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Adolescent Health Focus on Nutritional and Lifestyle Interventions for Optimal Growth and Performance Presented By: Adrienne M. Aschmetat, D.O. Date: November 3, 2015 Disclosures None 2 Outline • • • • • Introduction to speaker Adolescent lifestyle and nutritional needs Why have a primary care doctor? Wrap Up Questions 3 Introduction to Speaker 4 My Educational Timeline • Michigan Native • • University of Detroit Mercy • • Bradenton, FL William Beaumont Hospital – Royal Oak, MI • • B.S. Biochemistry, M.S. Chemistry Lake Erie College of Osteopathic Medicine • • Richmond, MI Internal Medicine/Pediatrics St. Mary Mercy • Primary Care Physician – Internal Medicine/Pediatrics 5 What really makes me tick… • Lifelong Athlete • • Softball, Cross Country, Powerlifting, Physique competitor, CrossFit, competitive hiking My passions • • • • Integrative approach to medicine Sports performance Nutrition and micronutrient optimization Lifestyle optimization for optimal performance and longevity ©2015 6 Adolescent Lifestyle Overview ©2015 7 Genetics Lifestyle, Movement, Stress, Sleep, Social Nutrition Base Image Courtesy of: www.dreamstime.com 8 Adolescent Lifestyle Nutrition ©2015 9 Nutrition • • Needs determined by degree of sexual maturation and biological maturity vs. chronological age Increased growth rates • Females – 10-12 years • • Increased proportion of body fat Males 14-16 years • Increased proportion of lean body mass and blood volume ©2015 10 Typical Adolescent Food Habits: • • • Increased tendency to skip meals Eat more meals outside the home Increased snacking • • • Energy-dense foods and beverages Increase consumption of fast foods Dieting/Fads ©2015 11 Adolescent Nutritional Needs • Energy • • Protein – up to 0.5g/pound of body weight • • i.e. 120lb adolescent requires ~60g protein per day Iron – 15mg/day females, 12mg/day males • • 2,300 kcal/day – females, 2,700 kcal/day – males* Meat (including shellfish) Calcium – 1300mg/day • • 3-4 servings dairy per day, dark green, leafy vegetables Bone mineral density reaches its peak between ages 20-30 years • • During adolescence, ½ of adult bone calcium is accumulated Zinc • • essential for growth and sexual maturation Meat, seafood, lentils, cheese ©2015 *for moderate activity 12 Ideal Adolescent Diet* • • • Protein 10-30% Fat 25-35% Carbohydrates 45-65% *if no comorbid medical conditions ©2015 Images Courtesy of: www.choosemyplate.gov 13 Adolescent Lifestyle Sleep ©2015 14 Sleep • Require 8.5-9.5 hours per night • Sleep latency naturally shifts towards later bedtime and later rise time • 2011 CDC Study* • Almost 70% high school students not getting recommended sleep on school nights *http://www.sciencedirect.com/science/article/pii/S0091743511002878 ©2015 15 Insufficient sleep associated with: • • • • • • • • • • • Drinking soda or pop 1 or more times per day (not including diet soda or diet pop) Not participating in 60 minutes of physical activity on 5 or more of the past 7 days Using computers 3 or more hours each day Being in a physical fight 1 or more times Cigarette use Alcohol use Marijuana use Current sexual activity Feeling sad or hopeless Seriously considering attempting suicide *http://www.sciencedirect.com/science/article/pii/S0091743511002878 ©2015 16 Healthy Sleep Hygiene* • Go to bed at the same time each night and rise at the same time each morning. • • • • • Asleep by 11:00 PM** Quiet, relaxing and cool bedroom Comfortable bed, use only for sleeping Remove all TVs, computers, and other “gadgets” from the bedroom. Avoid large meals a few hours before bedtime. *as recommended by the National Sleep Foundation **speaker caveat ©2015 17 Adolescent Lifestyle Stress ©2015 18 Sources of Adolescent Stress* • • • • • • • • • • • school demands and frustrations negative thoughts and feelings about themselves changes in their bodies problems with friends and/or peers at school unsafe living environment/neighborhood separation or divorce of parents chronic illness or severe problems in the family death of a loved one moving or changing schools taking on too many activities or having too high expectations family financial problems *American Academy of Child and Adolescent Psychiatry http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Helping-Teenagers-With-Stress-066.aspx 19 Ways to Decrease Stress • • Exercise and eat regularly Avoid excess caffeine intake • • • Avoid illegal drugs, alcohol and tobacco Learn relaxation exercises • • • • • • • abdominal breathing and muscle relaxation techniques Develop assertiveness training skills Rehearse and practice situations which cause stress. Learn practical coping skills Decrease negative self-talk Learn to feel good about doing a competent or "good