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Mary Story and Jamie Stang
NUTRIENT REQUIREMENTS The phenomenal growth that occurs in adolescence, second only to that in the first year of life, creates increased demands for energy and nutrients. Total nutrient needs are higher during adolescence than any other time in the lifecycle. Nutrition and physical growth are integrally related; 1 optimal nutrition is a requisite for achieving full growth potential. Failure to consume an adequate 1 diet at this time can result in delayed sexual maturation and can arrest or slow linear growth. Nutrition is also important during this time to help prevent adult diet-related chronic diseases, such as cardiovascular disease, cancer, and osteoporosis. Prior to puberty, nutrient needs are similar for boys and girls. It is during puberty that body composition and biologic changes (e.g., menarche) emerge which affect gender-specific nutrient 1 needs. Nutrient needs for both males and females increase sharply during adolescence. Nutrient needs parallel the rate of growth, with the greatest nutrient demands occurring during the peak velocity of growth. At the peak of the adolescent growth spurt, the nutritional requirements may be 2 twice as high as those of the remaining period of adolescence. DIETARY REFERENCE INTAKES Dietary reference intakes (DRIs) developed by the Food and Nutrition Board of the Institute of Medicine provide quantitative estimates of nutrient intakes to be used for planning and assessing 3-7 diets for healthy people. The DRIs replace and expand upon the Recommended Dietary Allowances (RDAs). The DRIs contain four categories of recommendations for nutrient reference values: • Recommended Dietary Allowance (RDA): The average daily dietary intake level that is sufficient to meet the nutrient requirement of nearly all (97-98%) healthy individuals in an ageand gender-specific group. Adequate Intake (AI): A recommended intake value based on observed or experimentally determined approximations or estimates of nutrient intake by a group of healthy people that are assumed to be adequate— used when an RDA cannot be determined. Tolerable Upper Intake Level (UL): The highest level of daily nutrient intake that is likely to pose no risk of adverse health effects for almost all individuals in the general population. As intake increases above the UL, the potential risk of adverse effects increases. Estimated Average Requirement (EAR): A daily nutrient intake value that is estimated to meet the requirement of half of the healthy individuals in an age and gender group. Used to determine dietary adequacy of populations but not for individuals.
Stang J, Story M (eds) Guidelines for Adolescent Nutrition Services (2005) http://www.epi.umn.edu/let/pubs/adol_book.shtm
nap. The AI is believed to cover needs of all adolescents in the group. Source: Data from reports from the Institute of Medicine.279 130 31 12 1.9 0.3 400 2.9 0. Food and Nutrition Board.300 25 700 2 120 8 240 1.6 43 1.250 55 9 19-30 yrs 2.1 14 1. however these nutrient recommendations are based on chronological age categories.250 40 8 Males 14-18 yrs 3.250 40 8 Females 14-18 yrs 2.9 12 1.2 1.6 56 900 90 5 15 120 1.071 130 26 10 1.8 45 700 55 8 a 9-13 yrs 2. health care providers should use prudent professional judgment and consider growth and sexual maturation status (see Chapter 1).1 1.2 34 600 45 5 11 60 0. Thus.9 12 1.1 46 700 65 5 15 75 1.6 34 1. