L7 Children and Adolescents: Nutrition Issues and Programs PDF

By Dr. Awatif Almehmadi 1 OVERVIEW Nutrition During Children and Adolescence. Nutrition-Related Problems of Children and Adolescents Examples of Nutrition Programs at the local, national and, international levels: ❖ The National School Lunch Program....

By Dr. Awatif Almehmadi 1 OVERVIEW Nutrition During Children and Adolescence. Nutrition-Related Problems of Children and Adolescents Examples of Nutrition Programs at the local, national and, international levels: ❖ The National School Lunch Program. ❖ The School Breakfast Program. ❖ The After School Snack Program. ❖ The Summer Food Service Program for Children. ❖ The Food Distribution Program. 2  Rates of childhood morbidity and mortality due to infectious diseases have decreased, but new dangers have arisen in the past few periods. Food preferences and eating behaviour are established early and persist into adulthood There has been an worrying increase in the prevalence of overweight and obese children and adolescents. Children are generally categorized as ages 1 to 11 years, while adolescents are ages 12 to 19 years. 3  There are four (4) stages of development : – 1- Biological Development. – 2- Cognitive Development. – 3- Psychological Development. – 4- Social Development.  ▪ Determinants of food choice in children ▪ Neophobia and Exposure ▪ Social Modelling ▪ Peer ▪ Hero ▪ Parent ▪ Despite the importance of healthful eating habits, unhealthful eating patterns are becoming more pronounced due to: ▪ Increased independence from parents ▪ Eating away from home ▪ Concern with physical appearance and body weight ▪ The need for peer acceptance  Greater in males than females, and runs in families (Hursti & Sjoden, 1997) Decreases with age (Birch, 1989) Minimal in infants being weaned; greater in toddlers and pre- schoolers (Birch et al, 1998) Often described as “fussy” or “picky” eating ❖ Child temperament, maternal characteristics and parent-child characteristics may play a role in fussy eating (Rendall, Harvey & Dodd, in prep). Modelling others Peer modelling Peers Preference for two foods established in 39 Heroes children Parents Children who preferred food A ate with 4 children who prefer food B 4 days later? Birch, 1980 Aim: To establish whether modelling influenced children’s consumption of, and liking for, fruit and vegetables. Design n = 402 children aged 4-11 years Baseline data phase; 16 day intervention phase Observed consumption at school: lunch and snack Parent reported consumption outside school: week day and week ends Self-reported liking pre- and post-intervention Food Dudes Enjoy a variety of fruit and vegetables Battle the evil “junk punks” Whole schools (peer-group culture) Encouraged positive referencing to fruit and vegetables (easily learnt songs, catchphrases): fruit tastes good vegetables make me strong Intervention: Letters from the food dudes addressed to the children and read out by the teacher Six 6-minute episodes of the food dudes Rewards: stickers, pencils and erasers Procedure: Baseline Phase: target foods presented at school snack and lunchtime and consumption recorded (observed/weighed) Intervention Phase: as baseline plus Food Dude letter read out by the teacher each day 2/3 days Food-Dude video Small reward for eating target food Results: Consumption during school snack and lunchtime was higher during the intervention phase than during the baseline phase of all 16 target foods (p < 0.001) Consumption outside school was higher during the intervention for week days (p < 0.05) but not weekends. Children’s liking for the target food and vegetables increased post- intervention (p = 0.001)  Children’s eating habits have changed over the past two decades. The Healthy Eating Index (HEI): Used as an indicator of diet quality, provides an overall picture of the variety and quantity of foods people choose to eat, and their compliance with specific dietary recommendations. HEI findings: Children ages 7 to 9 have a lower diet quality than younger children. Most children do not meet recommended intakes of vegetables or meat. most children skip breakfast  Adolescence (from Latin adolescere meaning "to grow up"). It is a transitional stage of physical and psychological human development that generally occurs during the period from puberty to legal adulthood (age of majority). The period of adolescence is most closely associated with the teenage years, though its physical, psychological and cultural expressions may begin earlier and end later.  Adolescence is a critical period of growth and development, so good nutrition is essential. During adolescence, the need for most nutrients including energy, protein, vitamins and minerals increases. As appetite is also likely to increase, it is important that food choices are made carefully. It can be tempting at this time to increase the intake of snack foods and fast foods that are high in fat, sugar and salt. Teenagers make many more choices for themselves than they did as children. Their interest in nutrition both valid information and misinformation derives from personal and immediate experiences.  