Diploma in

Nutrition
Week - 22
 TOPICS
1. Introduction to Diet during Adolescence

2. Recommended Dietary Allowances

3. Dietary Guidelines for Adolescents

4. Eating Disorders

5. Predisposition to Osteoporosis
Introduction to Diet during
Adolescence
Physiological Changes
• Maximum nutritional requirements of adolescent males and females begin around
12 to 15 years old and 10 to 13 years old, respectively.
• Human body begins to develop a crucial body composition, which is roughly 10%
body fat.
• 22% of fat is essential to ensure regular ovulation in an adolescent female body.
• Zinc shortage has a big impact on the bodies of adolescent males and females
• The demand for energy, protein, minerals, and vitamins increases rapidly during
adolescence due to the increased intensity of growth.
• Between the ages of 18 and 20, adolescent boys and girls acquire adult height.

Secular Changes
• A series of temporal periods is referred to as “secular.”
• Secular changes are therefore dimensional shifts or shifts in the maturational
schedule over a generation.
Key Changes during Adolescence

Increase in height and weight Body composition

• Puberty refers to the physical changes that a
kid goes through while moving into teenage
years.
• All of a child’s delayed growth processes are
brought up to speed.
• Human body continues to grow at the same
rate as it did during childhood.
• As a result, adolescence is often known as a
person’s second development era.
• A growth spurt occurs in adolescent boys and
girls between the ages of 13 and 16, and 11 and
14, respectively.
• These two generational cohorts are the ones
that experience the most growth.
• Height and weight gain the greatest in girls
during the pre-menarche years
• Most adolescent females acquire roughly 2 to
3 cm in height when menstruation begins.
• In late adolescence, however, this growth slows
down and then halts.
• In comparison to girls, adolescent males reach
their maximum weight faster, while their
skeletal growth takes longer.
• At 17 years old, a female’s skeletal structure
reaches full size, whereas men attain full size at
20 years old.
• Bone mineralization also increases at this age.
• However, if the water content of bones declines
over time, the human body may suffer due to
that.
• The body of a teenage female can
accumulate more total body fat than a male’s
body.
• The body of an adolescent boy can retain
more muscle mass deposits than a girl’s body.

Pubertal changes result in three structural changes in males:

1. Higher lean body mass
2. Larger skeleton
3. Less adipose tissue in terms of the ratio of total body mass

Sexual maturity
• Breast, axillary, and pubic hair growth are all signs of adolescent female development.
• Menarche is a harbinger of rapid growth stages.
• Girls in today’s age reach menarche earlier than those in prior generations.
• This could be attributed to girls consuming more nutritious and healthier foods.
• During their adolescent years, boys experience a range of sexual changes, including deepening of
voice, development of axillary, pubic, penis, and testicles, and broadening of shoulders.
Psycho-social changes

• This transitional phase can force adolescents

to think about self-identity.
• An individual becomes sensible to process
thoughts on sexual development, gathers the
ability of decision making and has freedom of
expression.
• Furthermore, the demands and pressures of
people around them can have an impact on
any adolescent.
• Clothing choices, eating habits, and social behavior, among other things, get affected. As a result,
psychological stress, emotional stress, social stress, and tensions occur.
• While the period of rapid physical growth may be brief, psychological development might take place
over a longer period of time.
• The psychological and neurological changes that take place during adolescence are inextricably
linked.
• Adolescents are more affected by their social and cultural environment since they may express their
preferences based on it.
• They could even want to be more self-reliant and responsible.
• They are willing to take control of their decisions, feelings, and actions, allowing them to become
independent of parental control.

