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Adolescent Nutritional Needs

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Adolescent Nutritional Needs Powered By Docstoc
					Adolescents and
  Nutrition
   Larissa and Theresa
   November 13, 2007
    Creative Lunches

  Baby carrots with spicy red pepper hummus
Skewers with mozzarella, grape tomato, and basil
     Pasta with lemon-basil pesto and feta
Honey roasted turkey, low-fat ranch and avocado
           pinwheels (flour tortillas)

     Recipes courtesy of the Food Network
               ---------------------------
Krusteaz fat-free muffins with apples and walnuts
              Chocolate Chip cookies
Adolescents and Nutrition

         Chapter 14 Outline
     Nutritional Needs in a Time of Change
    Normal Physical Growth and Development
        Normal Psychosocial Development
   Health and Eating-Related Behaviors During
                     Adolescence
     Energy and Nutrition Requirements of
                     Adolescents
     Nutrition Screening, Assessment, and
                     Intervention
           Physical Activity and Sports
    Promoting Healthy Eating and Physical
                 Activity Behaviors
Nutritional Needs in a
  Time of Change
Nutritional Needs in a
  Time of Change

“Adolescents” are defined as young adults
   from the ages of 11-21 years of age.

Due to the specific developmental changes
 that adolescents go through, their specific
nutritional needs are different from those of
             children or adults.
Nutritional Needs in a
  Time of Change

The tasks of adolescence include the development of a
 personal identity and a unique value system separate
from parents and other family members, a struggle for
 personal independence accompanied by the need for
   economic and emotional family support, and the
 adjustment to a new body that has changed in shape,
            size, and physiologic capacity.
Nutritional Needs in a
  Time of Change

      The dramatic physical growth and
  development experienced by adolescents
significantly increases their needs for energy,
        protein, vitamins and minerals
Nutritional Needs in a
  Time of Change
     The search for personal identity and
independence among adolescents can lead to
positive, health-enhancing behaviors such as
    adoption of healthful eating practices,
    participation in competitive and non-
competitive physical activities, and an overall
  interest in developing a healthy lifestyle.
Normal Physical Growth
   and Development
Normal Physical Growth
   and Development

      Early adolescence encompasses the
 occurrence of puberty, which is the physical
 transformation of a child into a young adult.
Normal Physical Growth
   and Development

   The biological changes that occur during
               puberty include:
              Sexual maturation
        Increases in height and weight
        Accumulation of skeletal mass
        Changes in body composition
Normal Physical Growth
   and Development

       Even though the sequence of these events are
      consistent among adolescents, the age of onset,
    duration, and tempo of the events will differ. These
  variations directly affect the nutrition requirements of
   adolescents. Therefore, the “biological age” or sexual
  maturation should be used to assess biological growth
  and development and the individual nutritional needs
       of adolescents rather than chronological age.
Normal Physical Growth
   and Development


              The Tanner Stages
  The Tanner Stages, also known as sexual maturation
 rate (SMR) is a scale of secondary sexual characteristics
 that allows health professionals to gauge the degree of
         pubertal maturation among adolescents.
Normal Physical Growth and
Development

                       Tanner Stages for Girls
  Stage                            Breast Development
    1                       Prepubertal, nipple elevation only
    2                            Small, raised breast bud
    3              General enlargement of raising of breast and areola
    4     Further enlargement with projection of areola and nipple as secondary
                                          mound
   5      Mature, adult contour, with areola in same contour as breast, and only
                                     nipple projecting


  Stage                           Pubic Hair Growth
    1                          Prepubertal, no pubic hair
    2                      Sparse growth of hair along labia
    3      Pigmentation, coarsening, and curling, with an increase in amount
    4          Hair resembles adult type, but not spread to medial thighs
    5            Adult type and quantity, has spread to medial thighs
Normal Physical Growth and
Development

                       Tanner Stages for Boys
 Stage                               Genital Development
   1      Prepubertal, no change in size or proportion of testes, scrotum, and penis
                                     from early childhood
  2       Enlargement of scrotum and testes, reddening and change in texture in
                        skin of scrotum, little or no penis enlargement
  3      Increase first in length, then width of penis, growth of testes and scrotum
  4      Enlargement of penis with growth in breadth and development of glands;
              further growth of testes and scrotum, darkening of scrotal skin
  5                             Adult size and shape genitalia


 Stage                            Pubic Hair Growth
   1                           Prepubertal, no pubic hair
   2                     Sparse growth of hair at base of penis
   3        Darkening, coarsening, and curling, with an increase in amount
   4           Hair resembles adult type, but not spread to medial thighs
   5             Adult type and quantity, has spread to medial thighs
Normal Physical Growth and
Development
       Among females, the first signs of
         puberty develop consistently:
       Development of breast buds and
         sparse, fine pubic hair (SMR
         Stage 2) at around 8-13 years
         old
       Menarche occurs 2 to 4 years
         after the onset of SMR Stage 2
         (SMR Stage 4), at an average
         age of 12-14 years old, but as
         early as 9-10 years old, and as
         late as 17 years old
Normal Physical Growth
   and Development


  Ethnic and racial differences are evident in
 the initiation of sexual maturation in females.
Normal Physical Growth
   and Development

 Onset of the linear growth spurt occurs most
  commonly during SMR Stage 2 in females,
 beginning between age 9.5 and 14.5 years old.
  As much as 15% to 25% of final adult height
    will be gained during puberty, with an
       average height gain of 9.8 inches.
Normal Physical Growth
   and Development


 The linear growth spurt in females lasts for 24
 to 26 months, usually ceasing around age 16.
  Linear growth maybe delayed or slowed in
     females with severe calorie restriction.
Normal Physical Growth and
Development
       Among males, the first signs of puberty
          develop consistently:
       Enlargement of the testes generally
          occurs between 9.5 and 13.5 years
          old (SMR Stage 2 to 3)
       Changes in scrotal color occurs between
          ages 10.5 and 14.5 years old, with an
          average age of 11.6 years old
       “Spermarche” generally occurs around
          age 14
Normal Physical Growth
   and Development

 Onset of the linear growth spurt occurs most
   commonly during SMR Stage 4 in males,
 occurring at an average age of 14.4 years old.
  At peak velocity, the adolescent male will
        gain 2.8 to 4.8 inches per year.
Normal Physical Growth
   and Development


    The linear growth spurt in males lasts
 throughout adolescence, ceasing around age
                     21.
Normal Physical Growth
   and Development


    Changes in Weight, Body
  Composition, and Skeletal Mass
Normal Physical Growth
   and Development

 As much as 50% of ideal adult weight during
 adolescence. In females, the peak weight gain
    follows the linear growth spurt by 3 to 6
  months. In this peak time, females will gain
  an average of 18.3 lbs per year. Weight gain
     will continue through adolescence, and
  females may gain up to 14 lbs in the second
               half of adolescence.
Normal Physical Growth
   and Development


  Peak muscle mass accumulation occurs
  around or just after the onset of menses.
Normal Physical Growth and
Development
Besides weight gain, the body composition of
     females dramatically changes during
     puberty, with average lean body mass
       decreasing, and average body fat
                  increasing.


 80% 80%     74%
 60%
                               Lean body mass
 40%
              27%              Body fat
 20%   16%
  0%
Normal Physical Growth
   and Development

 Adolescent females gain approximately 2.5
   lbs of body fat each year during puberty.
  Research suggests that females must have
  approximately 17% body fat for menarche
 and 25% body fat for the development and
 maintenance of regular ovulatory menstrual
                     cycles.
Normal Physical Growth
   and Development
  Even though the gain of body fat is normal
  and necessary for females during puberty,
       some view this negatively. Weight
   dissatisfaction is common among teenage
      females, and can lead to potentially
      dangerous behaviors such as calorie
  restriction, chronic dieting, use of laxatives
 and/or diet pills, and can sometimes lead to
      development of an eating disorder.
Normal Physical Growth
   and Development

  In males, peak weight gain coincides with
 peak linear growth and peak muscle mass
   accumulation. During peak weight gain,
   males gain an average of 20 lbs. per year.
 Unlike females, body fat decreases in males
 during adolescence, resulting in an average
   body fat percentage of 12% by the end of
                   puberty.
Normal Physical Growth
   and Development


  Almost 50% of adult bone mass is accrued
  during adolescence. By the age of 18 years,
     almost 90% of adult mass is formed.
Normal Physical Growth and
Development
       A variety of factors contribute to bone mass
          accrual:
       Genetics
       Hormonal changes
       Weight bearing exercise
       Smoking
       Alcohol consumption

       Dietary intake of:
       Calcium
       Vitamin D
       Protein
       Phosphorus
       Boron
       Iron
Normal Physical Growth
   and Development


      Due to the content of bone (calcium,
  phosphorus, and protein), adequate intakes
 of these nutrients are especially important for
    optimal bone growth and development.
Normal Physical Growth
   and Development


  Almost 50% of adult bone mass is accrued
  during adolescence. By the age of 18 years,
     almost 90% of adult mass is formed.
Normal Psychosocial
   Development
Normal Psychosocial
   Development


During adolescence, an individual develops
  a sense of personal identity, a moral and
ethical value system, feelings of self-esteem
  and worth, and a vision of occupational
                 aspirations.
Normal Psychosocial
   Development

The period of psychosocial development can
       be divided into three periods:
     Early adolescence (11 to 14 years)
    Middle adolescence (15 to 17 years)
     Late adolescence (18 to 21 years)
Normal Psychosocial
   Development

             Early Adolescence

 Due to dramatic biological changes in their bodies,
adolescents begin to have a heightened awareness of
  body image and sexuality. The dramatic change to
 shape and size of the body can cause a great deal of
   ambivalence among adolescents, leading to poor
   body images and possibly even eating disorders.
Normal Psychosocial
   Development

   Peer influence is extremely strong during early
  adolescence. Due to being very conscious of their
physical appearance and behaviors, young teenagers
       feel the need to “fit in” with their peers.
    Consequently, young teenagers will develop
preferences and make choices based on those of their
                      peer group.
Normal Psychosocial
   Development

Due to the wide range of age for puberty, adolescents
 (especially males) can run into situations in which
 they are considered “late bloomers”. They can feel
 inferior to their already-developed peers, and can
resort to the use of anabolic steroids or supplements
                       to “fit in”.
Normal Psychosocial
   Development


  Females who mature earlier are reported to have
 more eating problems and poorer body images than
those who develop later. They are also more likely to
   participate in “adult” behaviors earlier, such as
       smoking, drinking, and sexual activity.
Normal Psychosocial
   Development

 Early adolescence is a time dominated by concrete
  thinking, egocentrism, and impulsive behavior.
 Abstract reasoning abilities are not yet developed,
limiting adolescents from being able to understand
 complex health and nutrition issues. They lack the
ability to understand how their behaviors now can
              affect their future health.
Normal Psychosocial
   Development

It is thought that educating adolescents on the normal
variations of age, duration, and tempo of the stages of
 puberty can reduce the feelings of inferiority and not
“fitting in”, as well as decreasing the probability for a
        poor self image or development of health-
                compromising behaviors.

