RDA

Introduction to Dietary Standards

• Recommended Dietary Allowance (RDA):
  • The RDA is defined as the average daily dietary intake level sufficient to meet the nutrient requirement of nearly all (97% to 98%) healthy individuals in a particular life-stage and gender group.
  • It is calculated as the Estimated Average Requirement (EAR) plus two standard deviations (RDA = EAR + 2SD).
  • RDA is used as the goal for usual intake by an individual.
• Estimated Average Requirement (EAR):
  • This is the median daily intake value estimated to meet the requirement of half the healthy individuals in a specific group.
  • It is primarily used to assess the nutrient intake of populations rather than individuals.

Energy Requirements

Energy requirements vary significantly based on age, growth rate, metabolic rate, and physical activity.

Infants (0–12 Months)

• ICMR-NIN 2020 Requirements:
  • 0–6 months: 550 kcal/day (approx. 92 kcal/kg/day).
  • 6–12 months: 670 kcal/day (approx. 80 kcal/kg/day).
  • Energy needs are based on total energy expenditure plus energy deposition for growth.

Children and Adolescents (ICMR-NIN 2020)

• Children 1–3 years: 1060–1110 kcal/day (approx. 82 kcal/kg/day).
• Children 4–6 years: 1350 kcal/day.
• Children 7–9 years: 1690 kcal/day.
• Adolescents (Boys):
  • 10–12 years: 2190 kcal/day.
  • 13–15 years: 2750 kcal/day.
  • 16–18 years: 3020 kcal/day.
• Adolescents (Girls):
  • 10–12 years: 2010 kcal/day.
  • 13–15 years: 2330 kcal/day.
  • 16–18 years: 2060 kcal/day.

Bedside Calculation of Calorie Requirement

• This method is often used by clinicians as a practical guide.
• 0–1 year: 100 kcal/kg.
• 1 year: 1000 kcal.
• >1 year: 1000 kcal + (100 kcal × each year of age) up to puberty.
• Puberty: 2400 kcal (1 unit of energy).

Holliday and Segar Formula (Fluid and Calorie Estimation)

• Used for maintenance fluid and caloric estimation in well-nourished and hospitalized children.
• First 10 kg: 100 kcal/kg.
• Next 10 kg (11–20 kg): 1000 kcal + 50 kcal/kg for each kg >10.
• >20 kg: 1500 kcal + 20 kcal/kg for each kg >20.

Protein Requirements

Protein is essential for the synthesis of tissues, enzymes, hormones, and antibodies. Requirements are higher per kilogram in infants due to rapid growth.

ICMR-NIN 2020 Standards

• Infants:
  • 0–6 months: 8.1 g/day.
  • 6–12 months: 10.5 g/day.
• Children:
  • 1–3 years: 11.3 g/day.
  • 4–6 years: 15.9 g/day.
  • 7–9 years: 23.3 g/day.
• Adolescent Boys:
  • 10–12 years: 31.8 g/day.
  • 13–15 years: 44.9 g/day.
  • 16–18 years: 55.4 g/day.
• Adolescent Girls:
  • 10–12 years: 32.8 g/day.
  • 13–15 years: 43.2 g/day.
  • 16–18 years: 46.2 g/day.

Fat Requirements

• Fats provide energy (9 kcal/g), structural elements for cell membranes, and vehicles for fat-soluble vitamins.
• Visible Fat RDA (ICMR 2020):
  • Infants (0–6 mo): 0 g (met by breast milk).
  • Infants (6–12 mo): 25 g/day.
  • Children (1–9 years): 25–30 g/day.
  • Adolescents (10–18 years): 35–50 g/day depending on gender and age.
• Total Fat Intake: Should contribute 30–40% of total energy for children 1–3 years and 25–35% for children 4–18 years.
• Essential Fatty Acids (EFA): Linoleic acid (3% of energy) and alpha-linolenic acid (0.3% of energy) are required.

Macronutrient Distribution

• Carbohydrates: Should provide 55–60% of total calories.
• Proteins: Should provide 10–15% of total calories.
• Fats: Should provide 25–30% of total calories.

Micronutrient Requirements: Fat-Soluble Vitamins

Vitamin A (Retinol)

• Functions: Vision, immune function, growth, and epithelial integrity.
• RDA (ICMR 2020):
  • Infants (0–12 mo): 350 mcg/day.
  • 1–3 years: 390 mcg/day.
  • 4–6 years: 510 mcg/day.
  • 7–9 years: 630 mcg/day.
  • Adolescents: 770–1000 mcg/day.
• Bedside Calculation: ~1500 IU/day (500 mcg).

