NUTRITION FOR ADOLESCENTS (10 – 19 YEARS)

 Adolescence is a period of tremendous physiologic, psychological, and cognitive transformation

during which a child becomes a young adult.
 Puberty occurs and is defined as the period of rapid growth and development during which a
child physically develops into an adult and becomes capable of reproduction.
 As teenagers grow rapidly, their bodies have special requirements of energy, protein, vitamins and
minerals, which is directly related to their increased appetites.
 Energy and nutrient requirements can be met by eating an adequate amount of a variety of nutritious
foods from the different food groups.

NUTRIENT REQUIREMENTS
ENERGY (Boys = 64.6 – 50.3 kcal / kg body weight / day) (Girls = 57.8 – 44.1 kcal / kg body weight / day)
Energy needs vary greatly among males and females. Estimated energy requirements (EER) are determined by:
(1) the energy needed while at rest to maintain vital functions such as breathing (basal metabolism); (2) their
growth rate; (3) their body composition; (4) their level of physical activity.
The required energy intake for adolescents is assessed best by monitoring weight and body mass index for
age (BMI/Age).
Adolescents at increased risk for inadequate energy intake include:
 Teens that “diet” or frequently restrict energy / caloric intake to reduce body weight.
 Individuals living in food-insecure households, temporary housing, or on the street.
 Adolescents who frequently use alcohol or illicit drugs, which may reduce appetite or replace food
intake.
 Teens with chronic health conditions such as cystic fibrosis, Crohn’s disease, or muscular dystrophy.

CARBOHYDRATES AND DIETARY FIBRE

Teens that are very active or actively growing need additional carbohydrates to maintain adequate
energy intake, whereas those who are inactive or have a chronic condition that limits mobility, may
require fewer carbohydrates.
Whole grains are the preferred source of carbohydrates because these foods provide vitamins, minerals, and
dietary fibre.

LIPIDS / FATS
Daily recommended intake (DRI) values for total fat intake have not been established for adolescents. Instead, it
is recommended that total fat intakes not exceed 30% to 35% of overall energy intake, with no more than 10%
of kilocalories coming from saturated fatty acids.
Adequate intakes of omega-6 and omega-3 fatty acids are needed to support growth and development, as
well as to reduce chronic disease risk later in life.
Prepared by: Ms. Abigail Caleb, Nutritionist (BSc., MSc.)
PROTEIN (Boys = 0.75 – 0.69 g / kg body weight / day) (Girls = 0.73 – 0.66 g / kg body weight / day)
During adolescence additional protein intake is to allow for adequate pubertal growth and positive
nitrogen balance. Protein requirements vary with degree of physical maturation.
Adolescents at increased risk for inadequate protein intake include: (1) food security issues (food
availability and food accessibility); (2) chronic illness; (3) frequent dieting; (4) substance use and abuse; (5)
vegan or macrobiotic diets (diets consisting primarily of whole grains, cereals and vegetables).
When protein intake is inadequate, alterations in growth and development are seen. In the still-growing
adolescent, insufficient protein intake results in delayed or stunted increases in height and weight. In the
physically mature teen, inadequate protein intake can result in weight loss, loss of lean body mass, and
alterations in body composition.
Impaired immune response and susceptibility to infection may also be seen.

MICRONUTRIENTS
The increased vitamin and mineral needs of adolescence to support physical growth and development
decline after physical maturation is complete.
However, the requirements for vitamins and minerals involved in bone formation are elevated throughout
adolescence and into adulthood, because bone density acquisition (peak bone mass) is not completed by
the end of puberty.
In general, adolescent males require greater amounts of most micronutrients during puberty, with the
exception of iron.

Iron (Boys = 14.6 – 18.8 mg/day) (Girls = 14.0 – 32.7 mg/day)

Iron needs are highest during periods of active growth among all teens (increased blood volume to feed the
new tissues), and are especially elevated after the onset of menstruation in adolescent females.
Iron needs remain elevated for women after age 18 but fall back to prepubescent levels in men once
growth and development are completed.
Rapid growth may temporarily decrease circulating iron levels, resulting in physiologic anaemia of growth.
During adolescence, iron deficiency anaemia may: (1) impair the immune response and decrease
resistance to infection; (2) decrease cognitive functioning; (3) decrease short-term memory; (4) reduce
energy and productivity levels.
In Guyana, 21% of children between 5 and 16 years old are anaemic1.

