Module 8: Adolescent Nutrition

vitamin D status of adolescents

** RDA= 5 micrograms per day -low levels are very common (low sun exposure, low intake of fatty fish and fortified dairy products) -low vitamin D associated with: low bone mass, high BP, Hyperglycemia, Dyslipidemia, high BMI, abdominal obesity -AAP recommends supplementation of 400 IU (10 micrograms) of vitamin D per day (for those who don't meet RDA)

folate status of adolescents

**RDA= 400 micrograms per day (most don't meet this) -consequences of low: Macrocytic (a.k.a. megaloblastic) anemia, birth defects (for offspring)

physical activity guidelines for adolescents

-60 mins/day of moderate/vigorous-intensity aerobic activities (should be vigorous at least 3 times per week) -include muscle strengthening activities (3 d/week) -include bone strengthening activities (3 d/week)

influence of declining frequency of family mealtimes

->1/3 food intake is outside home (more added sugar, more solid fats) -negatively impacts: quality of food choices, body image, risky behaviors, academic outcomes

effects of iron deficiency anemia

-Delayed or impaired growth and development -Fatigue -Impaired immune function -Impaired physical performance -Increased susceptibility to lead poisoning -For pregnant teens: increased risk of preterm birth or LBW infant

physiological & psychological benefits of physical activity

-Improved aerobic endurance -Improved muscular strength -Reduced risk of childhood obesity -Increased bone mineral density -Improved self-esteem

influence of snacking behaviors

-account for ~25% of overall calorie intake of adolescents -typical snacks are high in calories, fat, added sugars, and sodium, but relatively low in vitamins and minerals -soft drinks -fruit drinks -dairy desserts -salty snacks -pizza

calcium status of adolescents

-adolescents= period of rapid bone accretion (1/2 of peak adult mass) -deposition of bone greatest among males **RDA=1300 mg/d (highest among adolescents -many do not meet RDA (especially females)

early adolescence -characteristics -health edu

-concrete thinking (as opposed to abstract thinking) -egocentrism (i.e., focus on self; ignores the impact of personal actions on outside world) -impulsive behavior -should focus on immediate consequences of eating and exercise behaviors (physical attractiveness, academic ability, physical performance

late adolscence -characteristics -health edu

-development of personal identity -moral beliefs -reduced economic and emotional dependence on family -improved abstract thinking -employ motivational counseling; appeal to older adolescents by encouraging them to take charge of their own health

treatment for iron-deficiency anemia

-dietary changes in iron intake are NOT sufficient to correct the deficiency (need iron supplementation) 1) consume iron rich foods -lean meats -legumes -iron-fortified breakfast cereal 2) consume dietary sources of vitamin C along with iron-rich foods to enhance absorption of iron 3) Avoid use of dairy products, calcium supplements, coffee, tea, and high-fiber foods within 1 hour of taking dietary supplements, as these may decrease iron absorption

strategies to prevent eating disorders

-discourage restrictive dieting/fasting -info about normal body fat changes that occur during puberty -carefully phrase weight-related recommendations -healthy behaviors rather than numbers on the scale -encourage children/adolescents to eat/stop eating in response to internal cues for hunger and satiety -build respectful and supportive relationships (parents, teachers, coaches) -educate young athletes that thinness is not necessarily associated with better sports performance -establish screening and support programs at high schools and colleges

middle adolescence -characteristics -health edu

-emotional and social independence from family -dominant influence of peers -emergence of abstract thinking (but little life application) -should still provide concrete, understandable examples

nutrition education & counseling strategies that are effective when working with adolescents

-establish trust & rapport -material shouldn't be too complex or too childish -involve teen in decision making (topics, goals, behavioral strategies) -limit to 1 or 2 goals per session -supply concrete recommendations -relate behavioral changes to immediate, relevant benefits (academic/athletic performance, appearance) -frequent follow up -use of technology

major provisions of the Healthy Hunger Free Kids Act of 2010

-extended funding for the Child Nutrition Program -expanded access to free (family income <130% poverty level) and reduced lunches (family income <185% poverty level) -required schools to develop wellness policies -established nutrition standards for foods served at school *lunches: meet 1/3 of the RDA for protein, calcium, iron, vitamin A, and vitamin C *breakfasts: meet 1/4 of the RDA

