Should adolescents be specifically targeted for nutrition in developing countries

s underlined above, but meanwhile, existing height and BMI reference data (48) are useful, provided adjustments are made for maturity. At the individual 17 level, obesity needs to be confirmed with skinfold thickness or waist circumference measurements, as high BMI may not correspond to obesity. Adolescent-specific reference data for international use will need to be developed and validated against other measures of obesity, and also, against co-morbidity risk factors. Two years after puberty, adult BMI cut- offs may be used for overweight, and it has been suggested that equivalent cut-offs be defined for BMI-for-age at adolescence (129). Overweight grade I, or BMI above 25 in adults, corresponds roughly to the 80th percentile, and grade II (BMI >30), to the 95th. Nutritional assessment also involves dietary assessment (and looking for clinical signs of specific nutritional deficiencies as appropriate). Dietary assessment is all too often by-passed as unnecessary or too complex in health and nutrition work, at population or individual level. Yet, it is essential, and simple dietary quality scores may be developed, or else, adapted from existing tools (130-131). There should be a systematic dietary enquiry in adolescents, at least in cases of too low or too high BMI, during pregnancy, and when specific micronutrient deficiencies are suspected. 3.2.2. Control of micronutrient deficiencies Iron deficiency and anaemia need to be controlled and prevented, particularly in girls, and ahead of pregnancy as much as possible. Iron deficiency is the predominant cause of anaemia (132), and correcting it is an investment in adult productive and reproductive lives. Successful anaemia control programmes are indeed recognised as highly cost-effective, as underlined by the World Bank (108). Adolescents are to us a key target group for inclusive approaches combining sanitation, parasite control, and dietary intake. Iron from animal sources is more highly bioavailable, but consumption is constrained by income. However, there are accessible means of improving bioavailability of inorganic iron, notably consumption of vitamin C-rich foods, and avoidance of iron absorption inhibitors, such as tea, with meals. Fermentation and germination of cereals and legumes are also beneficial, although often overlooked. Iron deficiency is often accompanied with other micronutrient deficiencies such as folate, and particularly in developing countries, vitamin A and possibly also zinc. Macronutrient intake may even be inadequate in certain cases. It is therefore wise to focus on food-based approaches to improve the quality of diets of adolescents. Schools are the primary entry point, through education, school-feeding programmes, and gardening; other community-based approaches also have to be considered. Micronutrient supplementation may be indicated based on prevalence data of anaemia and vitamin A deficiency. However, for one, data on adolescents is seldom collected. Furthermore, adolescents (and even school children) are 18 usually not a priority target group for iron and vitamin A supplementation. Improving diets may be more realistic, and schools are an excellent setting to pilot-test location-specific measures to improve the nutritional quality of diets. In the case of vitamin A at least, there is now enough examples of successful dietary-based programmes (123, 133-134) to argue for such approaches. In the long-run, it is more cost-effective to stimulate local production, processing, and trade of micronutrient-dense foods, rather than to increase micronutrient supplement imports. Additionally, foods are not only nutrient mixtures; heretofore unknown protective factors are increasingly identified in various foods. Youth groups may also be resourceful for programmes designed to increase production and intake of provitamin A providing foods. In addition to education and dietary diversification, schools may be an effective vehicle for micronutrient-fortified foods. In Turkey, zinc-fortified bread was pilot-tested in school-age children, with positive preliminary results (135). There is scope for the concept of multi- nutrient fortified snacks or drinks for school children, as successfully tested in South Africa (136). Nonetheless, food-based approaches may not suffice, and adolescent girls should be a priority target group for iron-folate supplements to be distributed through schools, community workers, and youth groups. Weekly dosage may be appropriate outside of pregnancy, as some findings suggest (137-138). 3.2.3. Nutritional management of adolescent pregnancy Early pregnancy is also a nutritional issue, and preventing it should be the objective. Nutrition has to be an important dimension of antenatal (and postnatal) care particularly in adolescents. There have been reports of low effectiveness of antenatal care in general and for adolescents in developing countries, even among those attending care (139-140). Pregnant adolescents are usually at high obstetric risk by definition, and particularly so if they are immature, short and underweight (<25th percentile of BMI) at the onset of pregnancy. Adequate weight gain may even be more critical than in adult women (141), which implies close monitoring. Benchmarks for weight gain have been suggested (142). A frequent weakness of weight monitoring however, whether in pregnancy or childhood, is that inadequate weight does not seem to trigger adequate nutrition responses. Health care providers may not have a clear idea of relevant and context-specific dietary advice that can be given to pregnant women, adolescent or not, or of the counselling approach, even if by chance they do a careful dietary enquiry. It is suggested that location-specific guidelines (adapted from generic ones) be 19 developed or made available for appropriate integration of nutrition counselling in antenatal health care. Regarding food supplementation during pregnancy in order to improve foetal growth, there may be high benefit in malnourished