Adolescence Nutrition

Topics for Discussion

• Adolescent growth and development
• Physical .Psychosocial . cognitive
• Dietary recommendation
• Nutritional issues for adolescents
• Prevention of nutritional disorders
• Obesity
 Adolescence
•It is the transitional stage between
childhood and adulthood beginning with the
appearance of the secondary sexual
character
 Periods of Adolescence
 Adolescence10-19y
 Early Adolescence 10-13y
 middle Adolescence 14-16y
 late Adolescence17-19 y
What is puberty?
 PUBERTY: is the period when sexual organs
mature, person become capable of
reproduction
 Girls begin puberty about 11 or 12; boys begin
at 13 or 14
.
 Influencing Factors
Genetics: 50-80% of variation in
pubertal timing

Environmental factors e.g.

nutritional status
 Physical growth

 Weight Gain
 Body fat increase
 Growth spurts
 GROWTH SPURT
Period of rapid growth changes in
height and weigh

largest percentage of the height occur

in 24-36m month Termed “the
adolescent growth spurt
 Psychological changes .

Adolescence emotional swing period

independence and search for autonomy

 peer influence

 Risk taking behaviors—alcohol, smoking


 Cognitive Processes
 Adolescence is a time for rapid cognitive
development
 Development of cognitive functions, that
enable the control and coordination of
thoughts and behavior
 Nutritionally vulnerability
Adolescent needs Adolescent character

 Rapid growth  Psychosocial

 Considerable gain in the  and cognitive
muscle mass changes
 Chang in the body
composition deposition
of fat
 Dietary recommendation
 Enjoy food but eat less
 avoid over sized portion
 make ½ of your plate vegetables and fruit
 drink water instead of sugary drink
 milk fat or low fat
 compare sodium on food
 make ½ your grain whole grains
Nutritional requirements
Energy EER for Boys 9-18 Years (Within the5th-85th
Percentile for BMI):
 EER = 88.5 - 61.9 x Age (yr) + PA x (26.7 x Weight
[kg] +903 x Height [m]) + 25 (kcal for energy
deposition) in which PA = Physical activity
coefficient for boys 3-18 years:
 FAT
 Total intake should not exceed >30% ,10%

from saturated fat

 Essential fatty acid omega 3

 Intake of dietary cholesterol should not

exceed 300 mg/day.

 Essential micronutrient
female male sex‫ء‬
9-10 13-15 Zinc
mgs

1300 1300 Calcium

mgs

300-400 mcg 300-400 mcg folic acid

15 12 Iron
mgs
 Fluid intake
 The water intake recommendation water 6-8
cup /day to avoid dehydration that can lead
to headache and loss of concentration and
irritability
 Fluid intake increase with hot weather and
increased activity
Nutritional adolescence issues
 Food habits
 Deficient micronutrients intake
 Eating disorders
 Obesity and its complication
 Special need groups athletes, Vegan
 Bad dietary habits
 Eat more fast food rich in fat and sugars
and salts
 Eat more soft drinks and sweets
 Eating outside the home and not eating
home meals
 Eat less fruits and vegetables in adequate
quantities
 Escaping breakfast
 Sedentary Lifestyles
 Physical activity is important for maintain energy
balance
 At least 60 minute is needed every day
 To improve bone health muscle strength
Decrease physical activity due to
 Video and computer games
 Parental work schedules
 Unsafe neighborhoods
 Eating disorders
Anorexia nervosa
 Definite neuropsychiatric disorder
It is a severe eating disorder in which
individuals refuse to eat ,fear of increasing
weight ,while denying their behavior and
appearance.

 This disorder primarily female /male ratio 1-

10 male to female
 Nutrition education for adolescence
 Nutrition education, which aims to pay attention to
dietary habits
 intake of sufficient and balanced food
 . Avoid excessive fast food
 Reduce intake of soda
 physical exercise regularly to burn excess calories
and strengthen muscles.
 Importance of breakfast intake
 Obesity in adolescence
 8% obesity in adolescence
 Causes of obesity
 Imbalance in calories
 Lack of physical activity with the spread of
technology
 Low intake of fruits and vegetables and avoiding
breakfast
 Rely on fast and processed foods
 Definition
Obesity a state of adiposity
in which body fat rise
above the ideal BMI
Etiology of obesity
Exogenous causes
Malnutrition
Medications

Endogenous causes
Endocrinal disorders
Genetic disorders
Classification
Exogenous causes Endogenous causes

 Simple obesity  Genetic disorders

 “Exogenous causes” (  Endocrinal
the great majority of  Hypothalamic
damage
cases)
 hypothyroidism
 energy imbalance  Cushing
 Medications syndrome
 Glucocorticoids
.
 Phenothiazines
 Exogenous Obesity

