Chapter 14 Adolescent Nutrition. Key Nutrition Concepts Nutrition needs should be determined by the...

Chapter 14Chapter 14

Adolescent NutritionAdolescent Nutrition

Key Nutrition ConceptsKey Nutrition Concepts

Nutrition needs should be Nutrition needs should be determined by the degree of determined by the degree of sexual maturation and biological sexual maturation and biological maturity (biological age) instead of maturity (biological age) instead of by chronological age.by chronological age.

Unhealthy eating behaviors Unhealthy eating behaviors common among adolescentscommon among adolescents

Key Nutrition ConceptsKey Nutrition Concepts

Concrete thinking and abstract Concrete thinking and abstract reasoning abilities do not develop reasoning abilities do not develop fully until late adolescence or early fully until late adolescence or early adulthood; therefore, education adulthood; therefore, education efforts need to be highly specific and efforts need to be highly specific and based on concrete principles.based on concrete principles.

Nutritional Needs in a Time of Nutritional Needs in a Time of ChangeChange

Biological, psychosocial and Biological, psychosocial and cognitive changes affect nutritional cognitive changes affect nutritional statusstatus

Rapid growth increases nutrient Rapid growth increases nutrient needsneeds

Desire for independence may Desire for independence may cause adoption of health-cause adoption of health-compromising eating behaviorscompromising eating behaviors

Normal Physical Growth and Normal Physical Growth and DevelopmentDevelopment

PubertyPuberty

Sexual Maturation Rating (SMR) or Sexual Maturation Rating (SMR) or “Tanner Stages”“Tanner Stages”

Changes in weight, body composition Changes in weight, body composition and skeletal massand skeletal mass

Normal Psychosocial Normal Psychosocial DevelopmentDevelopment

Early adolescence (11 to 14)Early adolescence (11 to 14)

Middle adolescence (15 to 17)Middle adolescence (15 to 17)

Late adolescence (18 to 21)Late adolescence (18 to 21)

Health and eating-related Health and eating-related behaviors during adolescencebehaviors during adolescence

Vegetarian dietsVegetarian diets

Dietary intake and adequacy Dietary intake and adequacy among adolescentsamong adolescents

Energy and Nutrient Energy and Nutrient Requirements of AdolescentsRequirements of Adolescents

EnergyEnergy

ProteinProtein

CarbohydratesCarbohydrates

Dietary fiberDietary fiber

CalciumCalcium

IronIron

ZincZinc

FolateFolate

Vitamin AVitamin A

Vitamin EVitamin E

Vitamin CVitamin C

Nutrition AssessmentNutrition Assessment

Nutrition screeningNutrition screening

Nutrition assessmentNutrition assessment

Nutrition interventionsNutrition interventions– nutrition education and counselingnutrition education and counseling

Physical Activity and SportsPhysical Activity and Sports

¼ of people ages 12-21 in the U.S. ¼ of people ages 12-21 in the U.S. are sedentaryare sedentary

Factors affecting physical activityFactors affecting physical activity– individualindividual– socialsocial– environmentalenvironmental

AthleticsAthletics– may affect nutritional needsmay affect nutritional needs

Promoting Healthy Eating and Promoting Healthy Eating and Physical ActivityPhysical Activity

Effective nutrition messages for Effective nutrition messages for youthyouth

Parent involvementParent involvement

School programsSchool programs– classroom nutrition educationclassroom nutrition education– school food servicesschool food services– nutrition environment of the schoolnutrition environment of the school

Eating DisordersEating DisordersObesity: Approx. 10 to 20 % of Obesity: Approx. 10 to 20 % of adolescents are obese and will remain adolescents are obese and will remain obese as adults. This is escalating as we obese as adults. This is escalating as we speak!speak!– Psychologic factors: Developmental obesityPsychologic factors: Developmental obesity

Food abuse as a result of abnormal family Food abuse as a result of abnormal family interactionsinteractions

– Physiologic factors: Examples:Physiologic factors: Examples:Set-point theorySet-point theory

Lower basal energy needLower basal energy need

Body temperature differences, etc Body temperature differences, etc

Treatment for ObesityTreatment for Obesity

Make sure the adolescent has reached Make sure the adolescent has reached full heightfull height

Make sure the adolescent is committedMake sure the adolescent is committed

Consider failure and self-esteem of Consider failure and self-esteem of adolescentadolescent

If the Adolescent is a good candidate, If the Adolescent is a good candidate, slow weight loss with increased activity slow weight loss with increased activity and diet modification are used.and diet modification are used.

