Adolescent Nutrition

Kathryn Camp, MS, RD, CSP

Topics for Discussion

Adolescent growth and development
Psychosocial development
Nutritional issues for adolescents
Acute and chronic disease risk
Influences on adolescent eating
behaviors
Effective nutrition interventions

Adolescence:
The Vulnerable Life Stage
Big

changes: Biological

Boysget tall, lean, and dense

(bones, that is)
Attain 15% of final adult ht
during puberty
Lean body mass doubles
Large calorie needsincrease
from 2,000 at 10 yr to 3,000 at
15 yr

Adolescence:
The Vulnerable Life Stage

Girlsget taller and fatter

% body fat increases from the teens into
the mid-20s
Gain almost 50% of their adult ideal
weight 6-9 mo before ht rate increases
during puberty
Dieting can have a negative impact on
linear growth during this time
Calorie needs increase by only 200 from
10 yr to 15 yr

Cognitive
Thinking style changes from
concrete to hypothetical and
abstract
takes the adolescent beyond the
here and now into the realm of
possibilities (David Elkind,
1984)

Identity development
Attempt to figure out who they are
Success is dependent on positive
interaction with the environment
home, school, and the community
They will try on different lifestyles
looking for the right fit
Risk taking behaviorsalcohol, drugs,
tobacco, sexual behaviors, self-injury
and suicide
Immediate and severe
consequences

Behaviors with Less

Pronounced Consequences
Eating choices
Physical activity and exercise
Affect adolescents sense of wellbeing, energy and health in the
short term
Affect adult-onset chronic disease
risk in the long term

Another
form of RiskTaking
Behavior

Nutrition Issues in
Adolescent Health

Cardiovascular and cancer disease risk

Osteoporosis and bone mineralization
Overweight and obesity
Type 2 diabetes
Eating disorders

Nutritional needs of the adolescent

Part athlete
2
Adolescents with chronic medical
concerns
Adolescent pregnancy

Cardiovascular Disease
and Cancer Risk

One-third of CVD and cancer-related morbidity

attributed to dietary patterns
Diets high in sat fat, total fat, and sodium and low
in fiber
Diets low in fruits and vegetables
Dietary fat
Recommended: <10% of calories from sat fat and
<30% total fat
Consumed: 1/3 of adolescents are in this range
Sodium
Recommended: <2.5 g/d
Consumed: 3-5 g/d
NHANES III data; 8891, McDowell 94

Fiber
Recommended: Age + 5
Consume: this amount
Fruits and vegetables high in fiber and low in fat and sodium
the least consumed food groups for
teens
1/4 eat 2 or more servings of fruit/d
<25% eat at least 5 servings of fruits
and vegetables daily

Munoz 97, Kennedy

95

Food Ingestion:
# 1 on Moms
ddx

Eating Away from Home

Teens directly spend more than

$5.4 billion in fast food restaurants
$9.6 billion in food and snack stores
$736 million in vending machines
78% in school
Fast foods tend to be low in Fe, Ca,
riboflavin, vitamin C, and folic acid
More meals missed at home thus the
choice of foods away is more
important than the time or place

Frequency of Fast Food

Restaurant Use Among
Positively associated with
Adolescents
(French 01)

Total kcal, % kcal from fat, daily

servings of soda, cheeseburgers,
french fries and pizza
Student employment, TV watching,
home availability of unhealthy foods
Negatively associated with
Daily servings of fruit, vegs, milk
Perceived maternal and peer
concerns about healthy eating
Not associated with overweight status

Overweight,
Obesity, and
Type 2
Diabetes

Etiology of
Obesity
Heritability
Homeostasis
Specific syndromes

Heritability
Survival advantage to conserve
energy as fat through human
evolution
Humans enriched for genes that
promote energy intake and storage
and minimize expenditure.
Enhance female fertility and ability
to breastfeed offspring

In modern industrial environment

easy access to calorically dense
foods
encourages sedentary lifestyle
Metabolic consequences of these
genes are maladaptive

Genetic Factors account for 20Buchard 97

40% of heritability of BMI

Rankinen 02

34 single gene mutations in 83

individuals reported by 2001
> 250 susceptibility genes linked
with human obesity phenotypes