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes.4 5 25 550 1.22 GUIDELINES FOR ADOLESCENT NUTRITION SERVICES Tables 1 and 2 provide the DRIs for adolescents.3 400 2.3-7 © by the National Academy of Sciences. when determining the nutrient needs of an individual adolescent. but lack of data or uncertainty in the data prevent being able to specify with confidence the percentage of individuals covered by this intake.4 5 30 425 1. and not rely solely on chronological age.3 16 1.403 130 25 12 1.300 21 700 2 120 8 240 1.368 130 28 11 1.067 130 38 17 1.000 25 900 3 150 18 310 1.0 34 600 45 5 11 60 0.0 1.0 300 1.edu/ ) . The DRIs provide the best estimate of nutrient requirements for adolescents. TABLE 1 DRIs and AIs: Recommended intakes for Adolescents. as opposed to individual levels of biological development. RDAs are set to meet the needs of almost all (97-98%) individuals in a group.2 1.9 34 1.8 4 20 375 1.3 16 1.0 300 1.300 35 890 3 150 11 410 2.152 130 38 16 1.2 400 2.1 46 700 75 5 15 90 1.4 5 30 550 1. courtesy of the National Academies Press. Vitamins and Minerals 9-13 yrs Energy (kcals/day) Carbohydrate (g/day) Total Fiber (g/day) n-6 Polyunsaturated Fat (g/day) n-3 Polyunsaturated Fat (g/day) Protein (g/day) Vitamins Vitamin A (µg/d) Vitamin C (mg/d) Vitamin D (µg/d) Vitamin E (mg/d) Vitamin K (µg/d) Thiamin (mg/d) Riboflavin (mg/d) Niacin (mg/d) f Vitamin B6 (mg/d) Folate (µg/d)g Vitamin B12 (µg/d) Pantothenic acid (mg/d) Biotin (µg/d) Choline (mg/d) Elements Calcium (mg/d) Chromium (µg/d) Copper (µg/d) Fluoride (mg/d) Iodine (µg/d) Iron (mg/d) Magnesium (mg/d) Manganese (mg/d) Molybdenum (µg/d) Phosphorus (mg/d) Selenium (µg/d) Zinc (mg/d) 2.3 400 2.3 45 700 55 11 Note: This table presents RDAs in bold type and AIs in ordinary type.300 24 890 3 150 15 360 1.4 5 25 400 1.2 43 1. (http://www.6 52 900 75 5 15 75 1.000 35 900 4 150 8 400 2. RDAs and AIs may both be used as goals for individual intake.8 4 20 375 1.250 55 11 19-30 yrs 3.0 14 1. Washington DC.
0 ND Lactation ≤18 yrs 2.000 50 1.0 ND 9-13 yrs 1. or carotenoids. Food and Nutrition Board.000 10 1.3-7 © by the National Academy of Sciences.6 4 280 ND ND 23 ND 17 2.8 40 UL = The maximum level of daily nutrient intake that is likely to pose no risk of adverse effects.5 ND 1.6 4 280 ND ND 23 ND 17 2.800 50 800 ND ND ND 30 80 800 ND ND ND 3. riboflavin. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes.700 1.000 ND ND ND 3.5 ND 8.8 40 ND 17 2.700 1. Vitamins and Elements Females 9-13 yrs Vitamins Vitamin A (µg/d) Vitamin C (mg/d) Vitamin D (µg/d) Vitamin E (mg/d) Vitamin K Thiamin Riboflavin Niacin (mg/d) Vitamin B6 (mg/d) Folate (µg/d) Vitamin B12 Pantothenic Acid Biotin Choline (g/d) Carotenoids Elements Arsenic Boron (mg/d) Calcium (g/d) Chromium Copper (µg/d) Fluoride (mg/d) Iodine (µg/d) Iron (mg/d) Magnesium (mg/d) Manganese (mg/d) Molybdenum (µg/d) Nickel (mg/d) Phosphorus (g/d) Selenium (µg/d) Silicon Vanadium (mg/d) Zinc (mg/d) * Males Pregnancy ≤18 yrs 2.800 1.5 ND 8. courtesy of the National Academies Press.700 1.000 ND ND ND 35 100 1.100 0.5 ND 14-18 yrs 2.800 50 800 ND ND ND 30 80 800 ND ND ND 3. biotin. In the absence of ULs. water.800 1.0 ND ND 11 2.0 4 400 ND ND 34 ND 20 2.200 50 600 ND ND ND 20 60 600 ND ND ND 2.800 1. Washington DC.700 1.000 10 900 45 350 9 1.000 10 900 45 350 9 1. pantothenic acid. ULs could not be established for vitamin K.0 4 400 ND 1.0 4 400 ND ND 34 ND 11 2.800 1.0 ND 19+yrs 3.700 1.100 0.000 2.000 ND ND ND 35 100 1.0 4 400 ND 1.Chapter 3.5 ND 5.800 50 800 ND ND ND 30 80 800 ND ND ND 3.000 50 1. Due to lack of suitable data.5 ND 8.000 10 1.5 ND 10.800 50 800 ND ND ND 30 80 800 ND ND ND 3. extra caution may be warranted in consuming levels above recommended