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Adolescent Nutrition

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Title: Adolescent Nutrition


1
Adolescent Nutrition
  • Kathryn Camp, MS, RD, CSP

2
Topics for Discussion
  • Adolescent growth and development
  • Psychosocial development
  • Nutritional issues for adolescents
  • Acute and chronic disease risk
  • Influences on adolescent eating behaviors
  • Effective nutrition interventions

3
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4
AdolescenceThe Vulnerable Life Stage
  • Big changes Biological
  • Boysget tall, lean, and dense (bones, that is)
  • Attain 15 of final adult ht during puberty
  • Lean body mass doubles
  • Large calorie needsincrease from 2,000 at 10 yr
    to 3,000 at 15 yr

5
AdolescenceThe Vulnerable Life Stage
  • Girlsget taller and fatter
  • body fat increases from the teens into the
    mid-20s
  • Gain almost 50 of their adult ideal weight 6-9
    mo before ht rate increases during puberty
  • Dieting can have a negative impact on linear
    growth during this time
  • Calorie needs increase by only 200 from 10 yr to
    15 yr

6
  • Cognitive
  • Thinking style changes from concrete to
    hypothetical and abstract
  • takes the adolescent beyond the here and now
    into the realm of possibilities (David Elkind,
    1984)

7
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8
  • Identity development
  • Attempt to figure out who they are
  • Success is dependent on positive interaction with
    the environmenthome, school, and the community
  • They will try on different lifestyles looking
    for the right fit
  • Risk taking behaviorsalcohol, drugs, tobacco,
    sexual behaviors, self-injury and suicide
  • Immediate and severe consequences

9
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10
Behaviors with Less Pronounced Consequences
  • Eating choices
  • Physical activity and exercise
  • Affect adolescents sense of well-being, energy
    and health in the short term
  • Affect adult-onset chronic disease risk in the
    long term

11
Another form of Risk-Taking Behavior
12
Nutrition Issues in Adolescent Health
  • Cardiovascular and cancer disease risk
  • Osteoporosis and bone mineralization
  • Overweight and obesity
  • Type 2 diabetes
  • Eating disorders

13
Cardiovascular Disease and Cancer Risk
  • One-third of CVD and cancer-related morbidity
    attributed to dietary patterns
  • Diets high in sat fat, total fat, and sodium and
    low in fiber
  • Diets low in fruits and vegetables
  • Dietary fat
  • Recommended lt10 of calories from sat fat and
    lt30 total fat
  • Consumed 1/3 of adolescents are in this range
  • Sodium
  • Recommended lt2.5 g/d
  • Consumed 3-5 g/d

NHANES III data 88-91, McDowell 94
14
  • Fiber
  • Recommended Age 5
  • Consume ½ this amount
  • Fruits and vegetables-
  • high in fiber and low in fat and sodium
  • the least consumed food groups for teens
  • 1/4 eat 2 or more servings of fruit/d
  • lt25 eat at least 5 servings of fruits and
    vegetables daily

Munoz 97, Kennedy 95
15
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16
Eating Away from Home
  • Teens directly spend more than
  • 5.4 billion in fast food restaurants
  • 9.6 billion in food and snack stores
  • 736 million in vending machines
  • 78 in school
  • Fast foods tend to be low in Fe, Ca, riboflavin,
    vitamin C, and folic acid
  • More meals missed at home thus the choice of
    foods away is more important than the time or
    place

17
Frequency of Fast Food Restaurant Use Among
Adolescents (French 01)
  • Positively associated with
  • Total kcal, kcal from fat, daily servings of
    soda, cheeseburgers, french fries and pizza
  • Student employment, TV watching, home
    availability of unhealthy foods
  • Negatively associated with
  • Daily servings of fruit, vegs, milk
  • Perceived maternal and peer concerns about
    healthy eating
  • Not associated with overweight status

18
Overweight, Obesity, and Type 2 Diabetes
19
Etiology of Obesity
  • Heritability
  • Homeostasis
  • Specific syndromes

20
Heritability
  • Survival advantage to conserve energy as fat
    through human evolution
  • Humans enriched for genes that promote energy
    intake and storage and minimize expenditure.
  • Enhance female fertility and ability to
    breastfeed offspring

21
  • In modern industrial environment
  • easy access to calorically dense foods
  • encourages sedentary lifestyle
  • Metabolic consequences of these genes are
    maladaptive

