6.2 Adolescence Flashcards
adolescence = period of rapid changes in (3) functions
- growth spurt = _____ _____ ______ = ______ nutritional needs
- gain of __% of adult height and ___% of weight
- high _________ in timing of growth spurt
- does age alone determined stage of maturity?
- best index for determining nutrient needs?
- physiological, psychological and cognitive functions –> can impact eating habits and eating reqs
- growth spurt = peak height velocity = highest nutritional needs
- gain of 20% height + 50% weight
- high variability in timing
- no!
- caloric requirements based on kcal/cm
explain height gain curve vs age, in girls bc boys
- age of puberty
- peak height velocity
- total height gain
- really rapid growth rate from 1-3 yo –> at 3, rapid drop in heigh gain –> into a steady quiescent period of growth
- then, girls have their peak height velocity at around 12 (9cm/y) vs boys are still in quiescent period (= longer period of growth) until around age 14 (10.3cm/y) peak
- then, rapid decrease and no more height gain for girls at 15 ish and 17 for boys
GIRLS: - age of puberty: 10-11 (8-14)
- peak height velocity: 9cm/y (at age 12)
- total height gain: 25 cm
BOYS: - age of puberty: 11-12 (9-15)
- peak height velocity: 10.3cm/y (at age 14)
- total height gain: 28 cm
why are boys generally higher than girls? (2)
- bc they have a higher peak velocity
- and bc they have an overall longer period of growth (since their peak height velocity is reached later
- adolescence encompasses what?
- puberty includes what?
- how is puberty progress defined?
- encompasses entirety of transformation from childhood to young adulthood
- puberty = transition period –> includes only physical changes that occur as a child attains reproductive capacity
- progress defined by sexual maturity ratings (SMRs) 1 through 5 (also called Tanner stages) –> characterizes when growth typically appears
- SMR = standards used clinically to describe what?
- based on development of what?
- sexual maturation: predictable _______, but _______ varies
- best guide for _______ and __________
- timing of growth is predictable based upon what?
- more accurate than growth charts?
- clinically to describe stage of development
- based on development of primary and secondary sexual characteristics
- sexual maturation = predictable sequence but timing varies
- best guide for growth and development
- predictable based upon sexual stage of maturation
- yes! growth charts are less accurate at puberty bc of crossing of growth channels
- what are some secondary sex characteristics used for tanner stages of development? girls vs boys?
- at what stage does peak growth velocity occurs for girls vs boys?
GIRLS:
- breast growth
- pubic hair growth
- menarche
- peak growth velocity often occurs soon after stage 2 (age range 8-15)
BOYS:
- testes growth
- penis growth
- pubic hair growth
- 20% of boys reach peak growth velocity during stage 5 (age range 13-18) (figure: between stage 4 and 5)
prepubsertal SMR1 –> adult SMR5
FEMALES:
- does sexual maturation happen before/at same time/after growth? when does growth stop?
- timing depends on what?
- menarche tends to occur when?
- at the deceleration phase of growth, later menses associated with what?
MALES:
- does sexual maturation happen before/at same time/after growth? when does growth stop?
- how do they have a greater growth spurt (3)
FEMALES:
- sexual maturation takes place earlier, then growth stops (no growth after sexual maturation) –> sexual maturation continues though
- timing depends on environmental factors –> ie lighting can impact growth (affects pineal gland + melatonin –> inhibits gonadal development and 2° sex charac (?))
- occur 1 year after breast development
- later menses associated with longer period of growth
MALES:
- growth can continue after sexual maturation has ended (most sexual maturation before peak height velocity ish) (contrary from females)
- more prolonged + more intense + occurs at a later year = longer total period of growth
- describe the external (9) and internal (6) factors that can affect lifestyle –> which affects individual food/easting behavior
- can internal factors affect external factors and vice versa?