intakes.000 1. vitamin B12. Unless otherwise specified.0 ND 19-30 yrs 3.000 10 600 40 350 6 1. Nutrition Needs of Adolescents 23 TABLE 2 DRIs: Tolerable Upper Intake Levels* (UL).000 10 900 45 350 9 1.5 ND 10. chromium and silicon.0 4 400 ND ND 34 ND 20 2. (http://www.200 50 600 NDf ND ND 20 60 600 ND ND ND 2.100 45 350 11 2.edu/ ) .5 ND 5.000 1.000 ND ND ND 3.700 1. Source: Data from reports from the Institute of Medicine.nap.0 3.5 ND 8. arsenic.100 45 350 11 2.000 10 600 40 350 6 1.5 400 ND ND 34 ND 17 2. the UL represents total intake from food. thiamin.000 10 900 45 350 9 1.0 ND 14-18 yrs 2.000 2. and supplements.
cholesterol. sodium and sugar. iron. including folate. adolescents consume diets that are inadequate in several vitamins and minerals. On average. This trend is more pronounced in females than males. Based on CSFII dietary data. vitamins A and E. This is not surprising. TABLE 3 Nutrients of Concern in the Average Diet of US Adolescents Nutrient Intakes Lower than Recommended Intakes Vitamins Folate Vitamin A Vitamin E Vitamin B6 Minerals Calcium Iron Zinc Magnesium Other Fiber Higher than Recommended Intakes Females ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Males ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Total fat Saturated fat Sodium Cholesterol Total sugars Source: Data from8-11 The 1994-96 USDA Continuing Survey of Food Intake By Individuals (CSFII) 24-hour recall data using a 2-day average showed that among all age groups of children and adolescents. 8-11 magnesium and calcium. Dietary fiber intake among adolescents is also low. zinc. On average. Table 3 lists nutrients of concern in the diets of adolescents. white children have somewhat higher intake levels of minerals and vitamins than black children. females ages 9. Diets consumed by many teens exceed current recommendations for total fat and saturated fat. . Figures 1 and 2 show the percent of females and males ages 9-18 whose diets are below recommended guidelines for several nutrients.9 income level. given the fact that most adolescents do not consume diets that comply with the Food 12 Guide Pyramid or the Dietary Guidelines for Americans.24 GUIDELINES FOR ADOLESCENT NUTRITION SERVICES NUTRIENT INTAKES: NATIONAL SURVEY FINDINGS Nutrient intakes of US adolescents suggest that many youth consume inadequate amounts of 8-11 vitamins and minerals.13 14-18 had the lowest mean intakes of vitamins and minerals. Several studies have found that mean nutrient levels among adolescents do not vary greatly by 8.
Alexandra. Intake below 80% of the RDAs. DCN-01-CD1. Intake below adequate intake of the DRI.usda.Chapter 3. 2001. Nutrition Needs of Adolescents 25 FIGURE 1 Percentage of Females and Males Ages 9-13 and 14-18 Whose Usual Dietary Intake is Below Recommended Guidelines for Selected Vitamins and Minerals* Females 100 90 90 89 Males 80 70 59 62 58 52 50 44 40 40 36 26 26 30 21 20 14 10 8 2 0 9 11 2 24 41 41 36 35 27 46 39 39 33 44 60 % 30 16 1 9-13y 9-13y 9-13y 9-13y 9-13y 9-13y 14-18y 14-18y 9-13y 14-18y 14-18y 9-13y Folate a Vitamin A b Vitamin E b Vitamin Calcium c Zinc b Iron b 14-18y a 14-18y 14-18y 14-18y Magnesium *Nutrient intake based on two-day dietary data from CSFII. 1994-96. Children’s diets in the mid-1990s: dietary intake and its relationship with school meal participation. http://www. Source: Data from Gleason P. VA: US Department of Agriculture. a b c Intake below the Estimated Average Requirement (EAR) of the Dietary Reference Intake (DRI).gov/oane/MENU/Published/CNP/cnp.fns. Suitor C.htm . Food and Nutrition Service.
