These nutrition notes for nursing bring together everything nursing officer, AIIMS NORCET, CHO and ANM exams ask about food and health: macronutrients, vitamins and their deficiency diseases, minerals, ICMR-NIN requirements, BMI, therapeutic diets, malnutrition and India’s nutrition programmes. Each section is built around facts that repeatedly appear as MCQs.
Nutrition overlaps heavily with community health and paediatrics, so revise it with our community health nursing notes and pediatric nursing notes.
Nutrition notes for nursing: scope and weightage
Nutrition questions appear in almost every nursing recruitment paper, either as a separate subject or within community health, paediatrics and medical-surgical nursing. CHO and ANM papers give it extra weight because programme facts (ICDS, POSHAN, Anemia Mukt Bharat, vitamin A) are part of daily field work. Expect direct recall questions on deficiency diseases and programme doses, and applied questions on diets for specific diseases.
Macronutrients and energy
| Nutrient | Energy per gram | Key exam facts |
|---|---|---|
| Carbohydrate | 4 kcal | Main energy source; glucose is the preferred fuel of the brain and RBCs |
| Protein | 4 kcal | Body building; egg protein is the reference protein because of its high biological value |
| Fat | 9 kcal | Most concentrated energy source; essential fatty acids are linoleic and alpha-linolenic acid |
| Alcohol | 7 kcal | Empty calories |
- Limiting amino acids: cereals are poor in lysine, pulses are poor in methionine, maize is poor in tryptophan and lysine. Eating cereals and pulses together improves protein quality (mutual supplementation).
- Dietary fibre prevents constipation and helps control blood glucose and cholesterol.
- Breast milk provides about 65 to 70 kcal per 100 ml. Breastfeeding should begin within one hour of birth, be exclusive for 6 months, and continue with complementary feeding up to 2 years or beyond.
Nutrient requirements (ICMR-NIN 2020)
The current Indian reference is “Nutrient Requirements for Indians, 2020” by ICMR-National Institute of Nutrition, Hyderabad. It uses a reference adult man of 65 kg and woman of 55 kg.
| Activity level | Man (kcal/day) | Woman (kcal/day) |
|---|---|---|
| Sedentary work | 2110 | 1660 |
| Moderate work | 2710 | 2130 |
| Heavy work | 3470 | 2720 |
- Protein RDA for adults: 0.83 g per kg body weight per day.
- Pregnancy: an extra 350 kcal per day; extra protein of 9.5 g in the second trimester and 22 g in the third trimester.
- Lactation: an extra 600 kcal per day for 0 to 6 months and 520 kcal for 7 to 12 months.
- Iron RDA: 19 mg per day for adult men and 29 mg per day for adult women. Calcium RDA for adults: 1000 mg per day.
Older textbooks quote the 2010 ICMR values (for example 60 kg man, 1 g/kg protein). If an option set has both, prefer the 2020 values unless the question names the older reference.
Vitamins and deficiency diseases table
| Vitamin | Deficiency disease or sign | Good sources and notes |
|---|---|---|
| A (retinol) | Night blindness, Bitot’s spots, xerophthalmia, keratomalacia | Liver, egg yolk, green leafy vegetables, yellow fruits; earliest symptom is night blindness |
| D (calciferol) | Rickets in children, osteomalacia in adults | Sunlight on skin, fish liver oil, fortified milk |
| E (tocopherol) | Haemolytic anaemia in preterm infants, neuropathy | Vegetable oils, nuts; an antioxidant |
| K | Bleeding; haemorrhagic disease (vitamin K deficiency bleeding) of the newborn | Green leafy vegetables, gut bacteria; 1 mg IM at birth for term babies, 0.5 mg for preterm |
| B1 (thiamine) | Beriberi (wet: cardiac; dry: neuritis), Wernicke encephalopathy | Whole grains; lost in polished rice; common in alcoholics |
| B2 (riboflavin) | Angular stomatitis, cheilosis, glossitis | Milk, eggs, green leafy vegetables |
| B3 (niacin) | Pellagra: dermatitis, diarrhoea, dementia (and death) | Seen in maize and jowar eaters; can be made from tryptophan |
| B6 (pyridoxine) | Peripheral neuropathy, convulsions in infants | Given with isoniazid to prevent neuropathy |
| B9 (folic acid) | Megaloblastic anaemia, neural tube defects in the foetus | Green leafy vegetables; 400 mcg daily around conception |
| B12 (cobalamin) | Megaloblastic (pernicious) anaemia, subacute combined degeneration of the cord | Only in animal foods; strict vegetarians are at risk; needs intrinsic factor |
| C (ascorbic acid) | Scurvy: bleeding gums, perifollicular haemorrhages, poor wound healing | Amla, guava, citrus; destroyed by heat; improves iron absorption |
WHO classification of xerophthalmia
- XN: night blindness. X1A: conjunctival xerosis. X1B: Bitot’s spots.
