Adolescent Nutrition

Introduction

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Formation of healthy eating patterns during adolescence is vital for growth, development, and reducing weight-related problems.  While adolescents have increased nutritional needs for growth and development, the highest prevalence of nutritional deficiencies occurs during adolescence.

Adolescents frequently consume inadequate fruits, vegetables, whole grains, and calcium, and exhibit excess consumption of of sweetened beverages and fast-food.  Food habits developed during adolescence are often carried into adulthood, and long-term complications of poor eating habits can include obesity, heart disease, hypertension, diabetes mellitus, hyperlipidemia, obstructive sleep apnea, osteoporosis, and cancer. 

An obese adolescent has a 90% risk of remaining obese as an adult, and the rate of adolescent obesity has risen from 5% in 1980 to 18% in 2010.

It is important for the pediatrician to be familiar with normal daily requirements in order to address any deficiencies or excess.  A diet and nutritional history is necessary while assessing adolescents at each of their checkups.

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Furthermore, the following advice is important not just for the adolescent but for the entire family.  Having meal preparation & eating routines, together, without television and seated at a table promotes not only better nutritional outcomes but improves family bonding and communication as well.

 

Evaluation of adolescent nutrition should include:

  • Evaluating growth and weight gain.  Make note of any weight loss, excessive weight gain, or failure to grow.
  • Amount of physical activity; Recommend ≥ 60 minutes/day
  • Quantity, quality, and number of meals/snacks per day
  • More:  Fruits, vegetables, whole grains, calcium, low-fat dairy
  • Less:   Sweetened beverages, fast food

 

Identify risks for nutritional deficiencies:

  • Eating disorders
  • Chronic medical conditions
  • Use of alcohol or drugs
  • Strict vegan diet
  • Low socio-economic status

 

Daily caloric requirements for adolescents

Daily Caloric Requirements:
9–18 year olds

Female

Male

Sedentary

1400-1800

1600-2400

Moderately Active

1600-2000

1800-2800

Active

1800-2400

2000-3200


 

Vitamins

Most commonly adolescents are deficient in vitamins A, B6, E, D, C, and folic acid. Usually, adolescents who are eating normal daily requirements of nutrients are not deficient in vitamins. Vitamin supplements may be added to meet requirements.
 

  • Vitamin D:
     
    • 15mcg/day or 600 IU/day. Found in fortified milk and cereal, egg yolks. Prevalence of deficiency is 14%; 20 times higher in non-Hispanic, black adolescents, twice as high in females and inversely related to weight
       

 

Meal compostion

The USDA replaced the previous "food pyramid" paradigm and instead now advocates use of ChooseMyPlate - a more illustrative example of the five food groups that are the building blocks for a healthy diet using a familiar image - a place setting.

Click on the link below to go to ChooseMyPlate.gov for resources such as recipies, trackers, resources for low budget eating, and daily food plans

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Fruits/Vegetables

Fewer than 2% of adolescents consume enough fruits and vegetables. Should total 3-6.5 cups per day.  Should make up HALF OF EACH PLATE (see diagram above).

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Grains:

½ of grains should be whole grain.  Examples include whole-wheat bread, brown rice, buckwheat, bulgur, oatmeal, rolled oats, quinoa, wild rice.
 

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Milk/Dairy:

3 cups per day. Skim or low-fat milk.

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Vegetarian Diets:

Vegetarian children tend to have lower BMI. Ensure adequate B12, folate, iron and zinc through either diet, supplementation or both.

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Items to avoid & counsel against:

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  • Avoid sugar-sweetened drinks - they provide excess calories with few nutrients.  Higher consumption linked with higher body weight in adolescents.  Includes soda, energy drinks, sports drinks like Gatorade & Vitamin Water.

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“Performance enhancing” supplements:

  • Creatine
    • Combination of glycine, arginine and methionine that facilitates production of adenosine triphosphate and increases free energy for muscle contractions. Not well studied in adolescents but in adults, creatine does not improve long duration aerobic performance.
    • Side effects include weight gain, headache, diarrhea, muscle strain and potentially increased risk of renal damage.
  • DHEA and androstenedione
    •  Precursors to testosterone. Not well-studied.
    • Side effects include HTN, hyperinsulinism, depression, paranoia, acne, as well as irreversible virilization in females and gynecomastia in males.

 

Further tips on eating healthy

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President's Council website with resources for eating healthy and being active.

 

Healthy recipe ideas

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CDC website with quick, tasty and healthy treats familes can easily make.

 

Tables

Click HERE for a PDF for the daily caloric recommendations for adolescents.

 

References

  1. Larson, N. Neumark-Sztainer, D. Adolescent Nutrition. Pediatr Rev 2009; 30:494-496.
  2. National Center for Health Statistics. Health, United States, 2011: With Special Features on Socioeconomic Status and Health. Hyattsville, MD; U.S. Department of Health and Human Services; 2012.
  3. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. Journal of the American Medical Association2012;307(5):483-490.
  4. Saintonge et al.  Implications of new definition of vitamin D deficiency in a multi-racial US adolescent population. Pediatrics. Mar. 2009 123 (3): 797.
  5. Schneider, M. Brill, S. Obesity in Children and Adolescents. Pediatr Rev 2005; 26; 155-162
  6. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Ofice, December 2010.
  7. Venkdeswaran, R. Nutrition for Youth. Clinical Family Practice Dec 2000 2(4) 791-822
  8. Wahl, Richard. Nutrition in the Adolescent. Pediatric Annals Feb. 1999
  9. Wang W. Diet in Mid-puberty and sedentary activity in pre-puberty predicting peak bone mass. American Journal of Clinical Nutrition. 77(2) 495. 2003