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Improving the nutritional health of adolescents—position statement—society for adolescent medicine

      Adolescent nutritional problems are common in the U.S.A. (
      • Story M.
      • Neumark-Sztainer D.
      School-based nutrition education programs and services for adolescents.
      ,

      Jacobson MS, Rees JM, Golden NH, Irwin CE, eds. Adolescent Nutritional Disorders: Prevention and Treatment. Ann NY Acad Sci. 1997; Vol 817.

      ) and throughout the world (
      • Eisenstein E.
      Chronic undernutrition during adolescence.
      ,
      • Kurz K.M.
      • Johnson-Welch C.
      ). Some young people lack adequate food (
      • Eisenstein E.
      Chronic undernutrition during adolescence.
      ,
      • Kurz K.M.
      • Johnson-Welch C.
      ) and others make poor food choices (
      • Neumark-Sztainer D.
      Excessive weight preoccupation Normative but not harmless.
      ,
      • Frank G.C.
      Methodological issues regarding eating behavior of high-risk adolescents.
      ). Conflicting media messages confuse and overwhelm modern adolescents, while rapidly changing lifestyles interfere with family centered eating patterns (
      • Frank G.C.
      Methodological issues regarding eating behavior of high-risk adolescents.
      ). Growth and development (
      • Spear B.
      Adolescent growth and development.
      ) as well as life long health (
      • Katzman D.K.
      • Zipursky R.B.
      Adolescents with anorexia nervosa The impact of the disorder on bones and brain.
      ,
      • Copperman N.
      • Haas T.
      • Arden M.R.
      Jacobson MS Multidisciplinary intervention in adolescents with cardiovascular risk factors.
      ,
      • Fisher M.
      • Golden N.H.
      • Katzman D.K.
      • et al.
      Eating disorders in adolescents A background paper.
      ) may be permanently impaired when food is not available, not eaten even though available, eaten in excess or out of balance with the normally accelerated, and sometimes modified needs of adolescents (

      Position of the American Dietetic Association: Teenage pregnancy and nutritional risks. J Am Diet Assoc 1994;94:449–450.

      ,
      • Meredith C.N.
      Exercise and fitness.
      ,

      Trahms CM. Nutritional care in metabolic disorders. In: Mahan LK, Escott-Stump S. eds. Krause’s Food Nutrition and Diet Therapy, 9th Edition. Philadelphia: WB Saunders, 1996:699–716.

      ).
      Adolescents need sufficient energy and specific nutrients in the categories of carbohydrates, protein, fat, vitamins, minerals and water, to fuel growth and supply basic daily needs. Demands are great since the rate of growth at this stage of life is second only to the rate in infancy; mature body tissues and organ systems are developing (
      • Spear B.
      Adolescent growth and development.
      ). Too little food and/or deficits of specific nutrients lead to depletion of energy stores, muscle wastage, and cardiac dysfunction, as well as interruptions in growth, sexual maturation and function (
      • Eisenstein E.
      Chronic undernutrition during adolescence.
      ). All body tissues are susceptible to inadequate nourishment. For example, normal bone strength may never be attained if adolescents are malnourished (
      • Katzman D.K.
      • Zipursky R.B.
      Adolescents with anorexia nervosa The impact of the disorder on bones and brain.
      ). Brain structure may be altered, and unless the situation is rapidly reversed, short term damage may extend to severely undermine adult health (
      • Fisher M.
      • Golden N.H.
      • Katzman D.K.
      • et al.
      Eating disorders in adolescents A background paper.
      ).
      Adolescent athletes, and those with eating disorders, who restrict food or fluid intake or who exercise beyond the limits of their physical development risk serious short and long-term consequences (
      • Fisher M.
      • Golden N.H.
      • Katzman D.K.
      • et al.
      Eating disorders in adolescents A background paper.
      ,
      • Meredith C.N.
      Exercise and fitness.
      ). At the other extreme, eating more food than needed during adolescence can cause excess fat to be stored throughout the rest of life. Being overweight or obese increases the risk that youth will develop conditions such as diabetes, heart, lung and blood vessel disease that lead to early death (

      Jacobson MS, Rees JM, Golden NH, Irwin CE, eds. Adolescent Nutritional Disorders: Prevention and Treatment. Ann NY Acad Sci. 1997; Vol 817.