-excessive ______ intake can reduce calcium absorption from the small intestine -excessive ________ intake (e.g., from soft drinks) coupled with an inadequate calcium intake may increase bone resorption and increase urinary calcium excretion -excessive _______ intake can increase urinary calcium excretion

-fiber -phosphorus -sodium

How well do teens adhere to the Dietary Guidelines and MyPlate?

-grains: enough, not enough whole grains -fruit: well below (increasing throughout the years) -vegetables: well below -proteins: males meet goals, females dont -dairy: well below -sodium: far exceed -saturated fats: exceed -added sugar: exceed (x2)

ways schools can promote healthy eating & physical activity

-high quality school breakfasts/lunches -physical education -health education -partner with families and community organizations to promote lifelong healthy eating -wellness resources to faculty and school staff -employ qualified people to provide nutrition services, health education, and physical education to students

men: _____ mass increases more than ____ mass--%body fat _____ women: ______ mass increases more than _____ mass---%body fat _____

-lean, fat---decreases -fat, lean---increases (potential cause of distress)

influence of meal skipping

-only 38% of teens eat breakfast daily (commonly skipped meal) -negative impacts for: energy, protein, fiber, calcium, folate

biological changes that occur during adolescents

-sexual maturation -increases in height & weight -changes in body comp (% fat) -accretion of skeletal mass

protein needs of adolescents

0.85 g/kg/d

typical pubertal growth spurt occurs about ________ earlier among girls than among boys

1 year

treating metabolic syndrome and type 2 diabetes among adolescents

1) Achieve and maintain healthy body weight 2) Engage in regular physical activity 3) DASH diet is a healthy dietary pattern; may need to incorporate carbohydrate counting

ways to assess iron status

1) Hemoglobin (low levels indicate iron deficiency anemia) 2) Hematocrit (low levels indicate iron deficiency anemia) 3) Serum iron (low levels may indicate early stages of iron deficiency, before anemia develops) 4) Serum ferritin (low levels may indicate early stages of iron deficiency, before anemia develops) 5) Transferrin saturation (low levels may indicate early stages of iron deficiency, before anemia develops)

commonly used dietary supplements among adolescents

1) MVMs 2) iron 3) vitamin C 4) calcium 5) vitamin E 6) B complex -herbal supplements & sports supplements (not well regulated or tested among younger populations)

treatment for eating disorders

1) Multidisciplinary approach -physician, nurse, dietician, psychologist 2) Intensity of therapy depends on severity of physical effects of eating disorder -outpatient program, day treatment program, inpatient program 3) Overall goals: -restore healthy body weight, improve social & emotional well-being, normalize eating behaviors

strategies for vegetarians to ensure nutrient adequacy

1) choose fortified foods 2) read labels 3) use of dietary supplements to fill nutrient gaps -suggested dietary pattern (table 14.3)

nutrition strategies used in the treatment of RED-S

1) early intervention (critical to limit bone loss) 2) sometimes hormonal medications are prescribed for females to restore regular menstrual cycles (increasing energy intake is better for correcting hormone imbalances) -daily energy intake should be at least 30 kcal/kg of fat free mass, preferably 45 kcal/kg FFM/d 3) calcium (to reach the RDA of 1300 mg/d) and vitamin D supplements (600 IU/d) -to restore bone mineral density 4) reduce training volume until health is restored

ways to prevent RED-S

1) educate athletes, parents, coaches, and trainers that amenorrhea or oligomenorrhea among female athletes is NOT normal and has serious consequences 2) nutrition education should focus on healthy eating behaviors, not on achieving a specific body weight, BMI, or % body fat 3) promote foods that are good sources of bone-building nutrients

