Nutrition Ch 14

Effective Nutrition Messages for Youth Include:

- "Present orientated" messages (teens do not think about future heath) - Concern about appearance - Achieving and maintaining a heathy weight - Having lots of energy - Optimizing sports performance - Environmental or moral aspects of food

Reasons Adolescents Adopt a Vegetarian Diet Include:

- Cultural or religious beliefs - Moral or environmental concerns - Health beliefs - To restrict fat and/or calories - A means of independence form family

US Adolescents have an Inadequate Intake of Vitamins and Minerals Including:

- Folate - Vitamins A, B6, C, E - Iron - Zinc - Magnesium - Phosphorus - Calcium - Dietary fiber

School Programs Should be a Part of a Comprehensive, Coordinated School Health Program that Includes:

- Health instruction - Physical education - School food services - Health services - Health promotion for faculty and staff - Integrated community efforts - Free breakfast/lunch

Calcium Requirements for Adolescents*

1. Adequate intake of calcium is critical to ensure peak bone mass 2. Calcium absorption rate in females is highest around menarche (7-10 year old girls)* 3. Calcium absorption rate in males is highest during early adolescents 4. ~4 times more calcium is retained during early adolescence compared to early adulthood (must educate children on importance) 5. Adolescents who do not include dairy should consume calcium-fortified foods 6. Soft drink consumption displaces nutrient-dense beverages, such as milk and fortified juices 7. DRI for ages 9-18 years is 1300 mg/day - The average intake is: --> 948 for females --> 1260 mg for males (both too low) 8. Weight bearing activities may lead to increased bone mineral density (ex: walking/running/bearing your own weight)

Nutritional Needs in a Change of Time

1. Biological, psychological, and cognitive changes affect nutritional status 2. Rapid growth increases nutrient needs 3. Desire for independence may cause adoption of health-compromising eating behaviors

Requirements for Selected Nutrients of Adolescents

1. Carbohydrates: 130 g/day or 45-65% of calories 2. Dietary fiber: - 26 g/day for adolescent females - 31 g/day for males <14 years of age - 38 g/day for older adolescent males 3. Make half of your grains WHOLE! 4. 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

Nutrient Environment of the School: Energy-Dense Foods (not nutrient-dense)

1. Chips, candy, or soft drinks sold in vending machines, as fundraising events, or offered as rewards by teachers send inconsistent nutrition messages to student 2. Commercial messages and advertisements, easy access to high-fat, high-sugar, high-sodium food products --> send conflicting messages about nutrition Few foods are both energy dense and nutrient dense (ex: avocado)

Three Periods of Psychological Development:

1. Early adolescence (11-14 y/o) - Concrete thinking, egocentrism, impulsive behavior 2. Middle adolescence (15-17 y/o) - development of emotional and social independence from the family 3. Late adolescence (18-21 y/o) - Abstract reasoning skills, a personal identity, personal choice, and individual moral beliefs develop

Energy Requirements of Adolescents

1. Energy needs are influenced by: - Activity level - Basal metabolic rate (BMR) - Pubertal growth and development 2. Because males have a greater increase in height, weight, and lean body mass (LBM), they have a higher caloric need than males 3. Level of physical activity declines during adolescence resulting in reduced energy requirements (especially in females) --> it is important to educate adolescents that they must remain physically active

Vitamin D Requirements for Adolescents

1. Essential role in facilitating intestinal absorption of calcium and phosphorus* 2. Essential for bone formation 3. Synthesized by the body via skin exposure to ultraviolet B rays of sunlight 4. Northern latitudes --> may require supplementation 5. RDA: 600 IU/day

Health-compromising Eating Behaviors Include

1. Excessive dieting 2. Meal skipping 3. Use of unconventional nutritional and non-nutritional supplements 4. Fad diets

Folate Requirements for Adolescents

1. Folate is required for DNA, RNA, and protein synthesis 2. DRI: 400 mcg 3. Severe folate deficiency leads to megaloblastic anemia - Severe deficiency is rare, but inadequate folate status appears to be more common 4. Folate added to fortified foods is better absorbed than folate from natural foods (ex: breakfast cereals) 5. Adequate folate intake for female adolescents reduced incidence of birth defects (such as spina bifida) --> it is imperative that women of reproductive age (15-44 years) consume adequate folic acid 6. Factors that Increase Folate Deficiency: - Skipping breakfast - No fortified foods