Familial Risk:
2-3 fold for
moderate
obesity
5-8 fold for
severe obesity
Bouchard 01

Obesity
Associated
Syndromes and
Conditions

Overweight Prevalence
Increasing

Overweight tracks into

Adulthood

Overweight
teenagers are
4-5 times as
likely to be
obese adults
(Guo and Chumlea
99)

35

4
3

36

37

BMIs of the
University of Miami
Blocking Machine

39

38

Causes of Marked Increase

in Overweight

Reflects a shift towards positive

energy balance

energy intake = energy

expenditure

100-300 kcal/d

PE
sed act

McDowell 94; Kann 99; Troiano 00,

NHANES II to III

Other Contributors to
Sedentary Lifestyles

Video and computer games

Parental work schedules
Unsafe neighborhoods
discourage parents from allowing
children to play outdoors
force parents to drive children to school
Lack of recreational facilities in lowincome neighborhoods

Prevalence of Overeating
Among 4,746 Adolescents
17.3% of
(Ackard
03)
girls and 7.8% of boys reported

overeating and were more likely to:

be overweight or obese
have dieted in the past year
be currently trying to lose wt
Those who met the criteria for binge
eating syndrome (3% of girls and 1% of
boys) had higher suicide risk (28% for
girls and boys)

Psychological and Economic

Consequences of Adolescent
Obesity

Discrimination, rejection and low

self-esteem (Gortmaker 93),
particularly for females
Less participation in PE and sports
activities
Lower college acceptance rates

(Canning 1966)

Health Issues in Overweigt

Adolescents

Growth
Taller, advanced bone age,
mature earlier
Early maturation is associated
with
increased fatness and truncal
fat distribution in adulthood

Hepatic Steatosis
Orthopedic Problems
Sleep Apnea
Occurs in 17% of obese children
and teens (Marcus 1996)
Deficits in learning, memory, and
vocabulary (Rhodes 1995)
Obesity hypoventilation syndrome
(rare, potentially fatal disorder)

Cardiovascular
Hyperlipidemia-- LDL and TG, HDL
Hypertension
Low frequency in children
Muscatine Study (Rames 1978)
1% of 6600 children 5 to 18 had
persistently elevated BP
60% with BP were >120% of
IBW

Type 2 Diabetes

3-10 fold increase in prevalence in

adolescents
Mean age is 13.5 yrs
95% of teens with Type 2 diabetes have a
BMI >85%ile
increased insulin resistance
21% of adolescents with BMIs >95th%ile had
impaired glucose tolerance (Rocchini 02)
Tremendous public health implications
Longer duration of disease, > risks of
complications

Dabelea 99; Vinicor 00; Richards 85

How Do Teens Attempt to

Lose Weight?

1999 Youth Risk Behavior Surveillance

58% exercised
40% ate less food or lower fat foods
13% fasted
8% took diet pills
5% vomited or took laxatives

Kann 1999

Weight-Related Eating
Disorders

Anorexia

nervosa

Self-starvation,
weight loss, intense
fear of weight gain,
body image distortion

Bulimia

nervosa

Binge eating and

purging

Binge

eating
disorder
Binge eating
without purging
resulting in weight
gain

Anorexic and
Bulemic Behaviors
Expressed in 10-20% of adolescent
girls
Mimic behaviors in AN and BN but are
not done with the frequency or
severity to classify as mental illness
Half of teen girls and 15% of boys
report dieting behaviors
Ranging from eating less fat to
fasting (Neumark-Sztainer 00)

Osteoporosis and Bone

Mineralization
Osteoporosis affects 25-30 million
adults in the US, women > men
15-25% with hip fractures require
long-term institutional care
Treatment of osteoporosis costs
$14 billion/yr
Etiology complexgenetic, hormonal,
physical activity, dietary factors

Maximum peak bone mass (PBM) at

skeletal maturity is protective
PBM is achieved during the late
stage of pubertal development
90-95% of PBM is attained by the
2nd decade of life
40% of which is during
adolescence

Low bone mineral density is

associated with fractures late in
life
Adequate nutrition, including
energy, protein, vitamins and
minerals are associated with good
bone health

