Adolescent Nutrition

Adolescence:
The Vulnerable Life Stage
Big changes: Biological
Boysget tall, lean, and dense (bones,
that is)
Attain 15% of final adult ht during
puberty
Lean body mass doubles
Large calorie needsincrease from
2,000 at 10 yr to 3,000 at 15 yr

Adolescence:
The Vulnerable Life Stage
Girlsget taller and fatter
% body fat increases from the teens into the
mid-20s
Gain almost 50% of their adult ideal weight 6-9
mo before ht rate increases during puberty
Dieting can have a negative impact on linear
growth during this time
Calorie needs increase by only 200 from 10 yr to
15 yr

Cognitive
Thinking style changes from concrete to
hypothetical and abstract
takes the adolescent beyond the here and
now into the realm of possibilities (David
Elkind, 1984)

 Identity development
Attempt to figure out who they are
Success is dependent on positive interaction
with the environmenthome, school, and the
community
They will try on different lifestyles looking for
the right fit
Risk taking behaviorsalcohol, drugs,
tobacco, sexual behaviors, self-injury and
suicide
Immediate and severe consequences

Behaviors with Less Pronounced

Consequences
Eating choices
Physical activity and exercise
Affect adolescents sense of well-being,
energy and health in the short term
Affect adult-onset chronic disease risk in the
long term

Nutrition Issues in Adolescent Health

Cardiovascular and cancer disease risk
Osteoporosis and bone mineralization
Overweight and obesity
Type 2 diabetes
Eating disorders

Nutritional needs of the adolescent athlete

Adolescents with chronic medical concerns
Adolescent pregnancy

Cardiovascular Disease and Cancer Risk

One-third of CVD and cancer-related morbidity attributed to
dietary patterns
Diets high in sat fat, total fat, and sodium and low in fiber
Diets low in fruits and vegetables
Dietary fat
Recommended: <10% of calories from sat fat and <30%
total fat
Consumed: 1/3 of adolescents are in this range
Sodium
Recommended: <2.5 g/d
Consumed: 3-5 g/d

 Fiber
Recommended: Age + 5
Consume: this amount
Fruits and vegetables high in fiber and low in fat and sodium
the least consumed food groups for teens
1/4 eat 2 or more servings of fruit/d
<25% eat at least 5 servings of fruits and
vegetables daily

Eating Away from Home

Teens directly spend more in:
fast food restaurants
food and snack stores
vending machines
78% in school
Fast foods tend to be low in Fe, Ca, riboflavin,
vitamin C, and folic acid
More meals missed at home thus the choice of
foods away is more important than the time or
place

Frequency of Fast Food Restaurant Use

Among Adolescents
Positively associated with
Total kcal, % kcal from fat, daily servings of
soda, cheeseburgers, french fries and pizza
Student employment, TV watching, home
availability of unhealthy foods
Negatively associated with
Daily servings of fruit, vegs, milk
Perceived maternal and peer concerns about
healthy eating
Not associated with overweight status

Etiology of Obesity
Heritability
Homeostasis
Specific syndromes

Heritability is a statistic used in breeding

and genetics works that estimates how
much variation in a phenotypic trait in a
population is due to genetic variation
among individuals in that population.

Heritability
Survival advantage to conserve energy as fat
through human evolution
Humans enriched for genes that promote energy
intake and storage and minimize expenditure.
Enhance female fertility and ability to breastfeed
offspring

 In modern industrial environment

easy access to calorically dense foods
encourages sedentary lifestyle
Metabolic consequences of these genes are
maladaptive

Genetic Factors account for 20-40% of

heritability of BMI
34 single gene mutations in 83 individuals reported
by 2001
> 250 susceptibility genes linked with human
obesity phenotypes
Familial Risk:

2-3 fold for moderate obesity

5-8 fold for severe obesity

Obesity Associated
Syndromes and
Conditions

Other Contributors to Sedentary Lifestyles

Video and computer games
Parental work schedules
Unsafe neighborhoods
discourage parents from allowing children to
play outdoors
force parents to drive children to school
Lack of recreational facilities in low-income
neighborhoods

Prevalence of Overeating Among

4,746 Adolescents (Ackard 03)
17.3% of girls and 7.8% of boys reported overeating
and were more likely to:
be overweight or obese
have dieted in the past year
be currently trying to lose wt
Those who met the criteria for binge eating
syndrome (3% of girls and 1% of boys) had higher
suicide risk (28% for girls and boys)

Psychological and Economic Consequences

of Adolescent Obesity
Discrimination, rejection and low self-esteem
(Gortmaker 93), particularly for females
Less participation in PE and sports activities
Lower college acceptance rates

Health Issues in Overweight Adolescents

Growth
Taller, advanced bone age, mature earlier
Early maturation is associated with
increased fatness and truncal fat distribution in
adulthood