Vitamin D (Cholecalciferol)

• Functions: Calcium and phosphorus absorption, bone mineralization.
• RDA (ICMR 2020): 400 IU (10 mcg) for infants; 600 IU (15 mcg) for children >1 year and adolescents.
• Note: Breast milk is deficient in Vitamin D (30–40 IU/L); supplementation is required for exclusively breastfed infants.

Vitamin E (Tocopherol)

• Functions: Antioxidant, immune function.
• RDA:
  • Infants: 4–5 mg/day.
  • Children: 6–11 mg/day.
  • Adolescents: 15 mg/day.

Vitamin K

• Functions: Blood clotting, bone metabolism.
• RDA:
  • Infants: 2.0–2.5 mcg/day.
  • Children: 30–55 mcg/day.
  • Adolescents: 60–75 mcg/day.

Micronutrient Requirements: Water-Soluble Vitamins

Thiamine (Vitamin B1)

• RDA (ICMR 2020):
  • Infants: 0.2–0.4 mg/day.
  • Children (1–9 years): 0.7–1.1 mg/day.
  • Adolescents: 1.4–2.2 mg/day.
• Bedside Calculation: 0.5–1.5 mg/day (or 1 mg/1000 kcal).

Riboflavin (Vitamin B2)

• RDA (ICMR 2020):
  • Infants: 0.4–0.6 mg/day.
  • Children (1–9 years): 0.9–1.6 mg/day.
  • Adolescents: 1.9–3.1 mg/day.

Niacin (Vitamin B3)

• RDA (ICMR 2020):
  • Infants: 2–5 mg/day.
  • Children (1–9 years): 7–11 mg/day.
  • Adolescents: 14–22 mg/day.

Pyridoxine (Vitamin B6)

• RDA (ICMR 2020):
  • Infants: 0.1–0.6 mg/day.
  • Children (1–9 years): 0.9–1.5 mg/day.
  • Adolescents: 1.9–3.0 mg/day.

Folic Acid (Vitamin B9)

• RDA (ICMR 2020):
  • Infants: 25–85 mcg/day.
  • Children (1–9 years): 110–170 mcg/day.
  • Adolescents: 220–340 mcg/day.

Vitamin B12 (Cyanocobalamin)

• RDA (ICMR 2020):
  • Infants: 1.2 mcg/day.
  • Children/Adolescents: 1.2–2.5 mcg/day.

Vitamin C (Ascorbic Acid)

• RDA (ICMR 2020):
  • Infants: 20–27 mg/day.
  • Children (1–9 years): 27–43 mg/day.
  • Adolescents: 52–82 mg/day.

Mineral Requirements

Calcium

• RDA (ICMR 2020):
  • Infants: 300 mg/day.
  • Children (1–3 years): 500 mg/day.
  • Children (4–9 years): 550–650 mg/day.
  • Adolescents (10–18 years): 850–1050 mg/day (highest requirement due to bone mass accretion).

Iron

• RDA (ICMR 2020):
  • Infants (6–12 mo): 3 mg/day.
  • Children (1–9 years): 8–15 mg/day.
  • Adolescent Boys: 16–26 mg/day.
  • Adolescent Girls: 28–32 mg/day.

Zinc

• RDA (ICMR 2020):
  • Infants (6–12 mo): 2.5 mg/day.
  • Children (1–9 years): 3.0–5.9 mg/day.
  • Adolescents: 8.5–17.6 mg/day.

Magnesium

• RDA (ICMR 2020):
  • Infants: 30 mg/day.
  • Children (1–9 years): 135–215 mg/day.
  • Adolescents: 255–405 mg/day.

Iodine

• RDA (ICMR 2020):
  • Infants: 100–130 mcg/day.
  • Children: 90–120 mcg/day.
  • Adolescents: 150 mcg/day.

Special Considerations: Preterm Infants

Preterm infants have higher metabolic needs and limited stores. The ESPGAN recommendations for preterm RDA are:

• Energy: 110–165 kcal/kg/day.
• Protein: 3–3.5 g/kg/day.
• Vitamin A: 1000 IU/day.
• Vitamin D: 400 IU/day.
• Vitamin E: 15 IU/day.
• Calcium: 100–200 mg/kg/day.
• Phosphorus: 50–150 mg/kg/day.
• Iron: 2.5 mg/kg/day (starting at 6–8 weeks).