hyperlipidemia, hypertension, iron deficiency anemia, food insecurity, eating ....
meals, and who engage in chronic fasting or dieting should be counseled on
ways to ... examples of appropriate food substitutions and hands on practice with
..... the length of the appointment, cognitive ability of the client, fluency in English,
and ...
Chapter 4 NUTRITION SCREENING, ASSESSMENT AND INTERVENTION Jamie Stang and Mary Story Substantial rates of growth and development, combined with developmentally appropriate psychosocial changes, such as an increasing need for independence and a desire to make lifestyle choices that conform to peer ideals and differ from those of the family, place adolescents at risk for poor nutritional status. Because biological and psychosocial growth and development are dynamic throughout adolescence, it is important that teenagers be screened for adequacy of dietary intake and nutritional status each year. The Guidelines for Adolescent Preventive Services (GAPS) recommends that nutrition screening be included as a routine part of annual health guidance.1 Common indicators of nutritional risk that should be considered during nutrition screening include overweight, underweight, hyperlipidemia, hypertension, iron deficiency anemia, food insecurity, eating disorders, substance use, and excessive intake of foods and beverages that have high fat or sugar contents. Pregnant females should also be assessed for adequacy of weight gain, compliance with prenatal vitamin-mineral supplement recommendations and appropriateness of macro- and micronutrient intakes. Adolescents who are found to be at nutritional risk during nutrition screening can benefit from a full nutrition assessment to determine appropriate dietary change recommendations. Table 1 provides an overview of medical, psychosocial, dietary and laboratory nutrition risk indicators that should be considered during the processes of nutrition screening and assessment. Nutrition Screening Nutrition screening should begin with an accurate measurement of height and weight, and calculation of BMI (body mass index). These data should be plotted on age and gender appropriate National Center for Health Statistics 2000 growth charts2 to determine the appropriateness of weight for height and the presence of potential growth disorders. Table 2 illustrates indicators of weight for height status. Adolescents who are found to be < 5th percentile of weight for height or BMI for age and gender are classified as underweight and should be referred to a primary health care provider for evaluation of potential metabolic disorders, chronic health conditions, or eating disorders. Adolescents with a BMI ≥ 85th percentile but < 95th percentile are classified as at-risk for overweight.3 They should be referred for a full medical evaluation to determine the presence or absence of obesity-related complications as illustrated in Figure 1.4 Teenagers with a BMI ≥ 95th percentile are classified as overweight and should be referred for a complete medical evaluation to determine potential obesity-related complications. For adolescents who have completed biological growth and development as assessed using sexual maturation rating (SMR) in conjunction with chronological age (see Chapter 1), referral to a weight management program that can address the unique psychosocial and cognitive needs of adolescents and that follows the principles set forth in “Obesity Evaluation and Treatment: Expert Committee Recommendations”3 may be appropriate. Additional information on assessment and treatment of overweight among adolescents can be found in Chapter 7. Stang J, Story M (eds) Guidelines for Adolescent Nutrition Services (2005) http://www.epi.umn.edu/let/pubs/adol_book.shtm
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GUIDELINES FOR ADOLESCENT NUTRITION SERVICES
TABLE 1 Elements of a Nutrition Screening and Assessment for Adolescents Medical and Psychosocial History Components of an Initial Nutrition Screening
Medical history Psychosocial history Socioeconomic status and history
Growth and Development
Diet and Physical Activity
Routine Screenings and Laboratory Tests
Body Mass Index (BMI)
Meal and snacking patterns
Hemoglobin (females)
Sexual Maturation Rating (SMR)
Nutrient and nonnutrient supplement use
Serum cholesterol or blood lipids Blood pressure
Food security Food allergies/ intolerances Special dietary practices Alcohol consumption Physical activity and competitive sports Indications for an In-depth Nutrition Assessment
Chronic disease
Underweight
Food insecurity
Hypertension
Substance use
Overweight
Meal skipping
Hyperlipidemia
Poverty and/or homelessness
At-risk for overweight
Inadequate micronutrient intake
Iron deficiency anemia
Depression or dysthymia
Delayed sexual maturation
Excessive intake of total or saturated fat
Disordered eating
Short stature or stunting
Food allergy or intolerance
Eating disorders Body image disorders Pregnancy or lactation
Vegetarian diet Use of nonnutritional or herbal supplements Competition in competitive sports Chronic dieting Fasting Alcohol consumption
Source: Jamie Stang, Division of Epidemiology, University of Minnesota.
Chapter 4. Nutrition Screening, Assessment and Intervention
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TABLE 2 Indicators of Height and Weight Status for Adolescents Indicator
Anthropometric Variable
Cut-off Values
Stunting (low height-for-age)
Height-for-age