                  What do you think?
Normal Psychosocial
   Development

           Middle Adolescence

   This period of time marks the development of
  emotional and social independence from family,
especially parents. Physical growth and development
       are mostly completed during this stage.
Normal Psychosocial
   Development


  Peer groups become more influential during this
time, and their influence on food peaks during this
                    time as well.
Normal Psychosocial
   Development


Body image issues are still important at this stage of
development. Although abstract reasoning begins to
 develop at this time, the need to “fit in” with peers
may supersede any understanding of the connection
    between current behavior and future health.
Normal Psychosocial
   Development

              Late Adolescence

This period is characterized by the development of a
 personal identity and individual moral and ethical
 beliefs. Physical change is nearly concluded at this
  time, and body image issues are less prevalent.
Normal Psychosocial
   Development

Young adults at this age tend to be less pressured by
  peer groups, and begin to be more influenced by
individual relationships they have. They become less
 dependent on their family for social and economical
 assistance. Personal choices begin to emerge at this
                        time.
Normal Psychosocial
   Development

  Abstract thinking is developed at this time, which
 will assist teens in developing a sense of future goals
and aspirations. They are now able to understand the
    connection between their behaviors and future
 health, and are more likely to modify their behavior
 for the good of their future health. This is especially
important for females who plan to get pregnant in the
                          future.
Health and Eating-Related
    Behaviors During
       Adolescence
 Health and Eating-Related
Behaviors During Adolescence



  Due to the busy lives of adolescents, they don’t have
  much time to sit down and eat a meal. Snacking and
   skipping meals are commonplace among this age
                         group.
 Health and Eating-Related
Behaviors During Adolescence



    Nutrition practitioners working with adolescents
      need to understand that snacking a common
  behavior. Instead of discouraging snacking, the focus
   should be on choosing health snacking alternatives.
 Health and Eating-Related
Behaviors During Adolescence



  Snacking has been shown to account for 25% to 33%
  of the daily caloric intake for adolescents. In parallel,
   the amount of food consumed outside of the home
              (i.e. fast food) is large as well.
Health and Eating-Related
Behaviors During Adolescence
                 Meals

          Only 29% of adolescent
            females eat breakfast
                   daily

          25% of adolescents eat
                 lunch daily

          1/3 of meals are eaten
              away from home
Health and Eating-Related
Behaviors During Adolescence
Health and Eating-Related
Behaviors During Adolescence
                    Fast Food

          31% of all food is eaten outside
                      of the home

               Teens eat at fast food
                 restaurants because:
           Informal, comfortable social
                         setting
             Inexpensive and socially
                acceptable food choices
         Food can be eaten outside of the
                  restaurant for busy
                      individuals
         Service and decision making are
                           fast
          Fast food restaurants employ
              adolescents, increasing the
                   social value of the
                     establishment
 Health and Eating-Related
Behaviors During Adolescence

  Adolescents should be encouraged to make healthier
           choices while eating out such as:

  Water, juice or milk     instead of    Soft drink
  Small sandwiches         instead of    Large choices
  Salad or baked potato    instead of    French fries
  Grilled items            instead of    Fried items
  Fruit and yogurt          instead of   Breakfast
  parfait, fruit cup, or                 sandwiches
  pancakes
 Health and Eating-Related
Behaviors During Adolescence

  Eating together as a family should be encouraged, as
   adolescents who eat family meals generally have
                    higher intakes of:
            Calcium                Folate
              Fiber                 Iron
            Vitamin A           Vitamin C
            Vitamin E           Vitamin B6
                       Vitamin B12
Health and Eating-Related
Behaviors During Adolescence
              Vegetarian Diets

            Approximately 1% of
            adolecents are vegetarian

          Cultural or religious beliefs
           Moral or environmental
                     concerns
                Health beliefs
          A means to restrict calories
                       or fat
            A means of exercising
                independence by
              adopting eating habits
              that are different from
                    the family
 Health and Eating-Related
Behaviors During Adolescence


        Vegetarian diets have shown to affect the
              development in adolescents

     Vegetarians are leaner and shorter in stature
  Menarche occurs 6 months later in vegetarian females
 Health and Eating-Related
Behaviors During Adolescence


     Well planned vegetarian diets can be beneficial,
  especially if small amounts of animal protein, such as
  milk and cheese, have a role. Vegetarian adolescents
   are twice as likely to consume fruits and vegetables,
     one third less likely to consume sweets, and one
   fourth less likely to consume salty snack foods than
                         omnivores.
 Health and Eating-Related
Behaviors During Adolescence


  If the diet restricts all animal-derived food, however,
  there is potential that the adolescent will not receive
                    adequate amounts of:
                  Protein          Calcium
                    Zinc               Iron
                Vitamin D          Vitamin B6
                          Vitamin B12
 Health and Eating-Related
Behaviors During Adolescence



  Adolescents who consume only vegan diets must be
  assessed for adequacy of total fat intake and essential
   fatty acid intake, so that adequate amounts of DHA
                    are being produced.
Health and Eating-Related Behaviors
During Adolescence

Suggested dietary food guide for lacto-ovo vegetarians
                      and vegans

     Food Groups           Lacto-ovo vegetarians          Vegans
                               (11+ years)              (11+ years)
                          2200-2800 calories/day   2200-2800 calories/day
 Bread, grains, cereal             9-11                    10-12
       Legumes                      2-3                     2-3
      Vegetables                    4-5                      1
         Fruits                      4                      3-4
      Nuts, seeds                    1                      4-6
  Milk, yogurt, cheese               3                       1
 Eggs (limit 3/week)                1/2                      3
   Fats, oils (added)               4-6                     4-6
Sugar (added teaspoons)             6-9                     6-9
 Health and Eating-Related
Behaviors During Adolescence


  Adolescents who report being on a vegetarian diet for
  health- or weight-related reasons should be carefully
   evaluated for the presence of an eating disorder or
  unhealthy eating behaviors. Practitioners should help
  the adolescent to explore how to be a vegetarian in a
                      safe manner.
Health and Eating-Related
Behaviors During Adolescence
  Dietary Intake and Adequacy among Adolescents

                   Vegetable Intake
 Only 35% adolescent males and 34% adolescent females
           report adequate intake of vegetables

                     Fruit Intake
 Only 23% adolescent males and 27% adolescent females
           report adequate intake of vegetables

 30% adolescents consume less than 1 serving vegetables
          daily, with potatoes accounting for half

62% adolescent males and 57% adolescent females consume
                less than 1 serving fruit daily
Health and Eating-Related
Behaviors During Adolescence
     Dietary Intake and Adequacy among
                  Adolescents

                    Grain Intake
Adequate grain intake was reported, however intake of
      whole grains was below recommendations

           Meat/Meat Alternative Intake
  Only 50% meet the recommended amount of meat
   servings daily, with 10% of adolescent males and
   18% adolescent females reported consuming less
             than one serving meat daily
Health and Eating-Related
Behaviors During Adolescence
     Dietary Intake and Adequacy among
                  Adolescents

                   Dairy Intake
  Dairy intake is especially low among adolescents.
     Only one third of adolescent males and 17% of
   adolescent females reported adequate amounts of
                   dairy consumption.
39% of adolescent females and 29% of adolescent males
    report consuming less than one serving of dairy
                          daily.
Health and Eating-Related
Behaviors During Adolescence
     Dietary Intake and Adequacy among
                  Adolescents

               Fat and Sugar Intake
32 % of all energy consumed by adolescents is from fat,
   and 21% of energy is consumed in the form of sugar
                  (that’s more than half!).

Male adolescents consume 35 tsp of sugar daily, while
   female adolescents consume around 26 tsp daily.
Energy and Nutrient
  Requirements of
    Adolescents
   Energy and Nutrient
Requirements for Adolescents



  Increases in lean body mass, skeletal mass, and body
    fat that occur during puberty result in energy and
  nutrient requirements that exceed those of any other
                        point in life.
   Energy and Nutrient
Requirements for Adolescents

    In general, adolescents consume diets that are
     inadequate in several vitamins and minerals,
                      including:
             Folate            VitaminA
          Vitamin B6           Vitamin C
          Vitamin E               Iron
             Zinc              Magnesium
          Phosphorus            Calcium
             as well as dietary fiber
    Energy and Nutrient Requirements for
    Adolescents
                             Macronutrient Needs

   The major macronutrient DRI’s for adolescents are based mostly on
                   activity levels and growth rates
      Adolescent Macronutrient DRI's Based on IOM Daily Recommended Intakes
              Estimated Carbohydrates              % Daily       Fiber   % Daily    Protein   % Daily
               Energy        (g)                   Energy         (g)     Energy      (g)     Energy
             Requirements                           from                 from Fat              from
               (Kcals)                              Carbs                                     Protein
                                                   Males
  9-13           2279                130           45-65         31      25-35       34       10-30
 14-18           3152                130           45-65         38      25-35       52       10-30
                                                  Females
  9-13            2071               130           45-65         26      25-35       34       10-30
 14-18            2368               130           45-65         26      25-35       46       10-30
Reference: Nutrition Through The Life Cycle Brown, Judith 2008
Energy and Nutrient Requirements for
Adolescents
                          Micronutrient Needs




Source: http://www.epi.umn.edu/let/pubs/img/adol_ch3.pdf
Energy and Nutrient Requirements for
Adolescents

       Energy


  The energy needs of
     adolescents are
     influenced by:

     activity level

  basal metabolic rate

 increased requirements
    to support pubertal
         growth and
        development
Energy and Nutrient Requirements for
Adolescents

       Energy

 For adolescents who
  participate in sports,
 are training to increase
    muscle mass, and
   those who are more
    active may require
  additional energy to
  meet their individual
           needs
Energy and Nutrient Requirements for
Adolescents

        Energy


Conversely, those who are
   not as physically active,
       or have physical
  limitations such as being
   handicapped, may have
        lower energy
        requirements
   Energy and Nutrient
Requirements for Adolescents


    When energy requirements for adolescents are not
    met, linear growth and sexual maturation may be
   delayed. Adequate energy intake can be assessed by
  using height, weight and body composition. If height,
  as well as weight-for-height continuously fall within
   the same percentiles on gender-appropriate growth
      charts, it can be assumed that energy intake is
                          adequate.
Energy and Nutrient Requirements for
Adolescents

      Protein

 The protein needs of
     adolescents are
   influenced by the
   amount of protein
       required for
     maintenance of
   existing lean body
  mass, plus allowances
     for the amount
   required to accrue
  additional lean body
  mass during puberty.
   Energy and Nutrient
Requirements for Adolescents



      Because protein needs vary with the degree of
   growth and development, it is recommended to use
  the developmental age rather the chronological age to
                determine protein needs.
Energy and Nutrient Requirements for
Adolescents

                 Carbohydrates

The recommended daily allowance of carbohydrates for
                     adolescents is
      130g/day or 45-65% of daily energy needs.