Heath-enhancing Eating Behaviors Include

1. Healthful eating practices 2. Physical activity 3. Interest in a healthy lifestyle (When talking to a patient, a nurse does not want to talk about "diet" or "exercise", one should encourage movement/physical activity) (Nurses should say "lifestyle changes", NOT "going on a diet)

Energy and Nutrition Requirements of Adolescents

1. Increase in lean body mass, skeletal mass, and body fat 2. Energy and nutrient needs during adolescence EXCEED those of any other point in life (needs are high) 3. Needs correspond to physical maturation stage 4. DRIs provide the best estimate of nutrient requirements for adolescents 5. Professional judgement must be used 6. Nutrient recommendations are based on chronological rather than biological development, so we need to assess*

Iron Requirements for Adolescents

1. Increased iron needs related to: - Rapid rate of linear growth - Increase in blood volume - Menarche in females 2. In females, iron needs are greatest after menarche 3. In males, iron needs are greatest during the growth spurt

Iron Deficiency vs Iron-Deficiency Anemia in Adolescents

1. Iron deficiency: - Determined by low serum iron, plasma ferritin, & transferrin saturation (measuring iron in the blood) - Iron deficiency is more frequent - Often undiagnosed because of expense - Symptoms: fatigue/pale 2. Iron-Deficiency Anemia - Determined by simple and inexpensive hemoglobin or hematocrit levels - Indicated more advanced stage of iron deficiency - Less frequent but almost exclusively in females

Maturation and Growth of Males

1. Males show a great deal of variation in chronological age at which sexual maturation takes places 2. Peak velocity of linear growth occurs during SMR 4 and ends with appearance of facial hair at ~age 14.4 3. Linear growth continues throughout adolescence ceasing at ~age 21

Dietary Intake and Adequacy Among Adolescents

1. Many adolescents have diets that do not match the Dietary Guidelines for Americans or the MyPlate Recommendations 2. Most have inadequate consumption of: - Dairy - Grains - Fruits & vegetables 3. 32% of calories from fat and 2% from added sugars

Maturation and Growth of Females

1. Menarche (the onset of first menstrual period) occurs 2-4 years after initial development of breast buds 2. Age of menarche ranges from 9-17 years old (great individual variation) 3. Peak linear growth occurs ~6 to 12 months prior to menarche (usually a growth spurt before 1st period) 4. Highly competitive athletes or severely restrictive diets may delay or slow growth

Promoting Heathy Eating and Physical Activity Behaviors

1. Parent Involvement: - Target plans - They are the gatekeepers of food - Serve as role models 2. Teens eat based on availability and convenience - Parents can capitalize on this - Stock a variety of nutritious ready-to-eat foods

Changes in Weight, Body Composition, and Skeletal Muscles in MALES

1. Peak weight gain at the same time as peak linear growth & peak muscle mass accumulation 2. Peak weight gain (~20 lbs per year) 3. Body fat decreases to ~12% (throughout life, males have less body fat and more lean muscle mass) 4. ~Half of bone mass is accrued in adolescence

Changes in Weight, Body Composition, and Skeletal Muscles in FEMALES

1. Peak weight gain follows linear growth spurt by 3-6 months - Gain of ~18.3 lbs per year 2. Average lean body mass decreases (depends on how athletic female is) - 44% increase in lean body mass (LBM) - 120% increase in body fat 3. 17% body fat is required for menarche to occur - May be delayed if female has an eating disorder, food insecurity, or is very athletic 4. 25% body fat is needed to maintain normal menstrual cycles

Factors Affecting Eating Behaviors:

1. Peer influence 2. Parental modeling 3. Food availability, preferences, cost, & convenience 4. Personal & cultural beliefs 5. Mass media 6. Body image

Protein Requirements of Adolescents

1. Protein requirements influenced by protein needed: - To main existing LBM - For growth of new LBM 2. Recommendation is 0.85 g/kg of body weight 3. Low protein intake is linked to: - Reductions in linear growth - Delays in sexual maturation - reduced LBM

Biological Changes of Puberty Include:

1. Sexual maturation 2. Increases in height and weight 3. Accumulation of skeletal mass 4. Changes in body composition (The sequence of maturation events is consistent but great individual variation in age of maturation)

Normal Psychological Development

1. The need to fit in can affect nutritional intake (eating in our culture is a social activity) - Who they eat with - Where they eat 2. Peer influences may be greater than family - May improve dietary intake - May lead to poor dietary intake

Normal Physical Growth and Development

1. There are variations in reaching sexual maturity affect nutrition requirements of adolescents - While the sequence of the biological events occurring during puberty is consistent, their onset, duration, and tempo is not. 2. Sexual maturation (or biological age), NOT chronological age, should be used to assess growth and development and nutritional needs

Nutrient Intake of Vegetarian Adolescents

1. Well-planned vegetarian diets can offer many healthy advantages - Best when small amounts of animal-derived foods are included 2. Vegans may have inadequate intakes of: - Protein - Calcium, zinc, and iron - Vitamins D, B6, and B12 - Vegans can take supplements or need better education on how to get proper nutrients

As few as ______% of adolescents have been found to consume breakfast regularly.

