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Community Nutrition Pdf 134095 | Indianjmedres1485477 718003 001158

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             Review Article                                                                                       Quick Response Code:
             Indian J Med Res 148, November 2018, pp 477-487
             DOI: 10.4103/ijmr.IJMR_2061_18
             National Institute of Nutrition: 100 years of empowering the nation 
             through nutrition
                                         1,†                †
             SubbaRao M. Gavaravarapu  & R. Hemalatha
             1                                                                            †
             Media, Communication & Extension Group, Extension & Training Division,  ICMR-National Institute of 
             Nutrition, Hyderabad, India
             Received November 11, 2018
                         The National Institute of Nutrition (NIN) has reached a remarkable milestone of completing 100 years 
                         of exemplary service to the nation. The long journey that started in a humble one-room laboratory 
                         at Coonoor (now in Tamil Nadu) in 1918 to a colossus of the nutrition research in the country today 
                         is dotted with several interesting vignettes. The NIN has always been at the forefront of need-based, 
                         pragmatic research. Its large-scale community-based interventions have been of great practical value in 
                         the nation’s fight against malnutrition. The evolution of nutrition as a modern science almost coincides 
                         with the growth of the Institute. Being the oldest in the fraternity of institutes under the Indian Council 
                         of Medical Research (ICMR), the NIN has grown from strength to strength due to the sheer relevance of 
                         its contributions in furthering nutrition science and promoting public health in the country. This article 
                         provides a historical overview of the evolution and contributions of ICMR-NIN in the areas of nutrition, 
                         food safety, public health and policy.
             Key words Food safety - NIN - Nutrition Research Laboratory - nutrition - public health nutrition
             Introduction                                                unit  transformed  into  Deficiency  Diseases  Enquiry 
                 The long journey of the National Institute of           in 1925 and then to Nutrition Research Laboratories 
             Nutrition (NIN) of the Indian Council of Medical            (NRLs), which in turn metamorphosed into the NIN in 
             Research (ICMR) at Hyderabad, India, from a humble          1958. Being the oldest institute in the ICMR fraternity, 
             one-room laboratory at Coonoor to the picturesque           the  NIN has contributed significantly in the area of 
             sprawling campus in the historic city of Hyderabad is       nutrition science and public health in the country.
             dotted with several interesting landscapes.  The NIN        The story of genesis
             has completed its 100 years journey in November                 Sir Robert McCarrison, the founder Director of 
             2018. The emergence of nutrition as a modern science        NIN, is justifiably credited to be the father of nutrition 
             almost synchronized with the starting of systematic 
             nutrition research in 1918 when Beri-beri Enquiry Unit      research in India. After some early studies on iodine 
             was established at Coonoor by the Indian Research           deficiency  disorders  (IDDs)  in  the  sub-Himalayan 
             Fund Association (IRFA) (now ICMR). This enquiry            areas, McCarrison’s research was kept in abeyance due 
             © 2018 Indian Journal of Medical Research, published by Wolters Kluwer - Medknow for Director-General, Indian Council of Medical Research
                                                                    477
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                  478                                                     INDIAN J MED RES, NOVEMBER 2018
                  to the First World War. Returning from the active war                                 (ii)        Continuously monitor diet and nutrition situation 
                  service in 1918, McCarrison proceeded to south India                                             of the country.
                  to join the Pasteur Institute in Coonoor. It is here, in                              (iii)       Evolve effective methods of management and 
                  the salubrious Nilgiri hills, that the journey of nutrition                                      prevention of nutritional problems keeping the 
                  research in India began from a one-room laboratory in                                            existing economic, social and administrative 
                  the Pasteur Institute. McCarrison was recalled to Britain                                        set-up in view.
                  in 1920 and he returned only in 1922, but the Unit was                                (iv)     Conduct operational research connected with 
                                                                     1                                            planning and implementation of national 
                  axed on financial grounds in 1923 . Two years later, 
                  due to McCarrison’s concerted efforts, it was restored                                          nutrition programmes.
                  as the Deficiency Diseases Enquiry. Around the same                                   (v)      Dovetail nutrition research with other health 
                  time, the Royal Commission on Agriculture was                                                   programmes of the government.
                  appointed to report on the Indian agricultural practices                              (vi)       Develop a band of young scientists, teachers in 
                  and policy under Lord Linlithgow (who later became                                              medical schools and health workers, well trained 
                  the Viceroy of India) and he was keenly interested                                              in nutrition.