Calcium
Milk and dairy products are primary
source of calcium in the US
Only 49% of boys and 20% of girls
consume the recommended number
of servings from the dairy group.
AI for calcium for 9-18 yr is 1300
mg/d
Girls 14-18 yrs consume 55% of this
goal at 713 mg 42 mg/d (Grove 98)

Calcium Content of Foods

Food Item

Serving
size
1 cup
1 oz
1 cup
3 oz

Mg calcium

Milk or yogurt
300
Cheese
175-275
Ca fort OJ
200-300
Salmon w
180
bones
Fort. cereal
1 cup
100
Broccoli
cup
47
3
cups
milk;
1
oz
cheese,
c
1300 mg
Orange
1 med
40
broccoli,
=

Soda Consumption: Effects

on body weight, dental
health and nutritional status

No association with dental

caries (Heller 01)
25% of adolescents drink
>26 oz of soda/d
Inverse relationship between
intake of nutrients found in milk
and fruit juice with soda
consumption
Riboflavin, vitamin A, calcium,
phosphorus, and vitamin C
(Harnack 99)

Mean Nutrient Intake by Level of

Soft Drink Consumption in
Adolescents
Soda/d:
0 oz
.1-13
13-26
>26 oz
Calories
Fat % of kcal
Folate ug
Vit C mg
Calcium
mg

1984
34 *
239
98
819

Riboflavin 2.1
* p<.05

oz
2149
32
238
100
804

oz
2312
32
191*
62*
652*

2604*
31
178*
52*
635*

1.9

1.6*

1.5*

Harnack 99

To Review Risky
Adolescent Nutritional
Weight gain leading to obesity and type 2
Issues
diabetes

Calcium intake and soft drink consumption

leading to inadequate bone mineralization
Eating habits that result in disordered
eating practices
Low consumption of fruit and vegetables
and high consumption of fat and sodium
are related to adult-onset disease risk

The relationship between the adolescent

diet and chronic disease risk is predicated
on the assumption that eating behaviors are
learned and solidified during childhood and
adolescence and are maintained into
adulthood (Lytle 02)

What Influences
Adolescents Food Choices?

Psychosocial
Strong Influences
Food preferences
Early childhood experiences,
exposure, genetics
Taste and appearance
Weak influence
Health and nutrition
Only 26% of college students were
motivated by health when making
dietary choices (Horacek 98)

The Meaning of Food

Study of 93 Canadian adolescent girls
Eating Junk food was associated
with pleasure, being with friends,
weight gain, independence, guilt,
affordability, and convenience.
Eating healthful food was
associated with family, meals, and
being at home

Chapman 93

Influences cont

Biological
I was hungry is often the first response
when asked why a specific food was
eaten
Lifestyle
Time and convenience
Teens would rather sleep than eat
breakfast (Neumark 99)
Cost
In a study of 12 high schools,
consumption of fresh fruits and vegs
when cost was by 50% (French 01)

More Influences

Familymajor influence
Food provider
Influences food attitudes,
preferences and values
Despite increased eating outside
the home, teens still obtain 65%
of their total energy from home.
Dinner at home is the most important
meal
80% of parents and teens place high
importance on this meal
1/3 of teens eat dinner q night at home

Effective Nutrition
Interventions for
Behaviorally based
Adolescents

Use developmentally appropriate

strategies
Include an environmental component
Sufficient amount of contact
Use technological advances such as
CD- ROMs

Hoelscher, JADA 2002;102:S52

Nutrition Intervention
Programs for Adolescents
Clueless in the Mall: An interactive
web site on calcium for teens
Texas Cooperative Extension Service
http://calcium.tamu.edu/
Committed to Kids: An integrated, 4level team approach to weight
management for adolescents
http://www.committed-to-kids.com/

Great Beginnings: Nutrition

curriculum for pregnant adolescents
University of New Hampshire
http://ceinfo.unh.edu/Common/Do
cuments/grtbegin.htm
Gimme 5: A school-based nutrition
intervention for high school students
Baylor College of Medicine

Adolescent Nutrition JADA, March 2002

Stay Tuned for Part

2