Background: Adolescents, comprised of 10–19 year olds, form the largest generation of young people in our history. There are an estimated 1.8 billion adolescents in the world, with 90% residing in low- and middle-income countries. The burden of disease among adolescents has its origins in infectious and injury-related causes, but nutritional deficiencies, suboptimal linear growth, and undernutrition are major public health problems, even as overweight may be on the rise in many contexts. Summary and Key Messages: Girls are most vulnerable to the influences of cultural and gender norms, which often discriminate against them. Dietary patterns and physical activity, in addition to schooling and countervailing social norms for early marriage, influence health and nutritional well-being of adolescents. Nutrient requirements – -including those for energy, protein, iron, calcium, and -others – increase in adolescence to support adequate growth and development. In settings where dietary intakes are suboptimal, anemia and micronutrient deficiencies are high. Endocrine factors are essential for promoting normal adolescent growth and are sensitive to undernutrition. Growth velocity increases during puberty when peak height velocity occurs and catch-up is possible; in girls, about 15–25% of adult height is attained. A premature pregnancy can halt linear growth and increase the risk of adverse birth outcomes. Research is needed to fill the huge data gaps related to nutrition and growth during adolescence, in addition to testing interventions during this second window of opportunity to enhance growth and development, improve human capital, and to end the intergenerational cycle of growth failure.

1.
Merriam Webster Dictionary. https://www.merriam-webster.com/dictionary/adolescence (cited December 18, 2017).
2.
Das Gupta M, Engelman R, Levy J, Gretchen L, Merrick T, Rosen JE: The Power of 1.8 Billion: Adolescents, Youth, and the Transformation of the Future, State of World Population, 2014.
3.
Bloom D, Canning D, Sevilla J: The Demographic Dividend: A New Perspective on the Economic Consequences of Population Change, 2003: Rand Corporation.
4.
Kassebaum N, et al: Child and adolescent health from 1990 to 2015: findings from the global burden of diseases, injuries, and risk factors 2015 study. JAMA Pediatr 2017; 171: 573–592.
5.
Patton GC, et al: Our future: a Lancet commission on adolescent health and wellbeing. Lancet 2016; 387: 2423–2478.
6.
Black RE, et al: Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013; 382: 427–451.
7.
Akseer N, et al: 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.
8.
NCD Risk Factor Collaboration (NCD-RisC): Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet 2017; 390: 2627–2642.
9.
Twig G, et al: Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood. N Engl J Med 2016; 374: 2430–2440.
10.
Saydah S, et al: Cardiometabolic risk factors among US adolescents and young adults and risk of early mortality. Pediatrics 2013; 131:e679–e686.
11.
Lobstein T, et al: Child and adolescent obesity: part of a bigger picture. Lancet 2015; 385: 2510–2520.
12.
Kozuki N, et al: Short maternal stature increases risk of small-for-gestational-age and preterm births in low- and middle-income countries: individual participant data meta-analysis and population attributable fraction. J Nutr 2015; 145: 2542–2550.
13.
Institute of Medicine: Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, D.C., 2006.
14.
Aurino E: Do boys eat better than girls in India? Longitudinal evidence on dietary diversity and food consumption disparities among children and adolescents. Econ Hum Biol 2017; 25: 99–111.
15.
Keats EC, Rappaport A, Jain R, Oh C, Shah S, Bhutta ZA: Diet and Eating Practices among Adolescent Girls in Low- and Middle-Income Countries: A Systematic Review. USAID, 2017.
16.
Kolodziejczyk JK, Merchant G, Norman GJ: Reliability and validity of child/adolescent food frequency questionnaires that assess foods and/or food groups. J Pediatr Gastroenterol Nutr 2012; 55: 4–13.
17.
Rodriguez CA, et al: Development and validation of a food frequency questionnaire to estimate intake among children and adolescents in Urban Peru. Nutrients 2017; 9:pii:E1121.
18.
Rogol AD, Roemmich JN, Clark PA: Growth at puberty. J Adolesc Health 2002; 31(suppl 6):192–200.
19.
Styne DM: The regulation of pubertal growth. Horm Res 2003; 60(suppl 1):22–26.
20.
Alonso LC, Rosenfield RL: Molecular genetic and endocrine mechanisms of hair growth. Horm Res 2003; 60: 1–13.
21.
Tanner JM, Whitehouse RH: Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 1976; 51: 170–179.
22.
Abrams SA, et al: Calcium absorption, bone mass accumulation, and kinetics increase during early pubertal development in girls. J Clin Endocrinol Metab 2000; 85: 1805–1809.
23.
Bailey DA, et al: Calcium accretion in girls and boys during puberty: a longitudinal analysis. J Bone Miner Res 2000; 15: 2245–2250.
24.
Maynard LM, et al: Total-body and regional bone mineral content and areal bone mineral density in children aged 8–18 y: the Fels Longitudinal Study. Am J Clin Nutr 1998; 68: 1111–1117.