 Fruits, vegetables, and whole grains should make up
              the vast majority of this intake
                          …..
Energy and Nutrient Requirements for
Adolescents

                  Carbohydrates

…however, sweeteners and added sugars can account for up
      to 21% of the adolescent carbohydrate intake.
Energy and Nutrient Requirements for
Adolescents

      Dietary Fiber

Dietary fiber is important for
   normal bowel function
   and may play a role in
   the prevention of chronic
   diseases such as cancers,
   chronic artery disease,
   and Type 2 diabetes.
   Adequate fiber intake is
   also thought to lower
   serum cholesterol levels,
   moderate blood glucose
   levels, and reduce the
   risk of obesity.
   Energy and Nutrient
Requirements for Adolescents


       The American Academy of Pediatrics (AAP)
       recommends that dietary fiber intake among
    adolescents should be 0.5g per kilogram of body
  weight. This corresponds to an average fiber intake of
   34.5g/day among 10 to 18 year old males, and 16.0-
  28.5g/day among 10 to 18 year old females. Further,
  dietary fiber intake should not exceed 35g/day, as it
    could affect the bioavailability of other nutrients.
   Energy and Nutrient
Requirements for Adolescents



  The DRI’s set the recommended daily intake of fiber
                        as such:
            26g/day for adolescent females
     31g/day for adolescent males < 14 years old
     38g/day for adolescent males > 14 years old
Energy and Nutrient Requirements for
Adolescents

 Data indicates that current dietary fiber intakes of
               adolescents are as follows:
          14.2 g/day for adolescent males
         12.3g/day for adolescent females


  40
  30                                    Females
  20                                    Males < 14 y.o.
  10                                    Males > 14 y.o.
  0
Energy and Nutrient Requirements for
Adolescents




                    Dietary Fat

 The human body requires fat and fatty acids for
   normal growth and development
   Energy and Nutrient
Requirements for Adolescents



  Current recommendations are that children over the
  age of 2 years old consume no more than 25-35% of
    calories from fat, and that no more than 10% of
        calories are derived from saturated fat.
   Energy and Nutrient
Requirements for Adolescents



     Approximately two-thirds of teens meet the
   recommendations for total fat and saturated fat.
   National guidelines also suggest that adolescents
    limit their cholesterol intake to no more than
                     300mg/day.
Energy and Nutrient Requirements for
Adolescents

          Calcium

 Achieving an adequate
   intake of calcium during
   adolescence is crucial to
   physical growth, and
   accrual of bone mass.
   Energy and Nutrient
Requirements for Adolescents




  Calcium need and absorption rates are higher during
    adolescence than any other time except infancy.
   Energy and Nutrient
Requirements for Adolescents



    Female adolescents appear to have the greatest
  capability for calcium absorption around the time of
  menarche, with calcium absorption rates decreasing
                       from then on.
   Energy and Nutrient
Requirements for Adolescents




    Calcium absorption for males also peak during
   adolescence, but a few years later than in females.
   Energy and Nutrient
Requirements for Adolescents




  Calcium absorption in adolescence is paramount, as
   by age 24 in females and age 26 in males, calcium
       accretion in bones is almost non-existent.
   Energy and Nutrient
Requirements for Adolescents


  The DRI for calcium for adolescents age 9-18 years of
   age is 1300mg/day. Research indicates that females
   of this age consume around 865mg/day, and males
  consume 1130mg/day. These levels are not adequate
    for optimal bone mass development. Supplements
      may be warranted for adolescents who do not
      consume adequate calcium from food sources.
   Energy and Nutrient
Requirements for Adolescents



    Foods that are fortified such as calcium-fortified
  juices and cereals can help. In addition, substituting
  milk and fortified juices for soft drinks can increase
   calcium consumption in adolescents. Females who
      restrict calories in order to lose weight are at
      especially high risk for calcium deficiencies.
   Energy and Nutrient
Requirements for Adolescents


      When questioned about the health benefits of
   calcium, 92% of adolescents knew it was needed for
   strong bones, 60% knew it was beneficial for “good
  teeth”, 60% knew that adolescence was a critical time
   for calcium absorption, but only 19% knew that the
   recommended number of servings daily for dairy is
                   four servings daily.
   Energy and Nutrient
Requirements for Adolescents



  In addition to calcium consumption, physical activity
      levels play a role in bone development during
        adolescence. Physical activity patterns and
  participation during adolescence have shown to be a
          good predictor of adult bone density.
Energy and Nutrient Requirements for
Adolescents

             Iron

 The rapid rate of linear
   growth, the increase in
   blood volume, and the
   onset of menarche all
   increase the adolescent’s
   need for iron.
   Energy and Nutrient
Requirements for Adolescents



   The DRI for iron for male and female adolescents:
    8mg/day for males and females 9-13 years old
         11mg/day for males 14-18 years old
        15mg/day for females 14-18 years old
   Energy and Nutrient
Requirements for Adolescents


  These recommendations are based on the amount of
   dietary iron needed for iron stores, plus additional
   amounts to support linear growth and the onset of
   menstruation. Iron needs of the adolescent will be
  highest during the male growth spurt, and following
   menarche in females. Lack of iron can lead to iron-
        deficiency anemia (more in Chapter 15).
   Energy and Nutrient
Requirements for Adolescents


    The availability of dietary iron for absorption and
  utilization by the body varies by its form. Heme iron
   is found in animal products, and non-heme iron is
   found in both animal and plant-based foods. Heme
    iron is highly bioavailable, while non-heme iron is
  much less so. More than 80% of iron is consumed in
      the non-heme form. Bioavailability of non-heme
  sources can be increased by consuming it with heme
       iron or Vitamin C. This is especially critical for
                   vegetarian adolescents.
   Energy and Nutrient
Requirements for Adolescents



  Data suggests that only <3% of adolescent males and
  young adolescent females consume less than the DRI
    for iron, 16% of older adolescent females have low
  iron intake (iron intake decreases in older adolescent
                         females).
Energy and Nutrient Requirements for
Adolescents

            Zinc

   The body’s need for zinc
     dramatically increases
      during the adolescent
       growth spurt, and is
     needed for synthesis of
    RNA and proteins, and is
      a cofactor in over 200
            enzymes.
   Energy and Nutrient
Requirements for Adolescents



    Males who are zinc-deficient often have retarded
       growth and delayed sexual maturation. Zinc
   supplementation in zinc-deficient adolescents often
  initiates accelerated growth and sexual development.
   Energy and Nutrient
Requirements for Adolescents


  Zinc bioavailability is dependent on the source. Zinc
   from animal sources is more bioavailable than zinc
      from plant sources. Zinc and iron compete for
    absorption, so elevated intakes of one can inhibit
  absorption of the other. Vegetarians and vegans who
   do not consume animal products are at risk for low
                        zinc intake.
   Energy and Nutrient
Requirements for Adolescents



   The DRI for zinc for male and female adolescents:
    8mg/day for males and females 9-13 years old
        11mg/day for males 14-18 years old
        9mg/day for females 14-18 years old
Energy and Nutrient Requirements for
Adolescents

             Folate
  Folate is an integral part of
     DNA, RNA, and protein
          synthesis. Thus,
         adolescents have
      increased folate needs
      during adolescence. In
      addition, studies show
    that adequate amounts of
    folate prior to pregnancy
     can reduce the incidence
     of spina bifida and other
      congenital anomalies.
   Energy and Nutrient
Requirements for Adolescents




  Folate in the form of folic acid is twice as bioavailable
  as other forms of folate. For this reason, dietary folate
        equivalents (DFE’s) are used in the DRI’s.
   Energy and Nutrient
Requirements for Adolescents



  The DRI for folate for male and female adolescents:
   300DFE/day for males and females 9-13 years old
  400DFE/day for males and females 14-18 years old
   Energy and Nutrient
Requirements for Adolescents


   Evidence indicates that a significant proportion of
    adolescents have inadequate folate status. Severe
  folate deficiency can result in megaloblastic anemia.
    Poor folate status among adolescent females also
       presents issues related to reproduction. The
  protective effects of folate occur early in pregnancy,
      often before a woman knows she is pregnant.
   Energy and Nutrient
Requirements for Adolescents



  Many adolescents do not consume adequate amounts
   of folate. Good opportunities for folate consumption
    are missed if adolescents skip breakfast and do not
  consume foods high in folate such as orange juice and
                     breakfast cereals.
Energy and Nutrient Requirements for
Adolescents




        Vitamin A
   Energy and Nutrient
Requirements for Adolescents


    The DRI for Vitamin A for adolescent males and
                          females:
   600 retinol activity equivalents/day for males and
                  females 9-13 years old
   700 retinol activity equivalents/day for males and
                 females 14-18 years old
   Energy and Nutrient
Requirements for Adolescents


  It has been reported that 52% of adolescent males and
  62% of adolescent females consume less than the DRI
        for Vitamin A daily. The low intake of fruits,
      vegetables, and dairy products by adolescents
       contribute to their less-than-adequate intakes.
Energy and Nutrient Requirements for
Adolescents

