Adolescent Nutrition

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Adolescent Nutrition

• Dr.Fatemeh Famouri
• Pediatric Gastroenterologist

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ADOLESCENCE

• It is the time between the onset of puberty and
  adulthood (11- 17 years old)
• Boys grow about 8 inches, gain about 45 pounds
  and increase their
• lean body mass.
• Girls grow about 6 inches, gain about 35 pounds
  and increase their
• body fat.
• Growth through adolescence is hormone driven.
  Growth spurts for girls
• begin between ages 10.5 and 11 years with a
  peak in the rate of growth at around age 12.
• Considerable gain in muscle and bone mass

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Definition

• Early adolescence 10 -15 years
• Mid adolescence 15-17
• Late adolescence 17-21, but variable.

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• differences between genders becomes apparent
• females higher fat percentage
• males more lean body mass

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Adolescence is an uncomfortable time for the
teen who is concerned with body image or body
changes or athletic activities. Low nutrient
snacks are a large part of the diet and adequate
amounts of fruits and vegetables are
missing. Factors that determine food selection
and consumption include the desire to be healthy,
fitness goals, amount of discretionary income,
social practices and peers.
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• improved nutrition in adolescence,particularly
  in girls, is the reduced risk of osteoporosis in
  older age.
• stunting becomes a permanent consequence of
  past malnutrition rather than being a sign of
  present malnutrition.
• If there is indeed catch-up growth in height,
  adolescence can provide a final chance for
  intervention to promote additional growth,with
  potential benefit in terms of physical work
  capacity and for girls, of diminished obstetric
  risk
• .

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• Linear growth may be limited by multiple
  simultaneous nutrient deficiencies in many
  populations,
• which could explain that interventions with
  specific individual nutrients (eg, vitamin A,
  iron, zinc)

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• increased pre-pregnancy weight and body stores
  of nutrients, thus contributing to improved
  future pregnancy and lactation outcome,
• improved iron status with reduced risk of
  anaemia in pregnancy, low birth weight, maternal
  morbidity and mortality, and with enhanced work
  productivity and perhaps linear growth
• improved folate status, with reduced risk of
  neural tube defects in the newborn and
  megaloblastic anaemia in pregnancy.
• Small girls are likely to become small women who
  are more likely to have small babies,
  particularly if at a young age

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• The overall nutritional status is better assessed
  with anthropometry, in adolescence as well as at
  other stages of the life cycle. Anthropometry is
  the single most inexpensive, non-invasive and
  universally applicable method of assessing body
  composition, size and proportions

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• Iodine deficiency disorders
• Iodine deficiency disorders were widely prevalent
  in most populations
• Neuromotor and cognitive impairments of variable
  degrees
• Iodine deficiency is recognized as the most
  common cause of preventable mental retardation in
  the world.

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Zinc

• Evidence from supplementation trials suggests
  that marginal zinc nutriture may also limit
  skeletal growth
• zinc supplementation increased accretion of
  fat-free mass and enhanced linear growth in those
  that were stunted at baseline

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Calcium

• ½ of peak bone mass accumulates in adolescence
• AI for calcium 1,300 mg for ages 918 years
• Inadequate calcium intake can lead to low peak
  bone mass and is a risk factor for osteoporosis

Figure 18.4
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Teenagers and calcium

• Teenagers have high calcium requirements.
• Around 50 of the adult skeleton is formed during
  the teenage years (RNI - boys 1000 mg/day, girls
  800 mg/day).
• Low calcium intakes (lt LRNI) found in 24 of
  11-14 year-old girls and 19 of 15-18 year-old
  girls.
• A lack of calcium may have consequences for
  future bone health e.g. increased risk of
  osteoporosis.

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Iron

• Additional iron supports muscle growth and
  increased blood volume
• Adolescent females need iron to support
  menstruation
• RDA for iron
• Females aged 1418 years 15 milligrams
• Males aged 1418 years 11 milligrams
• Iron deficiency is common in adolescence,
  especially among individuals who limit intake of
  enriched grains, lean meats, and legumes

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Iron absorption

• Good sources meat (especially lean red meat),
  liver and offal, green leafy vegetables, pulses
  (beans, lentils), dried fruit, nuts and seeds,
  bread and fortified breakfast cereals.
• Iron from meat sources (heme iron) is readily
  absorbed by the body.
• Vitamin C helps the body to absorb iron from
  other sources (non-heme iron).

