Your speaker Yvonne Bishop-Weston Bsc. Dip ION. mBANT. CNHC • Nutritional Therapist • Specialise in children's health from pre-conceptual onwards including eating disorders and neuro-atypical • www.newforesthealth.com @nutritionistW1 1
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We are programmed to look after babies “Even in adults who have no children of their own, images of a baby’s face triggered what we think might be a deeply embedded response to reach out and care for that child" Marc H. Bornstein, head of the Child and Family Research Section of the Eunice Kennedy Shriver National Institute of Child Health and Human Development 3
How do we feel about teenagers? Is there enough focus on and support for teenagers? Do we give them what they need and deserve? 4
Teens - a time of high need • Hormonal orchestra at full volume • Puberty triggers rapid growth and Estimated average calorie (kcal) requirements per day development Age Males Females • Muscle and bone mass increase 0-3 months 545 515 4-6 months 690 645 • 7-9 months 825 765 Girls lay down body fat 10-12 months 920 865 1-3 years 1,230 1,165 • High need for calories and nutrients 4-6 years 1,715 1,545 7-10 years 1,970 1,740 • Body and mind need support 11-14 years 2,220 1,845 15-18 years 2,755 2,110 19-50 years 2,550 1,940 51-59 years 2,550 1,900 60-64 years 2,380 1,900 65-74 years 2,330 1,900 75+ years 2,100 1,810 Source: UK Department of Health 5
Meeting needs Diet is a key factor in addressing these need – fact not theory A well balanced diet can: • Support ideal weight and self-esteem • Support balanced mood and energy and resistance to stress • Protect health, minimising time off sick • Aid concentration, behaviour and performance • Reduce health risk and future health risk including type 2 diabetes, heart disease, osteoporosis 6
Are teenagers needs met? Clinical observations • Tired • Stressed • Behaviour problems • Body image issues • Perfectionism • Lack of practical skills • ‘Junk’ food cheap and ubiquitous • Secondary school food often poor example and self-selection not ideal 7
The bigger picture National Diet and Nutrition Survey: Results from years 1-4 (combined Rolling Programme 2008/2009 – 2011/12) Updates from years 5-6 (2012/3-21013/4) • Largest UK national survey, assessment of diet, nutrient intake and nutritional status and estimation of general UK population health from 1.5 yrs • Teenagers in particular have insufficient intake of many nutrients • Nutrient levels are better met in younger children 8
Fruit and vegetables Fruit and vegetable intake Mean daily consumption of fruit and veg in 11-18 yrs NDNS yrs 1-4 Boys Girls 3 portions 2.7 portions Percentage 11-18 yrs who met 5-a-day target Boys Girls 10% 7% NDNS yrs 5-6 National Diet and Nutrition Survey: Results from Reached 5 a day: Years 1-4 (combined Rolling Programme 2008/2009 – 8% 11-18 yrs (2.6 2011/12) portions/day day) 27% of adults <65 yrs (4 portions/day) 9
Ref 1 - Fruit and vegetables 10
Omega 3 Oily fish intake • All age groups fell short of the recommended intake of one portion of oily fish a week (140g) National Diet and Nutrition Survey: Results from Years 1-4 (combined Rolling Programme 2008/2009 – 2011/12) Result the same in years 5-6 11
Ref 2 – Benefits of fats including on mood and behaviour Higher information processing speed less impulsivity Remission (of depression); 40% of patients on low dose 100% patients on high dose 12
Teens - vitamins and minerals • NDNS - mean intakes of minerals from food sources were below the RNI for especially 11 to 18 yrs • Girls in particular had intakes of key minerals below the LRNI National Diet and Nutrition Survey: Results from years 1-4 DRV’s are the recommended nutritional intakes for the UK. They include: RNI - Reference Nutrient Intake (97.5% of the population's requirement is met) EAR - Estimated Average Requirement (Adequate for 50% of the population need) LRNI – Lower Reference Nutrient Intake (only adequate for 2.5% of the population, unlikely level could maintain good health for most people) 13
