Nutrition Across the Lifespan Quiz
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AdolescentNutrition.pptxAdolescent Nutrition
Class Objectives
By the end of this class, the student will be able to:
Identify normal biological changes that occur during adolescence
Recognize changes in nutrient needs and eating behaviors
Recognize differences in diagnostic criteria for eating disorders
Identify treatments for eating disorders
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Normal Physical Growth and Development
Variations in reaching sexual maturity affect nutrition requirements of adolescents
Sexual maturation (or biological age)—not chronological age—should be used to assess growth and development and nutritional needs
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Sexual Maturation Rating or “Tanner Stages”
Sexual Maturation Rating (SMR) (“Tanner Stages”)—scale of secondary sexual characteristics used to assess degree of pubertal maturation
SMR 1=prepuburtal growth & development
SMR 2-5=occurrences of puberty
SMR 5= sexual maturation has concluded
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Table 14-1 p363
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Tanner’s Sexual Maturation Ratings (SMR)
Females
Males
Changes in Weight, Body Composition, and Skeletal Muscles in Females
Peak weight gain follows linear growth spurt by 3 to 6 months
Gain of ~18.3 pounds per year
Average lean body mass decreases
44% increase in lean body mass (LBM)
120% increase in body fat
17% body fat is required for menarche to occur
25% body fat needed to maintain normal menstrual cycles
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Changes in Weight, Body Composition, and Skeletal Muscles in Males
Peak wt gain at the same time as peak linear growth & peak muscle mass accumulation
Peak wt gain, ~20 lb per year
Body fat decreases to ~12%
~Half of bone mass is accrued in adolescence
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Health and Eating-Related Behaviors During Adolescence
Factors affecting eating behaviors
Peer influence
Parental modeling
Food availability, preferences, cost , convenience
Personal & cultural beliefs
Mass media
Body image
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Vegetarian Diets During Adolescence
~4% follow a vegetarian diet
Reasons:
Cultural or religious beliefs
Moral or environmental concerns
Health beliefs
To restrict fat and/or calories
A means of independence from family
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Energy and Nutrient Requirements of Adolescents
Increases in lean body mass, skeletal mass and body fat
Energy & nutrient needs during adolescence exceed those of any other point in life
Needs correspond to physical maturation stage
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Energy Requirements of Adolescents
Energy needs are influenced by:
Activity level
Basal metabolic rate (BMR)
Pubertal growth & development
Males greater increases in ht, wt, & lean body mass higher caloric needs than females
Level of physical activity declines during adolescence decr energy requirements
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Protein Requirements of Adolescents
Protein requirements influenced by protein needed:
To maintain existing LBM
For growth of new LBM
Recommendation is 0.85 g/kg body wt
Low protein intakes linked to:
Reductions in linear growth
Delays in sexual maturation
Reduced LBM
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Requirements for Selected Nutrients of Adolescents
Carbohydrates:
130 g/day or 45-65% of calories
Dietary Fiber:
DRI recommends
26 g/day for adolescent females
31 g/day for males <14 years of age
38 g/day for older adolescent males
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Requirements for Selected Nutrients of Adolescents
Fat:
Required as dietary fat and essential fatty acids for growth and development
25-35% of calories from total fat
<10% calories from saturated fat
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Requirements for Selected Micronutrients of Adolescents
Iron: Increased needs related to rapid rate of linear growth, increase in blood volume, menarche in females
Deficiency 2-11% among adolescents
Folate: Deficiency leads to Megaloblastic anemia
DRI 400 mcg
Calcium: Adequate intake is critical to ensure peak bone mass
~4 times more calcium retained during early adolescence compared to early adulthood
DRI for ages 9-18 years is 1300 mg/d
Average intake is: 948 mg for females, 1260 mg for males
+ Vitamin D: RDA – 600 IU/day
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Three Main Eating Disorders
Anorexia nervosa
Characterized by extreme wt loss, poor body image, & irrational fears of wt gain & obesity
Bulimia nervosa
Characterized by recurrent episodes of rapid uncontrolled eating of large amounts of food in a short period of time frequently followed by purging
Binge-eating disorder
Characterized by periodic binge eating not followed by vomiting or use of laxatives
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Etiology of Eating Disorders
Environmental factors:
Media Influences
Societal and cultural norms
Food availability and accessibility
Family factors:
Family dynamics
Interpersonal factors:
Peer norms and behaviors
Abuse experiences
Personal factors:
Biological, Psychological
Knowledge, attitudes and behaviors
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Prognosis for People with Anorexia Nervosa
Early diagnosis & treatment improves chances for recovery
Recovery rates
<50% fully recover
~33% show improvement
~20% chronically affected
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Anorexia Nervosa – Diagnostic Criteria
No Known Medical or Psychiatric (Schizophrenia, Obsessive Compulsive) Illness Accounting for Anorexia and Weight Loss
Body Weight Between 15-20% Below That Expected Weight
Intense Fear of Weight Gain Even When Underweight
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Eating disorders in the form of anorexia nervosa and bulimia is believed to affect as many as 2 million teens mostly female (< 10% of cases are males) in USA.
