Intergenerational Transmission of Nutritional Disorders

Nutrition Screening

Management of Nutritional Disorders

Advocacy

Future Research

Summary

Executive Summary

References

Nutritional Disorders

Millions of adolescents in both HICs and LMICs suffer from underweight, resulting in potentially permanent growth stunting, delayed puberty, cognitive impairment, decreased school/work productivity, and death [1]. Overweight in adolescence, however, increases cardiorespiratory and metabolic morbidity in adulthood and premature mortality [4]. Overweight affects one in five adolescents in HICs, in LMICs, the prevalence is one in 10 and is increasing faster than in HICs [5]. Weight alone is an incomplete proxy for nutritional health. The leading global cause of disability in adolescents is iron deficiency anemia, affecting 20.8% of LMIC adolescents and 18.0% of HIC adolescents [6]. Iron deficiency anemia in adolescence interferes with physical and cognitive growth, impairing capacity for physical work and learning. Common contributors include inadequate dietary iron, higher iron requirements during puberty, menstrual losses in girls, and parasitic infections [6]. Overweight adolescents are at higher risk of iron deficiency and may have decreased response to iron supplementation, possibly from adiposity-related inflammation reducing availability and absorption of iron and earlier onset of menstrual losses in overweight girls [7]. Dietary calcium requirements are highest during adolescence, when approximately 40%
۶۰% of adult bone mass is accrued [8]. However, among 14
۱۸ year olds in the United States, only 42% of boys and 13% of girls consume adequate amounts of dietary calcium [9]. In LMICs, where dairy products and fortified foods are less accessible than in HICs, the average calcium intake among adolescents is less than half of that among American adolescents [10]. Vitamin D, which is primarily obtained by humans through cutaneous synthesis from sunlight exposure, is necessary for most dietary calcium absorption [8]. Unfortunately, even in nations with abundant sunshine, there is a high prevalence of vitamin D deficiency among adolescents; risk factors that reduce cutaneous synthesis include darker skin pigmentation, obesity, covered clothing style, and time spent indoors [11]. Therefore, vitamin D from fortified foods or supplementation is recommended for all adolescents [8]; however, less than half of adolescents in either HICs or LMICs consume adequate dietary vitamin D [9,10]. Other micronutrient deficiencies contributing to significant morbidity among adolescents (especially in LMICs) include folic acid, iodine, vitamin A, and zinc deficiencies; these are priority targets for intervention by the Centers for Disease Control and Prevention [12].