Chapter 14 Adolescent Nutrition Nutrition Through the Life Cycle Judith E. Brown.
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Transcript of Chapter 14 Adolescent Nutrition Nutrition Through the Life Cycle Judith E. Brown.
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Chapter 14 Adolescent Nutrition
Nutrition Through the Life Cycle Judith E. Brown
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Vegetarian Diets during Adolescence
• About 4% of adolescents report following a vegetarian diet
• Reasons adolescents adopt a vegetarian diets include:– Cultural or religious beliefs
– Moral or ethical concerns
– Health beliefs
– To restrict fat and/or calories
– A means of independence from family
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Types of Vegetarian Diets and Food Excluded
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Nutrient Intake of Vegan Adolescents
• Well-planned vegetarian diets can offer many healthy advantages– Best when small amounts of animal-derived
foods
• Vegans may have inadequate intakes– Protein– Calcium, Zinc, and Iron– Vitamins D, B6, and B12
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Total Fat and Essential Fatty Acid Intake of Vegan
Adolescents • Vegans may have inadequate intakes
– Total fat
– Essential fatty acids especially alpha-linolenic acid
• Encourage intakes of
– Soy products: Soybean oil & Soybeans
– Flaxseed, Walnuts, Tofu
– Walnut oil, Canola oil
– Eggs
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Nutritional Needs in a Time of Change
• Health-compromising eating behaviors– Excessive dieting– Meal skipping– Use of unconventional nutritional and
nonnutritional supplements– Fad diets
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Nutritional Needs in a Time of Change
• Health-enhancing eating behaviors– Healthful eating practices– Physical activity– Interest in a healthy lifestyle
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Normal Physical Growth and Development
• Puberty occurs during early adolescence• Biological changes of puberty include:
– Sexual maturation– Increases in ht & wt– Accumulation of skeletal mass– Changes in body composition
• The sequence of maturation events is consistent but great individual variation in age of maturation
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Normal Physical Growth and Development
• Variations in reaching sexual maturity affect nutrition requirements of adolescents
• Sexual maturation (or biological age)—not chronological age—should be used to assess growth and development and nutritional needs
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Sexual Maturation Rating or “Tanner Stages”
• Sexual Maturation Rating (SMR) (a.k.a. “Tanner Stages”)—scale of secondary sexual characteristics used to assess degree of pubertal maturation – SMR 1=prepuburtal growth & development– SMR 2-4=occurrences of puberty– SMR 5= sexual maturation has concluded
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Maturation and Growth of Females
• Menarche (onset of first menstrual period) occurs 2-4 years after initial development of breast buds
• Age of menarche ranges from 9 to 17 years
• Peak linear growth occurs ~6 to 12 months prior to menarche
• Severely restrictive diets may delay or slow growth
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Maturation and Growth of Males
• Males show great deal of variation in chronological age at which sexual maturation takes place
• Peak velocity of linear growth occurs during SMR 4 & ends with appearance of facial hair at ~age 14.4
• Linear growth continues throughout adolescence ceasing at ~age 21
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Changes in Weight, Body Composition, and Skeletal
Muscles in Females• Peak weight gain follows linear growth spurt by 3 to
6 months – Gain of ~18.3 pounds per year
• Average lean body mass decreases– 44% increase in lean body mass (LBM)– 120% increase in body fat
• 17% body fat is required for menarche to occur • 25% body fat needed to maintain normal menstrual
cycles
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Changes in Weight, Body Composition, and Skeletal
Muscles in Males • Peak wt gain at the same time
– Peak linear growth & – Peak muscle mass accumulation
• Peak wt gain, ~20 lb per year
• Body fat decreases to ~12%
• ~Half of bone mass is accrued in adolescence
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Normal Psychosocial Development
• Adolescents develop:– A sense of personal identity– A moral & ethical value system– Feelings of self-esteem or self-worth – A vision of occupational aspirations
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Normal Psychosocial Development
• Three periods of psychosocial development:– Early adolescence (11 to 14)– Middle adolescence (15 to 17)– Late adolescence (18 to 21)
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Normal Psychosocial Development
• The need to fit in can affect nutritional intake– Who they eat with– Where they eat
• Peer influences may be greater than family– May improve dietary intake– May lead to poor dietary intake
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Health and Eating-related Behaviors during Adolescence
• Factors affecting eating behaviors– Peer influence– Parental modeling– Food availability, preferences, & cost – Personal & cultural beliefs– Mass media– Body image
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Conceptual Model for Factors Influencing Eating Behavior of Adolescents
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Health and Eating-related Behaviors during Adolescence
• The model depicts 3 interacting levels of influence on adolescent eating behaviors– Personal or individual– Environmental– Macrosystem
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Health and Eating-related Behaviors during Adolescence
• Busy lives lead to different eating styles– Little time to sit down for a meal– Snacking and meal skipping common– Eating away from home and at fast-food
restaurants– Consuming more soft drinks, less nutrient
dense drinks– Eating meals in front of the television