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A healthy diet is important for teenagers

• Eating a healthy, balanced diet can
• promote wellbeing by improving mood, energy and
  self-esteem to help reduce anxiety and stress
• best concentration and performance
• reduce the risk of ill-health now and in the
  future, e.g. obesity, heart disease, cancer, and
  type 2 diabetes
• increase productivity/attainment and reduce days
  off sick.

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Nutrient needs of adolescents

• Growth not age should be ultimate indicator of
  nutrient needs.
• Energy needs are greater during adolescence than
  at any other time of life with exception of
  pregnancy lactation.
• Energy Proteins RDAs
• Males
• Age (yrs) Kcal/kg Kcal/day
  Proteins g/kg Proteins
  gm/day
• 11-14 55 2500
  1.0
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• 15-18 45 3000
  0.9
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• Females
• Age (yrs) Kcal/kg Kcal/day
  Proteins g/kg Proteins
  gm/day
• 11-14 47 2200
  1.0
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• 15-18 40 2200
  0.9
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• Vitamins Minerals
• Higher vitamins and minerals needs.
• Three nutrients of importance i.e. vitamin A,
  iron and calcium.
• AI for calcium 1300 mg/day, for iron is 11 mg/day
  (boys) and 15 mg/day (girls).
• Improving fruit vegetable intake will help in
  obtaining adequate vitamin A.

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Dietary recommendations

• Teenagers should consume a variety of foods from
  each of the four main food groups

Bread, rice, potatoes, pasta and other starchy
foods (33)
Fruit and vegetables (33)
Meat, fish, eggs, beans and other non-dairy
sources of protein (12)
Milk and dairy foods (15)
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Food Guide Pyramid

• serving sizes can help you control the amount of
  calories, fat, saturated fat, cholesterol, sugar
  or sodium in your diet.
• Grains, Bread, Cereal and Pasta form the Base
• Fruits and Vegetables
• Lean Meat and Fish, Beans, Eggs
• Dairy Products
• Fats and Sweets

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Macronutrients
- average intakes (Scottish NDNS and Survey of
Sugar Intake data)
Macronutrient Recommended intake ( food energy) Boys average intake ( food energy) Girls average intake ( food energy)
Fat 35 35.4 35.9
of which saturates 11 14.2 14.3
Carbohydrate 50 51.6 51.1
of which added sugars (NMES) 11 16.7 16.4
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What about dietary fiber?

• average dietary fibre intakes to be low in
  teenagers
• - Boys (11-14 years) 11.6 g/day
• (15-18 years) 13.3 g/day
• - Girls (1114 years) 10.2 g/day
• (15-18 years) 10.6 g/day
• Reference values
• - 15 g/day (11-14 years)
• - 18 g/day (15 years or above)

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What about salt?

• NDNS survey results - average salt intakes above
  recommendations in teenagers
• - Boys (11-14 years) 6.75 g/day
• (15-18 years) 8.25 g/day
• - Girls (11-18 years) 5.75 g/day
• (excluding salt added in cooking or at the
  table
• Recommended maximum daily salt intake
• - 11 years and over up to 6 g/day.

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Teenagers and energy balance

• Levels of overweight and obesity are increasing
  35 of teenagers (12-15 years) are classified as
  overweight or obese (Scottish Health Survey
  2009).
• Teenagers, especially girls, often try to control
  their weight by adopting very low energy diets or
  smoking.
• Restricted diets may lead to nutrient
  deficiencies and other health consequences.
• Teenagers of unhealthy weight may need guidance
  on lifestyle changes to help them achieve a
  healthy weight.

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Teenagers physical activity

• Physical activity through life is important for
  maintaining energy balance and overall health.
• At least 60 mins of moderate-intensity physical
  activity each day is recommended.
• Include activities that improve bone health,
  muscle strength and flexibility at least twice
  per week.
• 68 of boys and 41 of girls (13-15 year-olds)
  achieve the recommended 60 mins per day

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Diet and cognitive ability

• Food eaten at school can make up a substantial
  proportion of the diet and have a significant
  effect on functions such as learning, memory,
  information processing and mood.
• Cognition represents a complex multidimensional
  set of abilities and cognitive performance is
  affected by many influencing factors.
• Nutritional effects are difficult to measure.