Key aspects to maintain the perfect body shape:

• An ideal body weight of an adolescent boy and girl under the age of 12 years is 34.3 kg and 35.0 kg,
respectively.
• A healthy body weight for a male and female teenager between the ages of 13 and 15 is 47.6 kg and
46.6 kg, respectively.
• Now, Adolescent males and females under the age of 16 to 17 years are required to weigh 55.4 kg and
52.1 kg, respectively.
• All of these body weights are based on the RDA for adolescents. These appropriate weights and
adequate nutrients will aid their growth and prepare their bodies for a healthy transition into
adulthood.
Recommended Dietary Allowances
Energy
• Male adolescent caloric needs begin to
outnumber female adolescent caloric needs.
• The metabolic demands of an adolescent
body rise due to two factors: growth and
energy expenditure.
• Individual energy requirements, on the other
hand, are determined by the individual body.
• Female teenagers eat less calories than their
male counterparts.
• The net energy values of boys and girls under
the age group of 10 to 12 years must be 2190
Kcal/d and 2010 Kcal/d respectively.
• The net energy values of boys and girls under
the age group of 13 to 15 years must be 2750
Kcal/d and 2330 Kcal/d respectively.
• The net energy values of boys and girls under
the age group of 16 to 17 years must be 3020
Kcal/d and 2440 Kcal/d respectively.
Proteins
• Adolescents’ protein requirements stay
constant until they reach the age of ten. Their
body’s protein requirements shift later in life,
when they begin their adolescent adventure.
• Although their protein requirements keeps
changing, especially for adolescent boys, their
bodies require more protein than a female’s
body.
• The adequate requirement of protein for the
boys and girls of 10 to 12 years of age group are
40.4 g/d and 39.9 g/d respectively.
• The adequate requirement of protein for the
boys and girls of 13 to 15 years of age group are
54.3 g/d and 51.9 g/d respectively.
• The adequate requirement of protein for the
boys and girls of 16 to 17 years of age group are
61.5 g/d and 55.5 g/d respectively.
• Points to remember concerning protein intake
in adolescents:
• Protein is estimated to be 12 to 14 percent of an
adolescent’s total energy consumption.
• Protein consumption is expected to exceed 1
gram per kilogramme of body weight.
Fats Iron

• The standard amount of visible fat allowed for
both boys and girls under the age group of 10
to 12 years is 35 g/day.
• The standard amount of visible fat allowed for
the boys and girls under the age group of 13 to
15 years is 45 g/day and 40 g/day respectively.
• The standard amount of visible fat allowed for
the boys and girls under the age group of 16 to
17 years is 50 g/day and 45 g/day respectively.
• The required need of iron for the boys and girls
of age group 10 to 12 years is 21 mg/d and 27
mg/d, respectively.
• The required need for iron for the boys and
girls of age group 13 to 15 years is 32 mg/d and
27 mg/d, respectively.
• The required need for iron for the boys and
girls aged 16 to 17 years is 28 mg/d and 26
mg/d, respectively.

Minerals Zinc

• RDA guidelines have set clear cut values of few • The adequate requirement of zinc for both

essential minerals for an adolescent body. boys and girls of age group 10 to 12 years is 9
mg/d.
• The adequate requirement of zinc for both
Calcium
boys and girls of age group 13 to 15 years is 11
• The RDA allows boys and girls in the age cat-
mg/d.
egories of 10 to 12, 13 to 15, and 16 to 17 years to
• The adequate requirement of zinc for both
consume 800 mg of calcium per day.
boys and girls of age group 16 to 17 years is 12
mg/d.
Magnesium

• The set RDA values of magnesium for boys and

girls aged 10 to 12 years are 120 mg/d and 160
mg/d, respectively.
• The set RDA values of magnesium for boys and
girls of age group 13 to 15 years is 165 mg/d
and 210 mg/d respectively.
• The set RDA values of magnesium for boys and
girls of age group 16 to 17 years is 195 mg/d
and 235 mg/d respectively.
• Calcium and iron are the two minerals that are required the most during adolescence’s growth
years.
• Calcium is required for the growth of all bones in the body. It strengthens the bones nutritionally and
protects them from potential bone disorders.
• It is believed that approximately 150 mg of calcium should be retained in an adolescent. This
amount of calcium aids in the development of bone mass.

• Iron is an important mineral for teenage strength.

1. Iron is required for the body’s hemoglobin synthesis.
2. It is necessary for the production of the requisite amount of blood for blood volume expansion.
3. It is one of the most important factors in the development of muscle mass.
4. Because they lose about 0.5 mg of iron each day during menstruation, girls should never sacrifice
their iron intake from diet.
5. Iron deficiency, often known as ‘anemia,’ must be supplied at all costs to avoid the onset of ane-
mia in the body.