Eating Disorders: Anorexia Eating Disorders: Anorexia NervosaNervosa

1 in 250 females 12-18 yrs1 in 250 females 12-18 yrs– 9 % die of starvation9 % die of starvation– 2-5 % commit suicide2-5 % commit suicide– 20% have decreased bone density20% have decreased bone density

Other problems:Other problems:– decreased heart sizedecreased heart size– damage to sex organsdamage to sex organs– abnormal metabolic rateabnormal metabolic rate

Physical signsPhysical signsFat store depletion Fat store depletion Muscle wasting Muscle wasting Skeletal appearance (cachexia) Skeletal appearance (cachexia) Amenorrhea/delayed menarche  Amenorrhea/delayed menarche  Fainting (postural hypotension) Fainting (postural hypotension) Irregular pulse/heart beat (cardiac Irregular pulse/heart beat (cardiac arrhythmia) arrhythmia) Fissures at corners of mouth (cheilosis) Fissures at corners of mouth (cheilosis) Yellowed skin (carotonemia) Yellowed skin (carotonemia) Dry, scaly skin Dry, scaly skin

Physical signsPhysical signsFine downy hair (lanugo) growing over body Fine downy hair (lanugo) growing over body (hirsutism) (hirsutism) Thin, dry, brittle hair Thin, dry, brittle hair Loss of hair from head (alopecia) Loss of hair from head (alopecia) Degradation of fingernails Degradation of fingernails Bluish tips of fingers and ear lobes (acrocyanosis) Bluish tips of fingers and ear lobes (acrocyanosis) Feeling extremely cold or hot (inability to regulate Feeling extremely cold or hot (inability to regulate body temperature) body temperature) Frequent night urination (inability to concentrate Frequent night urination (inability to concentrate urine) urine) Constipation Constipation

Anorexia Diagnosis Dx defined Anorexia Diagnosis Dx defined by Am. Psychiatric Assoc.by Am. Psychiatric Assoc.

Refusal to maintain body wt.: 15% Refusal to maintain body wt.: 15% below expectedbelow expected

Fear of gaining wt even though under Fear of gaining wt even though under wtwt

Disturbance in body imageDisturbance in body image

Absence of three consecutive Absence of three consecutive menstrual cyclesmenstrual cycles

Bulimia NervosaBulimia Nervosa

Incidence: 2-4 % of college females Incidence: 2-4 % of college females may meet criteria with as many as may meet criteria with as many as 20% showing some characteristics20% showing some characteristics

Symptoms: gorging with vomiting or Symptoms: gorging with vomiting or purging (vomiting, laxative, purging (vomiting, laxative, excessive exercise)excessive exercise)

APA Criteria for BulimiaAPA Criteria for Bulimia

Recurrent episodes of food bingingRecurrent episodes of food binging

lack of control over bingeslack of control over binges

regular self-induced vomiting, use of regular self-induced vomiting, use of laxative, diuretics, strict dieting or laxative, diuretics, strict dieting or fasting or vigorous exercisefasting or vigorous exercise

average of 2 or more binges/week for average of 2 or more binges/week for 3 months3 months

Over concern with body shape and Over concern with body shape and weightweight

Problems with BulimiaProblems with BulimiaDental decayDental decay

Throat irritationThroat irritation

Esophageal Esophageal inflammationinflammation

Rectal BleedingRectal Bleeding

Swollen Salivary Swollen Salivary glandsglands

broken blood broken blood vessels in face and vessels in face and throat throat

DehydrationDehydration

FistulasFistulas

Kidney damageKidney damage

Syrup of ipecac Syrup of ipecac toxicitytoxicity

Eating Disorder TreatmentEating Disorder Treatment

Psychotherapy: Address the Psychotherapy: Address the underlying problemunderlying problem

Medical: Keep the person alive while Medical: Keep the person alive while therapy happenstherapy happens

Nutritional: Meet client’s nutritional Nutritional: Meet client’s nutritional needs; re-learn proper eating habits needs; re-learn proper eating habits and intakesand intakes– Client has lost touch with what is normalClient has lost touch with what is normal

Adolescent PregnancyAdolescent Pregnancy

Factors affecting pregnant nutritional Factors affecting pregnant nutritional needsneeds

GrowthGrowth

Nutrient storesNutrient stores

Gynecologic ageGynecologic age

Preconception nutritional statusPreconception nutritional status

Gynecologic AgeGynecologic Age

The number of years between the The number of years between the onset of menses and conceptiononset of menses and conception– More sexually mature adolescents have More sexually mature adolescents have

no more physically-based complications no more physically-based complications than do adult womenthan do adult women

– Few adolescents within 2 years of Few adolescents within 2 years of menarche ovulate regularlymenarche ovulate regularly

– Those who become pregnant will need Those who become pregnant will need special attention to reduce risk of lbw and special attention to reduce risk of lbw and other complicationsother complications

Complications of Adolescent Complications of Adolescent PregnancyPregnancy

1st and 3rd trimester bleeding1st and 3rd trimester bleeding

anemiaanemia

difficult labor and deliverydifficult labor and delivery

cephalopelvic disproportioncephalopelvic disproportion

PIHPIH

InfectionsInfections

Maternal mortality is 2.5 X greater Maternal mortality is 2.5 X greater than older womenthan older women

Hazards to InfantHazards to Infant

PrematurityPrematurity

stillbirthstillbirth

LBWLBW

perinatal and infant deathsperinatal and infant deaths

physical deformitiesphysical deformities

Community involvement in Community involvement in nutritionally supportive environmentsnutritionally supportive environmentsModel nutrition programModel nutrition program– CANfit ProgramCANfit Program– The California Adolescent Nutrition and The California Adolescent Nutrition and

Fitness Program | Home | CANFIT works Fitness Program | Home | CANFIT works to improve the nutrition and fitness of to improve the nutrition and fitness of California´sCalifornia´s low-income African American, American low-income African American, American Indian, Latino, and Asian/ Pacific Islande Indian, Latino, and Asian/ Pacific Islander youthr youth