Adolescent health

1. Lecture 01 – Adolescent Health Statistics
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2. • Adolescent – a special age group
• Morbidity/ mortality related to adolescent age group
• Health statistics of adolescent age group
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3. • Adolescent
• Malnutrition
• Anaemia
• Child marriage
• Teenage pregnancy
• NFHS- 5 data
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4. Speciality of Adolescent Age Group
 Adolescence is the phase of life between childhood and adulthood, 10 to 19
years of age (WHO)
 According to Kishori Shakti Yojna (ICDS) adolescent girls belong to 11-18 years
 Unique stage of human development and it lays foundations of good health
 Adolescents experience rapid physical, cognitive and
psychosocial growth
 Changes during this period affects how they feel, think,
make decisions, interact with the world around them
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5.  Adolescents establish patterns of behavior related to diet, physical activity,
substance use and sexual activity
 These behaviors depending on their nature either protect them or destroy
them in the future
 Despite being thought of as a healthy stage of life, there is significant death,
illness and injury in the adolescent years
 Many of these are preventable or treatable
Speciality of Adolescent Age Group
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6. 1. Early: 10-14 years
• Growth spurts, physical changes becomes easily noticeable, gender
consciousness
2. Late: 15-19 years
• Growth spurts continues, gain interest in romantic and sexual relationship,
development of sexual identity
Classification of Adolescent Age Group
• Young adults: 20-24 years
• Almost completed physical development, risk taking
behavior declines, more emotional stability
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7. Adolescent Health Statistics
• Adolescents are making up 16% of the world’s population, 1.3 billion adolescents
in the world today(UNICEF, 2022)
• Largest adolescent population of World: 253 million (21% of Indian population),
every 5th person is between 10 to 19 years
• India’s continued development depends on the large
number of adolescents if they are safe, healthy, educated
and equipped with information and life skills
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8. Indian Adolescent
• Both girls and boys lack access to information on issues affecting their lives
• They have limited spaces to develop competencies
• Girls are exposed to multiple layers of vulnerability due to social norms
It affects their ability to move freely and to make decisions
• About 43 per cent of girls drop out before completing
secondary education (UNICEF)
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9. Indian Adolescent
• Child marriage, a deeply rooted social norm in India
• Every year at least 1.5 million girls under 18 get married in India, alone
accounting for a third of the global total (UNICEF)
• Girls who become pregnant are at a higher risk of maternal and newborn
disease and death
• Babies born from adolescent mother are at an
increased risk of stunting
It leads to cognitive and physical deficits in young children
and reduces productivity in adults
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10. Preventable/ treatable health problems in adolescents:
a) Nutritional disorders like undernutrition, anaemia & overweight
b) Early & unintended pregnancy
c) Unsafe sex leading to STI/AIDS
d) Alcohol, tobacco and drug abuse
e) Mental health concerns
f) Injuries & violence
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11. Malnutrition in Adolescents (NFHS-5)
Gender (15-19
years of age)
Malnutrition Proportion
(%)
Female Undernutrition (Thin) 40
Overweight/obese 5
Male Undernutrition (Thin) 41
Overweight/obese 7
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12. Geographical variation of malnutrition (NFHS-5)
Gender
(15-19 yrs.)
Area Undernutrition
(%)
Overweight/
Obesity (%)
Female Urban 13 33
Rural 21 20
Male Urban 13 30
Rural 18 19
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13. Malnutrition (15-19 yrs.) with State wise variation (NFHS-5)
Gender Malnutrition States
Female Undernutrition Jharkhand and Bihar (26% each),
Gujarat, Dadra & Nagar Haveli,
Daman & Diu (25% each)
Overnutrition Puducherry (46%), Chandigarh
(44%), Delhi, Tamil Nadu, Punjab
(41% each), Kerala, Andaman &
Nicobar Islands (38% each)
Male Undernutrition Bihar (22), Madhya Pradesh,
Gujarat (21% each)
Overnutrition Andaman & Nicobar Island (45%),
Puducherry (43%), Lakshadweep
(41%)
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14. Anaemia Prevalence
Country/
State
NFHS Girls aged 15-
19 years,
anaemic
(<12.0 g/dl)
(%)
Boys aged
15-19 years,
anaemic
(<13.0 g/dl)
(%)
Pregnant
women age
15-49
years,
anaemic
(<11.0
g/dl) (%)
India NFHS-5 59.1 31.1 52.2
NFHS-4 54.1 29.2 50.4
West
Bengal
NFHS-5 70.8 38.7 62.3
NFHS-4 62.2 31.7 53.6
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15. Trends in Anaemia status (NFHS-5)
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16. Teenage Pregnancy
• In India, 7% of women aged 15-19 years have begun childbearing (NFHS- 5)
• Teenage pregnancy is relatively high in rural areas (8%)
• Teenage pregnancy decreases with an increasing level of schooling and with
increasing level of wealth
18% of women age 15-19 with no schooling have already
begun childbearing whereas only 4% of women who had 12 or
more years of schooling
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17. • Teenage pregnancy is more among Scheduled Tribe girls and Muslim girls
• Fig 1: State wise variation of Teenage Pregnancy
22%
16%
13%
12%
11%
10%
0%
5%
10%
15%
20%
25%
Tripura West Bengal Andhra
Pradesh
Assam Bihar Jharkhand
Teenage Pregnancy (%)‐ NFHS 5
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18. Mental Health problems in adolescents
• Globally, one in seven 10-19-year-olds experiences a mental disorder
• Mental health problems accounts for 13% of the global burden of disease in
this age group (WHO, 2021)
• National Mental Health Survey (2015–2016) reported about
7% prevalence of psychiatric disorders in 13–17 years and
was nearly equal among both genders
• Suicide is the 4th leading cause of death among 15-29 years
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19. • Depression, anxiety and behavioral disorders are the leading causes of illness
and disability among adolescents
• Failing to address adolescent mental health conditions hinders healthy
adulthood
• Major challenges in India are:
1. Early identification of mental health problems
2. Treatment gap
3. Lack of Professionals
4. Interventions that address the same
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20. Other statistics related to adolescents
• Tobacco use among youth of India (15-24 years): 11.9%
Source: Tobacco Use Among the Youth in India: Evidence From Global Adult
Tobacco Survey-2 (2016-2017)
• Two out of every seven new HIV infections globally in 2019
were among young people (15–24 years)
Source: UNAIDS, 2021
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21. • Health & Family Welfare Statistics in India (2019-2020)
• A Profile of Adolescents & Youth in India (UNFPA)
