Puberty marks the beginning of adolescence, the time between childhood and young adulthood. The Dietary Reference Intakes (DRIs) divide adolescence into two age groups: ages 9-13 and ages 14-18. Puberty brings a number of major physical changes including the development of the reproductive organs, the onset of menstruation in females, growth spurts, and changing body composition. During this time, girls may experience a greater increase in body fat, while boys tend to gain more muscle and bone mass. All of these changes should be supported with sound nutrition.

Nutrient Needs in Adolescence

Energy and Macronutrients

Adequate energy intake is necessary to support the dramatic growth that takes place during adolescence. Estimated calorie needs vary widely based on age, sex, and activity level. For ages 9-13, daily energy needs range from about 1,400-2,200 calories for girls and 1,600-2,600 calories for boys. For ages 14 to 18, needs increase to about 1,800-2,400 calories for girls and 2,000-3,200 calories for boys. Calorie needs vary based on activity level. The extra energy required for physical development during the teenage years should be obtained primarily from nutrient-dense foods to support adequate nutrient intake and a healthy body weight.

For children and adolescents ages 4-18, the Acceptable Macronutrient Distribution Ranges (AMDRs) recommend:

• Carbohydrates: 45–65% of total calories, preferably from high-fiber foods such as whole grains

• Protein: 10–30% of total calories, from sources such as meat, poultry, fish, beans, nuts, and seeds

• Fat: 25–35% of total calories, with an emphasis on unsaturated plant-based fats to support heart health

Micronutrients

Most micronutrient recommendations for adolescents are similar as for adults, though children this age need more of certain nutrients to support rapid growth. Key micronutrients for adolescents include calcium, vitamin D, vitamin A, and iron.

• Calcium levels increase to 1,300 mg/day during adolescence to support bone growth and prevent osteoporosis later in life. Low-fat dairy products and foods fortified with calcium, such as breakfast cereals and orange juice, are excellent sources of calcium.
• Iron needs rise during adolescence due to growth and increased blood volume. Needs increase to 15 mg/day for girls ages 14–18 with the onset of menstruation, while adolescent boys require 11 mg/day to support the development of lean body mass.
• Vitamin A supports normal growth and development and is readily obtained through adequate intake of fruits and vegetables.

Common Nutrition-Related Health Concerns in Adolescence

Disordered Eating

Eating disorders involve extreme behaviors related to food and exercise and may include under-eating, overeating, or purging behaviors. Eating disorders often stem from stress, low self-esteem, and other psychological and emotional issues. They are most prevalent among adolescent girls but have been increasing among adolescent boys in recent years. Because eating disorders often lead to malnourishment, adolescents with eating disorders are deprived of the crucial nutrients their still-growing bodies need. Girls with anorexia experience nutritional and hormonal problems that negatively influence peak bone density, increasing their risk for osteoporosis and fracture throughout life.^[1] Signs and symptoms of these disorders include sudden weight loss, lethargy, vomiting after meals, and the use of appetite suppressants or laxatives. Eating disorders can be life-threatening if left untreated and typically require a combination of medical, psychological, and nutritional therapy.

Obesity

Children need adequate caloric intake for growth, and it is important not to impose very restrictive diets. However, exceeding caloric requirements on a regular basis can lead to excess weight gain. According to the Centers for Disease Control and Prevention (CDC), the prevalence of obesity was 18.4% for youth ages 6-11 and 20.6% for youth ages 12-19 in 2106.^[2]

Factors contributing to childhood and adolescent obesity include:

• Limited breastfeeding support early in life

• Larger portion sizes

• Limited access to nutrient-rich foods

• Increased availability of fast food and vending machines

• Reduced physical education in schools

• Sedentary lifestyles

• Media messages promoting highly processed foods

Children who suffer from obesity are more likely to become overweight or obese adults. Obesity has a profound effect on self-esteem, energy, and activity level. Even more importantly, it is a major risk factor for a number of diseases later in life, including cardiovascular disease, Type 2 diabetes, stroke, hypertension, and certain cancers.^[3]

One major contributing factor to childhood obesity is the consumption of added sugars, especially in the form of sugar sweetened beverages.^[4] Added sugars include not only in desserts and soft drinks, but also ingredients in items such as bread, cookies, cakes, pies, jams, condiments, and other processed foods. Young children and adolescents consume an average of 362 calories per day from added sugars, or about 16% of daily calories, exceeding current recommendations.^[5]

When a child gains weight more rapidly than expected for growth, caregivers should focus on supporting eating competence, following the Division of Responsibility, encouraging physical activity, and reducing sedentary behaviors. For most children and adolescents, the goal is not weight loss, but allowing height to catch up with weight as growth continues. Rapid weight loss is not recommended due to risks of nutrient deficiencies and impaired growth.

Nutritionally Vulnerable ADOLESCENTS

One of the psychological and emotional changes that takes place during this life stage includes the desire for independence as adolescents develop individual identities apart from their families. One way that teenagers assert their independence is by choosing what to eat. They have their own money to purchase food and tend to eat more meals away from home. Without proper guidance, this can increase nutritional vulnerability.

At this life stage, young people still need the structure of family meals. Evidence shows that eating family meals is associated with nutritional benefits, including eating a diet with more fruits, vegetables, fiber, and micronutrients, and less fried food, soda, and saturated and trans-fat.^[6]

attributions

This section is an adaptation of “Nutrition in Adolescence” in Nutrition: Science and Everyday Application, v. 1.0 by Alice Callahan, PhD; Heather Leonard, MEd, RDN; and Tamberly Powell, MS, RDN licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.