According to WHO, individuals between 12 and 19 years are
considered adolescents.
The period of transition from childhood to adulthood is called
adolescence with accelerated physical, biochemical and
emotional development.
There are many physical and mental changes which result due to
the influence of hormones. It is during this period that the final
growth spurt occurs with increase in height and weight.
The growth spurt of boys is slower than that of girls. The growth
spurt signals the onset of critical body composition of 10 per
cent body fat. However, 22 per cent of body fat is required to
maintain regular ovulation. Growth velocity is maximum for
boys between 12-15 years and for girls 10-13 years.
They attain their adult stature between 18-20 but bone mass
continues to increase up to age of 25. With the profound
growth of adolescence there is increased demands for
energy, protein, minerals and vitamins.
nutritional requirements
YEARS
NUTRIENTS 13-15 16-19
BOYS GIRLS BOYS GIRLS
Body Weight 50.5 49.6 64.4 55.7
ENERGY 2860 2400 3320 2500
Kcal
Protein g 50.5 49.6 64.4 55.7
Visible Fat g 45 40 50 35
Calcium Mg 1000 1000 1050 1050
Iron Mg 22 30 26 32
Vitamin A 930 890 1000 860
Thiamine mg 1.9 1.6 2.2 1.7
Riboflavin mg 1.6 1.4 1.8 1.2
Niacin µg/kg 16 14 17 14
Pyridoxin mg 2.0 2.0 2.0 2.0
Ascorbic acid 40 40 40 40
mg
Dietary folate 150 150 200 200
µg
Vitamin B12 0.2-1.0 0.2-1.0 0.2-1.0 0.2-1.0
µg
Magnesium 165 210 195 235
mg
Zinc mg 11 11 12 12
ENERGY
Caloric needs increase with the metabolic demands of
growth and energy expenditure.
Although individual needs vary, girls consume fewer kilo
calories than boys.
Boys need 2860-3320 kcal a day. Sometimes the large
appetite characteristic of this growth period leads
adolescents to satisfy their hunger with snack foods that are
high in sugar and fat and low in protein.
The calories for both boys and girls from the age group of 1-
3 years to 7-9 years remain the same.
From the age of 10 years, there is a marked difference in the
caloric needs of boys and girls.
Adults, both female and male require less calories compared
to 18-19 year old.
Growth and physical activity contribute significantly to the
total energy requirement.
PROTEINS
For most adolescents, eating to satisfy appetite offers a
reasonably sensitive indicator of energy needs.
Protein needs represent 11-12 per cent of energy intake.
The protein intake usually 1g/kg body weight.
This meets growth needs and for the pubertal changes in
both sexes and for the developing muscle mass in boys.
The protein requirements for both boys and girls are the
same up to the age of ten years.
But there is a gradual difference in their requirements from
the age of 13 years where the boys have a higher
requirement compared to girls.
This pattern is similar to calorie requirement. Between 10-12
years the requirement of protein for girls is higher compared
to boys.
Both for boys and girls, the total protein requirement
increases, as the age increases during adolescence.
But per kilogram of body weight the requirement decreases.
FAT AND ESSENTIAL FATTY ACIDS
Total fat intake below 25% E is considered to affect growth in
children and adolescents
Food low in fat, saturate fat and trans fat should be emphasised
in meal planning.
The desirable level of visible fat intake for adolescents in 35-50
g/d.
The essential fatty acid requirements is 3% E for adolescents
since the requirements of fatty acids for adolescents has not been
established the recommendations are same as in adults.
-linolenic acid helps in relaxing muscles and blood vessels of
the uterus and reduces menstrual cramps.
It also reduces inflammation of mucous membrane of the uterus.
Thus it reduces abdominal pain before, during and after
menstrual periods.
MINERALS
Calcium
During adolescence, 1000 mg of calcium and 1000 mg of
phosphorus per day is needed.
Bone growth demands calcium.
About 150 mg of calcium must be retained every day to allow for
the increase in bone mass.
Adolescents who have less bone mineral density are susceptible
for osteoporosis later in their life.
Elemental Ca : P ratio of 1: 1should be maintained
Iron
Iron is needed for haemoglobin synthesis necessitated by the
considerable expansion of blood volume.
Girls need to ensure adequate intake of iron as they lose 0.5
mg/day by way of menstruation.