Calcium (1300 mg/day)

Calcium needs are greater during puberty and adolescence than during childhood or the adult years
because of accelerated muscular, skeletal, and endocrine development.
Bone mass is acquired at much higher rates during puberty than any other time of life. In fact, females
accumulate approximately 37% of their total skeletal mass from ages 11 to 15 years, making adolescence a
crucial time for osteoporosis prevention.
However, calcium intake usually declines with age during adolescence, especially among females.

1Pan American Health Organisation- Guyana, Ministry of Health Guyana, United Nations Children’s Fund-Guyana and Inter-American Development
Bank. (2013). Survey of Iron, Iodine and Vitamin A Status and Antibody Levels in Guyana: Final Report. Micronutrient Survey Report.
Prepared by: Ms. Abigail Caleb, Nutritionist (BSc., MSc.)
Research suggests that high soft drink consumption in the adolescent population contributes to low calcium
intake by displacing milk consumption.

Folic Acid/Folate/Folacin (400 µg/day)

The need for folic acid increases during later adolescence to: (1) support increase of lean body mass; (2)
prevent neural tube defects among females of reproductive age.

Vitamin D (5µg/day)
Vitamin D plays an important role in facilitating calcium and phosphorus absorption and metabolism,
which has important implications for bone development during adolescence.
Vitamin D can be obtained from food sources; synthesised by the exposure of skin to sunlight (vitamin D2); or
ingested through supplements in the form of vitamin D2 or D3.

SUPPLEMENT USE
The consumption of moderate portions of a wide variety of foods is preferred to nutrient supplementation
as a method for obtaining adequate nutrient intake.
Health professionals should screen adolescents for supplement use and should counsel them accordingly.

PSYCHOSOCIAL DEVELOPMENT CAN AFFECT HEALTH AND NUTRITIONAL STATUS:

 Preoccupation with body size, body shape, and body image (the mental self-concept and perception of personal
body size), resulting from the rapid growth and development that has occurred, may lead to dieting and possibly
disordered eating behaviours.
 Diminishing trust and respect for adults as authority figures, including nutrition and health professionals.
 Strong influence of peers, especially around areas of body image and appearance, with the influence of a few select
peers becoming more important than that of large groups as adulthood approaches.
 More pronounced social, emotional, and financial independence, leading to increased independent decision making
related to food and beverage intake.
 Significant cognitive development as abstract reasoning is nearly complete and egocentrism decreases; however,
teens may still revert to less complex thinking patterns when they are stressed.
 Developed future orientation, which is required to understand the link between current behaviour and chronic
health risks.
 Development of social, emotional, financial, and physical independence from family as teens leave home to attend
college or seek employment.
 Development of a core set of values and beliefs that guide moral, ethical, and health decisions.
 Food choices are more likely to be based on taste, cost, and peer behaviours than on health benefits because these
influences satisfy a teen’s innate preference for immediate reward.

Prepared by: Ms. Abigail Caleb, Nutritionist (BSc., MSc.)

 FACTORS AFFECTING FOOD INTAKE IN ADOLESCENCE

1. IRREGULAR MEALS AND SNACKING

Meal skipping increases throughout adolescence as teens try to sleep longer in the morning, try to lose weight
through energy / calorie restriction, and try to manage their busy lives.
Breakfast is the most commonly skipped meal. Attending schools far away from home, having challenges
with transportation; and attending early morning classes/lessons all promote breakfast skipping. Breakfast
skipping has been associated with poor health outcomes, including: (1) higher body weight for height
(Body Mass Index / BMI); (2) poorer concentration and school performance; (3) increased risk of
inadequate nutrient intake.
Adolescents who skip breakfast tend to have a higher intake of added sugars and poorer intake of key nutrients
(e.g., calcium, vitamin A) compared with those who eat breakfast (containing healthy foods).
Teens who skip meals often snack in response to hunger instead of eating a meal.
Snack foods consumed by teens are often energy-dense and nutrient poor - high in added fats, sugars, and
sodium. Carbonated beverages and other sugar-sweetened beverages are consumed commonly, accounting for a
substantial proportion of daily caloric intake and representing an important source of caffeine consumption.
However, healthy snacks can make positive contributions to intake of key nutrients.