• National Family Health Survey (NFHS-5) 2019-21
• Young People and HIV (UNAIDS, 2021)
• Adolescent development and participation (UN(CEF)
https://www.unicef.org/india/what-we-do/adolescent-development-participation
• Handbook of Health and Well-Being
https://link.springer.com/book/10.1007/978-981-16-8263-6
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22. • Adolescent is the preparatory phase of adulthood
• Wellbeing during adolescence would predict the wellbeing during adulthood
• During this stage of life, children have specific needs based on:
1. Gender
2. Socio-economic status
3. Overall cultural belief of the community
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24. Lecture 02 – Introduction to Nutrition & Dietetics
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25. • Terminologies related to nutrition
• Physiology of food intake
• Signals of satiety
• Determinants of food habit
• Dietary Reference Intakes (DRIs)
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26. • Nutrition
• Diet
• Dietetics
• Food habit
• Dietary Reference Intakes
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27. Introduction
• Nutrition: Process of providing or obtaining food required for health & growth
• “Nutrition” is derived from Latin word “Nutritio” ; means “to nourish”
• Intake of food should be considered in relation to the body’s dietary needs
• Includes food intake, absorption, assimilation, catabolism,
biosynthesis and excretion
• Outcome of nutrition: Growth, development,
maintenance, reproduction, health and disease
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28. Food Components
• According to chemical nature, nutrients are
1. Carbohydrate
2. Proteins
3. Fats
4. Minerals
5. Vitamins
• Food can be a liquid or solid source of nutrients
• Nutrients are individual components of food that provide nourishment
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29.  Micronutrients
• Required in minute amounts and are vital to the
proper functioning of the body
• Their absence leads to severe consequences
• Includes vitamins and minerals
 Macronutrients
• Required in gram amounts and are the primary source of energy and
building blocks for body
• Includes carbohydrates, proteins, fats
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30. Functional foods
• The whole, fortified and enhanced foods provide physiological health benefits
beyond the provision of essential nutrients (When consumed on a regular basis)
• It contains bioactive components that promote health and reduce the risk for
chronic diseases
• Do not differ in appearance from conventional foods
and can be consumed as a part of regular diet
• E.g. whole oat products contain beta-glucan which
reduces the total LDL cholesterol
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31. Food Additives
• Example:
Aspartame is a sweetener which is added to soft drinks
and chewing gum
Calcium silicate is an anticaking substance which
prevents caking of baking powder and salt
• Chemical substances added to food to enhance its flavours, appearance,
taste and other characteristics
• Some are preservatives
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32. Diet & Dietary supplements
• Diet: Mixture of various foods in different proportions
taken at a prescribed point of time
• Dietary supplements: Commercial products that contain
specific nutrients or their combinations to enhance the
nutritional value of food. E.g. vitamins, minerals, fats,
amino acids
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33. Dietetics
• Practical application of scientific understanding of nutrition
a) Deals with understanding nutrients, diet patterns, food
choices and food habits and effects on health
b) Involves integrating biochemical, physiological, social
and managerial concepts to develop nutritional practices
required for a healthy lifestyle
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34. Physiological factors related to Food Intake
• Hunger is the signal for the body to eat, sensation of hunger is triggered by the
sight, smell or thought of food
• Consumption of food decreases hunger and results in satiety
• Satiety is the sensation that delays food intake and induces a feeling of fullness
• Hypothalamus receives various signals from the body
and processes them to result in satiety
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35. Signals of satiety
• Food intake stimulates stretch receptors of stomach which relay nerve impulses
• Gut hormones like Cholecystokinin, Grehlin, and Peptide YY are released in
response to food intake
• Protein hormone leptin released by adipose tissues, act on hypothalamus and
inhibit food intake
• Stringent control of blood sugar and amino acid levels
can ‘autoregulate’ the intake of carbohydrates and
proteins, the same is not true about fat metabolism
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36. Factors influencing food intake
Physiological need
• Hunger
• Satiety
• Metabolism
Sensory appeal
• Appearance
• Smell
• Taste
• Texture
• Pleasure
• Variety
Social Influence
• Hospitality
• Resources
• Obligation
Habit
• Social norms
• Timing
• Availability
• Peer pressure
Psychological influence
• Boredom
• Depression
• Comfort
• Rejection
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37. Meal Structure
• Core food: Base of the meal & called ‘staple food’
• The meal is constructed around the core food, E.g. People of West Bengal
have rice as their staple food
• Secondary foods: Eaten along with the core food
• With specific properties- promote strength, preserve health and provide
extra nutrients, E.g. meat, fish or vegetables eaten with rice
• Peripheral foods/ Non-essential foods: Eaten occasionally
• Do not form parts of a regular meal E.g. cakes or sweets
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38. Components of food habit of a person
• Food choices refer to the personal preferences of each individual
which may be different from everyone else
• Two main determinants of food choices: availability & accessibility
Cost of meals
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39. Dietary Reference Intakes (DRIs)
• The amount of a particular nutrient that a person must consume in decided
according to various guidelines and recommendations
• A set of quantitative estimates of specific nutrients of each category
Dietary Reference Intakes
(DRIs)
Estimated Average Requirements (EAR)
Recommended Dietary Allowances (RDA)
Adequate Intake (AI)
Tolerable Upper Intake Level (UL)
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40. • RDA (Recommended Dietary Allowances):
• Average daily dietary intake level that is sufficient to meet the nutrient
requirement of nearly all (97 to 98 percent) healthy individuals in a
particular life stage and gender group
• RDA is intended to be used as a goal for daily intake by individuals
• if an EAR cannot be set, no RDA will be set
RDA= EAR + 2SD (when standard deviation is known)
RDA= 1.2 X EAR
Or
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41. • EAR (Estimated Average Requirements):
• Daily intake value that is estimated to meet the requirement in half of the healthy
individuals in a life stage or gender group