                  in McCarrison’s work. In 1926, the members of the                                     (vii)      Disseminate nutrition information for institutional 
                  Royal Commission paid a visit to Coonoor to acquaint                                           and community benefit.
                  themselves with the work, and McCarrison took this                                    (viii)     Advise governments and other organizations on 
                  opportunity to submit a memorandum on ‘Malnutrition                                             issues relating to nutrition.
                  as a cause of physical inefficiency and ill health among                              Establishment of research centres
                  masses in India’, which highlighted the connection                                          In the 1970s, the Institute further widened its scope 
                  between nutrition and agriculture. The memorandum                                     of research with the establishment of the following 
                  also emphasised the need for closer co-ordination                                     three important centres:
                  of  research  among  diverse  fields  such  as  nutrition,                            (i)   National Nutrition Monitoring Bureau (NNMB) 
                  medicine, veterinary and agricultural sciences in India.                                     was set up under the ICMR in 1972 in 10 
                  The Commission realized that nutrition research had                                          States. The Bureau through regular and periodic 
                  a fundamental role in agricultural development in                                            surveys generated a dynamic database on diet and 
                  India and soon recommended in their report that there                                        nutritional status of the communities regularly till 
                  was a need to establish a central institute for nutrition 
                              2                                                                                since 1975. These studies included repeat surveys 
                  research . Taking advantage of this recommendation,                                          among rural, tribal and urban population.
                  McCarrison submitted a proposal to the IRFA that the                                  (ii)   Laboratory Animals Information Service (LAIS) 
                  unit under him be recognized as equivalent to a central                                      which was earlier housed in Haffkines Institute, 
                                 2
                  institution . It was in 1929 that the unit in Coonoor                                        Bombay (now Mumbai) was shifted to the premises 
                  came to be known as the NRLs and became the                                                  of the NIN in 1976. It was renamed as Laboratory 
                  only institution in India to be exclusively devoted to                                       Animal Information Service Centre (LAISC). In 
                  research in human nutrition. By 1935, the NRL had six                                        1995, it was re-designated as the National Cancer 
                  rooms including a lecture hall and a nutrition museum                                        for Laboratory Animal Sciences (NCLAs). This has 
                                                                                              3
                  on the second floor of the Pasteur Institute in Coonoor .                                    been elevated as a full-fledged research institute, 
                  In 1949, the IRFA was re-designated as the ICMR with                                         National Animal Resource Facility for Biomedical 
                  an additional scope of work and responsibilities. Under                                      Research (NARFBR) in 2017.
                  ICMR, earlier institutes, including NRL, were expanded                                (iii)   Recognising the significant contributions made 
                  and many new research institutes were set up. The year                                       by the NIN in food toxins research, Food and 
                  1969 marked the Golden Jubilee celebrations of NRL                                           Drug Toxicology Research Centre (FDTRC) was 
                  on completion of 50 yr of its existence. In recognition                                      established by the ICMR in 1978.
                  of its yeomen contributions to nutrition research, the 
                  governing body of ICMR renamed and re-designated                                      Highlights of research achievements
                                                                                        2,4
                  NRL as the National Institute of Nutrition (NIN) .                                    Early studies on nutrient deficiency disorders
                                             5
                  Objectives of NIN                                                                           While epidemiological studies on beriberi were 
                  (i)         Identify various dietary and nutrition problems                                                                                                       1
                                                                                                        continued during the early decades of its founding , 
                             prevalent among different segments of the                                  special surveys were conducted on beriberi in endemic 
                             population.                                                                areas as well as among tribal population in Bihar 
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                                             GAVARAVARAPU & HEMALATHA: 100 YEARS OF NIN                                        479
             region. The studies on parboiled and milled rice helped      and rewritten with data obtained after updating some 
             to explain the incidence of beriberi among rice eaters in    methods of nutrient estimation and was published as 
                                                                                                                      17
             the east coast of Andhra region where milled rice was        ‘Nutritive Value of Indian Foods’ in 1970s . Analysis 
             consumed largely and no incidence in Madras where            of foods for their nutrient composition has been the 
                                                     6,7                  basis for the periodical revision of this publication.
             parboiled rice was consumed more . Systematic 
             epidemiological investigations have demonstrated that             More recently, the database profiling the nutritive 
             beriberi has characteristic effects on the chronological     values of Indian foods has been readied in 2017. 
