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New Focus on Reducing Anemia in Adolescent Girls

By Marion Roche, PhD

The target set out by the World Health Assembly is to reduce the anemia in all women of reproductive age by 50% by 2025. Women make up about 3.5 billion in population on our planet. In order to reach this World Health Assembly target, it will be essential to address anemia in the 600 million adolescent girls in the world and recently their nutrition has been getting more attention.

The global birth rate has declined over the past decade, except when analyzing the rate for adolescent girls, with 17-20 million adolescent pregnancies per year. Eleven percent of all pregnancies are to adolescents and 95% of these adolescent pregnancies are occurring in developing countries.

Complications from pregnancy and child birth are the second greatest contributor to mortality for girls 15-19 years of age. Young maternal age increases the risk for anemia during pregnancy, yet adolescent women are less likely to be covered by health services, including micronutrient supplementation, than older women. Compared with older mothers, pregnancy during adolescence is associated with a 50% increased risk of stillbirths and neonatal deaths, and greater risk of preterm birth, low birth weight and small for gestational age (SGA) (Bhutta et al, 2013; Kozuki et al, 2013; Gibbs et al, 2012).

Reducing anemia in adolescents is often motivated by efforts to improve maternal and newborn health outcomes for pregnant adolescents; however, benefits for improving adolescent school performance and productivity at work and in their personal lives should also be valued.

Globally, iron deficiency anaemia is the third most important cause of lost disability adjusted life years (DALYs) in adolescents worldwide at 3%, behind alcohol and unsafe sex (Sawyer et al, 2012).

Adolescents have among the highest energy needs in their diets, yet in developing countries many of them struggle to meet their micronutrient needs. The World Health Organization recommends intermittent or weekly Iron Folic Acid Supplements for non-pregnant women of reproductive age, including adolescent girls. IFA supplementation programs have often been designed to be delivered through the existing health systems, without specific strategies for reaching adolescent girls.

I have heard adolescence referred to as “the awkward years” when individuals explore self-expression and autonomy, but it is also definitely an awkward period for public health services in terms of delivering nutrition, as we often fail to reach this age group.

There have been examples of programs going beyond the health system to reach adolescent girls, such as through schools, peer outreach, factory settings where adolescents work in some countries and even sales in private pharmacies to target middle and upper income adolescent girls.
The Micronutrient Initiative implemented a pilot project with promising results in Chhattisgarh, India where teachers distributed the IFA supplements to 66,709 female students once per week during the school year over a 2 year pilot.

It was new for the schools to become involved in distribution of health commodities, but engaged teachers proved to be effective advocates. There were also efforts to reach the even more vulnerable out of school girls through the integrated child development centers, yet this proved to be a more challenging group of adolescents to reach. Peer to peer outreach by the school girls offered a potential strategy. The current project is being scaled up to reach over 3.5 million school girls.

Adolescent girls have much to offer to their friends, families and communities beyond being potential future mothers. It is time to get them the nutrients they need to thrive in school, work and life.


Is Nutrition Influencing Puberty in Teen Girls?

By Meghan Anderson Thomas

The age of menarche has decreased significantly in the past century, from an average age of 16-17 years old to younger than 13 years of age (Buttke, Sircar, & Martin, 2012). There are several different theories as to why this may be occurring. Some believe that environmental toxins or exposure to estrogen-disrupting compounds (EDC) may play a role. EDCs are found in household plastics, cleaners, deodorizers and personal care products. Other theories include increased body mass index in children and adolescents. Increased hormones found in obese children maybe responsible for the earlier onset of puberty. Finally, nutritional implications such as breast versus bottle-feeding and increased dairy and meat intake in adolescence may also play a role in puberty at younger ages.

