ADOLESCENCE and HEALTH

-Dr Meenakshi N. Mehta.   MD, DCH, FIAP, FICN.

Adolescence is the phenomenon of   transitional slow merging of an individual from childhood to adulthood. This is the period of rapid growth and maturation of all organs specially physical, endocrine and genital and is accompanied by complex myriad changes, physical, physiological, emotional, sexual, psychosocial and cognitive resulting in an evolvement of a child into a strange adult.. Adolescence is the crucial period of life when many health problems if ignored have serious consequences in later adult life of immediate concern are those influencing health of adolescents girls who are on the doorsteps of marriage and influencing maternal and child health. A major benefit could also be by delaying her marriage after 18 years, atleast avoid ill effects of teen pregnancy, low birth weight [LBW], high neonatal and child mortality. and morbidity, and allow her own growth, benefits of nutrition and physical, sexual and emotional readiness before she conceives. The scenario is worst in rural areas with social taboos, where girls are illiterate, uneducated and hence unable to follow any advice on maternal health, family planning and child rearing.

Adolescence is the most neglected period of life particularly in a developing country like India. It is very difficult, yet an important and exciting period of life of an individual. A period of turmoil, when an adolescent demands independence, yet is mostly dependent, rejects advice outright, is rebellious, yet needs to be guided through difficulties wants to defend on his/her own attitudes, pattern of thinking and decisions, yet needs subtle help and guidance, wants to shoulder responsibilities but is not equipped to do so .In short, he/ she wants to assert his individual position in society independently but unfortunately isn’t ready yet. Depending on the culture and the context, adolescents are commonly known as “ teenagers [10 –19 yrs], young people [10 –24 yrs] and youths [15 – 24 yrs ]   as per WHO classification. The word teen means to “ excite, to provoke or irritate. During this period children are irritable and start getting excited and provoked by sexual stimulations. The word teenage is commonly used by layman and hence comprise children between 13 to 19 years.. G Stanley 100 popularized “Adolescence” years ago. It is derived from Latin word “ adolescere” which literally means, “to grow up”, i.e. adolescence is the period during which individual grows from childhood to adulthood. Whereas “ Puberty “   is derived from Latin word Pubescre to be covered with hair . Puberty is a period characterized by the appearance of hair on specific area. In developed countries adolescents comprise about 15% of total population. Whereas in the developing countries their number is almost, about 30%. In India, adolescents [10-19 yrs] comprise about 20% and 30% are youths [10 –24yrs], this is likely to increase by another 11% in next 15 years.

Further many adult diseases like insulin resistance type 2 diabetes, hypertension, coronary artery disease, hyperlipedimia, stroke and certain cancers and most important obesity although have origin in foetal life or early childhood are either reinforced or aggravated during adolescence and hence it is the pediatricians who must look after adolescents more meaningfully to intervene and prevent these adult metabolic diseases.

Problems of Adolescence

1] Nutritional Concerns:  Underweight, obesity, nutritional anemia, anorexia, vitamin and mineral deficiency.

2] Adolescent   gynecology, menstrual problems, teenage pregnancy, HIV/AIDS.

3] Psychosocial issues plus drugs, alcoholism, smoking, masturbation, and premarital sex. HIV/AIDS, aggressiveness/ rebellious tendency, identity crisis, depression to crime suicidal tendency

4] Endocrinology: Acne, delayed puberty, short stature, thyroid disorders , gynecomastia, Turner syndrome, hirsutism.

5] Educational problems: Peer competition and pressures, poor concentration and scholastic performance, escapism

Nutritional Concerns:  The rapid growth and increase in physical activity creates special nutritional needs which are higher during adolescence than at any other times in life and children achieve their full growth as per their full growth as per their genetic potential. Failure to consume adequate diet at this time can potentially retard physical growth, intellectual capacity and delay in sexual maturation; the nutrition of adolescent girls is of special importance given the far reaching effects of maternal undernutrition.

Objectives of Nutritional Requirements:

1]  Provide the necessary nutrients to the demands of physical and intellectual growth and to improve preexisting nutritional disorders if any.