Lifestyle. Food Preferring. Early childhood experiences, exposure, genetics. Taste and appearance. Health and nutrition. Religion. Cost. Family.  Growth and development are rapid during the teenage years. A growth spurt usually begins around the age of 10 in girls, and 12 in boys – adding an average of 23cm to height and 20-26 kg in weight (boys and girls). Body composition also changes during puberty – in boys the proportion of fat declines from an average of 15% to about 10%. In girls the proportion increases from 15% to around 20%. Extra energy and nutrients are therefore required to support growth and development. Energy and nutrient needs are at their absolute highest. Eating a healthy, balanced diet can: promote wellbeing by improving mood, energy and self-esteem to help reduce stress; depression. Increase concentration and performance. reduce the risk of ill-health now and in the future, e.g. obesity, heart disease, cancer, and type 2 diabetes; increase productivity/attainment and reduce days off sick.  THE EATWELL PLATE a FOOD STANDARDS AGENCY food.gov.uk USE THE EATWELL PLATE TO HELP YOU GET THE BALANCE RIGHT. IT SHOWS HOW MUCH OF WHAT YOU EAT SHOULD COME FROM EACH FOOD GROUP. Bread, rice, Fruit and potatoes, pasta vegetables ando l r statchyfcxxls Meat, fish, Milk and eggs, beans dairy fo o d s andothernon dairy sourcesof protem Foods and drinks high in fat and/or sugar Teenagers should consume a variety of foods from each of the four main food groups: Bread, rice, potatoes, Fruit and vegetables (33%) pasta and other starchy foods (32%) Meat, fish, eggs, beans and other non-dairy Milk and dairy foods (15%) sources of protein (20%)  These dietary improvements are in line with following a healthy, balanced diet, as in The eatwell plate model. More fruit and vegetables, pulses, wholegrain foods (5 A DAY, micronutrients, dietary fibre) More milk and diary foods (calcium, zinc, riboflavin, vitamin A) More iron-rich foods (e.g. lean meat, pulses, dried fruit, fortified bread and breakfast cereals) More oily fish (long-chain omega-3 fatty acids, vitamin D) Less foods high in saturates and added sugars (e.g. biscuits, cakes, pastries, candy, soft drinks) Less salt (e.g. from salty snacks, processed foods, salt added at table)  Levels of overweight and obesity are increasing: 35% of teenagers (12-15 years) are classified as overweight or obese. Teenagers, especially girls, often try to control their weight by adopting very low energy diets or smoking. Restricted diets may lead to nutrient deficiencies and other health consequences. Teenagers of unhealthy weight may need guidance on lifestyle changes to help them achieve a healthy weight. The short-term consequences of obesity in teenagers include psychological problems (e.g. low self esteem), increased cardiovascular risk factors, diabetes and asthma. The long-term consequences include persistence of obesity and CVD risk factors into adult life and premature death. The majority of obese adolescents will remain obese into adulthood.  NDNS survey found average dietary fibre (NSP) intakes to be low in teenagers: - Boys (11-14 years) 11.6 g/day (15-18 years) 13.3 g/day - Girls (11–14 years) 10.2 g/day (15-18 years) 10.6 g/day Reference values: - 15 g/day (11-14 years) - 18 g/day (15 years or above)  NDNS survey results - average salt intakes above recommendations in teenagers: - Boys (11-14 years) 6.75 g/day (15-18 years) 8.25 g/day - Girls (11-18 years) 5.75 g/day (excluding salt added in cooking or at the table) Recommended maximum daily salt intake: - 11 years and over: up to 6 g/day.  Teenagers have increased iron requirements. Girls need more iron than boys to replace menstrual losses (RNI: boys 11.3 g/day, girls 14.8 g/day). Low iron intakes (< LRNI) in 44% of girls (11-14 years) and 48% of girls (15-18 years). 9% of girls (15-18 years) were found to have poor iron status (Hb < 12g/dl). Lack of iron leads to an increased risk of iron deficiency anaemia and associated health consequences. Teenagers who follow a vegetarian diet or restrict food intake (e.g. to lose weight) particularly at risk.  Good sources: meat (especially lean red meat), liver and offal, green leafy vegetables, pulses (beans, lentils), dried fruit, nuts and seeds, bread and fortified breakfast cereals. Iron from meat sources (haem iron) is readily absorbed by the body. Vitamin C helps the body to absorb iron from other sources (non-haem iron).  Teenagers have high calcium requirements. Around 50% of the adult skeleton is formed during the teenage years (RNI - boys 1000 mg/day, girls 800 mg/day). Low calcium intakes (< LRNI) found in 24% of 11-14 year-old girls and 19% of 15-18 year-old girls. A lack of calcium may have consequences for future bone health e.g. increased risk of osteoporosis. During puberty, the total amount of calcium deposited (as bone) per day is greater than at any other time in life. Therefore, total calcium needs are greatest during adolescence. Teenagers have high calcium requirements due to rapid increase in bone mass during teenage years. Absorption of calcium is also greater during adolescence than in childhood and adulthood, due to hormonal changes.  