|Assessment of Nutritional Status in Emergency-Affected Populations - Adolescents (UNSSCN, 2000, 24 p.)|
This RNIS supplement discusses the assessment of undernutrition in adolescents in emergency situations. The World Health Organization (WHO) defines adolescents as persons aged 10-19 years old. Because of the focus on humanitarian emergencies, the discussion will include only an evaluation of acute undernutrition. This paper will not address many other important nutritional problems in adolescents, such as anaemia and other micronutrient deficiencies, poor nutritional habits, eating disorders, and obesity 1.
The report will also not directly address chronic undernutrition. In children and young adolescents, chronic undernutrition leads to stunting (low height-for-age). In adolescents, chronic undernutrition also delays normal maturation 2-8. Although chronic undernutrition is an important and widespread problem 9 with multiple adverse health outcomes, it is not usually the highest nutritional priority in emergency situations. In such situations, acute undernutrition is often common and, at least in young children, may account for a substantial proportion of overall mortality 10. Moreover, the distinction between acute and chronic undernutrition among adolescents and adults is not nearly as clear as it is among young children. Since adults and older adolescents no longer increase their height, they cannot become stunted, and thinness may result from either a sudden or longstanding food deficit.
This discussion emphasizes practical issues of anthropometric assessment of nutritional status rather than general knowledge of adolescent growth and development. Nonetheless, this supplement does include some information on these topics so that the reader can understand the difficulties associated with anthropometric assessment in this age group.
This paper also points out some of the deficiencies of the current recommendations regarding the nutritional assessment of adolescents, including those published by WHO. Examples of assessments that have used the recommended procedures are included. Many of these assessments have produced misleading results, and at least one has resulted in the implementation of potentially unneeded interventions.
In displaced and emergency-affected populations, the most common method of assessing the overall nutritional status in a population is to weigh and measure children 6-59 months of age 11-14. However, emergencies in Europe, Central Asia, and Africa have highlighted the nutritional vulnerability of other population subgroups, such as elderly adults 1, 15-19. Adolescents have not traditionally been considered at disproportionately elevated nutritional risk in emergency situations. Nonetheless, because of rapid growth in stature, muscle mass, and fat mass during the peak of the adolescent growth spurt, the requirements for some nutrients is as high or higher in adolescents than in other age groups 13. Between 10 and 19 years of age, the requirement for many micronutrients, including vitamin A, thiamine, riboflavin, niacin, folic acid, vitamin B12, vitamin C, and iodine, reaches levels required by non-pregnant adults. Moreover, rapid growth produces a higher requirement among adolescents 10-14 years of age for calcium than any other population age group except pregnant women. The 2,420 kcal required per day by adolescents 15-19 years of age is the highest energy requirement of any age group. The recommended general ration of 2100 kcal per person per day for populations wholly dependent on relief food is based on a distribution of age and sex which assumes that 20% of the population are adolescents 10-19 years of age and 56% are adults. In populations with a higher proportion of adolescents or adults, this ration may provide insufficient energy 13.
Adolescence may also present a nutritional opportunity, although little is known about the short and long-term effects of acute undernutrition during adolescence. In many cultures, a large proportion of girls have their first pregnancy during adolescence. Improvement in nutritional status can improve pregnancy outcomes, including maternal death, foetal death, and preterm delivery, experienced by pregnant adolescents 9.