• In males, body mass increases approximately 4.3 kg/year, whereas female body mass increases
about 4 kg/year.
• In males, hemoglobin levels rise by about 2 g/dl. On the other hand, females experience a 1 g/dl in-
crease in hemoglobin.
• Males require 0.7 mg/day of hemoglobin for growth, whilst females require 0.45 mg/day.

Vitamins

Vitamins are divided into two categories: fat-soluble vitamins and water-soluble
vitamins. Some of these are:
• Vitamin A includes retinol and b-carotene.
• Thiamin which is commonly known as
vitamin B1.
• Riboflavin which is also termed as vitamin B2.
• Niacin equivalent or simple Niacin.
• Pyridoxine is also known as vitamin B6.
• Ascorbic acid which is generally called
vitamin C.
• Dietary folate is also referred to as folic acid or folacin.
• Vitamin B12, also termed as
cyanocobalamin.
• Boys and girls between the ages of 10 and 12 years, 13 to 15 years, and 16 to 17 years require 600 mg of
retinol each day.
• Boys and girls between the ages of 10 and 12 years, 13 to 15 years, and 16 to 17 years require 4800 mg
of b-carotene per day.
• The RDA values for the intake of thiamine for boys and girls under the age groups of 10 to 12 years is 1.1
mg/d and 1.0 mg/d respectively.
• The RDA values for the intake of thiamine for boys and girls under the age groups of 13 to 15 years is
1.4 mg/d and 1.2 mg/d respectively.
• The RDA values for the intake of thiamine for boys and girls under the age groups of 16 to 17 years is
1.5 mg/d and 1.0 mg/d respectively.
• The needed quantity of riboflavin for boys and girls under the age group of 10 to 12 years is 1.3 mg/d
and 1.2 mg/d.
• The needed quantity of riboflavin for boys and girls under the age group of 13 to 15 years is 1.6 mg/d
and 1.4 mg/d.
• The needed quantity of riboflavin for boys and girls under the age group of 16 to 17 years is 1.8 mg/d
and 1.2 mg/d.
• Intake of niacin equivalent for boys and girls under the age group of 10 to 12 years is 15 mg/d and 13
mg/d respectively.
• Intake of niacin equivalent for boys and girls under the age group of 13 to 15 years is 16 mg/d and 14
mg/d respectively.
• The dietary intake of niacin equivalent for boys and girls under the age group of 16 to 17 years is 17
mg/d and 14 mg/d respectively.
• The RDA of Pyridoxine for both boys and girls under the age group of 10 to 12 years is 1.6 mg/d.
• The RDA of Pyridoxine for both boys and girls under the age groups of 13 to 15 years and 16 to 17 years
is 2.0 mg/d.
• The adequate intake of ascorbic acid for both boys and girls under the age groups of 10 to 12 years,
13 to 15 years and 16 to 17 years is 40 mg/d.
• The RDA values allocated for dietary folate for both boys and girls under the age group of 10 to 12
years is 140 mg/d.
• For both boys and girls under the age group of 13 to 15 years is 150 mg/d.
• The allocated for dietary folate for both boys and girls under the age group of 16 to 17 years is 200
mg/d.
• Vitamin B12 intake requirements for boys and girls under the age of 10 to 12 years, 13 to 15 years, and
16 to 17 years are between 0.2 mg/d and 1.0 mg/d.
Role of Vitamins during adolescence