- X2: corneal xerosis. X3A: corneal ulceration less than one-third of the cornea. X3B: keratomalacia, one-third or more.
- XS: corneal scar. XF: xerophthalmic fundus.
- Treatment schedule (age over 1 year): 2 lakh IU vitamin A orally on day 0, day 1 and day 14. Half the dose (1 lakh IU) for infants 6 to 12 months, and 50,000 IU below 6 months.
Minerals and trace elements
| Mineral | Deficiency or excess | Exam facts |
|---|---|---|
| Iron | Iron deficiency (microcytic hypochromic) anaemia | Haem iron (meat) is better absorbed; vitamin C helps, tea, coffee and phytates reduce absorption |
| Iodine | Goitre, cretinism, mental retardation, stillbirths | Iodised salt: at least 30 ppm at production and 15 ppm at consumer level |
| Calcium | Rickets, osteoporosis, tetany | Milk is the best source; needs vitamin D |
| Zinc | Growth retardation, delayed wound healing | Zinc for 14 days is given with ORS in childhood diarrhoea |
| Fluoride | Low: dental caries. High: dental and skeletal fluorosis, genu valgum | Fluorosis is endemic in parts of Rajasthan, Andhra Pradesh and Telangana; defluoridation by the Nalgonda technique |
| Sodium | Excess linked to hypertension | WHO advises less than 5 g salt per day for adults |
WHO haemoglobin cut-offs for anaemia: below 11 g/dL in children 6 to 59 months and pregnant women, below 12 g/dL in non-pregnant women, below 13 g/dL in adult men.
BMI categories and Asian cut-offs
BMI = weight (kg) divided by height (m) squared. Because Asians have more body fat and higher cardiometabolic risk at lower BMI, the WHO Asia-Pacific cut-offs are lower than the international ones.
| Category | WHO international | WHO Asia-Pacific (used for Indians) |
|---|---|---|
| Underweight | Below 18.5 | Below 18.5 |
| Normal | 18.5 to 24.9 | 18.5 to 22.9 |
| Overweight | 25.0 to 29.9 | 23.0 to 24.9 |
| Obese | 30 and above | 25 and above |
Abdominal obesity in Indian adults is commonly defined as a waist circumference of 90 cm or more in men and 80 cm or more in women.
Malnutrition
| Feature | Kwashiorkor | Marasmus |
|---|---|---|
| Main deficit | Protein, with relatively adequate calories | Both calories and protein |
| Oedema | Present (pitting, starts in feet) | Absent |
| Appearance | Moon face, flaky paint dermatosis, sparse discoloured hair (flag sign), fatty liver | Severe wasting, “old man” face, loose skin folds |
| Appetite and mood | Poor appetite, apathetic, irritable | Often alert and hungry |
- Anthropometric terms: stunting is low height for age (chronic undernutrition); wasting is low weight for height (acute); underweight is low weight for age (composite).
- Severe acute malnutrition (6 to 59 months): weight-for-height below minus 3 SD, or MUAC below 115 mm, or bilateral pitting oedema. Moderate acute malnutrition: weight-for-height between minus 3 and minus 2 SD, or MUAC 115 to 124 mm.