           Vitamin E

  Vitamin E is well known for
     its antioxidant properties,
        which is important as
         body mass expands
         during adolescence.
   Energy and Nutrient
Requirements for Adolescents




     National surveys suggest that dietary intakes of
  Vitamin E are well below recommended levels, which
      could be indicative of poor Vitamin E status.
   Energy and Nutrient
Requirements for Adolescents


     The DRI for Vitamin E for adolescent males and
                       females:
    11mg tocopherol/day for males and females 9-13
                       years old
   15mg tocopherol/day for males and females 14-18
                       years old
Energy and Nutrient Requirements for
Adolescents

          Vitamin C

  Vitamin C is involved in the
     synthesis of collagen and
     other connective tissues.
      Due to this, Vitamin C
      plays an important role
          in growth and
         development for
           adolescents.
   Energy and Nutrient
Requirements for Adolescents


     Vitamin C also acts as an antioxidant. Smoking
   increases the need for antioxidant protection in the
  body. Consequently, smoking decreases the amount
    of serum Vitamin C. On average, adolescents who
      smoke consume lower-quality diets, and don’t
   consume much produce, which is a main source of
                       Vitamin C.
   Energy and Nutrient
Requirements for Adolescents


   The DRI for Vitamin C for adolescent males and
                      females:
   45mg/day for males and females 9-13 years old
        75mg/day for males 14-18 years old
        65mg/day for males 14-18 years old
     Activity Time!
The Food Guide Pyramid
Food Guide Pyramid Activity



  Each person has been given 7 pieces of construction
  paper, 3 pieces of ribbon, a copy of the Food Guide
        Pyramid, a glue stick, and two baggies.

    The first page is the cover of your Food Pyramid
  booklet. If you choose, you can paste the Food Guide
    Pyramid on the cover, and label the page as you
                           wish.
Food Guide Pyramid Activity



   In one baggie, you will find food group names, as
  well as pieces of paper with numbers of servings on
                            it.

  Using the Food Guide Pyramid, place the name of a
    food group, with its corresponding number of
        servings on each page in your booklet.
Food Guide Pyramid Activity



     In the second baggie, you will find pictures of
                  different food items.

  It is your job to put the different food items on their
                 correct food group page.
Food Guide Pyramid Activity




   Lastly, tie your booklet together with the pieces of
    ribbon provided. Now you have your own Food
  Guide Pyramid booklet to help you make nutritious
                      food choices!
Food Guide Pyramid Activity


                   Discussion

      Where did you put the peanut butter?

              What about the eggs?

   Where did you put the onion rings and pizza?
Nutrition Screening,
 Assessment, and
    Intervention
Nutrition Screening, Assessment, and
            Intervention


   The American Medical
   Association Guidelines
        for Adolescent
    Preventative Services
     (GAPS) recommend
      that all adolescents
    receive annual health
      guidance related to
   healthy dietary habits
        and methods to
       achieve a healthy
            weight.
Nutrition Screening,
Assessment, and Intervention
          Common concerns to be
              evaluated in
               adolescents:

          Overweight/underweight
               Eating disorders
               Hyperlipidemia
                Hypertension
           Iron-deficiency anemia
               Food insecurity
          Excessive intake of high-
              fat/high-sugar foods
                 and beverages
Nutrition Screening, Assessment,
        and Intervention



   Teens should have their BMI evaluated. Teens falling
   below the 5th percentile for weight-for-height or BMI-
   for-age are considered underweight. Teens above the
     85th but under the 95th percentile are considered at
       risk for being overweight. Teens above the 95th
            percentile are considered overweight.
Nutrition Screening, Assessment,
        and Intervention




   Dietary assessment should also be conducted using
   food-frequency questionnaires, 24-hour recalls, or
                     food diaries.
Nutrition Screening,
Assessment, and Intervention
          Indicators of nutrition
                 risk include:
               Food choices
             Eating behaviors
           Food resources (i.e.
            financial ability to eat
                     well)
          Weight and body image
                  Growth
             Physical activity
            Medical conditions
                 Lifestyle
Nutrition Screening, Assessment,
        and Intervention



         Nutrition Education and Counseling

    Providing nutrition education and counseling to
      adolescents requires a great deal of skill and
     understanding of normal adolescent growth,
   development and behavior. It is important to treat
   adolescents as individuals, with unique needs and
                        concerns.
Nutrition Screening, Assessment,
        and Intervention



           Nutrition Education and Counseling

    It is important to involve the teen in the decision-
   making processes during nutrition counseling, so that
     they are encouraged to be involved in personal
   decisions about health. Behavioral changes are more
       likely when the teen has been involved in the
                     decision-making.
Physical Activity and Sports
Physical Activity and Sports


    Regular physical
    activity has many
     health benefits,
  including improving
     endurance and
   muscular strength,
  may reduce the risk of
   obesity, and builds
   bone mass density.
Nutrition Screening, Assessment,
        and Intervention



   The International Consensus Conference on Physical
   Activity Guidelines for Adolescents recommends that
     all adolescents be physically active daily as part of
   play, games, sports, work, transportation, recreation,
   physical education, or planned exercise. Further, it is
    recommended that adolescents engage in at least 60
              minutes of physical activity daily.
Nutrition Screening, Assessment,
        and Intervention




     Despite common knowledge on the benefits of
    physical activity, only 35% of adolescents (more
   males than females) get the recommended amount
     daily, and 10% report little to no moderate or
               vigorous physical activity
Nutrition Screening, Assessment,
        and Intervention



   Schools offer an ideal setting for promoting physical
     activity through physical education classes. About
     half of U.S. adolescents attend physical education
   classes at least once a week, but are not always active
         for more than 20 minutes during the class.
Nutrition Screening, Assessment,
        and Intervention




    Adolescents who participate in competitive sports
   will likely meet these requirements for the season in
   which they are playing. Therefore, their needs may
      change from season to season, and need to be
                     evaluated as such.
Promoting Healthy Eating and
  Physical Activity Behaviors
Promoting Healthy Eating and
  Physical Activity Behaviors


   Meeting the challenge
     of improving the
   nutritional health of
   teenagers requires a
    cooperative effort.
Promoting Healthy Eating and
  Physical Activity Behaviors



         Effective Nutrition Messages for Youth

   Teens often think that eating healthy is eating things
   that do not taste good but are good for you. Creative
     menu/snack planning is integral for promoting
              health eating in the adolescent.
Promoting Healthy Eating and
  Physical Activity Behaviors


                 Parent Involvement

Parents also need nutrition education, as they are the
    primary role model for the adolescent. Parental
   concerns include whether or not teens should be
  involved in choosing meals, preparing alternative
 meals for teens when they don’t like what is served,
and restricting intake of certain foods. Teenagers tend
 to eat what is available and convenient, and parents
    can capitalize on this by having healthful, easy
         choices available for the adolescent.
Promoting Healthy Eating and
  Physical Activity Behaviors




                School Programs

 Efforts to promote healthful eating and physical
   activity should be part of a comprehensive,
       coordinated school health program.
Promoting Healthy Eating and
  Physical Activity Behaviors



                 School Programs

Nutrition/dietary education at the high school level
 is required in 82% of school districts and 87% of
 schools in the U.S., with an average of 5 hours of
nutrition education being taught as part of a health
                 education course.
Promoting Healthy Eating and
  Physical Activity Behaviors



        Nutrition Environment of the School

    School breakfast and lunch programs should
reinforce what is taught in the classroom and what is
  learned at home. Nutritional messages should be
consistent and not confusing, and should be the same
throughout meals, vending machines, school parties,
                          etc.
Promoting Healthy Eating and
  Physical Activity Behaviors


        Nutrition Environment of the School

School wellness policies are now required in all U.S.
 school districts. The points of the policies include
goals for nutrition education, physical activity, and
 other school-based activities, nutrition guidelines,
guidelines for reimbursable school meals, a plan for
measuring implementation of plans, and community
    involvement (i.e. volunteers/parents in the
                   lunchroom, etc.)

See example of Westhill Central School Wellness Plan
Promoting Healthy Eating and
  Physical Activity Behaviors

        Nutrition Environment of the School

 Most schools do well with the Wellness Plans, but
     here are some statistics that need work:

 65% address nutritional guidelines for fundraising
                       events
65% address nutritional guidelines for teachers using
          food rewards in the classroom
63% address nutritional guidelines for celebrations or
                      parties
50% address the requirement for recess, at least at the
                  elementary level
Promoting Healthy Eating and
  Physical Activity Behaviors




Community Involvement in Nutritionally Supportive
                Environments

   Adolescents are more likely to adhere to good
    nutritional behaviors when the messages are
  consistent at home, in school, at work, and in the
                       media.
Promoting Healthy Eating and
  Physical Activity Behaviors



Community Involvement in Nutritionally Supportive
                Environments

  One model nutrition program is CANfit, California
  Adolescent Nutrition and Fitness Program. Their
     goals include development of an after-school
program for African-American girls, focusing on self-
image, healthy eating, and physical activity, nutrition
  and physical activity program for adolescents and
 their parents, and a Latino adolescent soccer league.
              References


       Nutrition Through the Life Cycle
               Judith E. Brown

            www.mypyramid.gov

           www.westhillschools.org

www.eduref.org (adapted Food Pyramid activity)

           www.foodnetwork.com
Eating Disorders Quiz
   Quiz courtesy of quizzes.gurl.com
 Eating Disorders Quiz:
       Answers

                      1. False!

 The development of eating disorders in males was
observed over 300 years ago! But since the, they have
been overlooked, understudied, and underreported.
   10% of an estimated 8 million people in the US
     suffering from an eating disorder are men.

 An important thing to remember is that most of the
basic and psychological factors that lead to an eating
disorder (for example: low self-esteem, a need to be
 accepted, depression, and anxiety) are the same for
               both men and women.
 Eating Disorders Quiz:
       Answers
2. Frequent episodes of eating large amounts of food,
 even when not hungry, eating quicker than normal,
       eating until feeling uncomfortably full.

  That isn’t to say that anyone who eats a lot at one
time or gets really full from one meal (which many of
  us do) is a binge eater. The frequency of eating is a
                   key differentiator.

  Other symptoms that occur with binge eating are:
 feeling like you are unable to control what or how
much you eat, feeling guilty, depressed or disgusted
after an episode of overeating and eating by yourself
because of shame or embarrassment associated with
 Eating Disorders Quiz:
       Answers

               3. During your teens

 Eating disorders usually start during your teenage
  years, but can begin to develop as early as age 8.
  Regardless of age, an eating disorder can develop
from a combination of emotional, psychological, and
                     social issues.

  Food is often used to make up for overwhelming
feelings while dieting/bingeing/purging can be used
  as a means of coping with some painful emotions.
 Eating Disorders Quiz:
       Answers
                4. All of the above

These symptoms or warning signs are usually much
 harder to detect because a person with an eating
  disorder will try to keep it a secret. Some other
          “secret” symptoms may include:
                   -refusing to eat
         -lying about how much was eaten
                       -fainting
              -throwing up after meals
   -calluses or scars on the knuckle from forced
                     throwing up
                 -denial of problems
 Eating Disorders Quiz:
       Answers


                       5. True

   Eating disorders can occur together with other
 psychiatric disorders such as: obsessive-compulsive
  disorder, anxiety, panic, and alcohol/drug abuse.
  Even though eating disorders affect many people
  without a prior family history, there are studies to
suggest and new evidence that suggest that heredity
(your genes) might play a part in the development of
          these disorders in certain people.
  Eating Disorders Quiz:
        Answers
         6. Malnutrition and heart problems

   Though in the beginning weight loss can cause
 people to become happier with self-image and thus
more confident, they are putting themselves and their
                  body at great risk.

  Malnutrition, heart problems, and other potentially
  fatal conditions can occur if a person with an eating
  disorder does not seek treatment for both his or her
emotional and physical symptoms. But, with the right
 treatment, anyone with an eating disorder can begin
  to eat right again, and improve both emotional and
                     physical health.
  Eating Disorders Quiz:
        Answers

                     7. Both A & B

As you can tell from the name, Night-Eating Disorder
   (NES) is a disorder in which a person does not eat
 until later in the day or evening. Albert Stunkard, an
 obesity researcher at the University of Pennsylvania,
  said that “People who exhibit NES don’t eat a lot at
one sitting, often skip breakfast, and don’t start eating
 until noon. They will overeat the rest of the day, and
   eat frequently. They also have difficulty falling or
                     staying asleep.”
  Eating Disorders Quiz:
        Answers

               8. Sleep Eating Disorder

Sleep Eating disorder is both a sleeping and an eating
  disorder. Someone that suffers from this condition
 tends to be overweight, sleep walks, and consumes
  large amounts of food during these sleep-walking
episodes. The food that is eaten usually contains a lot
                  of sugar and fat.

Sufferers don’t usually remember or realize that this
       happens putting them at a great risk to
         unintentionally injure themselves.
  Eating Disorders Quiz:
        Answers

           9. Body Dysmorphic Disorder

 Having an eating disorder doesn’t necessarily mean
   that a person has a problem with food. BDD is a
fixation or obsession with imperfections and flaws in
one’s visual appearance, however slight or imagined.

      Someone that suffers from BDD has an eating
   disorder because of his or her obsession with any
little or imaginary imperfection. These obsessions can
   include any part of the face and body, such as the
   nose, hair, and skin. Some of the “imperfections”
     include: a large nose, wrinkles, acne, and scars.
  Eating Disorders Quiz:
        Answers

           10. Pica & Rumination Disorder

  A person that suffers from Pica has a compulsive
craving for eating, chewing, or licking non-food items
  or non-nutritional foods for one month or longer.
 This may include: plaster, baking soda, glue, chalk,
           cigarette ashes, and paint chips.

People with Rumination Disorder will, after a period
 of normal eating, repeatedly regurgitate (spit out)
  and re-chew their food for one month or longer.
Adolescent Nutrition:
Conditions and Interventions
Chapter 15
    Theresa and Larissa
    November 13, 2007
Overweight and Obesity
   Increases in adolescent obesity over the past 2 decades mirrors that
    of adults
   Genetics, environmental factors, and the interactions between the 2
    are the most likely causes for the increase
   Risk factors for obesity
       Having at least 1 overweight parent
       Coming from a low-income family
       Parents who are African American, Hispanic, or American
        Indian/Native Alaskan
       Being diagnosed with a chronic or disabling condition that limits
        mobility
       Consuming diets high in kcals and added sugars/fats
       Inadequate physical activity
 Overweight and Obesity
Males                                                    At-risk of   Overweight
                                                         Overweight
  White                                                  38.7         19.1
  Black                                                  31.4         18.5
  Mexican American                                       37.3         18.3
Male Total                                               36.8         18.3
Females
  White                                                  30.4         15.4
  Black                                                  42.1         25.4
  Mexican American                                       31.1         14.1
Female Total                                             31.7         16.4


85th percentile<BMI<95th percentile = at risk for overweight
95th percentile<BMI = overweight (Chart from Table 15.1 in text)
Overweight and Obesity

   34.3% U.S. students
    are at risk for
    overweight
   17.4% are overweight




                           Source:
                           http://www.jupiterimages.com/popup2.aspx?navigationSubType=itemdetails&itemID=23
                           491905
OK135S057
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Overweight and Obesity

   Greater than 70% of overweight adolescents can be
    expected to remain overweight into adulthood,
    therefore early identification of overweight is ideal
   Medical and health implications of
    overweight/obesity include hypertension,
    dyslipidemia, insulin resistance, type 2 diabetes,
    sleep apnea and other hypoventilation disorders,
    orthopedic problems, hepatic diseases, lower
    cardio-respiratory fitness, body image disturbances,
    and lower self-esteem
       “In one study, a third of newly diagnosed diabetic patients
        had BMI values above the 90th percentile.”
Overweight and Obesity
   It is recommended for adolescents to be
    screened yearly for weight-for-height
                                                                 Assessment for
                                                                 Medical Complications
                                     Assessment of
                                                                        •Family history
                                     Weight-for-Height                 •Blood pressure
                                                                         •Blood lipids
                                     Not at risk of overweight           •Blood sugar
                                         <85th percentile         •Large BMI (weight history
                                                                          •Depression
                                                                    •Concern about weight
                                      At risk of overweight
    BMI                              85th but <95th percentile



                                           Overweight               All of the conditions listed
                                          95th percentile                    above, plus:
                                                                       •Orthopedic disorders
                                                                      •Respiratory disorders



Source – Illustration 15.2 in text
Obesity and Overweight:
Weight Management
   For individuals who are at risk for overweight,
    have not completed puberty, and have no weight-
    related medical complications, weight
    maintenance is recommended.
   For individuals who are at risk for overweight with
    medical complications, are overweight, or who
    are older and have completed physical growth
    and development, weight loss is recommended.
Obesity and Overweight:
Weight Management
   There are no specific diets      Sedentary activities should
    for adolescent weight             be limited to less than 2
    management.                       hours per day
   Their treatment should           Referrals to community
    include appropriate kcal          centers and recreation
    intake and optimum nutrient       programs for fun,
    intake for growth and             noncompetitive activity
    development.                     Incorporate physical activity
   No “avoid” foods, no kcal         into daily living for
    counting                          nonathletes
   Portion control and balance
    should be emphasized for
    lifelong healthy habits
    Obesity and Overweight:
    General Guidelines for Weight Management Therapy (Table 15.2)

    Early intervention is recommended, preferably before the child reaches the 95th percentile for BMI
    Parents should be informed of medical complications associated with childhood overweight, and
     all youth should be assessed for medical complications
    All family members and caregivers should be involved in the weight management program
    All family members should be assessed to determine their readiness to make behavior changes,
     and treatment should not begin until all family members are ready to adopt behavior changes
    Weight management programs should emphasize goals of improving eating and physical activity
     patterns as opposed to specific weight goals
    Programs should be skill based, with families taught to identify problem behaviors, monitor such
     behaviors, utilize behavior modification principles to address problem behaviors, and implement
     problem-solving skills when dealing with obstacles to behavior change
    Families should be involved in assessing current eating and activity patterns, deciding which
     behaviors need to be modified, setting goals for behavior changes, and determining how these
     goals will be achieved
    New behavior changes should not be instituted until previous changes have been accomplished
     and maintained
    Routine follow-up visits should be scheduled to monitor progress and prevent relapse to former
     eating and activity patterns
Obesity and Overweight
   Severely obese adolescents are at risk for orthostatic hypotension,
    diarrhea, hyperuricemia, cholelithiasis, electrolyte imbalance, and
    reduced serum protein levels, among other conditions
   Rapid weight loss may be required for severely obese adolescents
     Very low kcal/protein-sparing modified fasts

     Continued medical supervision

   Appetite suppressants and other medications may be used, but only
    with intensive medical follow-up, as there have only been few
    studies done with these medications and adolescents
   Bariatric surgery is also an option for those unable to obtain
    adequate weight loss after 6+ months, are at Tanner III, BMI 40+
    (with complications) or 50+ (without complications). Surgery
    complications are not uncommon. Counseling and support is
    needed, and a multivitamin-mineral supplement may be needed
    following surgery
Supplement Use:
Vitamin-Mineral Supplements
   Supplements are taken by teens for a variety of reasons, including improving
    health, treating iron-deficiency anemia, increasing energy, building muscle, and
    losing weight
   Teen supplement use in the U.S. ranges from 16%-33% of all teens
   More than half of teens taking supplements take them occasionally
       Some studies found racial differences between supplement users, and some found no
        difference
   ~28% female teens and 24% male teens use supplements
   About half the supplements are multivitamins with no minerals
   34% are individual vitamins/minerals (Vitamin C, calcium, iron, Vitamin E, B-
    vitamin complex)
   18% multivitamins with minerals
   17% iron + Vitamin C
   Adolescents who take vitamin/mineral supplements tend to eat a more nutritious
    diet (less saturated/total fat, more carbs, higher in folate, calcium, iron, Vitamins E,
    C, A) than those who don’t use supplements
Supplement Use:
Herbal Remedies
   Adolescents take herbal remedies for a variety of reasons, including:
     Weight loss

     ADD treament
     Increase energy and stamina

     Special health care needs such as autism spectrum, ADD, cystic
       fibrosis
   A study of 78 Australian teens found that 18% used herbal
    supplements, 5% used creatine and guarana, 1% used coenzyme Q
   A study of 353 Canadian teens found that 4.1% used herbal weight-
    control products, 6% used energizers (i.e. bee pollen), 1.6% used L-
    carnitine, and 5.3% used creatine
   More studies are needed to determine the safety of these products
    for adolescents, especially when dealing with potentially dangerous
    side effects