• Folacin and vitamin B12 are required for DNA

and RNA synthesis. Furthermore, when tissue
synthesis occurs at a faster rate, these two
vitamins are required in greater quantities.
• An increase in calorie consumption might raise
the body’s requirement for thiamine, riboflavin,
and niacin.
• Tissue development necessitates amino acid
metabolism elements. This is especially
important when it comes to sending
information to non-essential amino acid
synthesis. As a result, the body’s vitamin B6
demand rises.
• Consuming 100 mg of vitamin B6 each day can
reduce premenstrual tension in adolescent
girls.
• Vitamin D is critical for the body’s skeletal
development.
• Vitamins A, C, and E are required for the
structural and functional development of
freshly created cells.
During their adolescent years, adolescent ladies have the modest disadvantage of overeating. This is
due to the following:
• Fat accumulation during menstrual periods is linked to female physiologic sexual variations.
• Furthermore, they are more likely to gain weight if they do not engage in regular physical activity.
• As a result of their weight gain, adolescent females may face societal or personal pressures. They
may turn to bad eating habits as a result of their obsession with their appearance. Obsessing over
weight loss may lead to self-imposed crash diets. Her health is likely to suffer as a result of this.
• Self-starvation frequently leads to complicated eating disorders such as anorexia or bulimia. Fur-
thermore, many illnesses may be severe in character and go unnoticed.
Dietary Guidelines for Adolescents
• For better eating habits, all teenage eating behaviors should be independent of their
emotions.
• Calorie and protein-rich foods can aid in the maintenance and support of growth spurts
during adolescence.
• Obesity and malnutrition should be avoided in the body if all nutritional foods are
sufficient.
• Calcium-rich foods should be consumed in a fair proportion by all females, especially
adolescents.
• Calcium is known to have a substantial impact on bone density in the body, which can
assist to prevent osteoporosis from developing.
• At all costs, avoid skipping meals. Your body needs to get the nutrients it needs at the right
time of day.
• Avoid items that are high in empty calories in your diet. A good example of one of these
foods is carbonated beverages.
• A poor diet throughout adolescence increases the risk of future health problems.
• Uncontrollable bodily changes may result from dietary deficits or excesses of certain substances.
• These modifications will have an adverse effect on adolescent growth.

Health issues that teenagers face:

• Obesity
• Eating disorders like Anorexia nervosa, bulimia nervosa, binge eating etc.
• Predisposition to osteoporosis
• Anemia
• Undernutrition
• Premenstrual Syndrome
• Malnutrition due to early marriage

Obesity
• Obesity affects a substantial percentage of the
population. However, the adolescent popula-
tion is more vulnerable to it because of their
dietary habits.
• Obesity in adolescence is more typically
caused by excessive calorie consumption than
by a lack of movement.
• Hormonal abnormalities in their bodies make
them crave various foods to satisfy their hun-
ger.
• To preserve their body form, an adolescent
will be more than delighted to participate in
sports, dance, or other physical activities.
• Controlling weight in order to improve one’s
attractiveness will compel them to participate
in these exercises despite their reluctance.

• Other factors that affect weight gain during adolescence:

1. Family
2. Emotional stress
3. Hormonal imbalance
Eating Disorders
• There are three common eating disorders: anorexia nervosa, bulimia nervosa, and binge
eating disorder.

Physical Signs of Anorexia Nervosa

• It is particularly prevalent throughout early and middle adolescence.

• The adjective “very thin” or “emaciated” is used to describe a person’s physical
appearance. The weight comes out to be less than 85% of one’s normal or ideal body
weight. In addition, the adolescent will endure fast weight loss.
• The monthly menstrual cycle of an adolescent female may be erratic.
• Lanugo, or fine, downy hair, will occur on numerous parts of the body, including the arms,
legs, and occasionally the cheeks.
• The adolescent will have extreme nausea, constipation, and bloating even after eating the
recommended amount of food.
• When an adolescent begins to struggle with anorexia nervosa, they start to:
• Obsess about cooking for others and maintaining a nutritious diet, yet refuse to eat.
• They invent small excuses to avoid eating dairy or meat products, which are otherwise their favorite
or go-to foods.
• They begin to eat much smaller servings of food and glare at other people who are eating.
• They begin to overwork themselves.
• Before consuming anything and everything, they start chatting about science and calories. They
become fixated on the nutritional information on food packages.
• They start substituting low-calorie condiments like mustard or vinegar for oils and fats.
• They pick on habits from social media, such as chopping their food into little pieces and using
smaller dinnerware, and begin to obsessively follow them.

Psychological signs:

• They begin to feel as though they have gained

weight, while having a really healthy body.
They are driven to perform inconceivable acts
by their constant fear of changing their body
shape.
• Weight, food, diet, and exercise are all they
ever think or talk about.
• They shun social gatherings, which results
in less social interactions, loneliness, and
melancholy.
• Emotional disengagement is also a typical
symptom among teenagers.
• Perfectionism to them means looking nice and
seeming healthy.
• They frequently have low self-esteem.
• Malnutrition causes weariness and weakness
in the body.
Physical signs of Bulimia nervosa:

• Extreme weight fluctuation is usually noticeable.