      ). The reproductive system, general physical abilities, self-esteem and social life are often adversely affected by long term over-fat conditions (

      Rees JM, Jacobson MS. Adolescent overweight and obesity: A rational approach to prevention and long term treatment. In Shenker IR ed. Monographs in Clinical Pediatrics: Adolescent Medicine, 1994:93–111.

      ). For other adolescents, including those who have a disease or genetic disorder interfering with metabolic function, obtaining a specific balance of nutrients is particularly important in order to avoid exacerbating the disorder or the early debilitating effects of the disease (

      Trahms CM. Nutritional care in metabolic disorders. In: Mahan LK, Escott-Stump S. eds. Krause’s Food Nutrition and Diet Therapy, 9th Edition. Philadelphia: WB Saunders, 1996:699–716.

      ). Childbearing adolescents need to adequately nourish themselves and their developing offspring without overeating foods rich in sugar and fat (

      Position of the American Dietetic Association: Teenage pregnancy and nutritional risks. J Am Diet Assoc 1994;94:449–450.

      ,
      • Rees J.M.
      • Lederman S.A.
      • Kiely J.
      Birth weight associated with lowest neonatal mortality Infants of adolescent and adult mothers.
      ). The recommendation that dietary folic acid be available during pregnancy to prevent neural tube defects in infants highlights the need for improved nutrient intake by reproductive-age adolescents as less than one-third routinely choose foods containing sufficient folic acid (
      Centers for Disease Control
      Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects.
      ).
      Developmentally appropriate assistance to adolescents, particularly high risk youth, including the homeless and incarcerated, helps them improve their nutritional habits and prepares them to live as productive adults who avoid many risks to health (
      • Story M.
      • Neumark-Sztainer D.
      School-based nutrition education programs and services for adolescents.
      ,

      Jacobson MS, Rees JM, Golden NH, Irwin CE, eds. Adolescent Nutritional Disorders: Prevention and Treatment. Ann NY Acad Sci. 1997; Vol 817.

      ,
      • Copperman N.
      • Haas T.
      • Arden M.R.
      Jacobson MS Multidisciplinary intervention in adolescents with cardiovascular risk factors.
      ,

      Rees JM, Jacobson MS. Adolescent overweight and obesity: A rational approach to prevention and long term treatment. In Shenker IR ed. Monographs in Clinical Pediatrics: Adolescent Medicine, 1994:93–111.

      ,
      • Rees J.M.
      • Lederman S.A.
      • Kiely J.
      Birth weight associated with lowest neonatal mortality Infants of adolescent and adult mothers.
      ,
      • Cusatis D.C.
      • Shannon B.M.
      Influences on adolescent eating behavior.
      ,

      McBurney KA. The nutritional health status of incarcerated youth. In Sheahan, PM, ed. Health Care of Incarcerated Youth: Report for the 1991 Tri-regional Workshops. Washington, DC: National Center for Education in Maternal and Child Health. Pg 37–45.

      ,
      Society for Adolescent Medicine Position Paper
      Eating disorders in adolescents.
      ). Thus, understanding and promoting nutritional health during adolescence warrants renewed attention, followed by the allocation of resources for nutritional advocacy, training, research, and care (
      • Story M.
      • Neumark-Sztainer D.
      School-based nutrition education programs and services for adolescents.
      ,
      • Frank G.C.
      Methodological issues regarding eating behavior of high-risk adolescents.
      ,
      • Adams L.B.
      Training and education Building the nutrition team.
      ,
      • Story M.
      • Blum R.W.
      Adolescent nutrition Self-perceived deficiencies and needs of practitioners working with youth.
      ). As an organization devoted to improving the total health of adolescents, the Society for Adolescent Medicine supports the following goals:
      • Insure access to adequately nourishing food for all adolescents.
      • Develop and maintain health services to assist adolescents to eat adequately, but not excessively, and to meet their nutritional needs, whether normal or modified by chronic disease, metabolic disorders, competitive athletics, pregnancy or other life events.
      • Implement nutritional education, health promotion and disease prevention programs for all adolescents, especially those at increased risk for inadequate or excessive nutritional intake.
      • Dedicate resources for research to determine the long and short-term consequences of nutritional intake during adolescence, as well as the potential to improve biological conditions by altering the intake of nutrients and to positively influence food choices at this stage of life.
      • Strengthen basic and advanced training opportunities in adolescent nutrition for nutritionists and adolescent health professionals, and for students preparing for these professions.

