3. Learning Objectives
• Explain why sexual maturity and biological maturity (biological age)
are better determinants of nutritional needs than chronological age.
• Explain how the psychosocial developmental stages of adolescence,
including levels of abstract reasoning and critical thinking abilities,
affect the types of health education messages and intervention
components that are effective with teens.
• Describe at least three eating behaviors commonly seen among
adolescents and the potential consequences of these behaviors on
nutritional status.
• Identify the key components of nutrition assessment and screening of
adolescents and how resulting data can be used during nutrition
education and counseling.
• Describe the roles that peers, families, schools, and communities play
in determining the dietary behaviors and nutritional status of
4. Learning Outcomes
• Students will be able to compare and contrast the significance of sexua
and biological maturity in determining appropriate nutritional
requirements over chronological age.
• Students will be able to analyze the impact of psychosocial
development during adolescence on the effectiveness of health
education messages and intervention strategies targeted towards
teenagers.
• Students will be able to identify and describe three prevalent eating
behaviors in adolescents and understand the potential implications of
these behaviors on their nutritional status.
• Students will be able to list and explain the essential elements of
nutrition assessment and screening in adolescents and demonstrate
how the collected data can inform nutrition education and counseling
practices.
• Students will be able to analyze and articulate the influence of peers,
5. Adolescence
• Adolescence ‘adolescere’ Latin = “to grow, to mature” i.e.
achieving an identity.
• Adolescence is defined as the period of life between 11 and 21
years of age.
• The transition between childhood and adulthood, is one of the
most dynamic periods of human development.
• It is a time of profound biological, emotional, social, and
cognitive changes during which a child develops into an adult.
6.
7. Adolescence
• Worldwide, there are nearly 1.8 billion people ages 10–24 years,
constituting one-quarter of the total population; 89 percent of young
people (ages 10–24 years) live in low- and middle-income countries
(LMICs).
• Adolescents are also called teenagers.
8. Biological Changes During Adolescence
• Many biological changes take place during the adolescent
years.
• Most obvious are the physical changes, for example;
• increases in height,
• acquisition of muscle mass,
• the distribution of body fat and
• the development of secondary sexual characteristics.
10. Puberty
Adolescence begins with the onset of puberty, a
developmental period in which hormonal changes cause rapid
physical alterations in the body, culminating in sexual
maturity.
Occurs in different times for individuals
BOYS 10 – 16 years and GIRLS 8 – 14 years
Girls generally start two years before boys
11. Normal Physical Growth and Development
• Puberty occurs during early adolescence
• Biological changes of puberty include:
• Sexual maturation
• Increases in height & weight
• Accumulation of skeletal mass
• Changes in body composition
• The sequence of maturation events is consistent but great individual
variation in age of maturation
12. Normal Physical Growth and Development
• Variations in reaching sexual maturity affect nutrition requirements of
adolescents
• Sexual maturation (or biological age)—not chronological age—should
be used to assess growth and development and nutritional needs
13. Sexual Maturation Rating or “Tanner Stages”
• Sexual Maturation Rating (SMR) (a.k.a. “Tanner Stages”)—
is a scale of secondary sexual characteristics used to assess
degree of pubertal maturation regardless of chronological
age.