• They’d start eating larger portions or more frequently in an attempt to acquire weight, but they’d fail.
• They would notice a decline in their dental health. There’s a danger of getting cavities or thedental
enamel gets eroded.
• Due to enlarged parotid glands, their cheeks may bulge.
• The calluses on the backs of the hands will start to form.
• They were always tired and weak.
• This disorder causes an irregular menstrual cycle in women.
• In bulimia nervosa patients, there is a peculiar eating and exercise patterns, like:
• They begin to binge eat.
• They’d always find excuses for going to the bathroom after they’d eaten to their hearts’ delight.
• You’ll notice that they puke frequently after eating.
• They’re always justifying overusing diuretics, laxatives, emetics, enemas, fasting, vomiting and
overexercising.
• They would pass down any opportunity to dine out again.

Psychological symptoms of Bulimia Nervosa:

• Adolescents with this condition will be

obsessive about nutritional value, calories,
exercise, and diets.
• They’d either be clearly uncomfortable with
people eating in front of them, or they’d be
visibly uncomfortable with people eating in
front of them. Alternatively, once they start
eating, they won’t be able to stop and stuff
everything into their mouth. because they
know they’ll vomit it out afterwards (in the
bathroom).
• While adapting to the feeling of emptiness,
they’d often pretend to be fine and grin
unusually more. They’d be suffering from
anxiety in silence.
• To avoid eating, they may turn to substance
misuse or alcohol addiction.
Binge Eating Disorder:

• An adolescent or a person of any age can suffer from binge eating disorder.
• This disorder is most usually undiagnosed until maturity.
• An adolescent with binge eating disorder would exhibit physical signs like:
1. They’d go from being slender to being overweight, in a short time.
2. Early on, they’d start to develop obesity-related health issues like type 2 diabetes, high
cholesterol, high blood pressure, and so on.
• In a binge-eating adolescent, there are specific eating and exercise patterns like:
1. They’d be more aware of the importance of losing weight, but their eating habits would not reflect
this.
2. They’d be locked in a vicious cycle of losing and gaining weight.
3. They’d keep a close eye on their diet and exercise regularly, yet they’d struggle to lose weight.
4. Even when they weren’t hungry, they’d be constantly eating.
5. When they went out to eat, they would always order more food than they could eat and then
force themselves to finish it.
6. They’d always wind up eating in lesser portions at social occasions, but they’d eat frequently.
Alternatively, they’d return home to eat properly.
7. They wouldn’t even break a sweat, no matter how hard they worked out.

Psychological signs

• They’d speak up more about mental health

difficulties such as depression, guilt, loneliness,
humiliation, emotional emptiness, and so on.
• They feel guilty after binge eating and are
frequently depressed.
• Most teenagers would excuse binge eating as
a way to cope with or overcome emotional
trauma or abuse.
• They wouldn’t feel at ease dining with close
friends and family, or at social gatherings. As
a result, they’d either skip meals entirely and
binge eat once they got home, or they’d eat
little but frequent servings at the get-together.
• They’d be irritable all of the time, and the
tiniest things may set off their anxiousness and
emotional outbursts.
Predisposition to Osteoporosis
• Your bones become brittle as a result of osteoporosis.
• Adolescents with this disorder may break their bones as a result of anything as simple as
bending or coughing.
• The hip, wrist, and spine are the most prevalent sites for osteoporosis-related fractures.
• Anyone can develop osteoporosis. As a result, it is advised that one follows a balanced
diet and takes prescribed medication.
• Certain outside activities might sometimes have a negative impact on your inside
wellness. Excessive activity, nutrition intake, or lowering body fat levels are all examples of
unhealthy behaviors.
• Low estrogen circulation, low bone mass, and irregular menses are the outcomes of these
three factors.
• Practically all teenagers are predisposed to osteoporosis due to two main factors: dietary
deficiency and exercise habits.
• Milk is the body’s principal calcium supply
Anemia Undernutrition

Factors that contribute to the spread of anemia:
• It occurs as a result of the body’s inability to
obtain nutritious meals.
• It occurs as a result of their specific dietary
preferences, which necessitate a tight diet.
• As a result, some people rely on supplements,
particularly pregnant women, to whom doctors
are now compelled to provide adequate iron
supplementation to prevent anemia.
• Poor calorie consumption has been associated
with a BMI deficit in various scientifi
investigations, notably in upper-middle-class
adolescent females.
• As a result, for some people, losing weight is
one of the primary causes of malnutrition.
• Rural girls may have a decreased food intake
as a result of their family’s circumstances,
resulting in undernutrition.