                                                    Source: www.cartoonstock.com/directory/h/herbal.asp
Supplement Use:
Ergogenic Supplements
   Supplements in this category include creatine, amino acids, protein powders,
    carnitine, anabolic-androgenic steroids, anabolic steroid precursors (DHEA), beta-
    hydroxy-methylbutyrate, growth hormones, and ephedra
   Steroids, etc. are taken orally, injected, or absorbed through patches
   Often taken outside of the sports season to avoid detection (1-3 month “stacking”)
   Used to increase lean body mass and improve strength
   Linked to infertility, hypertension, physeal closure, depression, aggression, and
    increased atherosclerosis risk
   Steroid precursors, such as andostenedione and DHEA have irreversible side effects
    like breast enlargement and prostate enlargement in males and hirsuitism in females
   Creatine is used to increase lean body mass and has not proven to be useful for
    endurance athletes. There are dose-related side effects.
   Ephedra was an ingredient in weight-loss supplements until its 2004 ban by the FDA
    for its increased risk of cardiac arrhythmias and other heart conditions.
   4% of adolescents report having used illegal steroids, more frequently among males
    (5%) than females (3%), and more frequently among Hispanic males (6%) than white
    (5%) or black males (4%)
   Steroid use peaks around 9th-10th grade
Substance Use
   Tobacco, alcohol, and recreational drug use
    directly affects adolescent nutrition status
   23% of adolescents smoke at least once a
    month and 13% smoke at least 1 cigarette
    per day
        Smokers have a higher Vitamin C
         requirement
   More than 80% of teens have tried alcohol
    by 12th grade
        Alcohol may replace nutritious foods in
         diet and can lead to reduced appetite
        Thiamin and other B-vitamin needs may
         be higher for large-quantity drinkers
   1 in 5 teens report using marijuana in the
    past month, 8% tried cocaine, 12% used
    inhalants, 8% used hallucinogens, 2.5%
    used heroin, 2% used other injectible drugs,
    and 6% used ecstasy and
    methamphetamines

                                                   Source: www.youcanschoolprogram.com/edu_health_drugs.htm
Substance Use

   Table 15.4 Potential effects of substance use on
    nutrition status
       Appetite suppression
       Reduced nutrient intake
       Decreased nutrient bioavailability
       Increased nutrient losses/malabsorption
       Altered nutrient synthesis, activation, and utilization
       Impaired nutrient metabolism and absorption
       Increased nutrient destruction
       Higher metabolic requirements of nutrients
       Inadequate weight gain/weight loss
       Iron deficiency anemia
       Decreased financial resources for food
Iron Deficiency Anemia
   Most common nutritional deficiency in children and teens
   Risk factors include rapid growth, inadequate dietary intake of iron or Vitamin C-rich
    foods, highly restrictive vegetarian diets, calorie-restricted diets, meal skipping,
    participation in strenuous or endurance sports, and heavy menstrual bleeding
   Effects include delayed/impaired growth and development, fatigue, increased
    susceptibility to infection secondary to depressed immune system function,
    reductions in physical performance and endurance, and increased susceptibility to
    lead poisoning
       Pregnant teens who are iron deficient early in gestation put their baby at risk for
        preterm delivery and LBW
   Table 15.5 for hemoglobin values
   Males do not need to be screened unless they exhibit symptoms; females should be
    screened every 5 years
   Treatment includes intake of foods high in Vitamin C and iron with iron
    supplementation (although there is controversy surrounding the recommended 60-
    120 mg)
       Side effects of supplementation (constipation, nausea, etc.) can be lessened by
        splitting the dosage throughout the day
       Calcium supplements, dairy, coffee, tea, and high-fiber may decrease iron
        absorption, and so should be avoided 1 hour before taking the iron supplement
Cardiovascular Disease:
Hypertension
   Adolescents are hypertensive if the average of 3 systolic and/or diastolic BP
    readings are >95th percentile based on age, sex, and height
           Normal BP <90th percentile
           Prehypertensive >90th and <95th
           Stage 1 hypertension >95th and <99th + 5 mmHg
           Stage 2 hypertension >99th + 5 mmHg
   Risk factors include family hx, high sodium intake, overweight,
    hyperlipidemia, inactive, tobacco use
       Teens with these risk factors should be routinely screened
   Decrease sodium intake, limit fat to 30% or less of kcal, consume adequate
    amounts of fruit, vegetables, whole grains, and low-fat dairy
       Table 15.8
       Weight loss recommended to overweight + hypertensive teens
       Possibly medications
Cardiovascular Disease:
Hyperlipidemia
   ~1 in 4 U.S. adolescents have elevated cholesterol
         Total >= 170 borderline   >= 200 abnormal
         LDL >= 100 borderline     >=130 abnormal
         HDL                       <40 abnormal
         TGs                       >= 200 abnormal
   Risk factors include family hx of CVD or high cholesterol,
    cigarette smoking, overweight, hypertension, diabetes mellitus,
    and low physical activity
   Early intervention may reduce risk of coronary artery diseases
    later in life
   <35% kcal from fat
   <10% saturated fat
   <300 mg cholesterol
   Counseled to make healthier choices
Children and Adolescents with Chronic
Health Conditions
   ~18% of children and adolescents have a
    chronic condition or disability
   Increased risk for nutrition-related health
    concerns because:
       Physical disorders or disabilities related to ability to
        consume, digest, or absorb nutrients
       Biochemical imbalances cased by long-term
        medications or internal metabolic disturbances
       Psychological stress from a chronic condition or
        physical disorder that may affect appetite and food
        intake
       Environmental factors that are often controlled by
        parents that may influence the child’s access to
        and acceptance of food                                     Source: www.lpfch.org/fundraising/news/fall01/cf.html

   As much as 40% of children and adolescents
    with special healthcare needs are at-risk for
    nutritional concerns that end with a referral to a
    dietician, including:
       Altered energy and nutrient needs
       Delayed growth
       Oral-motor dysfunction
       Elimination problems
       Drug/nutrient interactions
       Appetite disturbances
       Unusual food habits
       Dental caries, gum disease
Children and Adolescents with Chronic
Health Conditions
   In diseases such as cystic fibrosis, malnutrition may be a major
    factor in poor growth and short stature
     Inadequate nutrient and energy intake, excessive nutrient losses,
       malabsorption, increased nutrient requirements
   Energy needs for adolescents with diseases such as cystic fibrosis
    may be 30-50% higher than the RDA for adequate growth
     Malabsorption, fever, infection, inflammation, etc.

   Undernourishment seen in those with chronic diseases
   Obesity seen in those with motor limitation or immobility
   Counseling these individuals is complex and requires
    interdisciplinary care
     Assessment of nutrition status followed by intervention and
       monitoring
     Drug-nutrient interactions
     Adolescent issues of food independence need to be factored in
Disordered Eating, Dieting,
and Eating Disorders




       Source:
       http://www.jupiterimages.com/popup2.aspx?navigationSubType=itemdetails&itemID=23491905
  The Continuum of Eating Concerns and
  Disorders
     Illustration 15.4

    Body                    Dieting                  Disordered            Clinically significant
Dissatisfaction            Behaviors                   Eating               eating disorders




      Between the endpoints are normative and more severe dieting behaviors
      such as self-induced vomiting and binge eating. While anorexic behaviors
      and unhealthy dieting may not be as intense as a full-fledged eating disorder,
      they can still negatively impact health and may lead to a severe eating
      disorder. Eating disorders can have potentially adverse effects on growth,
      psychosocial development, and physical health outcome.
Prevalence of Eating Disorders
Table 15.9 – Estimated Prevalence and Brief Description of
Weight-Related Concerns/Disorders Among Adolescents
Disorder                         Estimated Prevalence

Anorexia Nervosa                 Approx. 0.2% - 1.0% of adolescent
                                 females and young women
Bulimia Nervosa                  Approx. 1% - 3% of adolescent
                                 females and young women
Binge Eating                     Estimated 30% of population currently
                                 dieting; 2% of general population
Disordered Eating Behaviors      Estimated 10% - 20% of adolescents
                                 although estimates vary
Dieting Behaviors                Estimates vary and range from 44% of adolescent
                                 females, 15% adolescent males, to 50% - 60% of all
                                 adolescent females are attempting to lose weight

Body Dissatisfaction             Estimates vary in accordance with type of
                                 measurement used and age, gender, and ethnicity of
                                 population; approx. 60% of girls and 35% of boys are
                                 not satisfied with their weight
Anorexia Nervosa

   “An eating disorder characterized by extreme
    weight loss, poor body image, and irrational
    fears of weight gain and obesity”
   Most severe condition on continuum
   9 out of 10 cases are female
       Males with the disease have only gained attention
        in recent years; before, they were usually
        diagnosed at later, harder-to-treat stages
Anorexia Nervosa

   Characteristics include self-       Restricting Subtype
    starvation and strong fears             No regular binging/purging
    of being fat                             behaviors
   Progression from simple             Nonrestricting Subtype
    dieting from social pressure            Regular episodes of binge
    or weight comments, and                  eating and purging
    then continues from weight          Both include refusal to
    loss, feelings of control, and       maintain a minimally
    comments about weight                normal weight
    loss                                    This is the differentiation
                                             between anorexia and other
                                             disorders
Anorexia Nervosa
Table 15.10 Diagnostic Criteria
   Refusal to maintain body weight at or above a minimally normal weight for age
    and height (e.g. weight loss leading to maintenance of body weight less than
    85% of that expected; or failure to make expected weight gain during period of
    growth, leading to body weight less than 85% of that expected)
   Intense fear of gaining weight or becoming fat, even though underweight
   Disturbance in the way in which one’s body weight or shape is experienced,
    undue influence of body weight or shape on self-evaluation, or denial of the
    seriousness of the current low body weight
   Amenorrhea in postmenarchal women; that is, the absence of at least 3
    consecutive menstrual cycles (a women is considered to have amenorrhea if her
    menstrual periods occur only following hormone-estrogen administration)
   Restricting Type
       During the episode of anorexia nervosa, the person has not regularly engaged in binge
        eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives,
        diuretics, or enemas)
   Binge-Eating/Purging Type
       During the episode of anorexia nervosa, the person has regularly engaged in binge-
        eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives,
        diuretics, or enemas)
Anorexia Nervosa