• SMR 1=pre-puburtal growth & development
• SMR 2-4=occurrence of puberty
• SMR 5= sexual maturation has concluded
14. Maturation and Growth of Females
• Menarche (onset of first menstrual period) occurs 2-4 years
after initial development of breast buds
• Age of menarche ranges from 9 to 17 years
• Peak linear growth occurs ~6 to 12 months prior to
menarche
• Severely restrictive diets may delay or slow growth
15. Maturation and Growth of Males
• Males show great deal of variation in chronological age at
which sexual maturation takes place
• Peak velocity of linear growth occurs during SMR 4 & ends
with appearance of facial hair at ~age 14.4
• Linear growth continues throughout adolescence ceasing at
~age 21
16. Changes in Weight, Body Composition, and
Skeletal Muscles in Females
• Peak weight gain follows linear growth spurt by 3 to 6
months
• Gain of ~18.3 pounds per year
• Average lean body mass decreases
• 44% increase in lean body mass (LBM)
• 120% increase in body fat
• 17% body fat is required for menarche to occur
• 25% body fat needed to maintain normal menstrual cycles
17. Changes in Weight, Body Composition, and
Skeletal Muscles in Males
•Peak wt gain at the same time
• Peak linear growth &
• Peak muscle mass accumulation
•Peak wt gain, ~20 lb per year
•Body fat decreases to ~12%
•~Half of bone mass is accrued in adolescence
18. Hormonal Changes
• Puberty is driven by the secretion of chemical messengers called
hormones
• Pituitary gland is stimulated in the brain and releases hormones that
stimulate endocrine glands
• These glands produce other hormones that act on body tissues and
cause maturation
• The most important change which marks puberty is that boys and
girls become capable of reproduction.
• Puberty ends when an adolescent reaches reproductive maturity.
19. Nutritional Needs in a Time of Change
• Biological, psychosocial and cognitive changes affect
nutritional status
• Rapid growth increases nutrient needs
• Desire for independence may cause adoption of health-
compromising eating behaviors such as:
Excessive dieting
Meal skipping
Use of unconventional nutritional and non-nutritional
supplements
Fad diets
20. Nutritional Needs in a Time of Change
• Health-enhancing eating behaviors
• Healthful eating practices
• Physical activity
• Interest in a healthy lifestyle
21. Key Nutrition Concepts
• Nutrition needs should be determined by the degree of sexual
maturation and biological maturity instead of chronological age
• Eating habits and behavior affected by lifestyle, activity level, growing
independence, need for peer acceptance, and concern with
appearance
22. “The willingness of adolescents to try out new behaviors
creates a unique opportunity for nutrition education and
health promotion. Adolescence is an especially important
time in the life cycle for nutrition education since dietary
habits adopted during this period are likely to persist into
adulthood.”
Jamie Stang
23. Importance of Adolescent Nutrition
• Adolescence is a critical part of development, with rapid growth and
physical, psychological, social, and intellectual changes.
• Adolescents have increased energy and nutrient demands.
• Inadequate consumption of nutrients can slow or stop linear growth,
resulting in stunting and delayed sexual maturation.
• Adolescents receive little health and nutrition attention except
regarding reproductive health.
24. Importance of Adolescent Nutrition
• Adolescents needs adequate and healthy diets to meet the growth
demands of puberty and to reduce the risk of malnutrition.
• Also a time for a time for establishing and maintaining healthy diet
and eating practices and healthy levels of physical activity.
• This is the time for learning to balance and increasing autonomy.
• Provide the second window of opportunity for fastest growth and
development after infancy.
25.
26.
27.
28. Goals of Adequate Nutrition
• Provide adequate nutrients for growth and development.
• Maintain nutritional status and prevent diseases.
• Promote optimal nutrition and prevent malnutrition (chronic and
acute).