EDCs include benzophenones, dichlorophenols, parabens, triclosan, which are compounds that effect estrogen signaling by binding to the receptor and have downstream effects (Buttke, Sircar, & Martin, 2012). These compounds are becoming increasingly common in everyday and household use. This type of exposure may be implicated as one of the causes of decreased age of menarche. In a study by Buttke et al, the level of urinary EDCs was analyzed in females between the ages of 6-11 and 12-19 (2012). Females with urinary EDCs above the 75th percentile have significantly lower age of menarche (Buttke, Sircar, & Martin, 2012). These results are worrisome, because pollutants in our environment are influencing the development of adolescents. This is a larger public health concern than previously believed. Further investigations are underway to better understand which products are the most dangerous culprits.

Obesity has become a major epidemic, whereas two-thirds of the Americans are overweight or obese and one-third of children are overweight or obese. While obesity in adulthood can lead to a plethora of health concerns, it was previously thought that childhood obesity might have reversible effects. However, obesity in young females has been shown to have an influence on early-onset puberty. Obesity causes an increase in certain hormonal levels including leptin, insulin, IGF-1, certain binding proteins, and androgens (Marcovecchio & Chiarelli, 2013). Early signs of puberty are not the only effects seen by the hormonal changes associated with obesity, hyperandrogenism may be present as well (Marcovecchio & Chiarelli, 2013). Hyperandrogenism involves increased body and facial hair, alopecia, acne, and increased libido. Both hyperandrogenism and earlier development in females may have extreme social effects in adolescent females.

Nutrition in newborns is predominately breast-feeding at approximately 75%, however, after just one-week postpartum breast feeding incidence drops to 16.2%. Approximately 20% of formula-fed infants are given soy-based formula (Andres, Moore, Linam, Casey, Cleves, & Badger , 2015). Isoflavones are organic compounds that act as phytoestrogens in mammals and are found in soy-based products and may be feared to cause estrogenic effects such as early-onset puberty (Andres, Moore, Linam, Casey, Cleves, & Badger , 2015). Currently, the most recent study on hormonal additives was done in 1988 by the FAO/WHO Committee on Food Additives Joint with the Federal Drug Administration (FDA) which showed no concern for human consumption of hormonal additives (Larrea & Chirinos, 2007). Later, Larrea and Chirinos show that the study may be concerning due to the inadequate scientific elements that were used (Larrea & Chirinos, 2007). Furthermore, previous studies on the effects of hormonal additives on early onset of puberty are inconclusive and current studies are still underway (Andres, Moore, Linam, Casey, Cleves, & Badger , 2015). The conclusions of the current longitudinal studies will be a vital factor in not only post-partum nutrition but child and adolescent nutrition as well.

The significance of all of the theories behind early menarche is due to the psychosocial effects of early maturity of young girls and the unwanted attention they may receive. Early onset of puberty also causes women to have longer exposure to estrogen, which may be associated with several types of cancers, including breast and endometrial cancer. Estrogen exposure also increases risks for cardiovascular disease and high cholesterol. These health-related side effects were significantly lower when women were experiencing menarche at older ages. Clearly, more research needs to be done in order to investigate the multifactorial causes of early menarche in adolescents; however, current studies seem to implicate both environmental and nutritional exposures.

Andres, A., Moore, M., Linam, L., Casey, P., Cleves, M., & Badger , T. (2015, March). Compared with feeding infants breast milk or cow-milk formulas, soy formula feeding does not affect subsequent reproductive organ size at 5 years of age. The Journal of Nutrition , .
Buttke, D., Sircar, K., & Martin, C. (2012). Exposure to endocrine-disrupting chemicals and age of menarche in adolescent girls in NHANES. Environmental Health Prospective , 120 (11), 2003-2008.
Larrea, F., & Chirinos, M. (2007). Impact on human health of hormonal additives used in animal production. Rev Invest Clin , 59 (3), 206-211.
Marcovecchio, M., & Chiarelli, F. (2013). Obesity and growth during childhood and puberty. World Review of Nutrition and Dietetics , 106, 135-141.
NIH. (2009-2010). Overweight and Obesity Statistics. Retrieved 2015, from National Institute of Diabetes and Digestive and Kidney Diseases: