Nutrition Management of the Adolescent

NUTRITION MANAGEMENT OF THE ADOLESCENT

Description
The Regular Diet for the Adolescent (11 to 19 years of age) includes a wide variety of foods to promote normal growth and development during puberty and to maintain a good nutritional status for health and disease prevention after the physiological growth has occurred. Foods are provided based on the Dietary Guidelines for Americans, the American Heart Association, the American Cancer Association, and the National Cholesterol Education Program (1-2).

Indications
The diet is served when specific dietary modifications are not therapeutically required.

Nutritional Adequacy
The Diet for the Adolescent is adequate to meet the Dietary Reference Intakes (DRIs) for the specific age as outlined in the Statement on Nutritional Adequacy,provided that a variety of foods is consumed. Energy and protein requirements vary with the adolescent’s age, sex, stage of growth, and physical activity. Special attention may be required to ensure adequate intake of iron, zinc, and calcium.

How to Order the Diet
Order as “Regular Diet” or “Regular Diet for Age ______.” The age of the patient will be taken into consideration in implementing the diet order. Any specific instructions should be indicated.

Planning the Diet
Energy needs vary with the sex, stage of growth, and physical activity of the adolescent. See Estimated Energy Requirement (EER) for Male and Females Under 30 Years of Age. An initial estimate for energy that relates more closely to physiological age can be obtained by calculating kilocalories divided by height in centimeters (3). This is determined by dividing the DRI for energy for the child’s age and sex by the reference height (listed on the Estimated Energy Requirement (EER) for Male and Females Under 30 Years of Age table and then multiplying kilocalories per centimeter by the adolescent’s height (4). If the height is unavailable or cannot be measured accurately, the DRI for the kilocalories per day may be used (4). Therefore, periodic adjustments in energy intake may be necessary to maintain an appropriate weight for height.

Protein needs for adolescents also relate more to the physiological age than chronological age. The RDA for protein is 0.95 g/kg weight for ages 11-13 then decreases slightly to 0.85 g/kg/day at the age of 14 to 18. Adequate intake ranges from 34 g/day (9 to 13 years) to 52 g/day (14 to 18 years) (4). See Dietary Reference Intake Values for Protein by Life Stage Group.

Girls generally begin puberty around 10 to 12 years of age and boys begin between 11 and 13 years of age. Likewise, girls usually have a peak height velocity around age 12 and boys around age 14. Young men often achieve an adult height greater than young women do because boys grow prepubertally 2 years more than girls do and have a longer period of growth once puberty starts. Girls generally stop growth at 16 years of age and boys at 18 years of age.

During puberty, body composition changes. Boys double their lean body mass between 10 and 17 years of age and maintain about 12% body fat by late puberty. Girls gain more fat during puberty and usually have 23% body fat by late puberty.

Vitamins and mineral needs increase as the adolescent grows. Calcium, iron, and zinc are particularly important for growth, and dietary intake is frequently inadequate. Careful food selection is required to meet the DRIs. Accepting changes that will improve nutrient intake seems to be most successful when the change is related to physical development, appearance, and sports performance.

The DRI for calcium is 1,300 mg for both sexes between the ages of 9 and 18 years (5). The accelerated skeletal and muscular development during adolescence makes this stage of life a critical time for bone growth and deposition of calcium.

The DRI for iron 14- to 18-year-olds is 11 mg/day for males and 15 mg/day for females (4). The need for iron increases during puberty with the increase in muscle mass and blood volume.

The RDA for zinc for males and females 14 to 18 years is 11 mg/day and 9 mg/day, respectively (4). Zinc is especially important during adolescence because of its role in growth and sexual maturation.

Recommendations from the Dietary Guidelines, the American Heart Association, the American Cancer Association, and the National Cholesterol Education Program should be applied for healthy adolescents. Refer to the Regular Diet-Adult for recommendations and guidelines.

See:
REGULAR DIET IN PREGNANCY AND LACTATION
See:
OBESITY AND WEIGHT MANAGEMENT

References

Dietary Guidelines for Americans 2005. Available at: www.healthierus.gov/dietaryguidelines on January 31, 2005.
National Cholesterol Education Program. Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Washington, DC: US Dept of Health and Human Services; 1991. NIH publication 91-2732.
Nutrition Management of the Adolescent. Pediatric Manual of Clinical Dietetics. 2nd ed. Chicago Ill: The American Dietetic Association; 2003.
Institute of Medicine’s Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (Macronutrients), Washington, DC, National Academy of Science, 2002.
Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press; 1997.