Poor nutritional status and its implications on adolescents

Introduction

According to Anand, Kant and Kapoor (2009), adolescence is a period of transition between childhood and adulthood that demands extra nutrients and energy-rich food for rapid growth and maturation. Inadequate diet and unfavourable environmental condition in developing nations like Nigeria may adversely affect the growth and nutrition of adolescents. Malnutrition, both undernutrition and overnutrition, refers to an impairment of health, resulting from a deficiency or from an excess or imbalance of nutrients. It is of public health significance among adolescents across the world (Mukhopadhyay, Bhadra & Bose, 2012).

The coexistence of overweight/obesity and underweight is rather common in developing countries and is found to be increased proportionally over time (Caballero, 2007). Several studies have investigated the nutritional status of children and adolescents from different parts of Nigeria (Adeyemi & Olufemi, 2009). According to World Health Organisation (2008), there are approximately 60 million children in Africa who are underweight; this prevalence is higher in rural areas compared to urban areas. Africa is ranked second continent behind South East Asia with underweight burdens in the world. However, Africa is now also beginning to experience the emerging problem of overweight. A recent study among Nigeria children in the age group 6–18 years suggests the existence of a double burden of underweight and overweight. Parallel to persistent undernutrition, obesity rates are increasing globally, including those of many low- and middle-income countries that previously had a very low prevalence (Adeyemi & Olufemi, 2009).

Globally, an estimated 10 percent of school-aged children between 5 to 7 years of age are overweight or obese, and around 43 million children under age five are overweight. Studies also show that the prevalence of overweight and obesity in the world today fluctuates between 11 and 23 percent. In South East Asia the prevalence of undernutrition (53.9%) is found among school-aged children. Another study among boys and girl aged 3–18 years of sub-Saharan Africa shows the prevalence of underweight at 36.3 percent. The prevalence of overweight among boys and girls is found to be 1.95 percent and 1.96 percent, respectively.

Definition of nutritional status

According to David (2005), nutritional status is the condition of the body in those respects influenced by the diet; the levels of nutrients in the body and the ability of those levels to maintain normal metabolic integrity. Srihari, Eilander and Muthayya (2007) opined that nutritional status of an individual refers to whether or not the individual is eating the correct amounts and types of nutrients that he or she ought to eat. They added that nutritional status can be determined by assessing several factors, including body composition and appearance, blood levels, existing conditions, and issues that may impact access to or ability to consume and absorb food and also influenced by the amount of each essential nutrient that an individual consumes.

For adolescents and adults, general adequacy of nutritional status is assessed by measuring weight and height; the result is commonly expressed as the body mass index, the ratio of weight in kilogramme (kg) to height in metre square (m²). Body fat may also be estimated, by measuring skinfold thickness, and muscle diameter is also measured. For children, weight and height for age are compared with standard data for adequately nourished children. The increase in the circumference of the head and the development of bones may also be measured (David, 2005).

Methods of nutritional status assessment

According to Lohman, Roch, and Mortorell (2008), a person’s nutritional status is the condition of the body that results from the utilization of essential nutrients made available from his/her daily diet. It depends on the relative nutrient needs of the body and the ability to digest and utilize them. It is measured by anthropometric, biochemical, clinical, and dietary methods (sometimes called ABCD’s of nutritional assessment).

Anthropometric method of nutritional status assessment

Anthropometric method is the objective measurements of body muscle and fat. It is used to compare individuals, to compare growth in the young, and to assess weight loss or gain in the mature individual. Weight and height are the most frequently used anthropometric measurements, and skin-fold measurements of several areas of the body are also taken. It is commonly expressed as the body mass index (BMI), the ratio of weight in kilogramme (kg) to height in metre square (m²) (Lohman et al, 2008).

Biochemical method of nutritional status assessment

In biochemical method of nutritional status, laboratory tests based on blood and urine is used to for the assessment of nutritional status. Evaluating nutritional status by laboratory methods is a very objective and precise approach in the determination of the nutritional status of an individual. It utilizes biochemical tests, performed in a hospital, commercial or other laboratory, to measure levels of nutrients in biological fluids (blood or urine) or to evaluate certain biochemical functions which are dependent on an adequate supply of essential nutrients.