The daily menstrual loss of iron is computed from the iron
content of blood lost during the menstrual period averaged over
a month.
If this lost iron is not replaced, it predisposes to iron deficiency
anaemia.
Iron is also needed for the synthesis of myoglobin which is
involved in muscle growth.
The additional requirement of iron during adolescence for the
growth spurt, expansion of blood volume and increase in Hb
concentration would 12 µg/kg for boys and 8 µg/kg for girls.
Girls would require an additional 8 µg/kg to compensate for
menstrual blood loss.
During adolescence there is an increase in body mass
corresponding to about 4.3 kg/year in the male and 4 kg/year
in the female.
With a further increase in haemoglobin by 2 g/dl in the male
and 1 g/dl in the female, the respective requirement to
growth alone is 0.7 mg/day in males and females.
The obligatory losses also increase with age.
The dietary absorption of iron is greater (5 per cent) in
adolescent girls compared to adolescent boys (3 per cent).
Body iron stores continue to increase during adolescence.
Zinc
Frank zinc deficiency is not normally seen in adolescents.
Zinc supplements have been shown to increase pubertal
growth in adolescents suffering from pubertal delay.
Vitamins
Skeletal growth requires vitamin D while the structural and
functional integrity of newly formed cells depends on the
availability of vitamins A, C and E.
The Expert Committee recommends daily allowance of 860
µg of retinol for adolescents.
When there is minimal exposure to sunlight 400 µg of
vitamin D is recommended.
The need for thiamine, riboflavin and niacin increases
directly with increased caloric intake.
Folic acid and B12 are essential for DNA synthesis and
needed in higher amounts when tissue synthesis is occurring
rapidly.
Tissue growth involves amino acid metabolism particularly
transamination to synthesise nonessential amino acids. So
the requirement for B6 is increased.
Premenstrual tension can be reduced if adolescent girls
consume 100 mg/day vitamin B6.
Dietary Guidelines
Diet in adolescents is very significant because it influences the
nutritional status later in life.
Adequate well balanced nutritious foods should be taken to
prevent obesity or under nutrition.
An adolescent girl should take enough calcium rich foods in
her diet to increase bone density. This helps in delaying the
onset of osteoporosis.
No meal of the day should be missed, as adolescence
represents a period of active life.
Junk food should be avoided.
Food should be colourful and attractive.
Avoid empty calorie foods such as carbonated beverages.
Iron rich foods may be included in the diet to prevent
anaemia.
Calorie and protein rich foods should be taken to support the
growth spurt.
Include fruits and vegetables in the diet to meet the vitamins,
minerals and fibre requirement.
Eating habits should be independent of emotions.
Parents should encourage the adolescents (both boys and
girls) to cook at home nutritious and tasty food.
Home based diets are best for children's growth.
Adolescents need to be encouraged to do physical activity
particularly outdoor games.
Physical activity regulates appetite.
premenstrual syndrome
This is not so uncommon in adolescence and is characterised
by physical and psychological symptoms which occur 7-10
days prior to the onset of periods and disappear within the
first day or two of menstrual flow.
These include weight gain, abdominal bloating, breast
engorgement and pain, constipation, peripheral oedema,
headache, irritability, anxiety, depression, tension, fatigue,
lack of concentration, increased appetite, craving for sweet
and salty foods.
The aetiology and pathophysiology have not been identified.
Management includes reassurance, exercise and dietary
modifications to meet all the nutritional requirements.
pcod
Polycystic ovary syndrome (PCOS) is a common health
problem caused by an imbalance of reproductive hormones.
The hormonal imbalance creates problems in the ovaries.
The ovaries make the egg that is released each month as part
of a healthy menstrual cycle.
With PCOS, the egg may not develop as it should or it may
not be released during ovulation as it should be.
PCOS can cause missed or irregular menstrual periods.
Irregular periods can lead to:
Infertility (inability to get pregnant). In fact, PCOS is one of
the most common causes of infertility in women.
Development of cysts (small fluid-filled sacs) in the
ovaries.
symptoms
Acne
Weight gain and trouble losing weight
Extra hair on the face and body. Often women get thicker,
darker facial hair and more hair on the chest, belly, and back.
Thinning hair on the scalp.