Bellisle F (2004) Effects of diet on behaviour
and cognition in children Br J Nutr 92 Suppl 2
S227-32.
Stevenson J (2006) Dietary influences on
cognitive development and behaviour in children
Proct Nutr Soc 65(4)361-5.
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Glycemia
The brain appears to be sensitive to short-term
fluctuations of glucose supply and therefore it
might be beneficial to maintain glycemia at
adequate levels to optimise cognition.
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Eating breakfast

• Starting each day with breakfast will supply
  energy to the brain body.
• Eating breakfast leads to improved energy and
  concentration levels throughout the morning.
• Breakfast consumption may improve cognitive
  function related to performance in school.
• Improvement of memory
• Other benefits of breakfast include better
  nutrient intakes and weight control.

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Fluids and hydration

• Even mild dehydration (1-2) can lead to
  headaches, irritability and loss of
  concentration. This level is not enough to cause
  feelings of thirst.
• The recommendation is to drink 6-8 glasses/day
  (1.2 litres) to prevent dehydration. People need
  to drink more when the weather is hot or when
  they have been active.
• All drinks count in terms of fluid intake but
  those without sugar are best between meals.

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Diet and IQ

• Brain health depends on optimal intakes of
  nutrients from the diet.
• Much speculation about the importance of long
  chain omega-3 fatty acids to behavioural and
  cognitive development, including IQ.
• Supplementation studies show the best outcome
  observed in children with learning disabilities.
• Current recommendation is one portion of oily
  fish (140g) per week.

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Diet and mood/behaviour

• There are a number of foods that have a
  pharmacological effect in the body which affects
  mood
• caffeine
• vaso-active amines, such as histamine
• tryptophan and serotonin.
• There is evidence to suggest that poor vitamin
  and mineral status may be associated with poor
  educational attainment and antisocial behaviour.

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Food additives and hyperactivity

• The Southampton study suggested that consumption
  of mixes of certain artificial food colours and
  the preservative sodium benzoate could be linked
  to increased hyperactivity in some children. The
  colours are
• sunset yellow FCF (E110)
• quinoline yellow (E104)
• carmoisine (E122)
• allura red (E129)
• tartrazine (E102)
• ponceau 4R (E124)
• An EU-wide mandatory warning must be put on any
  food and drink (except drinks with more than 1.2
  alcohol) that contains any of the six colours.

Bateman B et al. 2007
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Eating Habits

• irregular eating habits
• snacks generally provide ¼ of daily energy intake
• more fast food less fruits, vegetables, milk
• food choices are often dictated by peers

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What do boys and girls want?

• boysys usually want to gain muscle and get taller
• Girls usually want to control their weight

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For girls some addition of fat is natural

• Need at least 17 body fat for normal periods
• Diet is a four letter word
• Improve eating habits and activity but dont
  starve or over exercise

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Boys mature later

• Growth spurt up to 2 years later than girls
• Full muscle mass doesnt develop until one year
  after full height achieved
• Excess calories and protein wont speed things up

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Make every drink count

• Cut the soft drinks
• Drink 3-4 cups of milk
• Drink at least 4 more cups
• of water or juice (watch the juice it has
  calories)

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During a sports event

• Drink at least 2 cups of water before event
• Continue to drink 4 ounces every half hour
• Cool, not cold, water is best
• Replace two cups of fluid for every pound lost

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Eat at least 5 servings of fruits and vegetables

• Lots of vitamins and minerals with few calories
• More fiber so you feel full
• Portion size palm of girls hand

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Eat more whole grain breads and cereals

• Wont cause weight gain if dont eat too much
• Depending on body size, will need 6-11 servings
• Portion size the palm of a girls hand

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Get enough protein but not too much

• Get protein from lean meat, fish and poultry
• Portion size palm of girls hand
• Protein also comes from dairy foods, dried beans
  and peas, peanut butter, nuts, seeds, soy foods