Typically observed in white, middle and upper income classes and with depression and family dyfunction.
Diagnostic criteria include: No known medical or psychiatric (schizophrenia, obsessive compulsive) illness accounting for anorexia and weight loss
Body weight between 15-20% below that expected weight.
Intense fear of weight gain even when underweight
In females malnutrition causes the absence of at least 3 menstrual cycles
Disturbed self image including denial of recognizing food needs, desired body image of extreme thinness. Normally associated with anxious, fearful and dependent personality. Psychological profile includes achievement oriented families, withdrawal from peer relationships, psychopathology in family setting.
Anorexia Nervosa – Diagnostic Criteria
In Females Malnutrition Causes the Absence of at Least 3 Menstrual Cycles
Disturbed Self Image Including Denial of Recognizing Food Needs, Desired Body Image of Extreme Thinness
Restrictive Type - No Purging Behavior
Binging/purging Type - Binging Followed by Vomiting, Diuretics or Laxatives
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Can have restrictive types in which there is no purging behavior or can have binging/purging type in which there is binging behavior followed by purging in the form of vomiting, diuretics or laxatives.
Health Risks of Anorexia Nervosa
Mortality Rates Between 2 and 20% Due to Multiple Organ System Failure Including
Electrolyte Imbalance Leading to Cardiovascular Abnormalities (Irregular Heart Beat and Inefficient Heart Pumping Due to Weakened Heart Muscles)
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Gastrointestinal symptoms are common causing symptoms similar to GI illnesses such as Crohn’s disease (ulcerative inflammatory disease of colon) which involve diarrhea, cramping and fever which may be difficult to diagnose as the onset of the disease can occur in teens and in young adult.
Cessation of menstruation is common due to diminished body fat and the physiological and psychological stresses associated with this condition.
Is a dangerous condition as studies indicate mortality rates between 2 and 20% and some have suggested that this condition is the biggest killer of young women. Serious cases require hospitalization with an interdisciplinary approach using doctors, psychiatrics, family therapists and dietitians.
Health Risks of Anorexia Nervosa
Decreased Blood Pressure
Kidney Dysfunction
Muscle Wasting and Decreased BMR
Defective Thermoregulation
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Health Risks of Anorexia Nervosa
Cessation of Menstruation
Change in Body Functions Characteristic of Starvation –
Dry Skin
Hirsutism (Excessive Body Hair)
Thin Brittle Dry Hair, Hair Loss
Dehydration and Edema
Gastrointestinal Symptoms - Diarrhea, Cramping and Fever
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Restriction of food intake results in a progression towards starvation resulting in cessation of menstruation or a delay in the onset of menstruation (due to decreased estrogen). Only half recover normal menstrual cycles.
A change in body functions characteristic of starvation occurs. Changes include dry skin, hirsutism (excessive body hair), thin brittle dry hair, hair loss, dehydration and edema.
Health Risks of Anorexia Nervosa
Growth Ceases and Atrophy of GI Tract
High Risk of Premature Bone Loss Greatly Increasing the Risk of Osteoporosis in Early Adulthood
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Growth ceases and atrophy of GI tract.
Anorexia causes a high risk of premature bone loss causing osteopenia (reduced bone mass density more than 1 standard deviation (SD) but less than 2.5 SD below the young adult mean) and consequently greatly increasing the risk of osteoporosis in early adulthood as well as later in later.
Untimately death due to a multiple organ system failure including an electrolyte imbalance leading to cardiovascular abnormalities (irregular heart beat and inefficient heart pumping due to weakened heart muscles), decreased blood pressure and kidney dysfunction. Also, death may be due to Wernicke’s encephalopathy (irreversible brain damage due to thiamin deficiency).
Recovery involves slow and gradual infusion of calories nagogastric nutrition or TPN (hypertonic solution through the catheter into superior vena cava- central vein which dilutes the solution).
Female Athlete Triad
Eating Disorder
Restrictive Dieting
Overexercising
Lack of Body Fat
Weight Loss
Osteoporosis
Loss of Calcium from Bones
Amenorhhea
Diminished Hormones
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Prognosis for People with Bulimia Nervosa
~2-3% die from disease
Recovery rates
~48% full recovery
~26% improvement
~26% chronicity
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Bulimia –Diagnostic Criteria
Binging Twice a Week Followed by Purging for 3 Months
Binging Involves Eating in a Discrete Period of Time an Excessive Amount of Food and a Lack of Control During the Eating
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Bulimia is a separate eating disorder from anorexia nervosa but this condition may be present in anorexics and one eating disorder can lead to another. In both types of eating disorders there is an over-concern with body weight, a tendency to drastically undereat and perceive foods as forbidden and give in to binge eating.