                                        8,9
             pattern of infant mortality . NRL’s focus also turned        Adopting the ‘key foods approach’, that contributes up 
             towards goitrogenic substances, epidemic dropsy,             to 75 per cent of the nutrient intakes considered. Using 
             burning feet and bladder stones. Stomatitis associated       latest techniques and precision tools, the new ‘Indian 
             with the deficiency of B group of vitamins, particularly     Food Composition Tables (IFCT) 2017, were brought 
             riboflavin, was described for the first time in India, and   out. The IFCT 2017 is the compilation of nutritional 
             a treatment with yeast and skimmed milk was found to         information on 151 discrete food components for 528 
                         2,10,11 
             be effective     .                                           key foods. The IFCT, for the first time in the Indian 
                 The need to add a clinical dimension and conduct         context, attempted to provide information on almost all 
             systematic clinical trials was felt, and C. Gopalan was      regular nutrients in foods alongside a whole range of 
                                                                                               18
             appointed as the clinical assistant to study diarrhoea       bioactive substances .
             and nutritional disorders at the Clinical Unit established   Formulation  of  recommended  dietary  allowances 
             at Stanley Hospital in Madras (Chennai). This clinical       (RDAs)
             unit was the first to describe a clinical condition called        The  first  recommendations  on  Recommended 
             ‘burning feet syndrome’, which was found to be due to        Dietary Allowances (RDA) were made for the Indian 
             vitamin B deficiency, and prescribed its treatment with      context in 1944 based on the recommendations of the 
                                          2, 12,13
             vitamin B (pantothenic acid)      .                                                                                3,4
                                                                          Health Committee of the League of Nations (1937) . 
             Nutritive values of Indian foods                             Later, the RDAs were modified in the early 1960s, and 
                                                                                                                                19
                 One of the important contributions of NIN has            then in the early 1970s, 1980, 1991 and last in 2010 . 
             been the assessment of nutritive values of commonly          An expert group constituted by the ICMR in 2008 
             consumed Indian foods. This was first taken up in 1935       revised and updated the nutrient requirements as well 
             and was completed in two years. Chemical analysis was        as dietary allowances for Indians. Data generated in 
             performed on more than 200 foods for nutritive values        India by NIN earlier became the basis and RDAs were 
             (energy, carbohydrate, protein, fat, vitamin and mineral     revised compared to the previous versions of 1944, 
             contents). Besides employing the already established         1958 and 1968. Recommendations for minerals such as 
             methods for vitamin analyses, newer and improved             calcium, phosphorus, zinc, selenium and iodine have 
             methods of analyses were employed, especially for the        been included as separate chapters.
                                                                 10,14    Dietary guidelines for Indians
             estimation of niacin, carotene and some B vitamins     . 
             ‘The Nutritive Value of Indian Foods and Planning of              A manual with information on the key practicable 
             Satisfactory Diets’ was published in 1937, in Health         points for diets and physical activity for Indians to 
             Bulletin No. 23, which turned out to be a very popular       ensure optimal health and freedom from disease was 
                         15
             contribution . Apart from this, the nutritive values         proposed for the first time in 1998. In 2011, after the 
             of fruits and vegetables were also determined during         RDAs were revised and the guidelines were redrafted, 
             1960s. The project on nutritive values of Indian foods                                        20
             was initiated at four centres (Coonoor, Bombay,              the revised version was released .
             Ambala and Mysore) and this work helped to fill gaps in      Studies on protein-energy malnutrition (PEM)
             the earlier ‘Health Bulletin’. This work generated new            Studies were conducted on protein-energy 
             data on nutrient as well as non-nutrient components          malnutrition (PEM) among infants, and some feeding 
             in a number of foods. The data from all the centres          trials were also conducted among children to study 
             were compiled, and Health Bulletin No. 23, brought           the effect of skimmed milk on their nutritional status, 
             out earlier, was updated and revised. The revised            which Aykroyd3 claimed as the first-ever  studies  to 
             edition was published as ICMR Special Report No.             give reconstituted skimmed milk powder to children in 
                16
             42  in 1962. This publication was thoroughly revised         a developing country and to show that this supplement 
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             480                                    INDIAN J MED RES, NOVEMBER 2018
             accelerated growth and improved the general condition.      nutritional status of children in rural areas and in urban 
             In fact, in later years, skimmed milk powder has been       slums, which was operated under the Integrated Child 
                                                                                                       4
             given to a large number of children suffering from          Development Scheme (ICDS) .