2] Provide adequate stores for illness or pregnancy and prevent LBW.

3] prevent adult onset diseases related to nutrition like hypertension and osteoporosis.

4] Encourage healthy eating habits and lifestyles.

ENERGY: needs may vary depending on sex, age, pubertal development and physical activity. Active adolescent engaged in sports would need higher energy [calcium] than a sedentary. Avoidance of excess calories creating obesity should be avoided. .The table below gives requirements of all nutrients.

Proteins: In general, requirement increases with a peak in girls at 12 years and 16 years in the body. If the energy intake is met with adequately the protein requirement is met with. In general, diet should provide 55% calories from complex carbohydrates and contain less than 30% of total calories from fat with less 10% from saturated fats and 300 mgm cholesterol..

UNDERNUTRITION: preexisting undernourished children are at risk. Despite increasing calories and proteins such children especially from low income group, fail to meet the high energy requirement of pubertal growth and suffer delays in sexual maturity and remain short and thin, perhaps intellectual deficits limiting their productivity and they manifest with weight, height and growth rate 70-80% less than well to do   adolescents. Problem is serious in stunted and undernourished girls who are at high risk of   LBW babies and obstetric complications due to small pelvis when they deliver. LBW besides its own consequences of high morbidity and mortality is at further risk of adult onset of metabolic diseases mentioned earlier.

OBESITY.:  currently a major problem in adolescents with present lifestyles of less physical activity consistent watching TV and consuming fast food like pizzas, breads, wafers, chips, popcorns, fried snacks and aerated drinks , ice creams supply empty calories. Obesity in adolescents is a high risk of future adulthood diabetes and heart disease.

Micronutrients: The dietary needs of vitamins especially Vit.A,D,E,C and B complex. groups and Folic Acid to maintain the structural and functional properties of new cells attained during growth .

Minerals: There is increased need for minerals Iron [Fe], Calcium [Ca], Zinc [Zn], Iodine [I2] . Calcium is required to meet with increased bone density and prevent osteoporosis. Preferred food source is dairy products and adequate Vit D is required for its oral absorption. Iron requirements peak during adolescence to meet with rapid growth, blood volume and functioning of Iron containing enzymes. In addition, monthly losses due to menstrual blood must be remembered. Nutritional Iron deficiency anemia [IDA] mainly a nutritional problem in adolescent girls with a high public health implication has very grievous consequences namely; poor work performance and cognitive skills and future maternal morbidity, premature labour, still birth, ante and post partum hemorrhage, shock, LBW babies etc. Hence prevention and treatment of IDA in adolescent girls should be tackled on war footing. Emphasis on dietary sources of iron with supplementation of Iron + Folic Acid tablets daily or biweekly and use of fortified   dietary articles to be encouraged. Supplementation of iron during pregnancy although routinely may be too late to prevent required benefits to mothers and their newborns GOI is supplementing Iron +Folic acid tablets to needy population under National Nutrition Anemia Programme. Zinc and Iodine is required to prevent retardation in tissue growth and sexual maturation. Iodine is necessary to prevent goiter, mental abnormality and poor work capacity and hypothyroidism in newborn.

Nutrition and Health Education for Adolescent Girls is crucial for a women’s life – will not only improve her own health but also health of future generation, indirectly health of Nation.   

STRATEGIES FOR PROMOTIONOF ADOLESCENT HEALTH**:
A =   Adopt healthy lifestyle.
D =   Develop appropriate IEC  strategy , discourage early marriage and
         Teenage pregnancy.
O =  Organize adolescent / youth friendly clnic
L  =  Lifeskill training, legal support, liaison with peers/parents.
E =  Educate about sexuality, safe sex, spirituality, responsible parenthood.
S =  Safe, secure and supportive environment.
C =  Counselling/curriculam in school inclusive of family education.
E =  Enable and empower for responsible ctizenship.
N =  Networking for experience sharing.
T  =  Training for income generation, teen clubs.
[ **  Health Dialogue, issue no. 46,  July – Sept.2006]