Nutrition in the adolescent

Trends in Nutrition-Related Risk Factors Identified Post-Operatively in Patients Treated for a Lower-Extremity Injury

This study investigated trends within a custom Sports Nutrition Assessment for Consultation (SNAC) survey designed to identify nutrition-related risk factors among post-operative lower-extremity youth athletes. Athletes aged 8-18 years who completed the SNAC at a sports medicine institution after lower-extremity surgery were reviewed for associations between SNAC questions and age/sex differences. Of 477 patients (15.0 ± 2.0 years; 47.8% female), 319 (66.9%) answered 'yes' to at least one question and were identified for a consult, though 216 (64.3%) declined. The most frequent questions to prompt a consult were a desire to better understand nutrition for recovery (41.5%) and regularly skipping at least one meal a day (29.8%). Inter-question responses were often significantly related, especially regarding appetite changes, weight changes, and/or meal-skipping. While consult acceptance was not significantly different between sex/age, males were more likely to report a desire to better understand nutrition (p = 0.004) and a weight change (p = 0.019), and females were more likely to report struggling with dizziness/fatigue (p < 0.001). Additionally, older athletes reported an appetite change (p = 0.022), meal-skipping (p = 0.002), a desire to better understand nutrition (p < 0.001), a weight change (p < 0.001), and an effort/recommendation to change their body composition/weight (p = 0.005). These findings demonstrate a link between risky nutrition behaviors and physical detriments.

Serum Iron Levels, Dietary Iron Intake, and Supplement Use in Relation to Metabolic Syndrome in Adolescents: A Cross-Sectional Study

The objective of this study was to investigate the potential associations between serum iron levels, dietary iron intake, and iron supplementation, and the prevalence of metabolic syndrome (MetS) in adolescents A cross-sectional analysis was conducted, utilizing data from adolescents participating in the 2003-2018 cycle of the National Health and Nutrition Examination Survey (NHANES). Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) pertaining to serum iron, dietary iron, and iron supplementation were derived through multivariate logistic regression models. Additionally, a restricted cubic spline (RCS) regression model was applied to explore the nonlinear relationship between dietary iron and serum iron concerning MetS. The study encompassed 4858 American adolescents aged 12 to 19, among whom 413 (8.5%) manifested MetS. The study cohort exhibited an average age of 15.52 years, comprising 2551 males (52.51%) and 2307 females (47.49%). Relative to individuals in the lowest serum iron quartile, those in the highest quartile for serum iron (OR = 0.33, 95% CI 0.21-0.50), the highest quartile for dietary iron (OR = 0.53, 95% CI 0.32-0.89), and those utilizing iron supplements (OR = 0.61, 95% CI 0.37-0.99) evinced a diminished prevalence of MetS, even post adjustment for potential confounding variables. A non-linear relationship was discerned between serum iron and MetS, exhibiting a statistically significant negative correlation when serum iron concentrations exceeded the inflection point (serum iron = 8.66 µmol/L, P for nonlinear < 0.001). This investigation reveals that higher levels of serum iron, increased dietary iron intake, and the use of iron supplements are linked to a lower prevalence of MetS in US adolescents. These findings suggest that dietary modifications could play a role in promoting the health of adolescents.

The impact of smartphone app-based interventions on adolescents' dietary intake: a systematic review and evaluation of equity factor reporting in intervention studies

CONTEXT

Adolescence is a critical stage for improving nutrition. The popularity of smartphones makes them an ideal platform for administering interventions to adolescents. A systematic review has yet to assess the impact of smartphone app-based interventions exclusively on adolescents' dietary intake. Furthermore, despite the impact of equity factors on dietary intake and the claim for mobile health of increased accessibility, there is minimal research on the reporting of equity factors in the evaluation of smartphone app-based nutrition-intervention research.

OBJECTIVES

This systematic review examines the effectiveness of smartphone app-based interventions on adolescents' dietary intake and the frequency with which equity factors and statistical analyses specific to equity factors are reported in these intervention studies.

DATA SOURCES

Databases (ie, Scopus, CINAHL, EMBASE, MEDLINE, PsycINFO, ERIC, and Cochrane Central Register for Randomized Control Trials) were searched for studies published from January 2008 to October 2022. Smartphone app-based intervention studies that were nutrition focused, evaluated at least 1 dietary intake variable, and included participants with a mean age between 10 and 19 years were included. All geographic locations were included.

DATA EXTRACTION AND ANALYSIS

Study characteristics, intervention results, and reported equity factors were extracted. Because of the heterogeneity of dietary outcomes, findings were reported as a narrative synthesis.

CONCLUSION

In total, 3087 studies were retrieved, 14 of which met the inclusion criteria. Eleven studies reported a statistically significant improvement in at least 1 dietary outcome because of the intervention. Reporting of at least 1 equity factor across articles' Introduction, Methods, Results, and Discussion sections was minimal (n = 5), and statistical analyses specific to equity factors were rare, occurring in only 4 of the 14 included studies. Future interventions should include a measurement of intervention adherence and report the impact of equity factors on the effectiveness and applicability of interventions for equity-deserving groups.

