This document discusses adolescent nutrition and recommended interventions. It begins by defining adolescents as those aged 10-19 according to WHO and Ethiopian guidelines. Adolescence is an important period for growth and development but one that is often neglected. Nutritional challenges during this period can affect long-term health and development. Factors like sexual maturation increase nutritional needs. Common problems include undernutrition, anemia, and vitamin/mineral deficiencies. Social norms and taboos also negatively impact adolescent girls' nutrition. Recommended interventions include nutrition education, counseling, improving access to services, and creating supportive environments. Nutrition assessments should monitor indicators like BMI and micronutrient status to identify those at risk.

1. ADOLESCENT NUTRITION
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2. Objectives
At the end of this session, participants will be able to describe:
Adolescent Perceptions on Food and Eating, Their Common Eating Behaviors
and Healthy Diet
The Social Norms on Food Taboo Preventing Adequate Nutrition for
Adolescent
 The recommended nutrition intervention for adolescents
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3. Adolescent Nutrition
Brainstorming and Large Group Discussion
1. What is the recommended age group to define adolescent?
2. What are the reason for focusing on adolescents?
3. What are the factors that increase nutrition requirements of adolescents?
4. What are the adolescent Perceptions on Food and Eating?
5. What are the Social Norms and Food Taboo Preventing Adequate Nutrition?
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4. The Basics of Adolescent Nutrition
Adolescents as defined by the World Health organization
(WHO) includes persons aged 10-19 years.
The Ethiopian national nutrition program (NNP2 2016-
2020) has considered adolescent as a person’s age between
10-19 years, mainly because of the contribution of delaying
first pregnancy until age of 19, which is very important for
reduction of low birth weight and stunting.
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5. Reason for Focusing on Adolescents
Health services in developing countries focus mainly on preschool-age
children and women who are pregnant,
Adolescence is the most neglected period of the life cycle.
It is not getting the required attention while adolescents make up over 20
percent of the total world population (Ethiopia 33-35%).
This high percentage of the population faces a series of serious nutritional
challenges not only affecting their growth and development but also their
livelihood as adults.
Adolescence is the time in life besides the critical window of the first 1,000
days to break the malnutrition cycle when the velocity of growth actually
increases ( Now, first 1,000 day+).
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6. Reason for Focusing on Adolescents…
Improving adolescent girls’ nutrition has the following reproductive health
benefits
Increased pre-pregnancy weight and body stores of nutrients, thus,
contributing to improved future pregnancy and lactation outcome, while
preserving the mother’s nutritional status and well-being.
Improved iron status will reduce the risk of anemia in pregnancy, low birth
weight, maternal morbidity and mortality, and enhance work productivity
and perhaps linear growth;
Improved folate status, will reduce risk of neural tube defects in the
newborn and megaloblastic anemia in pregnancy.
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7. The Main Nutrition Problems Affecting Adolescent Populations Worldwide
Under nutrition
Iron deficiency anemia
Iodine deficiency
Vitamin A deficiency
Calcium deficiency and
Obesity
Other specific nutrient deficiencies like zinc, foliate, …
According to EDHS 2011
o In Ethiopia, the proportion of non-pregnant adolescents aged 15-19 years with chronic malnutrition
(BMI <18.5) was (36% Change to 2016/2019)
o The prevalence of anemia in adolescents aged 15-19 years was 13% 7

