Nutrition through the

Lifespan: Infancy, Childhood

& Adolescence
Nutrition of the Infant
 Nutrient Needs during
Infancy
• 1st year of life period of phenomenal growth &
development; infants grow faster during 1st
year than ever again
• Early nutrition affects later development
• Early feeding sets stage for eating habits that
influence nutrition status throughout life
• In developed countries, type of milk infant
receives & age at which solid foods are
introduced have most effect on infant’s
nutrition status
• Growth of infants & children is important
parameter in assessing nutrition status
 Nutrient Needs during
Infancy
• Nutrients to support
growth
– Rapid growth & metabolism
require ample supply of all
nutrients
• Infants double weight by
6 months & triple it by a
year
• Slows considerably by
end of the 1st year
• Proportionate to weight,
basal metabolic rate is
high
– Energy nutrients, vitamins &
minerals critical to growth
process are most important
• 100 kcalories/kg per day
• Vitamins A & D; calcium
– By about 6 months,
growth rate begins to
slow—but activity level
increases
• Energy needs increase
less rapidly
• Some energy saved by
slower growth is used
for increased activity
• As growth slows,
infants spontaneously
reduce energy intakes
 Nutrient Needs during
Infancy
• Water
– Important nutrient need for infants, as for
everyone
– The younger the child, the more of body
weight that is composed of water
– Breast milk or infant formula provides enough
water to replace fluid losses for healthy infant
• However, water is easy to lose
• Conditions that cause rapid fluid loss (i.e. vomiting or
diarrhea) require administration of an electrolyte
solution formulated for infants
 Breast Milk
• Energy nutrients
– Carbohydrates – Protein
• Lactose is carbohydrate
found in breast milk &
infant formulas
• Easily digested; enhances
calcium absorption
– Lipids
• Main source of energy in
both breast milk & infant
formulas
• Breast milk contains
generous proportion of
linoleic acid & linolenic
acid
• Also contains their
derivatives arachidonic
acid & docosahexaenoic
acid (DHA)
• Mainly alpha-lactalbumin
& lactoferrin
• Easily digested
• Lactoferrin benefits iron
nutrition & acts as
antibacterial agent
• Helps absorb iron into
bloodstream & keeps
intestinal bacteria under
control
Breastfeeding offers
benefits to both
mother & baby &
should be encouraged
whenever possible
• Research studies & arachidonic acid & DHA
– Found abundantly in developing brain & retina of the eye
– Studies show higher scores on visual & mental
development tests for breast-fed infants, compared to
formula-fed infants
– Infants fed formula with added DHA & arachidonic acid
had better visual function at 1 year than those fed
standard formula
– Results mixed regarding mental development & addition
of DHA & arachidonic acid
 Breast Milk
• Vitamins & minerals – Mineral content
– Vitamin content of • Calcium content ideal for
breast milk is ample, if bone growth; well-
mother is well absorbed
nourished • Low in sodium
– Exception: vitamin D • Iron & zinc are highly
• Deficiency impairs absorbable
bone mineralization – Supplements may be
• Deficiency most likely prescribed
in infants who: • Vitamin D
– Are not exposed to • Iron
sunlight daily
– Have darkly • Fluoride (after 6 months)
pigmented skin American Academy of Pediatrics
– Receive breast milk •Keep infants out of direct sunlight
without vitamin D •Vitamin D supplement for infants
supplementation who are breastfed exclusively
 Breast Milk
• Immunological protection
– Unsurpassed protection against infection
– Protective factors
• Antiviral agents
• Antibacterial agents
• Other infection inhibitors (i.e. enzymes, hormones &
lipids)
– Colostrum
• Premilk substance produced for first 2-3 days of
lactation
• Contains antibodies & white cells from mother’s blood
• Contains maternal immune factors that inactivate
harmful bacteria within the digestive tract
• Breast milk also delivers immune factors, but not to
the extent of colostrum
 Breast Milk
• Immunological • Other potential benefits
protection (con’t) – Protection against
obesity in childhood &
– Breastfed babies are later years
less prone to stomach &
– Protection against
intestinal disorders development of cardio-
during first few months; vascular disease &
less vomiting & diarrhea increased cholesterol
– Protects against other levels
common illnesses of – May have positive effect
infancy on later intelligence
• Middle ear infection
Studies related to
• Respiratory illness
these potential
benefits are
inconclusive, however
 Infant Formula
• Mothers who bottle • The infant thrives on
feed can still provide formula offered with
closeness, warmth & affection
