CM5.1-22 | Nutrition in Community Health — Graded Quiz

Correct. ICMR-NIN 2020: sedentary adult woman ≈ 1660 kcal/day; sedentary adult man ≈ 2110 kcal/day.

ICMR-NIN 2020 energy RDA: sedentary woman 1660 kcal, sedentary man 2110 kcal. Macronutrient AMDR: carbohydrate 50-60%, protein 10-15%, fat 20-30%. Dietary fibre: 40 g/day.

Incorrect. ICMR-NIN 2020 reference values: sedentary woman ≈ 1660 kcal/day, sedentary man ≈ 2110 kcal/day. 2400 kcal applies to a moderately active man. 1200 kcal is a very low calorie diet threshold used in obesity management.

Correct. ICMR-NIN 2020 sets the iron RDA for adult non-pregnant women at 29 mg/day — higher than the WHO value (18 mg/day) because it accounts for lower bioavailability of non-haem iron in the predominantly vegetarian Indian diet.

ICMR-NIN 2020 iron RDA: men 19 mg/day; non-pregnant women 29 mg/day; pregnant women 35 mg/day; lactating women 21 mg/day. Higher women's RDA compensates for menstrual loss AND lower bioavailability of plant-source iron. Anaemia in India: 57.0% women 15-49 years (NFHS-5).

Incorrect. The ICMR-NIN 2020 iron RDA for non-pregnant adult women is 29 mg/day. 8 mg/day is the US RDA for men; 18 mg is the WHO value (lower bioavailability correction not applied); 45 mg/day is the tolerable upper limit, not the RDA.

Correct. Bitot's spots are pathognomonic of Vitamin A deficiency (VAD). They are caused by squamous metaplasia of the bulbar conjunctival epithelium. Night blindness (nyctalopia) is the earliest symptom; Bitot's spots are the earliest specific sign.

VAD xerophthalmia classification (WHO): XN (night blindness), X1A (conjunctival xerosis), X1B (Bitot's spots), X2 (corneal xerosis), X3A (corneal ulcer <1/3 cornea), X3B (>1/3 cornea = keratomalacia), XS (corneal scar), XF (xerophthalmic fundus). Bitot's spots = grade X1B.

Incorrect. Bitot's spots are specific to Vitamin A deficiency. Vitamin C deficiency causes scurvy (bleeding gums, perifollicular haemorrhage). Vitamin B12 deficiency causes megaloblastic anaemia and subacute combined degeneration of the cord. Zinc deficiency causes delayed wound healing, dwarfism, hypogonadism.

Correct. PM-POSHAN targets children in Classes 1-8 (6-14 years) in government and government-aided schools. It provides a cooked mid-day meal on all school days to improve enrolment, attendance, and nutritional status.

National nutrition programme summary: ICDS (0-6 years, PLMs); PM-POSHAN / Mid-Day Meal (6-14 years, Classes 1-8); WIFS (Adolescent 10-19 years, weekly iron-folic acid); PMMVY (maternity benefit ₹5000 for first child); NHM Supplementary Nutrition (PLMs via Anganwadi). Menu: calorie ≥450 kcal, protein ≥12 g (primary); ≥700 kcal, ≥20 g protein (upper primary).

Incorrect. PM-POSHAN serves school children in Classes 1-8. Option B describes ICDS (0-6 years, Anganwadi). Option C describes the Kishori Shakti Yojana/SABLA (adolescent girls 11-14 years). Option D describes PMMVY and Antenatal supplementation programmes.

Correct. WIFS targets adolescents aged 10-19 years — both boys and girls — delivered through schools (in-school) and Anganwadi centres / community ASHA outreach (out-of-school). Dose: 1 IFA tablet weekly (100 mg elemental iron + 500 µg folic acid) + albendazole 400 mg twice yearly.

WIFS dose: 1 tablet/week (100 mg Fe + 500 µg FA) + biannual albendazole. School-based delivery through teachers. Community-based through ASHA/ANM for out-of-school adolescents. Rationale: weekly dosing reduces gastrointestinal side effects vs daily; iron stores are replenished over 20 weeks of weekly dosing.

Incorrect. WIFS targets adolescents 10-19 years of both sexes. It is NOT limited to girls or rural areas only. Pregnant women receive daily IFA (180 tablets over pregnancy), not weekly. Children under 5 with anaemia receive therapeutic iron syrup (3 mg/kg/day).

Correct. WHO defines the food safety danger zone as 5-60°C — temperatures at which most food-borne pathogens multiply rapidly. Cooking food to ≥70°C core temperature kills most pathogens. Refrigeration at <5°C retards multiplication without killing pathogens.

WHO 5 Keys Key 4 (Safe temperatures): Keep hot food above 60°C; cold food below 5°C. Never leave cooked food at room temperature (15-35°C) for >2 hours. 'Two-hour rule': food left at room temperature for >2 hours must be discarded. Pathogen multiplication is fastest at 37°C (human body temperature).

Incorrect. The danger zone is 5-60°C (WHO 5 Keys to Safer Food). Temperatures below 5°C retard growth; above 60°C destroy most pathogens. The specific thresholds 5°C and 60°C are internationally standardised.

Correct. Double-fortified salt (DFS) contains BOTH iodine AND iron. It addresses the two most prevalent micronutrient deficiencies in India simultaneously. DFS has been piloted in several states (Madhya Pradesh, Tamil Nadu) and is an FSSAI-approved product.

Food fortification types in India: (1) Universal Salt Iodisation (USI) — iodine; (2) Double-fortified salt (DFS) — iodine + iron; (3) Wheat flour fortification — iron, folic acid, Vitamin B12 (FSSAI mandate 2019); (4) Edible oil fortification — Vitamin A + D; (5) Milk fortification — Vitamin A + D. DFS iron concentration: 850-1000 ppm ferrous fumarate or NaFeEDTA.