• At this level of intake, the other half of a specified group would not have its
nutritional needs met
• AI (Adequate Intake):
• Based on experimentally derived intake levels or approximations of observed
mean nutrient intakes by a group of healthy people
• Established when scientific data is insufficient for determining EAR
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42. • Comparison of AI with RDA
• Similarities: Both the AI and RDA are to be used as a goal for individual intake
• Both are intended to cover the needs of nearly all persons in a life stage group
• Differences:
• There is much less certainty about AI value than about RDA value
• AIs must be used with greater care than RDAs
• RDA is always calculated from EAR by using a formula that takes
into account expected variation in requirement for the nutrient
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43. Tolerable Upper Intake Level (UL)
• Highest level of daily nutrient intake that is likely to pose no adverse effects in
almost all individuals in the specified life stage group
• UL is not intended to be a recommended level of intake
• UL is based on an evaluation conducted for risk assessment of nutrients
• Need for setting UL is more with increased fortification of foods
and increased use of dietary supplements
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44. Fig: Dietary Reference Intakes
Source: https://www.ncbi.nlm.nih.gov/books/NBK114332/
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45. • Uses of DRIs
DRI values provide the scientific basis for nutrition professionals, governments,
and NGOs to carry out activities:
• Developing nutrition labels
• Developing dietary guidelines and food guides
• Ensuring foods and supplements contain safe levels of nutrients
• Creating patient and consumer counseling and
educational programs
• Assessing nutrient intakes and monitoring nutritional
status of the population
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46. • Ganong’s review of Medical Physiology (24th Edition)
• Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin
B12, Pantothenic Acid, Biotin, and Choline
https://www.ncbi.nlm.nih.gov/books/NBK114332/
• Supplemental Nutrition Assistance Program: Examining the Evidence to Define Benefit
Adequacy https://www.ncbi.nlm.nih.gov/books/NBK206912/
• Core, secondary and peripheral foods in the diets of Hispanic,
Navajo, and Jemez Indian children
https://www.sciencedirect.com/science/article/abs/pii/S00028223
21021696
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47. • Nutrition involves consumption of food required for
individual health and growth
• Dietary needs are controlled by hunger and satiety which
forms a complex physiology
• Individual food habits are influenced by several factors
• DRIs is generic term for a set of nutrient reference values
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49. Lecture 03 – Role of Macronutrients
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50. A. Carbohydrate, Protein, fat & their function in our body
B. Role of Dietary fiber
C. Water & it’s function in our body
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51. 1. Carbohydrate
2. Protein
3. Fat
4. Dietary fibers
5. Limiting amino acids
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52. Carbohydrate
• Principal source of energy
• Chemically, carbohydrates are polyhydroxy aldehydes or ketones
• Based on chemical nature carbohydrates are classified into:
1. Monosaccharide
2. Disaccharides
3. Oligosaccharides
4. Polysaccharides
Simple carbohydrate
Complex carbohydrate
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53. Monosaccharides
• Simplest form - fundamental building blocks of carbohydrates
• Hexoses- contain 6 carbon atoms E.g. glucose, fructose, galactose
• Organs like brain and RBC depend entirely on glucose for energy
• Xylitol, sorbitol and mannitol- used as sweeteners in diabetic food,
less likely to result in dental caries
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54. Please write the content here
Sources of Monosaccharides
Monosaccharides Source
Glucose Sweets, confectionaries and ice creams
Fructose Honey and fruits
Galactose Milk and dairy products
Xylose Wine and beer
Mannose Fruits
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55. Disaccharides
• Formed by combination of two monosaccharide units
• Sucrose (Glucose + Fructose) most common disaccharide present in our diets
Source: Table sugar, fruits, vegetables, and cereals
• Lactose (Glucose + Galactose) found mostly in dairy products
• Maltose (Glucose + Glucose) - malt sugar, found in
germinating grains and as a fermentation product of
wheat and barley
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56. Oligosaccharides
• Made of 3-8 monosaccharide units, ‘Oligo’ means few, joined by covalent bonds
• Based on the number of monosaccharide further classified into
1. Trisaccharides (raffinose)
2. Tetrasaccharides (stachyose)
3. Pentasaccharides (verbascose)
• Found in leeks, onions, garlic, legumes etc.
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57. Polysaccharides
• Comprised of several (>10) monosaccharide units
• Starch (glucose Unit) : Cereals, potatoes, beans, and tubers
• Resistant starch: Not digested in small intestine but are fermented by the
bacteria in large intestine, help in colonic function
• Glycogen: Primary storage polysaccharide
• Structural components of plants and animals: Cellulose,
chitin and pectin; not digestible by humans
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58. Function of carbohydrate
• Predominant source of energy (4 Kcal/gram)
• Carbohydrates in diet prevent the breakdown of proteins and fats
• Required for synthesis of glycolipids, mucopolysaccharides and glycoproteins
• Stored glycogen (Liver) is useful during periods of fasting
• Carbohydrates in diet prevent loss of electrolytes like
sodium and water, ensures palatability and taste
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59. Daily Intake of Carbohydrate
• Amount of carbohydrate taken must provide sufficient energy, supply
essential sugars and prevent ketosis
• Dietary carbohydrates must represent 50% of calorie intake in the diet
• Predominant intake must be in the form of complex carbohydrates
• Simple sugars must not constitute more than 10%
of the total energy
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60. Proteins
• Nitrogen-containing macronutrients, supply essential and non-essential amino acids
• Depending on requirement in diet, they are classified as:
1. Essential: Not produced in the body and have to be supplied in diet
2. Non-Essential: Can be manufactured within body, need not be supplied in diet
3. Conditionally essential: Amino acids which become
essential if there precursors are deficient
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61. Example of Amino acids
Essential
Amino Acids
Conditionally Essential
Amino Acids
Non-Essential
Amino Acids
Histidine
Isoleucine
Leucine
Lysine
Methionine
Phenylalanine
Threonine
Tryptophan
Valine
Cysteine
Tyrosine
Arginine
Alanine
Aspartic Acid
Asparagine
Glutamic Acid
Glutamine
Glycine
Proline
Serine
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62. Classification of Protein