Energy Energy
Intake Expenditure

nutritional, activity levels,

 Obesity
Health Risks
 Diabetes (Type 2)
 Hypertension and Heart Disease
 Neurologic Complications
 Respiratory Disease
 Orthopedic Condition
 Psychosocial Disorders
 Hyperlipidemia
 GI Manifestations
 Menstrual Disorders
Diagnostic Work-up
ASSESSMENT OF CHILDHOOD OBESITY
Anthropometry
Clinical assessment
 laboratory assessment
 Dietary assessment
Anthropometry
Diagnosis using BMI
 CDC percentile
 < 5%ile Underweight
 5-84%ile Healthy Weight
 85-94%ile Overweight
 95-98%ile Obesity
 99%ile2 Second degree
 severe obesity >120%
 Clinical examination
 Review of Systems for Possible
etiologies Complication of obesity
 General examination
 Systemic examination
 Signs of endocrinal disease
 DIETARY HISTORY


24 hour recall
Food frequency questionnaire
Dietary preferences
 readiness for change
 previous attempts
Assess Physical Activity/Inactivity
 Daily activity
 Screen time
 TV in room
 Social/community support for
activity
 Barriers to physical activity
 Assess patient’s and family’s
activity and exercise habits.
Laboratory assessment

 Fasting blood glucose and/or HgA1c

 Fasting lipid panel/Non-fasting if fasting
not feasible
 ALT, AST, consider GGT
 Consider 25 OH Vitamin D
 Risk factors
Family history (+) for CVD
Parent with known dyslipidemia
Child with DM
family history of DM
Child with special risk condition
Healthy weight
• Risk factors
present
MANGEMENTS DIMENSION

Dietary Intervention
Physical Activity Intervention

Behavioral Intervention
Stages of weight management

Stage 1: Prevention
Stage 2: Structured Wt Mgt protocol
Stage 3: Comprehensive
Multidisciplinary protocol
Stage 4: Tertiary Care protocol
Prevention of BMI 5%–84%
 Diet and physical activity
• 5 or more servings of fruits and vegetables per
day
• 2 or fewer hours of screen time per day, and no
television in the room where the child sleeps
• 1 hour or more of daily physical activity
• No sugar-sweetened beverages
 Behavioral change
Nutrition education,
 self-monitoring of food,
physical activity,
Self reward,
 Evaluation and reinforcement
 coping ability skills,
 physical activity advices
Education about what is meant by a
healthy lifestyle’.
Guidelines on how to incorporate
physical activity are also needed
We advice activities of low to
moderate intensity such as walking,
biking, swimming,
T.V Watching
limit T.V Watching 2 hours
 movable games
 no unhealthy snacks
 healthy snacks
 Staged 2
Structured Weight Management

BMI > 95th percentile

 or > 85th percentile with health risk
factors
Monthly visits working on behavior
change
Individualized meal plan/snacks with low amounts of
high calorie foods
[16]
TEE in Overweight Girls and boys
Ages 3 Through 18 Years

 Girls
 TEE = 389 – (41.2 × age [y]) + PA (1)× (15.0 × weight [kg] + 701.6
× height [m])
 boys
 TEE = 114 – (50.9 × age [y]) + PA × (19.5 × weight [kg] + 1161.4 ×
height [m])
Dietary recommendation
 3 meals; 1-2 nutritious snacks
 3 servings of protein/day
 3 servings of dairy/day
 1.5-2 servings of fruit/day
 4-5 servings of non-starchy vegetables
 Dessert only on special occasion
 No sugar-sweetened beverages
 No fast food
 Pharmacotherapy

Orlistat (Xenical) FDA-approved

for > age 12
Metformin FDA-approved for T2DM > age 10
 Messages for all Children
 􀂃􀂃 Limit sugar-sweetened beverages
 􀂃􀂃 Eat at least 5 servings of fruits and vegetables
 􀂃􀂃 Moderate to vigorous physical activity for at
least 60 minutes a day
 􀂃􀂃 Limit screen time to no more than 2 hours/day
 􀂃􀂃 Remove television from children's bedrooms
 􀂃􀂃 Eat breakfast every day
 􀂃􀂃 Limit eating out, especially at fast food
 􀂃􀂃 Have regular family meals
 􀂃􀂃 Limit portion sizes
An example from the Maine Collaborative:
 􀂃􀂃 5 fruits and vegetables
 􀂃􀂃 2 hours or less of TV per day
 􀂃􀂃 1 hour or more physical activity
 􀂃􀂃 0 servings of sweetened beverages
Be master of your habits,
Or they will master you
Thanks
THANKS