31. Factors Affecting Health and eating related
behavior during adolescence
Eating patterns and behaviors of adolescents are affected by
many factors:
• Peer influence
• Parental modeling
• Food availability
• Food preference
• Cost
• Convenience
• Personal and cultural beliefs
• Mass media
• Body image
32. Eating habits of adolescents are not
static
• They fluctuate throughout adolescence in relation to
psychological and cognitive development
• Adolescents lead busy lives
• Many involved in extracurricular sport or academic
activities
• This leave little time to sit and eat meal
• Snacking or meal skipping are common
33. The occurrence of meal skipping
increases as adolescents mature
• Breakfast is the most commonly skipped meal
• 29% of female adolescents tend to eat breakfast
• Skipping breakfast can dramatically decreases intakes of
energy, protein, fiber, Ca, and folate
• 25% of adolescents skip lunch
34. • As adolescents mature, they spend less time with the
family and more time with peer
• Eating away from home
• Fast food accounts for 33% of food eaten
• Eating at fast food restaurant has a direct bearing on the
nutritional status of the adolescents (Fast foods are high in
fats and Low in fiber and nutrients)
38. Nutrient Intakes of Adolescents
• Adolescents are more likely to have inadequate intake of
vitamins & minerals including:
• Folate
• Vitamins A, B6, C, & E
• Iron & zinc
• Magnesium
• Phosphorus & calcium
39. Energy Requirements of Adolescents
Energy needs are influenced by:
• Activity level
• Basal metabolic rate (BMR)
• Pubertal growth & development
Because males have greater increases in height, weight, & lean body
mass (LBM) & higher BMR, they have a higher caloric need than
females (Suggested amount of calories for moderately active females
aged 12 to 18 is 2,000, whereas for males the need ranges from 2,200
to 2,800 calories)
Level of physical activity declines during adolescence resulting in
reduced energy requirements
40. Protein Requirements of Adolescents
Protein requirements influenced by protein needed:
• To maintain existing LBM
• For growth of new LBM
DRI is 0.85 g/kg body wt
Low protein intakes linked to:
• Reductions in linear growth
• Delays in sexual maturation
• Reduced LBM
41. Requirements for Selected Nutrients of
Adolescents
• Carbohydrates:
• 130 g/day or 45-65% of calories
• Dietary Fiber:
• Recommended
• 26 g/day for adolescent females
• 31 g/day for males <14 years of age
• 38 g/day for older adolescent males
42. Requirements for Selected Nutrients of
Adolescents
Fat:
• Required as dietary fat and essential fatty acids for growth and
development
• 25-35% of calories from total fat
• <10% calories from saturated fat
43. Calcium Requirements for Adolescents
• Adequate intake of calcium is critical to ensure peak bone mass
• Calcium absorption rate in females is highest around menarche
• Calcium absorption rate in males highest during early adolescence
• ~4 times more calcium absorbed during early adolescence compared
to early adulthood
• Adolescences who do not include dairy should consume calcium-
fortified foods
• Soft drink consumption displaces nutrient-dense beverages such as
milk & fortified juices
44. Calcium Requirements for Adolescents
• DRI for ages 9-18 years is 1300 mg/d
• Average intake is:
• 865 mg for females
• 1130 mg for males
• Weight-bearing activities may lead in increased bone mineral
density
45. Iron Requirements for Adolescents
• Increased iron needs related to:
• Rapid rate of linear growth
• Increase in blood volume
• Menarche in females
• In females, iron needs greatest after menarche
• In males, iron needs greatest during the growth spurt
o In boys, peak iron requirement occurs at 14 to 18 years of age
o Requirement for iron in adolescent girls increases from 8 mg to 15
mg/day at the age of 14 to account for menstrual losses
46. Iron Deficiency in Adolescents
• Iron deficiency vs. iron-deficiency anemia
• Iron deficiency
• Determined by low serum iron, plasma ferritin & transferrin
saturation
• Iron deficiency more frequent
• Often undiagnosed because of expense
47. Iron Deficiency in Adolescents
• Iron deficiency vs. iron-deficiency anemia
• Iron-deficiency anemia
• Determined by simple and inexpensive hemoglobin or
hematocrit levels
• Indicates more advanced stage of iron deficiency