• Dietary proteins are classified according to their nutritional value:
1. Complete proteins: Contain all essential amino acids
• Mostly include proteins of animal source, E.g. meat, eggs, and fish
2. Incomplete Proteins: Usually deficient in one or more essential amino acids
• Mostly of plant origin, E.g. legumes, lentils etc.
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63. Function of Protein
• Proteins compose the major lean body mass
• Structural components of the body like hair and nails are made of proteins
• Enzymes, hormones, antibodies, clotting factors and connective tissue are
made of proteins
• Act as buffers and maintain the acid base balance
• In starvation, break down to yield energy (4 Kcal/g)
• Dietary proteins induce satiety
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64. Daily Intake of Protein
• The recommended dietary intake of proteins is 1 g/ kg of body weight
• Supplementary action of protein: Example - Rice-dahl combination diet
Cereal proteins are deficient in lysine, threonine & pulse proteins in methionine
(known as "limiting“’ amino acids)
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65. Fats or lipids
• High energy nutrients, chemically insoluble in water or aqueous solutions
• Fatty acids are esters of carboxylic acids with hydrocarbons in the side chain
• Derived either from phospholipids or triglycerides
• Triglycerides constitute majority of fat content in the human body (90-95%)
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66. Classification of lipids (according to structure)
Simple lipids:
• Esters of alcohols and fatty acids
• Triglycerides are esters of fatty acids with glycerol
• Waxes are esters of long chain fatty acids with
long chain alcohols
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67. Complex lipids
• Contain other chemical molecules like phosphate
or carbohydrate or protein groups
• Phospholipids contain a phosphate group in
addition to alcohol and fatty acids
• Glycolipids contain a carbohydrate group in
addition to alcohol and fatty acids
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68. Derived lipids
• Derived from simple and complex lipids by hydrolysis
• May contain complex structures and hydrocarbon rings in their structure
• Sterols are derived lipids with cyclopentano ring structure
• Example – cholesterol, carotenoids and fat-soluble vitamins (Vitamin A, E, and K)
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69. Classification according to number of hydrogen atoms and bonds
1. Monounsaturated fatty acids : Nuts, canola oil, olive oil, mustard oil
2. Polyunsaturated fatty acids
• Mostly in liquid state at room temperature E.g. safflower oil and vegetable oil
• Essential fatty acids: alpha- linolenic acid (ω-3 FA)) & linoleic acid (ω-6 FA)
• ω-3 FAs present in salmon, canola and flax oil
• ω-6 FAs are present in safflower oil, sunflower oil and corn oil
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70. 3. Trans-fat or trans-unsaturated fatty acids:
Vegetable oils which are unsaturated fats can be converted to solid or semi-solid
forms by the process of hydrogenation
4. Saturated fatty acids:
Saturated with hydrogen atoms
Found in meat, dairy products, butter, ghee, coconut oil, palm oil
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71. Function of Lipids
• Lipids constitute nearly 60 % of the total body energy (9 Kcal/g)
• Provide essential fatty acids like alpha-linoleic acid and linolenic acid
• Form the precursors for sterol synthesis and structural components of the tissues
• Fats add taste and palatability of food
• Fatty acids make hormones that regulate immune system and
central nervous system
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72. Daily Intake of fat
• Dietary intake of fats should provide sufficient quantity of essential fatty acids
• Amount of saturated fat, trans fat and cholesterol must be kept minimum, as
these are associated with a high risk of coronary artery disease
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73. Dietary fibre
• Indigestible part of plant material, non-starch polysaccharides
1. Soluble Fiber: Dissolve in water and are fermented in the large intestine
Example: pectin, gums and mucilage
Sources: Vegetables, legumes and plant extracts
2. Insoluble Fiber: Insoluble in water and are not well fermented
Example: Cellulose, hemicellulose and lignin
Source: Whole cereals like wheat bran
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74. Benefits of Dietary fibre
• Adds bulk to the diet and may reduce appetite
• Lowers the absorption of glucose and cholesterol by trapping them, reducing
risk of diabetes and heart disease
• Beneficial effects in regulating blood pressure
• Adds bulk to the stool & eases its passage
• Consumption of 25g- 35g/ day of dietary fiber can
reduce the risk of heart disease
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75. Water
• Comprises 70% of the body structure
• Humans cannot survive without water and fluids beyond 10 days
• Amount of fluid taken by a person depends on- body weight, climatic
conditions and level of activity
• On an average a person must consume
approximately 35 ml/kg body weight of fluids
(no fixed recommendation)
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76. • Park’s Text Book of Preventive & Social Medicine
(25th Edition)
• Indian Food Composition Tables (NIN-ICMR), 2017
• Community Medicine with Recent Advances (AH
Suryakantha), 4th Edition
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77. N
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78. Lecture 04 – Role of Micronutrients
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79. • Fat soluble vitamins- A, D, E, K
• Water soluble vitamins- B, C
• Few Minerals related to health & wellbeing
• Trace Elements
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80. • Vitamins
• Minerals
• Night blindness
• Rickets
• Anaemia
• Scurvy
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81. Vitamin A
• Parent compound is alcoholic form called ‘all-trans-retinol, has a β-ionone ring
attached to an isoprenoid chain
• Aldehyde derivative is ‘retinal’ and carboxylic acid derivative is ‘retinoic acid’
• Retinol, retinal & retinoic acid are found in foods of animal origin
• Most food of plant origin contains precursor compounds
of vitamin A, these are pigments called as carotenes
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82. Sources of Vitamin A
• Animal Sources: red meat, liver, whole milk and dairy products
• Plant sources : Carrots, ripe papaya, mango, green vegetables (peas), pumpkin,
peaches, apricots and vegetable oils are rich in carotenes
• Plant sources are usually identified by their high or deep yellow/ orange color
• Fortified food: vanaspati , margarine, milk
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83. Function of Vit A
• Growth & repair of Epithelial tissue- healthy skin, mucous membrane, teeth,
skeletal and soft tissues
• Formation of rhodopsin in the retinal cells of eye, allows vision in low light
• Males: Maintains epithelial integrity of the epididymis, prostate and seminal
vesicles, required for spermatogenesis
• In females: required for growth of the fertilized
ova, production of steroid hormones
N
P
T
E
L