In general, laboratory methods are used to determine deficiencies in:

1. Serum protein, particularly albumin level;
2. The blood-forming nutrients: iron, folacin, vitamin B₆, and vitamin B₁₂;
3. Water-soluble vitamins: thiamine, riboflavin, niacin, and vitamin C;
4. The fat-soluble vitamins: A, D, E, and K;
5. Minerals: iron, iodine and other trace elements;
6. Levels of blood lipids such as cholesterol and triglycerides, glucose and various enzymes which are implicated in heart disease, diabetes, and other chronic diseases.

The objectives of biochemical method for the assessment of nutritional status have two primary functions:

• To detect marginal nutritional deficiencies in individuals, particularly when dietary histories are questionable or unavailable; their use is especially important before overt clinical signs of disease appear, thus permitting the initiation of appropriate remedial steps.
• To supplement or enhance other studies, such as dietary or community assessment among specific population groups, in order to pinpoint nutritional problems that these modalities may have suggested or failed to reveal.

Clinical data

Clinical data can be used to determine the nutritional status of an individual by obtaining the information about the individual’s medical history, including acute and chronic illness and diagnostic procedures, therapies, or treatments that may increase nutrient needs or induce malabsorption. In this current medications are documented, and both prescription drugs and over-the-counter drugs, such as laxatives or analgesics, are included in the analysis. Vitamins, minerals, and herbal preparations are also reviewed. Physical signs of malnutrition are documented during the nutrition interview.

Dietary data method of nutritional status assessment

There are many ways to document dietary intake. The accuracy of the data is frequently challenged, however, since both questioning and observing can impact the actual intake. During a nutrition interview the practitioner may ask what the individual ate during the previous twenty-four hours, beginning with the last item eaten prior to the interview. Practitioners can train individuals on completing a food diary, and they can request that the record be kept for either three days or one week. Documentation includes portion sizes and how the food was prepared. Brand names or the restaurant where the food was eaten can assist in assessing the details of the intake. Estimating portion sizes is difficult, and requesting that every food be measured or weighed is time-consuming and can be impractical. Food models and photographs of foods are therefore used to assist in recalling the portion size of the food.

During the nutrition interview, data collection will include questions about the individual’s lifestyle—including the number of meals eaten daily, where they are eaten, and who prepared the meals. Information about allergies, food intolerances, and food avoidances, as well as caffeine and alcohol use, should be collected. Exercise frequency and occupation help to identify the need for increased calories.

Importance of good nutrition to health status

In order for the bodies to function properly and stay healthy, it is important that we follow a good nutritious diet. Foods are made up of six (6) classes of nutrients. These nutrients are macronutrients (protein, carbohydrates, fats), micronutrients (vitamins and minerals) and water. If you neglect to have the right combination of these six classes of foods, it will be very difficult to live a healthy lifestyle and achieve a health nutritional status (Medhi, Barua & Mahanta, 2009).

The following are the importance of good nutrition to health status:

1. Building blocks of muscles

When you eat foods that contain protein, they are broken down in the body as amino acids. These amino acids are then used to build and repair any muscle tissue. This is great for those who are physically active or exercise regularly. This means you will be able to recover at a faster rate than if you were not to consume protein. Every tissue in your body is made up of protein and it is important to consume enough through your diet to replenish it. Protein is also needed to help your immune and nervous system (Medhi, et al, 2009).

2. Provision of energy

Foods such as carbohydrates give you energy to function properly throughout your day. In fact, muscle glycogen is an important element to helping you maintain your energy levels throughout your day. When carbohydrates are ingested your pancreas releases a hormone called insulin. Insulin helps the carbohydrates to be stored in the muscles or as fat. Stored carbohydrates in the body are also known as glycogen. Glycogen (stored carbohydrates) is important to have in your body before working out. They will be an energy supply and not only enable you to achieve better fat loss results, but also help your overall physique (Medhi, et al, 2009).

3. Provision of fats

Without fats you will not be able to survive. They are one of the three macronutrients. Stored fats are our main source of energy. They also help to keep our body warm during cold weather. Fats lubricate joints which in terms, keeps your muscles loose and mobile for better workouts. Fats are also a dwelling spot for fat-soluble vitamins such as A, D, E, and K. These vitamins are stored in our body’s fat and can become toxic if too much is taken (Medhi, et al, 2009).