• Less frequent but almost exclusively females
48. Iron Deficiency in Adolescents
• Estimates of iron deficiency:
• 9% of 12-15 y/o females
• 5% of 12-16 y/o males
• 11% of 15-19 y/o females
• 2% of 15-19 y/o males
49. Vitamin D Requirements for Adolescents
• Vitamin D-fat soluble vitamin:
• Essential role in facilitating intestinal absorption of calcium and
phosphorus
• Essential for bone formation
• Synthesized by the body via skin exposure of ultraviolet B rays of
sunlight
• Food sources: fatty fish, fish oils, egg yolks of hens fed Vitamin D
fortified feed
• Majority of Vitamin D from Vitamin D fortified foods (milk,
breakfast cereals, margarines, and some juices)
50. Folate Requirements for Adolescents
• Folate required for DNA, RNA & protein synthesis
• DRI: 400 mcg
• Severe folate deficiency leads to megaloblastic anemia
• Severe deficiency rare but inadequate folate status appears
to be more common
51. Folate Requirements for Adolescents
• Folate added to fortified foods is better absorbed than folate from
natural foods
• Adequate folate intake for female adolescents reduces incidence of
birth defects like spina bifida
• It is imperative that women of reproductive age (15 to 44 years)
consume adequate folic acid
• Increased risk of folate deficiency
• Skipping breakfast
• Not consuming orange juice or fortified cereals
52. Vitamin C Requirements for Adolescents
• Vitamin C—marginally adequate among adolescents
• Involved in the synthesis of collagen and other connective tissues
• Acts as an antioxidant
• Smoking need for Vitamin C
53. Eating Practices in Adolescence
In early adolescence, peer pressure overtakes parental influence on
food choices
• Risk of overeating
• Lack adequate fruits, vegetables, dairy foods, and whole grains
Nutrients most likely to be deficient are:
• Fiber, vitamin A, calcium, iron, and potassium
54. Nutrition Concerns During Adolescence (cont’d)
• Increased consumption of soft drinks
• In the last 50 years, the ratio of milk to soft- drink consumption has changed
dramatically
• Soft drinks and sweetened beverages provide more calories without
nutrients
• Soft-drink consumption is linked to low intakes of vitamins A and C, some B
vitamins, calcium, and phosphorus
55. • Health organizations, including the World Health Organization
(WHO) and the American Academy of Pediatrics (AAP),
recommend limiting or avoiding the consumption of soft drinks,
particularly by children and adolescents, to support better health
outcomes. Instead, they encourage the intake of water, milk,
and other healthier beverages as part of a balanced diet.
56. Nutrition Concerns During Adolescence (cont’d)
• Overweight and obesity
• The prevalence of obesity among youth has risen dramatically in recent years
• Overweight and obesity in adolescence increase the risk of several diseases
in adulthood
• Overweight and obesity can have negative social and psychological
consequences
• Fundamental cause of overweight and obesity is an imbalance between
caloric intake and caloric expenditure
57. Nutrition Concerns During Adolescence (cont’d)
Healthy lifestyles and obesity prevention
• Prevention of obesity is critical
• Barriers to parents taking action
Lack of time
Believe that children will outgrow their excess weight
Lack of knowledge
Fear they will cause eating disorders
58. Nutrition Concerns During Adolescence (cont’d)
• Healthy lifestyles and obesity prevention (cont’d)
• The American Academy of Pediatrics recommends that BMI be calculated and
plotted once a year for all youth aged 2 and older as part of routine pediatric
health visits
• A key recommendation in the 2010 Dietary Guidelines for Americans is that
the rate of weight gain be reduced in overweight children while allowing for
growth and development
59. Nutrition Screening, Assessment, and
Intervention
• The AMA recommends all adolescents receive annual health screening &
guidance
• Screening should include:
• Wt, ht, & BMI
• Disordered eating tendencies
• Blood lipid levels
• Blood pressure
• Iron status (hemoglobin/hematocrit)
• Dietary intake/adequacy
65. Nutrition Screening, Assessment, and
Intervention
• Nutrition screening should include a brief dietary assessment
• Food frequency questionnaires
• 24-hour recalls
• Food diaries or Food Records
66. Nutrition Education and Counseling