Media use, dietary intake, and diet quality of adolescents in Saudi Arabia

BACKGROUND

Excessive media use can affect diet of adolescents, but relevant data in Saudi Arabia are lacking. The present study aimed to explore the association between media use, dietary intake, and diet quality among adolescents.

METHODS

This cross-sectional study included data of 631 adolescents (ages 11-18 years) who were randomly recruited from 16 schools located in two main cities in the Western region of Saudi Arabia (Madinah and Jeddah). Envelopes including a questionnaire were sent home to collect sociodemographic data. Students then completed the short-form food frequency questionnaire to assess diet quality. Data on media use, anthropometrics, and 24-h dietary recalls were also collected.

RESULTS

A high proportion of adolescents (86.2%) exceeded media use recommendations of ≤2 h per day. Significantly higher proportions of younger adolescents, males, and non-Saudis reported media use within the recommendation compared to their peers. Media use predicted lower diet quality score (B = -0.67 [95% CI: -1.09 to -0.28]) and lower intake of calcium, zinc, vitamin D, and vitamin C (B = -104 [95% CI: -203 to -5.24], B = -2.13 [95% CI: -4.15 to -0.11], B = -23.5 [95% CI: -41.3 to -5.65], B = -24.0 [95% CI: -45.1 to -2.96], respectively).

CONCLUSION

Interventions to limit media use are urgently needed for adolescents in Saudi Arabia to improve diet quality and overall nutritional health.

IMPACT

Excessive media use can affect diet of adolescents, but relevant data are lacking in Saudi Arabia. The majority of adolescents exceed the recommendations for media use. Media use was negatively associated with diet quality and intake of calcium, zinc, vitamin D, and vitamin C. This study will inform public health entities and policy makers to draw evidence-based, culturally tailored recommendations and develop nutrition interventions to enhance diet quality and nutritional status of adolescents. Findings of this study highlight the urgency to develop intervention programs and policies that aim to limit media use among adolescents.

Associations of a metal mixture with iron status in U.S. adolescents: Evidence from the National Health and Nutrition Examination Survey

Iron is needed for normal development in adolescence. Exposure to individual environmental metals (e.g., lead) has been associated with altered iron status in adolescence, but little is known about the cumulative associations of multiple metals with Fe status. We used data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) to examine associations between a metal mixture (lead, manganese, cadmium, selenium) and iron status in 588 U.S. adolescents (12-17 years). We estimated cumulative and interactive associations of the metal mixture with five iron status metrics using Bayesian Kernel Machine Regression (BKMR). Higher concentrations of manganese and cadmium were associated with lower log-transformed ferritin concentrations. Interactions were observed between manganese, cadmium, and lead for ferritin and the transferrin receptor, where iron status tended to be worse at higher concentrations of all metals. These results may reflect competition between environmental metals and iron for cellular uptake. Mixed metal exposures may alter normal iron function, which has implications for adolescent development.

The Association between Milk Intake and Nutrient Intake Adequacy among Japanese Female Junior High School Students: A Cross-Sectional Study

The consumption of dairy products, including milk, may be important for improving the overall quality of a diet. The aim of this study was to examine the relationship between milk intake and nutritional adequacy among Japanese female junior high school students. The participants of this study were Japanese female junior high school students aged between 12 and 15 years. Dietary habits over the past month were assessed by a brief self-administered diet history questionnaire. The adequacy of each nutrient intake was determined based on the Dietary Reference Intakes for Japanese 2020, with two goals: the estimated average requirement for fourteen nutrients and tentative dietary goals for preventing lifestyle-related diseases for six nutrients. The participants were classified into five groups according to milk intake (Q1 (lowest) to Q5 (highest)) by quintile. The adequacy of vitamin B₂, calcium, magnesium, and potassium were higher among students with a higher milk consumption than among those with a lower milk consumption. However, the intake of saturated fatty acids was in excess among higher milk consumers. The present study suggests that milk intake was related to an adequate intake of some vitamins and minerals and an inadequate intake of saturated fatty acids among Japanese female junior high school students.

Gender differences in dietary behaviors among Japanese adolescents

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Few studies assessed a variety of adolescent dietary behaviours in Japan.

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The findings suggest that gender differences existed in dietary behaviors.

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Girls tended to adopt regular dietary behaviors as compared to boys.

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Schools support modeling and reinforcing healthy dietary behaviors.

