Adolescent Nutrition Notes Part 1

Nutrition Through the Life Cycle  Adolescent Nutrition 1. Define: menarche, puberty, precocious puberty, leptin, sexual maturation rating Menarche: the first menstrual cycle ● Occurs 2-4 years after the initial development of breast buds and pubic hair → SMR stage 4 ○ Avg age 12.5 years ○ Can occur as early as 8 years and as late as 17 years ○ May be delayed in highly competitive athletes or in girls who severely restricted their caloric intake to reduce body weight ○ Early-onset of menarche (age 10.6 years) is 4x more likely among overweight/obese ○ Growth after menarche generally 2-3 inches  Puberty: the time frame during which the body matures from that of a child to that of a young adult ○ Females: 10.5-14 ○ Males: 12-16.5  Precocious puberty (Marshall and Tanner studies 1969) ● Breast <8 years old ● Pubic hair < 9 years ● Or 2.5 standard deviations below mean ○ By 7 years of age, 27% of the African-American girls and 7% of white girls had begun breast/pubic hair development ○ At age 8, 48%of African-American girls and 15% of white girls began development  Leptin ● Produced by fat tissue; is a key signal that lets the reproductive system know that levels are nutrition is sufficient to support puberty ○ Indirect mediation of puberty  Sexual maturation rating (Tanner SMR) ● The scale of secondary sexual characteristics used to assess the degree of pubertal growth and development (regardless of age) ● Should be used to assess biological growth and development (or biological age) and the individual nutritional needs of adolescents rather than chronological age   2. Name the age period that defines adolescence as well as each age period in the stages of Adolescence. ● IOM defines as ages 9-18 years ● Early adolescence = 11-14 years ○ The onset of puberty and increased cognitive development ● Middle = 15-17 years ○ Increased independence and experimentation ● Late = 18-21 years ○ Making important personal, occupational and life decisions   3. List important changes at each stage of adolescence. Include both cognitive and psychological Changes. ● Physiologic changes during puberty ○ Growth after menarche generally 2-3 inches and puberty is earlier for girls ○ Menarche occurs 2-4 years after the initial development of breast buds and pubic hair (STAGE 4) ■ Avg. age = 12.5 years ■ Can occur as early as 8 years and as late as 17 years ○ ○ Menarche may be delayed in highly competitive athletes or girls who are severely restricted their intake to reduce body weight Early-onset of menarche (by age 10.6 years) is 4x more liekly among overweight/obese 4. Discuss pertinent gender differences in adolescent development. Include differences in height, weight and body composition in your discussion. PHYSICAL GROWTH ● Puberty ○ Females 8-13 years ■ Occurs earlier with a 2.5-year gender difference on average ○ Males 9.5-13.5 years ● Females peak earlier at 12 years ○ Only 2-3 inches after menarche ○ 1 year after breast development ● Males peak around 14 years ● Achieve 95% of growth by ○ 13 for females ○ 15 for males  WEIGHT Females peak weight gain follows linear growth spurt by 3-6 months ○ Avg. 12.5 years gain 18.3 lb per year ○ Weight gain slows around the time of menarche but continues ■ May gain as much as 14 lb in the latter half ● Among males, peak weight gain coincides with the timing of peak linear growth and peak muscle mass accumulation ○ 20 lb per year  BODY COMPOSITION ● Pre-Puberty ○ Body fat and muscle ■ Similar to males and females, 15-19% ● Puberty ○ Bone mass → increase of 7-8% year ■ By 18 years, 90% BMD achieved ○ Body fat ■ Females → 16-27% during puberty (gain 2.5 lb per years of body fat) ■ Males → 15 to 12% during puberty ○ Lean muscle mass ■ Females → increase 44% (occurs around/just after the onset of menses) ■ Males → double or more that of females ● 5. Describe the major changes at each stage of the Sexual Maturation Rating (SMR) for males and Females. ● SMR is based on breast development and the appearance of pubic hair among females and on testicular and penile development and the appearance of pubic hair among males ● Sexual maturation correlates highly with linear growth, changes in weight, body composition, and hormonal changes  MALES ● Stage 1: Prepubertal growth and development ● Stages 2-5: occurrences of puberty ○ Testicular enlargement (9.5-13.5 years) ■ SMR stage 2-3 ■ Concludes between 12.7-17 years ○ Pubic hair growth ■ Among males occurred approximately 6 months earlier among white/black vs Mexican/American ■ No significant relationship between pubarche and body weight or composition was noted among men ○ Age of spermarche = 14 years ○ Growth spurt ■ Acne ■ Axillary perspiration ■ Axillary hair ■ Facial hair ■ Voice change ○ Peak velocity of linear growth → Stage 4 at 14.4 years ■ Following testicular development and appearance of faint facial hair ● Stage 5: sexual maturation concluded  ● Linear growth will continue throughout adolescence at a slow rate ceasing at about 21 years ● The use of stimulant medications for conditions such as attention deficit hyperactivity disorder has been suggested to reduce or delay linear growth velocity among males 14-16 years  FEMALES ● Stage 1: Prepuberty ○ Breast development ○ Pubic hair growth (Stage 3) ■ Occurs 1 year earlier in black girls vs Mexican/white ○ The growth spurt (age 12) ■ Height increases by 2.8-4.8 in (7-12 cm a year) ○ Menarche ■ Acne ■ Axillar perspiration ■ Axillary hair  6. Describe the pattern of growth in bone, fat and lean tissue mass for males as females as they reach maturity. Include in your discussion nutrients important for bone growth. ● ● Pre-Puberty ○ Body fat and muscle ■ Similar to males and females, 15-19% Puberty ○ Bone mass → increase of 7-8% year ■ By 18 years, 90% BMD achieved ○ Body fat ■ Females → 16-27% during puberty (gain 2.5 lb per years of body fat) ■ Males → 15 to 12% during puberty ○ Lean muscle mass ■ Females → increase 44% (occurs around/just after the onset of menses) ■ Males → double or more that of females   NUTRIENTS IMPORTANT FOR BONE GROWTH ● Vitamin C ○ Bone growth, collagen synthesis (structure for bone formation) ■ Abundant in fruits, veggies ● Vitamin A ○ Bone elongation, cell differentiation ■ beta -carotenes, eggs, fatty fish ● Calcium/Vitamin D ○ Bone mass ○ Acquired during adolescence ○ A lot of exercise to increase bone mass ■ C: fortified grains, fortified milk, dairy, leafy greens ■ VD: sun exposure (harder for dark-skinned), fatty fish, eggs, dairy   7. Summarize energy and macronutrient needs in the adolescent. ● ● Energy ○ Growth, but difficult to assess ■ Determine calories through EER ■ Determination of energy needs based on VELOCITY GROWTH will provide a better estimate ● Sex, height, weight, age, activity level Macronutrients ○ Carbohydrates (45-65%) or 130 g/day ■ Need to spare protein ■ Enough carbs so lean mass isn’t degrades ■ 0.5 gm/kg fiber (no more than 35 g/day) DRI for FIBER ○ Protein (10-30%) ■ Used for growth and development ● Needs are age-dependent → to maintain add/lean muscle ● Typically adequate except for vegan, etc. (food insecure) ● Higher when growing ■ 0.9 g/kg for 9-13 higher 11-14 RDA ■ 0.85 g/kg for 14-18 ○ Fat (25-35%) ■ Similar to adults ■ Want less than 10% saturated fats  8. Select micronutrients of importance during adolescence and explain why they are important. ● Folic Acid → DNA/protein synthesis ○ Striking growing changes/increases active growing phases ■ Fortified foods (bread, cereal), leafy greens, lentils, legumes, egg, OJ  ● Vitamin C → bone growth, collagen synthesis ○ Collagen synthesis (structure for bone formation) ■ Abundant in fruits and veggies  ● Vitamin A → bone elongation, cell differentiation ■ Beta-carotenes, eggs, fatty, fish  ● Iron → linear growth increased blood volume ○ The onset of menarche increases needs ○ Highest need during the male’s growth spurt ■ Legumes, red meat, dark leafy greens, enriched grains  ● Zinc → cofactor for enzymes, sexual maturation ■ Meats, fishes, poultry, fortified grains, nuts ● Calcium/vitamin D → bone mass ○ Acquired during adolescence ○ Lot of exercises to increase bone mass early on ○ VD: the intestinal absorption of calcium and phosphorus ■ sun exposure (harder for dark-skinned), fatty fish, eggs, dairy ○ VC: ■ fortified grains, fortified milk, dairy, leafy greens   9. Identify changes and influences on adolescent eating behavior ● Influences ○ Discretionary income → allowance, working ■ Eating more meals away from home  ○ Peer group ■ What the group eats, and wear → stronger influence than family  ○ Emotions, self-concept ■ A lot of moodiness → very strong influence  ○ Schedules ■ Time pressures  ○ Personal and social beliefs ■ Vegetarian, vegan → food preferences, family/peer attitudes ■ Search for personal autonomy and peer acceptance that characterizes adolescent psychosocial development often leads to the development of health-compromising eating behaviors ○  Food preferences ■ Energy-dense foods, appetite dependent, less parent-driven   ● Eating practices ○ Meals away from home ■ More than ⅓ of energy intake ■ 35% of fat and sugar intake ■ More consumption of fast foods  ○ Meal skipping ■ Breakfast/lunch most often ■ Females skip more ■ Decreased intake of energy, protein, fibers, calcium, folate ■ Black and Hispanic youth are more likely to skip lunch  ○ Snacking ■ Up to 90% go adolescence snack ■ Factors with LOW snack consumption ● Attempting to lose weight ● Concern overweight ● Dieting ● Greater nightly sleeping time  ■ Factors with HIGH snack consumption ● Self-identifying as picky eater ● Frequent involvement in cooking at home ● Attempting to gain weight ● Snacking while watching TV ● Amount of time playing games  ○ Energy-dense ■ Energy drinks → lead to cardiovascular disease if intake is too high ● Caffeine consumption is early  ○ Vegetarians ■ Menarche occurs 6 months later ■ Are leaner   Macrosystem factors: include food production and distribution systems and mass media and advertising, play a more distal and indirect role in food patterns Chapter 15: Adolescent Nutrition: Conditions & Interventions You should be able to: 1.Define: ARFID, anorexia nervosa, ergogenic ARFID:Avoidant restrictive food intake disorder ● A new diagnosis in the DSM-5 ● Similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed ● Unlike anorexia, it does not involve distress about body shape or size or fears of fatness ○ “Picky eating” to the extreme  Anorexia nervosa ● Strongly linked to mortality ● Most severe ● Characterized by extreme weight loss, poor body image, and irrational fears of weight gain and obesity ○ Restricting and non-restricting subtypes ○ 10-15% will die ○ Excessive exercise  Non-restrictive ● Restrict diet and also binge and purge  Restrictive ● Restrict diet ONLY  Ergogenic ● Nutritional products that are purported to enhance performance. Examples range from caffeine and protein powders to sports drinks and energy gels and bars ● Supplement towards athletes that can be taken orally, injected, or by patches ○ Commonly used outside of direct sport season to avoid detection in urine ○ Promise increased muscle mass and strength, improved athletic ability (supplements can increase risk for dehydration) - body image  2.Describe special considerations with a pregnant adolescent. ● Pregnant teens that are iron deficient in the early stages of gestation are at increased risk of preterm delivery and delivery of a low-birthweight infant ○ Preterm (37 wks), early preterm (34 wks) ● Competition between the mom and fetus for nutrients ○ Mom wins during adolescence  ● Energy and nutrient needs ○ Poor outcomes → underweight, preterm, perinatal death ○ Growing adolescent ■ Biological immaturity ○ Lifestyle ■ Drugs, smoking, poor diet, ● Iron deficiency and vitamin D insufficient in 30-6-% ○ Weight gain ■ Similar to adult ● Gain between 33-35 lbs ■ If growing, towards the upper end of this range  3.Identify adolescent risky behaviors. ● Substance abuse: can influence dietary intakes ○ Alcohol ■ 21% of alcohol is absorbed by the stomach and 80% is metabolized by the liver ■ Girls have less enzymes so we digest/metabolize slower ■ Average age of first drink is 13 years ■ Heavy drinking throughout college ● 5% during ages 12-13 ● 13% in ages 14-15 ● 29% in ages 16-17 ○ Tobacco ■ 12-18 years ■ Vitamin C and E are higher ○ Marijuana ■ Increased appetite ● Influences ○ Peer pressure ○ family  4.Discuss items to monitor in the fluid intake and diet of the adolescent athlete. ● The best method of assessing the nutrient needs of athletes is to begin with general dietary needs based on SMR ● Diet ○ High carbohydrate ● ● ● ● ● ○ Adequate protein ■ Higher in protein recommendations ● 1-1.5 kg ■ Too much protein strains the kidneys Competitive athletes may need 500-1500 additional calories per day ■ Recommend being on upper limit for calorie intake ○ Protein should supply no more than 30 percent of calories in the diet ○ Special concern for vegan athletes or diets that restrict caloric intake to maintain a particular weight ■ Any weight loss that is NOT transient (e.g. dehydration) signifies that the caloric intake is inadequate to support growth and development ■ Vegans and those who restrict caloric intake are at risk ○ plant -based protein may increase needed intake due to bioavailability being lower Monitor body weight in season ○ Make sure weight loss isn’t drastic Follow MyPlate recommendations ○ May need upper limit of food group servings ■ Increased energy needs ○ Eat pre-event meal at least 2-3 h prior to exercise ○ Post-event meals should contain 400-600 calories, high-carbohydrate foods, and non caffeinated fluids Calcium ○ May need supplement as intake is below DRI ○ Female athletes with low intake at risk of fracture ■ Increase intake to reduce this risk Fluids ○ Dehydration and overheating ○ Body temp regulation is not as good as adulthood as adolescents ignore signs of fluid loss ■ 1 cup prior ■ ½ cup every 15-20 minutes ■ Replace after at least 1 cup ■ Sports drinks for activity > 1 hours ■ Each pound of body weight lost during activity requires ingestion of 16 oz of fluid each 30 min ○ Diluted juice for intense or long-duration events  5.List risk factors for obesity in the adolescent. Recall what percentage of children and adolescents have obesity. ● At least one overweight parent ● Low income/low socioeconomic status ● ethnic/racial ○ hispanic/native american/alaskan native ○ African american ■ Obesity among females is highest in black teens ■ Obesity among males is highest in Mexican Americans ■ 20.5% are obese ■ 34.5% of US adolescents are overweight ● Conditions that limit physical activity ○ Physical disability/chronic or disability condition that limits mobility  6.Describe comorbidities that can occur with overweight and obese adolescents. ● Type 2 diabetes ○ Insulin resistance ● Nonalcoholic fatty liver disease ○ Hepatic disease ● Orthopedic complications ● Psychosocial ● Hypoventilation disorder ● Heart disease ● Dyslipidemia ● Early puberty ● Heart disease ● Sleep apnea ● Asthma ● Iron deficiency ○ Treat with iron rich foods/supplements ● Substance use ● hypertension/hyperlipidemia - DASH diet → low soidum ● Diabetes ● Metabolic syndrome  7.Discuss initial strategies for weight loss in this population and if unable to maintain or reach weight loss goals, discuss the benefits and risks of bariatric surgery. ● Weight goals for overweight/obese adolescents 12-19 years old ● We want them to get taller and thin out ○ 85th to <95%tiles (overweight) ■ Weight maintenance or slow weight gain ○ 95th to <99 %tile ■ Weight loss no more than 2 lbs per week ○ > 99%tile ■ Weight loss no more than 2 lbs per week ■ Any weight loss beyond this is hard on the body  ● Weight loss medication: ORLISTAT ○ Pancreatic lipase inhibitor that causes for malabsorption ○ Use for kids 12+  ● Adolescent bariatric surgery (gastric bypass) ○ Qualifications ■ BMI of > 35 with medical major complications ■ BMI of > 40 with minor comorbidities + mass growth spurt (SMR stage IV or V) ○ Teen labs consortium ■ 242 adolescents ■ Roux-en-Y or sleeve ○ 3 years after surgery ■ Weight decreased by 27% ■ Diabetes ● Type 2 diabetes remission in 95% who had condition at baseline (went away) ● 76% remission of prediabetes ■ Low ferritin in 57% ● Low iron body stores (common) ● Iron deficiency ○ Benefits ■ Reduce weight and averse morbidities ■ Significant improvements in weight, cardiometabolic health, and weight-related quality of life, but micronutrient deficiency (iron) and future abdominal procedures needed in some parts ■ Less likely to be nutrient deficient who have limited food take after ○ Risks ■ Bypass has malabsorption ■ Additional surgeries may be needed  8.Name risk factors for developing an eating disorder ● Body dissatisfaction → dieting behaviors → disordered eating → clinically significant eating disorders ● Dieting behaviors ○ Are alarmingly high ■ Significant issue for teens of all ages, races, ethnicities ■ Increases risk of being overweight in the future ■ Used by youth who are not overweight ● Inadequate intake essential nutrients ● Hunger and cravings ● Increased risk for later