INTERNAL:
- physiological needs and characteristics
- body image –> used as self-concept + can be distorted by environmental factors
- personal values and beliefs –> greater independence of thought can change eating habits + can integrate societal values, modified by media –> can lead to wanting to modify body shape
- food preferences and meanings
- psychosocial development
- health
EXTERNAL:
- family unit and family characteristics! –> disrupting family unit can cause rebellion or predispose to ED –> meal eating in family = protective factor against inappropriate eating behaviors
- parenting practices
- peers
- social and cultural norms and values
- mass media
- fast foods
- food fads
- nutrition knowledge
- personal experiences (alcohol, social drug use, cigarette)
*yes! ie social values and mass media can modify personal values and beliefs
what (2) influences external and internal factors that impact lifestyle/eating behaviors?
- social-economic political system
- food availability, production and distribution system
internal factors of adolescence
- multiple _________ changes (new body image) –> altered eating behavior
- ___% of females 14-18 yo have dieted (only ___% classified as obese) –> increase risk of (2)
- explain risk of weight cycling
- multiple physiological hanges
- 70% of females (15% obese)
- increase risk of nutrient deficiencies and life-long risk of weight cycling
WEIGHT CYCLING: - body uses set point to maintain body weight
- 10% drop in body weight (fat AND muscle) = 15% drop in BMR –> then change to normal diet again –> greater weight gain (mostly adipose) –> leads to overall shift of increase adipose vs lean tissue…
what are 4 factors that impact negatively adolescent’s eating behaviour?
- big eaters of fast foods: low nutrient and fiber + high sugar and sodium
- poor nutrition knowledge: 20% believe that fat should be removed altogether from diet
- personal experiences (drugs, alcohol)
- smoking
adolescents:
- ___% of cals = snacks
- big eaters of fast foods –> low (2) but high (2)
- poor nutrition knowledge –> fear of what?
- risks of smoking? (3)
- 25% cals = snacks
- fast foods = low nutrient and fiber + high sugar and sodium
- fear of fat!
- increasing incidence of smoking, especially in girls:
1. nicotine = decrease food intake and increase weight loss
2. smoking eases hunger signals (animal studies) –> increase risk of nutrient deficiencies
3. quitting associated with mean increase of 10 lbs (bc no anorexic effect of nicotine anymore)
how can family affect dietary intake during adolescence?
- prevalence ish?
- should encourage what?
*frequency of family meals associated with improved nutrient intake
- number of family meals drops off during high school
- should encourage adolescents and families to find time to incorporate family meals several times a week
what influence do peers have on nutritional status/eating behavior? (3 ish)
- minimal influence on fruit and veg intake
- stronger influence on consumption of whole grain foods, dairy products and breakfast
- snack and soft drink consumption grater when adolescent’s peers had high consumption of these items
- which meal is often skipped in adolescents? –> leads to (3)
- why skip meals?
- eating fewer meals associated with what?
- meal skipping is common, especially breakfast!
1. can cause disturbances to appetite regulation
2. may lead to overeating during subsequent meal times
3. can lead to undereating overall - to lose weight
- associated with reduction of diet quality (can lead to iron and zinc deficiency)
what are 4 ways media affect dietary intake during adolescence ish?
- no longer restricted to television and print –> social media
- more time spent on media that in school –> most children and teenagers have TV in bedrooms
- susceptible to marketing of foods high in sugar, fat and sodium impacts dietary choices
- sets unrealistic body image expectations –> must help adolescents understand that images in advertisements are manipulated
*teens integrate societal values during that time period and internalize
how can school influence dietary intake during adolescence? (2 ish)
- at least one meal per day at school
- vending machines are a concern –> increase fast foods –> most common items are soft drinks, chips and sweets
what are (physiological ish) consequences faced by food insecure adolescents? (5)
- experience increased irritability + lower grades + poorer psychosocial functioning
- have lower energy intake + decrease fruit and veg intake
how can fad diets influence dietary intake during adolescence?
- adolescents often concerned about weight loos as their bodies change
- often exposed to fat diets in media –> more often used by teenagers with lower self-esteem
- positive influences protect against unhealthy eating
- obese children vs teens –> impact of obesity on psyche?