weight. http://www. Alexandra. Children’s diets in the mid-1990s: dietary intake and its relationship with school meal participation. Source: Data from Gleason P. Due to the wide variability in the timing of growth and maturation among adolescents. The 14-18y 9-13y 9-13y 9-13y . Cholesterol. 1994-96.usda.gov/oane/MENU/Published/CNP/cnp.26 GUIDELINES FOR ADOLESCENT NUTRITION SERVICES FIGURE 2 Percentage of Females and Males Ages 9-13 and 14-18 Whose Usual Dietary Intake Does Not Meet the Recommended Guidelines for Fat. 2001. Sodium. the calculation of energy 14 needs based on height will provide a better estimate than total daily caloric recommendation.fns. Food and Nutrition Service. VA: US Department of Agriculture. and lean body mass than females.htm ENERGY AND NUTRIENT NEEDS Energy Energy needs of adolescents are influenced by activity level. and increased requirements to support pubertal growth and development. Intake below 80% of the RDAs. Suitor C. and Fiber* Females 100 94 95 Males 99 95 90 86 86 83 80 80 82 72 80 73 70 60 67 76 69 59 54 % 50 40 30 24 20 9 15 10 14-18y 9-13y 0 14-18y 14-18y 14-18y 9-13y Total Fata Saturated Fatb Sodiumc Cholesterold Fibere *Nutrient intake based on two day dietary data from CSFII. Intake below adequate intake of the DRI. Adolescent males have higher caloric requirements since they 1 experience greater increases in height. DCN-01-CD1. basal metabolic rate. Basal metabolic rate is closely associated with the amount of lean body mass. a b c Intake below the Estimated Average Requirement (EAR) of the Dietary Reference Intake (DRI).
900 Kcal/cm* 14. DC: National Academy Press. and chicken.34 0. 8th Edition.000 2. with soft drinks alone providing 8% caloric intake among adolescents. Washington.33 The DRI for energy is based upon the assumption of a light to moderate activity level.4 15. inadequate monetary resources to purchase food. Modern nutrition in health and disease. Calorie (Kcal) Kcal/day 2.54 cm = 1 in Source: Data taken from Gong EJ. cakes/cookies/donuts.500 3. The adolescent growth spurt is sensitive to energy and nutrient deprivation. TABLE 4 Recommended Caloric (Kcal) and Protein Intakes for Adolescents Age (years) Females 11-14 15-18 19-24 Males 11-14 15-18 19-24 *2. chips.29 0. delays in sexual maturation. reductions in linear growth.200 2. Philadelphia. sugar. Subar and colleagues showed the top 10 sources of energy among teens were milk.18 intakes can lead to delayed puberty or growth retardation.200 2. Adolescents who participate in competitive sports and those who are more physically active than average may require additional energy to meet their daily caloric needs. In: Shils ME. Olson JA. Commission on Life Sciences. breads.28 0.4 Protein (grams) Grams/day 46 44 46 45 59 58 Grams/cm 0. and 1989 Recommended Daily Allowances. 1994. Nutrition Needs of Adolescents 27 RDAs for total calories and calories per centimeter of height by age group are listed in Table 4 and the DRIs for total energy intakes by age group are listed in Table 1.0 13. Diet.0 16. and reduced accumulation of lean body mass may be seen. When protein intakes are consistently inadequate. 1988-94 showed a mean energy intake of 1793 calories/day for females ages 12-19 15 16 and 2843 calories/day for males ages 12-19. Nutrition and adolescence.9 17. Heard FP. cereal. Food and Nutrition Board. . Adolescents who are not physically active and those who have chronic or handicapping conditions that limit mobility will require less energy to meet their needs. corresponding to the usual timing of peak height velocity. beverages provided 21% of energy intake. cheese. beef.5 13.27 0. Protein Protein needs of adolescents are influenced by the amount of protein required for maintenance of existing lean body mass and accrual of additional lean body mass during the adolescent growth spurt.200 2. soft drinks. or secondary to other factors such as substance abuse or chronic illness. Chronically low energy 17.29 0. One day dietary recall data from the third National Health and Nutrition Examination Survey (NHANES III).Chapter 3. PA: Lea & Febiger. Insufficient energy intake may occur because of restrictive dieting. Using CSFII data. In NHANES III. Shike M. 1989. Protein requirements per unit of height are highest for females in the 11 to 14 year age range and for males in the 15 to 18 year age range. 10th Edition of the RDAs. eds.
