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

2

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 development

• Muscle and bone mass increase

• Girls lay down body fat

• High need for calories and nutrients

• Body and mind need support

Estimated average calorie (kcal) requirements

per day

Age Males Females

0-3 months 545 515

4-6 months 690 645

7-9 months 825 765

10-12 months 920 865

1-3 years 1,230 1,165

4-6 years 1,715 1,545

7-10 years 1,970 1,740

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

Percentage 11-18 yrs who met 5-a-day target

National Diet and Nutrition Survey: Results from Years 1-4 (combined Rolling Programme 2008/2009 – 2011/12)

Boys Girls

3 portions 2.7 portions

Boys Girls

10% 7%

9

NDNS yrs 5-6 Reached 5 a day: 8% 11-18 yrs (2.6

portions/day day)

27% of adults <65 yrs (4 portions/day)

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

Higher information processing speed less impulsivity

Remission (of depression); 40% of patients on low dose 100% patients on high dose

Ref 2 – Benefits of fats including on mood and behaviour

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 (inadequate level for over 95% of the population) Vitamin A Folate Calcium Magnesium Zinc Iron Iodine Selenium

Gir

ls 13% girls &

boys

18% yrs 5-6

8% yrs 1-4

8% yrs 5-6

19% yrs 1-4

19% yrs 5-6

53% yrs 1-4

48% yrs 5-6

22% yrs 1-4

22% yrs 5-6

46% yrs 1-4

48% yrs 5-6

22% yrs 1-4

26% yrs 5-6

46% yrs 1-4

44% yrs 5-6

Bo

ys 13% girls &

boys

14% yrs 5-6

Not stated

5% yrs 5-6

8% yrs 1-4

12% yrs 1-4

28% yrs 1-4

27% yrs 5-6

12% yrs 1-4

17% yrs 5-6

6% yrs 1-4

9% yrs 5-6

9% yrs 1-4

16% yrs 5-6

22% yrs 1-4

23% yrs 5-6

Req

uir

ed f

or

Immunity

First-line mucous membrane defence

Eyesight

Blood cell production

Prevention of neural tube defects

Bone and teeth health

Heart, muscle and nerve function

Bone health

Vitamin D activation

Muscle and nerve function

Immunity

Learning and memory

Growth

Healing

Hormonal balance, skin

Fatigue

Cognitive function

Growth

Cognitive development

Thyroid health and metabolic rate

Antioxidant

Thyroid health

14

Teens - vitamins and minerals

* 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 analysis by Dr. Pamela Mason & Dr. Carrie Ruxton

Female

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 analysis 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

National Diet and Nutrition Survey: Results from Years 1-4

11-15 yrs 16-24 yrs

44% 40%

18

NDNS.years 5-6 11-18 yrs 48% girls below LRNI

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

< 25 nmol/L is deficient 25–50 nmol/L may be inadequate in some people >50 nmol/L is sufficient for most of population

UK average levels vitamin D level (25-OHD) 25 nmol/L

1.5-3 yrs

4-10 yrs

11-18 yrs

Girls 7.5%

15.6% 24.4%

Boys 12.3% 19.7%

21

NDNS Yr 5-6 15% girls 17% boys 11-18yrs below 25nmol/L

Vitamin D (25-OHD) concentration below lower threshold NDNS years 1-4

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

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

25

Oxford Clack Nutrition Study

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?

27

First day back at Primary school Baked pork sausages

Diced potatoes Baked beans and salad

Ice cream

What do older children self-select?

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?

Only 3% agreed never eat junk food on a regular basis

Junk food availability and selection

Significant association between violent behaviours and intake of junk foods

32

Teen habits – self selection

33

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?

How do we support this vital time?

• Ensure the needs of teens are taken into account and met in strategy development

• Strategy needs to start with the early years but we also need to support those beyond that stage • Leading by example, parents, schools, role models • Breakfasts in schools for older children • Remove availability of cheap healthy foods in schools and colleges and

replace with better options - Academy compliance • Prevent fast-food outlets in close proximity to schools • Relevant, practical education, how to shop and prepare nutritious food

on a budget • Better education on the vital function of micronutrients in the national

curriculum, help teens focus on nutrition rather than just weight • Sell the benefits of good food in teen-appeal ways including the use of

Apps and social media • Use of role models

• Consider the role of supplementation

34

Supplementation

In the NDNS generally younger children fared better than teens. Is this due to: • Better provision? • Greater parental control? • Increased supplementation? • For children - supplement use was most common among children aged four

to ten years with 16% taking at least one supplement during the four-day diary period

35

Effects of supplementation on cognition – multivitamins/minerals

Even people who are likely to be getting sufficient nutrients had improved cognition with vitamin and mineral supplementation

36

Effects of Supplementation on mood – Multivitamin and Minerals

Vitamin and mineral supplementation had the potential to improve brain function in healthy children

37

Summary – teenagers are an at risk group

• Evidence of inadequate nutrient levels in teens. This is likely to have both day to day and long term risks to health

• Strategies are needed to support teen nutrition and to engage them in better diets

• We need to consider dietary supplement recommendations for teenagers as we do for pre-conceptual, pregnancy, young children and the over 65’s

38