2. FAST FOODS AND CONVENIENCE FOODS

Convenience foods include foods and beverages from canteens, vendors, vending machines, fast-food
restaurants and convenience stores / supermarkets.
As adolescents spend considerable amounts of time in and around schools, convenience foods available at
school and in the surrounding neighbourhood are likely to influence their eating patterns.
Convenience foods tend to be low in vitamins, minerals and fibre, but high in energy / calories, fat, sugars
and sodium/salt.
Few teens are willing to stop purchasing these foods due to their low price, convenient access and taste appeal.

3. FAMILY MEALS
The frequency with which adolescents eat meals with their families decreases with age.
Positive influences of family meals on adolescents:
(1) Adolescents have better academic performance
(2) Adolescents are less likely to engage in risky behaviours such as drinking alcohol and smoking
(3) Family meals allow for more communication between teens and their parents
(4) Family meals provide an ideal environment for parents to promote healthy eating habits. E.g., Teens
that eat at home more frequently have been found to consume fewer carbonated beverages and more calcium-
rich foods, fruits and vegetables.

Prepared by: Ms. Abigail Caleb, Nutritionist (BSc., MSc.)

 4. PEER INFLUENCE
Peer influence and acceptance may become more important than family values, creating periods of conflict
between teens and parents.
All of these changes have a direct effect on the nutrient needs and dietary behaviours of adolescents.

5. MEDIA AND ADVERTISING

Food and beverage companies promote their products to youth using a number of different techniques
including: (1) contests; (2) product placements (e.g., billboards near schools); (3) sponsorships; (4) celebrity
endorsements; (5) viral marketing (social media platforms). They also use multiple platforms.
As the time that youth spend with media has increased, so has the ability for advertisers to influence their
eating behaviours.
The most viewed food advertisements are usually for products high in fat, sugar and/or sodium, as well as
for fast-food restaurants.

6. DIETING AND BODY IMAGE

Body image concerns are common during adolescence.
Poor body image can lead to weight control issues and dieting.
Eating nutrient-dense foods (e.g., skim milk, fruits and vegetables) to limit energy / calories and getting
regular exercise are healthy weight loss behaviours when used in moderation and can be a starting point for
nutrition education and counselling to improve eating behaviours.

7. VEGETARIAN DIETARY PATTERNS

Well-planned vegetarian diets that include a variety of whole grains, peas, beans, nuts, vegetables and fruits
can provide adequate nutrients for teens that have completed the majority of their growth and
development.
Vegetarian diets that include eggs or dairy products can meet the DRIs for all nutrients.
Vegan and macrobiotic diets, which do not include animal products of any kind, do not provide natural
sources of vitamin B12 and may be deficient in calcium, vitamin D, zinc, iron, and long-chain omega-3
fatty acids. Therefore, vegan adolescents must choose foods fortified with these nutrients or take a daily
multivitamin-mineral supplement.
Vegetarian diets that become increasingly more restrictive should be viewed with caution, because this may
signal the development of disordered eating, with the vegetarian diet used as a means to hide a restriction of
food intake.

NOTE: The rebellion that is associated with the teen years is actually a display of their search for independence
and a sense of autonomy. Food can be, and often is, used as a means of establishing independence. Adolescents
may choose to become vegetarian as a way to: (1) distinguish themselves from their meat-eating parents; (2)
express their moral and ethical concerns over animal welfare or the environment; (3) express their concerns
over their health or body weight.

Prepared by: Ms. Abigail Caleb, Nutritionist (BSc., MSc.)

 NUTRIENT IMBALANCES
The food choices by some adolescents make them prone to nutrient imbalances because they consume foods
high in energy / calories, fat, sodium / salt and sugar and low in vitamins, minerals and dietary fibre.
19% of adolescents in Guyana are overweight or obese and 8% are underweight2.
NB. Consumption of milk, fruits and vegetables are particularly low in this age group. These foods are
rich in calcium, zinc and iron and several vitamins.

OVER-NUTRITION (Overweight and Obesity)

Counselling related to excessive energy / calorie intakes among adolescents should focus on reducing intake of
excess kilocalories, especially those from added sugars and sweeteners consumed through carbonated
beverages and candy and excess kilocalories from fats consumed through snack foods and fried food.
Tips should be provided for selecting nutrient-dense foods and beverages at all locations where teens spend
their time.