teens consume about twice the recommended level of protein and 31% of adolescent boys 9 14-18 years of age consume more than twice the RDA for protein. and ice cream. such as fruit. Foods that contribute the most carbohydrate to the diets of adolescents include (in descending order) yeast bread. donuts. Mean intake of added sugars ranges from 23 teaspoons/day (nearly 1/2 cup) for females ages 9-18 to 9 36 teaspoons/day (3/4 cup) for males ages 14 to 18. those who severely restrict calories. The DRIs do not list specific requirements for total fat intake. The Dietary Guidelines for Americans recommend that adolescents consume no more than 30% of 22 calories from fat. Adolescents consume 19 approximately 53% of their calories as carbohydrate. Dietary recommendations suggest that 50% or more of total daily calories should come from carbohydrate. cheese. National data suggest black 9. Minerals Calcium Calcium needs during adolescence are greater than they are in either childhood or adulthood because of the dramatic increase in skeletal growth.15 adolescents consumed more total fat and saturated fat than did white youth. Soft drinks are a major source of added sweeteners in the diets of adolescents. DRI values for total protein intake by age are listed in Table 1. Dietary 24-hour recall data from NHANES III (1988-94) showed the mean percentage of energy for 15 adolescents ages 12-19 was about 34% from total fat and 12% from saturated fat.11. DRI values for total carbohydrate intake are listed in Table 1. and foods such as cakes. adolescents have attained . Recommended protein intakes based upon age. Fat The human body requires dietary fat and essential fatty acids for normal growth and development. margarine. adequate calcium intake is important for the development of dense bone mass and the 23 reduction of the lifetime risk of fractures and osteoporosis. Because about 45% of peak bone mass is attained during adolescence. By age 17. soft drinks. Only about one-third of females and one-fourth of males ages 14 to 18 met the recommendations for total fat and saturated fats (Figure 2). National data suggest that on average. Carbohydrates Carbohydrate is the body’s primary source of dietary energy. Studies consistently show that 9. donuts. sugars. and foods such as 16 cakes.28 GUIDELINES FOR ADOLESCENT NUTRITION SERVICES US adolescents consume more than adequate amounts of protein. quick breads. and legumes are also the main source of dietary fiber. with no more than 10-25% of calories derived from sweeteners. among teenage boys it nearly tripled between 1977 and 1994. Major sources of total and saturated fat intakes among adolescents include milk. cookies. and vegans (see Chapter 17). milk. syrups. with no more than 10% of calories derived from saturated fat. but do make recommendations for the intake of linoleic (n-6) and α-linolenic (n-3) polyunsaturated fatty acids (Table 1). beef. ready-to-eat 16 cereal. Soft drink consumption has steadily increased over the years 21 among adolescents. cookies. Sweeteners and added sugars provide approximately 20% of total calories to the diets of adolescents. vegetables. whole grains. There were no differences by gender. such as sucrose and high fructose corn syrup.21 adolescents’ intakes of total fat and saturated fat exceed recommendations. accounting for over 20 12% of all carbohydrate consumed. Carbohydrate-rich foods. and jams. Subgroups of adolescents who may be at risk for marginal or low protein intakes include those from food-insecure households. gender and height are shown in Table 4.
