NUTRITION IN ADOLESCENCE

(13-18 Years Old)

OBJECTIVES:
At the end of the Unit the student should be able to:

1. Define terms associated with adolescence.

2. Describe the Stages and Characteristics of Adolescence
3. Identify psychological changes of adolescence during each stage.
4. Describe how macro and micronutrient needs change as a child matures from
school-age years to adolescence.
5. Identify the feeding problems encountered during adolescence.
6. Identify the Special Nutritional Needs of Adolescence.

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 NUTRITION IN ADOLESCENCE
(13-18 Years Old)
INTRODUCTION:
Providing nutritional needs of adolescence is a challenge to the health professional,
because this period is characterized by:
▪ Accelerated Growth and Development
▪ Social changes : lifestyle, food habits and physical activities
▪ Emotional problem associated with increased personal and academic responsibilities;
Psychological Concerns Result: Eating Disorders
▪ Problems with some teenagers that demand special nutritional needs; such as
Smoking,- Drug Abuse,- Alcohol Abuse,- Pregnancy, and eating disorder.
PURPOSE OF NUTRITION CARE
▪ To provide adequate nutrient intake for normal growth and development during
puberty,
▪ To maintain an adequate nutritional state that promotes health and prevents disease
after physiological growth is complete.
DEFINITION
▪ Adolescence – Is the transition period between childhood to adulthood characterized
by dramatically accelerated physical, physiological, biochemical, and psychological
changes.
▪ Puberty – period which is characterized by increase in hormone secretion, rapid
growth, and appearance of secondary sex characteristics; pubescence.
▪ Growth Spurt – most rapid phase of adolescent growth.
▪ Peak – highest point of adolescent growth.
▪ Menarche – beginning of menstrual function

STAGES OF ADOLESCENCE
Adolescence Is the transition period between childhood to adulthood. It is marked by the
beginning of secondary sex characteristics and the end of somatic growth; with girls maturing
earlier than boys.
3 Stages
1. Prepuberty or Prepubescence
▪ The average of chronological ages for this period are 9-12 years old
▪ Endocrine changes start, for some girls – menarche or onset of menstruation
may occur.
2. Puberty or Pubescence
▪ Average chronological ages over 13-15 years old.
▪ Maturation of body – adolescents gain about 15-20% of adult height and 40-
50% of adult weight.
▪ Hip width increases in the girls.
▪ Girls gain more fat than boys, but boys gain more lean tissues than girl.
▪ In general, girls start puberty development two years ahead of boys

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 ▪ Other indications of sexual maturation:
▪ Pubic Hair Growth, Development of the Genitalia, Change in Voice
▪ Girls reach almost full height by the onset of menstruation called menarche.
▪ The growth spurt that occurs during adolescence includes rapid bone growth,
increased muscle mass, and increased body fat. It is the 18 to 24 month period,
when growth rate is the fastest but its occurrence varies among individuals.
a. Growth spurts for girls tend to begin around 10 -11 years of age
b. Growth spurt for boys begin around 12 to 13 years of age
c. Linear growth and weight gains continue until 19 for females and early
twenties for males, with the latter gaining more length in the long bones
than females.
3. Postpuberty or Postpubescence
▪ Growth slows down following the attainment of sexual maturity.
▪ This final process of adolescence (16-18 years old) is characterized by:
a. Maturation of the Sex Organ Function
b. Cessation of Growth for Females
c. Beginning of Adulthood
PSYCHOLOGICAL CHANGES DURING ADOLESCENCE
▪ In the first stage (10-12 years old), include pubertal and cognitive changes; the adolescent
is aware of peer relationships, starts to be conscious of the body parts and body image;
trusts and parents adults.
▪ In the second stage or mid-adolescent period (13-15 years old), time of increase
independence and experimentation; there is more peer pressure, more independence from
parents and less trustful of adults; and significant cognitive development.
▪ In the last stage or late adolescence (16 to 18 years old), time to make important personal
and vocational decisions; he/she has established a body image; definitely shows
independence; makes plans for the future; and establishes more intimacy and permanent
relationships with others. More interest is given on healthcare and careers.
NUTRITIONAL NEEDS OF ADOLESCENCE
The Philippine Recommended Energy and Nutrient Intakes (RENI) divide adolescence into
three age groups ; 10 to 12 years old; 13 to 15 years old; and 16 to 18 years old.
▪ Energy: Carbohydrates should supply 50-60% of total calories needed/day. There is
higher energy expenditure for males. The energy needs of teenagers vary greatly
depending on body sizes, rate of growth and physical activity. Comparing the three stages
of adolescence, energy needs of boys and girls.