Unhealthy dietary behaviors in adolescence are an important public health problem. Gender differences in dietary behaviors have already appeared during adolescence. However, few studies have assessed a variety of adolescent dietary behaviors in Japan. We aimed to clarify gender differences in unhealthy dietary behaviors among Japanese adolescents. The participants consisted of 84,988 participants from seventh to 12th grades. Unhealthy dietary behaviors were defined according to the National Health and Nutrition Survey. Multivariable logistic regression was used to analyze a nationally representative sample of Japanese adolescents from the 2014 to 2015 Lifestyle Survey. The effective response rate was 51.4%. The prevalence of unhealthy dietary behaviors (skipping breakfast, snacking, eating out, skipping meals, eating alone at dinner, and subjectively poor diet quality) among boys and girls was 14.2% versus 12.4%, 19.6% versus 14.1%, 10.6% versus 7.0%, 7.9% versus 5.6%, 13.3% versus 12.1%, and 12.3% versus 15.8%, respectively. Compared with boys, girls were more negatively associated with skipping breakfast [OR = 0.76 (95% CI 0.73–0.79)], snacking [OR = 0.67 (95% CI 0.65–0.70)], eating out [OR = 0.62 (95% CI 0.59–0.66)], skipping meals [OR = 0.61 (95% CI 0.58–0.65)], and eating alone at dinner [OR = 0.79 (95% CI 0.76–0.83)]. However, girls were more positively associated with subjectively poor diet quality [OR = 1.19 (95% CI 1.14.1.24)]. The findings suggest that gender differences existed in dietary behaviors. Gender differences in dietary behaviors suggest opportunities for tailoring interventions related to dietary education in schools.

Mothers' Nutrition Knowledge Is Unlikely to Be Related to Adolescents' Habitual Nutrient Intake Inadequacy in Japan: A Cross-Sectional Study of Japanese Junior High School Students

Dietary habits in adolescence persist into adulthood; thus, it is important to identify the factors that influence adolescent diet and establish a healthy diet. This study aimed to examine the association between mothers' nutrition knowledge and their children's nutrient intake inadequacy among Japanese junior high school student-mother dyads. The participants were 288 students and their mothers. Data regarding mothers' nutrition knowledge were obtained using a validated, self-administered general nutrition knowledge questionnaire for Japanese adults (JGNKQ). Participants were categorised into two groups according to the mothers' total JGNKQ scores. Adolescents' dietary habits during the preceding month were assessed using a brief self-administered diet history questionnaire. Inadequacy of each nutrient intake was assessed using the cut-point method, which showed that 14 nutrients were below "estimated average requirement (EAR)" and five nutrients were outside the range of "tentative dietary goal to prevent lifestyle-related diseases (DG)". In the habitual daily nutrient intakes and the proportion of nutrient intake inadequacy of the students, no differences were observed according to mother's nutritional knowledge level. Our findings suggest that mothers' nutrition knowledge may not be directly associated with adolescents' nutrient intake among Japanese junior high school student-mother dyads.

Peritoneal Dialysis Case Forum

The Trials and Tribulations of an Adolescent Patient with End-Stage Renal Disease

Breakfast skipping is related to inadequacy of vitamin and mineral intakes among Japanese female junior high school students: a cross-sectional study

Breakfast skipping is a public health issue which affects nutrient intake among adolescents worldwide. However, there have been few reports comparing intake and reference values to assess the deficiency of nutrient intake between breakfast consumers and skippers. Therefore, the present study aimed to examine the relationship between breakfast skipping and adequacy of total habitual nutrient intake among junior high school female students. The participants were 516 Japanese female junior high school students. Dietary habits during the preceding month were assessed using a brief self-administered diet history questionnaire. Inadequacy of each nutrient intake was assessed by the cut-point method, based on the estimated average requirement for fourteen nutrients and on dietary goal values for five nutrients. The overall nutritional inadequacy in participants was assessed by the number of consumed nutrients which did not meet the requirements as per the dietary reference intakes for Japanese, 2015 version. The participants were classified into two groups according to the frequency of breakfast eating: breakfast consumers (seven times/week) and breakfast skippers (0-6 times/week). Adequacy of vitamin A, vitamin B1, vitamin B2, vitamin C, Ca, Fe, Zn and K was higher among breakfast consumers than among skippers. Breakfast consumers had more intakes of fruits, vegetables and dairy products. Our findings suggest that breakfast skipping was related to deficiencies in vitamin and mineral intakes, and to an unfavourable dietary pattern, among Japanese female junior high school students.

Food insecurity among formerly homeless youth in supportive housing: A social-ecological analysis of a structural intervention

A growing body of research indicates that structural interventions to provide permanent supportive housing (PSH) to homeless adults within a Housing First approach can improve their health. However, research is lacking regarding the impact of PSH on youth experiencing homelessness. This article seeks to understand how PSH for youth impacts a basic health need-food security- across multiple levels of the social-ecological environment. In January of 2014, San Francisco, California opened the city's first municipally-funded PSH building exclusively designated for transition-aged youth (ages 18-24). We conducted 20 months of participant observation and in-depth interviews with 39 youth from April 2014 to December 2015. Ethnographic fieldnotes and interview transcripts were analyzed using grounded theory. We present our social-ecological assessment regarding food insecurity for formerly homeless youth in supportive housing. We found that although housing removes some major sources of food insecurity from their lives, it adds others. Many of the participating youth were frequently hungry and went without food for entire days. Mechanisms across multiple levels of the social-ecological model contribute to food insecurity. Mechanisms on the structural level include stigma, neighborhood food resources, and monthly hunger cycles. Mechanisms on the institutional level include the transition into housing and housing policies regarding kitchen use and food storage. Interpersonal level mechanisms include food sharing within social networks. Individual level mechanisms include limited cooking skills, equipment, and coping strategies to manage hunger. Although supportive housing provides shelter to youth, effective implementation of the Housing First/PSH model for youth must ensure their access to an affordable nutritious diet.