22
Genetic Factors account for 20-40 of
heritability of BMI
Buchard 97 Rankinen 02
  • 34 single gene mutations in 83 individuals
    reported by 2001
  • gt 250 susceptibility genes linked with human
    obesity phenotypes

Familial Risk 2-3 fold for moderate obesity 5-8
fold for severe obesity Bouchard 01
23
Obesity Associated Syndromes and Conditions
24
Overweight Prevalence Increasing
25
Overweight tracks into Adulthood
  • Overweight teenagers are 4-5 times as likely to
    be obese adults (Guo and Chumlea 99)

26
BMIs of the University of Miami Blocking Machine
27
Causes of Marked Increase in Overweight
  • Reflects a shift towards positive energy balance
  • energy intake energy expenditure

McDowell 94 Kann 99 Troiano 00,NHANES II to III
28
Other Contributors to Sedentary Lifestyles
  • Video and computer games
  • Parental work schedules
  • Unsafe neighborhoods
  • discourage parents from allowing children to play
    outdoors
  • force parents to drive children to school
  • Lack of recreational facilities in low-income
    neighborhoods

29
Prevalence of Overeating Among 4,746 Adolescents
(Ackard 03)
  • 17.3 of girls and 7.8 of boys reported
    overeating and were more likely to
  • be overweight or obese
  • have dieted in the past year
  • be currently trying to lose wt
  • Those who met the criteria for binge eating
    syndrome (3 of girls and 1 of boys) had higher
    suicide risk (28 for girls and boys)

30
Psychological and Economic Consequences of
Adolescent Obesity
  • Discrimination, rejection and low self-esteem
    (Gortmaker 93), particularly for females
  • Less participation in PE and sports activities
  • Lower college acceptance rates (Canning 1966)

31
Health Issues in Overweigt Adolescents
  • Growth
  • Taller, advanced bone age, mature earlier
  • Early maturation is associated with
  • increased fatness and truncal fat distribution in
    adulthood

32
  • Hepatic Steatosis
  • Orthopedic Problems
  • Sleep Apnea
  • Occurs in 17 of obese children and teens (Marcus
    1996)
  • Deficits in learning, memory, and vocabulary
    (Rhodes 1995)
  • Obesity hypoventilation syndrome (rare,
    potentially fatal disorder)

33
Cardiovascular
  • Hyperlipidemia--? LDL and TG, ? HDL
  • Hypertension
  • Low frequency in children
  • Muscatine Study (Rames 1978)
  • 1 of 6600 children 5 to 18 had persistently
    elevated BP
  • 60 with ? BP were gt120 of IBW

34
Type 2 Diabetes
  • 3-10 fold increase in prevalence in adolescents
  • Mean age is 13.5 yrs
  • 95 of teens with Type 2 diabetes have a BMI
    gt85ile
  • increased insulin resistance
  • 21 of adolescents with BMIs gt95thile had
    impaired glucose tolerance (Rocchini 02)
  • Tremendous public health implications
  • Longer duration of disease, gt risks of
    complications

Dabelea 99 Vinicor 00 Richards 85
35
How Do Teens Attempt to Lose Weight?
  • 1999 Youth Risk Behavior Surveillance
  • 58 exercised
  • 40 ate less food or lower fat foods
  • 13 fasted
  • 8 took diet pills
  • 5 vomited or took laxatives

Kann 1999
36
Weight-Related Eating Disorders
37
  • Anorexia nervosa
  • Self-starvation, weight loss, intense fear of
    weight gain, body image distortion

38
  • Bulimia nervosa
  • Binge eating and purging
  • Binge eating disorder
  • Binge eating without purging resulting in weight
    gain

39
Anorexic andBulemic Behaviors
  • Expressed in 10-20 of adolescent girls
  • Mimic behaviors in AN and BN but are not done
    with the frequency or severity to classify as
    mental illness
  • Half of teen girls and 15 of boys report dieting
    behaviors
  • Ranging from eating less fat to fasting
    (Neumark-Sztainer 00)

40
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41
Osteoporosis and Bone Mineralization
  • Osteoporosis affects 25-30 million adults in the
    US, women gt men
  • 15-25 with hip fractures require long-term
    institutional care
  • Treatment of osteoporosis costs 14 billion/yr
  • Etiology complexgenetic, hormonal, physical
    activity, dietary factors

42
  • Maximum peak bone mass (PBM) at skeletal maturity
    is protective
  • PBM is achieved during the late stage of pubertal
    development
  • 90-95 of PBM is attained by the 2nd decade of
    life
  • 40 of which is during adolescence