stimulation to infant

• Infants must receive

breast milk or infant
formula for 1st year
– Cow’s milk of any kind
is not appropriate for
infants
– Breastfed babies who
are weaned before 1
year must be weaned to
infant formula
 Infant Formula
• Infant formula composition
– manufactured to be similar in content to breast
milk
– Formulas do not contain protective antibodies,
however
– Immunizations & reliable health measures can
minimize this disadvantage
• Infant formula standards
– National & international standards
• In US, based on AAP recommendations
• FDA mandates quality control procedures to ensure
standards are met
– Therefore, all standard formulas are
nutritionally similar
 Infant Formula
• Special formulas
– Some infants
cannot tolerate
standard formulas
• Premature infants
• Infants allergic to
milk protein
• Lactose intolerant
• Other needs
Soy & other alternatives to
milk-based formulas are also
useful for vegetarian families
• Risks of formula feeding
– Unavailability of formula
in some developing
countries & poor areas of
US
– Overdilution in attempt to
save money
• May result in malnutrition
& failure to grow
– Preparation with
contaminated water
• Often causes infections,
diarrhea, dehydration,
failure to absorb nutrients
• When sanitation is poor,
breastfeeding should take
priority over formula use
 Infant Formula
• Iron in formula
– AAP recommends iron-fortified formula for
all formula-fed infants
– Increased use of iron-fortified formula in
recent decades is credited with decline in
iron-deficiency anemia in US infants
• Nursing bottle tooth decay
– Dentists advise against putting infant to
bed with a bottle as a pacifier
• Salivary flow diminishes as infant falls asleep
• Prolonged sucking pushes jaw line out of shape
• Prolonged sucking on bottle of formula, juice,
milk bathes upper teeth in carbohydrate-rich
fluid, contributing to tooth decay
 Transition to Cow’s Milk
• AAP advises against cow’s milk in 1st year
– Whole cow’s milk in younger infants can cause intestinal
bleeding
– Higher protein concentration in cow’s milk stresses
infant kidneys
– Cow’s milk is poor source of iron; higher in calcium &
lower in vitamin C, both reducing iron absorption
• After 1st year, children between 1-2 years need
fat of whole milk
• Between 2-5 years, gradual transition from whole
to lower-fat milks can start—without excessive
restriction of dietary fat
2005 Dietary Guidelines
During 1st year, infants need children 2-8 years should
breast milk or iron-fortified consume 2 cups fat-free or
infant formula low-fat milk or equivalent milk
products
 Introducing First Foods
• Changes in body organs during 1st year affect
readiness for solid foods
• When to introduce solids
– AAP recommends exclusive breastfeeding for 6 months
– Infants usually developmentally ready for
complementary foods between 4-6 months
Considerations concerning
introduction of food
Infants’ nutrient needs
Physical readiness for different forms of
food
Need to detect & control allergic reactions
 Introducing First Foods
• Foods to provide iron & • Foods such as iron-fortified
vitamin C cereals & formulas, mashed
– Infant storage of iron is legumes, & strained meats
depleted by end of 1st year provide iron
– Sources of iron:
• Breast milk & iron-fortified
formula
• Iron-fortified cereals
• Meat or meat alternatives
– Vitamin C enhances iron
absorption; needs to be
added to diet
• Fruits & vegetables provide
best source
• Juices poor choice due to
possible effects & excessive
kcalories
 Introducing First Foods
• Physical readiness • Allergy-causing foods
for solid foods – Introduce new foods
– Ability to swallow singly & at intervals
• Allows for detection of
foods (4-6 months)
allergies &
– Able to sit with identification of
support & control offending food
head movements • Offer food for several
days & observe for
– At age 6 months allergic response
• If allergic response,
discontinue offending
food before introducing
another
 Introducing First Foods
• Choice of foods • Foods to omit
– Commercial baby foods – Sweets, including baby
generally have high desserts convey few
nutrient density nutrients, high in
– Alternative is to kcalories
blenderized small – Canned vegetables
portion of table food contain too much
– Foods should be free of sodium
added salt & sugar – Honey & corn syrup
carry risk of botulism
2005 Dietary Guidelines – Foods that present
Infants & young children should not eat or choking hazard
drink unpasteurized milk, milk products,
juices; raw or undercooked eggs, meat,
poultry, shellfish or fish, or raw sprouts
 Introducing First Foods
• Foods at 1 year
– Cow’s milk provides major source of nutrients
• 2-3 cups per day
• Excess milk contributes to iron-deficiency anemia