Observed primarily but not exclusively in adolescent females who are preoccupied with body image and their self-worth are tied to feelings about their bodies. Some studies suggest that up to 20% of females in late adolescence experience bulimia.
Bulimia typically occurs in late adolescence or early adulthood after a series of unsuccessful weight reducing diets. Typically observed in outwardly successful and busy individuals who have a delay in psychosocial development into adulthood and are more easily frustrated individuals.
Although bulimia is usually observed in individuals of normal weight, there is also weight fluctuation of 10 lbs in a short space of time.
Diagnosis includes:
(1) binging twice a week followed by purging for 3 months in which the binging involves eating in a discrete period of time an excessive amount of food and a lack of control during the eating. Compulsion to eat is not a response to hunger but a means to dull various emotional states including depression and stress by binging and vomiting.
Bulimia –Diagnostic Criteria
Compensatory Behavior to Prevent Weight Gain
Purging Which Involves Regular Self-induced Vomiting, Laxatives, Diuretics, Enemas
A of bulimia called bulimarexia, in which purging type involves use of exercise or fasting in which the fasting is accompanied by a depleted nutritional state.
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There is compensatory behavior to prevent weight gain. Purging which involves regular self-induced vomiting, laxatives, diuretics, enemas. A non-purging type of bulimia called bulimarexia, which involves use of exercise or fasting in which the fasting is accompanied by a depleted nutritional state.
Bulimics can also undergo rigid dieting so that the binge is worsened and accelerated by hunger.
Bulimia –Diagnostic Criteria
Distorted/ill-informed Attitudes Regarding Food and Nutrition
Self Evaluation According to Body Shape and Weight and a Fear of Gaining Too Much Weight
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There are distorted/ill-informed attitudes regarding food and nutrition ( cookie could be considered as a binge and cause great concern Bulimics self evaluate according to body shape and weight and a fear of gaining too much weight.
There is a preoccupation with body weight and food with secretive binge eating involving several emotional states including anticipation, anxiety, urgency to begin, rapid and uncontrolled intake of food, relief and relaxation followed by disappointment and shame.
Health Risks of Bulimia
Vomiting Behavior Causes
Irritation and Infection of Esophagus, Salivary Glands
Erosion of Teeth and Dental Caries
Electrolyte Imbalances
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Risks to bulimia include irritation and infection of esophagus, salivary glands, erosion of teeth and dental caries and electrolyte imbalances due to the vomiting behavior.
Fluid and electrolyte imbalances can cause abnormal heart rhythms and kidney injury due to urinary tract infections.
Health Risks of Bulimia
Abnormal Heart Rhythms Due to Fluid and Electrolyte Imbalances From the Overuse of Emetics, Drugs Used to Induce Vomiting
Kidney Injury Due to Urinary Tract Infections
Increased Risk of Sub-clinical Malnutrition
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Overuse of emetics, drugs used to induce vomiting, can cause heart failure due to electrolyte imbalances. Also increased risk of sub-clinical malnutrition.
Non-specified eating disorders
Non-specific eating disorders could involve fear of obesity, fear of hypercholesterolemia which cause reduced food intake.
can also include binge eaters who consume less than during binge, rarely purge and show less restraint in dieting
Binge eaters show similar emotions to other eating disorders
feeling out of control, embarrassment and guilt about binges and self-disgust, depression and anxiety regarding their own body size.
These disorders could cause delayed sexual maturation and deteriorating linear growth which is preceded normally by reduced food intake and by 1-2 years of inadequate weight gain.
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Also can have atypical eating disorders in teens which do not fit in pattern of other eating disorders such as pica or rumination disorders.
These could involve fear of obesity, fear of hypercholesterolemia which cause reduced food intake. These disorders could cause delayed sexual maturation and deteriorating linear growth which is preceded normally by reduced food intake and by 1-2 years of inadequate weight gain.
Non-specified eating disorders can also include binge eaters who consume less than during binge, rarely purge and show less restraint in dieting. Binge eaters show, however, similar emotions of feeling out of control, embarrassment and guilt about binges and self-disgust, depression and anxiety regarding their own body size.
Treating Eating Disorders
Goal of eating-disorder treatment programs
Restore body weight
Improve social and emotional well-being
Normalize eating behaviors
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Treating Eating Disorders
Core components of programs:
Treatment of medical comorbidities
Restoration of body weight to normal
Nutrition education & counseling
Individualized psychotherapy
Family therapy
Group therapy
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Treating Eating Disorders
A multidisciplinary team approach
Team may consist of
Physician
Dietitian
Nurse
Psychologist
Psychiatrist
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