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ADOLESCENTS (13 – 18 YEARS) – PART 3 DR. ABEER M. ALJAADI MODIFIED BY : DR. AWATIF ALMEHMADI Adolescent Nutrition: Conditions and Interventions Chapter 15th : Nutrition Through the Life Cycle, 6e. Judith E. Brown LEARNING OBJECTIVES By the end of today’s lecture, students will be able to: ...

ADOLESCENTS (13 – 18 YEARS) – PART 3 DR. ABEER M. ALJAADI MODIFIED BY : DR. AWATIF ALMEHMADI Adolescent Nutrition: Conditions and Interventions Chapter 15th : Nutrition Through the Life Cycle, 6e. Judith E. Brown LEARNING OBJECTIVES By the end of today’s lecture, students will be able to:  Describe at least five chronic health issues that are considered comorbid conditions of adolescent obesity, including the proposed mechanisms by which obesity raises the risk for these conditions. OVERWEIGHT AND OBESITY  Prevalence of overweight and obesity among adolescents has nearly doubled in the last 20 years  Exact reasons? Not clear  Environmental factors, or interactions between genetic and environmental factors, are the most likely causes of the dramatic rise in overweight and obesity.  Risk factors  having at least one overweight or obese parent; low socioeconomic status; being of African American, Hispanic, or American Indian/Native Alaskan race/ethnicity; and being diagnosed with a chronic or disabling condition that limits mobility  Inadequate levels of physical activity and consuming diets high in total calories and added sugars and fats are behavioral risk factors common among a significant proportion of adolescents. These environmental factors increase the risk of developing obesity if an adolescent is genetically predisposed to obesity. DEFINITIONS AND CLASSIFICATION Weight status among adolescents should be assessed by calculating body mass index (BMI). BMI values are compared to age- and gender-appropriate percentiles to determine the appropriateness of the individual’s weight for height. HEALTH IMPLICATIONS OF ADOLESCENT OVERWEIGHT AND OBESITY 1. hypertension 2. dyslipidemia 3. insulin resistance Longitudinal studies: increased risk 4. type 2 diabetes mellitus of morbidity and premature 5. sleep apnea and other hypoventilation disorders mortality from coronary heart 6. orthopedic problems disease, stroke, diabetes, asthma, 7. hepatic diseases and hypertension among adults 8. body image disturbances who were overweight or obese 9. lowered self-esteem during adolescence. ASSESSMENT AND TREATMENT OF ADOLESCENT OVERWEIGHT AND OBESITY  Screening – every year (weight-for- height )  Risk factors present >> in–depth assessment  ASSESSMENT AND TREATMENT OF ADOLESCENT OVERWEIGHT AND OBESITY  Treatment  A staged care process is recommended based on BMI, co-morbid conditions, age, and progress with previous stages of treatment  Stage 1: Prevention Plus: Adolescents with BMI of ≥85th but > increased dietary intake of foods rich in iron and vit. C + iron supplementation.  SPECIAL DIETARY CONCERNS AMONG ADOLESCENTS  Hypertension (HTN) – elevated BP vs. Hypertension (see table)  Average of three readings  Risk factors among adolescents: family history of HTN, high dietary intake of Na, overweight or obesity, hyperlipidemia, inactive lifestyle, and tobacco use.  display one or more of these risk factors >> routinely screened for HTN.  DASH eating plan From the Clinical Practice Guideline for Screening and Management of High BP in Children and Adolescents Source: American Academy of Pediatrics (2017) https://publications.aap.org/pediatrics/article/140/3/e20171904/38358/Clinical-Practice-Guideline-for-Screening-and?autologincheck=redirected  SPECIAL DIETARY CONCERNS AMONG ADOLESCENTS  Hyperlipidemia – specific guidelines  1 in 4 has elevated cholesterol  ​classification criteria  CHILD 1 (Cardiovascular Health Integrated Lifestyle Diet) diet  DASH diet + (fiber+breakfast+less juice+less Na+less fast food)  Diabetes and Metabolic Syndrome – specific considerations​  Type 2 diabetes prevention includes reaching and maintaining a healthy body weight, engaging in regu- lar physical activity, and following the DASH diet  SPECIAL DIETARY CONCERNS AMONG ADOLESCENTS  Children and Adolescents with Chronic Health Conditions  Increased risk for nutrition-related health problems because of (1) physical - may affect their ability to consume, digest, or absorb nutrients (2) biochemical imbalances caused by medications or internal metabolic disturbances (3) psychological stress from a chronic condition or physical disorder that may affect a child’s appetite and food intake (4) environmental factors, often controlled by parents who may influence the child’s access to and acceptance of food  Common nutrition problems: Altered energy and nutrient needs (e.g., inborn errors Elimination problems of metabolism, enzyme deficiencies) Drug/nutrient interactions Delayed growth Appetite disturbances Oral-motor dysfunction (e.g., neurological Unusual food habits (e.g., rumination) disorders, swallowing disorders) Dental caries, gum disease  SUMMARY 1. More than one-third of adolescents are overweight and 18 % are obese. 2. National guidelines specify a four-stage approach to weight management for adolescents, which may include bariatric surgery in the presence of extreme obesity or life-threatening comorbid conditions. 3. Dieting is common among adolescents: 33 % males and 63 % females reporting dieting during the past month. 4. Risk factors for iron deficiency anemia, the most common nutrition deficiency among adolescents, include rapid growth, low dietary Fe intake, meal skipping, dieting, athletic participation, and heavy menstrual bleeding. 5. Cholesterol levels drop during puberty, thus routine screening for hyperlipidemia should be done before age 10 and again after age 17.