Transcript SMML PowerPoint Template

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
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Outline
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Introduction to speaker
Adolescent lifestyle and nutritional needs
Why have a primary care doctor?
Wrap Up
Questions
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Introduction to Speaker
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My Educational Timeline
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Michigan Native
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University of Detroit Mercy
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Bradenton, FL
William Beaumont Hospital – Royal Oak, MI
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B.S. Biochemistry, M.S. Chemistry
Lake Erie College of Osteopathic Medicine
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Richmond, MI
Internal Medicine/Pediatrics
St. Mary Mercy
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Primary Care Physician – Internal Medicine/Pediatrics
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What really makes me tick…
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Lifelong Athlete
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Softball, Cross Country, Powerlifting, Physique competitor,
CrossFit, competitive hiking
My passions
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Integrative approach to medicine
Sports performance
Nutrition and micronutrient optimization
Lifestyle optimization for optimal performance and longevity
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Adolescent Lifestyle
Overview
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Genetics
Lifestyle, Movement,
Stress, Sleep, Social
Nutrition
Base Image Courtesy of: www.dreamstime.com
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Adolescent Lifestyle
Nutrition
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Nutrition
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Needs determined by degree of sexual maturation
and biological maturity vs. chronological age
Increased growth rates
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Females – 10-12 years
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Increased proportion of body fat
Males 14-16 years
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Increased proportion of lean body mass and blood volume
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Typical Adolescent Food Habits:
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Increased tendency to skip meals
Eat more meals outside the home
Increased snacking
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Energy-dense foods and beverages
Increase consumption of fast foods
Dieting/Fads
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Adolescent Nutritional Needs
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Energy
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Protein – up to 0.5g/pound of body weight
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i.e. 120lb adolescent requires ~60g protein per day
Iron – 15mg/day females, 12mg/day males
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2,300 kcal/day – females, 2,700 kcal/day – males*
Meat (including shellfish)
Calcium – 1300mg/day
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3-4 servings dairy per day, dark green, leafy vegetables
Bone mineral density reaches its peak between ages 20-30 years
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During adolescence, ½ of adult bone calcium is accumulated
Zinc
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essential for growth and sexual maturation
Meat, seafood, lentils, cheese
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*for moderate activity
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Ideal Adolescent Diet*
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Protein 10-30%
Fat 25-35%
Carbohydrates 45-65%
*if no comorbid medical conditions
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Images Courtesy of: www.choosemyplate.gov
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Adolescent Lifestyle
Sleep
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Sleep
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Require 8.5-9.5 hours per night
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Sleep latency naturally shifts towards later
bedtime and later rise time
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2011 CDC Study*
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Almost 70% high school students not getting recommended
sleep on school nights
*http://www.sciencedirect.com/science/article/pii/S0091743511002878
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Insufficient sleep associated with:
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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
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Healthy Sleep Hygiene*
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Go to bed at the same time each night and rise
at the same time each morning.
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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
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Adolescent Lifestyle
Stress
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Sources of Adolescent Stress*
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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
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Ways to Decrease Stress
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Exercise and eat regularly
Avoid excess caffeine intake
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Avoid illegal drugs, alcohol and tobacco
Learn relaxation exercises
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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
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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
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How To Help Your Students Relax
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Box Breathing (Four-square breathing)
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Diaphragmatic breathing technique
Used by large number of high performing athletes, CEOs,
entrepreneurs, military, etc.
Short Term benefits*
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Reduction of anxiety
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Control of “fight or flight” response
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Enhances blood flow to brain, calming
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Enhances learning and skill development
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Increase in focused attention and long term concentration
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Clear thought processing
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Enhanced recall
*Based on research from the National Center for Complementary and Alternative Medicine
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How To Help Your Student Relax
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Box Breathing (Four-square breathing)
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Long Term Benefits
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Long term anxiety reduction
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Chronic pain reduction
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Increased sense of well being
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Improve immune function
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Enhanced lung capacity
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Enhanced body awareness
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Enhanced control of bodily functions
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Enhanced sense of presence
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Increased energy
*Based on research from the National Center for Complementary and Alternative Medicine
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*Image courtesy of:
http://dharmaineverywave.com/wpcontent/uploads/2012/08/SquareBreathe1.png
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Take Relaxation to the Next Level
Combine it with heart rate monitors!
(Neurofeedback)
Normal heart rates for adolescents = 40’s – 80’s
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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
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Why A Primary Care Doctor Is Needed
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Assessment for Indicators of Nutritional Risk
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Family history
Overweight/underweight
Eating disorders
Hyperlipidemia
Hypertension
Iron-deficiency anemia
Drug-nutrient interactions
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Assessment of Unhealthy Eating Practices
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Frequent dieting
Meal skipping
Food fads
Portion sizes
Emotional eating
Increased consumption of high fat and sugar
beverages and foods
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Nutrition screening also includes:
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Physical examination
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Measurement of growth parameters
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Height, weight, BMI
Measurement of vital signs
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Heart rate, blood pressure
Assessment of sexual maturity rating
Other indicators of nutritional deficiency or imbalance
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i.e. skin darkening around neckline indicating insulin resistance
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If at increased nutritional risk:
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Food frequency questionnaire
24-hour dietary recall
Food diary
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Assessment of Physical Activity Behaviors
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Daily activity patterns
Amount of moderate exercise
Amount of screen time
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TV, computer, phone, video games, etc.
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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
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http://www.cdc.gov/nchs/data/hestat/underweight_child_07_10/underweight_child_07_
10.htm
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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
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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
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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
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Counseling provided by physician:
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Understanding health
Understanding meaning of healthy foods
Home environment
Behaviors and emotions around eating
Portion sizes
Healthy drinks
Parenting
Physical activity
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Counseling provided by physician:
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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
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Wrap Up
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Image Courtesy of: http://www.communitycommons.org/wp-content/uploads/2014/11/5210.png
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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
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[email protected]
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