– Other foods—in variety & amounts sufficient to
round out total energy needs
• Meat & meat alternatives
• Iron-fortified cereal
• Enriched or whole-grain bread
• Fruits & vegetables
– By 1 year, child will sit at table
• Able to eat many of same foods as rest of family
• Drinks liquids from cup, rather than bottle
 Looking Ahead
• Major emphasis during 1st year is to encourage
eating habits to support continued normal weight
as child grows

– Introduce variety of nutritious foods, offered in inviting

way
– Do not force infant to finish bottle or entire jar of food
– Avoid concentrated sweets, empty-kcalorie foods
– Encourage physical activity
– Avoid use of food as reward or comfort for unhappiness;
do not associate food deprivation with punishment
– Select nutrient-dense, low-kcalorie foods that satisfy
appetite because of bulk
– Begin dental health activities
– Avoid fat-modified diet
 Mealtimes
• Developmental & nutritional • Ideally, a 1 year old eats
needs should be considered many of the same healthy
during mealtimes foods as the rest of the
– Discourage unacceptable family
behaviors by removing child
from the table to wait until
later to eat
– Let the child explore &
enjoy food
– Don’t force food on children
– Limit sweets strictly
• Exploring & experimenting
are normal behaviors during
1st year
Early& Middle Childhood
 Energy & Nutrient Needs
• After 1st year, growth rate slows, but
dramatic changes in the body continue
• Children’s appetites
– Appetite declines markedly around the 1st
birthday, consistent with slowed growth rate
• After this point, appetite fluctuates
• Not a point of concern: child will need & demand
more food during periods of rapid growth
– Although food energy intake varies from meal
to meal, total daily energy intake remains
fairly constant
– Children need to be directed in selecting right
foods, however
 Energy & Nutrient Needs
• Energy
– Individual children’s energy needs vary widely,
depending on growth & physical activity
• At 1 year: child needs approximately 800 kcal/day
• 6 years: active child needs twice that, 1600 kcal/day
• 10 years: active child needs about 2000 kcal/day
– Total energy needs increase gradually with age,
while energy needs per kilogram of body weight
decreases
– Physically active children require more energy due
to amount of energy expenditure
– Inactive children can become obese even when
they eat less food than the average
– Strategies to prevent obesity must focus on 2005 Dietary
balancing energy intake with energy expenditure Guidelines
Children should
engage in 60
minutes of
physical activity
most days of
the week
 Energy & Nutrient Needs
• Nutrients
– Steady growth necessitates gradual increase in
intake of most nutrients
– Children accumulate nutrient stores before
adolescence
• During adolescent growth spurt, nutrient stores help
keep pace with the demand
• Especially true of calcium
– Eating patterns influence nutritional health
during childhood, the teen years & throughout
the lifespan
 Energy & Nutrient Needs
• Food patterns for children
– Meals & snacks should include variety of foods
from each food group
• Amounts suited to child’s appetite & needs
• Higher-kcalorie choices are more appropriate for
active older children
– Nutrition concerns for US children
• According to surveys, majority of children between 2-
9 years consume a diet ranked “poor” or “needs
improvement”
• By 15-18 months, french fries is most commonly
consumed vegetable
• Infants & toddlers need greater variety of nutrient-
dense vegetables & fruits at meals & snacks
 Energy & Nutrient Needs
• Children’s food choices
– Parents & other caregivers can foster the
development of healthy eating habits in
children
– Nutrients should be delivered in meals &
snacks that are nutritious & appeal to the child
– Candy, cola & other concentrated sweets
should be limited
• Preference for sweets is innate
• Children need direction in selecting appropriate foods
 Malnutrition in Children
• Hunger & malnutrition prevalent in
some groups—even in US & Canada
– Low-income families more likely to be
hungry & malnourished
– Estimated 13 million US children
affected by food insecurity
Food insecurity:
Limited or uncertain
access to foods of
sufficient quality or
quantity to sustain a
healthy & active life
 Malnutrition in Children
• Effects of hunger
– Short-term & long-term hunger exerts
negative effects on behavior & health
– Short-term
• Impairs attention & productivity
• Causes irritability, apathy & disinterest
– Long-term
• Impairs growth & immune defenses
– Food assistance programs designed to protect
against hunger & improve health
• WIC
• School Breakfast programs
• National School Lunch programs