25.
Guo SS, et al: Age- and maturity-related changes in body composition during adolescence into adulthood: the Fels Longitudinal Study. Int J Obes Relat Metab Disord 1997; 21: 1167–1175.
26.
Roth DE, et al: Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 Demographic and Health Surveys from 64 countries (1993–2015). Lancet Glob Health 2017; 5:e1249–e1257.
27.
Prentice AM, et al: Critical windows for nutritional interventions against stunting. Am J Clin Nutr 2013; 97: 911–918.
28.
Proos LA, Hofvander Y, Tuvemo T: Menarcheal age and growth pattern of Indian girls adopted in Sweden. I. Menarcheal age. Acta Paediatr Scand 1991; 80: 852–858.
29.
Teilmann G, et al: Early puberty in internationally adopted girls: hormonal and clinical markers of puberty in 276 girls examined biannually over two years. Horm Res 2009; 72: 236–246.
30.
Lui JC, Nilsson O, Baron J: Growth plate senescence and catch-up growth. Endocr Dev 2011; 21: 23–29.
31.
Gafni RI, et al: Catch-up growth is associated with delayed senescence of the growth plate in rabbits. Pediatr Res 2001; 50: 618–623.
32.
Marino R, et al: Catch-up growth after hypothyroidism is caused by delayed growth plate senescence. Endocrinology 2008; 149: 1820–1828.
33.
Forcinito P, et al: Growth-inhibiting conditions slow growth plate senescence. J Endocrinol 2011; 208: 59–67.
34.
Preece MA, Baines MJ: A new family of mathematical models describing the human growth curve. Ann Hum Biol 1978; 5: 1–24.
35.
Karlberg J: A biologically-oriented mathematical model (ICP) for human growth. Acta Paediatr Scand Suppl 1989; 350: 70–94.
36.
Luna B: Developmental changes in cognitive control through adolescence. Adv Child Dev Behav 2009; 37: 233–278.
37.
Luna B, Padmanabhan A, O’Hearn K: What has fMRI told us about the development of cognitive control through adolescence? Brain Cogn 2010; 72: 101–113.
38.
Institute of Medicine: Dietary Reference Intakes for Calcium and Vitamin D. Washington, D.C., 2011.
39.
Dibba B, et al: Bone mineral contents and plasma osteocalcin concentrations of Gambian children 12 and 24 mo after the withdrawal of a calcium supplement. Am J Clin Nutr 2002; 76: 681–686.
40.
Dibba B, et al: Effect of calcium supplementation on bone mineral accretion in gambian children accustomed to a low-calcium diet. Am J Clin Nutr 2000; 71: 544–549.
41.
Mackelvie KJ, et al: A school-based exercise intervention augments bone mineral accrual in early pubertal girls. J Pediatr 2001; 139: 501–508.
42.
Roberts JL, Stein AD: The impact of nutritional interventions beyond the first 2 years of life on linear growth: a systematic review and meta-analysis. Adv Nutr 2017; 8: 323–336.
43.
Lassi ZS, et al: Systematic review on evidence-based adolescent nutrition interventions. Ann N Y Acad Sci 2017; 1393: 34–50.
44.
Christian P, Murray-Kolb L: Nutrient interactions and multiple-micronutrient supplementation. In: Nutrition and the developing brain. Editor(s) Victoria Hall Moran, Nicola Lowe. Taylor and Francis, UK, 2017.
45.
United Nations Children’s Fund, Progress for Children: A Report Card on Adolescents. New York, 2012.
46.
United Nations Children’s Fund, Ending Child Marriage: Progress and Prospects, 2014.
47.
Kozuki N, et al: The associations of parity and maternal age with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis. BMC Public Health 2013; 13(suppl 3):S2.
48.
Fall CH, et al: Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration). Lancet Glob Health 2015; 3:e366–e377.
49.
Fall CHD, et al: Disadvantages of having an adolescent mother. Lancet Glob Health 2016; 4:e787–e788.
50.
Smith GC, et al: Predicting cesarean section and uterine rupture among women attempting vaginal birth after prior cesarean section. PLoS Med 2005; 2:e252.
51.
Wallace J, et al: Nutrient partitioning during adolescent pregnancy. Reproduction 2001; 122: 347–357.
52.
Rah JH, et al: Pregnancy and lactation hinder growth and nutritional status of adolescent girls in rural Bangladesh. J Nutr 2008; 138: 1505–1511.
53.
Gigante DP, Rasmussen KM, Victora CG: Pregnancy increases BMI in adolescents of a population-based birth cohort. J Nutr 2005; 135: 74–80.
54.
Lundeen EA, et al: Adolescent pregnancy and attained height among black South African girls: matched-pair prospective study. PLoS One 2016; 11:e0147861.
55.
Motil KJ, Kertz B, Thotathuchery M: Lactational performance of adolescent mothers shows preliminary differences from that of adult women. J Adolesc Health 1997; 20: 442–449.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.