ADOLESCENT NUTRITION

DR REJI MOHAN Assistant Professor in OBGYN SAT HOSPITAL GOVT.MEDICAL COLLEGE

UN Millennium Development Goals

1. Eradicate extreme poverty and hunger 2. Achieve universal primary education

3. Promote gender equality

4. Reduce child mortality 5. Improve maternal health
2

UN Millennium Development Goals

6. Combat HIV/AIDS, malaria, other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development

Relationship of nutrition with other MDGs

Improved income Improved health status poverty child mortality maternal mortality primary education Nutrition

Nutrition

Improved school performance

Global partnership

Population

Environment

Gender equality/ women empowerment

 Nutrition is indicator and outcome of development and is central to the MDGs

DEFINITION OF ADOLESCENCE
Adolescence is a transitional stage of physical and mental development that occurs between childhood and adulthood.

WHO : period of life between 10 and 19 years.

ADOLESCENT HEALTH
Nearly one-sixth of the world population are constituted by adolescents. Adolescent health is therefore an important component of global health. Vulnerable group. Adolescence is a period of rapid growth and development and is when puberty occurs. The demand for energy and most nutrients are relatively high

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

It is important to encourage an active lifestyle with a healthy, balanced diet during this time.
This is because good habits practised now are likely to benefit their health for the rest of their lives

 Disruptions in the balance between nutrient requirements and intake during adolescence impact on such major health problems as atherosclerosis, hypertension, obesity, anorexia nervosa, bulemia nervosa, and birth of suboptimal-weight infants. Dietary and exercise habits formed as the adolescent achieves increased independence have the potential to enhance or undermine health throughout life.

To reduce the risk of developing these diseases, it is important to: eat a balanced diet; eat plenty of fruit and vegetables stay active

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 (Lytle 02)

Nutrient Requirements

Critical Thinking Question: Why does your body need food? Answer: Food has two main functions: 1) Food provides raw materials for cells to build new molecules for growth and reproduction 2) Food provides energy

Nutrients
Many cells of the body (ex. liver cells) can convert one molecule into another based on what is needed Essential nutrients: must be provided by the diet because they cant be created through conversions

Nutrition
Nutrient: substance used by the body for growth, maintenance, and repair Categories of nutrients:
Carbohydrates Lipids Proteins

Vitamins
Minerals Water

Major Nutrients

Body Uses of Carbohydrates

Preferred source (esp. glucose) to produce cellular energy (ATP) Examples: neurons and red blood cells

Dietary Sources of Carbohydrates

Most are derived from plants Sugars (fruits) and starches (vegetables) Exceptions: lactose from milk and small amounts of glycogens from meats

Dietary Requirements of Carbohydrates

125-175 grams/day (mainly complex carbohydrates)
Complex carbohydrates bread, cereal, rice, potatoes

Dietary Requirements of Carbohydrates

Excesses: Obesity Nutritional deficits (empty calories) Gastrointestinal problems (constipation) Deficits: Tissue wasting (muscle breakdown) Metabolic acidosis (fat breakdown)

Dietary Sources of Lipids

Saturated fats from animal products (meat and dairy) Unsaturated fats from nuts, seeds, and vegetable oils

Cholesterol from egg yolk, meats, and milk products

Trans fats
Healthy vegetable oils that have been hydrogenated to make them more solid Used in many snack and junk foods Increases shelf life of foods (they dont get rancid) Have the most negative effect on cholesterol raises the bad, lowers the good

Body Uses of Lipids

Help body absorb fat-soluble vitamins

Major energy fuel for liver cells and skeletal muscle

Main component of ALL cell membranes

Adipose tissue protects organs, provides insulation, and stores energy

Cholesterol is necessary to make hormones and bile

Dietary Requirements of Lipids

30% or less of total caloric intake
Saturated fats should be less than 10% of total calories Cholesterol should be less than 250 mg (ex. one egg yolk)

Dietary Requirements of Lipids

Excesses: Obesity Increased risk of cardiovascular disease Deficits: Weight loss Difficulty with temperature regulation Poor growth/repair