women (143-144). There is unfortunately no specific data on adolescents, and the possibility of an adverse effect on foetal growth is a concern, as already discussed. Micronutrient supplements do not seem to pose this problem, and based on available evidence, pregnant adolescents with marginal micronutrient status may derive particular benefit from supplements of vitamin A, zinc, and calcium, in addition to iron-folate, as they are more liable to be deficient that adult women. A controlled zinc supplementation trial in African-American pregnant women with low plasma zinc resulted in a significant and substantial increase in birth weight, particularly in low BMI women, without unduly increasing the risk of cephalopelvic disproportion (145). Vitamin A supplementation during pregnancy resulted in a spectacular reduction of maternal mortality in Nepal (18). Calcium supplements may reduce the risk of premature delivery (but not intra-uterine growth retardation), pre-eclampsia and pregnancy-induced hypertension, according to systematic reviews and meta-analyses of nutrition interventions in pregnancy (146). As pregnant adolescents are at higher risk of pregnancy-induced hypertension and pre-eclampsia, calcium supplements may be of benefit (147). Furthermore, calcium supplements during pregnancy were associated with significantly lower blood pressure in the offspring, according to a controlled trial (148). In the Gambia, Prentice et al (149) observed no benefit of calcium supplements for one year after delivery on breastmilk calcium or on maternal bone mineral content, although dietary calcium intakes were low. Pregnant adolescents should be a priority subgroup for observational and intervention studies on calcium nutriture in different populations. Before pregnancy, or as early as possible, it is important to supply iodine in endemic areas without a salt iodization programme, in order to improve survival and prevent mental abnormalities in the new-born (150). Nutritional care in the postpartum may be particularly important in teenage mothers, (151). In addition to micronutrient supplementation as appropriate and diet counselling, support for breastfeeding is likely even more critical than in adult mothers, in view of reports of poorer 20 lactation performance and practices in adolescents, and of higher nutritional risk in the offspring, particularly among low-income mothers (97). 3.2.4. Management of severe malnutrition in adolescents Prevention of malnutrition in adolescents is done primarily through promotion of healthy eating, and food security measures for adequate access to food. The school has a key role in the former, while agriculture and community-based approaches are the main vehicle for the latter. In adolescents, malnutrition may be more common than normally assumed in emergency situations, and as part of emergency health care, the health sector should address this issue. Once detected, severe malnutrition is reportedly to be treated much the same as in younger children (152), although refeeding may be more difficult because of anorexia and resistance to tube feeding, and because protein content of the diet is more critical because of more common oedema. The problem is that owing to inadequate scientific basis for screening, management, and discharge criteria, severe malnourished adolescents are seldom included in therapeutic or supplementary feeding programmes offered younger children in emergency settings, other than on an ad hoc basis. Furthermore, unless the nutritional status of adolescents is appraised, it is uneasy to draw attention on high malnutrition rates, and on the need to provide nutritional support. This raises again the issue of inadequate anthropometric indicators for assessing nutritional status of adolescents. Not only height and BMI, but also the mid-arm circumference should be validated in adolescents. 3.2.5. Prevention (management) of obesity Prevention of obesity among adolescents is highly relevant wherever it is widespread in certain population segments, or else where it may soon become so. It would likely be irrelevant only in poorer groups of low income countries, particularly in rural areas. Except perhaps in poorest countries, clustering of obesity and other chronic diseases is observed in the lower income population groups. The risk behaviours are first established in society sectors with time and money to access processed foods, motorised transportation, tobacco and alcohol; as such items become accessible, the risks spread to other groups, while the more privileged are switching to healthier foods and lifestyles (50). Primary prevention of obesity is predominantly done through promoting healthy eating and physical activity, and schools are consequently the main entry point. It is not much different among adolescents and younger 21 school-age children, except that obesity prevention should be given more emphasis in adolescents. Essentially the same messages on eating hold, whether for general health, and for the prevention of obesity and other chronic diseases (see above). Where obesity is increasing and leanness is becoming a social norm, prevention of eating disturbances through strengthening self-esteem and a positive body image is more pertinent at adolescence, and particularly in girls. Schools appear as an ideal setting, as it can be assumed that in developing countries, the related problems of obesity and eating disturbances are more likely to be encountered in better-off adolescents, whose majority would still be in school, and who are under a marked influence of western youth lifestyles and values. Based on suggestions of Rosen and Neumark-Sztainer (76), school-based prevention programmes should target the following: 1) Reducing body dissatisfaction; 2) Critical thinking about socio-cultural and peer norms; 3) Understanding physical development; 4) improved knowledge about nutrition and weight control; and 5) Skill development for healthy eating and weight management. Ideally, this should be combined with opportunities for healthy eating right at