 Malnutrition in Children
• Hunger & school performance
– Children who eat nutritious breakfast do better
than their peers who miss breakfast
• Poor or no breakfast results in poor intake of several
nutrients
• Likely to be associated with
– Overweight
– Poor performance on tasks requiring concentration
– Shorter attention span
– Lower scores on tests
– Increases in absences & tardiness
• Chronically underfed children are affected the most
– Nutritious breakfast is central feature of
nutrition & health
 Malnutrition in Children
• Iron deficiency &
behavior
– Common problem, – Some manifestations
despite efforts to correct • Shortened attention
– Important roles of iron span
• Involved in carrying • Reduction in overall
oxygen in blood intellectual
performance
• Part of large molecules
that release energy in • Poor performance on
cells tests
• Key roles in brain & • Conduct disturbances
nervous system function – Children who were iron
– Deficiency usually not deficient as infants are
diagnosed until long after likely to continue to
effects on child’s brain perform poorly, even
after problem is
corrected
 Malnutrition in Children
• Preventing iron deficiency
– Children’s foods must deliver 7-10 mg of iron
daily
– Iron-rich foods
• Lean meats, fish, poultry, eggs, legumes
• Whole-grain or enriched breads & cereals
• Other nutrient deficiencies
– Often result in behavioral & physical symptoms
as well
– Any departure from normal healthy
appearance & behavior is sign of possible poor
nutrition
 Lead Poisoning in Children
• Two-way interaction
– Lead poisoning can cause
an iron deficiency
– Iron deficiency can impair
the body’s defenses
against lead absorption
• Mild lead toxicity has non-
specific effects
– Diarrhea
– Irritability
– Reduced ability of blood to
carry oxygen
– Fatigue
– Symptoms reversible if
exposure stops soon
enough
• Higher levels of exposure
result in more pronounced
symptoms
– Loss of general cognitive,
verbal & perceptual
abilities
– Development of learning
disabilities & behavioral
problems
• Severe lead toxicity results
in
– Irreversible nerve damage
– Paralysis
– Mental retardation
– Death
 Lead Poisoning in Children
• Incidence
– Efficient absorption of lead during periods of rapid
growth make fetuses, infants & children most vulnerable
– Most prevalent in children under 6 years
– Blood concentrations usually peak around age 2 due to
exploration of the environment & “hand to mouth”
activities
• Helping to eradicate the problem
– Bans on use of lead in fuel
– Elimination of lead in paints, lead-soldered cans
– Nationwide monitoring system, aggressive community
programs for testing & treating
 Food Allergies
• Asymptomatic & symptomatic allergies
– Allergies affect approximately 6% of children
– Generally diminish with age
– “True” food allergy occurs when food protein
elicits an immunological response
• Always involve antibodies (antigen-antibody
response)
• May or may not produce symptoms
• Once diagnosed, therapy requires strict elimination of
offending food
• Food intolerance is problem resulting from food
exposure, but does not involve immune system
 Food Allergies
• Allergy symptoms
– Symptoms depend on location of reaction
• Digestive tract: nausea or vomiting
• Skin: rashes
• Nasal passages & lungs: inflammation or asthma
• Generalized, systemic: dangerous all-systems shock
reaction—anaphylactic shock
• Immediate & delayed reactions
– Immediate reactions occur within minutes after
exposure to antigen
– Delay reactions may occur after several, up to 24 hours
after exposure
– Immediate reactions are easiest for identification of
causative factor; delayed reactions more difficult to
pinpoint
 Food Allergies
• Anaphylactic shock
– Life-threatening allergic
reaction
– Common offending foods
• Peanuts or tree nuts
• Milk
• Eggs
• Wheat or soybeans
• Fish or shellfish
– Eggs, milk, soy & peanuts
cause majority of problems
– Peanuts most life-threatening
• Protecting against reaction
– Pack lunches & snacks
– “No swapping” policy
– Teach child to recognize
symptoms
• Symptoms of impending
anaphylactic reaction
– Tingling sensation in mouth
– Swelling of tongue & throat
– Irritated, reddened eyes
– Difficulty breathing, asthma
– Hives, swelling, rashes
– Vomiting, abdominal
cramps, diarrhea
– Drop in BP
– Loss of consciousness
– Death
 Food Allergies
• Food labeling • Other adverse reactions
– Must announce to foods—not true
presence of common allergies
allergens, in plain – Reaction specific to MSG
language
– Reaction to chemicals in
– Clearly identify foods
potential cross-
contamination during – Symptoms of digestive
production diseases are aggravated
by eating specific foods
– Enzyme deficiencies (i.e.
