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    Topic review

    Adolescents Malnutrition

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    Submitted by: Ruth Charles Shapu

    Definition

    Adolescents are young individuals that are between the ages of 10 and 19 years old. 

    Malnutrition refers to deficiencies, excesses or imbalances in an individual intake of energy and/or nutrients 

    1. Introduction

    Adolescents are young individuals that are between the ages of 10 and 19 years’ old; this is a period of transition from childhood to adulthood and also a critical phase of physical growth and development [1]. Globally, there are about 1.2 billion adolescents; 90% of them reside in low and middle-income countries, and 125 million lives in areas affected by conflict [2] [3]. This stage is sensitive to malnutrition as a result of the increased physiological need for nutrition that can be affected by insufficiency, excess, or inequality in individual energy intake, which can affect them and their future generation [2] [4] [5]

    Adolescence, when growth spurts occur, may expose them to malnutrition [2] [6] [7] [8]. They gain 20% to 25% of their height and up to 50% of their ideal weight [9] [10]. To support this rapid growth, there is a need for increased demand of energy, protein, minerals and vitamins [11] [12]. Sufficient nutrient intake of both macro and micro-nutrients is essential at this stage to meet the increased demand due to speedy growth, sexual maturation and menstruation [13]. Under-nutrition may contribute to underweight, poor performance at school, poor general health, pregnancy and birth complications, and less economic productivity [14] [15]. Whereas over-nutrition may contribute to non-communicable diseases such as hypertension, coronary heart disease, stroke, diabetes, sleep apnea and cancer, among others [12] [16]. Globally under-nutrition deficiency is a risk factor contributing to the burden of disease among adolescents [17]. The prevalence of iron, iodine and vitamins deficiencies  among younger adolescent girls is high in lower social development index countries  [18]

    2.  Malnutrition in Adolescent Girls

    In Nigeria, the prevalence of child marriage before the age of 18 years is 39%, and 16% of adolescent girls are married off before the age of 15 years, resulting to motherhood in childhood. Early marriage exposes adolescent girls to pregnancy complications such cephalon–pelvic disproportion that tends to double the burden of malnutrition, placing the child at higher risk of mortality before their fifth birthday due to little or no information about malnutrition, diet, and nutritional status [19] [20] [21]. Though malnutrition itself is a problem found among both boys and girls, the adverse effect is more on the girl child. If an adolescent girl enters into the reproductive cycle in a malnourished state, she will grow up into a malnourished adult and give birth to a malnourished child, as shown in Figure 1 [22], contributing to an unproductive community and the cycle of inter generational transfer of malnutrition. The key to breaking the cycle of inter generational transmission of malnutrition is to improve the nutrition of adolescent girls, in general, to ensure longer-term sustainable results in reducing malnutrition, poverty, and food insecurity [23] [24] [25]. Without adequate knowledge, attitude, and practice towards reducing malnutrition among adolescent girls and young women before, during and after pregnancy, it will be impossible to have a healthy community. 

    Studies conducted among adolescent girls in Maiduguri Metropolitan Council, Borno state reveals that (80.2%) of adolescent girls have poor knowledge, about (57.3%) had poor attitude and (49.5%) had poor practice towards reducing malnutrition. There is a need to focus on both school-based and community-based health education intervention to address the poor knowledge, attitude, and practice among adolescent girls for a healthier future [26]

    i will recommend more context-specific and relevant studies should be conducted in middle and low income countries since these settings bear more burden of malnutrition  and early marriage globally. Most adolescent girls in low and middle income countries go into motherhood with little or no knowledge about malnutrition and its consequences; focusing on adolescent girls is not only important for her but also for her children in the near future in preventing the cycle of inter-generational transmission of malnutrition [27]. Furthermore, there should be more intervention studies among these age groups which should be gender sensitive in some settings to help close the gap that exists within these age groups.

    Figure 1. Nutrition throughout the life cycle showing the effect of malnutrition on the adolescent girl and her unborn child