84. • Vit A is implied in myelination of neurons, maintaining neuronal plasticity and
cognitive function
• Innate immunity: Maintain the integrity of mucosal barriers, functions of
neutrophils, macrophages, natural killer cells
• Adaptive immunity: Development of T and B lymphocytes
N
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85. Daily Requirements
• Daily requirement is increased in infectious diseases, hyperthyroidism, alcoholism
and renal disease
• Recommended daily intake by Indian adolescents (ICMR): 600 mcg of Retinol or
4800 mcg of β carotene (1:8 conversion ratio)
• Excess consumption of vitamin A results in Hypervitaminosis A
(Raised intracranial pressure, headaches, blurring of vision,
nausea, hair loss and irritability)
• Chronic high intake can lead to osteoporosis
N
P
T
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86. Deficiency of Vit A
• Predominantly ocular: Night blindness, conjunctival xerosis, Bitot's spots, corneal
xerosis and keratomalacia
• “Xerophthalmia" (dry eye) comprises all the ocular manifestations of vitamin A
deficiency ranging from night blindness to keratomalacia
• Extra-ocular: follicular hyperkeratosis, anorexia and growth retardation
• Deficiency leads to increase in morbidity and mortality due
to respiratory and intestinal infection
N
P
T
E
L

87. Vitamin D
• Only vitamin that can be synthesized in the body from a provitamin
• Synthesized from 7-dehydrocholesterol at the skin surface on exposure to
ultraviolet radiation (sunlight)
Organ Function
Intestine Promotes absorption of calcium & phosphorous
Bone Stimulates mineralization, enhances bone resorption,
collagen maturation
Kidney Increase tubular reabsorption of phosphates,
reabsorption of calcium
Others Normal growth
N
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88. • Obtained from cod liver oil, fish, dairy products, and whole eggs
• Daily Vit D requirement: 400 IU for children < 12 months
600 IU for 1-70 years, 800 IU for >70 years of age
• Daily requirement increased in pregnancy & lactation
• Deficiency: Rickets in children, Osteomalacia in adults
Vitamin D
N
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T
E
L