             PEM and has proved a lifesaver3. The two severe             Contribution to the National Prophylaxis Programme 
             forms of protein-calorie malnutrition investigated          against nutritional blindness due to vitamin A 
             during the 1960s by the Institute were kwashiorkor and      deficiency (NPPNB due to VAD)
                                   21-23
             nutritional marasmus     . Detailed studies have been 
             undertaken on the dietary intakes and the biochemical           During the 1960s, after some preliminary clinical 
             status of children manifesting these different forms of     trials , the effect of oral administration of a large dose 
             malnutrition with a view to understand the common           of vitamin A on serum vitamin A of 2500 children 
             aetiological background. It was around this time that       was studied. Based on this study outcome, the NIN 
             the dietary intake data from urban-rural multicentric       recommended administration of 200,000 IU each to 
             community studies on the diets of preschool children        children at six-monthly intervals to avoid immediate 
             were thoroughly examined for their energy and protein       toxic manifestations and for providing effective and 
             intakes. It turned out to be a surprising revelation        consistent cover against vitamin A deficiency (VAD)2. 
             that the protein concentration of their diets was           This paved the way for a nationwide vitamin A 
             nearly adequate contributing to about 10 per cent of        prophylaxis programme with its inclusion in the Fourth 
                                                                                                26
             their energy; however, the average energy intake was        Five-year plan in 1969 .
                             24
             grossly deficient . This analysis paved way for a new           Another landmark operational research carried out 
             hypothesis that the malnutrition among underprivileged      by the NIN was the feasibility study to link the National 
             children was due to energy deficiency and not solely        Programme for Vitamin A Supplementation to prevent 
             due to protein deficiency. The large-scale community        nutritional blindness among young children with a 
             studies were initiated to test this hypothesis and this     universal immunization programme (UIP) to increase 
             view was soon endorsed even by UN organizations like        its coverage. In spite of its implementation for over two 
             WHO and UNICEF2.                                            decades, the coverage for vitamin A supplementation 
                 Studies were carried out to assess whether the poor     was very poor. The NIN had carried out the above 
             mental performance of the children is solely attributable   operational research in seven States of India and showed 
             to the earlier episode of kwashiorkor or to other causes    that it was feasible to link Vitamin A Supplementation 
             as well. The observations showed that non-nutritional       Programme with the existing high-coverage trends of 
             factors, particularly maternal attitudes, played an         UIP27. Based on the recommendations of the NIN, it 
             equally important role in the mental development of         became a national programme and is being implemented 
                     25                                                  throughout India, and the coverage of vitamin A 
             children .                                                  supplementation has increased to over 70-80 per cent in 
             Contribution to national programmes and policies            the later years. The prevalence of VAD disorders such 
             Providing nutrient requirements for national                as Bitot spots and other ocular signs has significantly 
                                                                                               2
             programmes aimed at vulnerable groups                       declined in later years .
                 The NIN through NNMB carried out nutritional            Supplementation of iron and folic acid to pregnant 
             assessment surveys on individuals as well as on             women
             families, covering different age groups and different           In 1968, a professional body that emanated earlier 
             socio-economic groups. NNMB reports have been               from NIN, the Nutrition Society of India, set up a study 
             used by nutritionists, epidemiologists, policymakers        group on nutritional anaemias under the leadership of 
             and more so by the Planning Commission in those             Gopalan with leading nutritionists and haematologists 
             days. One of the most significant research findings of      of those times as members. After carefully examining 
             the Institute in the 1960s was that the prevalence of       various studies carried out in India till then, the study 
             severe forms of malnutrition among preschool children       group recommended that a programme of iron folate 
             was mainly due to energy deficiency and not due to          supplementation be taken up for pregnant women 
                                                                  24
             protein deficiency, as was assumed for many decades .       and preschool children as a prophylactic measure. 
             This was one of the bases for the Government of             The government introduced the National Nutritional 
             India in the 1970s, to launch a supplementary feeding       Anaemia Prophylaxis Programme aimed at pregnant 
                                                                                                             28
             programme to provide 300 Kcal/day to improve the            women and young children in 1970 .
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...Review article quick response code indian j med res november pp doi ijmr national institute of nutrition years empowering the nation through subbarao m gavaravarapu r hemalatha media communication extension group training division icmr hyderabad india received nin has reached a remarkable milestone completing exemplary service to long journey that started in humble one room laboratory at coonoor now tamil nadu colossus research country today is dotted with several interesting vignettes always been forefront need based pragmatic its large scale community interventions have great practical value s fight against malnutrition evolution as modern science almost coincides growth being oldest fraternity institutes under council medical grown from strength due sheer relevance contributions furthering and promoting public health this provides historical overview areas food safety policy key words introduction unit transformed into deficiency diseases enquiry then laboratories nrls which turn me...

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