Addressing Nutritional Deficiencies in Adolescents

Introduction

Nutrition is a fundamental asset of life and growth. Having the required nutritional intake is crucial for general body development, with benefits including stronger bones and muscles,  pivotal for maintaining healthy skin, hair, and vision, and prevention of many conditions later in life. Proper nutrient intake also supports hormonal balance, contributing to the onset of puberty, establishment of healthy reproductive systems, and allowing for maximum growth. Apart from the physical importance, cognitive functions including academic performance are closely linked to nutrition, making it essential to address deficiencies for optimal learning outcomes.

Addressing nutritional deficiencies in adolescents is of paramount importance due to its significant impact. During adolescence, the body undergoes rapid physical and cognitive changes, requiring adequate nutrients for optimising functionality. Nutritional deficiencies at this stage can lead to a range of consequences, including stunted growth, compromised immune function, impaired cognitive development, and increased susceptibility to chronic diseases. Nutritional habits established during adolescence can continue into adulthood, influencing long-term health outcomes, therefore it is fundamental to correct and maintain the appropriate nutritional intake. 

Given the critical role of nutrition in shaping physical and mental well-being, addressing nutritional deficiencies in adolescents is a foundational step toward promoting a healthy lifestyle.

Identification of nutritional deficiencies

Common nutritional deficiencies in adolescents

Iron

Iron is a mineral that has a major role in the formation of haemoglobin, the protein in red blood cells responsible for transporting oxygen from the lungs to various parts throughout the body. Apart from aiding in oxygen transport, iron is also involved in several physiological processes, including energy production, DNA synthesis, hormone production, and immune function. 

According to the National Institute of Health, Office of Dietary Supplements, these are the recommended amount of iron needed per day for the adolescent age group:

• Children aged 9-13: 8mg
• Teenage people AMAB aged 14-18: 11mg
• Teenage people AFAB aged 14-18: 15mg¹

Being deficient in iron over some time can lead to less haemoglobin production causing one of the most common nutritional deficiencies worldwide- iron deficiency anaemia. It is typically characterised by symptoms such as fatigue, weakness, pale complexion, shortness of breath, and brain fogginess. 

Due to menstruation, adolescent people AFAB are especially at a higher risk for iron deficiency. Research shows that the prevalence of iron deficiency can range from 12.6% in people AFAB aged 10-14, to as high as 50%.^2,3

Sources of iron-rich foods in:

• Red meats: Beef, mutton, pork
• Leafy green vegetables: Collard greens, kale, spinach
• Legumes: Beans, lentils, chickpeas

Calcium

Calcium is another mineral that has essential functions in the body, including strengthening bones and teeth, helping with muscle functions, nerve transmissions, and clotting of blood. 

The recommended daily intake of calcium for adolescents includes: 

• Children aged 9-13: 1,300mg
• Teenagers aged 14-18: 1,300mg¹

The adolescence time frame is a critical period for bone formation as more than half of the peak bone mass is attained during this time obtained during this time.⁴ Having a deficiency in calcium during adolescence can have significant implications for growth and development. Calcium deficiency can growth-related issues, with a 2017 study showing people AMAB with a low calcium intake had shorter adult stature.⁵ 

Sources of calcium-rich foods include:

• Dairy products: Milk, yoghurt, cheese
• Tofu
• Black beans
• Leafy green vegetables: Collard greens, kale, spinach, and broccoli 

Vitamin D

Vitamin D is a fat-soluble vitamin that has a multitude of roles including the promotion of calcium absorption and supporting bone health. In addition to its involvement in bone strengthening, vitamin D also helps with mood regulation, immune functions, and nerve transmissions. Additionally, due to the interplaying role of vitamin D with calcium, a sufficient source of vitamin D is also needed to utilise calcium efficiently.  

The recommended daily intake of vitamin D for adolescents includes: 

• Children aged 9-13: 15mcg (micrograms)
• Teenagers aged 14-18: 15mcg (micrograms)¹

As vitamin D enhances the absorption of calcium from the intestines into the bloodstream, having an inadequate intake of it can lead to conditions like osteoporosis, osteomalacia, and rickets. Due to their effect on muscles and bones, the manifestations of vitamin D deficiency amongst adolescents can include pain in weight-bearing joints, back, and/or thighs, difficulty in walking and/or running, and muscle cramps.

