of energy no safe allowances are made, only average requirement is made. 4

5 Components required to derive RDA Reference body weight Intake: Nutrient intake is assumed to follow Gaussian distribution, unless it is known to be otherwise Bioavailability Healthy well being Based on the most recent scientific evidence review 5

6 Reference body weight for deriving RDAs Comparison of 95 th Centile values of weight, height by age and gender Rural India (16 States) and WHO/MGRS median values Weight (kg) 11.2 (10.9) 13.0 (13.3) 14.8 (15.3) Males Height (cm) 82.4 (82.3) 90.7 (91.9) 99.1 (99.9) Age (years) 1+ Weight (kg) (10.2) Females (12.7) (15.0) Height (cm) 81.6 (80.7) 89.8 (90.7) 98.2 (99.0) WHO Mean 95% Values in parenthesis -reference body weight considered for fixing Indian RDAs for 1-3 y. ICMR RDA (2010) 6

7 REFERENCE BODY WEIGHT The definition for reference Indian adult man and woman were modified with regard to age (20-39y to 18-29y of age) with a normal BMI and a body weight of 60kg and 55kg respectively. 7

8 Definition-Energy Is for a healthy, well nourished and active population. Specify energy requirements in terms of energy output for productive work and leisure activity of adults and tissue deposition in infants, children and during pregnancy and milk secretion during lactation. Need to specify an appropriate body weight and quantum of physical activity desirable. Intake above the actual requirement-obesity Below-under nutrition. No safe allowances 8

9 RDA: Basis for requirements ENERGY Requirement = total energy expenditure (TEE) + energy deposition TEE= * kg, FAO/WHO/UNU (2004) DLW method Energy deposition during growth = weight gain (g/d) x energy deposited (kcal/d) 1-3 years Age Body wt kg Wt gain kg/y Energy cost wt gain TEE kcal/d Requirement kcal/d (/kg/d) (85) (85) * Ref. equitation on Table 48 9

10 ENERGY A reduction of 4-8 % of energy (100kcal, 145 for moderate and 310 kcal for heavy work per day) has been recommended on account of a lower physical activity level in men. In women the requirement remains similar on account of a higher reference body weight. Current estimate of energy requirement for infants is lower by 11-20% than the 1988 estimate. Committee considered the requirement for children at different physical activity levels at different ages years there is an increase in requirements based on a higher physical activity level of Indian children of that age group. 10

11 BMR of Indians is about 5% lower compared to the BMR of developed countries (Shetty et al, 1986) 11

12 RDA: Basis for requirements PROTEIN Safe level of protein intake= Maintenance requirements(from N balance studies) + growth (equation adapted from FAO/WHO 2007)+ 2 SD. g protein/kg/day Age Maintenance Growth total Safe level (2SD) Safe level Indian diet* * Cereal-pulse-milk diet having PDCAAS of 77.4% PDCAAS= protein digestibility corrected amino acid score =protein digestibility x AAS 12

13 PROTEIN Given that surveys such as the NFHS and NNMB have reported pre-pregnancy weight of 47 kg, and GWG of only 8 kg, it is worth recording that the additional high quality protein requirement in such a pregnant woman gaining 8 kg during pregnancy, is 0.4, 5.5 and 18.2 g/day. It is important that the higher intake of protein recommended during pregnancy should come from a normal, varied diet, and not from commercial highprotein supplements. 13

14 Extra allowances of nutrients during pregnancy Group Particulars Net energy Kcal/d Protein g/d Visible Fat g/d Ca mg/d Iron mg/d Zn mg/d Woman 55 Kg Moderate work Pregnant Lactation 0-6 m m Vit. A mg/d Retinol b-carotene Thia mine mg/d Riboflavin mg/d Niacin equivale nt mg/d Pyridoxine mg/d Ascor-bic Acid mg/d Folic acid mg/d Vit.B 1 2 mg/d

15 FAT Minimum total fat intakes for adults: 15%E to ensure adequate consumption of total energy, essential fatty acids and fat soluble vitamins for most individuals. 20% E for women of reproductive age and adults with BMI <18.5, especially in developing countries in which dietary fat may be important to achieve adequate energy intake in malnourished populations. Maximum Total fat intakes for adults: 30-35%E for most individuals. Minimal intakes of visible fat in Indian adults range between g/p/day To ensure optimal fat quality, the use of correct combination of vegetable oils is recommended. 15

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17 Fiber: 40 g/ 2000 kcal Minerals: Minerals like zinc, selenium and iodine has been included as separate chapters in the new document. Calcium and Phosphorous: Current level of calcium consumption is reported to be providing less than 400 mg Ca/d/Cu. The present Committee, in view of the evidences, made upward revision of calcium requirements for adults (600 mg/d). During pregnancy and lactation the requirement is further enhanced to 1200 mg. Elemental Ca:P ratio of 1:1 is maintained. 17

18 Recent studies: The mean fractional absorption in irondeficient subjects was 17.5% and in normal women 7.3% These values are greater than absorption values (5%) used earlier for calculating iron RDA of for adult women. Considering the fact that iron absorption is inversely related to body iron stores and that Indians have reduced iron stores compared to their peers in developed countries, a realistic estimate of iron absorption would be 5% for adult male and 8% for adult female. These figures are in agreement with the recommendations of WHO/FAO, lists three bio-availability levels of 5, 10, and 15%. 18