UNDER-NUTRITION (Underweight and Micronutrient Deficiencies)

Refer to section under Nutrition for Pre-schoolers and School-Aged Children

OTHER INTERVENTIONS / SOLUTIONS

 Government: Ministry of Education, including schools, and Ministry of Health should ensure that the
type of foods available at schools is nutritious so that students can make healthy food choices.
 Caregivers: Caregivers should encourage desired food choices by providing nutritious foods at home
and limiting access to foods that are high in fat, sugar and sodium.
A typical lunch/dinner should contain a Staple food for energy + a Food from Animal / Legume to
promote growth + a Vegetable, and Fruit whenever possible to maintain health.

2 Ministry of Health Guyana and Centres for Disease Control. (2010). Global School-based Student Health Survey: Guyana 2010 Fact Sheet.
Prepared by: Ms. Abigail Caleb, Nutritionist (BSc., MSc.)
Know a few of these

HEALTHY EATING TIPS FOR ADOLESCENTS

1. Aim for 3 regular meals per day and ensure that a variety of foods are chosen from the different
food groups to meet nutritional needs.
2. Do not skip meals especially breakfast or a morning meal as this encourages over-eating later in the
day and choosing foods that are not healthy.
3. Do not replace healthy snacks with foods of poor nutritional value.
For adolescents who snack frequently nutritious snacks should be encouraged. Examples are low fat
dairy products, whole grains, nuts, peanut butter, crackers, fruit and vegetable juices, fresh fruits and
vegetables.
4. Consume foods that are low in fats (saturated, Trans, total), sugars and salt/sodium to prevent the
onset of chronic non-communicable diseases like diabetes mellitus, cardiovascular diseases and cancers.
List example
5. Eat when hungry and stop when full.
6. Adolescents who eat away from home should carry from home nutritious, affordable snacks such as
milk, biscuits, fruits that are in season, and sandwiches made with a protein source and vegetables.
7. Adolescents who are concerned about their weight should eat in moderation and participate in
regular physical activity.

PHYSICAL ACTIVITY
All youth should be active at least 60 minutes or 1 hour each day, including participation in vigorous
activity at least 3 days each week.
In addition, muscle- and bone-strengthening activities should each be included in the 60 minutes of
physical activity at least three times a week.
Strengthening activities include: lifting weights, working resistance bands, heavy gardening, climbing stairs,
hill walking, cycling, dance, push-ups, sit-ups, squats.

Prepared by: Ms. Abigail Caleb, Nutritionist (BSc., MSc.)

 NUTRITIONALLY HIGH-RISK ADOLESCENTS

1. Vegetarian (especially vegan)

2. Disordered Eating
- Binge-purge behaviour; Compensatory exercise; Laxative and Diuretic abuse; Binge eating
3. Eating Disorders
- Anorexia nervosa; Bulimia nervosa
4. Underweight
5. Overweight and Obese
6. Chronic Non-communicable Diseases
- Hypertension and Hyperlipidaemia. Risk factors for other cardiovascular diseases.
- Diabetes Mellitus (Type 1 and Type 2)
7. Athletic
- Teenage athletes have unique nutrient needs.
- Adequate fluid intake to prevent dehydration is especially critical for young athletes. Young athletes are
at higher risk for dehydration because they produce more heat during exercise but have less ability to
transfer heat from the muscles to the skin. They also sweat less, which decreases their capacity to get rid
of heat through the evaporation of the sweat.
- Athletes who participate in sports that use competitive weight categories or emphasise body weight are
at elevated risk for the development of disordered eating behaviours.
- A concern among female athletes is the female athlete triad relationship, a grouping of low body weight
and inadequate body fat levels, amenorrhea (abnormal absence of menstruation), and osteoporosis. The
female athlete triad may lead to premature bone loss, decreased bone density, increased risk of stress
fractures, and eventual infertility.
8. Pregnant
- Adolescent females who become pregnant are at particularly high risk for nutritional deficiencies
because of elevated nutrient needs.
- Pregnant adolescents with a gynaecologic age (the number of years between the onset of menstruation
and current age) of less than 4 and those who are undernourished at the time of conception have the
greatest nutritional needs.
- As with adult women, pregnant teens require additional folic acid, iron and calcium. As well as vitamin
D, zinc, and other micronutrients to support foetal growth.
- Pregnant teens should have a full nutrition assessment done early in pregnancy to determine any nutrient
deficiencies and to promote adequate weight gain.

Prepared by: Ms. Abigail Caleb, Nutritionist (BSc., MSc.)