calcium carbonate 26 contains the highest proportion (40%) of elemental calcium by weight and is the least expensive.9 oz/day (n = 136) 2149 238 100. Soft drink consumption by adolescents may displace the consumption of more nutrient-dense beverages.1 – 12. Milk provides the greatest amount of calcium in the diets of adolescents. The onset of menstruation imposes additional iron needs for girls. The RDA for iron is 8 mg/day for 9-13 year olds. Of the calcium supplements available. Males consume greater amounts of calcium at all ages than females (Figure 1). Iron Iron is vital for transporting oxygen in the bloodstream and for preventing anemia.9 oz /day (n = 120) 2312 191 62. adolescents in the highest soft drink consumption category were found to consume less calcium and vitamin C than non-soft drink consumers 25 (Table 5). Nutrition Needs of Adolescents 29 approximately 90% of their adult bone mass. the mean calcium intake of adolescent 24 girls ages 12-15 was 796 mg/day and 822 mg/day for ages 16-19. Iron needs are highest during the adolescent growth spurt in males and after menarche in females. orange juice.3 820 0. Alternatives exist for youth with lactose intolerance. .5 636 Source: Data from: Harnack L. Story M. breakfast bars. citrate. cereals) and can be excellent sources of calcium. or phosphate– have 25-35% absorption rates.g. Many adolescents with lactose intolerance can tolerate small amounts of milk. In NHANES III. Stang J.0-25. many of these foods are fortified to the same level as milk (300 mg/serving). Thus. Only 19% or about 2 out of 10 adolescent girls meet their calcium recommendations. especially when consumed with meals. The efficiency of absorption of calcium from supplements is greatest when calcium is taken with food in doses of not more than 500 mg. Supplemental calcium may be warranted when adolescents are unable or unwilling to get sufficient calcium from food sources. Lactose-free and lowlactose milks and chewable enzyme tablets are also available. adolescence represents a “window of opportunity” for optimal bone development and future health. Soft drink consumption among US children and adolescents. lactate. ice 16 cream and frozen yogurt.Chapter 3. Most chemical forms of calcium– carbonate. TABLE 5 Mean Nutrient Level of Soft Drink Consumption for Adolescents Nonconsumers (n = 70) Energy (kcal) Folate (µg) Vitamin C (mg) Calcium (mg) 1984 239 98. such as milk and juices.6 804 13. The DRI for calcium for 9 to 18 year olds is 1300 mg/day. J Am Diet Assoc 1999:99(4). For both male and female adolescents. 11 mg/day for males ages 14-18 and 15 mg/day for females ages 14-18. followed by cheese. the need for iron increases with rapid growth and the expansion of blood volume and muscle mass. Calcium-fortified foods are widely available (e. In one study. Yogurt and aged cheese are better 23 tolerated than milk.2 652 ≥ 26 oz/day (n = 97) 2604 178 52.. 436-441. bread.