lactose intolerance)
– Psychological reactions
 Food Allergies
• Food dislikes
– Should be considered seriously
• Food aversions may be natural protection
from allergic or adverse reaction
– Allergy testing & nutritional knowledge
can help to make decisions in diet
alterations
 Hyperactivity
• Affects behavior & learning in about 5-10% of
school-aged children
• Untreated, interferes with social development &
ability to learn
• Treatment focused on relieving symptoms &
controlling associated problems
– Behavior modification
– Special educational techniques
– Psychological counseling
– Drug therapy, if indicated
• No evidence of link between specific foods &
hyperactivity
– Dietary alterations do not resolve problem
 Food Choices & Eating
Habits
• Food choices & physical activity
– Promote healthy growth
– Help prevent degenerative diseases of later life
– Early childhood provides opportunity to
influence food choices made by children
• Mealtimes at home
– Feeding requires blend of nutritious foods and
nurturing of child’s self-esteem & well-being
– Challenge to prepare foods that appeal to
child’s tastes & provide needed nutrients
– Child’s preferences should be treated with
respect
 Food Choices & Eating
Habits
• Honoring children’s • Eating is more fun
preferences when friends are there
– Preferences seem full of
contradictions
– Prefer to eat at small
tables & be served
smaller portions
– Enjoy company of
peers—tends to
increase food intake
– Environment should be
free of anxiety &
negative emotions
 Food Choices & Eating
Habits
• Avoiding power
struggles
– Problems over food often
arise as child begins to
assert independence (2nd or
3rd year)
• Child is developing
ability to regulate or
determine his own likes
& dislikes
• Children who are coerced
(or bribed) to eat specific
foods are less likely to
try them again
• Children more likely to
try foods again when left
to decide for themselves
• Strategies
– Introduce new foods one
at a time & in small
portion
– Present several times to
expose child to new taste
– Present new food at
beginning of meal
– Allow child to make
decision to accept or
reject
Parent is responsible for what child
is offered to eat; child is
responsible for how much or even
whether to eat
(Ellyn Satter, dietician & family therapist)
 Food Choices & Eating
Habits
• Television’s influence
– Watching TV adversely affects
children’s nutritional health Average child
• Contributes to overweight & inactivity sees about
• Less likely to eat fruits & vegetables 30,000
commercials
• Snack on kcalorie-dense snacks that a year
are advertised
– Commercials often focus on foods
that add sugar, fat, salt to diet &
displace foods that provide
needed nutrients
– Parents can teach children to
evaluate food ads & make
healthy choices
 Food Choices & Eating
Habits
• Preventing choking
– Parents must be alert to dangers of
choking
• Adult should be present when child is eating
• Child should sit when eating
Choking child is
• Play first a silent child

– Meal should be preceded by activity

• Children eat better following
• Tend to hurry through meal to get to
activity when it follows meal
 Food Choices & Eating
Habits
• Child participation
– Planning & preparing meals
provides learning experience
• Encourages child to eat foods he has
prepared
• Colorful vegetables give opportunity to
learn colors, growing of foods, shapes
& textures
• Even young children can practice
various skills of measuring, stirring,
decorating, arranging foods
 Food Choices & Eating
Habits
• Snacks • Preventing dental
– Frequent snacks reduce caries
hunger for mealtime – Teach children good
dental practices
– Teach child how to
• Brush & floss after
snack; rather than not meals
to snack • Brush or rinse after
– Snacks should be as snacks
nutritious as foods • Avoid sticky foods
served at meals • Select crisp or fibrous
foods frequently
– Easy-to-prepare,
healthy snacks should 2005 Dietary Guidelines
be readily available Reduce incidence of dental
caries by practicing good oral
hygiene & consuming sugar-
and starch-containing foods &
beverages less frequently
 Food Choices & Eating
Habits
• Serving as role models
– Parents are single most important influence on
child’s food habits
– Likes & dislikes are readily communicated to
child
– Mealtime with parents, older siblings, other
caregivers provides opportunity to promote
physical & emotional health at every stage
– Good beginnings will reduce conflicts &