Irregular periods. Often women with PCOS have fewer than
nine periods a year. Some women have no periods others
have very heavy bleeding
Fertility problems. Many women who have PCOS have
trouble getting pregnant (infertility)
Depression
causes
Heredity
High levels of androgens.
Androgens are sometimes called "male hormones," although
all women make small amounts of androgens.
Androgens control the development of male traits, such as
male-pattern baldness.
Women with PCOS have more androgens than normal.
Higher than normal androgen levels in women can prevent
the ovaries from releasing an egg (ovulation) during each
menstrual cycle, and can cause extra hair growth and acne,
two signs of PCOS.
High levels of insulin.
Insulin is a hormone that controls how the food you eat is
changed into energy.
Insulin resistance is when the body's cells do not respond
normally to insulin. As a result, your insulin blood levels
become higher than normal.
Many women with PCOS have insulin resistance, especially
those who have overweight or obesity, have unhealthy eating
habits, do not get enough physical activity, and have a family
history of diabetes (usually type 2 diabetes). Over time,
insulin resistance can lead to type 2 diabetes.
special need of girls during menarche
Menstrual cycle is something which every women goes
through monthly. During this time the symptoms vary from
women to women, some have stomach cramps, hormonal
imbalance leading to an irregular cycle, and premenstrual
syndrome (PMS) or a post-menstrual syndrome. The
syndromes have symptoms like sudden depression, anxiety,
mood swings and food cravings. These have gotten
aggravated due to lifestyle changes, including dietary habits.
Calcium
Calcium deficiency can exacerbate symptoms of PMS like
depression and irritability.
Increasing calcium intake reduced mood, concentration, and
behaviour symptoms, reduced pain during the menstrual
phase of the cycle, and reduced water retention during the
premenstrual phase.
The calcium effect on PMS is correlated to the production of
serotonin and tryptophan metabolism.
The diet should include dairy products, green leafy
vegetables, fish.
Complex carbohydrates
Eating carbs turns up levels of serotonin, a neurotransmitter
in the central nervous system, which contributes to a general
sense of well-being and happiness.
Most women with PMS experience a drop in serotonin
levels, which triggers cravings for carbs because the body
uses carbs to make serotonin.
"If cortisol is high and serotonin is low, the requirement of
carbs and fats are high.
Complex carbohydrates are found in foods such as peas,
beans, whole grains, and vegetables.
Magnesium
Magnesium calms the nervous system and reduces the
activity of the hypothalamic-pituitary-adrenal (HPA) axis.
The result is less anxiety, less cortisol, and a better capacity
to cope with stress. Reduced stress can, in turn, have positive
effects on your menstrual cycle and health.
Magnesium supplementation has been demonstrated to
improve the metabolic condition insulin resistance.
magnesium may prevent dysmenorrhea (menstrual cramps)
in some people. It works by relaxing the smooth muscle of
the uterus and by reducing the prostaglandins that cause
period pain.
Vitamin B6
B6 helps make "happy neurotransmitters" like serotonin and
dopamine.
B6 has the unique ability to increase amounts of the
neurotransmitters dopamine and serotonin in the brain. Dopamine
regulates motivation, cognition, and pleasure.
Serotonin regulates mood, appetite, sleep, memory, and sexual
desire.
B6 helps make a certain kind of prostaglandin (a type of chemical
messenger) that tends to be low in people with PMS.
Prostaglandins are tiny compounds that have hormone-like effects
on the body. There are many types of prostaglandins, some that
cause period pain, and others that reduce it.
deficiency in a specific type of prostaglandin the PgE1, a good
kind of prostaglandin may be involved with exacerbating PMS.
B6 is required for the synthesis of PgE1.
Iron
Girls would require an additional 8 µg/kg to compensate for
menstrual blood loss.
About 0.5 mg of iron is lost during mensuration.
The deficiency of iron causes iron deficiency anaemia.
Sources:liver, red meat, beans, such as red kidney beans, and
chickpeas, nuts, dried fruit such as dried apricots, fortified
breakfast cereals, soy bean flour.
ZINC
Women with dysmenorrhea have high levels of
prostaglandins, hormones believed to cause menstrual
cramping. Prostaglandins are believed to temporarily reduce
or stop blood supply to the uterus, thus depriving the uterus
of oxygen resulting in contractions and pain.
Zinc inhibits the metabolism of prostaglandins ruling out this
mechanism of action.