- explain impact on teens. Vicious cycle
- obese children: no impaired socialization/long term psychological harms if they lose weight before adolescence
VS teens: obesity affects psyche much more than earlier years - poorer self worth –> greater passivity and dependency –> increase teasing and discrimination
- food = source of comfort –> vicious cycle –> greater obesity
4 ways to prevent/treat pediatric/adolescent overweight and obesity
- educate parents about risks to children –> parent targeted interventions more successful
- intensive lifestyle and diet modifications remains primary treatment
- motivational interview used to treat obesity –> strengthens personal motivation for change in atmosphere of acceptance + emphasize behavioral goals
- weight maintenance usually the goal for children 2-11 years old –> allows for decrease in BMI values
anorexia nervosa
- use what to diagnose?
- diagnosis criteria
- in the context of what?
- intense fear of what? even though what?
- disturbance in what?
- ________ of seriousness or current low body weight
- diagnostic and statistical manual of mental disorders (DSM-5)
- restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory and physical health
- psychological element: intense fear of gaining weight or becoming fat, even though underweight
- disturbance in way in which one’s body weight or shape is experienced –> undue influence of body weight or shape on self-evaluation
- DENIAL! resists intervention –> difficult to treat therapeutically/psychologically bc pt might lie to therapist
anorexia nervosa:
- mortality rates: __-___% due to what? (2 examples)
- 2-20% due to multiple organ system failure including electrolyte imbalance, leading to cardiovascular abnormalities (arrhythmia: inefficient heart pumping due to weakened heart muscles and due to inadequate nutrient/food intake)
health risks of anorexia nervosa (11 ish)
- growth cessation
- atrophy of GI tract
- GI symptoms (diarrhea, cramping and fever)
- cessation of menstruation (need 18% body fat to maintain)
- change in body functions characteristic of starvation (dry skin, hirsutism (excessive body hair), thin brittle dry hair/hair loss, dehydration and edema (from low protein status: low albumin = water drawn in tissues)
- high risk of premature bone loss: greatly increase risk of osteoporosis in early adulthood (driven by low estrogen levels)
- muscle wasting and decrease BMR
- defective thermoregulation
- decreased blood pressure, dehydration
- kidney dysfunction
- death may be due to Wernicke’s encephalopathy (from thiamine deficiency)
adolescent eating disorders:
- treatment goals (2)
- treatment includes (4)
- refeeding syndrom characterized by (4)
- reach suitable weight for body type, age, and height + reestablish healthy eating habits (+ good nutrition knowledge)
- medical stabilization + treatment of complications + refeeding (careful!) + psychosocial rehabilitation –> all in a specialized clinic where no food restriction at all –> normalize eating behaviors)
REFEEDING SYNDROM: - hypokalemia, hypophosphatemia, hypomagnesemia, thiamin defiency
what are 4 characteristics/diagnostic criteria for bulimia?
- binging > once /week followed by purging, for 2 months
*binging = eating in a discrete period of time an excessive amount of food and a lack of control while eating - compulsion to eat not a response to hunger (used as stress management)
- distorted/ill-informed attitudes regarding food and nutrition
- self evaluation according to body shape and weight; fear of gaining too much weight
vomiting behavior in bulimia:
- leads to irritation and infection of (2)
- _______ can cause (2) in the mouth)
- when vomiting is severe –> __________
- __________ imbalances
- prolonged vomiting –> loss of what via what? –> explain consequence
- irritation and infection of esophagus and salivary glands
- acidity can cause erosion of teeth and dental caries
- dehydration
- electrolyte imbalances
- prolonged vomiting –> loss of acidic hydrogen particles via stomach acid
*excess bicarbonate (alkaline pH) –> body aims to restore water and pH balance –> hypokalemia
*hypokalemia leads to muslce weakness, twitching, cramping
*excess bicarbonate –> slower breathing rate
how to treat bulimia? 2ish
- cessation of binging and puring activity and normalization of weight gain
- suggest frequent small meals to enable normal hunger and satiety cues + reduce binging and purging behavior