   ~10-15% of anorexia patients die from the
    disease
       Causes of death include weakened immune
        system, gastric ruptures, cardiac arrhythmias,
        heart failure, and suicide
   The diagnosis is commonly denied by both
    the individual and their family, delaying
    treatment and resulting in a poorer prognosis
   Early recognition is essential
   Recovery rates are ~40% - 50%
Bulimia Nervosa

   “An eating disorder characterized by recurrent
    episodes of rapid, uncontrolled eating of large
    amounts of food in a short period of time. Episodes
    of binge eating are often followed by purging.”
       Purging includes self-induced vomiting, laxative, diuretic,
        and/or obsessive exercising
   Anorexia and bulimia sometimes overlap
   90% of bulimic individuals are female
   Bulimics may show weight maintenance or extreme
    weight fluctuations
Bulimia Nervosa
Table 15.11 Diagnostic Criteria
   A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both
    of the following:
       Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is
        definitely larger than most people would eat during a similar period of time and under similar
        circumstances
       A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating
        of control what or how much one is eating)
   B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as
    self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting;
    or excessive exercise
   C. The binge eating and inappropriate compensatory behaviors both occur, on average, at
    least twice a week for 3 months
   D. Self-evaluation is unduly influenced by body shape and weight
   E. The disturbance does not occur exclusively during episodes of anorexia nervosa
   Purging Type: During the current episode of bulimia nervosa, the person regularly
    engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
   Nonpurging Types: During the current episode of bulimia nervosa, the person has used
    other inappropriate compensatory behaviors, such as fasting or excessive exercise, but
    has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or
    enemas
Bulimia Nervosa

   Individuals with bulimia nervosa can be
    overweight, underweight, or average weight
    for height
   May be proceeded by a history of dieting or
    restrictive eating
   5% mortality, usually due to heart failure from
    electrolyte imbalance or suicide
   50% - 60% recovery
Binge-Eating Disorder

   “An eating disorder characterized by periodic
    binge eating, which normally is not followed
    by vomiting or the use of laxatives”
   More prevalent among overweight clinical
    populations (30%) than non-dieters (5%
    females and 3% males)
   No significant difference between males and
    females
Binge-Eating Disorder
Table 15.12 Diagnostic Criteria
   A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both
    of the following:
       Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is
        definitely larger than most people would eat in a similar period of time and under similar
        circumstances
       A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating
        or control what or how much one is eating)
   B. The binge-eating episodes are associated with three (or more) of the following:
       Eating much more rapidly than normal
       Eating until feeling uncomfortably full
       Eating large amounts of food when not feeling physically hungry
       Eating alone because of being embarrassed by how much one is eating
       Feeling disgusted with oneself, depressed, or guilty after overeating
       Experiencing marked distress regarding binge eating
       Occurring, on average, at least 2 days a week for 6 months
   C. The method of determining frequency differs from that used for bulimia nervosa; future
    research should address whether the preferred method of setting a frequency threshold is
    counting the number of days on which binges occur or counting the number of episodes of
    binge eating
   D. The binge eating is not associated with regular use of inappropriate compensatory
    behaviors (e.g. purging, fasting, excessive exercise) and does not occur exclusively during
    the course of anorexia nervosa or bulimia nervosa
Disordered Eating Behaviors

   Anorexic or bulimic behaviors with less frequency or
    intensity than required for formal diagnosis
   Self-induced vomiting, laxative use, use of diet pills,
    fasting or extreme dieting, binge eating, excessive
    physical activity
   Between 10% - 20% teens have engaged in
    anorexic or bulimic behaviors
   Often overlooked in overweight adolescents, even
    though they have reported those behaviors
   Prevention is crucial because these behaviors can
    lead to a full-blown eating disorder
Dieting Behaviors
   Alarmingly high prevalence
     44% adolescent girls, 37% adolescent boys

     62% female and 30% male dieted in last month to lose weight

     50% - 60% adolescent girls consider themselves overweight

   Previously considered white, middle-class female issue, but it is
    prevalent among Hispanic males 39%) and females (51%)
   Often used in youth who are not even overweight
   Behaviors such as skipped meals or restricted energy intake/food
    groups are common, which put the individual at risk for nutrient
    deficiencies
     These deficiencies and behaviors can lead to cravings for
       specific foods, and maybe binging episodes
   Increased risk for eating disorders
Dieting Behaviors

   Dieting and unhealthy weight-control may
    increase likelihood of overweight in future
   Effective nutrition communication should aim
    for healthy lifestyle changes rather than
    short-term dieting, which are hard to sustain
       This communication can help prevent eating
        disorders AND overweight
Body Dissatisfaction

   Body image and self-esteem are closely
    intertwined in adolescence
   Body dissatisfaction is probably main
    contributing factor to disordered eating,
    dieting, and eating disorders
Body dissatisfaction

   Foster a good body
    image
       In overweight
        adolescents help them to
        improve body image
        while simultaneously
        working on weight control
Eating Disorder Etiology

   Etiology is multifactorial; the factors do not function
    independently, but interact
   Can be different for each individual
       For one, it may be family, for another it may be peers and
        their sports team
   Can also depend the specific disorder
   An understanding of etiology is essential to
    development of treatment, whether in individual
    treatment (assessing factors that led to onset of a
    condition) or group prevention (identify and address
    factors that can lead to a condition)
Eating Disorder Etiology
Rosen & Neumark-Sztainer
   Socioenvironmental factors:                        Personal factors:
       Sociocultural norms (thinness, eating,             Biological (genetic disposition, BMI, age,
        food prep, roles of women)                          gender, stage of development)
       Food availability (types, amount)                  Psychological (self-esteem, body image,
       Familial factors (communication patterns,           drive for thinness, depression)
        parental expectations, boundaries, weight          Cognitive/affective (nutritional
        concerns and dieting behaviors of                   knowledge/attitudes, media
        parents/siblings, family meals)                     internalization)
       Peer norms and behaviors (dieting              Behavioral factors:
        behaviors, eating patterns, weight                 Eating behaviors (meal patterns, fast food
        concerns)                                           consumption, nutritional variety, bingeing)
       Abuse experiences (by family                       Dieting and other weight-management
        members/other adults, rape experiences)             behaviors (dieting frequency, types of
       Media influences (images, thin/fat actor            methods used, purging behaviors
        roles)                                             Physical activity behaviors (TV viewing,
                                                            sport involvement, daily activities)
                                                           Coping behaviors (with dieting failures,
                                                            with frustrations)
                                                           Skills (self-efficacy in dealing with harmful
                                                            social norms, skills in food prep, media
                                                            advocacy skills)
Treating Eating Disorders

   Multidisciplinary approach
       Physician, nutritionist, nurse, psychologist, and/or
        psychiatrist
       Nutritionist essential at all stages of treatment
           Adolescent may be more open to discussing their
            concerns with a dietician rather than a psychologist
           Normalization of eating patterns and comfort with these
            changes
           Denial of the condition or lack of motivation may cause
            difficulty implementing changes, so working closely with
            the other care professionals is important
           ADA paper
Preventing Eating Disorders

   Major public health issue
   Address onset factors that are applicable to a
    large proportion of the population
       Also think about modifiable factors and factors
        suitable for discussing in the designated setting
       Example: Media awareness and advocacy
Eating Disorder Prevention Settings:
Clinical, School, and Community
   Clinical
       Beneficial because risk factors can be assessed
       Channels for communication concerning body and diet issues
       Questions concerning body image and eating patterns should be discussed during
        routine check-ups
   School
       Majority of prevention programs
       Reach all adolescents
       Social interactions
       Aims to reach both general population and at-risk individuals
       Aims for changes in levels of personal knowledge/attitudes and social norms (ideas of
        thinness), policy changes (tolerance for weight-teasing), and environmental changes
        (food availability)
       Table 15.15
   Community
       Girl Scouts
       Faith youth groups
       Positive media
Preventing Eating Disorders

   Addressing all                           Addressing at-risk
    adolescents                               adolescents
       Pros:                                    Pros:
           High prevalence of                       Better use of limited
            eating concerns across                    resources
            all adolescents                          More intensive
           Difficulties in identifying               interventions
            at-risk individuals                      Interventions developed
           Developing positive                       for at-risk teens (ballet
            eating social norms                       dancers, diabetic youth,
                                                      overweight girls)

Both types are necessary for a good prevention program.
Preventing Eating Disorders:
Table 15.14 Screening Elements and Warning Signs for Individuals
with Eating Disorders
Screening                        Warning Signs
Body image and weight history    •Distorted body image
                                 •Extreme dissatisfaction with body shape or size
                                 •Profound fear of gaining weight or becoming fat
                                 •Unexplained weight change or fluctuations >10lbs.

Eating and related behaviors     •Very low caloric intake; avoidance of fatty foods
                                 •Poor appetite; frequent bloating
                                 •Difficult eating in front of others
                                 •Chronic dieting despite not being overweight
                                 •Binge-eating episodes
                                 •Self-induced vomiting; laxative or diuretic use

Meal patterns                    •Fasting or frequent meal skipping to lose weight
                                 •Erratic meal pattern with wide variations in caloric intake

Physical activity                •Participation in physical activity with weight or size requirement (e.g., gymnastics,
                                 wrestling, ballet)
                                 •Overtraining or “compulsive” attitude about physical activity

Psychosocial assessment          •Depression
                                 •Constant thoughts about food or weight
                                 •Pressure from others to be a certain shape or size
                                 •History of physical or sexual abuse or other traumatizing life event

Health history                   •Secondary amenorrhea or irregular menses
                                 •Fainting episodes or frequent light-headedness
                                 •Constipation or diarrhea unexplained by other causes

Physical examination             •BMI <5th percentile
                                 •Varying heart rate, decreased blood pressure after arising suddenly
                                 •Hypothermia; cold intolerance
                                 •Loss of muscle mass
                                 •Tooth enamel dimineralization
Links

   http://www.dairycouncilofca.org/Tools/Default
    .aspx
   http://www.novanewsnow.com/article-
    116588-Liverpool-resident-will-die-without-
    treatment.html
Eating Disorders Quiz
Quiz courtesy of quizzes.gurl.com
Eating Disorders Quiz:

Answers
   1. False!

   The development of eating disorders in males was
   observed over 300 years ago! But since the, they have been
   overlooked, understudied, and underreported. 10% of an
   estimated 8 million people in the US suffering from an
   eating disorder are men.