 Hepatic Steatosis
Orthopedic Problems
Sleep Apnea
Occurs in 17% of obese children and teens
(Marcus 1996)
Deficits in learning, memory, and vocabulary
(Rhodes 1995)
Obesity hypoventilation syndrome (rare,
potentially fatal disorder)

Cardiovascular
Hyperlipidemia-- LDL , HDL
Hypertension
Low frequency in children
Muscatine Study (Rames 1978)
1% of 6600 children 5 to 18 had persistently
elevated BP
60% with BP were >120% of IBW

Type 2 Diabetes
3-10 fold increase in prevalence in adolescents
Mean age is 13.5 yrs
95% of teens with Type 2 diabetes have a BMI
>85%ile
increased insulin resistance
21% of adolescents with BMIs >95th%ile had
impaired glucose tolerance
Tremendous public health implications
Longer duration of disease, > risks of
complications

How Do Teens Attempt to Lose Weight?

Youth Risk Behavior Surveillance
58% exercised
40% ate less food or lower fat foods
13% fasted
8% took diet pills
5% vomited or took laxatives

Weight-Related Eating Disorders

Anorexia

nervosa

Self-starvation, weight
loss, intense fear of
weight gain, body image
distortion

Bulimia

nervosa

Binge eating and purging

Binge

eating disorder

Binge eating without purging resulting in

weight gain

Anorexic and
Bulemic Behaviors

Expressed in 10-20% of adolescent girls

Mimic behaviors in AN and BN but are not done
with the frequency or severity to classify as mental
illness
Half of teen girls and 15% of boys report dieting
behaviors
Ranging from eating less fat to fasting

Osteoporosis and Bone Mineralization

Osteoporosis affects 25-30 million adults in the US,
women > men
15-25% with hip fractures require long-term
institutional care
Treatment of osteoporosis costs
$14 billion/yr
Etiology complexgenetic, hormonal, physical
activity, dietary factors

 Maximum peak bone mass (PBM) at skeletal

maturity is protective
PBM is achieved during the late stage of pubertal
development
90-95% of PBM is attained by the 2nd decade of
life
40% of which is during adolescence

 Low bone mineral density is associated with

fractures late in life
Adequate nutrition, including energy, protein,
vitamins and minerals are associated with good
bone health

Calcium
Milk and dairy products are primary source of
calcium in the US
Only 49% of boys and 20% of girls consume the
recommended number of servings from the dairy
group.
AI for calcium for 9-18 yr is 1300 mg/d
Girls 14-18 yrs consume 55% of this goal at 713 mg
42 mg/d

Calcium Content of Foods

Food Item
Milk or yogurt
Cheese
Ca fort OJ
Salmon w bones
Fort. cereal
Broccoli
Orange
1300 mg =

Serving size
1 cup
1 oz
1 cup
3 oz
1 cup
cup
1 med

Mg calcium
300
175-275
200-300
180
100
47
40

3 cups milk; 1 oz cheese, c broccoli,

1 orange, 1 c cereal

Soda Consumption: Effects on body

weight, dental health and nutritional
status
No association with dental
caries
25% of adolescents drink
>26 oz of soda/day
Inverse relationship between intake of nutrients
found in milk and fruit juice with soda consumption
Riboflavin, vitamin A, calcium, phosphorus, and
vitamin C

To Review Risky Adolescent Nutritional Issues

Weight gain leading to obesity and type 2 diabetes
Calcium intake and soft drink consumption leading
to inadequate bone mineralization
Eating habits that result in disordered eating
practices
Low consumption of fruit and vegetables and high
consumption of fat and sodium are related to adultonset disease risk

The relationship between the adolescent diet and

chronic disease risk is predicated on the
assumption that eating behaviors are learned and
solidified during childhood and adolescence and
are maintained into adulthood

What Influences Adolescents Food Choices?

Psychosocial
Strong Influences
Food preferences
Early childhood experiences, exposure,
genetics
Taste and appearance
Weak influence
Health and nutrition
Only 26% of college students were
motivated by health when making dietary
choices (Horacek 98)

The Meaning of Food

Study of 93 Canadian adolescent girls
Eating Junk food was associated with pleasure,
being with friends, weight gain, independence,
guilt, affordability, and convenience.
Eating healthful food was associated with family,
meals, and being at home

Influences cont
Biological
I was hungry is often the first response when
asked why a specific food was eaten
Lifestyle
Time and convenience
Teens would rather sleep than eat breakfast
(Neumark 99)

Cost
In a study of 12 high schools, consumption of
fresh fruits and vegs when cost was by
50%

More Influences
Familymajor influence
Food provider
Influences food attitudes,
preferences and values
Despite increased eating outside
the home, teens still obtain 65%
of their total energy from home.
Dinner at home is the most important meal
80% of parents and teens place high
importance on this meal
1/3 of teens eat dinner q night at home

Effective Nutrition Interventions for

Adolescents
Behaviorally based
Use developmentally appropriate strategies
Include an environmental component
Sufficient amount of contact
Use technological advances such as CD- ROMs