Anemia in Indian women continues to be highly prevalent, and is thought to be due to low dietary iron content. The high risk of dietary iron deficiency is based on the Indian Council of Medical Research recommendation of 21 mg/d, but there is a need for a secure and transparent determination of the Estimated Average Requirement (EAR) of iron in this population. In nonpregnant, nonlactating women of reproductive age (WRA), the EAR of iron was determined to be 15 mg/d. Applying this value to daily iron intakes among WRA in nationally representative Indian state–based data showed that the median risk of dietary iron deficiency was lower than previously thought (65%; IQR: 48–78%), with considerable heterogeneity between states (range: 25–93%). However, in a validation, this risk matched the risk of iron deficiency as defined by blood biomarkers in a recently completed survey. When the risk of dietary iron deficiency was modelled for an increase in iron intake through food fortification of a single dietary staple, that provided 10 mg/d, the median risk reduced substantially (from 65% to 20%), and it virtually disappeared when supplementary iron intakes through the national iron supplementation program were considered. The risk of exceeding the tolerable upper level (TUL) of intake of iron remains low in the population when receiving fortification of 10 mg/d, but is much higher if they consume greater amounts of iron through supplements (range: 0–54%). This newly and transparently defined Indian EAR of iron should be used to evaluate, with precision, the benefits and risks of iron fortification and supplementation policies.
The daily energy requirements are now based on replacing the measured daily energy expenditure (WHO/FAO/UNU 1985). When energy expenditure is equal to energy intake, energy balance is achieved, and is best indicated by weight stability. The specific energy requirement (expenditure) of a population is calculated using a factorial method that is based on the product of estimates of the basal metabolic rate (BMR), and the physical activity level (PAL). Some calculations also consider additional energy expenditure due to the thermic effect of food (TEF) which is typically about 10% of BMR. During pregnancy and in childhood, energy cost of deposition of tissues and optimal growth and during, lactation, energy cost of milk secretion is added. However, the factorial method is potentially problematic, as errors in any one factor propagate through to the final estimate of the requirement. For example, BMR is predicted from age and gender specific equations provided by the FAO/WHO/UNU, but these equations overestimate BMR of adult Indians by 5 to 12%. The PAL used for sedentary activities may also be wrong. In the latest recommendation of the Indian Council of Medical Research, the PAL is taken to be 1.53 for sedentary adults; this may need to be revised to a lower value as studies indicate that PAL of sedentary adult Indians is generally lower. In this context, the current energy recommendation may be overestimated in Indians, and should be reconsidered in the context of the dual burden of nutritional disease.
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