Body Uses of Proteins

Major component of structural materials (skin, nails, muscles) Regulate chemical reactions (enzymes)

Dietary Requirements of Proteins

Depends on age, size, and metabolic rate

0.8 grams per kilogram of body weight

General conversion divide weight in pounds by 3 to equal the number of grams needed

Dietary Sources of Proteins

Most complete proteins come from animal products (eggs, milk, meat) Complete proteins: contain all essential amino acids Legumes (beans and peas), nuts, leafy greens also have proteins, but are incomplete Incomplete proteins: missing or low in one or more of the essential amino acids

Dietary Requirements of Proteins

Excesses: Obesity Aggravation of chronic disease
Deficits: Profound weight loss and tissue wasting Poor growth/repair Anemia

Vitamins
Most vitamins are used as coenzymes, helping enzymes with their chemical reactions Most must be ingested the body can only make Vitamins A, B, D, and K

Vitamins
Two main categories:

1. Water-soluble: absorbed with water, not stored in the body, excreted in the urine if not used
2. Fat-soluble: absorbed with fats, stored in the body, excesses can lead to toxicity

Minerals
Body requires moderate amounts of 7 minerals (Ca, P, K, S, Na, Cl, Mg) and trace amounts of about 12 others Make up 4% of the body weight, mostly due to Ca and P in bones Provide strength to certain structures

Minerals
Vital components to many biological compounds (ex. iron (Fe) in hemoglobin) Important electrolytes (sodium/chloride ions) Found in mostly vegetables, legumes, milk, and meats

Nutrient Requirements
Increased calories: for girls 2,200 Cal/day and for boys 2,500+ Cal/day Protein requirements of 0.8 1.0 g/kg/d Protein: 50-60 grams/day Fat: adult levels of 30% of calories should be encouraged.

Fiber: 30-40 grams/day Needed for normal bowel function, preventing cancer, and coronary artery disease

 Calcium: 1,300-1,500 mg/day Iron: for girls 15 mg/day and for boys 12 mg/day Necessary for transporting oxygen Needed to make red blood cells (menstruation) Vitamins A, C, E Vitamin A is needed for vision Vitamin C used quickly under emotional and physical stress Vitamin E is an antioxidant

Other minerals: zinc, phosphorous, magnesium Zinc is necessary for protein formation and sexual maturation

Reasons for Nutritional Deficiencies in Teens

More responsibilities More freedom Increase in sedentary activities, ex. video games Changes in traditional family (more responsible for own meals) Social pressures, ex. being thin, rebelling against parents, showing athletic prowess
ALL OF THESE CAN RESULT IN POOR FOOD CHOICES!!

Nutritional Deficiencies in Adolescents

Ca (only 600-800 mg/day consumed) Fe (iron-deficient anemia affects 2-10% of this age group) Excess sodium Dietary fat >33% of calories Simple sugars exceed complex carbs Fiber <50% of RDA

Reasons Teens Have Increased Nutritional Requirements

Proper nutrition improves behavior, school performance cognitive development! Proper nutrition increases participation in school activities! Proper nutrition now will lead to good eating habits later in life!

Dietary Sources of Nutrients Needed by Adolescents

Vitamin A:
Tomatoes, carrots, spinach, broccoli, sweet potato

Iron:

Vitamin B6: Vitamin E:

Soybeans, bananas, meat, fish, beans, nuts, whole grains

Oils (wheat germ, sunflower, safflower, corn), almonds, peanuts

Calcium: Zinc:

Fish, green vegetables, nuts, iron-fortified cereals, raisins. Dairy products, green leafy vegetables, salmon Red meat, oysters, crabmeat, beans, whole grains Whole seeds, nuts, legumes, grains Peas, beans, whole grains, sweet potato, green leafy vegetables

Vitamin D: Vitamin C:

Sunlight, fortified milk

Peppers, broccoli, citrus fruits, strawberries, melons, tomatoes, cabbage, green leafy vegetables, papaya, winter squash Green leafy vegetables, beans, asparagus, orange juice

Magnesium:
Fiber:

Folic acid:

Sweets, oils, fats

Milk

Meat

Vegetables

Fruits

Cereals legumes, roots, tubers

Healthy Diet:

Food intake

Carbohydrates
e.g. Rice, Chapati Protein-based e.g. Milk, Egg, Dal and Meat.