nutrition interventions used in the treatment of muscle dysmorphia

1) evidence-based methods to determine energy, protein, and other nutrient needs 2) shift focus away from numbers to healthy eating behaviors 3) reduce or eliminate use of dietary supplements, including protein and amino acid supplements 4) focus on eating foods to satisfy hunger rather than relying on external cues, such as rigid diet plans

factors that influence bone mass

1) hormones -estrogen, testosterone, and growth hormone (stimulate it) 2) body weight -abnormally low body fat limits bone growth/deve. (decreases production of the aforementioned hormones) -higher body weight= higher bone mineral density 3) exercise -increases bone mineral density (bone remodeling from the stress of weight-bearing exercise) 4) dietary intake of bone-building nutrients -calcium, phosphorus, magnesium, vit. D, vit. K -avoid excessive intakes of nutrients that impair Ca absorption/increase Ca excretion (fiber, phosphorus, sodium) 5) cig smoking & alcohol impairs bone growth & development 6) caffeine -excessive intake of caffeine (>400 mg/d) may increase urinary calcium excretion.

how high levels of physical activity influences nutritional needs

1) increased energy needs (add 500 to 1500 kcal/d) -majority from carbs 2) increased protein needs (shouldn't exceed 30% of total kcal) -discourage high protein diet: high in fat/sat. fat, limit energy availability (lack of carbs), increase risk for dehydration (increased excretion of nitrogenous waste products) 3) increased fluid needs 4) focus on calcium intake (especially for female athletes)

influences on eating behaviors

1) individual influences (intrapersonal) -knowledge, beliefs, self-efficacy, food preferences, hunger, meal/snack patterns, weight-control behaviors, time constraints, economic constraints 2) social environmental influence (interpersonal) -family -peer network 3) physical environmental influences (community setting)) -availability of foods -transportation of food outlets 4) macro influences (societal) -media/advertising, local/state/nation food production & distribution, laws, cultural norms

why teens are at increased risk for iron deficiency anemia

1) its quite common (10% of adolescent females) -iron-deficiency without anemia is more prevalent -black and Mexican females are at higher risk -teens from low-income families are at higher risk 2) Increased demand for iron to support rapid growth and increase in blood volume 3) inadequate dietary intake of foods rich in iron and/or vitamin C -skipping meals -adopting vegan diets -calorie restriction for weight control 4) increased iron losses -endurance sports -heavy menstrual bleeding

treating hypertension among adolescents

1) loss of excess weight 2) DASH diet

ways to identify RED-S in athletes

1) regular physical check-ups (at start of training season) 2) ask about menarche and the regularity of the menstrual cycle 3) stress fractures (possible sign of low bone mineral density)

recommended fiber intakes for adolescents

14 g/1000 kcal -typically consume less than half of the recommended amount of fiber -intakes of fruits, vegetables, and whole grains tend to be low among adolescents

as much as _______% of adult bone mass accrues during adolescence

50

during puberty, adolescents gain as much as ______% of their healthy adult weight

50

fat needs

AMDR: 25% to 35% of total kcal (most teens are within this range) -limit saturated fat to no more than 10%

prevalence of overweight/obesity among adolescents

Ages 12 to 15 years 38.7% have BMI-for-age ≥ 85th percentile 20.6% have BMI-for-age ≥ 95th percentile Ages 16 to 19 years 41.5% have BMI-for-age ≥ 85th percentile 20.5% have BMI-for-age ≥ 95th percentile

nutritional concerns/benefits for vegetarians

BENEFITS: -higher fiber -lower saturated fat -Higher levels of some vitamins and minerals that tend to be low in adolescent diets (e.g., potassium, magnesium, folate, vitamin E) -lower risk of overweight/obesity CONCERNS: -protein -calcium -zinc -iron -omega-3 fatty acids -vitamin D -vitamin B-6 -vitamin B-12

treating hyperlipidemia among adolescents

CHILD 1 guidelines -includes DASH recommendations -additional guidance on fat intake, fiber intake, and family meals