89. Vitamin E
• Generic name for a group of closely related and naturally occurring fat soluble
compounds, Tocopherols
• Has significant roles in reproduction and as an antioxidant
• Plant source: Wheat germ oil (richest source), corn oil, soy bean
• Animal sources: Egg yolk, liver and milk are relatively poorer
N
P
T
E
L

90. Vitamin K
• Anti-hemorrhagic factor and named after the German word ‘Koagulation.’
• Synthesized by intestinal bacteria
• Sources: green leafy vegetables, sprouts, cabbage, fermented dairy products,
soybean, kiwi fruits, and grapes
• Daily requirement: 60 mcg (9-13 years), 75 mcg (14-18 years)
• Persons on anticoagulants need supplementary vitamin K
• Prolonged antibiotic use may cause Deficiency of Vit K
N
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91. Function of Vit K
• Essential substrate in synthesis of various clotting factors- formation of the blood
clot and prevent excessive bleeding
• Carboxylation of osteocalcin- maintain bone density and reduces risk of fractures
• Function: Regulation of cell growth, cell proliferation, intercellular communication,
neuronal development and prevention of aging
• Osteocalcin prevent cardiovascular diseases
• Deficiency- Haemorrhagic disease of new born
N
P
T
E
L

92. Vitamin B 1 (Thiamine)
• Source: whole grain cereals , wheat, Bengal gram, yeast, pulses, oilseeds and
nuts, especially groundnut
• Meat, fish , eggs, vegetables and fruits contain smaller amounts
• Milk is an important source of thiamine for infants
• Indian people get 60-85 % of the total supply from cereals
• Deficiency: Beriberi, Wernick’s Encephalopathy
N
P
T
E
L

93. Vitamin B2 (Riboflavin)
• Sources: Milk, eggs, liver, kidney and green leafy vegetables
• Meat and fish contain small amounts
• Germination increases the riboflavin content of pulses and cereals
• Deficiency: Angular stomatitis
Occurs frequently in malnourished children
N
P
T
E
L