8. Factors that Increase Nutrition Requirements of Adolescents:
Sexual maturation;
Increases in height and weight;
Completion of skeletal growth accompanied by a marked increase
in skeletal mass
Changes in body composition
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9. Factors that Increase Nutrition Requirements of Adolescents…
Due to biological and physiological changes during adolescence, there is
increased nutritional need at this stage
 Adolescents gain up to 50% of their adult weight, more than 20% of their
adult height, and 50% of their adult skeletal mass during this period
Caloric and protein requirements are maximal.
Mineral and vitamin needs during adolescence are increased due to the
rapid growth and development;
Calcium needs during adolescence are greater than they are in either
childhood or adulthood because of the dramatic increase in skeletal
growth;
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10. Factors that Increase Nutrition Requirements of Adolescents…
The need of iron also increases with rapid growth and the
expansion of blood volume and muscle mass. The onset of
menstruation imposes additional iron needs for girls;
Zinc is important in adolescence because of its role in
growth and sexual maturation; and infection
Iodine is important for proper growth and development
Vitamins are also very important to ensure appropriate
growth and development during adolescence.
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11. Factors that Increase Nutrition Requirements of Adolescents…
Dietary fiber is important for:
Normal bowel function
Play a role in the prevention of chronic disease (certain ca, CAD, type-
II DM)
Reduce serum cholesterol levels
Reduce the risk of obesity (By regulating serum glucose level)
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12. Adolescent Perceptions on Food and Eating, Their Common Eating
Behaviors and Healthy Diet
Adolescent Perceptions on Food and Eating
• Adolescent food choices and eating behavior are influenced by
taste, hunger, convenience, availability, and parental and
cultural influences.
• Many adolescents feel that healthy eating is not a primary concern
during the teenage years.
• Adolescents say that in order to improve their eating, healthy
foods should be appealing and taste good and more widely
available.
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13. Adolescent Perceptions…
Common Eating Behaviors of Adolescents
The cognitive, physical, social and lifestyle changes during adolescence can
create profound changes in their eating patterns.
Teens, as a group, tends to Snack, miss meals, eat away from home,
consume fast foods, and diet (especially among girls-Widespread practice)
more frequently than younger children.
Snacking
Adolescents consume at least one snack per day.
However, if the adolescent has a high BMI then the snacks should be low
in sugar, sodium and fat and high in vitamins and minerals.
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14. Adolescent Perceptions…
Non-traditional eating patterns
Eating patterns such as vegetarianism may be adopted as
a way of exploring new roles and lifestyles, testing adult
restrictions or becoming interested in global or
environmental issues.
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15. Healthy Diet
A healthy diet provides enough calories and nutrients for growth
and health.
Healthy diet plans can help to prevent health problems such as
Anemia
Eating disorders
DM
Obesity.
Etc…
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16. What is Healthy Diet
Healthy diet is-
Aiming for regular meals and healthy snacks
Eating food from all of the food groups each day to meet the nutritional
requirements
Balancing nutrient rich food with moderate amount of other food such as
sweets
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17. What is Dietary diversity?
Dietary diversity is
Eating a variety of food groups at every meal.
Is Food contains at least four food groups on each meal
Adolescents should eat at least four or more groups as indicated in the
table below.
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18. Diversified food Table