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Dietary Intake and Adequacy among Adolescents
• Many adolescents have diets that do not match the Dietary Guidelines for Americans or the MyPyramid Recommendations
• Most have inadequate consumption of:– Dairy – Grains – Fruits – Vegetables
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Dietary Intake and Adequacy among Adolescents
• Data from NHANES-adolescents’ diets consist of– Less than 1 serving of vegetables per day
• White potatoes make up half of the vegetables
– Less than 1 serving fruits per day– Adequate intake of grains but whole grains less
than adequate– 32% of calories from fat & 21% from added
sugars
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Percentage of Adolescents Meeting the Recommended
Number of MyPyramid Servings
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Energy and Nutrient Requirements of Adolescents
• Increases in lean body mass, skeletal mass and body fat
• Energy & nutrient needs during adolescence exceed those of any other point in life
• Needs correspond to physical maturation stage
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Energy and Nutrient Requirements of Adolescents
• Dietary references intakes for selected vitamins & minerals are on Table 14.7
• Professional judgment needs to be used
• Nutrient recommendations based on chronological rather than biological development
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Nutrient Intakes of Adolescents
• U.S. adolescents have inadequate intake of vitamins & minerals including:– Folate– Vitamins A, B6, C, & E– Iron & zinc– Magnesium– Phosphorus & calcium
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Nutrient Intakes of
Adolescents
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Energy Requirements of Adolescents
• Energy needs are influenced by:– Activity level – Basal metabolic rate (BMR) – Pubertal growth & development
• Because males have greater increases in ht, wt, & lean body mass (LBM) & higher BMR, they have a higher caloric need than females
• Level of physical activity declines during adolescence resulting in reduced energy requirements
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Protein Requirements of Adolescents
• Protein requirements influenced by protein needed:
– To maintain existing LBM
– For growth of new LBM
• DRI is 0.85 g/kg body wt
• Low protein intakes linked to:
– Reductions in linear growth
– Delays in sexual maturation
– Reduced LBM
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Requirements for Selected Nutrients of Adolescents
• Carbohydrates: – 130 g/day or 45-65% of calories
• Dietary Fiber: – AAP recommends
• 26 g/day for adolescent females
• 31 g/day for males <14 years of age
• 38 g/day for older adolescent males
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Requirements for Selected Nutrients of Adolescents
• Fat:– Required as dietary fat and essential fatty acids
for growth and development– 25-35% of calories from total fat– <10% calories from saturated fat
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Calcium Requirements for Adolescents
• Adequate intake of calcium is critical to ensure peak bone mass
• Calcium absorption rate in females is highest around menarche
• Calcium absorption rate in males highest during early adolescence
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Calcium Requirements for Adolescents
• ~4 times more calcium absorbed during early adolescence compared to early adulthood
• Adolescences who do not include dairy should consume calcium-fortified foods
• Soft drink consumption displaces nutrient-dense beverages such as milk & fortified juices
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Calcium Requirements for Adolescents
• DRI for ages 9-18 years is 1300 mg/d
• Average intake is:– 865 mg for females– 1130 mg for males
• Weight-bearing activities may lead in increased bone mineral density
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Iron Requirements for Adolescents
• Increased iron needs related to:– Rapid rate of linear growth– Increase in blood volume– Menarche in females
• In females, iron needs greatest after menarche
• In males, iron needs greatest during the growth spurt
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Iron Deficiency in Adolescents
• Iron deficiency vs. iron-deficiency anemia– Iron deficiency
• Determined by low serum iron, plasma ferritin & transferrin saturation
• Iron deficiency more frequent
• Often undiagnosed because of expense
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Iron Deficiency in Adolescents
• Iron deficiency vs. iron-deficiency anemia– Iron-deficiency anemia
• Determined by simple and inexpensive hemoglobin or hematocrit levels
• Indicates more advanced stage of iron deficiency
• Less frequent but almost exclusively females
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Iron Deficiency in Adolescents
• Estimates of iron deficiency:– 9% of 12-15 y/o females– 5% of 12-16 y/o males– 11% of 15-19 y/o females– 2% of 15-19 y/o males
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Vitamin D Requirements for Adolescents
• Vitamin D-fat soluble:– Essential role in facilitating intestinal absorption of
calcium and phosphorus
– Essential for bone formation
– Synthesized by the body via skin exposure of ultraviolet B rays of sunlight
– Food sources: fatty fish, fish oils, egg yolks of hens fed Vitamin D fortified feed
– Majority of Vitamin D from Vitamin D fortified foods (milk, breakfast cereals, margarines, and some juices)
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Folate Requirements for Adolescents
• Folate required for DNA, RNA & protein synthesis
• DRI: 400 mcg
• Severe folate deficiency leads to megaloblastic anemia
• Severe deficiency rare but inadequate folate status appears to be more common
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Folate Requirements for Adolescents
• Folate added to fortified foods is better absorbed than folate from natural foods
• Adequate folate intake for female adolescents reduces incidence of birth defects like spina bifida