10 to 12 y.o 13 to 15 y.o. 16 to 18 y.o.

MALES 2140 kcal 2800 kcal 2840 kcal
FEMALES 1920 kcal 2250 kcal 2050 kcal

▪ Protein: Boys have higher protein need than girls due to greater gain in height and lean
body mass during puberty.
Undernutrition can inhibit bone development, resulting in lower peak bone mass and
lower height increase velocity resulting to stunting.
Severe undernutrition can delay puberty or halt its progression as seen in cases of
anorexia nervosa.

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 Protein allowances for females and males within 13 – 15 years of age are 63 grams
and 71 grams/day, respectively. But in late adolescence males for the 16 -18 age
group need more protein (73 g/day) while it decreases ( 59 g/day) for the females.
Protein supplies about 15 to 20 % of total kcalories/day.
▪ Minerals:
Calcium and iron – often lacking in Filipino teenagers yet the most critical for growth and
development. Iron- is the key nutrient for growth since it is a component of muscle and
blood.
➢ Needs to increase in girls as they begin to menstruate. Boys as their lean body
mass develops.
Adolescents incorporate twice amount of calcium, iron, zinc and magnesium into their
bodies for bones, muscles, body fluids, blood and endocrine functions.
➢ To meet this higher need, adolescents should consume iron-rich animal foods liver
and internal organs, beef, chicken, and fish, green leafy veg, legumes and nuts.
➢ If iron meets cannot be met by diet alone, supplements may be warranted.
➢ Calcium requirements reach it peak during adolescence years. Milk is a significant
source of calcium. Alternative sources like sardines and other small fishes eaten
with bones, oysters, tofu, green vegetables and legumes must be taken if
teenagers do not like milk.
▪ Vitamins: The needs for thiamin, niacin and riboflavin correlate with energy intake. These
are needed to release energy from carbohydrates.
Males have higher need for vitamin A, C and B-complex because of differences in the
number of active body cells as reflected in body weight.
➢ Include vitamin C-rich foods to absorb iron better
➢ Vitamin C also helps maintain good defense system against common infection.
➢ Sources of Vitamin C: citrus fruits, cabbage-type veg., dark green vegetables,
melon, strawberries, papayas, mangoes, lettuce, and tomatoes
▪ Water: It is important to drink water per se or as is up to 12 glasses a day.
The reasons for adequate water supply during adolescence are accelerated growth
and development of body cells, increased energy utilization, other metabolic
processes, active exercise and sports.
FEEDING PROBLEMS DURING ADOLESCENCE:
1. Skipping meals or Irregular Meals and Snacking. Probably the most common is
omitting breakfast, because when eaten later in school or at work, school cafeterias,
street foods and fast foods are handy places for quick breakfast which usually turns out
to be a snack.
These food choices are empty-calorie foods usually high in fat, sodium and calorie but
low in essential macro and micro nutrient.
How to Encourage Intake of Nutritious Snacks
▪ Time management, prepare the night before or prepare a breakfast-to-go.
▪ Teach adolescents on proper food choices – choose nutritious items rather than
junk foods or items high in fat-calories and concentrated sweets.
▪ Let them know that it Will provide extra energy and boost nutrient intake
(particularly fortified foods)