- MUAC tape colours: red below 11.5 cm, yellow 11.5 to 12.5 cm, green above 12.5 cm.
- Complicated SAM is managed in Nutrition Rehabilitation Centres (NRCs) using WHO steps: treat hypoglycaemia, hypothermia and dehydration (ReSoMal) first; start feeds with F-75 (stabilisation) and move to F-100 (rehabilitation).
- Refeeding syndrome (low phosphate, potassium, magnesium) can occur when severely malnourished patients are fed too fast.
Therapeutic diets
| Condition | Diet principle |
|---|---|
| Diabetes mellitus | Calorie-controlled, complex carbohydrates, high fibre, low glycaemic index foods, regular meal timings |
| Hypertension and heart disease | Low sodium, low saturated and trans fat, more fruits and vegetables (DASH pattern) |
| Chronic kidney disease | Controlled protein, restricted sodium, potassium and phosphorus, fluid as per urine output |
| Cirrhosis with ascites | Sodium restriction, adequate calories and protein; avoid alcohol |
| Peptic ulcer and GERD | Small frequent meals, avoid irritants, no food 2 to 3 hours before lying down |
| Burns, TB, post-operative | High calorie, high protein diet |
| Coeliac disease | Gluten-free: avoid wheat, barley and rye (oats if contaminated); rice and maize allowed |
| Phenylketonuria | Low phenylalanine diet |
| Gout | Low purine (limit organ meat, red meat, alcohol), plenty of fluids |
| Hepatitis | High carbohydrate, moderate protein, low fat |
Hospital diet progression usually runs clear liquid, full liquid, soft, then normal diet. For nasogastric feeding, check tube position before each feed and keep the head end raised to about 30 to 45 degrees to prevent aspiration. More detail on diets in disease is in our medical-surgical nursing notes.
Nutrition programmes in India
ICDS, Saksham Anganwadi and POSHAN 2.0
- ICDS began on 2 October 1975. Its six services are supplementary nutrition, pre-school non-formal education, nutrition and health education, immunisation, health check-up and referral services.
- Since 2021-22 it runs under the umbrella “Mission Saksham Anganwadi and POSHAN 2.0” of the Ministry of Women and Child Development.
- Supplementary nutrition norms: children 6 months to 6 years about 500 kcal and 12 to 15 g protein; severely underweight children about 800 kcal and 20 to 25 g protein; pregnant and lactating women about 600 kcal and 18 to 20 g protein.
POSHAN Abhiyaan
- Launched on 8 March 2018 from Jhunjhunu, Rajasthan, to reduce stunting, undernutrition, anaemia and low birth weight.
- Poshan Maah is observed every September and Poshan Pakhwada in March.
PM POSHAN (earlier Mid-Day Meal)
- The Mid-Day Meal scheme was renamed PM POSHAN (Pradhan Mantri Poshan Shakti Nirman) in 2021.
- Norms: primary classes 450 kcal and 12 g protein; upper primary 700 kcal and 20 g protein per child per day.
Anemia Mukt Bharat (6x6x6 strategy)
Launched in 2018 under POSHAN Abhiyaan, it targets six beneficiary groups through six interventions and six institutional mechanisms.
| Beneficiary | Prophylactic IFA dose |
|---|---|
| Children 6 to 59 months | 1 ml IFA syrup (20 mg elemental iron + 100 mcg folic acid), twice a week |
| Children 5 to 9 years | 1 pink IFA tablet (45 mg iron + 400 mcg folic acid), weekly |
| Adolescents 10 to 19 years | 1 blue IFA tablet (60 mg iron + 500 mcg folic acid), weekly |
| Women of reproductive age (non-pregnant, non-lactating) | 1 red IFA tablet (60 mg iron + 500 mcg folic acid), weekly |
| Pregnant women | 1 red IFA tablet daily for 180 days, starting from the second trimester |
| Lactating mothers | 1 red IFA tablet daily for 180 days after delivery |
Deworming with albendazole (200 mg for 1 to 2 years, 400 mg above 2 years) is given biannually; National Deworming Day is observed on 10 February and 10 August.