The biggest source of vitamin D is sunlight, but due to the country’s location, climate, and cultural beliefs, vitamin D amongst adolescents may vary. Despite countries having adequate exposure to sunlight, research has shown a high prevalence of vitamin D deficiency amongst adolescents in the Middle East, Southern Asia, and North Africa.⁶

Sources of vitamin D-rich foods include:

• Fish: Herring, sardines, salmon
• Egg yolks
• Mushrooms

Vitamin A

Similar to vitamin D, vitamin A is also a fat-soluble vitamin that has important functions throughout the body, particularly with vision, immune strength, and skin health. Vitamin A supports the production of rhodopsin, a pigment in the retina that enables the eyes to adjust to the variations in light intensity and helps facilitate night vision. 

The recommended daily intake of vitamin A for adolescents includes:

• Children aged 9-13: 600 mcg RAE (micrograms of retinol activity equivalents)
• Teenage people AMAB aged 14-18: 900 mcg RAE (micrograms of retinol activity equivalents)
• Teenage people AFAB aged 14-18: 700 mcg RAE (micrograms of retinol activity equivalents)¹

Inadequate vitamin A intake can lead to conditions like night blindness and dry eyes.

Vitamin A-rich foods include:

• Beef liver
• Leafy green vegetables: Kale, spinach, broccoli
• Sweet potato

Causes of nutritional deficiencies

Nutritional deficiencies among adolescents can arise from various factors. 

In this important time, adolescents can have erratic eating habits due to changes in both their physical and cognitive aspects. A preference for processed and easy-to-consume/cook foods high in sugars, and fats, and low in nutritional value is a common issue, especially in developed countries. A diet lacking whole foods such as fruits, vegetables, whole grains, and proteins can contribute to deficiencies in vitamins, minerals, and other essential nutrients.

According to a study in 2011, there was a prevalence of 0.3% of anorexia, 0.9% of bulimia, and 1.6% of binge-eating disorder among adolescents.⁷ Certain diets or restrictive eating patterns to lose weight or to conform to peer pressure can often eliminate entire food groups or severely restrict calorie intake, leading to inadequate nutrient intake. Furthermore, busy schedules and school demands may lead adolescents to skip meals instead of regular balanced meals. Irregular eating patterns can disrupt nutrient absorption and contribute to deficiencies over some time. 

Certain medical conditions affecting the gastrointestinal tract, such as celiac disease, inflammatory bowel disease (IBD), and lactose intolerance, can impair nutrient absorption and lead to deficiencies even if there is adequate dietary intake.

Socioeconomic factors, such as poverty and food insecurity, can limit access to nutrient-rich foods. Adolescents from low-income families may rely on inexpensive, calorie-dense foods for sustenance. Research shows that the place of residence and parental occupation can play a significant part in thinness and stunting among adolescents.⁸

Intervention strategies

Intervention strategies for addressing nutritional deficiencies can be implemented through education of nutrition, promotion of healthy eating behaviours, and addressing underlying factors contributing to inadequate nutrition. 

Providing adolescents with education about the importance of nutrition, food groups, and healthy eating habits through school curriculums or social media engagements can help them make informed food choices by themselves. Teaching basic cooking skills, meal planning techniques, and budget-friendly shopping strategies can also empower them to prepare healthy, homemade meals and snacks while allowing them to gain a necessary skill. Furthermore, involving parents and family members in nutrition education can create a supportive environment to reinforce the appropriate healthy choices. 

Providing vitamin and mineral supplements and fortification, when indicated and under the guidance of healthcare professionals, can help address specific nutrient deficiencies. Food fortification has shown success in deficiencies of zinc, iron, and vitamin A, especially in lower and lower-middle-income countries.⁹ Furthermore, nutritional supplementation has been shown to decrease the incidence of iron deficiency anaemia in adolescents and improve birth outcomes in pregnant adolescents.¹⁰

For adolescents with socioeconomic issues, collaboration through the local government, local farmers, and food banks can increase access to fresh, affordable produce and nutritious foods.

Finally, conducting regular screenings and assessments to identify adolescents at risk of nutritional deficiencies can allow for early intervention and targeted support.

Summary

Nutritional deficiencies in adolescents can arise from various factors, ranging from poor dietary choices, limitation in access to nutrient-rich foods, and irregular eating patterns, to possible underlying medical conditions. These deficiencies can have significant implications for growth, development, and overall health, leading to a multitude of diseases. Addressing these nutritional deficiencies requires a multifaceted approach, including nutrition education, screening and assessment, supplementation and fortification, behavioural interventions, and family and community support, with the collaboration of healthcare professionals. By implementing comprehensive intervention strategies, adolescents can be empowered to make healthier food choices, improve dietary intake, and mitigate the long-term consequences of nutritional deficiencies on their health and well-being, while maximising their abilities.