Asian herbals and aphrodisiacs used for managing ED

In the East, many herbal tonics and preparations are used to assist the aging male improve his sexual drive or ability to perform penetrative sex by increasing sexual stimulation, erectile, ejaculatory, orgasmic and other responses for sexual function and satisfaction. The herbs and tonics act as or as “pick-me-ups” and energizing tonics which help the tired and fatigued male and those with sexual asthenia. The myths and realities concerning Tongkat Ali, sea horse, cobra meat and blood, animal penises and testicles amongst many other herbs and portions for oral intake or local application used by traditional “medical” practitioners and village doctors will be discussed.

Nutritional Considerations for Performance in Young Athletes

Nutrition is an integral component to any athletes training and performance program. In adults the balance between energy intake and energy demands is crucial in training, recovery, and performance. In young athletes the demands for training and performance remain but should be a secondary focus behind the demands associated with maintaining the proper growth and maturation. Research interventions imposing significant physiological loads and diet manipulation are limited in youth due to the ethical considerations related to potential negative impacts on the growth and maturation processes associated with younger individuals. This necessary limitation results in practitioners providing nutritional guidance to young athletes to rely on exercise nutrition recommendations intended for adults. While many of the recommendations can appropriately be repurposed for the younger athlete attention needs to be taken towards the differences in metabolic needs and physiological differences.

Evidence and knowledge gaps for the association between energy drink use and high-risk behaviors among adolescents and young adults

Sales of energy drinks have increased rapidly since their introduction to the marketplace in the 1990s. Despite the health concerns raised about these beverages, which are often highly caffeinated, surprisingly little data are available to estimate the prevalence of their use. This review presents the results of secondary data analyses of a nationally representative data set of schoolchildren in the United States and reviews the available research on the association between energy drink use and risk-taking behaviors. Approximately one-third of the students surveyed were recent users of energy drinks, with substantial variation by age, sex, and race/ethnicity. Among the health and safety concerns related to energy drinks and their consumption is the possible potentiation of risk-taking behaviors. The review of available research reveals that, although there does appear to be a strong and consistent positive association between the use of energy drinks and risk-taking behavior, all but one of the available studies used cross-sectional designs, thereby limiting the ability to make inferences about the temporal nature of the association. Thus, more research is needed to understand the nature of this association and how energy drinks, particularly those containing caffeine, might impact adolescent health and safety, especially given the high prevalence of their use among youth.

Knowledge, attitudes and behaviour regarding nutrition and dietary intake of seventh-grade students in rural areas of Mi Yun County, Beijing, China

OBJECTIVES

To investigate the knowledge, attitudes and behaviour of seventh-grade students regarding nutrition and dietary intake, to collect data that would facilitate the design and implementation of interventions aimed at promoting good nutrition in adolescents via the school and to contribute to the improvement of adolescents' health in rural regions.

METHODS

This was a descriptive, cross-sectional study in which a 27-item, self-administered, structured questionnaire, designed in Chinese, was administered to seventh-grade students attending one of three rural middle schools, chosen randomly from 15 middle schools, in Mi Yun County, Beijing.

RESULTS

In terms of nutrition knowledge, 84.5 % of respondents had scores of between 3 and 7. Based on our analysis of the completed questionnaires, during the 7 days preceding completion of the questionnaire 43.6 % of respondents had eaten fresh fruit at least once per day, 71.3 % had eaten vegetables at least once per day, 22.3 % had consumed at least one glass of milk (or soy milk or yogurt) each day and 68.6 % had eaten breakfast every day. In total, 95.2 % of respondents thought nutrition was very important or important to their health, and 94.2 % thought it was very important or important to develop healthy dietary habits. Of the respondents, 52.7 % thought good food quality was the most important aspect of nutrition and dietary intake and 62.2 % thought food safety was the most important aspect.

CONCLUSIONS

Based on the results of our survey we suggest their should be continuous efforts to teach adolescents in rural areas of China about various aspects of good nutrition, to encourage diversity in their choice of breakfasts, to guarantee food safety and to improve food quality.

Eating Behaviours and Body Weight Concerns among Adolescent Girls

This paper presents a global review of research done on adolescent eating behaviours and food choices and the probable factors underlying it. Worldwide adolescent girls tend to develop moderate to high level of disordered eating behaviour as a result of their excessive concern with body weight or obsession with thinness. The objective of the review is to understand the concerns over body weight and the current eating patterns of adolescent girls in the developed and developing countries.