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• Limit low nutrient foods with lots of fat, sugar
  and sodium
• Make fast food a special occasion
• choose grilled or broiled meat, fish or poultry
• choose side salads, baked potatoes
• choose milk, water or juice

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Disordered Eating

• Disordered eating patterns are more prevalent in
  adolescent females than males
• May be linked with poor body image or low
  self-esteem
• Teens often adopt unhealthy habits such as
• Skipping meals
• Using food substitutes
• Taking diet pills or nutritional supplements
• Purging through vomiting, laxatives, or diuretics
• Eating family meals promotes healthy eating
  patterns

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Anorexia Nervosa

• Refusal to maintain body weight over a minimal
  normal weight.
• Intense fear of gaining weight or becoming fat,
  even though underweight.
• Denial of low body weight.
• In females, absence of at least 3 consecutive
  menstrual cycles.
• .

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Anorexia NervosaClinical Laboratory Findings

• LANUGO and EDEMA of the skin, bradycardia and
  hypotension, constipation, normochromic anemia
  and leukopenia, hyponatremia, hypoglycemia, low
  hormonal levels (estrogen or testosterone, LSH,
  FSH) but normal TSH and increased cortisol
• SKELETAL CHANGE OSTEOPENIA

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Anorexia NervosaSigns of Malnutrition

• Easy pinching in the posterior region of the
  arms, due to to loss of fat
• Hollowing temporal muscles
• Wasting of the tigh muscles
• Easily plucked hairs
• MEMO the laboratory signs of malnutrition are
  HYPOALBUMINEMIA and HYPOPREALBUMINEMIA

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Treatment for Anorexia Nervosa

• Close supervision
• Individual and family counseling
• Self-acceptance
• Time and patience
• Nutrition therapy

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Bulimia Nervosa

• Characterized episodes of binge eating
  alternating with purging
• Female to male ratio 101
• Some genetic factors may be involved, but and
  above all cultural attitudes toward standards of
  physical attractiveness
• 3 modalities are the most frequent
• Self induced vomiting via fingers or ipecac
• Abuse laxatives (e.g. bisacodyl, cascara or
  senna)
• Misuse diuretics
• In addition to diuretics also diet pills
  (containing ephedrine)

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Bulimia Nervosa Complications

• Oral loss of enamel of the anterior teeth and
  dental caries
• GI tract frequent vomiting can induce GE-reflux
  (occasionally tears in the esophagus). The abuse
  of laxatives can lead to constipation due to
  damage of the myo-enteric plexus
• Abnormalities of the electrolytes
• Metabolic alkalosis due to frequent vomiting
• HYPOKALEMIA present in 5 of the patients

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Bulimia Nervosa Treatment

• Replenish potassium losses
• Eventually I.V. fluids and lytes
• Monitor lytes frequently
• and, of course
• Refer for psychiatric or psychologic counseling

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Treatment for Bulimia

• Eating only at mealtime
• Portion control
• Close supervision after eating
• Psychological counseling

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ObesityHealth Consequences

• Cardiovascular disease risk
• Type 2 diabetes (epidemic)
• Hypertension
• Orthopedic
• Sleep apnea
• Gall bladder disease/steatohepatitis
• Psychosocial problems

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Body Mass Index

• Weight in kg divided by height in m2
• NORMAL BMI 18 to 24 years of age
• BMI lt 18 suspect malnutrition
• BMI 24 to 30 overweight
• BMI 30 to 40 obesity
• BMI above 40 morbid obesity

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Obesity Treatments

• Caloric restrictions restrict fats to less
  than 30 of the total caloric intake
• Modification of lifestyle and exercise
• A walk of 1 mile (1.5 m) burns 100 Kcal
• Walk 2 - 3- or even 4 miles, 4 or 5x weekly, and
  add some resistance exercise 2 or 3 times weekly
  (all under some supervision).
• The dietary variations the high protein low
  carbohydrate (only 20 grams of CHO/day)

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Final Comments

• The recipe for effective weight loss is a
  combination of
• Motivation
• Physical activity
• Caloric restriction
• And all this with a lifelong adherence
• BUT
• MEMO Prevention of weight gain is the first step
  EVEN IN CHILDREN

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