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LNP
Adolescence is the period of transition between childhood and adulthood,
and it is characterized by intense body changes resulting from puberty and by
impulses of emotional, mental, and social development.

All these changes are part of a continuous and dynamic process that starts
with the fetal life, changes during childhood, with favorable or unfavorable
influences from the setting and from the social context, and end with the
complete physical growth and sexual maturation, personality consolidation,
economical independence, and integration of the individual within his/
her social group.
Growth and Development in Adolescence
Adolescence is a significant period for physical growth and sexual
maturation. Nutrition being an important determinant of physical
growth of adolescents is an important area that needs attention.
Growth retardation is one of the most important health concerns for
adolescents and their parents as well as health care workers.

Inadequate nutritional intake during adolescence can have serious

consequences throughout the reproductive years and beyond. Poor
nutrition during adolescence can impair the work capacity and
productivity of adolescent boys and girls in their later years. Further,
an undernourished girl is at the risk of developing complications
during pregnancy and the chances of her giving birth to a low birth
weight baby increases, thus perpetuating a vicious cycle of
malnutrition and ill-health.
Rationale for Focusing on Adolescent Nutrition:
 Large percentage of adolescents are suffering from nutritional deficiencies.
 Adolescents are often the neglected population group.
 The nutrition program is either focused on pregnant women or child but rarely
on the adolescents.
 Around 1.2 billion people, or 1 in 6 of the world’s population, are adolescents
age 10 to 19 years
 Nearly, 35% of the global burden of disease has its root in adolescence.
 However, researches regarding stunting and wasting among the adolescents
are relatively less compared to other age group
 Inadequate nutrition places an adolescent in the risk of chronic disease.
Globally, the prevalence of obesity (BMI >2 S.D BMI-for-age z score) has risen
from <1% in 1975 to more than 5% in girls and nearly 8% in boys age 5–19
years in 2016.
 Good nutrition and nutritional habits at this period of time determines the
overall health pattern of a nation
Why is Adolescence a Nutritionally Critically Important Period of Life?

 This phase of life experiences sharp increase in physical growth and

development. During this period, adolescents will experience a weight
gain equivalent to 65% of their weight at the beginning of the period and
40% of their final weight, and a height gain equivalent to 15% of their
adult height (Brasel, 1982)
 Food habits and food style changes drastically during this period which
may have longer term impact in health and life
 Increased nutritional demand due to sharp physical and mental growth
 It is the second-best window of opportunity to catch up with proper
growth and development, if provided with adequate nutrition.
Importance of Adolescent Nutrition in Life Cycle Approach:

 Adolescent health is one of the most important stages in the life cycle approach.
 The health status and the behavior at this stage determines the health in coming
days.
 Adolescent is an important linkage in life cycle approach.
 Adolescent health represents the health status of child and determines the health
of adult
 Health intervention at such age is sustainable, suitable and effective.
 Proper care and attention need to be given.
 Proper nutrition is necessary for the overall growth of individual, develop the
immunity and also to rule out the occurrence of chronic disease in future which
often have roots in this period
 Proper intervention at adolescent period is also necessary to intervene the poverty
cycle
Major components of food
Major components of food include protein, fats, carbohydrates, minerals and vitamins which perform
different functions.

Function of various food components

 Proteins are of greatest importance in nutrition. Proteins are required for bodybuilding and
help in repair and maintenance of body tissues.
 Fats are high-energy foods and a source of energy. They also make the food more palatable and
provide fat-soluble vitamins.
 Carbohydrates form the major component of most diets and are the main source of energy.
 Vitamins and minerals are required in small quantities. They do not yield energy but enable the
body to use other nutrients and also play in important role in growth, repair and regulation of
vital body functions.
 Requirements for iron and calcium are particularly increased in adolescence, due to rapid
physical growth during adolescence.
 Calcium needs during adolescence are greater than they are in either childhood or adulthood
because of rapid increase in lean body mass and skeletal growth
 Zinc is especially important in adolescence because of its role in growth and sexual maturation.
Some sources of zinc are grains, nuts, meat, cheese and milk.
Balanced Diet
A balanced diet is one that provides all nutrients (carbohydrates, proteins, fats, vitamins and minerals) in
required amounts and proportions for maintaining health and general well being and also makes a small
provision for extra nutrients to withstand short duration of leanness. It can be achieved through a blend of
four basic food groups, i.e. carbohydrates, proteins, fats, vitamins and minerals. As these are present in
different types of food items like dals, chapati or rice, green vegetables, easily available fruits and milk it is
important to eat these food items in the right mix everyday.