Considerations when educating & counseling adolescents:
1) Initial component of session should involve:
• Getting to know adolescent, including personal health or nutrition-related
concerns
• Providing overview of events & content of counseling session
2) Involve adolescent in decision-making process
3) Encourage adolescent to suggest ways to change
4) Work toward only 1 or 2 goals per counseling session
67. Nutrition Education and Counseling
• Use of technology to facilitate education and counseling
• Text messaging
• Podcasts
• YouTube
• Facebook
• Twitter
• Technology can serve as a means to convey nutrition info in an
engaging way
68. Recommendations on Physical Activity
• The Physical Activities Guidelines for Americans recommend
adolescents:
• Be physically active every day
• Engage in 60 minutes or more physical activity
• Include muscle- and bone-strengthening activities at least 3 days a week
69. Nutritional Considerations for Physically
Active Adolescents
• High levels of activity combined with growth & development increase
needs for energy, protein & certain vitamins & minerals
• Nutrient needs higher during intense training & competition seasons
• Monitor changes in body weight to assess for adequate energy and
protein intake
70. Promoting Healthy Eating and Physical
Activity Behaviors
Parent involvement
• Target parents
• They are gatekeepers of foods
• Serve as role models
Teenagers eat based on availability and convenience
• Parents can capitalize on this
• Stock a variety of nutritious ready-to-eat foods
71. Nutritional problems of adolescent age
Disordered eating abnormal behaviors related to food and eating may
include:
• starving,
• bingeing,
• vomiting,
• laxative abuse, or excessive exercise accompanied by unrealistic ideas
about food, a distorted body image, and psychological and
developmental abnormalities
72. Anorexia nervosa (AN)
AN a disease characterized by:
(l) refusal to maintain a minimally normal body weight,
(2) intense fear of gaining weight,
(3) body image distortion, and
(4) amenorrhea in postmenarcheal females; it may be one of two
subtypes: restricting or binge eating/purging
73. TYPES
l. Restricting type: During the current episode of AN, the person has
not regularly engaged in binge eating or purging behavior.
2. Binge eating/purging type: During the current episode of AN, the
person has regularly engaged in binge eating and purging behavior.
74. • Binge an episode of eating marked by three particular features:
• (1) the amount of food eaten is larger than most persons would eat
under similar circumstances;
• (2) the excessive eating occurs in a discrete period, usually less than 2
hours; and
• (3) the eating is accompanied by a subjective sense of loss of control
• Binge eating disorder (BED) a disorder characterized by the
occurrence of binge eating episodes at least twice a week for a 6-
month period
75. Bulimia nervosa (BN)
• Bulimia nervosa (BN) an illness characterized by repeated episodes of
binge eating followed by inappropriate compensatory methods such
as purging including self-induced vomiting or misuse of laxatives,
diuretics, enemas, or nonpurging, including fasting or engaging in
excessive exercise purging methods intended to reverse the effects of
binge eating; self-induced vomiting is the most common purging
method, but additional methods include laxative, enema. and diuretic
abuse
77. AN: Treatment
Nutrition
Increase food intake to raise the BMR
Prevent further weight loss
Restore appropriate food habits
Ultimately weight gain
Some weight restoration and treatment of malnutrition may make
psychotherapy more effective
Psychological
Cognitive behavior therapy
Determine underlying emotional problems
Reject the sense of accomplishment associated with weight loss
Family therapy, support group
79. Assessment of Intake in Eating Disorders
• Calories compared with DRI
• Evaluate macronutrient (carbohydrate, protein, fat)
• Evaluate micronutrient intake compared with DRI
• Estimate fluids and compare with needs
• Evaluate alcohol, caffeine, drugs, dietary supplements
80. Dietary Intake in AN
• Generally inadequate caloric intake, <1000 kcals/day
• Tend to avoid fat
• Many follow a vegetarian lifestyle
• Identify whether vegetarian lifestyle coincided with onset of disease
81. Dietary Intake in BN
• Highly variable; in one study mean intake of 4446 kcals; 44%