19. The Social Norms and Food Taboo Preventing Adequate Nutrition of Adolescent in East and
West Hararghe Zones of Oromia Region and Gewane Woreda of Afar Regions
A rapid assessment recently carried out by CARE Ethiopia in East and West
Hararghe zones of Oromia region and Gewane woreda of Afar showed that;
 Adolescents (both male and female) are not given special attention on
nutrition and dietary issues
 Families used to consider them as any member of the family in the
community.
 The feeding practice of males and females is not the same and the
community prioritizes feeding of adolescent boys than adolescent girls and
mothers.
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20. The Social Norms and Food Taboo…
 This practice is related to the better respect given to men
 Adolescents (male and female) in the area are usually engaged in helping
their families on the farm, and shepherding livestock, alongside schooling
activities as their daily job.
 One of the informants reported hearing that if a girl eats food containing
red paper her interest towards men will increase and food containing red
paper is not given.
 Adolescent girls were discouraged from eating ground nut because of the
perception that it increases their sexual desire towards male even though
this perception is showing a decreasing trend.
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21. The Social Norms and Food Taboo…
 Previously it was believed that if an adolescent girl drinks milk she will
refuse to take a command from her parents and others
 Furthermore, when adolescent girls are back from school, they will be
ordered to go and fetch water or collect fuel wood so they don’t get the
time to eat properly and because of economic dependence, females and
adolescent girls don’t get balanced diet.
 because of fear, Adolescent girls may not eat together with other members
of the family and even when they sit together for food they eat a small
amount because of traditional norms related to how women and girls
should behave.
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22. The Recommended Nutrition Intervention for Adolescents
Nutrition Intervention for Adolescents: Integration of Health, Nutrition and
Development Programs for Adolescents
 Interventions for adolescents should include:
1. Provide accurate knowledge through SBCC
2. Build skills;
3. Provide counseling;
4. Improve access to health and nutrition services; and
5. Create safe and supportive environments.
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23. The Recommended Nutrition Intervention for Adolescents…
Under the Health Sector the interventions are;
1. Conduct SBCC using all opportunities such as Health extension program
(HEP) outreach, community conversation, school health programs etc...
2. Conduct individual counseling and provide comprehensive and nutritional
assessment and counseling services for adolescents during HEP outreach
and house to house visits;
3. Conduct regular monitoring of the nutritional status of adolescents
during school health service programs;
4. provide school based, and health facility based for out of school
adolescents biannual deworming
5. Ensure adolescents access to micronutrient services:
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24. …Cont
6. Provide youth friendly reproductive health services at facility level
7. Promote economic empowerment for out of school adolescents through
various economic strengthening opportunities;
8. Provide youth-friendly nutrition counseling for pregnant adolescents as
part of ANC;
9. Provide clinical care for infections and other conditions:
11.Management of acute malnutrition in adolescents, particularly in
emergency situations.
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25. Nutrition Assessment and Counseling
 Nutrition assessment is a tool used to identify those adolescents
who are
at risk of under/over-weight/obsese
Micronutrient deficiency; and
to assess related risk factors

26. Nutrition Assessment and Counseling…
 The screening for adequacy of dietary intake and nutritional status
of adolescent and youth should be
 conducted periodically and as required
It is advisable to include common indicators of nutritional
risk like growth (underweight and over overweight)
physical activity
Hyperlipidemia
Hypertension
Iron deficiency anemia,
food insecurity

27. Nutrition Assessment and Counseling…
 The screening for adequacy of dietary intake and
nutritional status of adolescent and youth should be…
Eating disorder
pregnancy,
Abnormal blood sugar
substance and alcohol use
 and excessive intake of foods and beverages that have high
fat or sugar contents.
Helps in identifying adolescents, who may be at nutritional risk
or potentially at risk, and who may benefit from appropriate
nutritional intervention.

28. Nutrition Assessment and Counseling…
 Nutrition assessment should be rapid and simple
 It begins with history and an accurate measurement of height and
weight
 calculation of BMI (body mass index)
 These data should be plotted on age and sex appropriate WHO
2007 growth charts to determine the nutritional status.
 The result of this assessment should be accompanied by an in-
depth nutritional assessment for those with abnormal results
and/or positive risk factors.

29. Recommended BMI for Age cutoff, WHO Growth reference 5-19 years
BMI = Weight in Kg/height in mt2
BMI (kg/m 2) Classification
≥ 95th percentile Obesity
85th to < 95th percentile Overweight
15th to < 85th percentile Healthy Weight
< 15th percentile Thinness/Underweight

30. Steps to plot and interpret BMI for age
 Step 1: Obtain accurate weights and height
 Step 2: Select the appropriate growth chart (age & gender)
 Step 3: Record the data
 Step 4: Calculate BMI
 Step 5: Plot measurements
 Step 6: Interpret the plotted measurements

33. In-depth Nutrition Assessments
 A complete and in-depth nutrition assessment should include a
survey of all available medical, psychosocial and laboratory data
 Detailed information on general dietary intake, adequacy as well
as information specific to the identified health risk, should be
obtained through rigorous dietary assessment