Good sources of calcium include milk and dairy products, green leafy vegetables, fish containing soft bones (e.g. canned sardines. The bioavailability of calcium from foods varies e.g. the bioavailability of calcium from milk is around 30% (i.e. only 30% of the calcium from milk is absorbed by the body), compared with 5% from spinach.  Minerals Zinc is essential for adequate growth and sexual development. Foods containing zinc include meats e.g. beef, lamb, pork etc. Vitamin A. Vitamin A is essential for good development of the eyes and for the immune system. Foods containing vitamin A include dairy foods, dark green vegetables and orange/red fruits and vegetables. B VITAMINS The B vitamins including B6, B2 and thiamin and niacin are important for many functions including breakdown and use of carbohydrate and protein in the body. Vitamin B12 and folate are also important for the nervous system and for making new cells in the body. Requirements for these nutrients are increased in children and adolescents but the latest National Diet and Nutrition Survey suggests that levels of these are mostly adequate except for vitamin B2 which is inadequate in girls aged 11-18 years old. Foods containing B vitamins include meats, cereals and vegetables.  Several of the vitamin recommendations for adolescents are similar to those for adults, including the recommendation for Vitamin D. During puberty, both the activation of Vitamin D and the absorption of calcium are enhanced, thus supporting the intense skeletal growth of the adolescent years without additional vitamin D.  Physical activity through life is important for maintaining energy balance and overall health. At least 60 mins of moderate-intensity physical activity each day is recommended. Include activities that improve bone health, muscle strength and flexibility at least twice per week e.g. running, cycling or swimming. 68% of boys and 41% of girls (13-15 year-olds) achieve the recommended 60 mins per day.  Starting each day with breakfast will supply energy to the brain & body. Eating breakfast leads to improved energy and concentration levels throughout the morning. Breakfast consumption may improve cognitive function related to performance in school. Other benefits of breakfast include better nutrient intakes and weight control. Skipping breakfast makes it more likely to snack on foods which are high in saturated fat or sugar before lunch.  Defined as: an eating pattern that becomes harmful to health such as Anorexia Nervosa, Bulimia Nervosa. An eating disorder characterized by recurrent binge eating and feelings of loss of control over eating that have lasted at least 6 months. Binge incident can be triggered by frustration, anger, depression, anxiety, permission to eat forbidden foods, and excessive Can affect anyone but most likely teenager's female. It is estimated that there are 1 million people affected in the UK, with the majority being 12 to 25 year-old women. New evidence to suggest genetic makeup may have a small impact and often linked to emotions. Related to feelings of boredom, anxiety, anger, loneliness, shame or sadness. Often a combination of many factors, events, feelings or pressures e.g. low self-esteem, family relationships, sexual or emotional abuse.  An eating disorder involving a psychological loss or rejection of appetite, followed by self-starvation; related in part to a distorted body image and to various social pressures commonly associated with puberty. 20  An eating disorder in which large quantities of food are eaten at one time (binge eating) and then purged from the body by vomiting, or misuse of laxatives, diuretics, or enemas.  The main difference between diagnoses is that anorexia nervosa is a syndrome of self-starvation involving significant weight loss of 15 percent or more of ideal body weight, whereas patients with bulimia nervosa are, by definition, at normal weight or above.  Behavioral – Physical activity – Food Preference – Cultural norms Environmental – Availability of fast food chain – Food choices offered in educational institutions Psychosocial – Educational Achievement – Socioeconomic status  Obesity is defined as having an excessive amount of body fat. It is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health, leading to reduced life expectancy and/or increased health problems. Immediate health effects: Obese youth are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. In a population-based sample of 5- to 17-year-olds, 70% of obese youth had at least one risk factor for cardiovascular disease. Obese adolescents are more likely to have prediabetes, a condition in which blood glucose levels indicate a high risk for development of diabetes. Children and adolescents who are obese are at greater risk for bone and joint problems, sleep apnea, and social and psychological problems.  2- The Continuing Survey of Food Intakes by Individuals results indicate that children of all ages, races, and ethnic groups were at risk of inadequate intakes of: – Magnesium – Zinc – Vitamins A – Vitamins E  3- The Problem of Childhood Obesity Over the past two decades, the percentage of children who are overweight has nearly doubled and the percentage of adolescents who are overweight has almost tripled.