enough” job rather than demanding perfection from self and others Take a break from stressful situations • • Can increase feelings of anxiety and agitation listen to music, talk to a friend, draw, write, or spend time with a pet Build a network of friends who help to cope in a positive way ©2015 20 How To Help Your Students Relax • Box Breathing (Four-square breathing) • • • Diaphragmatic breathing technique Used by large number of high performing athletes, CEOs, entrepreneurs, military, etc. Short Term benefits* • Reduction of anxiety • Control of “fight or flight” response • Enhances blood flow to brain, calming • Enhances learning and skill development • Increase in focused attention and long term concentration • Clear thought processing • Enhanced recall *Based on research from the National Center for Complementary and Alternative Medicine ©2015 21 How To Help Your Student Relax • Box Breathing (Four-square breathing) • Long Term Benefits • Long term anxiety reduction • Chronic pain reduction • Increased sense of well being • Improve immune function • Enhanced lung capacity • Enhanced body awareness • Enhanced control of bodily functions • Enhanced sense of presence • Increased energy *Based on research from the National Center for Complementary and Alternative Medicine ©2015 22 *Image courtesy of: http://dharmaineverywave.com/wpcontent/uploads/2012/08/SquareBreathe1.png ©2015 23 Take Relaxation to the Next Level Combine it with heart rate monitors! (Neurofeedback) Normal heart rates for adolescents = 40’s – 80’s 1. 2. 3. 4. 5. Teach how to palpate own pulse (radial/thumb) Teach how to box breathe Perform baseline HR with HR monitor on Perform box breathing Re-measure baseline HR and calculate change ©2015 24 Why A Primary Care Doctor Is Needed ©2015 25 Assessment for Indicators of Nutritional Risk • • • • • • • Family history Overweight/underweight Eating disorders Hyperlipidemia Hypertension Iron-deficiency anemia Drug-nutrient interactions 26 Assessment of Unhealthy Eating Practices • • • • • • Frequent dieting Meal skipping Food fads Portion sizes Emotional eating Increased consumption of high fat and sugar beverages and foods ©2015 27 Nutrition screening also includes: • Physical examination • Measurement of growth parameters • • Height, weight, BMI Measurement of vital signs • • • Heart rate, blood pressure Assessment of sexual maturity rating Other indicators of nutritional deficiency or imbalance • i.e. skin darkening around neckline indicating insulin resistance ©2015 28 If at increased nutritional risk: • • • Food frequency questionnaire 24-hour dietary recall Food diary ©2015 29 Assessment of Physical Activity Behaviors • • • Daily activity patterns Amount of moderate exercise Amount of screen time • TV, computer, phone, video games, etc. ©2015 30 To Little or To Much BMI ≤ 5% = Underweight* BMI 5% - 85% = Normal Weight BMI > 85% and < 95% = Overweight* BMI >95% = Obese* BMI ≥ 120% = Severe Obesity** *Require additional medical evaluation **Classification still under debate ©2015 31 http://www.cdc.gov/nchs/data/hestat/underweight_child_07_10/underweight_child_07_ 10.htm ©2015 32 Percentage of high school students who were obese* — selected U.S. states, Youth Risk Behavior Survey, 2003 http://www.cdc.gov/healthyschools/obesity/obesity-youth.htm ©2015 33 Percentage of high school students who were obese* — selected U.S. states, Youth Risk Behavior Survey, 2013 http://www.cdc.gov/healthyschools/obesity/obesity-youth.htm ©2015 34 Lab Assessment: INDICATION LABS RE-SCREEN BMI 85-94% without risk factors or family history unknown Fasting Lipid Profile (Chol, LDL, HDL, TG) Every 2 years BMI 85-94% with risk factors* Fasting Lipid Profile, AST, ALT, Fasting glucose Every 2 years BMI ≥ 95% Fasting Lipid Profile, AST, ALT, Fasting glucose Every 2 years *risk factors = 1st degree relative with obesity, Type 2 Diabetes, hypertension, lipid abnormality, or heart disease ©2015 35 Counseling provided by physician: • • • • • • • • Understanding health Understanding meaning of healthy foods Home environment Behaviors and emotions around eating Portion sizes Healthy drinks Parenting Physical activity ©2015 36 Counseling provided by physician: • • • • • • • • • Label reading Screen time and sleep Meal patterns and snacks Eating outside the home Holidays/special occasions Healthy Family (food rules for all) Community partneers Bullying and teasing Unintentional disruptions ©2015 37 Wrap Up ©2015 38 Image Courtesy of: http://www.communitycommons.org/wp-content/uploads/2014/11/5210.png 39 Other References: Pediatric Nutrition, 7th Edition 2. Care of the Young Athlete, 2nd Edition 3. Pediatric Obesity Clinical Decision Support (AAP) 4. Nelson’s Textbook of Pediatrics, 20th Edition 1. ©2015 40 [email protected] ©2015 41