34. Elements of a Nutrition Assessment for Adolescents
Medical and
Psychosocial
History
Growth and
Development
Diet and Physical
Activity
Routine screenings and
Laboratory Tests
Components
of an initial
Nutrition
screening
 Medical
history
 Psychosocial
history
 Socioeconomic
status and history
BMI for age  Meal and snacking patterns
 Nutrient and non
nutrient
 supplement use
 Food security
 Food allergy intolerances
 Special dietary practices
 Alcohol consumption
 Physical activity and
competitive sports
 Hemoglobin (females)
 Serum cholesterol
or blood lipids
 Blood pressure

35. Elements of a Nutrition Assessment for Adolescents…
Medical and
Psychosocial
History
Growth and
Development
Diet and Physical
Activity
Routine screenings and
Laboratory Tests
Indications of
an in-depth
nutrition
assessment
 Chronic disease
 Substance use
 Poverty
 Depression
 Eating disorder
 Body image
disorder
 Pregnancy
or
lactation
Underweight
Overweight
At-risk for
overweight
Delayed sexual
maturation
Short stature or
stunting
 Food insecurity
 Meal skipping
 inadequate micronutrient intake
 Excessive intake of total or
 saturated fat
 Food allergy or intolerance
 Vegetarian diet
 Competition in competitive
sports
 Fasting
 Alcohol consumption
 Hypertension
 Hyperlipidemia
 Iron deficiency anemia

36. Nutrition Education and Counseling
 One of the keys to effective nutrition education and counseling of
adolescents is a good understanding of normal adolescent
psychosocial development.
 Adolescents are striving to achieve independence yet they are
highly influenced by the beliefs and behaviors of peers.
 They are developing abstract reasoning skills, however they may
revert to more concrete cognitive skills when faced with new
challenges or perceived stressful situations.
 These aspects of adolescent development need to be integrated
into all nutrition education and counseling (as classroom nutrition
education presentations or individual counseling sessions)

37. General Consideration for Nutrition Education and Counseling
 Nutrition education involves teaching the client about the
importance of nutrition, providing educational materials that
reinforce messages about healthy eating.
 Teaching adolescents skills essential for making dietary
change, and providing information on how to sustain behavior
change
 Use the information gathered during nutrition screening during
nutrition education and counseling sessions.
 Adolescents who have one or more indicators of nutritional risk
should be included for counseling.

38. General Consideration for Nutrition Education and Counseling…
 Prior to beginning the education process, it is helpful
to assess:
 what the adolescent already knows about nutrition
 How ready they are to adopt new eating behaviors and
 If there are any language or learning barriers that may need
to be addressed in order to facilitate the nutrition education
process

39. Case study
 Bachu age 16 came to health facility for nutrition services.
She weighs 35 kg and height of 1.5m. Bachu gets the least
attention regarding diet in the family and she also believes
that she is already grown and usually doesn’t get adequate
and variety of food. She commonly misses breakfast and
sometimes dinner. She has fatigue and dizziness and not
able to attend and concentrate on school.
 Demonstrate how you can counsel Bachu using GALIDRAA
and counseling and classify BMI for Age.

40. Case study…
Hana is a young woman of 17 years who has recently married. You talk
to her about the need to eat adequately.
Ayantu is in her last month of pregnancy and does not know where
she will give birth. (PW)
Chaltu is a 13 years young woman learning grade 5 she is skipping her
meals fearing her over weight. (Adolescent)
You visit Lelise who is 4 months pregnant. Lelise has not yet visited the
health clinic. (BF)

41. Adolescents and women nutrition
Group work
 Prepare the six food Group
 Adolescent nutrition
 Food Taboos
 Beliefs
 Pregnant Women nutrition
 Food Taboos
 Beliefs
 Lactating Women nutrition
 Food Taboos
 Beliefs

42. Galatoomaa!!!
July 6, 2023 42