To ensure adequate body stores of vitamin A.71 umol/L) have been 27 found in 18% to 33% of female adolescents. and whole grains. which is found in meat. and poultry. up to 500. Because the absorption of iron from plant foods is low. 700 µg/day and males ages 14-18. Data from the CSFII showed that about one-third of adolescents had inadequate intakes of zinc (Figure 1). The RDA for zinc for males and females ages 9-13 is 8 mg/day.6% for males ages 15-19. Zinc Zinc is associated with more than 100 specific enzymes and is vital for protein formation and gene expression. respectively. Bioavailability of nonheme iron can be enhanced by consuming it with heme sources of iron or vitamin C. Indigestible fibers found in many plant-based sources of zinc can inhibit its absorption. . 6-7% 27 for females ages 15-19. vitamin A plays a vital role in reproduction. and 0. Vegetarians. Zinc and iron compete for absorption. but only about half (56%) of females ages 14-18 had adequate intakes (Figure 1). Rates of iron deficiency tend to be higher in adolescents from low-income families. Heme iron. The most common dietary sources of iron in diets of adolescents included ready-to-eat cereal. (See Appendix A: Food Sources of Vitamins and Minerals). However. vegetarians need to 28 consume twice as much iron to meet their daily requirement. so elevated intakes of one can reduce the absorption of the other. In the CSFII survey about 30% of adolescents had inadequate intakes of vitamin A (Figure 1). found predominantly in grains. boys and girls ages 9-13 should consume 600 µg/day.000 children in developing 28 countries go blind each year because of vitamin A deficiency. Many breakfast cereals are fortified with zinc. The availability of dietary iron for absorption and utilization by the body varies by its form. 900 µg/day. fish. Zinc is important in adolescence because of its role in growth and sexual maturation. Zinc is naturally abundant in red meats. shellfish. is highly bioavailable while nonheme iron. bread. is much less so. More than 80% of the iron consumed is in the form of nonheme iron. National data suggest that most adolescent males (98%) met recommended dietary intake guidelines for iron. Serum zinc levels indicative of mild zinc deficiency (<10.30 GUIDELINES FOR ADOLESCENT NUTRITION SERVICES Estimates of iron deficiency among adolescents are 3-4% for males and females ages 11-14. Males who are zinc deficient experience growth failure and delayed sexual development. For males and females ages 14-18. and teens who do not consume many animal-derived products are at highest risk for low intakes of zinc. and 28 immune function. especially 28 night blindness. and beef. It is known that serum zinc levels decline in response to the rapid growth and hormonal changes that occur during adolescence. Adolescents who take iron supplements may be at increased risk of developing mild zinc deficiency if iron intake is over twice as high as that of zinc. particularly vegans. The most obvious symptom of inadequate vitamin A consumption is vision impairment. Vision impairment caused by inadequate vitamin A is rarely seen in the US. growth. the RDA is 11 mg/day and 9 mg/day. Vitamins Vitamin A Besides being important for normal vision. females ages 14-18. which occurs after vitamin A stores have been depleted.
31 subclinical folate deficiency. adolescents have increased requirements for folate during puberty. There are few data available on the vitamin E status of adolescents. Folate Folate plays an integral role in DNA. salad dressings/mayonnaise. RNA and protein synthesis. which is rare among adolescents. fruit drinks. Evidence suggests that smokers have poorer vitamin C status than nonsmokers. Vitamin C Vitamin C is involved in the synthesis of collagen and other connective tissues. 12% of adolescent females were mildly folate-deficient. Male students (37%) are more likely to smoke compared to 29 female students. and 16 white potatoes. the requirement for smokers is increased by 35 mg/day. which become increasingly important as body mass expands during adolescence. and dried beans or lentils. The RDA for vitamin E for 9-13 year olds is 11 mg/day and 15 mg/day for 14-18 year olds. 86-98% of adolescents had adequate dietary intakes of vitamin C (Figure 1). carrots.Chapter 3. There is evidence. Severe folate deficiency results in the development of megaloblastic anemia. Teens who skip breakfast or do not commonly consume orange juice and ready-to-eat cereals are at an increased risk for having a low consumption of folate. bread. a precursor of vitamin A. . margarine. milk. ready-to-eat cereals. 