overeating, 19% undereating
• When not binge eating may follow a low fat diet
82. Management of Eating Disorders
• Multidisciplinary team including physicians, nutritionists,
psychotherapists
• May include inpatient medical or psychiatric hospitalization, partial
hospitalization and residential treatment, intensive outpatient, or
outpatient programs
83. Treatment Goals
• AN: weight gain and correction of malnutrition disorders;
normalization of eating patterns and behaviors
• BN: weight maintenance in the short term even if patient is
overweight until eating habits are stabilized
84. Factors Affecting Weight Gain in AN
• Fluid balance
• Polyuria seen in starvation
• Edema from starvation or refeeding
• Hydration ratio in tissues
• Metabolic rate
• Resting energy expenditure
• Postprandial energy expenditure
85. Factors Affecting Weight Gain in AN
• Energy cost of tissue gained
• Lean body mass
• Adipose tissue
• Previous obesity
• Physical activity
86. Nutritional Care in AN
• Often require hospitalization to begin refeeding
• Some require enteral feedings, but most can be rehabbed with oral
feedings
• Goal is increase in energy intake with weight gain
• Energy intake must be increased gradually while minimizing caloric
expenditure
87. Nutritional Care in AN
• Initial calorie prescriptions 1000-1600 kcals, or 30-40 kcals/kg
• Increase 100 to 200 kcals q 2-3 days; may be as high as 70-100
kcal/kg/day
• Hospitalized patients: goal is 2-3 lb/week
• Outpatients: 1 pound/week
88. Refeeding Syndrome
• Refeeding malnourished patients with AN can result in life-threatening
hypophosphatemia, cardiac arrhythmia, and delirium
• May be precipitated by high-calorie feeding regimens
• Patients weighing less than 70% desirable body weight at greatest risk
• Serum phos, mg, K+, calcium must be closely monitored and
supplements provided as needed
89. Micronutrients
• Vitamin-mineral supplements: may have increased need in anabolism;
100% RDA multivitamin with minerals (iron may ↑ constipation)
• Encourage calcium-rich foods and Vitamin D
90. MNT in AN
• Early treatment: caloric intake usually low, can be provided in 3 meals
per day; snacking may relieve some physical discomfort
• Later treatment: as caloric prescription increases, snacks become
unavoidable
• Defined formula liquid supplements may be helpful; patients may be
more willing to accept them than large volumes of food
91. Quiz
• 01. Which age period marks the maximum height growth in
humans?
• Why is height growth high in the _______period.
• Which factor primarily influences the maximum height growth in
adolescence?
• What is the best strategy to optimize height growth during
adolescence?
• What is a potential consequences of height growth being
Altered prematurely during adolescence?
92. QUIZ NO 02
• What is BMR?
• How BMR affect energy requirements in adolescent period?
• Why do males have higher BMR than females?
• Is there anyThe Relationship Between BMR and Food Intake?
93. Assignment and presentation
• Write assignment on Eating Disorders during adolescent
Understanding, Health Consequences, Treatment, and
Prevention"
• Presentation on common interventions on adolescent nutrition
that were being implemented at community level in Pakistan
94. ACTIVITY
• Activity: "Mindful Eating Practice“
• Objective: To promote mindful eating habits among students
during the adolescent period, fostering a healthier relationship
with food and an awareness of hunger cues.
• Mindful eating promotes an understanding of hunger and satiety
cues, which can help prevent overeating and improve digestion.
Encourage students to be patient with themselves during the
process and to approach mindful eating with curiosity and non-
judgment
95. Research Point of view
• Search the latest three journey Research on adolescent and read
the objectives etc.
• Exploring the Impact of Digital Media and Technology on Adolescent
Nutrition and Eating Behaviors“
• Unraveling Hidden Dynamics: The Influence of Unseen Peer
Connections on Adolescent Nutrition Choices"
• Exploring the Impact of Alcohol Consumption on Adolescent Nutrition
and Its Implications for Health and Well-Being“
• Evaluating the Effectiveness of a Community-Based Nutrition
Intervention on Improving Dietary Behaviors and Nutritional
Knowledge among Adolescents"