confusion over foods that can result in
nutrition & health problems
 Nutrition at School
• School has important role
• “Schools &
in food & nutrition
behaviors
– School lunches
– Nutrition & food
education
• US government-funded
programs designed to
provide nutritious, high-
quality foods at school
communities share
responsibility to
provide all students
with access to high-
quality foods &
school-based nutrition
services as an integral
part of the total
education program”
American Dietetic Association
 School Breakfast Program
• Research continues to show
positive impact breakfast has
on school performance &
health
• Program available in >80% of
nation’s schools; however
many children still do not
participate
• School breakfast must include
– 1 serving fluid milk
– 1 serving fruit or vegetable or
full-strength juice
– 2 servings of bread or
alternates; or 2 servings of
meat or alternates; or 1
serving of each
School Lunch Program
• Served to over 28 million
children
• Designed to provide at
least ⅓ of
recommendation for
energy, protein, vitamins A
& C, iron, calcium
• Must include specified
numbers of servings from
each food group
• In order to reduce
cardiovascular disease risk,
must follow Dietary
Guidelines for Americans
 Nutrition at School
• Competing influences at school
– Short lunch periods & long lines prevent
some students from eating school lunch,
or rushing through meal
– School lunch programs can be
undermined
• Fast-food restaurants in or near school
• Ala carte choices that are less nutritious
• Snack foods & carbonated beverages from
school store or vending machines
The Teen Years
 The Teen Years

• Complex changes occur during

adolescence
– Physical changes increase nutrient needs
– Emotional, intellectual & social changes makes
meeting needs a challenge
• Teenagers make more choices & decisions
for themselves
– Food choices profoundly affect health
– Social pressures compete with other choices
 Adolescent Growth &
Development
• Abrupt & dramatic increase
in growth rate associated
with onset of adolescence
– Hormones direct intensity
& duration of adolescent
growth spurt
– Profound effect on every
organ of body, including
brain
– Growth patterns of males
& females become distinct
• Female growth spurt
starts at age 10-11
• Male growth spurt begins
around age 12-13
• Duration of spurt is about
2 ½ years
‪ Gender differences during
adolescent growth
• Males
– Increase lean body mass
(muscle, bone)
– Grow 8 inches taller
– Gain about 45 lbs
• Females
– Fat becomes larger
percentage of total body
weight
– Grow 6 inches taller
– Gain approximately 35 lbs
 Energy & Nutrient Needs
• Vary greatly, depending on current rate
of growth, gender, body composition,
physical activity
– Boys’ energy needs may be especially high—
active 15 year old may need 3500+ kcalories
a day to maintain weight
– Girls’ energy needs peak sooner & decline
earlier than males—inactive 15 year old may
need <1800 kcalories to avoid excessive
weight gain
 Energy & Nutrient Needs
• Obesity
– Problem of obesity becomes more apparent
during adolescence
• Estimated 15% of US children & adolescents 6-19
years are overweight
• Most evident in African American & Hispanic children
of both genders
– Consequences & attitudes regarding obesity
increase emphasis to control weight
• Frequent “diets” & unhealthy weight-loss attempts
• Can result in nutritional deficiencies
• Extremely restrictive dieting has dramatic physical
consequences of its own
 Energy & Nutrient Needs
• Vitamins
– Recommendations for
most vitamins are similar
to adult needs
• Iron
– Need increases for both
males & females
• Start of menstruation
increases need in females
• Increase in lean body
mass increases need in
males
• Adolescent growth spurt
also increases need
Iron RDA
• Males
– 9-13 yr: 8 mg/day
– 9-13 yr in growth spurt: 10.9
mg/day
– 14-18 yr: 11 mg/day
– 14-18 yr in growth spurt: 13.9
mg/day
• Females
– 9-13 yr: 8 mg/day
– 9-13 yr in menarche: 10.5 mg/day
– 9-13 yr in menarche & growth
spurt: 11.6 mg/day
– 14-18 yr: 15 mg/day
– 14-18 yr in growth spurt: 16
mg/day
 Energy & Nutrient Needs
• Calcium
– Need for calcium peaks during teens
– Crucial time for bone development
– Low intake common among teens
• 90% of females & 70% of males (aged 12-19) fall
below recommendations
• Teenage girls are most vulnerable—intakes start to
decline as needs are greatest
• Combined with inactivity, bone mass development is
compromised
– Increasing milk products in diet to meet