Premenstrual Syndrome

• Physical and psychological symptoms characterize premenstrual syndrome in adolescence.

• It usually happens 7 to 10 days before the start of periods.
• Moreover, it fades away gradually on the first or second day of menstruation.
• The following are some of the symptoms that an adolescent female may notice:
1. Weight gain
2. Pain in breasts
3. Abdominal bloating
4. Increases appetite
5. Peripheral oedema
6. Constipation
7. Irritability
8. Headache
9. Anxiety
10. Tension
11. Stress
12. Depression
13. Lack in concentration
14. Craving for sweets and salty food items
Malnutrition due to early marriage

• Certain girls, it appears, marry at a young age,

i.e. shortly after menarche.
• When they are still adolescents, some even
end up conceiving a child. These soon-to-be
mothers, are considered at a ‘high risk’ of
maternal or perinatal death.
• Perinatal mortality is the number of stillbirths
and deaths per 1000 live births in the first year
of life. The rates of newborn mortality are also
greater.
• A woman’s body should be biologically mature
when she considers having a child.
• A physiologically mature female has reached
menarche and has been menstruating for at
least five years to be considered
physiologically mature.
• This is a significant consideration because it
has a greater impact on pregnancy than the
female’s chronological age.
Impacts of early marriage and motherhood on females:

• When adolescent girls become pregnant shortly after menarche, they show indications of malnutri-
tion.
• She must balance her personal needs with those of the conceptus, the embryo in the uterus during
the early stages of pregnancy.
• Preeclampsia, eclampsia, and subsequent pregnancy loss may be more common than previously
believed.

Let’s take a look at what these three medical problems really mean:
• Preeclampsia is a high-blood-pressure syndrome that occurs during pregnancy.
• Eclampsia develops when preeclampsia is not appropriately controlled. It is most commonly defined
as the presence of preeclampsia and seizures during pregnancy.
• Pregnancy wastage occurs when the female conceives a child but cannot give birth to a healthy
child.

Relationship between maternal body weight and low birth weight:

• Lactation failure is a common occurrence among adolescent mothers

• This factor has the potential to increase newborn mortality or morbidity. The number of newborn
deaths per 1,000 live births is known as the infant mortality rate.
• The introduction of supplements into the female’s diet at a young age may be a cause of baby
death and morbidity.
• The reduced size of the pelvis can sometimes affect delivery.
• The rate of premature deliveries can increase and even the occurrence of incidence of low birth
weight can also get high.
Smoking

Let’s look at some factors that often induce adolescents to smoke:

• Smoking with friends or parents.
• Intrafamilial smoking habits.
• Combined smoking with alcohol and drugs.
• Perception towards cigarettes

• Regularly smoking as an adolescent can lead to recurrent respiratory infections, lung

development difficulties, reductions in vital capacity (the maximum amount of air exhaled
from a person’s lungs after maximal inhalation), lung cancer, etc.
• As a result, smoking should be avoided at all costs by adolescents.
Alcohol Drinking

• Heavy drinking during youth and adulthood puts a person at risk for pancreatitis, hepatitis,
liver cirrhosis, hypertension, and anemia, among other health problems.
• Several studies have found that drinking throughout puberty has an impact on bone density
growth.
Drug Usage

• Adolescents are more likely to embrace destructive behaviors despite being aware of the
negative repercussions of drug or substance misuse.
• Changes in brain development are one of the concerns that teenagers may experience as
a result of substance misuse.
• During growth and maturation, adolescent drug consumption can affect body systems
such as neurocognitive functions, brain morphology, and neural plasticity.