Iron: ICMR-NIN Requirement by Age and Sex, Absorption, Anaemia Figures and Programme Doses

Iron is the mineral that lets blood carry oxygen. It sits at the centre of haemoglobin, the red pigment of red blood cells, and when the supply runs short the result is iron deficiency and, in time, anaemia. ICMR-NIN's Nutrient Requirements for Indians 2020 sets the recommended allowance at 19 mg a day for an adult man and 29 mg for an adult woman, with a tolerable upper limit of 45 mg. This entry in the minerals section of the handbook gives the values for every age, the survey figures, and what the national programme hands out.

What does iron do in the body?

Its main job is oxygen transport. ICMR-NIN's 2024 Dietary Guidelines describe iron as necessary for forming haemoglobin, and a fall in haemoglobin as anaemia, marked by paleness, easy fatigue and more infections. They add that iron is needed for the brain development of the foetus, that deficiency in pregnancy raises maternal mortality and may lower birth weight, and that in children it impairs learning ability. WHO lists tiredness, dizziness, cold hands and feet, headache and breathlessness on exertion as the common symptoms of anaemia.

One feature sets iron apart from other minerals. The body has no physiological way of excreting it, so iron balance is controlled only at the point of absorption, as a 2010 review in the American Journal of Clinical Nutrition put it. A person with low stores therefore absorbs more from the same meal, and excess from tablets or repeated transfusion cannot simply be passed out.

Haem and non-haem iron: the two forms on your plate

Food carries iron in two forms. Haem iron comes from meat, poultry, liver and fish. Non-haem iron is the form in cereals, millets, pulses and vegetables. ICMR-NIN's 2020 report notes that meat, poultry and liver hold highly bioavailable haem iron and also raise the absorption of non-haem iron eaten with them, the so-called meat factor. A 2009 review from the National Institute of Nutrition observed that cereals and millets, which form the bulk of Indian diets, are their main sources of non-haem iron.

The practical difference is how much gets through. The 2010 review put iron bioavailability at 14 to 18 per cent from mixed diets and 5 to 12 per cent from vegetarian diets, in people with no iron stores. ICMR-NIN's expert group used 8 per cent for men, women and adolescents, 6 per cent for children and 12 per cent for pregnant women when it set the 2020 values. The article on iron-rich Indian foods and why eating them is not enough goes through the food groups one by one.

How much iron do you need under ICMR-NIN's 2020 values?

An adult man needs 19 mg a day and an adult woman 29 mg, on the recommended allowance that covers nearly every healthy person. The same report gives an estimated average requirement, 11 mg and 15 mg, which it asks planners to use when judging a population's diet. Adolescent girls have the highest allowance of anyone, 32 mg at 16 to 18 years. The table gives both values for each group.

One row surprises people. The allowance in pregnancy, 27 mg, is lower than for a non-pregnant woman because the expert group applied the higher 12 per cent absorption seen in pregnant Indian women; the average requirement itself rises from 15 to 21 mg. The report also recommends at least 20 mg of vitamin C for every 1,000 kcal of the diet to improve iron absorption.

Which Indian foods carry the most iron per portion?

Among everyday foods, millets, whole pulses, green leafy vegetables and oilseeds give the most in a normal helping, and liver leads the non-vegetarian list. The table converts the per 100 g values of the Indian Food Composition Tables 2017 into household portions, with raw weights for grains and pulses. It is a working list, not a ranking: the iron table of Indian foods has the ranked figures.

Rice and milk, the base of many Indian meals, bring almost no iron, so a plate built on them depends on what goes alongside. The gap between cereals is wide: 60 g of bajra gives nearly ten times the iron of 60 g of milled rice. The comparison of bajra and wheat has the full panels, and bajra khichdi puts a millet and a pulse in one pot.

What helps and what blocks iron absorption?

Vitamin C and flesh foods help; tea, coffee and the phytate of grains and pulses hold iron back. A stable-isotope study in young women in Bengaluru measured both effects from a rice meal. One cup of black tea with the meal cut iron absorption by 49 per cent in women with normal iron status and by 59 per cent in women with iron deficiency anaemia. Vitamin C added at twice the molar amount of the iron raised absorption by 270 and 291 per cent. The anaemic women absorbed about 2.5 times as much as the others.

The vitamin C table shows why the fruit matters: guava has 214 mg and amla 252 mg per 100 g, against 48 mg for lemon juice. Chai is discussed in tea and iron absorption. One caution: the Bengaluru study measured single meals, and the 2010 review notes that across a varied diet any one enhancer or inhibitor has a more modest effect, with a person's own iron status mattering more.

Anaemia and iron deficiency in India: the survey figures

The National Family Health Survey of 2019-21 (NFHS-5) found anaemia in 57 per cent of women and 25 per cent of men aged 15 to 49, up from 53 and 23 per cent in 2015-16. Among children aged 6 to 59 months the figure was 67 per cent, up from 59 per cent. It was 59 per cent in girls aged 15 to 19, 52 per cent in pregnant women and 61 per cent in breastfeeding women.