94. Vitamin B3 (Niacin)
• An essential amino acid, tryptophan serves as its precursor
• Source: liver, kidney meat, poultry, fish, legumes and groundnut
• Milk is a poor source of niacin but its proteins are rich in tryptophan which is
converted in the body into niacin
• Deficiency : Pellagra
Characterized by three D's - Diarrhoea, Dermatitis & Dementia
N
P
T
E
L

95. Vitamin B6 (Pyridoxine)
• Source: Milk, liver, meat, egg yolk, fish , whole grain cereals, legumes, vegetables
• Deficiency - Peripheral neuritis
Folate (Vit B9)
• Source: liver, meat, dairy products, eggs, milk, fruits
and cereals, leafy vegetables
• Overcooking destroys much of folic acid
• Deficiency – Megaloblastic anaemia, glossitis, cheilosis,
GI disturbances, Nural tube defects in new born
N
P
T
E
L

96. Vitamin B12 (Cobalamin)
• Source: liver, kidney, meat, fish , eggs, milk and cheese
• Not found in foods of vegetable origin
• Function: Red cell formation, DNA synthesis, growth & repair of new cells
• Absorption required Intrinsic factors in Intestine
• Deficiency- Megaloblastic anaemia
Initially deficiency masked by high intake of Folate in diet
N
P
T
E
L

97. Vitamin C (Ascorbic acid)
• Potent antioxidant
• Source: fresh fruits (Guava) and green leafy vegetables
• Germinating pulses contain good amounts
• Amla is the richest sources of vitamin C
• Deficiency – Scurvy
Signs: Bleeding gums, subcutaneous bruising or bleeding
into skin or joints, delayed wound healing, anaemia,
weakness
N
P
T
E
L

98. Minerals
• MAJOR MINERALS : Calcium , phosphorus, sodium, potassium and magnesium
• TRACE ELEMENTS : Iron , iodine, fluorine , zinc , copper cobalt, chromium,
manganese etc.
• These are elements required by the body in quantities of less than a few
milligrams per day
N
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T
E
L

99. Calcium
• Formation of bones and teeth, coagulation of blood, contraction of muscles,
cardiac action, milk production
• Relay of electrical and chemical messages & keep the membranes of cells intact
• Metabolism of enzymes and hormones
• Source: Milk and milk products, egg, fish
N
P
T
E
L

100. Sodium
• Sodium is found in all body fluids
• Added to food during cooking in the form of sodium chloride
• Sodium is lost from the body through urine and sweat
• Depletion of sodium chloride causes muscular cramps
• Adult requirement of salt is about 5 g /day
• Intake of more than 10 g of salt/ day have definitive tendency
to raise blood pressure
N
P
T
E
L

101. • Potassium: Vasoactive, increases blood flow & sustains metabolic needs
• Source: Fruits (banana) & vegetables, leafy greens, lentils, coconut water
• Magnesium
• Deficiency occur in chronic alcoholics, cirrhosis of liver, toxaemia of pregnancy,
protein-energy malnutrition and malabsorption syndrome
• Source:Whole grains and dark-green, leafy vegetables
Low-fat milk and yogurt, dried beans and legumes , nuts
N
P
T
E
L

102. Iron
• Formation of hemoglobin, brain development and function, regulation of body
temperature, muscle activity, and catecholamine metabolism
• Central function of iron is "oxygen transport", and cell respiration
• Heme-iron: Liver, meat, poultry and fish; readily available iron
• Non-heme iron: Cereals, green leafy vegetables, legumes, nuts,
oilseeds, jaggery and dried fruits; Bioavailability is poor
• Phytates in bran, phosphates in egg yolk, tannin in tea
and oxalates in vegetables inhibit absorption
N
P
T
E
L

103. • Park’s Text Book of Preventive & Social Medicine
(25th Edition)
• Indian Food Composition Tables (NIN-ICMR), 2017
• Community Medicine with Recent Advances (AH
Suryakantha), 4th Edition
N
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E
L