Salads, Vegetables Fruits

Increase fiber

Decrease oily foods

No to soft drinks
Recommendations of IAP: Indian Pediatrics 2004; 41:559

Courtesy Dr.Swati Bhave, 2005.

CARBOHYDRATES
Major and immediate source of energy. Complex carbohydrates recommended High-sugar foods not preferred. Grains, cereals, fresh fruits, vegetables

FATS
Source of essential fatty acids. Unsaturated fat recommended. e.g. Corn, cottonseed, Til oil, soybean, and sunflower oils contain about 50% polyunsaturated fat. Saturated fats increase cholesterol levels.

PROTEINS
Daily requirements Boys = 0.29-0.32 g/cm height Girls = 0.27-0.29 g/cm height 0.8 1.2 g/kg bodyweight High intensity athletes = 1.21.8 g/kg Pulses, lentils, soya, dairy products and animal food products.

Iron
Anemia is most common nutritional deficiency in adolescents. Increased red cell mass during adolescence. Daily need Boys = 12 mg/d & Girls = 18 mg/d Green leafy vegetables, jaggery, wet dates, whole-grain, dried beans, peas & dried fruits, nuts & fortified wheat products, eggs, red meat etc.

Calcium
Most bone adolescence. mass acquired during Typical intake of calcium = about 800 mg/ d

Daily need = 1300 mg

Consumption of soft drinks & caffeine contribute substantially to low calcium intake in adolescents. Bone mass deficiency may is irreversible.

Zinc

Second most abundant trace mineral in the body. (next to iron) Necessary for normal growth. Clinically apparent deficiency rare. Daily need = 15 mg Green leafy vegetables, wheat germ, whole grains meat, cheese, eggs, poultry, liver.

Milk and its products, yogurts, cheese, paneer, banana.

Good eating habits

Maintain hygienic habits Eat slowly, chew properly Avoid TV viewing or reading while you eat Small frequent meals Never skip meals, specially breakfast Dont overeat

Brain Food Improves performance in studies Improves physical activities Does not contribute to overweight Keeps you healthy

Why is Fast Food unhealthy ?

High in calorie, fat, sodium and low in fiber which can cause
Obesity, Hypertension, Heart diseases, Diabetes, Cancer etc.

Contains preservatives Choose low-calorie and low-fat meals, snacks and desserts Have low fat or skim milk drinks.

PHYSICAL ACTIVITY: Types of physical activity Daily Chores: walking, climbing stairs, cycling, household activities, etc. Exercise: planned & structured subset of leisure time physical activity undertaken for improving or maintaining physical fitness. 30-60 minutes every day Sports: involves competition. It may become an occupation.

PHYSICAL ACTIVITY:

Importance

This includes :

Cardio-respiratory i.e. Heart & Lung fitness

Muscle strength Endurance & flexibility

Adults should aim for a healthy body weight for their height and try to keep it at that level.
The Body Mass Index (BMI) is a good indicator if a person is underweight, overweight or a healthy weight. To calculate BMI (kg/m2), divide weight (kg) by height (m) x height (m).
Recommended BMI range Underweight less than 18.5 Normal 18.5 - less than 25 Overweight 25 - less than 30 Obese 30 - 40 Very obese over 40

Easy Ways to Improve Your Nutrition

Eat smaller portions more frequently Vary your diet so you dont get bored Dont overeat foods with added sweeteners Put color into your diet with fruits and vegetables Think ahead so that you have snacks available when you need energy Replace soda/lemonade/sports drinks with fruit juice EAT BREAKFAST Drink water, it helps to fill you up START MOVING!

Key points

Proper Nutrition & Regular Physical Activity are very important for Growth Prevention of illness Future health