19 IRON-Basis International recommendations are 2-3 times lower than the Indian RDA. Higher bioavailability of iron attributable to increased ascorbic acid content and heme iron consumption. This magnitude of difference in RDA in itself is cause for concern as physiological requirements for the different age/sex categories do not vary to this extent across populations. This implies that enhancing bioavailability rather than density or content is of paramount importance for addressing iron requirement for Indians. 19

20 Magnesium: Recommended 340 mg of dietary Mg Zinc: For adult man and NPNL woman for zinc is set at 12 and 10 mg/day respectively recommendations for all physiological groups for zinc has been added. Selenium: 40 µg/day Iodine: 150µg/day is retained Iron: iron has been reduced significantly among all physiological groups. To achieve this, the committee recommended that the density of ascorbic acid should be atleast 20mg/ 1000 kcal. Absorption earlier 2-5%, Now 5-8% Sodium & Potassium: A safe intake of 2500 mg/day which amounts to 5g/day of salt, desirable sodium : potassium ratio in the diet was fixed at 1:1 (in mmol). 1 g Nacl contain 39% Na ++ 20

21 WATER SOLUBLE VITAMINS: Folate: Allowance of folic acid is given in terms of dietary folate rather than free folic acid. Committee retains the 75 ug physiological requirement of folic acid which can be obtained from 200ug of dietary folate per day. Vitamin B12: The present ICMR Committee retains the earlier recommendation of 1µg/day. Ascorbic acid (Vitamin C): Decided to retain the earlier recommendations of RDA for ascorbic acid for all age groups except for pregnancy where an additional 20mg/day is recommended for meeting extra needs of foetal growth. 21

22 FAT SOLUBLE VITAMINS: Vitamin A: The present Committee modified the extent of conversion efficiency of1:4 to 1:8. Upward revision of retinol to 800 µg is recommended during pregnancy. Committee recommends that a minimum of 50% RE be drawn from animal sources. Vitamin D: Committee retains the earlier recommendations on vitamin D considering outdoor physical activity as a means of achieving adequate vitamin D status, Under situations of minimal exposure to sunlight, a specific recommendation of a daily supplement of 400 IU (10 µg) is retained. 22

23 FAT SOLUBLE VITAMINS: Vitamin E: Requirement of alpha tocopherol suggested is 0.8 mg/ g of dietary essential fatty acids. This roughly works out to 8-10 mg tocopherol /d, depending on the edible oil used. 55 μg of vitamin K /d for adults Antioxidants: Recommended 400g/day of fruits and vegetables to. 23

24 Body Weight (Kg) Energy (Kcal/Day) Proteins (g/day) GROUP CATEGORY Revised Old Revised Old Revised Old Sedentary MAN WOMAN INFANTS CHILDREN Moderate Heavy Sedentary Moderate Heavy Pregnant Lact. <6 mths Lact mths mths /kg 108/kg 1.16/kg 2.05/kg 6 12 mths /kg 98/kg 1.69/kg 1.65/kg 1-3 yrs yrs yrs BOYS yrs GIRLS yrs BOYS yrs GIRLS yrs BOYS yrs GIRLS yrs

25 Visible Fat (g/day) Calcium (mgl/day) Iron (mg/day) GROUP CATEGORY Revised Old Revised Old Revised Old Sedentary 25 MAN WOMAN INFANTS CHILDREN Moderate Heavy 40 Sedentary 20 Moderate Heavy 30 Pregnant Lact. <6 mths 30 Lact mths mths µg/kg mths yrs yrs yrs BOYS yrs GIRLS yrs BOYS yrs GIRLS yrs BOYS yrs GIRLS yrs

26 Retinol (µg/day) Β Carotene (µg/day) Thiamin (mg/day) GROUP CATEGORY Revised Old Revised Old Revised Old Sedentary MAN WOMAN INFANTS CHILDREN BOYS Moderate Heavy Sedentary Moderate Heavy Pregnant Lact. <6 mths Lact mths mths µg/kg mths µg/kg 1-3 yrs yrs yrs yrs GIRLS yrs BOYS yrs GIRLS yrs BOYS yrs GIRLS yrs

27 Riboflavin (mg/day) Niacin Eq. (mg/day) Vit. B6 (mg/day) GROUP CATEGORY Revised Old Revised Old Revised Old Sedentary MAN WOMAN INFANTS CHILDREN Moderate Heavy Sedentary Moderate Heavy Pregnant Lact. <6 mths Lact mths mths µg/kg 710 µg/kg 710 µg/kg mths µg/kg 650 µg/kg 650 µg/kg yrs yrs yrs BOYS yrs GIRLS yrs BOYS yrs GIRLS yrs BOYS yrs GIRLS yrs

28 GROUP MAN WOMAN INFANTS CHILDREN BOYS GIRLS BOYS GIRLS BOYS GIRLS Category Sedentary Moderate Heavy Sedentary Moderate Heavy Vit C (mg/day) Dietary Folate (µg/day) Vit. B12 (µg/day) Revised Old Revised Old (FF) Revised Old Pregnant Lact. <6 mths Lact mths 0 6 mths 6 12 mths 1-3 yrs yrs yrs yrs yrs yrs yrs yrs yrs

29 MAN GROUP CATEGORY Zinc (mg/day) Magnesium (mg/day) WOMAN INFANTS CHILDREN Sedentary Moderate Heavy Sedentary Moderate Heavy Pregnant Lact. <6 mths Lact mths mths mths yrs yrs yrs BOYS yrs GIRLS yrs BOYS yrs GIRLS yrs BOYS yrs GIRLS yrs

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