    The entry is from 10.3390/nu12082426

    References

    1. UNICEF. Adolescence an Age of Opportunity; United Nation Children’s Fund; United Nation Children’s Fund: New York, NY, USA, 2011; pp. 1-148.
    2. UNICEF. The State of the World’s Children 2011: Adolescence an Age of Opportunity; United Nation Children’s Fund: New York, NY, USA, 2011; pp. 1-148.
    3. Christian, P.; Smith, E.R; Adolescent Undernutrition: Global Burden, Physiology, and Nutritional Risks. Ann. Nutr. Metab 2018, 72, 316-328, 10.1159/000488865.
    4. World Health Organization. Adolescent Pregnancy; WHO: Geneva, Switzerland, 2012
    5. World Health Organization. Adolescent Pregnancy: Issues in Adolescent Health and Development; World Health Organization: Geneva, Switzerland, 2004
    6. WHO. The Global Strategy for Women’s and Children’s and Adolescents’ Health (2016–2030): Survive, Thrive, Transform; United Nations: New York, NY, USA, 2015; pp. 1-108.
    7. Christian, P.; Smith, E.R; Adolescent Undernutrition: Global Burden, Physiology, and Nutritional Risks. Ann. Nutr. Metab 2018, 72, 316-328, 10.1159/000488865.
    8. UNFPA & UNICEF. Fact Sheet: Girls and Young Women. In United Nations Adolescent Girls Task Force; UnitedNations: New York, NY, USA, 2012; pp. 1–6
    9. Ward, S.; Hisley, S.. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, and Families; F.A. Davis Company: Philadelphia, PA, USA, 2015; pp. 1-1260.
    10. World Health Organization. Guideline: Implementing Effective Actions for Improving Adolescent Nutrition; WorldHealth Organization: Geneva, Switzerland, 2018; ISBN 9789241513708.
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    13. World Health organization(WHO). Adolescents: Agents of Change for a Well-Nourished World: An ExpertConsultation on Nutrition Programming for the Next Generation. 19–20 June 2018. Available online: https://www.who.int/nutrition/events/2018-consultation-adolescents-19to29jun/en/ (accessed on 17 September 2019)
    14. World Health Organization. Adolescent Pregnancy: Issues in Adolescent Health and Development; World HealthOrganization: Geneva, Switzerland, 2004; pp. 1–92.
    15. World Health Organization. Adolescent Nutrition: A Review of the Situation in Selected South-East AsianCountries (No. SEA-NUT-163); Available online: https://apps.who.int/iris/handle/10665/204764 (accessed on1 June 2018)
    16. Branca, F.; Piwoz, E.; Schultink, W.; Sullivan, L.M; Nutrition and health in women, children, and adolescent girls. Br. Med. J. 2015, 351, 27-31, org/10.1136/bmj.h4173.
    17. Black, R.E.; Victora, C.G.; Walker, S.P.; Bhutta, Z.A.; Christian, P.; De Onis, M.; Ezzati, M.; Grantham-Mcgregor, S.; Katz, J.; Martorell, R.; et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013, 382, 427-451, Lancet.
    18. Akseer, N.; Al-gashm, S.; Mehta, S.; Mokdad, A.; Bhutta, Z.A.; Global and regional trends in the nutritional status of young people: A critical and neglected age group. Ann. N. Y. Acad. Sci 2017, 1393, 3-20, 10.1111/nyas.13336..
    19. World Health Organization (WHO). The Health of the People: What Works: The African Regional Health Report 2014; World Health Organization: Geneva, Switzerland, 2014.
    20. Save the children. Changing the story (of the Nigerian child). Save Child. Niger. 2016, 1–8
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    22. ACC/SCN. Low Birthweight: Report of a Meeting in Dhaka, Bangladesh on 14–17 June 1999; ACC/SCN in Collaboration with ICDDR,B: Geneva, Switzerland, 2000; Volume 63, pp. 1–56.
    23. Bhutta, Z.A.; Das, J.K.; Rizvi, A.; Gaffey, M.F.; Walker, N.; Horton, S.; Webb, P.; Lartey, A.; Black, R.E.; Evidence-based interventions for improvement of maternal and child nutrition: What can be done and at what cost?. Lancet 2013, 382, 452-477, 10.1016/S0140-6736(13)60996-4..
    24. Mason, J.B.; Saldanha, L.S.; Ramakrishnan, U.; Lowe, A.; Elizabeth, A.; Girard, A.W.; Mcfarland, D.A.; Martorell, R.; Opportunities for improving maternal nutrition and birth outcomes : Synthesis of country experiences. Food Nutr. Bull 2013, 33, 104-138, org/10.1177/15648265120332S107.
    25. Mason, J.B.; Shrimpton, R.; Saldanha, L.S.; Ramakrishnan, U.; Victora, C.G.; Girard, A.W.; McFarland, D.A.; Martorell, R.; The first 500 days of life: Policies to support maternal nutrition. Glob. Health Action 2015, 8, 1-8, 10.3402/gha.v7.23623..
    26. Ruth Charles Shapu, Suriani Ismail, Norliza Ahmad, Lim Poh Ying and Ibrahim Abubakar Njodi; Knowledge, Attitude, and Practice of Adolescent Girls Towards Reducing Malnutrition in Maiduguri Metropolitan Council, Borno State, Nigeria: Cross-Sectional Study. nutrients 2020, 12, 1-20, org/10.3390/nu12061681.
    27. Ruth Charles Shapu, Suriani Ismail, Norliza Ahmad, Poh Ying Lim and Ibrahim Abubakar Njodi; Systematic Review: Effect of Health Education Intervention on Improving Knowledge, Attitudes and Practices of Adolescents on Malnutrition. nutrients 2020, 12, 1-19, 10.3390/nu12082426.
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