school. As suggested above, BMI monitoring could be done in schools through systematic, perhaps yearly, measuring of weights and heights. Those above the cut-off for overweight (as well as the underweight school-children and adolescents) could be referred to health services for further assessment and counselling. Confirmation of obesity can be based upon skinfold thickness (or waist circumference: see 57). Children or adolescents who are referred for obesity, and whose birth record indicates that they were born at term but were of small size, as well as those who have a family history of diabetes or cardiovascular disease, are at particularly high risk. They should get relevant advice and support, and benefit from closer monitoring for body weight reduction/maintenance. Sensible snacking, staying away from dieting, avoidance of meal skipping, breakfast in particular, are additional dietary advice for weight control. While breakfast may be useful in the framework of weight control (153), it is observed that adolescents have a tendency to skip it, and obese people as well (154). Physical activity requires particular emphasis. As recommended by the American Medical Association (155), early signs of eating disorders are a low BMI (<5th percentile), or loss of 2 BMI units or loss of 10% of previous weight, combined with inappropriate feelings of being overweight, or extreme measures reported to lose weight. In addition to individual counselling, obesity/eating disorder prevention could involve small group work with those at particular risk. 22 3.3. Clinical nutrition case management This may not receive as much attention as the other two components of the global strategy for adolescent nutrition, but it is nonetheless indispensable for health care services to deal with nutritional aspects of diseases in adolescents in an appropriate manner. Although conditions requiring special diets would normally be handled by specialised health personnel, health service providers have to be aware of basic principles of nutritional management of common diseases. Among adolescents, diabetes and HIV are relevant and particularly challenging nutrition-wise. Type 1 diabetes is in industrialised countries the third most common disease in young people after asthma and cerebral palsy (156). With increasing obesity, there is evidence of growing incidence of type-2 diabetes among adolescents of developed countries. It is likely that among the diseases that call for modified diets in adolescence, diabetes is close to the top of the list. There are quite a few reports of declining metabolic control of type-1 diabetes in adolescents, owing in part to reduced self-management (157-158). A consistent observation is that family support is associated with better control of diabetes in adolescence (159-160). Group approaches to self-care may be even more effective than in adults. In contrast with type-1, those with type-2 diabetes are generally obese, and the primary aim of treatment should be gradual and sustained weight loss for glucose control and reduction of blood lipids. However, treatment of adolescents with type-2 diabetes is reportedly very difficult. Specific education, a strong interaction with the health care team, and direct involvement of the family, have been advocated (161). Regarding HIV/AIDS, adequate nutrition can improve the status and course of the disease, in adolescents and other affected age groups. However, in developing countries where malnutrition is widespread owing to poverty, and where adolescents are not a priority group for nutrition, improving the quality of diet may be quite a challenge. Multiple micronutrient supplements may have benefits (162). These supplements, and basic hygiene with food and water, may be the only feasible and the most cost-effective measures in many developing countries where HIV-infected people cannot afford the costly medication. A practical guide for nutrition in HIV has been recently developed in Zimbabwe (163). There is a risk of vertical transmission of HIV by breastmilk, but it has to be measured against the advantages of breastfeeding. It has been suggested, based on current research data, that women with HIV could breastfeed for 4 months without increasing the transmission risk (164). However, the 23 final decision is in the hands of mothers, who need to be adequately informed by health care providers, particularly adolescents. Multivitamin supplementation of infected women during pregnancy was shown to reduce low birth weights in Tanzania, while improving the immunity (165). Pregnant adolescents should be the first to receive these supplements wherever available. 4. Conclusions and recommendations Nutritional vulnerability may in certain respects be lower in adolescence than early childhood, although adolescent pregnancy is a high risk condition. It is mostly because adolescence provides a window of opportunity for long term positive impact that nutrition should be a programmatic priority in adolescents. It is a challenge, however, considering that while health is not a major concern at that age, promotion of healthy nutrition behaviours is the core element. Furthermore, there is very little data on adolescent nutrition to back up programmes and their funding. Adolescents who are not attending school may also be quite difficult to reach in certain settings. Nutrition promotion is to be the pillar of the global strategy to address nutrition issues in adolescence. Schools, more than health care centres, appear as the main entry point: adolescents are generally healthy, nutrition can be integrated in health promoting school programmes, and nutrition activities may be school-led to also reach those adolescents that are no longer in school. Schools ought to develop close links with health services for prevention and management of specific nutrition disorders, and with community development programmes to address food security problems. To us, a global strategy of this nature can be implemented without necessarily requiring a specific programme for adolescent nutrition. It is