      References

        • Story M.
        • Neumark-Sztainer D.
        School-based nutrition education programs and services for adolescents.
        Adolesc Med State Art Reviews. 1996; 7: 287-302
      1. Jacobson MS, Rees JM, Golden NH, Irwin CE, eds. Adolescent Nutritional Disorders: Prevention and Treatment. Ann NY Acad Sci. 1997; Vol 817.

        • Eisenstein E.
        Chronic undernutrition during adolescence.
        Ann NY Acad Sci. 1997; 817: 138-161
        • Kurz K.M.
        • Johnson-Welch C.
        The nutrition and lives of adolescents in developing countries. International Center for Research on Women Publications, Washington, DC1994
        • Neumark-Sztainer D.
        Excessive weight preoccupation.
        Nutri Today. 1995; 30: 68-74
        • Frank G.C.
        Methodological issues regarding eating behavior of high-risk adolescents.
        Ann NY Acad Sci. 1997; 817: 66-82
        • Spear B.
        Adolescent growth and development.
        in: Rickert V.I. Adolescent Nutrition Assessment and Management. Chapman and Hall, New York, NY1995: 1-24
        • Katzman D.K.
        • Zipursky R.B.
        Adolescents with anorexia nervosa.
        Ann NY Acad Sci. 1997; 817: 127-137
        • Copperman N.
        • Haas T.
        • Arden M.R.
        Jacobson MS.
        Ann NY Acad Sci. 1997; 817: 199-207
        • Fisher M.
        • Golden N.H.
        • Katzman D.K.
        • et al.
        Eating disorders in adolescents.
        J Adolesc Health. 1995; 16: 420-437
      2. Position of the American Dietetic Association: Teenage pregnancy and nutritional risks. J Am Diet Assoc 1994;94:449–450.

        • Meredith C.N.
        Exercise and fitness.
        in: Rickert V.I. Adolescent Nutrition Assessment and Management. Chapman and Hall, New York, NY1995: 25-42
      3. Trahms CM. Nutritional care in metabolic disorders. In: Mahan LK, Escott-Stump S. eds. Krause’s Food Nutrition and Diet Therapy, 9th Edition. Philadelphia: WB Saunders, 1996:699–716.

      4. Rees JM, Jacobson MS. Adolescent overweight and obesity: A rational approach to prevention and long term treatment. In Shenker IR ed. Monographs in Clinical Pediatrics: Adolescent Medicine, 1994:93–111.

        • Rees J.M.
        • Lederman S.A.
        • Kiely J.
        Birth weight associated with lowest neonatal mortality.
        Pediatrics. 1996; 98: 1161-1166
        • Centers for Disease Control
        Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects.
        MMWR. 1992; 41: 1-7
        • Cusatis D.C.
        • Shannon B.M.
        Influences on adolescent eating behavior.
        J Adolesc Health. 1996; 18: 27-34
      5. McBurney KA. The nutritional health status of incarcerated youth. In Sheahan, PM, ed. Health Care of Incarcerated Youth: Report for the 1991 Tri-regional Workshops. Washington, DC: National Center for Education in Maternal and Child Health. Pg 37–45.

        • Society for Adolescent Medicine Position Paper
        Eating disorders in adolescents.
        J Adolesc Health. 1995; 16: 476-480
        • Adams L.B.
        Training and education.
        in: Rickert V.I. Adolescent Nutrition Assessment and Management. Chapman and Hall, New York, NY1995: 593-608
        • Story M.
        • Blum R.W.
        Adolescent nutrition.
        J Am Diet Assoc. 1988; 88: 591-594