Chapter 14: Adolescent Nutrition

 Age: between 11 and 21 years of age

Period of profound changes
 biological
Need to fit in
Peer influences -  psychosocial affect nutritional status/intake
↑↓ dietary intake  cognitive

 Major occurrence: puberty in early adolescence

Puberty: physical transformation of a child into a young adult.
Biological changes:
1. sexual maturation (↑ nutrient needs)
• correspond to physical
2. ↑ in height and weight maturation stage
3. accumulation of skeletal muscles, • exceed those of any other
4. changes in body composition point in life
Males
• variation in chronological age in which maturation takes place
• Peak velocity of linear growth: 14.4 yrs
- during SMR 4, ends with appearance of facial hair
- ceases at 21 yrs
• Peak weight gain: 9 kg/year (20 lbs)
• Body fat: ↓ to 12% Occurs at the same time
• Muscle mass accumulation: half of bone mass as peak linear growth

is accrued in adolescence

Females
 Menarche (onset of first menstrual period):
- occurs 2-4 yrs after initial breast development
- 9 – 17 years
 Peak linear growth: 6 – 12 months prior to menarche
(delayed/slowed in highly competitive athletes and severely restrictive diets)
  Peak weight gain: 8.3 kg/year
(follows linear growth spurt by 3 – 6 months)
 LBM: ↑ 44%, average LBM ↓
 Body fat: ↑ 120 %
- 17% required for menarche to occur
- 25% needed to maintain menstrual cycles

Sequence of events is consistent among adolescents.

Age of onset, and duration of these events vary greatly between and
within these individuals.
SMR - scale of secondary sexual characteristics
↪ Physiological changes that signal puberty Pubic hair growth
Breast development
- used to assess degree of pubertal maturation Pubic hair growth
Genital development
- stages 1 – 5
SMR 1= pre-pubertal growth & development
SMR 2-5= occurrences of puberty
SMR 5= sexual maturation has concluded
These variations affect nutritional requirements!
Biological age (sexual maturation) should be used to assess growth,
development and nutrient needs, NOT chronological age

 desire for independence leads to certain behaviors that are:

Health- Compromising Health-Enhancing

 excessive dieting  Healthful eating

 meal skipping practices
 fad diets  Physical activity
 non-nutritional  Interest in a healthy
supplements lifestyle

Eating Behaviour:
 Eating Disorders
Affecters Influencers

 Peer influence  Macro-system

 Parental modelling  Environment
 Food availability, cost,  Personal
convenience
 Personal, cultural beliefs
 Mass media
 Bo
dy
image

Disordered Eating Behaviour

Anorexic or bulimic behaviors but with less frequency or intensity for
formal diagnosis.

Etiology of Eating Disorders:

• Social influences – pressure to be thin, advertising, peer

pressure
• Family dynamics – power, control issue, dominating parents
• Psychological – perfectionism, low self-esteem, feeling out of
control, external compliance
• Biological

Treating Eating Disorders: Multidisciplinary approach, consist of:

• Physician Psychiatrist
• Nurse Psychologist
• Nutritionist
Eating Disorders
 Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder
Extreme weight loss, Recurrent episodes Periodic binge eating
poor body image, of rapid uncontrolled not followed by
irrational fears of eating of large vomiting or use of
weight gain and amounts of food in a laxatives
obesity short period of time
• 10 – 15% die frequently followed
from disease by purging
• deaths related • 5% die from
to: weakened disease
immune • Deaths related
system, gastric to: heart failure
ruptures, resulting from
cardiac electrolyte
arrhythmia, abnormality or
heart failure, suicide
suicide • Recovery rate:
• early diagnosis 50 – 60%
and treatment
↑ chances for
recovery
• Recovery rate:
40 – 50%

Eating Styles:
 Snacking
 Meal skipping
 Away from home, fast food restaurants
 While watching TV
 ↑ soft drinks ↓ nutrient dense drinks
 Vegetarian Diets
Reasons for adopting:
Type Foods Excluded
 cultural/religious belief
1. Semi/partial veg Red meat
 moral/environmental concern
Meat, poultry, fish,
2. Lacto-ovo-veg
seafood  health benefits
Meat, poultry, fish,
 restrict fat/calories
3. Lacto-veg  independence from family
seafood, egg
4. Vegan Meat, poultry, fish,
(total veg) seafood, egg, dairy
Same as vegans, may
5. macrobiotic
include fish

Physical Activity
 should be active DAILY
 Muscle and bone-strengthening activities 3 days/week
- ↑ aerobic endurance and muscle strength
- ↓ risk of developing obesity
- build bone mass density

Energy and Nutrient Requirements

 based on chronological age
 based on DRI, provide best estimate
 professional judgement to be used
Energy Requirements Influenced by:
Activity level
Caloric Need
Males > Females
Basal Metabolic Rate
Pubertal growth and development
Adolescents
Age Male Female
Energy Requirement 9-13 2279 kcal 2071 kcal
(ER)
14-18 3152 kcal 2368 kcal
9-13 31 g/day
Dietary Fiber 26 g/day
14-18 38 g/day
130 g/day
Carbohydrates
45-65 % of calories
Protein maintain existing and 0.85g /kg of body weight
growth of new LBM 10-30 % of calories
Fat required as dietary fat and 25 – 35 % of calories
essential fatty acids for growth
and development < 10% calories from saturated fat
↓ protein intake: delay in sexual maturation
↓ LBM ↓ linear growth

Mineral Requirements
AI
• ensures peakAge
bone massDRI
Males
around menarche Females
Ca 9 - 18 1300 mg/dayduring early
1260adolescence
mg 948 mg
• Absorption is highest
• Retained 4 times ↑ in
early adolescence than early adulthood
• Consume calcium-fortified foods, milk and fortified juices
• Weight bearing activities ↑ bone mineral density
Fe after menarche
• Needs are greatest during growth spurt
• ↑ needs related to: ↑ blood volume
rapid rate of linear growth
menarche

Deficiency
Iron Deficiency Iron-deficiency Anemia

• ↓in the amount of Fe • advanced/end stage of Fe

stored in the body deficiency
• Test: ↓serum iron, Plasma • Test: hemoglobin (common
measure) or hematocrit
ferritin and Transferrin
levels
saturation (sensitive • less frequent
measure) • almost exclusively in females
• more frequent
• often undiagnosed due to
expense

Vitamin Requirements
Folate Vitamin D
400 mcg 600 IU/day

• required for DNA, RNA, and • facilitates intestinal absorption

protein synthesis of Ca and P
• Severe deficiency (rare) → • essential for bone formation
megaloblastic anemia • synthesized by the body via
• Inadequate status more sun rays (UV light B )
common
• better absorbed in fortified
foods than natural foods
• AI ↓ incidence of birth
 defects like spina bifida
• Intake imperative for women
of reproductive age (15 – 44
yrs)
• Skipping breakfast, no
fortified foods ↑ risk of
folate deficiency

Inadequate Intake common in Adolescents

• Folate Diets do not match Dietary Caloric Consumption:

Guidelines Recommendation 32% from Fat
• Vitamins A, C, E, & B6 Inadequate consumption of: 21% from added sugar
• Iron, Zinc, Magnesium • Dairy
• Phosphorus & calcium • Grains
• Fruits and Vegetables
• Dietary fiber