Anaemia and iron deficiency are not the same thing. NFHS-5 measured haemoglobin from a finger prick. The Comprehensive National Nutrition Survey of 2019, as tabulated in ICMR-NIN's 2024 guidelines, found iron deficiency in 32.1 per cent of children aged 1 to 4, 17.0 per cent at 5 to 9 and 21.5 per cent at 10 to 19, alongside folate and vitamin B12 deficiency. WHO names thalassaemia, sickle cell trait, malaria and other infections among the causes of anaemia besides dietary iron.

What does India's national anaemia programme give, and to whom?

The Ministry of Health and Family Welfare's programme, set out in 2018 as the Intensified National Iron Plus Initiative, gives preventive iron and folic acid (IFA) to six groups, alongside deworming, testing, fortified foods in public schemes and attention to malaria, haemoglobinopathies and fluorosis. Its target was a fall in anaemia of 3 percentage points a year. The doses below are what its operational guidelines specify for prevention, reported as the programme's schedule and not as advice to self-medicate. Treating diagnosed anaemia is for a health worker or doctor.

The guidelines add that preventive iron should be withheld during acute illness such as fever, diarrhoea or pneumonia, and in thalassaemia major or a history of repeated blood transfusion. Uptake is the weak point: NFHS-5 found that 88 per cent of women with a recent birth were given or bought IFA, but only 44 per cent took it for 100 days or more. The pregnancy diet guide sets the tablets in the context of the whole diet.

What does the evidence say about iron supplements and food?

For pregnancy the evidence is large and fairly consistent on blood measures. The Cochrane review updated in 2024 included 57 trials with 48,971 women. Daily iron probably reduced iron-deficiency anaemia at term, 5.0 per cent against 18.4 per cent on moderate-certainty evidence, and may reduce maternal anaemia, 4.0 against 7.4 per cent, on low-certainty evidence. Low birth weight was probably a little less common, 5.2 against 6.1 per cent. For preterm birth and neonatal death there was little or no difference.

On diet, the Indian evidence explains the problem better than it solves it. The 2009 review from the National Institute of Nutrition estimated iron intake at less than 50 per cent of the allowance then in force, with an iron density of about 8.5 mg per 1,000 kcal, and attributed low bioavailability to high phytate and a low ratio of vitamin C to iron. It called dietary diversification the sustainable strategy. Single-meal studies show mechanism, not that diet alone corrects anaemia.

A worked example: one vegetarian day against the requirement

This is an illustration, not a real person. Take a 24-year-old vegetarian postgraduate student in Chennai. Her day holds poha at breakfast (60 g, 2.7 mg of iron), rice (75 g raw, 0.5 mg), whole masoor (30 g, 2.3 mg) and amaranth leaves (100 g, 4.6 mg) at lunch, and two chapatis (60 g atta, 2.5 mg) with rajma (30 g, 1.8 mg) at dinner. The total is about 14.4 mg: just under the average requirement of 15 mg and half the allowance of 29 mg.

At the 8 per cent absorption ICMR-NIN assumes for adults, 14.4 mg yields about 1.2 mg absorbed, against the 2.3 mg that 29 mg would yield. Two swaps raise the intake: bajra rotis in place of chapatis add 1.4 mg, and a tablespoon of black sesame in a chutney adds 2.1 mg, taking the day to about 17.9 mg. A guava at lunch and tea moved an hour from meals work on absorption instead. Food narrows the gap without closing it, which is why the programme offers a weekly tablet.

Common mistakes and myths about iron

The second mistake is to treat every case of tiredness or low haemoglobin as iron deficiency and reach for a tablet. Deficiency of folate or vitamin B12, infection, and inherited conditions such as thalassaemia lower haemoglobin too. The third is to count milligrams eaten and ignore absorption, for instance by taking the iron tablet with the morning chai. The fourth is to stop the pregnancy tablets early, when the programme's schedule runs for at least 180 days.

Too much iron, side effects and when to see a doctor

ICMR-NIN's tolerable upper limit is 45 mg a day for adults and for adolescents from 13 years, and 40 mg for infants and children up to 12, counted as habitual intake from all sources. A daily 60 mg tablet exceeds that by design, which is why such doses belong inside a programme or a prescription and not in a self-chosen routine. Because the body cannot excrete iron, people with thalassaemia major or repeated transfusions should take no iron without their specialist's instruction. Keep tablets out of the reach of children.

The national programme's guidelines, following WHO, class haemoglobin below 11 g/dl as anaemia in children aged 6 to 59 months and in pregnant women, below 12 g/dl in non-pregnant women and below 13 g/dl in men. Reading your own report against those lines is the doctor's job, because finding the cause matters more than the number. The anaemia diet chart covers eating alongside treatment.

Learning this properly

Iron comes up in NNWA's teaching under requirements, life-stage nutrition and public health. The academy is a private skill institution in Kolkata teaching online in English and Hindi, and its courses prepare people to coach healthy clients and refer medical cases; none is a degree or a dietitian qualification. The Public Health Nutrition course looks at anaemia programmes and surveys, and the Diploma in Nutrition, Dietetics and Public Health covers requirements and diet planning.