Zinc status and its association with the health of adolescents: a review of studies in India

BACKGROUND

Zinc is important in adolescence because of its role in growth and sexual maturation. Adolescents from developing countries such as India may be at high risk of zinc deficiency because of unwholesome food habits and poor bioavailability of zinc from plant-based diets.

OBJECTIVE

(1) to study zinc status and its association with profile of other micronutrients, (2) to construct a simple tool in the form of Adolescent Micronutrient Quality Index (AMQI) to assess quality of diets of the girls and (3) to examine the effect of zinc supplement on health of adolescent girls.

METHODS

Girls (10-16 years) from two secondary schools of Pune, Maharashtra state, in Western India were enrolled in a cross-sectional study (n = 630). Data were collected on dietary intake, cognitive performance, taste acuity, haemoglobin, erythrocyte zinc and plasma levels of zinc, vitamin C, β-carotene and retinol. AMQI was developed using age-sex-specific Indian dietary guidelines and healthy foods and habits described in the recent US dietary guidelines. Zinc-rich recipes were developed considering habitual diets of the girls and vegetarian sources of zinc. An intervention trial (n = 180) was conducted to assess the effect of zinc-rich dietary supplements and ayurvedic zinc (Jasad) supplementation.

RESULTS

Prevalence of micronutrient deficiencies was high in these girls. Poor cognitive performance was seen in half of the girls, and salt taste perception was affected in 45%. AMQI was correlated with nutrient intakes and blood micronutrient levels (p < 0.01), indicating the potential of AMQI to measure micronutrient quality of diets of adolescent girls. Results of the intervention trial indicated that supplementation of zinc-rich recipes vis-a-vis ayurvedic Jasad zinc has the potential to improve plasma zinc status, cognitive performance and taste acuity in adolescent girls.

CONCLUSIONS

Review of the studies on Indian adolescent girls demonstrates the necessity of adopting zinc and micronutrient-rich diets for positive health building in adolescents.

Moving beyond the stigma: systematic review of video games and their potential to combat obesity

Increasing epidemic proportions of overweight children in the United States presents formidable challenges for education and healthcare. Given the popularity and pervasiveness of video gaming culture in North American children, the perfect opportunity arises to investigate the potential of video games to promote healthful behaviour. Our objective was to systematically review the literature for possible benefits of active and educational video games targeting diet and physical activity in children. A review of English-language journal articles from 1998 to 2011 using EMBASE and PubMed was conducted. Thirty-four studies concerned with children, video games, physical, and/or nutritional outcomes were included. Results of these studies that showed some benefit (increased physical activity and nutritional knowledge as a result of gaming) demonstrate the possibility of video games to combat childhood obesity—looking beyond the stigma attached to gaming.

Assessing the nutritional status of Palestinian adolescents from East Jerusalem: a school-based study 2002-03

In Palestine, there is a little information about nutrition of adolescents compared to other age groups. This study was designed to assess the nutritional status of Palestinian school-aged children (11-16 years) in East Jerusalem during 2002-03. A school-based cross-sectional study targeted randomly 313 adolescents from public and private schools. A previously validated and reliable questionnaire was administered through interviews that included anthropometric and hemoglobin measurements, 24-h dietary intake recall and physical activity questionnaire. It was found that being overweight (24.3%) or obese (9.9%) coexisted with being underweight (4.8%) and/or anemic (23.3%). Only 22.4% of the study subject had physical activity for ≥5 days a week with boys being more physically active than girls (p < 0.01). Inadequate energy intake had 55.66% of boys and 64.81% of girls; inadequate protein intake was reported by 15.07% of boys and 43.08% of girls. The majority of them met <80% of the recommended daily allowances for most micronutrients. The whole sample and especially boys consumed more total, saturated fat, less monounsaturated fat and carbohydrates than what is advised. Obese and overweight adolescents had lower energy intake (p < 0.05) and a lower trend in being physically active than normal weight counterparts. School health education programs targeted at adolescents and parents need to be developed as part of overweight-obesity, malnutrition and anemia prevention.

Poor diet quality and food habits are related to impaired nutritional status in 13- to 18-year-old adolescents in Jeddah