Vitamin A prophylaxis
- First dose 1 lakh IU at 9 months with the measles-rubella vaccine.
- Then 2 lakh IU every 6 months up to 5 years: a total of 9 doses (17 lakh IU).
Iodine
The National Goitre Control Programme (1962) was renamed the National Iodine Deficiency Disorders Control Programme (NIDDCP) in 1992. Global Iodine Deficiency Disorders Prevention Day is 21 October. For other health programmes, see our national health programmes notes.
Food adulteration and fortification
| Food | Adulterant or toxin | Effect |
|---|---|---|
| Mustard oil | Argemone oil (sanguinarine) | Epidemic dropsy |
| Khesari dal (Lathyrus sativus) | BOAA neurotoxin | Neurolathyrism (spastic paralysis of legs) |
| Groundnut, maize | Aflatoxin (Aspergillus flavus) | Liver damage, liver cancer |
| Bajra, rye | Ergot (Claviceps purpurea) | Ergotism |
| Turmeric, dal | Metanil yellow (non-permitted dye) | Toxic; detected by HCl test (turns pink) |
| Black pepper | Dried papaya seeds | Fraud; seeds float in alcohol |
| Milk | Water, starch | Starch detected with iodine (blue colour) |
- The Food Safety and Standards Act 2006 replaced the Prevention of Food Adulteration Act 1954; FSSAI is the regulator.
- FSSAI fortification standards cover five staples: rice, wheat flour, edible oil, milk and salt. Fortified food carries the “+F” logo.
- Double fortified salt contains iodine and iron. Edible oil and milk are fortified with vitamins A and D.
Quick revision points
- Fat gives 9 kcal per gram; carbohydrate and protein give 4 kcal.
- Egg protein is the reference protein.
- Pulses are deficient in methionine; cereals in lysine.
- Earliest sign of vitamin A deficiency is night blindness.
- Bitot’s spots are X1B in the WHO classification.
- Pellagra is linked to maize and jowar diets; its 3 Ds are dermatitis, diarrhoea, dementia.
- Vitamin B12 is found only in animal foods.
- Pyridoxine prevents isoniazid neuropathy.
- Amla is one of the richest sources of vitamin C.
- Kwashiorkor has oedema; marasmus does not.
- MUAC below 115 mm in a child 6 to 59 months indicates SAM.
- Asian BMI of 23 to 24.9 is overweight.
- ICMR-NIN 2020 reference man is 65 kg and woman 55 kg.
- Extra energy in pregnancy is 350 kcal per day.
- Adolescent IFA tablet under Anemia Mukt Bharat is blue; children 5 to 9 get pink.
- Vitamin A prophylaxis gives 9 doses from 9 months to 5 years.
- PM POSHAN gives 450 kcal to primary and 700 kcal to upper primary children.
- Argemone oil causes epidemic dropsy; Lathyrus causes neurolathyrism.
Test yourself on these topics with the CHO test series or the NORCET test series. Nutrition also features strongly in the CHO exam pattern and syllabus.
Frequently asked questions
Which nutrition topics are most important for nursing exams?
Vitamin and mineral deficiency diseases, ICMR-NIN requirements, malnutrition grading, therapeutic diets and programme doses (Anemia Mukt Bharat, vitamin A, ICDS and PM POSHAN norms) are asked most often.
Which RDA values should I follow, 2010 or 2020?
Follow the ICMR-NIN “Nutrient Requirements for Indians, 2020” for current questions. Many older books still carry 2010 figures, so read the question carefully for the reference year.
Is nutrition asked separately in the CHO exam?
Most CHO papers include nutrition within community health and maternal and child health. Programme-based questions are common because CHOs run these services at Ayushman Arogya Mandirs.
What is the difference between stunting and wasting?
Stunting is low height for age and reflects chronic undernutrition. Wasting is low weight for height and reflects recent, acute undernutrition.
Where can I get nutrition notes in PDF?
Concept RNA shares free subject PDFs on the free PDF notes page, which you can use alongside this guide.
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