Incorrect. DFS = iodine + iron. Zinc and Vitamin A fortification is technically feasible but not the standard definition of DFS in India. Iron + folic acid is a tablet formulation (IFA tablet), not a salt fortification.

Correct. NNMB (NIN Hyderabad) conducts repeat cross-sectional dietary and nutritional status surveys in rural households across multiple states. It provides data on dietary intakes, nutritional status (anthropometric + clinical + biochemical), and food consumption patterns over time.

NNMB: established 1972, based at NIN (Hyderabad, ICMR). Coverage: 10 states, periodic repeat surveys. Data collected: dietary recall (24-hour), clinical examination, anthropometric measurements. Key finding: tracks secular trends in dietary patterns and nutritional status among rural poor. Complements NFHS (which is periodic, nationally representative).

Incorrect. NNMB is a survey-based continuous monitoring system, not a real-time programme tracker. Option B describes POSHAN Tracker (programme monitoring). Option C is a description of targeted micronutrient surveys, not NNMB's design. Option D describes field-level screening, not NNMB.

Correct. The classic 3 Ds triad — dermatitis, diarrhoea, dementia — is pellagra, caused by niacin (Vitamin B3) deficiency. Maize is a pellagra-genic staple because it contains niacin bound to niacytin (not bioavailable) and is deficient in tryptophan (niacin precursor). Treatment: nicotinamide 300-500 mg/day.

Pellagra mnemonic: 4 Ds — Dermatitis (Casal's necklace on photo-exposed skin), Diarrhoea, Dementia (actually confusion and depression), Death (if untreated). Pellagra occurs in maize-dominated diets (maize niacin is bound); treatment: nicotinamide. Sorghum/jowar diet also causes pellagra due to excess leucine (inhibits tryptophan→niacin conversion).

Incorrect. The 3 Ds triad is pellagra = niacin deficiency. Thiamine (B1) deficiency causes beriberi (wet: cardiac failure; dry: neuropathy) or Wernicke's encephalopathy (3 Ws: Wernicke's triad — ophthalmoplegia, ataxia, confusion). Riboflavin (B2) deficiency causes cheilosis, angular stomatitis, corneal vascularisation. Pyridoxine (B6) deficiency causes peripheral neuropathy and sideroblastic anaemia.

Correct. Vitamin D3 (cholecalciferol) is synthesised from 7-dehydrocholesterol in the skin by UVB radiation (290-320 nm). Deficiency causes rickets in children (softening of bones, bow legs, rachitic rosary) and osteomalacia in adults. The liver converts D3 to 25-OHD (calcidiol); the kidney converts it to 1,25-(OH)2D (calcitriol — the active form).

Vitamin D pathway: skin (7-DHC + UVB) → D3 → liver (25-hydroxylation) → 25-OHD (storage form) → kidney (1-alpha hydroxylation) → 1,25-(OH)2D (active). Function: calcium and phosphorus absorption. Deficiency: rickets (children), osteomalacia (adults), possibly immune dysfunction. ICMR-NIN 2020 RDA: 600 IU (15 µg) for adults.

Incorrect. Vitamin D is a fat-soluble vitamin; sunlight is its primary source (80-90% of body's Vitamin D comes from skin synthesis). Pellagra is caused by niacin deficiency (not Vitamin D). Nutritional anaemia in India is primarily due to iron deficiency. ICMR-NIN 2020 RDA: 400 IU/day for 0-12 months, 600 IU/day for 1-70 years, 800 IU/day for >70 years (not all age groups 800 IU).

Correct. Colostrum is the 'liquid gold' — rich in secretory IgA (passive immunity), lactoferrin (antibacterial), leukocytes (active immune cells), growth factors (EGF), and Vitamin A. Its protein content (5-15 g/100 mL) is 3-5 times higher than mature milk (1-1.3 g/100 mL). It is rightly called the 'first vaccine.'

Colostrum vs mature milk: Colostrum has higher protein, IgA, Vitamin A, beta-carotene (yellow colour), leukocytes, lactoferrin; lower fat and lactose. Mature milk has higher fat, lactose, and caloric density. Colostrum initiates gut immune programming and passive immunity. Counsel: initiate breastfeeding within 1 hour of birth; offer colostrum as first feed.

Incorrect. Colostrum should NEVER be discarded. It is immunologically and nutritionally superior to mature milk in several ways. Discarding colostrum (a common traditional belief) is a harmful practice that must be counselled against. Colostrum does not cause neonatal jaundice — early breastfeeding prevents jaundice by promoting meconium passage.

Correct. WHO/UNICEF IYCF 2021 revised indicator: minimum dietary diversity (MDD) is achieved when a child 6-23 months consumes foods from ≥5 of 8 food groups in the past 24 hours. (Note: the 2010 indicator used 4 of 7 groups — the revised 2021 standard uses 5 of 8 groups.)

8 IYCF food groups: (1) Grains/roots/tubers, (2) Legumes/nuts, (3) Dairy (milk, curd, paneer), (4) Flesh foods (meat, poultry, fish), (5) Eggs, (6) Vitamin A-rich fruits & vegetables, (7) Other fruits & vegetables, (8) Human milk. MDD ≥5 groups (2021). NFHS-5: MDD 11.9%, minimum meal frequency 42%, minimum acceptable diet only 11.3%.

Incorrect. The revised 2021 WHO/UNICEF threshold is ≥5 food groups out of 8. The older 2010 threshold was ≥4 of 7 groups — this has been updated. India's NFHS-5 reports only 11.9% of children 6-23 months meet MDD.