In recent decades, diets have changed rapidly in the Kingdom of Saudi Arabia (KSA) because the Western diet is replacing the traditional Arabic diet. This has resulted in an alarming increase in the number of overweight and obese children and adolescents in KSA. It is well documented that lifestyle is strongly associated with the development of obesity. Nevertheless, this remains to be demonstrated in adolescents from a rapidly developing country in the Middle East such as Saudi Arabia. This study tested the hypothesis that the new current dietary habits are related to the increase in overweight and obese Saudi Arabian adolescents. In 2006, a cross-sectional study was conducted among 239 adolescents (13-18 years old) who were selected by cluster sampling from schools in Jeddah, KSA. The nutritional status was assessed by anthropometric and biochemical parameters at the Saudi German Hospitals Group, Jeddah. Dietary habits were evaluated by a 3-day dietary recall (food diary) and a food frequency questionnaire. The mean age of the participants was 15.5 ± 2.5 years. The mean body mass index was 27.43 ± 4.61 kg/m(2). A total of 44.6% of the adolescents were overweight, and 56.6%, 30.5%, and 13.0% of energy was derived from carbohydrates, fats, and proteins, respectively. Compared with the Dietary Reference Intake, carbohydrate and fat intakes were higher, and calcium, iron, and zinc intakes were lower. Higher cholesterol and lower hemoglobin levels were found in 30.5% and 53.6% of the adolescents, respectively. In summary, increased weight status of 13- to 18-year-old Saudi adolescents was related to their inadequate dietary habits. This indicates the importance of rapidly promoting a healthier lifestyle among Saudi Arabian adolescents.

Self-control, diet concerns and eater prototypes influence fatty foods consumption of adolescents in three countries

As adolescent overweight has become a widespread problem in the developed world, it is timely to understand commonalities underlying dietary practices across countries. This study examines whether consumption of fruits and vegetables and fatty foods among adolescents in different countries is related to the same individual difference and social influence factors-in particular, adolescents' self-control, diet concerns and perceptions of typical (un)healthy eating peers (prototypes). We included 511 normal weight and overweight adolescents (14-19 years) from the United States, the Netherlands and Hungary, who completed a survey during class hours. After controlling for country and demographics, an additional 8% of the variance in the consumption of fatty foods was explained by self-control, diet concerns and prototypes of unhealthy eaters. Only 3% of fruit and vegetable consumption was explained by these factors, and only the association with self-control was significant. This study demonstrates that the same individual difference and social influence factors may influence adolescents' dietary practices in different countries. In addition to highlighting country differences in dietary practices and the prevalence of overweight, exploring common factors that may shape dietary practices across countries is important for future research. These commonalities may advance conceptual understanding and inform prevention across developed countries.

Nutritional deficiencies in children on restricted diets

Pediatric nutritional deficiencies are associated not only with poverty and developing countries, but also in children in the developed world who adhere to restricted diets. At times, these diets are medically necessary, such as the gluten-free diet for management of celiac disease or exclusion diets in children with food allergies. At other times, the diets are self-selected by children with behavioral disorders, or parent-selected because of nutrition misinformation, cultural preferences, alternative nutrition therapies, or misconceptions regarding food tolerance. Health care providers must be vigilant in monitoring both growth and feeding patterns to identify inappropriate dietary changes that may result in nutritional deficiencies.

Cool and independent or foolish and undisciplined? Adolescents' prototypes of (un)healthy eaters and their association with eating behaviour

PURPOSE

The Prototype/Willingness model states that adolescents' willingness to engage in health-related behaviours is determined by the favourability of prototypes of persons engaging in this behaviour. The objective of the present study is to systematically investigate the content and evaluation of adolescents' prototypes of (un)healthy eaters and examine their associations with eating behaviour.

METHODS

Four studies (including a pilot study) were conducted that addressed the salience (N=79), the characteristics (N=287), and the evaluation (N=167) of eater prototypes, and their association with eating behaviour (N=97), respectively.

RESULTS

These studies revealed that (1) adolescents hold salient and distinct images of typical (un)healthy eaters; (2) the healthy eater prototype mostly consists of positive traits whereas the unhealthy eater prototype reflects mostly negative traits; (3) eater-specific prototypes are distinct from generic risk prototypes and unrelated to age, bodyweight, and social desirability; and (4) unhealthy eater prototypes are significantly associated with unhealthy eating behaviour.

CONCLUSION

Adolescents hold relatively unfavourable social images of unhealthy eaters and relatively favourable images of healthy eaters. Only unhealthy eater prototypes are associated with actual food consumption, suggesting that addressing unhealthy eater prototypes may be an important and novel ingredient of interventions aimed at changing adolescents' unhealthy eating habits.

Sociodemographic correlates of food habits among school adolescents (12-15 year) in North Gaza Strip

BACKGROUND

There is little information about meal patterns and food consumption of adolescents in Palestine. The objective of this study was to describe the association between sociodemographic factors and food intake, and meal patterns among Palestinian school adolescents (12-15 year) in North Gaza Strip.

METHODS

A cross-sectional study was conducted in 2002 comprising 944 subjects in 10 schools in Gaza city, Jabalia village and Jabalia refugee camp. Self-administered questionnaires were filled in by students and parents to obtain data on frequency of meals, food intake and sociodemographic characteristics.