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 ▪ Let your teenager help with planning diets for the whole family (the food
pyramid is the most practical guide to good nutrition and it offers a variety of
foods).
▪ At least once a day, usually the evening meal, dining should be relaxed, sit-
down mealtime for the family to enjoy and communicate pleasantly.
2. Reliance on fast food. fast foods tend to be high in fat, calories, and sodium, and low
in fiber calcium and vitamins with proper choices, fast food can be incorporated into a
healthy diet.
3. Establishing Body Image. The female adolescent who gets too conscious with her
body shape and figure, become a prey to false advertisements food fads and fallacies
or bad practices of some peers on how to stay slim.
4. Food Dislikes and Food Idiosyncrasies: During adolescence, food dislikes and
idiosyncrasies are due to :
▪ past food habits
▪ Maybe a result of advertisements
▪ What peers eat
Nutrition care:
a. Establishing proper food habits and introducing new foods should start in later
infancy.
b. Patience and discipline on the part of the mother- making them eat vegetables.
c. Elders must be the role model in buying and eating foods because it influences
the habits of children.
d. In nursery schools with feeding programs, teachers can help by being the
model.
5. Influence of Substance Abusers
A growing problem for teenagers who are curious, adventurous and want to try
something novel especially under peer pressure or pushers.
Ex. Marijuana, cocaine, ecstacy, alcohol, smoking and smokeless tobacco.
▪ Parents and teachers should be alert about the adolescents involvement.
▪ They should start education early about the harmful effects of substance abuse
that could ruin their future.
6. Inadequate Dietary Intake
Conditioning Factors of Inadequate Dietary Intake:
a. Poverty is one of the most common reasons for inadequate intake for essential
nutrients.
▪ Planning low cost meals which will meet the nutritional requirements of family.
▪ Encourage home garden whenever feasible- easy-to-grow produce include:
papaya, malunggay, pechay, mustasa, okra, eggplant, peppers (especially the
sili leaves), sweet potatoes, cassava, gabi, and many others depending on the
region of soil ad quality.
▪ Raising few chickens and hogs in backyard (be sure to practice sanitation and
safety).
b. Parasitism is a problem in the tropics and in developing countries. The parasites
interfere with nutrient utilization by competing with their host for their own food
needs.

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SPECIAL CONSIDERATIONS FOR THE ADOLESCENT RELATED TO NUTRITION
CONCERNS
1. Eating Disorders:
Anorexia Nervosa – a serious, potentially life-threatening eating disorder that is
characterized by self-starvation. Psychological in nature, the condition result in
malnutrition, hair loss, low blood pressure, weakness, amenorrhea, brain damage, and
even death; and therefore requires psychiatric as well as nutritional management.
Dietary Recommendation:
The important of food for growth, development and maintenance of the body should be
explained to the client. An increase of 200 kcal per week above the usual intake can be
made during the early stages of treatment, with greater increases as the patient becomes
more comfortable with eating.
Treatment requires:
▪ Development of a strong and trusting relationship between the client and the health
care professionals involved in the case.
▪ That the client learn and accept that weight gain and a change in body contours are
normal during adolescence.
▪ Nutritional therapy so the client will understand the need for both nutrients and
calories and how best to obtain them.
▪ Individual and family counselling so the problem is understood by everyone.
▪ Close supervision by the health care professional.
▪ Time and patience from all involved.
Bulimia Nervosa – also known as “GORGE and PURGE”. A serious eating disorder
characterized by recurrent episodes of binge eating- eating and recurrent inappropriate
compensatory behaviours (such as self-induced vomiting; misuse of laxatives, diuretics or
other medications; fasting or excessive exercise) to prevent weight gain.
Dietary Recommendation:
▪ Refrain from skipping meals
▪ Avoid finger foods and select meals and snacks that require eating at the table.
▪ Eat meals at regularly timed meals consisting of a variety of foods enough quantity.
▪ Include fresh fruits or vegetables salad at meals to prolong eating times.
▪ Eat more high-fiber foods to increase bulk.
▪ Consume enough fluids, 8 to 10 glasses a day mostly water.
▪ Include 30 minutes of exercise daily as this may be an important tool in controlling
bulimia.
2. Overweight
Overweight during adolescence is particularly unfortunate because it is apt to diminish
the individual’s self-esteem and, consequently, can exclude her or him from the
normal social life of the teen years, further diminishing self-esteem.