4. Provision of vitamins and minerals

Vitamins and minerals are important nutrients our bodies need in order not only to function properly but also allow chemical reactions to occur at a faster rate. B-complex vitamins provide a great health benefit as they help to further break down carbohydrates which in terms will give you energy (Medhi, et al, 2009).

5.   Prevention of nutritional deficiencies

Many nutritional deficiencies, such as rickets and scurvy, used to be common for children to have but are now very rare. This is because we now know that proper nutrition prevents the dangerous effects of disorders caused by nutritional deficiencies. It is important to make sure children get enough vitamins and minerals, by eating foods from all of the recommended food groups daily, especially fruits and vegetables (Medhi, et al, 2009).

6.   Prevention of obesity

Good nutrition habits like eating fruits and vegetables every day and limiting sugar intake prevents childhood and adolescent obesity. Childhood and adolescent obesity is becoming such a problem that obesity-related health problems which adults often have are now appearing in children and adolescent. There are now cases of type II diabetes and high cholesterol in school children. If children and adolescents are taught good nutritional practices by their parents, they are less likely to be over-nourished and become obese. Good nutrition habits like eating fruits and vegetables every day and limiting sugar intake prevents childhood and adolescent obesity related problems that can last an entire lifetime.

7.   Disease prevention

Too much or too little of certain nutrients can also contribute to health issues. For instance, a lack of calcium in your diet can predispose you to developing osteoporosis, or weakening of your bones, while too much saturated fat can cause cardiovascular disease, and too few fruits and vegetables in your nutrition plan is associated with an increased incidence of cancer. Consuming foods from a wide variety of sources helps ensure your body has the nutrients it needs to avoid these health problems.

Signs and symptoms of poor nutritional status

According to Drewnowski and Popkin (2009), the following are the signs and symptoms of poor nutritional status:

1. Weight changes

Changes in weight, be in gain or loss, are not always a symptom of poor nutrition.  It is perfectly possible to gain or lose weight whilst eating a healthy balanced and nutritious diet.  However, often a rapid weight change may indicate changing eating patterns and be an early sign of poor nutrition. Weight loss, particularly to levels that are considered unhealthy, may occur due to decreased intake, which leaves the risk of not enough food being consumed to meet requirements.  On the other hand, weight gain may be due to excessive intake of high calorie, low nutrient foods which do not provide the necessary nutrition.

2. Disease and illness

As many nutrients found in food are essential for the processes that take place in the body, if these are not consumed things can start to go wrong.  Lack of certain nutrients can lead to debilitating conditions which in the long term can have serious consequences. Lack of calcium for example, especially during years of bone growth, can lead to osteoporosis late in life, while a lack of iron can lead to anaemia.  Not enough vitamin B₁₂ can lead to nervous system problems over time and lack of vitamin A results in blindness, although this is mainly seen in populations with very low intake due to lack of food supply such as in third world countries.

It is common that people with poor nutritional intake are often more susceptible to viruses and infections as their body lacks the energy and nutrients needed to feed the immune system and fight disease.  These people may seem to constantly have a cold or the flu and rarely appear to be completely healthy. If you suspect you have a condition caused by lack of a certain nutrient or by a poor diet in general, see your health professional to determine if this is the case.  Symptoms associated with malnutrition are often similar to those of many other conditions, so it is essential to get a correct diagnosis to determine the right treatment.

3. Tiredness and lack of concentration

Although these may not seem as serious as a full blown disease or condition, feeling lethargic, tired and unable to concentrate can make everyday activities a lot more difficult and can impact your life in a big way from how you perform at work to having enough energy to do exercise. Tiredness can be related to a huge number of nutrient deficiencies, although the most common are things like iron, particularly in women and athletes, B₁₂ and water.  Skipping meals can also lead to lethargy as the body is not receiving the energy it requires to function.

4. Physical symptoms

Sometimes it is possible to see physical effects of a poor diet.  These could be things like flaky, dry skin, lifeless, thin hair, cracked nails, diarrhoea or constipation, poor oral health and poor would healing.  In severe cases, infertility, and lack of menstruation in women may result.