RESULTS

High household socioeconomic status (SES) was associated with the increased number of meals and the increased intakes of many nutritious foods such as; animal food items, fruits and vegetables and dairy foods. The percentage of adolescents having breakfast daily of high and low SES was 74.5% vs 55% in boys and 65.6% vs 45% in girls. The percentage of girls with refugee status who had lunch was higher (90.2%) compared to the local citizen girls (83.9%), (p = 0.03). Girls were less likely to skip daily lunch (OR = 0.55, 95% CI = 0.36-0.87, p = 0.01) compared to boys. Risk of skipping lunch was three times higher among adolescents living in the village compared to Gaza well-off area (OR = 3.3, 95% CI = 1.72-6.31, p < 0.001). Adolescents who were having lunch daily were less likely to skip breakfast or dinner. Only 11.6% of boys and 16.2% of girls consumed fruits daily. In multivariate analysis, SES was positively associated with food frequency intake scores in both genders. Boys from the refugee camp and the village had a significant higher consumption of fruits and vegetables than boys from high and low income area in Gaza City, while it was the opposite in girls.

CONCLUSION

Meal skipping is common, particularly among those of low SES and the intakes of many nutritious foods such as animal food items, fruits and vegetables and dairy foods seem to be low among adolescents of low SES. The results of this study could be used as an important base-line for future monitoring of the nutritional situation of adolescents.

The relationship between BMI and iron status in iron-deficient adolescent Iranian girls

Objective

Many Iranian adolescent girls are Fe-deficient, but it is unclear whether Fe deficiency is associated with other nutritional risk indicators. The present study aimed to investigate the association between Fe deficiency and weight status (measured as BMI) among a representative sample of adolescent girls.

Design

A cross-sectional study. Fe-deficient high-school girls (with or without anaemia) were selected by systematic random sampling among all students in grades 1 to 4 from high schools for girls. Blood samples were collected and analysed for Hb, haematocrit, serum ferritin, Fe and total Fe binding capacity. Weight and height were measured. BMI was calculated and compared with age- and gender-specific BMI reference values.

Setting

South Iran.

Subjects

A total of 431 adolescent girls aged 13–20 years.

Results

Some 15·3 % of the participants were at risk for overweight and 9·5 % of them were overweight. An inverse association was found between serum ferritin and BMI (r = −0·38, β = −0·21, P < 0·001). Anaemia was more prevalent among overweight Fe-deficient adolescents than among those Fe-deficient and at risk for overweight or normal weight (34·1 % v. 28·8 % v. 27·8 %, respectively; P < 0·001).

Conclusions

An inverse association was found between BMI and serum ferritin. Overweight adolescents demonstrated an increased prevalence of Fe-deficiency anaemia. It seems that both abnormalities of weight and Fe status should simultaneously be targeted in overweight female adolescents.

Nutritional status in pregnant adolescents: a systematic review of biochemical markers

Adolescent pregnancy is a major public health challenge for many industrialized countries and is associated with significant medical, nutritional, social and economic risk for mothers and their infants. Despite this, relatively little is known about the nutritional status of this population. The aim of this paper was to conduct a systematic review of the current evidence relating to the biochemical markers of nutritional status of pregnant adolescents living in industrialized countries. Six papers were identified that fulfilled the inclusion criteria, the majority of which were conducted in the United States. The studies were of variable quality and most failed to control for potential confounders which may have strongly influenced the findings. Due to limited research, conclusions cannot be drawn about the zinc and calcium status of pregnant adolescents, and data on folate and vitamin B(12) status appeared conflicting. There was some consensus among studies, however, to suggest that indicators of anaemia and iron status were compromised in pregnant adolescents, particularly during the third trimester of pregnancy. Chronological age did not appear to influence nutritional status, although there was some evidence to suggest that increasing gynaecologic age may positively influence plasma ferritin levels. Current research is limited by sampling and measurement bias, and research is urgently required to address these limitations. Further consideration should also be made of the influence of the role of socio-economic support on pregnant adolescents' nutritional status. The achievement of improved nutrition in pregnancy among adolescents requires multidisciplinary collaborations of adolescent healthcare providers, academics, professional organizations, policymakers, industry and service users. Only once this is achieved can adolescent nutrition, and adolescent nutrition in pregnancy, be significantly and sustainably optimized.

A systematic review of dietary assessments of pregnant adolescents in industrialised countries

Adolescent pregnancy is a major public health challenge for many industrialised countries and is associated with significant medical, nutritional, social and economic risk for mothers and their infants. Despite this, relatively little is known about the nutrient intakes of adolescents during pregnancy. The aim of this study is to review the current evidence relating to the dietary assessment of pregnant adolescents living in industrialised countries. Nine papers were identified that fulfilled the inclusion criteria, seven of which were conducted in the USA. Mean nutrient intakes were compared with the most recent US dietary reference intakes (DRI) for pregnant adolescents. Despite the poor quality of the majority of studies, there appeared to be some consensus to suggest that the nutrient intakes of pregnant adolescents were below the DRI for energy, iron, folate, calcium, vitamin E and magnesium, nutrients which are recognised to be vital for fetal growth and development during pregnancy. Modest differences were observed in nutrient intake between trimesters and age groups. Current research is limited by sampling and measurement bias, and research is urgently required to address these limitations. Further consideration should also be made of the influence of age and of role of socio-economic support on pregnant adolescents' nutrient intake. The achievement of improved nutrition in pregnancy among adolescents requires multidisciplinary collaborations of adolescent health care providers, academics, professional organisations, policy makers, industry and service users. Only once this is achieved can adolescent nutrition, and adolescent nutrition in pregnancy, be significantly and sustainably optimised.