calcium intake recommendations increases
bone density
– Physical activity helps to increase bone
strength
 Food Choices & Health
Habits
• Busy lifestyle & increased
demands on time result in
irregular eating habits
– Quick snacks & fast foods as
main meal
– Few evening meals with
family
– Missed meals, especially
breakfast
• Snacks
– About ¼ of daily energy
intake comes from snacks
– Can contribute to some of
needed nutrients if selected
carefully
– Often fall short in fiber,
calcium, iron & vitamin A;
high in saturated fat &
sodium
 Food Choices & Health
Habits
• Beverages
– Increased consumption of soft
drinks, at all meals—have
become primary beverage
– Rarely select juices, except at
breakfast, or milk at meals
– Bone density is at risk if soft
drinks displace milk from diet
– Regular soft drink
consumption linked to obesity
– Caffeine in drinks presents
problems as well
– Moderate intake of caffeine
seems relatively harmless;
greater amounts can result in
symptoms associated with
anxiety
 Food Choices & Health
Habits
• Eating away from home
– About ⅓ of meals consumed away from home
– Nutritional welfare is enhanced or hindered by
food choices made
– Many fast food restaurants offer more
nutritious choices—making healthy decisions
easier
• Peer influence
– Peers are integral part of day-to-day life of
teens
– Gatekeepers can set the environment so that
nutritious foods are available—ultimately the
teen will make the choice
 Nutrition in Practice—Childhood
Obesity & Chronic Diseases

• Incidence of childhood • Behaviors influence

obesity & onset of development as well—
“adult diseases” has beginning early in life
increased to – Overeating
unprecedented – Physical inactivity
numbers – Cigarette smoking
– Type 2 diabetes
– Hypertension
– Cardiovascular diseases
– Increased blood lipids
• Role of genetics
– Genetics does not seem to play determining
role in development of obesity, CVD,
hypertension, type 2 diabetes
• Individual is not destined from birth to develop them
– Appears to be a permissive role
• If the tendency is inherited, factors in the
environment (poor diet, sedentary lifestyle, cigarette
smoking) may push development of conditions
– Relationship between genes & environment is
synergistic one
• Combined effects are greater than the sum of their
individual effects
• Events during fetal development
– Theory of fetal programming, or fetal origins of
disease—link maternal malnutrition or other
harmful conditions to lifelong effects
– Malnutrition at critical period of fetal
development may increase tendency to
develop obesity & certain diseases
– Infant birthweight considered indicator of fetal
nutrition status
• Lower birthweight increases risk of adult
hypertension
• Postnatal growth also influences adult blood pressure
• This pattern of growth—low birthweight followed by
“catch up” growth—seems to be a link
• Increased prevalence of type 2 diabetes
– On the increase in children & adolescents
– Obesity is primary risk factor
– Most children diagnosed with type 2 diabetes are
obese
– Most diagnosed during puberty
– As incidence of obesity & inactivity increase,
disease is appearing in younger & younger children
• How type 2 diabetes develops
– Body’s cells become insulin-resistant
– Results in reduction of amount of glucose entering
cells from the blood
– Prevention & treatment depend on weight
management & activity
• Development of
CVD – Fatty streaks begin to
– Most CVD involves appear in arteries during
atherosclerosis 1st decade of life
• Begin to turn to plaque
• Accumulation of
during adolescence
cholesterol & other
lipids along arterial • Later calcify & become
walls lesions that block blood
flow, resulting in heart
• Often interferes with
attack or stroke
blood flow to heart,
leading to coronary • Especially occurs in boys
heart disease & young men
• Stroke results when • Dramatic increase in heart
blood flow to brain is disease at about age 45
compromised for men & 55 for women
• Blood cholesterol in
children
– Atherosclerotic lesions
reflect blood
cholesterol
• As cholesterol
increases, lesion
coverage increases
• Cholesterol values at
birth are similar in all
populations
– Changes in cholesterol
levels
• Differences emerge in
early childhood
• Cholesterol tends to
increase as saturated fat
intake increases
• Also correlates with
childhood obesity;
especially central obesity
• In obese children: LDL
cholesterol often too
high & HDL levels too
low