9 National nutrition surveys suggest that dietary intakes of vitamin E are below recommended levels. and cheese. The RDA for folate is 300 µg/day for 9-13 year olds and 400 µg/day for 14-18 year olds. The low intake of fruits. and tomatoes. which are primary sources of vitamin C. milk. The top five sources of dietary folate consumed by adolescents include 16 ready-to-eat cereal. even with comparable vitamin C intakes. vegetables and milk and dairy products by adolescents contributes to their less than optimal intake of vitamin A. On average. nuts/seeds. Nutrition Needs of Adolescents 31 The top five dietary sources of vitamin A in the diets of adolescents are ready-to-eat cereal. based on low serum folate levels. National data suggests that many adolescents do not consume adequate amounts of folate (Figure 1). orange juice. Vitamin E Vitamin E is well known for its antioxidant properties. vitamin C is an important nutrient during adolescent growth and development. that a number of adolescents have inadequate folate status. Almost 90% of vitamin C in the typical diet comes from fruits and vegetables. spinach and other greens. The RDA for vitamin C is 45 mg/day for 9-13 year olds. Because smoking increases oxidative stress and metabolic turnover of 4 vitamin C. For this reason. is most commonly 16 consumed by teens in carrots. 75 mg/day for males ages 14-18 and 65 mg/day for females ages 14-18. tomatoes. Thus. with citrus fruits. and milk. while 8-48% of female teens had been shown to have low red cell folate levels indicative of 30. tomatoes and potatoes being major contributors. Beta-carotene. 16 cakes/cookies/quick breads/donuts. however. The five most common sources of vitamin C among adolescents are orange and grapefruit juice. Increasing adolescent intakes of vitamin E through dietary sources is a challenge. Among adolescents the five most commonly consumed sources of vitamin E are margarine. sweet potatoes. About 40% of adolescents had lower than recommended intakes in the CSFII survey (Figure 1). According to CSFII data. adolescents who use tobacco and other substances have poorer quality diets and consume fewer fruits and vegetables. Fortified breakfast cereals and nuts are good sources of vitamin E to recommend for youth. 33% of students in 29 grades 9-12 report current cigarette use. In one study. Nationwide. tomatoes. given that many of the sources of vitamin E are high fat foods.
The protective effects of folate occur early in pregnancy. often before a teen may know she is pregnant. Adolescents’ mean fiber intake is well below the age-adjusted target goal (Figure 2). and whole grains among adolescents is the greatest contributing factor affecting fiber intake among adolescents. Average intake for both adolescent males and females exceeds this target (Figure 2). and chronic illnesses. almost twice the target goal. lactation. which exceeds the goal of 300 mg/day. Males ages 1422 18 have a mean cholesterol intake of 320 mg/day. Adequate fiber intake is also thought to reduce serum cholesterol levels. it is recommended that all women capable of becoming pregnant consume 400 µg/day from supplements or highly fortified breakfast cereals in addition to food folate from a varied diet that includes fruits. National data show that mean daily fiber intake among girls ages 9-18 is only 12 g. and may reduce the risk of Down syndrome among offspring. such as certain cancers. tomatoes. Recommendations by the American Health Foundation suggest that daily fiber goals for youth be based on an “age plus five” rule.32 GUIDELINES FOR ADOLESCENT NUTRITION SERVICES Adequate intakes of folate prior to pregnancy can reduce the incidence of spina bifida and select 32 other congenital anomalies. Adolescent males 14-18 have especially high mean intakes– 4474 9 mg/day. and whole grains. popcorn and related snack foods. and among males 9-18 years of 16 age it is 15 g. moderate blood sugar levels. The 22 suggested sodium intake is 2400 mg/day. and may play a role in the prevention of chronic diseases. 16 potatoes. These are discussed in the individual chapters on specific topics. vegetables. Adolescents who skip breakfast or do not routinely consume whole grain breads or ready-to-eat cereals are at high risk for having an inadequate consumption of fiber. Thus. ready-to-eat cereal. . FACTORS INFLUENCING NUTRIENT NEEDS There are many factors and conditions which affect nutrient needs during adolescence including pregnancy. where the individual’s age is added to 33 the number five. vegetables. and type 2 diabetes mellitus. The low intake of fruit. level of physical activity. Other Food Components Fiber Dietary fiber is important for normal bowel function. it is important that female adolescents who are sexually active consume adequate folic acid. Cholesterol and sodium Mean cholesterol and sodium intakes increase with age for both males and females. In view of the evidence linking folate intake with neural tube defects in the fetus. and reduce the risk of obesity. coronary artery disease. A factor of 10 is added to age to determine the recommended upper limit of fiber intake. and corn. Significant sources of fiber in the diet of adolescents include whole grain breads.
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