felt that explicit policies are needed at country level, however, to identify local priority issues, and to address these in a cohesive manner. WHO could provide guidance to nation states for developing their policy on adolescent nutrition. A high priority in nearly all contexts is to improve nutritional status of girls, with emphasis on micronutrients, preferably before, and at least early in their first pregnancy. This could go a long way towards curbing maternal and infant mortality, and contribute to breaking the vicious cycle of intergenerational malnutrition, poverty, and even chronic disease. School- 24 based, health facility-based, and community-based activities carried out in a coordinated fashion should be considered to improve nutrition of adolescent girls. Another relevant priority world-wide is the prevention of obesity (and disordered eating), with a particular emphasis, again on adolescent girls because they are more susceptible. Urban schools are preferred settings, as it is assumed that those adolescents at higher risk of obesity are thereby targeted. There is at present so little data on adolescents' nutritional status and micronutrient nutrition, eating patterns and underlying influences, and on impact of nutrition intervention in adolescence, that research needs are immense. In order to develop appropriate anthropometric reference data, a multi-country study, with longitudinal and cross-sectional components, on adolescents’ somatic growth and maturation should be considered high priority. Such data are needed to define not only cut-off points, but also rates of too low or too high values that should trigger action at programme or individual level. Meanwhile, the feasibility of routine weight and height measurements in schools, including adolescents and younger children, deserves to be examined. BMI nomograms and tables with percentile cut-offs for under-, as well as over-weight, as well as appropriate guidelines for their use with adolescents (and younger school-age children), could be useful for schools and health services, while efforts are pursued to develop specific reference data. Another priority research need is for well-controlled studies on the effects of micronutrient status/supplements on bone mineralisation, the timing and magnitude of the growth spurt, and maturation in adolescent boys and girls, in particular vitamin A, calcium, zinc, and iron. It was suggested earlier that adolescents (and schools) were ideal targets for food-based approaches to improving micronutrient status, in particular vitamin A and iron. The effectiveness of pilot interventions focusing on achievable improvements of micronutrient status through food would urgently need to be evaluated, with considerations of process, cost and sustainability in addition to micronutrient status impact. Much research is still needed to provide a stronger base for effective nutrition monitoring and management in pregnancy in general, and adolescent pregnancy in particular. In this regard, studies on the effect of multiple micronutrient (or food supplementation) on maternal and 25 foetal outcomes in adolescent pregnancy are warranted, because it is as yet unclear how the adolescent mother and the foetus partition the extra nutrients. A better understanding of adolescents’ diets and eating behaviours is essential for relevant education programmes. Additionally, dietary enquiry tools specifically designed for adolescents are direly needed. The enquiry should encompass household food security, food diversity (as indicator of nutritional quality), eating practices and underlying influences, and physical activity. These tools need to be developed and validated in different settings, in connection with school-based or health centre-based intervention programmes rather than as free-standing research, for higher relevance. Participatory approaches are particularly well suited for research work with adolescents. Research on two contrasting themes – severe malnutrition and obesity in adolescents - is also recommended as a means of strengthening programmes. Studies on nutritional assessment, rehabilitation, and discharge criteria in severely malnourished adolescents are called for, as well as evaluation research on the impact of school-based pilot projects for nutrition promotion and prevention of obesity. 261 FIG.1. CONCEPTUAL FRAMEWORK OF NUTRITIONAL PROBLEMS AND CAUSAL FACTORS IN ADOLESCENCE Malnutrition during foetal life/ infancy/childhood; Low body stores Livelihood factors: -Sedentary lifestyle (or heavy physical work) -Alcohol - Smoking Malnutrition, micronutrient malnutrition, obesity, and other nutrition-related chronic diseases Infectious diseases & other health problems Socio-economic factors : Access to food; Food supplies Psycho-social factors : Eating patterns Eating disturbances Cultural patterns & practices Typical eating styles of adolescents Lack of access to nutritious and safe food (poverty) Changes in processed food supplies Early pregnancy DIETARY INADEQUACIES Food supply deficit 271 FIG 2. STRATEGY FOR NUTRITION INTERVENTION IN ADOLESCENCE CLINICAL CASE MANAGEMENT Diabetes HIV/AIDS Other PREVENTION- MANAGEMENT MICRONUTRIENT MALNUTRITION EARLY PREGNANCY UNDERNUTRITION/MALNUTRITION OBESITY (and associated chronic diseases) EATING DISORDERS NUTRITION PROMOTION HEALTHY EATING BREASTFEEDING PHYSICAL ACTIVITY SELF-ESTEEM 281 REFERENCES 15. Ahmed F, Khan MR, Karim R, et al. Serum retinol and biochemical measures of iron status in adolescent schoolgirls in urban Bangladesh. Eur J Clin Nutr 1996; 50:346-51 160. Anderson JA, Brackett J, Ho J, Laffel LMB. An office-based intervention to maintain parent-adolescent teamwork in diabetes management. Diabetes Care 1999; 22:713-21 137. Angeles-Agdeppa I, Schultink W, Sastroamidjojo S, et al. Weekly nutrient supplementation to build iron stores in female Indonesian adolescents. Am J Clin Nut 1997; 66:177-83 32. Aspray TJ, Prentice A, Cole TJ, et al. Low bone mineral content is common but osteoporotic fractures are rare in elderly rural Gambian women. J Bone Miner Res 1996; 11: 1019-25 147. Atallah AN, Hofmeyr GJ, Duley L. Calcium supplementation during pregnancy to prevent hypertensive disorders and related adverse outcomes (Cochrane Review). In: The Cochrane Library Issue 3, 1998. Oxford: Update Software 117. Bandura A. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall, 1986 99. Barker DJP. Mothers, babies, and disease in later life. London: BMJ Publ Group, 1994 16. Barker DJP, Bull AR, Osmond C, Simmonds SJ. Fetal and placental size and risk of hypertension in adult life. Brit Med J 1990; 301:259-62 14. Barr F, Brabin L, Agbaje S, et al. Reducing iron deficiency anaemia due to heavy menstrual blood loss in Nigerian rural adolescents. Public Health Nut 1998; 1:249-57 9. Behrman JR. The economic rationale for investing in nutrition in developing countries. Washington: USAID, Office of Nutrition, 1992 148. Belizan JM, Villar J, Bergel E, et al. Long-term effect of calcium supplementation during pregnancy on the blood pressure of offspring: follow-up of randomised controlled trial. Brit Med J 1997; 315:281-5 156. Betts P, Buckley M, Davis R, et al. The care of young people with diabetes. Diab Med 1996; 13 (Suppl 4):S54-9 162. Bijlsma M. Living positively. Nutrition Guide for People with HIV/AIDS (2nd ed). Zimbabwe: Mutare City Health Department 1997 2. Blum RW. Global trends in adolescent health. J Am Med Assoc 1991; 265:2711-9 88. Blum RW. Improving the health of youth. A community perspective. J Adolesc Health 1998; 23:254-8 87. Bongaarts J, Cohen B. Introduction and overview. Studies in Family Planning 1998; 29:99-105 291 140 Brabin L, Verhoeff FH, Kazembe P, et al. Improving antenatal care for pregnant adolescents in southern Malawi. Acta Obstet Gynecol Scand 1998; 77:402-9 157. Brink SJ, Moltz K. The message of the DCCT for children and adolescents. Diabetes Spectrum 1997; 10:259-67 159. Burrough TE, Harris MA, Pontious SL, Santiago JV. Research on social support in adolescents with IDDM: a critical review. Diab Educ 1997; 23:438-48 97. Buvinic M. The costs of adolescence childbearing: evidence from Chile, Barbados, Guatemala, and Mexico. Studies in Family Planning 1998; 29:201-9 45. Castillo-Duran C, Garcia H, Venegas P, et al. Zinc supplementation increases growth velocity of male children and adolescents with short stature. Acta Paediatr 1994; 83:833-7 69. Cavadini C, Decarli B, Dirren H, et al. Assessment of adolescent food habits in Switzerland. Appetite 1999; 32:97-106 143. Ceesay SM, Prentice AM, Cole TJ, et al. Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia : 5-year randomized controlled trial. Brit Med J 1997; 315 :786-90 25. Chan GM, McMurray M, Westover K, et al. Effects of increased dietary calcium intake upon calcium and bone mineral status of lactating adolescent and adult women. Am J Clin Nutr 1987; 46:319-23 27. Chan GM, Hoffman K, McMurray M. Effects of dairy products on bone and body composition in pubertal girls J. Paediatr 1995; 126:551-6 65. Chauliac M, deBeco J. Nutritional habits of adolescents in the Paris suburbs. Arch Pediatr 1996; 3:227-34 114. Chauliac M, Barros T, Masse-Raimbault AM, Yepez R. Jardins scolaires et ộducation alimentaire en milieu andin. Food Nutr Agric [FAO] 1996; 16:14-22 109. Chendi H. Adolescent sexuality and reproductive health: does education matter? In: Kuate-Defo B (ed): Sexuality and reproductive health during adolescence in Africa with special reference to Cameroon. Ottawa, Canada: University of Ottawa Press, 1998, pp.351-63 118. Contento IR, Manning AD, Shannon B. Research perspective on school-based nutrition education. J Nutr Educ 1992; 24:247-60 138. Cook JD, Reddy MB. Efficacy of weekly compared with daily iron supplementation. Am J Clin Nutr 1995; 62:117-20 5. Cordonnier D. ẫvộnements quotidiens et bien-ờtre à l’adolescence. Vers de nouvelles stratộgies d’ộducation pour la santộ. Genốve: ẫd Mộd Hyg, 1995 154. Cornelius LJ. Health habits of school-age children. J Health Care Underserv 1991; 2:374-95 301 113. Delisle H. La sộcuritộ alimentaire, ses liens avec la nutrition et la santộ. In: Delisle H, Shaw DJ (Eds). The Quest for Food Security in the Twenty First Century. Can J Development Studies 1998a; 19 (Special Issue): 307-21 150. De Long GR, Leslie PW, Wang SH et al. Effect on infant nortality of iodination of irrigation water in a severely iodine-deficient area of China. Lancet 1997; 350 :771-3 7. DeMaeyer E, Adiels-Tegman M. The prevalence of anaemia in the world World Health Stats Q 1985; 38:302-16 62. Dennison CM, Shepherd R. Adolescent food choice: an application of the theory of planned behaviour. J Human Nutr Dietet 1995; 8:9-23 123. De Pee S, Bloem MW, Satoto, et al. Impact of a social marketing campaign promoting dark-green leafy vegetables and eggs in Central Java, Indonesia. Int J Vitam Nutr Res 1998a; 68:389-98 129. Dietz WH, Robinson TN. Use of the body mass index (BMI) as a measure of overweight in children and adolescents (editorial). J Pediatr 1998; 132:191-3 82. Dinger MK, Waigandt A. Dietary intake and physical activity behaviors of male and female college students. Am J Health Prom 1997; 11:360-2 64. Douch JG, Story M, Dresser C, et al. Correlates of high-fat/low nutrient-dense snack consumption among adolescents: results from two national health surveys. Am J Health Prom 1995; 10:85-8 58. Douketis JD, Feightner JW, Attia J, et al. Examen mộdical pộriodique, mise à jour de 1999: 1. Dộtection, prộvention et traitement de l’obộsitộ. Can Med Assoc J 1999; 160 (10 Suppl):S1-12 155. Elster AB, Kuznets NJ. AMA guidelines for adolescent preventive services (GAPS). Recommendations and rationale. Chicago: AMA, 1995 91. Eveleth PB, Tanner JM. Worldwide variation in human growth, 2nd ed. Cambridge: Cambridge University Press, 1990 128. FAO. Social communication in nutrition: a methodology for intervention. Rome: FAO, 1994 127. FAO. Preparation and use of food based dietary guidelines. Rome: FAO, 1997. 164. Fawzi WM, Msaamanga GI, Spiegelman D, et al. Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1 infected women in Tanzania. Lancet 1998; 351:1477-82 19. Fazio-Tirrozzo G, Brabin L, Brabin B, et al. A community based study of vitamin A and vitamin E status of adolescent girls living in Shire Valley, Malawi. Eur J Clin Nutr 1998; 52:637-42 311 72. Fisher M, Golden NH, Katzman DK, et al. Eating disorders in adolescents. A background paper. J Adolesc Health 1995; 16:420-37 112. Fitzgerald FT. The tyranny of health. N Engl J Med 1994; 331:196-8 111. Fứrde OH. Is imposing risk awareness cultural imperialism? Soc Sci Med 1998; 47:1155-9 101. Forrester TE, Wilks RJ, Bennett FI, et al. Fetal growth and cardiovascular risk factors in Jamaican school children Brit Med J 1996; 312:156-60 57. Freedman DS, Serdula MK, Srinavasan R, Berenson GS. Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 1999; 69:308-17 162. Friis H, Michaelsen KF. Micronutrients and HIV infection: a review. Eur J Clin Nutr 1998; 52:157-63 74. Gard MCE, Freeman CP. Dismantling a myth: Review of eating disorders and socioeconomic status. Int J Eat Disord 1996; 20:1-12 151. Gillespie S. Improving adolescent and maternal nutrition: an overview of benefits and options. UNICEF Staff Working Papers, Nutrition Series, 1997 132. Gillespie SR, Johnston J. Expert consultation on anemia determinants and interventions. Ottawa: Micronutrient Initiative, 1998 100. Godfrey K, Forrester T, Barker DJP, et al. Maternal nutritional status in pregnancy and blood pressure in childhood. Br J Obstet Gynaecol 1994; 101:398-403 35. Golden MHN. Is complete catch-up possible for stunted malnourished children? Eur J Clin Nutr 1994; 48 (Suppl 1): S58-71 59. Gortmaker SL, Must A, Perrin JM, et al. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med 1993; 329:1008-12 120. Greene AL. Future time perspective in adolescence: the present of things future revisited. J Youth Adolesc 1986; 15:99-113 146. Gỹlmezoglu M, de Onis M, Villar J. Effectiveness of interventions to prevent or treat impaired fetal growth. Obstet Gynecol Survey 1997; 52:139-49 92. Gutierrez Y, King JC. Nutrition during teenage pregnancy. Pediatr Ann 1993; 22:99-108 38. Haas JD, Murdoch S, Rivera J, Martorell R. Early nutrition and later physical work capacity. Nut Rev 1996; 54 (Suppl II): S41-48 115. Hall A, Bundy D. The partnership for child development: promoting the health, nutrition and education of school-age children. SCN News 1998; 16:4-7 321 37. Harrison K, Fleming A, Briggs N, Rossiter C. Growth during pregnancy in Nigerian teenage primigravidae. Brit J Obstet Gynecol 1985; 92(Suppl 5):32-9 24. Heany RP. Nutrition and catch-up bone augmentation in young women (Editorial). Am J Clin Nutr 1998; 68:523-4 78. Heinberg LJ, Wood KC, Thompson JK. Body image. In: Rickert VI (Ed). Adolescent Nutrition – Assessment and management. New York: Chapman & Hall Inc., 1996:136-56 86. Inoussa S, Alihonou E, Vissoh S, et al. Influence of women’s social status on the nutritional status of adolescent girls in Bộnin. Washington, D.C: ICRW Nutrition of Adolescent Girls Research Program, No.8, 1994 131. International Vitamin A Consultative Group (IVACG). Guidelines for the development of a simplified dietary assessment to identify groups at risk for inadequate intake of vitamin A. Washington, D.C.: International Life Science Institute, 1989 106. Jacoby ER, Cueto S, Pollitt E. When science and politics listen to each other: good prospects from a new school breakfast program in Peru. Am J Clin Nutr 1998; 67 (Suppl):S795-7 104. James P. The global nutrition challenge in the Millenium: Presentation of the draft Commission Report. In: ACC/SCN Symposium Report Nutrition Policy Paper #17, Challenges for the 21st Century: A gender perspective on nutrition through the life cycle, pp.25-55, 1998 66. Johnston PK, Haddad EH. Vegetarian and other dietary practices. In: Rickert VI (Ed). Adolescent Nutrition – Assessment and management. New York: Chapman & Hall Inc, 1996:57-88 22. Key JD, Key LL Jr. Calcium needs of adolescents. Curr Opin Pediatr 1994; 6:379-82 135. Kilic I, Ozalp I, Coskun T, et al. The effect of zinc-supplemented bread consumption on school children with asymptomatic zinc deficiency. J Pediatr Gastroenterol Nutr 1998; 26:167-71 124. Kim Y. The effects of a breastfeeding campaign on adolescent Korean women. Pediat Nurs 1998; 24:235-40 44. King JC. Does poor zinc nutriture retard skeletal growth and mineralisation in adolescents? Am J Clin Nutr 1996; 64:375-6 121. Kotler P, Roberto E. Social marketing: strategies for changing public behavior. New York: The Free Press, 1989 90. Kramer MS. Determinants of low birth weight: methodological assessment and meta- analysis. Bull WHO 1987; 65:663-737 145. Krebs NF. Zinc supplementation during lactation. Am J Clin Nutr 1998; 68 (Suppl):509S-12 331 34. Kurz KM. Adolescent nutritional status in developing countries. Proc Nutr Soc 1996; 55:321-31 89. Kurz KM. Health consequences of adolescent childbearing in developing countries. Washington, D.C., ICRW Working Paper No. 4, 1997 6. Kurz KM, Johnson-Welch C. The nutrition and lives of adolescents in developing countries: Findings from the nutrition of adolescent girls research program. ICRW, 1994 54. Lauer R, Clarke W. Use of cholesterol measurements in childhood for the prediction of adult hypercholesterolemia. J Am Med Assoc 1990; 264:3034-8 17. Law CM, Shiell AW, Is blood pressure inversely related to birthweight? The strength of evidence from a systematic review of the literature. J Hypertension 1996; 14:935-41 43. Lộger J, Czernichow P. Croissance et taille finale des sujets nộs avec un retard de croissance: facteurs prộdictifs. In: Journộes Parisiennes de Pộdiatrie 1999. Paris: Mộdecine- Sciences Flammarion 1999:61-7 52. Leon DA, Koupilova I, Lithell HO, et al. Failure to realise growth potential in utero and adult obesity in relation to blood pressure in 50 year-old Swedish men. BMJ 1996; 312:401-6 164. Leroy V, Newell ML, Dabis F et al. International multicentre pooled analysis of late postnatal mother-to-child transmission of HIV-1 infection. Lancet 1998; 352:597-600 85. Leslie J. Improving the nutrition of women in the Third World. In: Pinstrup-Andersen P et al (eds). Child Growth and