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Folate Requirements for Adolescents
• It is imperative that women of reproductive age (15 to 44 years) consume adequate folic acid
• Increased risk of folate deficiency– Skipping breakfast– Not consuming orange juice or fortified cereals
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Vitamin C Requirements for Adolescents
• Vitamin C—marginally adequate among adolescents
• Involved in the synthesis of collagen and other connective tissues
• Acts as an antioxidant
• Smoking need for Vitamin C
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Nutrition Screening, Assessment, and Intervention
• The AMA recommends all adolescents receive annual health screening & guidance
• Screening should include:– Wt, ht, & BMI
– Disordered eating tendencies
– Blood lipid levels
– Blood pressure
– Iron status (hemoglobin/hematocrit)
– Food security/insecurity
– Dietary intake/adequacy
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Nutrition Screening, Assessment, and Intervention
• Nutrition screening should include a brief dietary assessment– Food frequency questionnaires
– 24-hour recalls
– Food diaries or Food Records
• Table 14.12 lists the advantages and disadvantages of each dietary assessment method
• Table 14.13 lists the nutrition risk indicators that may warrant further assessment and counseling
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Nutrition Education and Counseling
• Considerations when educating & counseling adolescents:
1) Initial component of session should involve:– Getting to know adolescent, including personal
health or nutrition-related concerns – Providing overview of events & content of
counseling session
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Nutrition Education and Counseling
• Considerations when educating & counseling adolescents (cont.):
2) Involve adolescent in decision-making process
3) Encourage adolescent to suggest ways to change
4) Work toward only 1 or 2 goals per counseling session
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Nutrition Education and Counseling
• Use of technology to facilitate education and counseling– Text messaging– Podcasts– YouTube– Facebook– Twitter
• Technology can serve as a means to convey nutrition info in an engaging way
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Physical Activity and Sports
• Physical activity—any bodily movement produced by skeletal muscles that results in energy expenditure
• Exercise—a subset of physical activity that is planned, structured, & repetitive & done to maintain physical fitness
• Physical fitness—set of attributes that are either health or skill related
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Benefit of Physical Activity
• Regular physical activity leads to:– Improved aerobic endurance & muscle strength– Reduced risk of obesity– Greater bone density– Positive self-esteem & self-concept– Lower levels of anxiety & stress
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Recommendations on Physical Activity
• The Physical Activities Guidelines for Americans recommend adolescents:– Be physically active every day– Engage in 60 minutes or more physical activity– Include muscle- and bone-strengthening
activities at least 3 days a week
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Physical Activity Practices of U.S. Adolescents
• Only 35% met activity guidelines• 25% reported no moderate to vigorous activity• Activity declines throughout adolescence• More males than females meet daily activity
guidelines• More white teens than African or Mexican
American teens meet activity guidelines
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Factors Affecting Physical Activity
• Adolescents more likely to be physically activity if they have:– Confidence in ability to exercise
– Positive perceptions of activity or sports
– Positive attitudes toward activity
– Peer & family support
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Nutritional Considerations for Physically Active Adolescents
• High levels of activity combined with growth & development increase needs for energy, protein & certain vitamins & minerals
• Nutrient needs higher during intense training & competition seasons
• Monitor changes in body weight to assess for adequate energy and protein intake
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Nutritional Considerations for Physically Active Adolescents
• Competitive athletes may need 500-1500 additional calories per day
• Protein should supply no more than 30% of calories in the diet
• Special concern for vegetarian athletes or restricted caloric intake to maintain a particular weight
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Promoting Healthy Eating and Physical Activity Behaviors
• Effective nutrition messages for youth– Teens are “present oriented” – Concerned about appearance – Achieving maintaining a healthy wt – Having lots of energy– Optimizing sports performance– Environmental or moral aspects of food
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Promoting Healthy Eating and Physical Activity Behaviors
• Parent involvement • Target parents
• They are gatekeepers of foods
• Serve as role models
• Teenagers eat based on availability and convenience
• Parents can capitalize on this
• Stock a variety of nutritious ready-to-eat foods
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Nutrition Education in Schools
• Nutrition instruction required by 67% of middle schools & 72% of high schools
• Most nutrition is offered in health education courses
• Nutrition education to health ed teachers has from 43% to 65% from 2000 to 2006
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School Wellness Policies
• All school districts with a federally-funded school meals program must have a wellness policy that addresses nutrition & physical activity
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Model Nutrition Program
• Numerous innovative nutrition programs exist that promote nutrition to youth
• One example is CANfit (California Adolescent Nutrition & Fitness)
• Visit the CANfit website at: http://www.canfit.org/