development of eating disorders ○ More prevalent now in hispanic females ■ The use of unhealthy weight control behaviors increase likelihood of being overweight ● Disordered eating ○ During a 3 year period of restrained eating = eating disorder   ● Factors contributing ○ Social norms for thinness ○ Peer influences ○ Familial relationships ○ trauma/adverse life experiences ○ Self-body perception  9. Compare and contrast the various types of eating disorders. ● Binge/purge eating behaviors (occur within 6-12 months for menarcheal weight changes) ○ Can be less frequent or intense needed for diagnosis ○ Frequent behaviors ■ Self-induced vomiting ■ Fasting or extreme dieting ■ Compensatory physical activity ■ Use of laxatives, diuretics, or diet pills ○ Prevalence difficult to estimate  ● Anorexia nervosa ○ Strongly linked to mortality (most common) !!!!! ○ Most severe ○ Characterized by extreme weight loss, poor body image, and irrational fears of weight gain and obesity ■ Excessive exercise ■ Restricting (restrict diet only) and non-restricting (restrict diet and also binge and purge) subtypes ■ 10-15% will die ● Bulimia nervosa ○ Characterized by repeated bouts of uncontrolled eating followed by self-induced vomiting, laxatives or diuretic use, fasting, or vigorous exercise ■ Purging and nonpurging types  ● Binge-eating disorder ○ Characterized by periodic binge eating not followed by vomiting or use of laxatives ■ Twice a week on average for over six months ■ Loss of control over binge eating ○ Dieting may be a risk factor  ● ARFID ○ Avoidant restrictive food intake disorder: a new diagnosis in the DSM-5; similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness ○ “Picky eating” dto the extreme  ● Eating disorder not otherwise specified (OSFED) → EGNOS ○ Developed to encompass individuals who do not meet strict criteria for anorexia or bulimia but still have significant eating disorder ○ Equally as serious as other eating disorders ■ Get insurance to cover this condition ● Tried to make it more specific but it’s serious and life threatening  ● Orthorexia ○ An obsession with proper or “healthful” eating ○ Although being aware of and concerned with the nutritional quality of the food you eat isn’t a problem in and of itself, people with orthorexia become so fixated on so-called ‘healthy eating’ that they actually damage their own well-being  Chapter 16: Midlife: Menopause & Andropause You should be able to: 1.Define: perimenopause, menopause, andropause, “hot flashes”, atresia, 17-estradiol, estrone ● Perimenopause ○ An approximately four-year period of decreasing estrogen production followed by the end of menstruation ● Menopause ○ A marking point for increased risk of cardiovascular disease and other chronic conditions for women ● Andropause ○ Graduate decline in male hormones (testosterone)  ● “Hot flashes”  ● Atresia ○  ● 17-estradiol ○  ● Estrone ○  2. Discuss changes in estrogen and progesterone from birth to menopause. ●  3. Describe other hormonal changes that occur during perimenopause/menopause. ● Increased GRH, FSH, LH ● Decreased 17-estradiol, progesterone  4. Summarize physiological changes that occur during menopause and perimenopause. ● Irregular menses ● Hot flashes and childs ● Sleep disturbances and night sweats ● Vaginal dryness and tissue atrophy ● ● ● ● ● ● Thinning hair and dry/thin skin Decreased breast fullness Redistribution of body fat/gain Increased LDL: HDL in blood Heart disease Osteoporosis  5. Identify treatments for menopausal and perimenopausal symptoms. Name risks and benefits of treatments. Be sure to include nutrients/foods of importance if indicated for treatment. ● Prescription drugs ○ Hormone replacement ■ estrogen/progesterone ● Benefits ○ Reduced hot flashes ○ Decreased vaginal dryness ○ Decreased bone loss ● Risks ○ Heart disease and stroke ○ Breast cancer ○ Other medications ■ Low dose antidepressant ● Hot flashes/depression ■ Bisphosphonates, calcitonin, PTH ● Low bone density ● Lifestyle changes ○ Health practices ■ Avoid smoking ■ Avoid excessive alcohol ■ Balanced diet ■ Maintain healthy weight ■ Exercise ■ Stress reduction  ● Dietary changes for menopause ○ Adequate vitamin D, Ca2+ ○ Low to moderate caffeine ○ Avoid excessive alcohol ○ Phytoestrogens ■ Soy isoflavones ■ Flaxseed lignans