104. N
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105. Lecture 05 – Basics of Adolescent Mental Health
1
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106.  Importance of Mental health in Adolescents
 Mental health issues of Adolescents
 Reasons for Conflicts in Adolescents
 Factors affecting Psychological health of Indian Adolescents
 Warning signs in Adolescents
 Role of Parents
 Promotion and Prevention of Mental health issues
2
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107.  Adolescent
 Mental Health
 Suicide
 Depression
 Warning signs
 Substance abuse
 Life skills
3
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108. What is Health?
According to WHO,
Health is a state of complete
 Physical
 Mental and
 Social well- being
AND
 Not merely the absence of disease or infirmity
4
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109. What is Mental Health?
According to WHO,
Mental health is a state of wellbeing that involves
 Being able to recognize own abilities
 Coping with normal stressors
 Working productively
 Contributing to society
5
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110. Why Mental Health in Adolescents is important?
 India accounts for one-fifth of the World’s Adolescent population
 Adolescence: Unique, formative and challenging phase
 Neither too young nor too old
 Nearly 50% of Mental health issues start by the age of 14 years
 Mental health problems account for 45% of the burden and
dysfunctionalities in the Adolescent population
6
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111. Why Mental Health in Adolescents is important?
Contd…..
 Good mental health helps Adolescents develop the resilience to face
challenges in life
 Adolescents have the creativity and potential to bring about change
 Physical, sexual, cognitive, social and emotional changes
 Invoke anxiety amongst Adolescents and parents alike
 Amongst others, depression, suicide, substance abuse are of
a great deal of significance
7
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112.  Depressive disorders
 Anxiety disorders
 Conduct disorders
 Attention Deficit Hyperactivity Disorder
 Eating disorders
What are various Mental health issues
Adolescents face?
8
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113. Depressive Disorders
9
 It is a condition that involves the body, mood,
and thoughts
 It interferes with normal functioning of daily life
Examples
 Major Depressive disorders (Major Depression)
 Dysthymia
 Premenstrual dysphoric disorders
 Psychotic depression
 Seasonal affective disorder
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114.  Group of mental illnesses
 Constant and overwhelming anxiety and fear
 The excessive anxiety can make avoid social
situations
Examples
 Generalized Anxiety disorder
 Panic disorder
 Special phobias
Anxiety Disorders
10
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115.  Pattern of aggression
 Towards others
 Serious violation of rules and social norms
 At home, in school and with peers
Conduct Disorders
11
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116.  Ongoing pattern of inattention
 Having difficulty staying on task and sustaining focus
 Hyperactive – continuous movement without reason
 Extreme restlessness
 Impulsivity - may act without thinking or have difficulty
with self-control
Attention Deficit Hyperactivity Disorder
12
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117. Anorexia nervosa
 Abnormally low body weight
 An intense fear of gaining weight
 Severely restrict the amount of food they eat
 Distorted perception of weight
Bulimia nervosa
 Secretly binge eat
 Get rid of calories
 Prevent weight gain
 Self induced vomiting, laxatives
 Diuretics, weight loss supplements
Eating disorders
13
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118. Estimates of number of mental disorders globally for girls
and boys aged 10–14 and 15–19, 2019
14
Source: Adolescent mental health statistics - UNICEF DATA
N
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119. Prevalence of anxiety, depression, and other mental
disorders among adolescent boys and girls aged 10-19,
2019
15
Source: Adolescent mental health statistics - UNICEF DATA
N
P
T
E
L

120. Top 10 causes of death for adolescent boys and girls
aged 15-19
16
Source: Adolescent mental health statistics - UNICEF DATA
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121. Why Conflicts Arise among Adolescents?
 Freedom and responsibility
 Individuality and independence
 Cooperation
 Authority
 Competition
17
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122. Factors affecting Psychological health of Indian
Adolescents
 Poor social support
 Breakdown of extended and joint families
 Smartphone and social media
 Increasing gaps between aspirations and possible achievements
 Substance abuse
18
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123. What are the Warning signs in Adolescents?
 Excessive sleep
 Lack of interest, spending time alone
 Decline in academic performance
 Weight loss
 Irritability, anger, aggressiveness and
other behavioural problems
 Mood changes, worries, fears
 Suicidal ideation or self harm
 Unexplained physical symptoms
19
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124. What Parents should do?
 Respect their opinion
 Respect their need for privacy
 Encourage healthy family and social times
 Show interest, love, affection and care
 Praise their achievements when warranted
 Encourage them to talk about feelings and emotions
20
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125. Promotion and Prevention of Mental health issues
 Healthy Sleep patterns
 Regular exercise
 Developing coping and problem solving styles
 Good interpersonal skills
 Learning to manage emotions
 Supportive family
 Life skills education
21
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126. TAKE HOME MESSAGE
22
 Adolescence: Unique, formative and challenging phase
 Anxiety and depression disorders are more prevalent
 Important to identify warning signs
 Promoting and preventing mental health issues
 Seek professional help when required
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127. 1. Mental health of adolescents [Internet]. [cited 2023 Apr
05];Available from: https://www.who.int/news-room/fact-
sheets/detail/adolescent-mental-health
2. Adolescent mental health statistics [Internet]. UNICEF DATA
[cited 2023 Apr 06];Available from:
https://data.unicef.org/topic/child-health/mental-health/
3. Nebhinani N, Jain S. Adolescent mental health: Issues,
challenges, and solutions. Ann Indian Psychiatry 2019;3(1):4.
23
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128. 24
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