43
  • Low bone mineral density is associated with
    fractures late in life
  • Adequate nutrition, including energy, protein,
    vitamins and minerals are associated with good
    bone health

44
Calcium
  • Milk and dairy products are primary source of
    calcium in the US
  • Only 49 of boys and 20 of girls consume the
    recommended number of servings from the dairy
    group.
  • AI for calcium for 9-18 yr is 1300 mg/d
  • Girls 14-18 yrs consume 55 of this goal at 713
    mg ? 42 mg/d (Grove 98)

45
Calcium Content of Foods
Food Item Serving size Mg calcium
Milk or yogurt 1 cup 300
Cheese 1 oz 175-275
Ca fort OJ 1 cup 200-300
Salmon w bones 3 oz 180
Fort. cereal 1 cup 100
Broccoli ½ cup 47
Orange 1 med 40
46
Soda Consumption Effects on body weight, dental
health and nutritional status
  • No association with dental caries (Heller 01)
  • 25 of adolescents drinkgt26 oz of soda/d
  • Inverse relationship between intake of nutrients
    found in milk and fruit juice with soda
    consumption
  • Riboflavin, vitamin A, calcium, phosphorus, and
    vitamin C (Harnack 99)

47
Mean Nutrient Intake by Level of Soft Drink
Consumption in Adolescents
Soda/d 0 oz .1-13 oz 13-26 oz gt26 oz
Calories 1984 2149 2312 2604
Fat of kcal 34 32 32 31
Folate ug 239 238 191 178
Vit C mg 98 100 62 52
Calcium mg 819 804 652 635
Riboflavin 2.1 1.9 1.6 1.5
plt.05
Harnack 99
48
To Review Risky Adolescent Nutritional Issues
  • Weight gain leading to obesity and type 2
    diabetes
  • Calcium intake and soft drink consumption leading
    to inadequate bone mineralization
  • Eating habits that result in disordered eating
    practices
  • Low consumption of fruit and vegetables and high
    consumption of fat and sodium are related to
    adult-onset disease risk

49
The relationship between the adolescent diet and
chronic disease risk is predicated on the
assumption that eating behaviors are learned and
solidified during childhood and adolescence and
are maintained into adulthood (Lytle 02)
50
What Influences Adolescents Food Choices?
  • Psychosocial
  • Strong Influences
  • Food preferences
  • Early childhood experiences, exposure, genetics
  • Taste and appearance
  • Weak influence
  • Health and nutrition
  • Only 26 of college students were motivated by
    health when making dietary choices (Horacek 98)

51
The Meaning of Food
  • Study of 93 Canadian adolescent girls
  • Eating Junk food was associated with pleasure,
    being with friends, weight gain, independence,
    guilt, affordability, and convenience.
  • Eating healthful food was associated with
    family, meals, and being at home

Chapman 93
52
Influences cont
  • Biological
  • I was hungry is often the first response when
    asked why a specific food was eaten
  • Lifestyle
  • Time and convenience
  • Teens would rather sleep than eat breakfast
    (Neumark 99)
  • Cost
  • In a study of 12 high schools, consumption of
    fresh fruits and vegs ? when cost was ? by 50
    (French 01)

53
More Influences
  • Familymajor influence
  • Food provider
  • Influences food attitudes, preferences and
    values
  • Despite increased eating outside the home, teens
    still obtain 65 of their total energy from
    home.
  • Dinner at home is the most important meal
  • 80 of parents and teens place high importance on
    this meal
  • 1/3 of teens eat dinner q night at home

54
Effective Nutrition Interventions for Adolescents
  • Behaviorally based
  • Use developmentally appropriate strategies
  • Include an environmental component
  • Sufficient amount of contact
  • Use technological advances such as CD- ROMs

Hoelscher, JADA 2002102S52
55
Nutrition Intervention Programs for Adolescents
  • Clueless in the Mall An interactive web site on
    calcium for teens
  • Texas Cooperative Extension Service
  • http//calcium.tamu.edu/
  • Committed to Kids An integrated, 4-level team
    approach to weight management for adolescents
  • http//www.committed-to-kids.com/

56
  • Great Beginnings Nutrition curriculum for
    pregnant adolescents
  • University of New Hampshire
  • http//ceinfo.unh.edu/Common/Documents/grtbegin.ht
    m
  • Gimme 5 A school-based nutrition intervention
    for high school students
  • Baylor College of Medicine

Adolescent Nutrition JADA, March 2002
57
Stay Tuned for Part 2
58
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