5. Conditions with high risk of poor nutrition

There are many conditions that may impact negatively on nutrition status and lead to inadequate intake.  For example those undergoing cancer treatments often experience changes in appetite which can lead to a drop in intake and poor nutrient intake at a time when they need it most.

Elderly people, especially those that are ill or have an impairment of some nature are also susceptible as many will rely on others for food or even forget to eat as well as a reduced appetite being common in old age. Those with eating disorders who are severely reducing intake are at a very high risk, as are alcoholics who may neglect food in favour of drinks which provide little or no nutrients.

2.6    Causes of poor nutritional status

There are several causes of poor nutritional status among these causes are as stated by Kumari and Krishna (2011):

1.   Poverty

Poverty and lack of resources are two causes of bad nutrition that contribute to the estimated 925 million people worldwide suffering the effects of malnutrition and its companion diseases, according to the Food and Agriculture Organization of the United Nations (FAO, 2008). The criteria for defining malnutrition are inadequate intake of protein and micronutrients, or vitamins and minerals, which causes millions of children to die each year or to suffer lifelong physical and mental disabilities as the result of bad nutrition.

2.   Limited access

According to the Centres for Disease Control and Prevention (CDC, 2010), bad nutrition is among the many factors contributing to childhood obesity. In some locations, access to supermarkets and large grocery stores is limited by distance, economic status and lack of transportation. Residents of many of these communities, although unable to obtain affordable, nutritious food, nonetheless have access to fast foods with their lower nutritional composition. This affects the daily nutritional needs of adults as well as children.

3.   Age-related nutrition deficiency

Aging is an additional cause of bad nutrition. Older adults who live alone or those with reduced mobility may have difficulty shopping for and preparing food. As a natural part of aging, changes that occur in taste and smell might cause a decrease in appetite, which leads to nutritional deficiencies. Economic hardship also contributes to the bad nutritional status of many senior citizens, because it limits their food choices. Physiological changes and illness contribute to a reduction in metabolic rate and diminished appetite.

4.   Social and environmental issues

Adolescents are notorious for bad nutritional choices. Peer influence, easy access to fast food, addictive behaviours, and being raised by caregivers who lack knowledge of proper nutrition can cause children to grow up suffering the effects of poor eating habits. The cycle continues in college, where many students consume a nutritionally poor diet lacking sufficient amounts of fruits, vegetables and dairy products; skip meals; and over-consume fast foods. This type of eating behaviour is not only bad nutritionally – it leads to nutrition-related health problems, including obesity.

5.   Medications

Some over-the-counter and prescription medications affect the appetite and interfere with nutrient absorption and metabolism. People taking these medications over a long period may suffer from the same nutritional deficiencies as those who eat nutritionally poor diets. According to CDC (2010), medications such as birth control pills can reduce nutrient metabolism, resulting in decreased levels of vitamin B₆ and folate. Some anticonvulsants can cause the liver to remove additional amounts of vitamin D, which aids calcium absorption. Excess amounts of some nutritional supplements inhibit nutrient absorption. For example, excess zinc, copper or iron might interfere with one another’s absorption.

2.7    Effects of poor nutritional status

Poor nutrition status can lead to serious health issues, because nutrition and diet affect how you feel, look, think and act. Poor nutritional status results in lower core strength, slower problem solving ability and muscle response time, and less alertness. According to Drewnowski and Popkin (2009), poor nutritional status creates many other negative health effects which include:

1.   Obesity

According to a National Centre of Health Statistics 2013 survey, about 65.2 percent of American adults are overweight or obese as a result of poor nutrition. Obesity is defined as having a body mass index (BMI) of 25 or more. Being overweight puts people at risk for developing a host of disorders and conditions, some of them life-threatening.

2.   Hypertension

The National Institutes of Health (2010) reports that hypertension is one of the possible outcomes of poor nutrition. Hypertension, also known as high blood pressure, is called the silent killer, because it frequently remains undetected and thus untreated until damage to the body has been done. Eating too much junk food, fried food, salt, sugar, dairy products, caffeine and refined food can cause hypertension.

