Jane M. Rees

Eating disorders in adolescents: A background paper

Although eating disorders primarily affect adolescents and young adults, much of the recent medical and psychiatric literature fails to consider the unique physiologic, psychologic, and developmental issues relevant to younger patients, more often describing older patients with more chronic and intractable disease. Pediatricians and adolescent medicine specialists see younger patients who have a shorter duration of illness and a different set of physiologic and psychologic responses to weight control. The Practice Guidelines for Eating Disorders, published in 1993 by the American Psychiatric Association (1), provide an excellent overview of the

Prenatal weight gain and postpartum weight loss patterns in adolescents

The standard weight gain curve for pregnant females is used for all ages but its suitability for pregnant adolescents has not been satisfactorily examined. The purpose of this project was to compare prenatal weight gain patterns of 80 adolescents (13-17 yr old) with those of the standard curve. Girls who were chronologically and physiologically younger tended to gain less weight prenatally then older girls. Girls who were underweight prior to pregnancy gained more weight prenatally than other girls. Term weight gain averaged 37 lb. Increase in height was not recorded during the course of the investigation. The development of standard curves for adolescents must be based on a larger study population, but the curves presented here are an important initial step toward achieving this goal.

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

Adolescent nutritional problems are common in the U.S.A. (1,2) and throughout the world (3,4). Some young people lack adequate food (3,4) and others make poor food choices (5,6). Conflicting media messages confuse and overwhelm modern adolescents, while rapidly changing lifestyles interfere with family centered eating patterns (6). Growth and development (7) as well as life long health (8–10) 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 (11–13). 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 (7). 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 (3). All body tissues are susceptible to inadequate nourishment. For example, normal bone strength may never be attained if adolescents are malnourished (8). Brain structure may be altered, and unless the situation is rapidly reversed, short term damage may extend to severely undermine adult health (10). 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 (10,12). 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 (2). The reproductive system, general physical abilities, selfesteem and social life are often adversely affected by long term over-fat conditions (14). 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 (13). Childbearing adolescents need to adequately nourish themselves and their developing offspring without overeating foods rich in sugar and fat (11,15). 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 (16). 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 (1,2,9,14,15,17–19). Thus, understanding and promoting nutritional health during adolescence warrants renewed attention, followed by the allocation of resources for nutritional advocacy, training, research, and care (1,6,20,21). As an organization devoted to improving the total health of adolescents, the Society for Adolescent Medicine supports the following goals:

Iron Fortification of Infant Foods A Decade of Change

A survey of iron-fortified commercial foods commonly marketed for consumption by infants was conducted in 1972 and again in 1982. Positive changes had occurred in infant formulas and cereals during that decade, in availability of fortifying iron, level of fortification, and label infor mation. Miscellaneous iron-containing products, cookies, and crackers were unreliable sources of dietary iron in both 1972 and 1982. Availability of fortifying iron in regular cereals had improved by 1982, though 10 percent lacked the label information. Fortified infant formulas and cereals contribute iron of high bioavailability to the typical infant diet in amounts equal to the USRDA. Food manufacturers need to continue to apply knowledge gained through research to sustain the lessened but still highly prevalent incidence of anemia in 1-2-year old children.

Overview: nutrition for pregnant and childbearing adolescents.

Studies have described maternal adaptation to support fetal development at various levels of nutritional status. However the usual conservation and control of energy by the pregnant mother is compromised during adolescent pregnancy when both the mother and the fetus are growing. Maternal growth may have biological consequences similar to starvation with a negative effect upon fetal growth. Research is needed to describe the metabolic response to gestation during various phases of adolescent physical development and how to best nourish both the adolescent mother and her fetus. Epidemiological findings indicate that the goal for birth weight leading to optimal infant survival is the same whether mothers are adolescent or adult. However new results show that young pregnant females gained more weight than older adolescents or adults to produce the same-weight infants. Major points raised at the final session of the Adolescent Nutritional Disorders: Prevention and Treatment conference held December 1995 under the auspices of the New York Academy of Science are summarized. Participants focused upon the biological interaction of the reproductive process with pubertal development complicated by risky patterns of eating developing overweight or idealizing thinness.

Nutrition for Pregnant and Childbearing Adolescents: Demographics, Developmental Needs, Behavior, and Outcome

There are approximately 1 million pregnancies each year among US adolescents and about half of these teens opt to continue their pregnancies. The birth rate for US adolescents 15-19 years of age probably plateaued during 1991-93 at 60/1000. There were increases however among younger adolescents (15-16 years old) and Hispanic teens. Moreover since contraceptive use is declining among adolescents this plateau is considered to largely reflect the temporary stabilization in the percentage of the sexually active population. Compared to older mothers. adolescents have markedly higher rates of late prenatal care preterm births and low birth weight. Anemia lung disease eclampsia and renal disease are also highest among mothers in the adolescent age group. Significant socioemotional adaptive and intelligence quotient deficits occur in children of adolescent mothers; 1 study classified 72% of these children as developmentally delayed by 3 years of age. This delay in large part reflects the failure of adolescent mothers to complete their own identity development and problems with attachment. In need of further research are the nutritional behaviors of pregnant adolescents and their interaction with the physiologic processes of pregnancy and puberty. A meta-analysis of 25 intervention studies concluded there was no significant program impact on initiation of sexual intercourse birth control use responsible sexual behavior and conception.

Neonatal Mortality among High Birth Weight Infants Born to African American Adolescent Mothers

Neonatal Mortality among High Birth Weight Infants Born to African American Adolescent Mothers

GESTATIONAL WEIGHT GAIN OF AFRICAN AMERICAN ADOLESCENT MOTHERS OF FAVORABLE BIRTH WEIGHT INFANTS • 30

GESTATIONAL WEIGHT GAIN OF AFRICAN AMERICAN ADOLESCENT MOTHERS OF FAVORABLE BIRTH WEIGHT INFANTS • 30