Balanced Diet

A young person should eat a diet balanced across the five food groups. They should eat:

 plenty of fruit and vegetables

 adequate quantities of rice and other cereals, potatoes, noodles and pasta
 some milk and dairy products such as yoghurt and cheese and
 some meat, fish, poultry, eggs and/or nuts and legumes.
 The relative proportion of the five groups is depicted in the diagram 1.
In addition, they should:
 choose foods that are low in salt and
 limit foods that contain a lot of fat or sugar.
Factors influencing nutrition of adolescents

 Lack of knowledge in the family and community about the importance of

nutrition during adolescence
 Lack of food because of socio-economic circumstances
 Inequitable distribution of food in the family wherein girls being denied
nutritious food
 Poor dietary intake of food and vegetables rich in iron
 Poor bioavailability of iron in the diet
 Hookworm infestation
 Diseases like Malaria
 Bad cooking habits (over boiling vegetables and straining water, removing husk
from wheat, eating polished rice and straining rice water, etc.)
 Perpetuation of a vicious cycle of malnutrition and infection, which might begin,
even before birth and may have more serious consequences for the girl child
Eating right and nutritious food during adolescence

 Food selection is based mainly on availability, convenience and time, rather

than food value
 Influence of peers, mass media, prevalent body image
 Personal self-esteem and body image guide the eating behaviour
 Missing meals and snacking are very common
 Fast food joints are mainly patronized by adolescents. These spoil the
appetite for regular meals and are high on calories and low on nutrients.
 Helps in achieving rapid growth and full growth potential
 Helps in timely sexual maturation
 Ensures adequate calcium deposition in the bones and helps in achieving
normal bone strength
 Establishes good eating habits and sets the tone for a lifetime of healthy
eating. This prevents obesity, osteoporosis (weak bones due to deficiency of
calcium), and diabetes in later life.
Young girls who have inadequate nutrition do not grow well and become stunted
women. Adolescent girls often suffer from anaemia because of poor consumption
of iron rich foods and also due to worm infestation and frequent infections.
Because of severe malnutrition and repeated illness, the growth spurt in early
adolescence does not occur and a slower and prolonged pubertal growth period is
seen in adolescents from lower socio-economic status. Hence, any damage to the
body physiology during adolescence, which places extra nutritional demand on
the body, like early pregnancy, is detrimental as growth this still to be attained.
Adolescent mothers are more likely to deliver low birth babies. Due to poor milk
production the infant may not be able to gain enough weight and remain
malnourished. If these babies are girls, they are likely to continue the cycle by
being stunted in adulthood, and so on, if something is not done to break this
cycle. Support is needed for nutrition at all stages - infancy, childhood,
adolescence and adulthood.
Definition of Overweight and Obesity
Overweight : A person may be overweight from extra muscle, bone, or
water, as well as from having too much fat. Both terms mean that a
person's weight is higher than what is thought to be healthy for his or her
height.

Obesity : Obesity is a state in which there is a generalized accumulation of

excess fat in adipose tissue in the body leading to more than 20% of
desirable weight. Obesity has several adverse health effects and can even
lead to premature death. Obesity leads to high blood cholesterol, high
blood pressure, heart disease, diabetes, gallbladder stone and certain
types of cancer.
Factors responsible for obesity

 Inactive life style

 Gene and family history
 Junk food and over eating
 Psychological
 Environmental causes
 Diseases
 Drugs
 Tobacco and alcohol
Nutritional Anaemia
 The need for iron increases with rapid growth and expansion of blood
volume and muscle mass. As boys gain lean body mass at a faster rate
than girls, they require more iron than girls.
 The onset of menstruation imposes additional needs for girls.
 Adolescents should be encouraged to consume iron rich foods (green
leafy vegetables, jaggery, meat) complemented with a Vitamin C source
like Citrus fruits (oranges, lemon) and Indian gooseberry (Amla).
 Adolescent girls need additional requirement of Iron to compensate for
menstrual blood loss.
Iron deficiency in diet leads to nutritional anaemia.