Self-esteem feelings of self-worth

OTHER IMPORTANT DIETARY RECOMMENDATIONS

1. Avoid skipping meals - Emphasize selection of nutritious snacks but these should never be
taken close to meal time.

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2. Avoid food fad or crash diet – growth and development at this stage demand for higher
nutrients.
3. Refrain from drinking too much soft drink.
▪ It delivers 30 to 55 milligrams of caffeine per 12-ounce serving since it may affect
bone health.
▪ Cola beverages should not be taken more than three 12-ounces a day. Fruit juices
and milk are better alternatives.
4. Give special attention to B vitamins ( by eating a variety of animal and plant foods ) to
relieve stress, stimulate appetite and aid in good digestion.

ADOLESCENTS WITH SPECIAL NUTRITIONAL NEEDS:

Pregnant Adolescent:
▪ Demands increased nutrient needs from both the pregnancy state, as well as for her
growth and development.
▪ A young female who conceives soon after her first menstruation is at greatest
physiologic risk, not only to herself but also to the fetus as she herself has not finished
growing and is still yet to reach peak bone mass. If the adolescent has been
undernourished and anemic before conception, her nutritional needs are even greater.
She should get medical care as soon as possible. A reputable clinic with available
dietetic services is recommended
▪ Other implications in her life are the psychosocial and social stresses. Indirectly, these
affect proper food intake. Family support and guidance counseling are critical for the
pregnant adolescent.
▪ A Practical clinical method of ensuring nutritional adequacy is to educate and
encourage the pregnant adolescent to gain the recommended amount of weight, which
is about 30 pounds for the entire gestation period. But if she is underweight to begin
with, 35-40 pounds will be appropriate.
Adolescent Athlete
▪ Energy, Protein, and Water Needs are most critical with the adolescent athlete.
▪ Factors that determine the amount of calories are the same for other athletes. These
include the kind, length of time or duration of the activity, intensity and frequency of
performing a specific activity. The body weight of the athlete is considered in estimating
or calculating energy needs for each activity.
▪ The adolescent athlete is particularly vulnerable to food fads and myths that would
enhance performance. Inappropriate use of nutritional supplements and other
“ergogenic aids” will do more harm than good.
Substance Abuse
▪ Addiction to street drugs, alcoholic drinks, and tobacco, is a current major public health
problem worldwide.
▪ Taking the drugs, heavy smoking and alcoholic drinking certainly causes loss of
appetite.
Acne
▪ The occurrence of acne is considered part of a normal development during
adolescence.
▪ It is initiated by the influence of testosterone on the sebaceous (oil) glands of the skin.
▪ Other factors that contribute to the appearance of acne are:

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 heredity, stress, composition of the skin tissues, hormonal imbalance as part of the
changes brought by adolescence, especially for girls as they menstruate. The severity
of the acne problem varies among teenagers, but diet is not a big causative factor
as once believed. Since it is more hormonal, serious cases should be medically
treated.
▪ Smooth complexion, clear skin, and glossy healthy hair are incentives to the
adolescent females. Healthy teeth, proper growth and development and attaining the
right weight for height with good figure all need proper nutrition and exercise. The
nutrition educator can use these incentives to encourage teenagers to eat properly and
choose foods and drinks wisely. Give them a list of healthy snacks ad what to pack for
their lunches. Additionally. Remind them of personal hygiene in grooming and in
handling food.

Patho-Physiological Factors of Pregnancy in Adolescence

Povery Age ( below 15 yrs ) Infection Anemia Underweight

POOR NUTRITIONAL STATUS

Deficiencies Clinical Findings

Folic acid Poor weight gain during

Other vitamins pregnancy
Calcium Low birth weight
Vitamin D premature birth
Micronutrients (trace minerals) Difficulties in delivery

MEDICAL MANAGEMENT NUTRITIONAL MANAGEMENT

Regular Prenatal Care Nutrition Education

Follow-up of Infant Balanced Diet (Pyramid)
Follow-up of Mother Energy-Protein Needs
Vitamin-Mineral Supplements Vitamin-Mineral Needs
Water/Fluid Needs