nutrition in developing countries: Priorities for Action. New York: Cornell University Press, 1995 10. Li R, Chen X, Yan H, et al. Functional consequences of iron supplementation in iron- deficient female cotton mill workers inn Beijing, China. Am J Clin Nutr 1994; 59:908-13 26. Lloyd T, Andon MB, Rollings N, et al. Calcium supplementation and bone mineral density in adolescent girls. J Am Med Assoc 1993; 270:841-4 139. McDonagh M. Is antenatal care effective in reducing maternal morbidity and mortality? Health Policy Plann 1996; 11:1-15 3. Maddaleno M, Silber TJ. An epidemiological view of adolescent health in Latin America. J Adolesc Health 1993; 14:595-604 36. Martorell R, Kettel Khan L, Schroeder DG. Reversibility of stunting: Epidemiological findings in children from developing countries. Eur J Clin Nutr 1994; 48 (Suppl 1):S45-57 81. Milligan RAK, Burke V, Dunbar D, et al. Associations between lifestyle and cardiovascular risk factors in 18-year-old Australians. J Adolesc Health 1997; 21:186-95 158. Morris AD, Boyle DIR, McMahon AD, et al. Adherence to insulin treatment, glycaemic control and ketoacidosis in insulin dependent diabetes mellitus. Lancet 1997; 350:1505-10 341 96. Motil KJ, Kertz B, Montandon CM, Ellis KJ. Dietary nutrients are diverted from milk production to body stores in lactating adolescents. Fed Proc 1996; 10:A190 47. Must A, Jacques PF, Dallal GE, Dietz WH. Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. Am J Clin Nutr 1991; 53:839-46, 1991 (Correction: Am J Clin Nutr 1991; 54:773) 56. Must A, Jacques PF, Dallal GE, et al. Long-term morbidity and mortality of overweight adolescents: a follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med 1992; 327:1350-5 11. Nelson M. Anaemia in adolescent girls: effects on cognitive function and activity. Proc Nutr Soc 1996; 55:359-67 80. Neumark-Sztainer D, Story M, Toporov E, et al. Covariations of eating behaviors with other health-related behaviors among adolescents. J Adolesc Health 1997; 20:450-8 68. Neumark-Sztainer D, Story M, Resnick MD, Blum RW. Lessons learned about adolescent nutrition from the Minnesota Adolescent Health Survey. J Am Diet Assoc 1998; 98:1449-56 77. Neumark-Sztainer D, Story M, Falkner NH, et al. Sociodemographic and personal characteristics of adolescents engaged in weight loss and weight/muscle gain behaviors: Who is doing what? Prev Med 1999; 28:40-50 67. Nowak M, Speare R. Gender differences in food-related concerns, beliefs and behaviours of north Queensland adolescents. J. Paediatr Child Health 1996; 32:424-7 110. Nutbeam D. Promoting health and preventing disease: An international perspective on youth health promotion. J Adolesc Health 1997; 20:39-402 134. Pant CR, Pokharel GP, Curtale F, et al. Impact of nutrition education and mega-dose vitamin A supplementation on the health of children in Nepal. Bull WHO 1996; 74:533-45 29. Parra-Cabrera S, Hernandez-Avila M, Tamayo-y-Orozco J, et al. Exercise and reproductive factors as predictors of bone density among osteoporotic women in Mexico City. Calcif Tissue Int 1996;59: 89-94 49. Pietrobelli A, Faith MS, Allison DB, et al. Body mass index as a measure of adiposity among children and adolescents: A validation study. J Pediatr 1998; 132:204-10 161. Pinhas-Hamiel O, Zeitler P. A weighty problem – Diagnosis and treatment of Type 2 diabetes in adolescents. Diabetes Spectrum 1997; 10:292-8 41. Popkin BM, Richards MK, Montiero CA. Stunting is associated with overweight in children of four nations that are undergoing the nutrition transition. J Nutr 1996; 126:3009-16 39. Post GB, Kemper HC. Nutrient intake and biological maturation during adolescence. The Amsterdam growth and health longitudinal study. Eur J Clin Nutr 1993; 47:400-8 149. Prentice A, Jarjou LM, Stirling DM, et al. Biochemical markers of calcium and bone metabolism during 18 months of lactation in Gambian women accustomed to a low calcium 351 intake and in those consuming a calcium supplement. J Clin Endocrinol Metab 1998; 83:1059-66 8. Raunklar RA, Sabio H. Anemia in the adolescent athlete. Am J Dis Child 1992; 146:1201-5 23. Recker RR, Davies KM, Hinders SM, et al. Bone gain in young adult women. J Am Med Assoc 1992; 268: 2403-8 21. Rees JM, Christine MT. Nutritional influences on physical growth and behavior in adolescence. In: Adams G (ed). Biology of adolescent behaviour and development. California: Sage Publications, 1989 141. Rees JM, Englebert-Fenton K, Gong E, Bach C. Weight gain in adolescents during pregnancy: rate related to birthweight outcome. Am J Clin Nutr 1992; 56:868-73 83. Robinson TN, Killen JD. Ethnic and gender differences in the relationship between television viewing and obesity, physical activity, and dietary fat intake. J Health Educ 1995; 26 (Suppl.2):91-7 130. Rockett HR, Colditz GA. Assessing diets of children and adolescents. Am J Clin Nutr 1997; 65 (Suppl): S1116-22 76. Rosen DS, Neumark-Sztainer D. Review of options for primary prevention of eating disturbances among adolescents. J Adolesc Health 1998; 23:354-63 94. Rush D. Effects of changes in maternal energy and protein intake during pregnancy, with special reference to fetal growth. In: Sharp F, Fraser RB, Milner RDG (Eds). Fetal growth. London: Royal Coll Obstetr and Gynecol 1989:203-29 122. Samuels SE. Project LEAN – Lessons learned from a national social marketing campaign. Pub Health Rep 1993; 108:45-53 28. Sandstead HH. Zinc deficiency. A public health problem? Am J Dis Child 1991; 145:853- 9 42. Sawaya Al, Dallal G, Solymos G, et al. Obesity and malnutrition in a shantytown population in the city of Sao Paolo, Brazil. Obes Res 1995; 3 (Suppl 2): S107-15 153. Schlundt DG, Hill JO, Sbrocco T, et al. The role of breakfast in the treatment of obesity: a randomized clinical trial. Am J Clin Nutr 1992; 55:645-51 95. Scholl TO, Hediger ML, Ances IG. Maternal growth during pregnancy and decreased infant birth weight. Am J Clin Nutr 1990; 51:790-3 116. Schucksmith J, Hendry LB. Health issues and adolescents: growing up, speaking out. England: Routledge, 1998 30. Scrimgeour EM. Prevention of fracture of