3.   High cholesterol and heart disease

Poor nutrition can lead to high cholesterol, which is a primary contributor to heart disease. The National Institutes of Health (2010) reports that more than 500,000 people in the United States die each year due to heart disease, which can be caused by a high fat diet. High cholesterol foods contain a large amount of saturated fat. Examples include ice cream, eggs, cheese, butter and beef. Instead of high fat foods, choose lean proteins such as chicken, turkey, fish and seafood and avoid processed foods.

4.   Diabetes

Diabetes also can be linked to poor nutrition. Some forms of the disease can result from consuming a sugar- and fat-laden diet, leading to weight gain. According to the National Institute of Health (2010), about 8 percent of the world’s population has diabetes.

5.   Stroke

A stroke that is caused by plaque that builds up in a blood vessel, then breaks free as a clot that travels to your brain and creates a blockage can be linked to poor nutrition. Strokes damage the brain and impair functioning, sometimes leading to death. Foods high in salt, fat and cholesterol increase your risk for stroke.

6.   Gout

According to the National Institutes of Health (2010), poor nutrition can lead to gout. With gout, uric acid build-up results in the formation of crystals in your joints. The painful swelling associated with gout can lead to permanent joint damage. A diet that is high in fat or cholesterol can cause gout. Some seafood–sardines, mussels, oysters and scallops–as well as red meat, poultry, pork, butter, whole milk, ice cream and cheese can increase the amount of uric acid in your body, causing gout.

7.   Cancer

According to the National Institutes of Health (2010), several types of cancer, including bladder, colon and breast cancers, may be partially caused by poor dietary habits. Limit your intake of foods that contains refined sugars, nitrates and hydrogenated oils, including hot dogs, processed meats, bacon, doughnuts and French fries.

• Management of poor nutritional status

Poor nutritional status lead to underweight, overweight or obesity. Due to their peculiarity and associated health implication, it is paramount to manage these unhealthy conditions to enhance the quality of life of the individuals.

Management of underweight

SohI (2007), pointed out that most often, being underweight is a sign of an accompanying disorder. This disorder must first be dealt with in order to bring weight back to normal. In addition, to this treatment, physical activity may need to be modified and psychological counselling may be required. After the treatment of the primary disorder is successful, nutritional support may be provided along with dietary changes. The objectives of dietary modification are to restore the body to its normal weight, rebuild tissue and store nutrients, and maintain the desirable body weight The nutrient required for the management of underweight areas follows;

1. Energy: A nutritious high energy diet providing calories over and above the body’s requirement will result in weight gain. An increase of about 500 -1000 cal per day can result in a weight gain of approximately one kilogram per week.
2. Protein: A liberal intake of high quality protein will help in building up of muscle tissue. A daily protein intake of two grams per kilogram of body weight will be required. For example, if your body weight is 60 kg, you require 75-120 g protein.
3. Carbohydrates: A high carbohydrate intake is also necessary to meet the energy requirements of a malnourished body. The bulk of the diet however should not be increased as it cuts down food intake. Avoid taking more fibre than is necessary for regular bowel movement.
4. Fats: Fats aid in the weight gain process, but they should only be used in amounts that can be tolerated. Emulsified fats like butter, cream etc. are better tolerated by the body.
5. Minerals and vitamins: These must be provided in sufficient amounts in order to counter for nutritional deficiencies.

Management of overweight or obesity

According to Mayo Clinic (2013) the following ways are used in preventing and to manage overweight or obesity.

1. Monitor your weight regularly: People who weigh themselves at least once a week are more successful in keeping of excess pounds. Monitoring your weight can tell you whether your efforts are working and can help you detect small weight gain before they become big problems.
2. Know and avoid the food traps that cause you to eat: Identify situations that trigger you out of control eating. Try to keep a journal and write down what you eat, how much you eat, when you ear, how you are feeling and how hungry you are. And develop strategies for handling these types of situation and stay in control of your eating behaviour.
3. Exercise regularly: An individual needs to get 150 to 250 minutes of moderate intensity activity a week to prevent weight gain. Moderately intense physically activities include fast walking and swimming.
4. Eat healthy meals and snacks: Focus on low calories, nutrients dense foods such as fruits, vegetables and whole grain. Avoid saturated fat and limit sweet and alcohol. Ensure that you choose cod that promotes healthy weight gain and good health more often than you choose food that don’t.
5. Consistent: Stick to your healthy weight plan during the week.

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