21%

Snacking accounts for ______% of daily energy intake.

23-29%

_______% of all teens eat lunch regularly.

75%

Vegetarian Diets During Adolescence

About 4% of adolescents report following a vegetarian diet

Normal Psychological Development

Adolescents develop: - A sense of personal identity - A moral and ethical value system - Feelings of self-esteem or self-worth -A vision of occupational aspirations

School Wellness Policies

All school districts with a federally-funded school meal program must have a wellness policy that addresses nutrition and physical activity

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 are common - Eating away from home and at fast-food restaurants - Consuming more soft drinks and less nutrient dense drinks - Eating meals in front of the TV

Iron Deficiency in Adolescents

Estimates of Iron Deficiency: - 9% of 12-15 y/o females - 5% of 12-15 y/o males - 11% of 15-19 y/o females - 2% of 15-19 y/o males

Model Nutrition Program

Numerous innovative nutrition programs exist that promote nutrition for youth Ex: CANFIT (California Adolescent Nutrition & Fitness)

Physical Activity for Adolescents

Physical Activity Guidelines for Americans: 1. Adolescents should be active everyday 2. Engage in muscle-and-bone-strengthening activities 3 days a week - Improves aerobic endurance and muscle strength (increases heart-rate and breathing) - May reduce risk of developing obesity - Builds bone mass density strengthening activities --> increase in lean muscle mass --> burn more calories

Community Involvement in Nutritionally Supportive Environments

Promoting lifelong heathy eating and physical activity behaviors among adolescents requires attention to multiple influences such as: - The community - Home - School - Media

Normal Physical Growth and Development

Puberty occurs during early adolescence. Adolescence generally refers to the period between ages 11 and 21. Physical, cognitive, and physchosocial maturation occur during these years, but not as the same speed for everyone.

Types of Vegetarian Diets and Foods Excluded

Semi- or partial- vegetarian: NO red meat Lacto-ovo-vegetarian: NO meat, poultry, fish, or seafood Lacto-vegetarian: NO meat, poultry, fish, seafood, or eggs Vegan (total vegetarian): NO meat, poultry, fish, seafood, eggs, dairy products (may include honey) Macrobiotic: NO meat, poultry, eggs, dairy products, seafood, fish (fish may be included in the diets of some macrobiotic vegetarians)

Sexual Maturation Rating: "Tanner Stages"

Sexual Maturation Rating (SMR)("Tanner Stages"): a scale of secondary sexual characteristics used to assess degree of pubertal maturation SMR 1 = prepubertal growth & development SMR 2-5 = occurrences of puberty SMR 5 = sexual maturation has concluded

Promoting Healthy Eating and Physical Activity Behaviors

The Center for Disease Control and Prevention published report - School Health Guidelines to Promote Healthy Eating and Physical Activity - Promote a developmental framework for school programs

Factors Affecting Physical Activity

The guidelines include recommendations to promote: - Healthy eating and lifelong physical activity - Include school policies - Physical and social environment recommendations - Appropriate physical education curricula and instruction - Person training - Family and community involvement - Program evaluation

Current recommendations call for _______% of total calories from fat. a.) 20-35% b.) 35-40% c.) 40-50% d.) <30%

a.) 20-35%

Protein should contribute approximately _______% of your energy intake. a.) <10% b.) 10-35% c.) 40% d.) 50%

b.) 10-35%

It is recommended that ______% of calories come from carbohydrates. a.) 40-50% b.) 45-55% c.) 45-65% d.) 50-65%

c.) 45-65%

Calculating Calories Content of a Smoothie An orange smoothie contains 10 g of protein, 100 g of carbohydrate, and 1 g of fat. How many total calories does this provide. a.) 299 b.) 399 c.) 550 d.) 449

d.) 449 100 x 4 = 400 10 x 4 = 40 1 x 9 = 9 Add up all of the products.