What is anaemia?
Our blood contains a red pigment called haemoglobin, which carries oxygen and is
rich in iron. Anaemia is the loss of oxygen carrying capacity of the blood due to
deficiency of haemoglobin in the red blood cells.

Iron deficiency anaemia is a major nutritional problem in adolescent boys and girls
in India. The ill effects of anaemia can be seen as:

 Reduced capacity to work and thus decreased productivity

 Increased risk to pregnant girls/women. (In India, 20-40% of maternal deaths are
due to anaemia).
 Anaemia may increase susceptibility to infections by impairing the immune
functions.
Main causes
Sign and symptom
 Inadequate iron intake/absorption/stores  Fatigue, lethargy, dizziness,
 Frequent dieting or restricted eating headaches
 Meal skipping  Shortness of breath, ringing in
 Substance abuse ears, taste disturbances
 Heavy/lengthy menstrual periods  Restless leg syndrome
 Rapid growth  Pallor, Flattened, brittle nails
 Adolescent Pregnancy (spoon nail)
 Parasitic infection  Angular stomatitis (cracks at mouth
corners)
Restless legs syndrome (RLS), also called Willis-Ekbom Disease,  Glossitis, Blue sclera (whites of
causes unpleasant or uncomfortable sensations in the legs and eyes), Pale conjunctivae
an irresistible urge to move them. Symptoms commonly occur in
the late afternoon or evening hours, and are often most severe
at night when a person is resting, such as sitting or lying in bed.
Key risks How can anaemia be prevented?
 Anaemia can be managed through proper diet and
 Impaired cognitive functioning iron supplementation.
and memory  To prevent anaemia, increase the intake of green
 Decreased school performance leafy vegetables and fruits.
 Compromised growth and  If an adolescent looks pale, fatigued or listless and
anaemia is suspected, refer to the nearest PHC.
development  Anaemia is treated by giving iron and folic acid tablets
 Increased lead and cadmium on a daily basis till 2-3 months after haemoglobin
absorption levels have returned to normal.
 Increased risk of pregnancy  Encourage adolescents, particularly those with risk
complications, factors for iron-deficiency anaemia, to follow the
 Including prematurity and fetal dietary strategies as discussed above.
 Adolescents who are at high risk for anaemia, such as
growth retardation female athletes with heavy menses, may benefit from
 Decreased work capacity routine or periodic use of a low dose iron
 Depressed immune function supplement.
Other deficiency states

 Inadequate nutrition during adolescence can potentially retard growth so that

the adolescent remains short and thin. The full height potential may not be
reached and the adolescent may remain stunted.
 The sexual maturation may be delayed with late onset of puberty.
 Poor nutrition impairs work capacity and the boy/girl may feel tired all the time.
 Zinc deficient diet results in growth failure and delayed sexual maturation.
 Iodine deficiency leads to a much wider spectrum of disorders commencing
with intrauterine life and extending through childhood to adulthood with
serious health and social implications.
 Iodine deficiency disorders include mental deficiency impaired mental
functions, neurological defects, increased stillbirths, and perinatal and infant
mortality.
Among adolescents…( Phil. Statistic based ) What are the nutritional status of
• Stunting has decreased significantly from Filipino adolescent?
According to national surveys in the
31.9% to 26.3% Philippines, 10% to 13% of adolescents
• Wasting has decreased but not significant at (13 to 19 years) are wasted (low weight-
5% level for-height), 33% to 37% are stunted (low
height-for-age), and 17% are
• Overweight is a growing problem underweight (low body mass index
• Majority have insufficiently physical activity [BMI]-for-age); iodine deficiency and
particularly among anemia are present in 12% and 14% of
Filipino adoles- cents, ...
females, 10-17 years old
• Current smokers decreased among all age
groups but there were
still smokers <18 years of age
What are the nutritional problems of adolescence? What are the nutritional challenges and intervention in
ive common nutritional concerns have been identified among adolescence?
adolescents: low consumption of fruit and vegetables, whole These problems include problems of overeating and/or
rains, and calcium and low-fat dairy foods; high consumption consistently making poor food choices, resulting in obesity.
of sweetened beverages; and frequent consumption of fast Conversely, other adolescents develop problems with
ood. unhealthy and extremely restrictive dieting without meeting
the minimum nutritional requirements necessary for healthy
growth and development.