Examples of inadequate vitamin and mineral intakes Many teens (11-18 year olds) fall below RNI on key nutrients Teens fare worse than other groups on many key nutrients Below LRNI ( in adequate level for over 95% of the population) Vitamin A Folate Calcium Magnesium Zinc Iron Iodine Selenium 13% girls & Girls 8% yrs 1-4 19% yrs 1-4 53% yrs 1-4 22% yrs 1-4 46% yrs 1-4 22% yrs 1-4 46% yrs 1-4 boys 8% yrs 5-6 19% yrs 5-6 48% yrs 5-6 22% yrs 5-6 48% yrs 5-6 26% yrs 5-6 44% yrs 5-6 18% yrs 5-6 13% girls & Boys 8% yrs 1-4 28% yrs 1-4 12% yrs 1-4 6% yrs 1-4 9% yrs 1-4 22% yrs 1-4 Not stated boys 5% yrs 5-6 12% yrs 1-4 27% yrs 5-6 17% yrs 5-6 9% yrs 5-6 16% yrs 5-6 23% yrs 5-6 14% yrs 5-6 Immunity Blood cell Bone and Bone health Immunity Fatigue Cognitive Antioxidant production teeth health development Required for First-line Vitamin D Learning and Cognitive Thyroid health mucous Prevention of Heart, muscle activation memory function Thyroid health membrane neural tube and nerve and metabolic Muscle and Growth Growth defence defects function rate nerve function Healing Eyesight Hormonal balance, skin 14
Teens - vitamins and minerals Female * PAGB Proprietary Association of Great Britain represents the manufacturers of branded over-the-counter medicines and food supplements in the United Kingdom Review of NDNS with a nalysis by Dr. Pamela Mason & Dr. Carrie Ruxton 15
Teens - vitamins and minerals Male * PAGB Proprietary Association of Great Britain represents the manufacturers of branded over-the-counter medicines and food supplements in the United Kingdom Review of NDNS with a nalysis by Dr. Pamela Mason & Dr. Carrie Ruxton 16
Teens fare the worst NDNS.years 5-6 (2012/13 – 2013/14) What are the potential consequences of low nutrient levels?
Iron • Teenagers have higher need for iron • Girls need more iron than boys (RNI: boys 11.3 g/day, girls 14.8 g/day) • Lack of iron increases anaemia risk • Teenagers who follow restricted diets are at greater risk of deficiency Mean iron intakes were below the RNI for teenage girls 11-15 yrs 16-24 yrs 44% 40% National Diet and Nutrition Survey: Results from Years 1-4 NDNS.years 5-6 11-18 yrs 48% girls below LRNI 18
Effects of supplementation on cognition - Iron Iron supplementation improved global cognition scores 19
Effects of supplementation on cognition – Iron Iron supplementation improved attention scores by approx. 90% 20
Vitamin D Vitamin D (25-OHD) concentration below lower threshold NDNS years 1-4 1.5-3 4-10 11-18 yrs yrs yrs Girls 15.6% 24.4% 7.5% Boys 12.3% 19.7% NDNS Yr 5-6 15% girls 17% boys < 25 nmol/L is deficient 25 – 50 nmol/L may be inadequate in some people 11-18yrs below >50 nmol/L is sufficient for most of population 25nmol/L UK average levels vitamin D level (25-OHD) 25 nmol/L Season 4-10 yrs 11-18 yrs 19-64 65+ Jan-March 31 40 39 29 April-June 8 13 24 21 July-Sept 2 13 8 4 Oct-Dec 12 24 17 26 21
Ref 3 - widespread vitamin D deficiency in Europe 22
Iodine 23
Iodine – child cognitive development The UK is classified as mildly iodine deficient by the WHO based on 2011 national study of 14-15 yr old girls 24
Oxford Clack Nutrition Study 25
How has it come to this? • Insufficient preparation in the early years? • Nutrition education to parents • Early nutrition education in schools • Treats and incentives based on unhealthy foods • Insufficient targeted focus on teen age group? • Natural time of independence • Self selection • Ubiquitous ‘junk food’ • Rapid rise of social media and influence • Insufficient focus on school food after primary years? 26
How has it come to this? First day back at Primary school Baked pork sausages Diced potatoes Baked beans and salad Ice cream What do older children self-select? 27
Teen Habits – self selection 28
Whole food - not half food (ref 4) 20% adults and children consume no whole grains. Low consumption in adolescents put down to difficulty identifying wholegrain products and their health benefits, taste and visual appeal and poor availability 29
Teen habits - breakfast omission Breakfast omission consistently associated with negative outcomes in secondary school children 30
Teen breakfast?
Junk food availability and selection Significant association between violent behaviours and intake of junk foods Only 3% agreed never eat junk food on a regular basis 32
Teen habits – self selection We have a childhood obesity strategy which will support healthy diets and activities What is the plan for older children? How can we make this work? 33
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