Interaction between maternal smoking and malnutrition in infant risk of gastroschisis

BACKGROUND

Gastroschisis is a severe birth defect characterized by a tear in the infant's abdominal wall. Young mothers have the highest risk of having an infant with gastroschisis. In an animal model, the defect resulted from exposure of pregnant mice to carbon monoxide (CO) in combination with a low protein and low zinc diet.

METHODS

We evaluated this model in a study of 55 infants with gastroschisis and 94 age-matched controls that included maternal interview with a food frequency questionnaire. Smoking cigarettes (> or = 1 pack/day) or marijuana (more than once) 3 months prior to pregnancy indicated CO exposure. Low protein or zinc intake and a low body mass index (BMI) indicated maternal malnutrition.

RESULTS

When assessed separately, high CO, low protein, low zinc, and low BMI were each significantly associated with an increased risk of gastroschisis. Although we observed significant CO-BMI and CO-zinc interactions after adjusting for income, only a combination of high CO exposure and low BMI yielded a synergistic adverse effect. Compared to the low risk of having an infant with gastroschisis for mothers who did not have low BMI and did not smoke, the risk of having an infant with gastroschisis was 16.3 times (95% CI, 2.49-113.4) higher for mothers who did not have low BMI but smoked, and 19.7 times (95% CI, 4.33-89.6) higher for mothers who did not smoke but had low BMI. However, the risk was 26.5 times (95% CI, 7.85-89.4) higher for mothers who had low BMI and smoked.

CONCLUSIONS

Our results suggest that young mothers are at increased risk of having an infant with gastroschisis if they smoke and are also malnourished.

Barriers that influence eating behaviors in adolescents

Adolescence is a time of rapid growth and development with biologic, psychological, and emotional changes occurring simultaneously. We conducted a critical review of the literature to analyze key topics in the study of adolescents' eating behaviors and to identify barriers to healthy eating experienced by adolescents. The literature documents that nutritional deficits and poor eating established during adolescence have long-term health, growth, and developmental consequences. Gaps in the literature are identified and recommendations for future studies are proposed.

Association between vegetarian diet and menstrual problems in young women: a case presentation and brief review

In the last twenty years, several studies have suggested the existence of an association between vegan diets and adolescent menstrual disorders. We share our experience with this problem and a review of the literature on the subject. We conclude that despite the existence of some evidence to the possible association between vegetarian diet and menstrual disorders, it is still not clear if this association is due solely to the vegetarian diet or due to the overall inadequate nutrition with decreased proportions of fat and protein in the diet. We believe that more prospective, well controlled studies are needed to truly explain this association.

International trends in adolescent nutrition

This paper addresses international trends in adolescent nutrition by reviewing the literature from English-language indexed journals and online sources from around the world. Information is presented by geographic region and by nation within region. The literature shows that malnutrition remains a significant problem for adolescents, worldwide, but that the types of nutritional problems impacting this group have changed significantly over the past two decades. While undernutrition and wasting are reported, these conditions, as well as growth stunting, seem to be on the decline. In developed countries, social pressures to achieve a distorted body image are creating a malnutrition of affluence among some groups of adolescents. There appears to be an increasing prevalence of obesity among adolescents worldwide, explained by widespread nutrition transitions to lipid-rich diets and a decrease in physical activity, especially among urban adolescents. These trends are of international importance as they imply the world will see a shift towards longer life spans for this adolescent cohort, with a concomitant increase in the prevalence of chronic diseases as it ages. The epidemiologic transition that will result may be a mixed blessing. It is likely to produce a larger and healthier international workforce, but it also has the potential of becoming a serious burden as demands for health care and support services for those with chronic diseases increase. To prevent inordinate health care demands on the international economy in the future, dietary recommendations with nutritional education programs that are culturally appropriate need to become national priorities.

Update of nutrition guidelines for the teen: trends and concerns

Sociocultural influences are known to affect adolescent eating patterns and behaviors. Some teens reject a meat-based diet to become vegetarians; others take up dieting to lose weight or develop an eating disorder. Teens require increased nutrients to provide for the accelerated growth that takes place during these years. Nutritional deficiencies in adolescence can lead to loss of height, osteoporosis, and delayed sexual maturation. Sports also play an important role in many teens' lives. The desire to excel can lead to increased training and prolonged periods of dieting. Disordered eating, amenorrhea, and osteoporosis describe the "female athlete triad." Although more frequently seen in girls, boys who participate in sports that have an emphasis on size and weight such as wrestling and body building are also at risk for subclinical eating disorders. This paper discusses issues surrounding restrictive and nonrestrictive food patterns of adolescents and their nutritional consequences.