the neck of the femur: evidence from developing countries of the relative unimportance of osteoporosis. Aust N Z J Med 1992; 22:85-6 361 4. Senderowitz J. Adolescent health: reassessing the passage to adulthood. World Bank Discussion Paper No. 272, Washington, D.C: World Bank, 1995 55. Serdula MK, Ivery D, Coates RJ, et al. Do obese children become obese adults? A review of the literature. Prev Med 1993; 22:167-77 70. Sharma I. Trends in the intake of ready-to-eat food among urban school children in Nepal. SCN News 1998; 16:21-2 31. Shatrugna V. Osteoporosis in the Asian region: newer questions. In: Shetty P, Gopalan G (ed). Diet, nutrition and chronic disease. An Asian perspective. UK: Smith & Gordon, 1998:81-3 60. Sheperd R and Dennison CM. Influences on adolescent food choices. Proc Nutr Soc 1996; 55:345-57 107. Simeon DT. School feeding in Jamaica: a review of its evaluation. Am J Clin Nutr 1998; 67 (Suppl):S790-4 133. Smitasiri S, Attig GA, Valyasevi A, et al. Social marketing vitamin A-rich foods in Thailand: a model nutrition communication behavior change process. New York: UNICEF, and Thailand: Institute of Nutrition of Mahidol University, 1993 61. Spear B. Adolescent growth and development. In: Rickert VI (Ed). Adolescent nutrition. Assessment and management. New York: Chapman & Hall, 1996:1-24 53. Stark D, Atkins E, Wolff DH et al. Longitudinal study of obesity in the National Survey of Health and Development. Brit Med J 1981; 283:12-7 73. Story M, French SA, Resnick MD, et al. Ethnic/racial and socioeconomic differences in dieting behaviors and body image perceptions in adolescents. Int J Eat Disord 1995; 18:173-9 71. Strasburger VC, Donnerstein E. Children, adolescents, and the media: issues and solutions. Pediatrics 1999; 103:129-39 33. Strause L, Saltman P, Smith KT, et al. Spinal bone loss in postmenopausal women supplemented with calcium and trace minerals. J Nutr 1994; 124:1060-4 20. Tiwari BD, Godbole MM, Chattopadhyay N, et al. Learning disabilities and poor motivation to achieve due to prolonged iodine deficiency. Am J Clin Nutr 1996; 63:782-6 103. Tullock J. Integrated approach to child health in developing countries. Lancet 1999; 354 (Suppl II):16-20 1. United Nations. The sex and age distribution of the world populations: The 1996 revision. New York: United Nations, 1997 63. U.S. Dept Health and Human Services, Am Sch Health Assoc, Assoc Adv Health Educ, Soc Public Health Educ, Inc. The National Adolescent Student Health Survey: A Report of the Health of America’s Youth. Oakland, CA: Third Party, 1989 371 84. U.S. Dept Health and Human Services. Physical activity and health: A report of the Surgeon General. Atlanta, Ga: Centers for disease control and prevention, 1996 13. Van den Broek NR, Letsky EA, White SA, Shenkin A. Iron status in pregnant women: which measurements are valid? Br J Haematol 1998; 103:817-24 40. Van Lenthe FJ, Kemper CG, van Michelen W. Rapid maturation in adolescence results in greater obesity in adulthood: the Amsterdam Growth and Health Study. Am J Clin Nutr 1996; 64:18-24 136. Van Stuijvenberg ME, Kvalsvig JD, Faber M, et al. Effect of iron-, iodine-, and
- carotene-fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial. Am J Clin Nutr 1999; 69:497-503 98. Vieira Bruno Z, Bailey P. Brazil: Adolescent longitudinal study. Summary of final report prepared for the Women’s Study Project, Family Health International, 1998 12. Walker SP, Grantham-McGregor S, Himes JH, Williams S. Adolescent Kingston girls’ school achievement: nutrition, health and social factors. Proc Nutr Soc 1996; 55:333-43 93. Wallace JM, Aitken RP, Cheyne MA. Nutrient partitioning and fetal growth in rapidly growing adolescent ewes. J Reprod Fertil 1996; 10:183-90 51. Wang Y, Popkin B, Zhai F. The nutritional status and dietary pattern of Chinese adolescents, 1991 and 1993. Eur J Clin Nutr 1998; 52: 908-16 18. West K, Katz J, Khatry SK, et al. Double blind, cluster randomised trial of low dose supplementation with vitamin A or
-carotene on mortality related to pregnancy in Nepal. Brit Med J 1999; 318:570-5 48. WHO. Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. Technical Report, Geneva, 1995a 142. WHO Maternal anthropometry and pregnancy outcomes. A WHO collaborative study. Geneva: WHO, 1995b 105. WHO. Promoting health through schools: The World Health Organization’s Global School Health Initiative. Geneva: WHO, 1996a 125. WHO. Preparation and use of food-based dietary guidelines. Report of a joint FAO/WHO Expert Consultation, Nicosie, Cyprus, 1995. Geneva: WHO, 1996b 50. WHO. Obesity - Preventing and managing the global epidemic. Report of a WHO consultation on obesity, 3-5 June 1997. Geneva: WHO, 1998a 126. WHO. Preparation and use of food-based dietary guidelines. Report of a joint FAO/WHO consultation. Geneva, WHO Tech Rep Series No 880, 1999b 152. WHO. Management of severe malnutrition: a manual for physicians and other senior health workers. Geneva: WHO, 1999c 381 102. WHO/UNFPA/UNICEF Study Group on Programming for Adolescent Health. Programming for Adolescent Health: Discussion Paper, WHO, 1995 75. Wilfley DE, Schreiber GB, Pike KM, et al. Eating disturbance and body image: comparison of a community sample of adult black and white women. Int J Eat Disord 1996; 20:377-87 144. Winkvist A, Habicht JP, Rasmussen KM. Linking maternal and infant benefits of a nutritional supplement during pregnancy and lactation. Am J Clin Nutr 1998; 68:656-61 119. Wodarski JS, Smokowski PR, Feit MD. Adolescent preventive health: a cost-beneficial social and life group paradigm. J Prevent Interv Community 1996; 14:1-40 46. Woodruff BA, Duffield A, Blanck H, et al. Prevalence of low body mass index and specific micronutrient deficiencies in adolescents 10-19 years of age in Bhutanese refugee camps, Nepal. UNHCR, 1999-11-25 99. Woodward M, Bolton-Smith C, Tunstall-Pedoe H. Deficient health knowledge, diet and other lifestyles in smokers: is a multifactorial approach required? Prev Med 1994; 23:354-61 108. World Bank. World Development Report 1993: Investing in Health. Washington, World Bank, 1993