implications of overweight/obesity among adolescents

Cardiovascular problems (hypertension, dyslipidemia) Endocrine problems (type 2 diabetes) Respiratory problems (asthma, sleep apnea) Bone and joint problems (injuries, arthritis) Liver problems (fatty liver) Mental health problems (depression)

how substance abuse can affect nutrition status of adolescents

MALNUTRITION: -Changes in appetite and food intake -Decreased nutrient absorption -Increased nutrient excretion -Decreased financial resources to purchase food -Altered cognitive function SPECIFIC INFLUENCES: -Tobacco: increases vitamin C requirements (to combat oxidative damage) -Alcohol: alters intake, absorption, metabolism, and excretion of B vitamins -Teens who use tobacco, alcohol, and illicit drugs are at increased risk for disordered eating

energy needs for adolescents

Males 9 - 13 years: ~2300 kcal/d 14 - 18 years: ~3200 kcal/d Females 9 - 13 years: ~2000 kcal/d 14 - 18 years: ~2400 kcal/d

RDA for iron

Males (age 14 - 18): 11 mg/d Females (age 14 - 18): 15 mg/d

treatment of adolescent overweight/obesity

Multi-staged approach, based on BMI-for-age and presence of other health conditions 1) Stage 1: Prevention Plus: general advice to choose age-appropriate portions for more nutrient-dense, less energy-dense foods, increase physical activity/decrease screen time 2) Stage 2: Structured Weight Management: add monitoring of food/activity, further limit screen time, utilize goal-setting 3) Stage 3: Comprehensive Multidisciplinary Intervention: more structured, more frequent contact, include health professionals from multiple disciplines (e.g., physician, nurse, RDN, mental health counselor) 4) Stage 4: Tertiary Care Intervention: work with professionals at a specialized weight management center for adolescents, may involve very-low-calorie diet (VLCDs), weight-loss medications (e.g., orlistat), and/or bariatric surgery

Muscle dysmorphia

a form of body dysmorphic disorder characterized by distorted body image (e.g., perceiving oneself as thin and weak) and an obsessive desire to attain a highly muscular physique -more common among males -attributed to slow or late physical development during puberty in combination with social pressures BEHAVIORS: -frequent body checking -disordered eating habits -compulsive/obsessive exercising -use of anabolic steroids

Relative Energy Deficiency in Sport (RED-S)

a syndrome of altered metabolism, immune function, and mental health caused by low energy availability in athletes -low energy availability may be unintentional or intentional

Orthorexia

an obsession with proper or healthful eating -when strict food rules begin to interfere with quality of life and result in physical or mental health problems

pubarche

appearance of pubic hair

thelarche

beginning of breast development

spermarche -average age

beginning of sperm production by testes -14 years

stage of sexual maturation is better than chronological age for assessing _________

biological growth & development for adolescents -variable age of onset -variable duration -variable tempo

sex hormones are important influencers for __________

bone formation -imbalances in estrogen or testosterone negatively impact bone mineral density

disordered eating vs. eating disorder

disordered eating: temporary changes in diet behaviors, no lasting impact on health eating disorder: prolonged unhealthy changes in diet behaviors, interferes with other aspects of daily life, lasting health consequences

eating disorders are a result of an interplay between ______ & _____ factors

genetic & environmental factors

scale of secondary sexual characteristics are used in assessment of adolescent ______ & _______ -examples

growth & development -enlargement of breasts, male genitalia, development of pubic hair

the total energy needs of adolescents are the ______ of all stages of the lifecycle because....

highest -due to the demands of growth (muscle, bone, and adipose tissue) and increased body mass

For a girl who is an "early bloomer " (i.e., menarche at age 10), it may be appropriate to emphasize ____________ to prevent iron deficiency, even though the upward shift in the RDA for iron for girls does not occur until age ______

iron-rich foods, 14

warning signs & diagnostic criteria for the 3 eating disorders

on tables

menarche -average age

onset of menses (first period) -12.5 years -early onset among overweight/obese girls -late onset among underweight girls

the leading predictor of eating disorders

restrained eating (extreme dieting)

tanner stages

sexual maturation rating scale (SMR)