   An important thing to remember is that most of the basic
   and psychological factors that lead to an eating disorder
   (for example: low self-esteem, a need to be accepted,
   depression, and anxiety) are the same for both men and
   women.
Eating Disorders Quiz:

Answers
   2. Frequent episodes of eating large amounts of food, even
   when not hungry, eating quicker than normal, eating until
   feeling uncomfortably full.

   That isn’t to say that anyone who eats a lot at one time or
   gets really full from one meal (which many of us do) is a
   binge eater. The frequency of eating is a key differentiator.

   Other symptoms that occur with binge eating are: feeling
   like you are unable to control what or how much you eat,
   feeling guilty, depressed or disgusted after an episode of
   overeating and eating by yourself because of shame or
   embarrassment associated with the amount of food you are
   eating.
Eating Disorders Quiz:

Answers
   3. During your teens

   Eating disorders usually start during your teenage years,
   but can begin to develop as early as age 8. Regardless of
   age, an eating disorder can develop from a combination of
   emotional, psychological, and social issues.

   Food is often used to make up for overwhelming feelings
   while dieting/bingeing/purging can be used as a means of
   coping with some painful emotions.
Eating Disorders Quiz:

Answers
   4. All of the above

   These symptoms or warning signs are usually much harder
   to detect because a person with an eating disorder will try
   to keep it a secret. Some other “secret” symptoms may
   include:
   -refusing to eat
   -lying about how much was eaten
   -fainting
   -throwing up after meals
   -calluses or scars on the knuckle from forced throwing up
   -denial of problems
Eating Disorders Quiz:

Answers
   5. True

   Eating disorders can occur together with other psychiatric
   disorders such as: obsessive-compulsive disorder, anxiety,
   panic, and alcohol/drug abuse. Even though eating
   disorders affect many people without a prior family
   history, there are studies to suggest and new evidence that
   suggest that heredity (your genes) might play a part in the
   development of these disorders in certain people.
Eating Disorders Quiz:

Answers
   6. Malnutrition and heart problems

   Though in the beginning weight loss can cause people to
   become happier with self-image and thus more confident,
   they are putting themselves and their body at great risk.

   Malnutrition, heart problems, and other potentially fatal
   conditions can occur if a person with an eating disorder
   does not seek treatment for both his or her emotional and
   physical symptoms. But, with the right treatment, anyone
   with an eating disorder can begin to eat right again, and
   improve both emotional and physical health.
Eating Disorders Quiz:

Answers
   7. Both A & B

   As you can tell from the name, Night-Eating Disorder
   (NES) is a disorder in which a person does not eat until
   later in the day or evening. Albert Stunkard, an obesity
   researcher at the University of Pennsylvania, said that
   “People who exhibit NES don’t eat a lot at one sitting, often
   skip breakfast, and don’t start eating until noon. They will
   overeat the rest of the day, and eat frequently. They also
   have difficulty falling or staying asleep.”
Eating Disorders Quiz:

Answers
   8. Sleep Eating Disorder

   Sleep Eating disorder is both a sleeping and an eating
   disorder. Someone that suffers from this condition tends to
   be overweight, sleep walks, and consumes large amounts of
   food during these sleep-walking episodes. The food that is
   eaten usually contains a lot of sugar and fat.

   Sufferers don’t usually remember or realize that this
   happens putting them at a great risk to unintentionally
   injure themselves.
Eating Disorders Quiz:

Answers
   9. Body Dysmorphic Disorder

   Having an eating disorder doesn’t necessarily mean that a
   person has a problem with food. BDD is a fixation or
   obsession with imperfections and flaws in one’s visual
   appearance, however slight or imagined.

   Someone that suffers from BDD has an eating disorder
   because of his or her obsession with any little or imaginary
   imperfection. These obsessions can include any part of the
   face and body, such as the nose, hair, and skin. Some of the
   “imperfections” include: a large nose, wrinkles, acne, and
   scars.
Eating Disorders Quiz:

Answers
   10. Pica & Rumination Disorder

   A person that suffers from Pica has a compulsive craving
   for eating, chewing, or licking non-food items or non-
   nutritional foods for one month or longer. This may
   include: plaster, baking soda, glue, chalk, cigarette ashes,
   and paint chips.

   People with Rumination Disorder will, after a period of
   normal eating, repeatedly regurgitate (spit out) and re-
   chew their food for one month or longer.
Adolescent Athletes
Theresa Camardo and Larissa Murphy
        November 13, 2007
 Benefits of Physical Activity
Aerobic endurance
Muscular strength
Reduce risk of
obesity
Builds bone density
Higher levels of
self-esteem and
self-concept
Lower levels of
stress and anxiety
     Adolescent Athletes
“54% of U.S. adolescents report
playing on 1 or more organized
sports teams” with a higher
percentage of males (62%) playing
sports than females (50%)
For males, sports participation spans
all racial and ethnic groups
White females (54%) are more likely
to participate in sports (45%)
         Fluids and Hydration
Counseling adolescent
athletes on regular fluid
intake is extremely important
Young and prepubertal are
especially vulnerable to heat
illnesses because they cannot
regulate body temperature as
efficiently as older
adolescents
Adolescents can also become
so involved in their physical
activity that they don’t pay
attention to physiological
signs of fluid loss such as
thirst and excessive sweating
Some also believe that if they
are not moving the entire
time, they don’t need to
hydrate
       Fluids and Hydration
How much fluid should be consumed?
 – 6-8 oz. prior to exercise
 – 4-6 oz. every 15-20 minutes during activity
 – at least 8 oz. after exercise
Weighing periodically before and after a workout
can determine fluid loss
– For every pound of body weight lost, 16 oz. of fluid need
  to be ingested
No more than 16 oz./30 min. should be taken in
so side effects such as nausea don’t occur
      Fluids and Hydration
What types of fluid should be consumed?
– Although water is inexpensive and easily
  available, it may not provide enough hydration
  to intense and/or long athletic events
– Juice diluted to a 1:2 water ratio or sports
  drinks with no more than 6% CHO is
  recommended for optimum physical
  perfomance
– More concentrated drinks may cause gastric
  discomfort and may delay gastric emptying
– Drinks with caffeine may actually reduce
  rehydration
             Athlete Nutrition
Some adolescent athletes
follow special diets or use
supplements to improve
physical performance
 – Surveys of collegiate
    athletes show more
    than 10% use
    supplements
 – Some of these diets
    include carb-loading
    and high-protein
              Athlete Nutrition
Carb-loading                     High-protein
 – Often used by distance         – Can take many forms
   runners                        – In general, the athlete
 – Weeklong process                 consumes 3-4 times the
                                    recommended protein intake
 – Begins with intense              coupled with a low intake of
   training 1 week before           carbs
   competition                   Cons of high-protein
 – The first 3 days are a low-    – Usually high in saturated fats,
   carb diet with exercise to       possibly leading to heart
   deplete glycogen stores          disease later in life
 – The 3 days before              – High protein and fat intake
   competition the athlete          delays digestion and
                                    absorption, lessening the
   rests and consumes a             amount of fuel available for
   high-carb diet to promote        physical activity
   glycogen creation and          – More water is required for
   storage                          protein breakdown, which
 – Body does not need that          leads to water and nitrogen
   much glycogen storage            loss which in turn can lead to
                                    dehydration and decreased
 – Can lead to fatigue during       physical performance
   low-carb phase, and water
   retention and weight gain
   in the high-carb phase
 Additional Nutritional Needs
Vary widely, but in general:
– 500-1500 additional kcal/day
– While protein needs are slightly increased,
  they should supply no more than 30% of kcal
– Nutrient needs may fluctuate throughout the
  year depending on how many sports they
  participate in
– Weight stability should be monitored; any
  weight loss indicates insufficient kcaloric intake
  (risks include vegetarians and kcal restriction)
    For vegetarians, extra protein intake may be needed
– Athletes may need to consume the upper limits
  of serving suggestions on MyPyramid.
 Additional Nutritional Needs
Due to increased risk of bone
fractures, eating the recommended
amount of calcium is very important
– Carbonated beverages may increase
  risk of fractures in athletes
Other additional needs vary with the
individual
 Additional Nutritional Needs
Pre-event meal at 2-3          Post-event meals should
hours before                   be 400-600 kcal and
– Eating any closer could      comprised mostly of high-
  lead to indigestion and      carb foods and adequate
  discomfort                   amounts noncaffeinated
High fat, fiber, and protein   fluids
foods should be avoided 4
hours prior to an event due
to longer digestion time
and the displacement of
complex carbs, the
athlete’s most readily
available source of energy
                  Female Athlete Triad




Source: http://www.hkeducationcenter.com/courses/OEC_Previews/hf-ft303_preview/images/fig_03.gif
     Female Athlete Triad
Prevalence:
– Sports where weight is emphasized such
  as gymnastics or ballet
– But can occur in any highly competitive
  athlete
– Coaches will tell the athlete that they
  need to lose weight
                Female Athlete Triad
      Signs and symptoms:                 Eating disorder signs and
       – Weight loss                      symptoms also occur:
       – No or irregular periods (no       – Continued dieting
         menses for 3 months, low          – Preoccupation with
         estrogen levels) --- due to         food/weight
         loss of body fat                  – Frequent bathroom trips
       – Fatigue and loss of                 after meals
         concentration                     – Laxative use
       – Stress fractures                  – Brittle hair/nails
       – Muscle injuries                   – Dental caries (bulimia)
                                           – Cold sensitivity
                                           – Low heart rate/blood
                                             pressure
                                           – Heart irregularities/chest
                                             pain

Source:
http://www.kidshealth.org/teen/food_fitness/sports/triad.html
      Female Athlete Triad
Treatments for the triad include
counseling, hormone replacement
therapy, and nutrition therapy
Female athletes should be encouraged to
enjoy their choice of sport without a heavy
emphasis on competition and to maintain
a healthy weight (it actually maximizes
their performance as opposed to being
underweight)
            Sources
http://www.kidshealth.org/teen/food
_fitness/sports/triad.html
http://www.pamf.org/teen/parents/h
ealth/nutrition.html
http://www.urbanext.uiuc.edu/hsnut
/hsath3b.html#5
Text – Nutrition Through the Life
Cycle, Judith E. Brown 2008

				
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