WHO defines adolescents as persons between 10 to 19 years age group. The number is even higher in developing countries. India has around 19.6 percentage of total population in the adolescent age group. This period is defined by rapid biological, cognitive, social and behavioural changes. 45% of the skeletal growth takes place and 15 to 25% of adult height is achieved during adolescence. During this growth spurt up to 37% of the total bone mass may be accumulated. These changes affect them physically and psychologically and could alter the way they perceive and consume food. These changes in taste preferences, taste sensitivity, olfactory changes combined with childhood food exposure, family income, availability of food and parental eating pattern are some of the determinants of adolescent diet. The growth pattern is different in girls and boys. Girls tend to sexually mature at a faster rate than boys. There is subcutaneous fat deposition on the abdomen and pelvic region in girls, the boys though mature slowly develop much more muscle mass and the development of height and weight is more compared to girls.
Why is Nutrition in Adolescence Important?
Nutrition influences different stages of life but the needs are great in this age group. The growth spurt in this age group results in 50 % increase in calcium and 15% increase in iron requirements. Adolescents express their control over food more than children, they should be made an ideal target for nutrition education. This might change not only their own eating pattern but they might also influence others in their age group. Improving adolescence nutrition behavior is an investment in adult health. Poor nutrition, adverse influence of parents, peer pressure can lead to chronic diseases in later life. Providing better nutrition to girls in adolescence leads to better pregnancy outcomes, lowers risk of anaemia and reduces incidence of osteoporosis in later life. Malnourishment leads to stunted growth in females and is associated with narrow female pelvis which affects pregnancy outcome.
Dietary changes in Adolescence
Girls require more iron and folic acid intake because of menstrual blood loss and increased demand. Since the metabolic rate is also high there is necessity of iodine which can be met by consumption of iodized salt. Boys require more Vitamin B as compared to girls to meet their extra demand of energy and muscle mass development. It is necessary to take care of nutrition of girls as they are more susceptible to malnutrition. There is an increased demand of calories and proteins to meet the growth requirements. There is an increased need for calcium for bone development.
Children in this age group consume more of carbohydrate-based calories and fewer proteins. There is difference seen in the diet pattern of the urban and rural adolescent children too. The urban teenager consumes more calories from foods such as high sugar candies, aerated and sugary drinks and refined and processed foods. Snacking on calorie rich foods which provide little nutrition, skipping meals and irregular meal times are common changes in this age group. Eating away from home, little intake of fruits and vegetables are some of the faulty dietary patterns in this age group.
Nutritional problems in adolescence
Undernutrition
Overall nutritional status of adolescent girls in India is extremely poor and there are 79% suffer from energy deficiency and are underweight, 74% have anaemia and 44% have Vitamin B deficiency. Low nutritional status delays the onset of puberty. Studies show that undernourished girls reach menarche later. Inadequate nutrition in adolescence can retard growth and sexual maturation. It can put them at a risk of chronic ailments in adulthood. Adolescent girls are at risk due to gender discrimination in access to food. A malnourished girl child can lead to problems in pregnancy, chances of low birth weight baby. In undernourished girls the menarche is delayed and the growth rate is slower. Undernourished child has limited capacity to learn and to work.
- Iron deficiency anaemia is a common nutritional problem in adolescents, prevalent in almost 50% of Indian adolescents. It can be identified if your teen is suffering weakness and tiredness out of proportion to his or her routine, irritability, scanty menses in girls, breathlessness and headache. Foods rich in iron are eggs, chicken and mutton which are good source of haem iron. Green leafy vegetables, jaggery, beetroot is some of the common vegetarian sources of iron.
- Micronutrient deficiency: deficiency of Vitamin A is commonly seen in adolescent females. It can be corrected by necessary dietary changes such as increased red and yellow fruits and vegetables such as papaya, mangoes, carrots and beetroots. Increased demand of calcium for skeletal growth if not met can lead to calcium deficiency. It can result in osteopenia in young adults especially in females. It also increases the risk of bone fracture even at early adolescent age. Following the calcium rich sources in food milk and milk products, curry leaves, raagi or nachani and drumsticks.
Overnutrition
Malnutrition doesn’t necessarily mean lack of food, it means not consuming the necessary nutritional food in necessary quantities. Excess of food also accounts to malnutrition. Malnourishment is seen in 30% of girls and 18% of boys in adolescent age group (Source- National Family health survey-India). Obesity and diet related chronic illnesses are severe problem not only in developed countries but also developing countries.
- Obesity related problems in adolescence includes psychological problems, aversion to social interaction, increased risk of heart disease, dyslipidaemia, impaired glucose metabolism, sleep apnoea. The likes and dislikes towards foods intensify in this age group. Heightened olfaction leads to avoidance of strong-smelling foods especially in girls. There is increased tendency to consume sweetened foods or carbohydrate-based foods especially in children who have had early long exposure to sweet foods in childhood. Obesity is also associated with gall bladder disease in teenagers.
- Eating disorders such as binge eating and night eating syndrome are commonly seen in teenagers. Anorexia nervosa and bulimia are extreme ends of the spectrum. Relentless pursuit of thinness is seen amongst younger girls. Adolescents especially girls who develop poor body image can take wrong steps to control their bodyweight. Biological changes if not properly understood, constant emphasis on looks and thinness can lead to body image issues which are a contributory factor to the eating disorders. Many follow crash diets which deprive the body of necessary nutrition and leads to many deficiency diseases. The excessive pursuit of being thin to look attractive can lead to anorexia nervosa. This disorder is high among non-overweight girls.
- Another eating disorder to affect this age group is bulimia where in the person induces vomiting after binge eating so as to maintain or lose weight. This induced vomiting has harmful side effects on the person’s health and growth. Young athletes who need to maintain a certain weight commit to diet and exercise at an extreme level which will not only hamper their performance but overall health.
Though adolescents are not prone to infections and this age group is usually considered healthy but they are vulnerable to a lot of socio-economic changes which results in behaviours which affect their health, take risks, impulsive behavior, unprotected sexual acitivity, substance abuse. Impulsive behaviours in teenagers/ adolescents is due to the limitation of brain development and socio-behavioural factors. The area of brain called the prefrontal cortex which acts like a brake in these impulsive behaviours is developing slowly and hence teenagers have to work harder to control their behavior. This leads to emotional and impulsive decisions such as alcohol consumption. Drug abuse, sexual activity, consumption of caffeinated drinks. If parents better understand the neurological changes in an adolescent brain, they can provide necessary support and resources which will help the teenagers lead a happy healthy life. Alcohol dependence or dependence on caffeine can affect their ability to learn and work.
Reference
- Nutrition in adolescent health and development- WHO 2005
- Ghai Essential Paediatrics by Dr O.P.Ghai
- Factors influencing food choices of adolescents by Neumark Sztainer, Story M, Perry C and Cassey MA.
- Image by Engin Akyurt from Pixabay