NALS final exam

• Child

  5-10
• Preadolescent girl


  1. 11 years
• Preadolescent boy


  10-12 years
• Girls mature (hit puberty) earlier than boys, on average
• Factors influencing eating attitudes/habits in preadolescents


  • Getting closer to the time when parents have less and less control over their child's intake – need to establish a sound foundation
  • Siblings
  • Peers
  • Social media
  • Other internet platforms
  • TV commercials, advertisements, etc.
  • Teachers/school administrators
  • School food services: NSLP
• NSLP meal pattern


  Must provide 1/3 of the DRIs (on average per week) based on the child's age or grade group
• School breakfast program

  Must provide ¼ of the DRI's on average
• DRIs for energy, protein, and total fat

  • Energy: 4-8 – girls: 1642 kcal/day, boys: 1742 kcal/day
  • Energy: 9-13 – girls: 2071 kcal/day, boys: 2279 kcal/day
  • Protein: 4-8 – 19 g/day
  • Protein: 9-13 – 34 g/day
  • Fat: 25-35 % of kcals
• Many adolescents are going through puberty at different times during the 9-13 age range (especially boys vs. girls) which can cause bodies to be very different, therefore it is better to express protein in g/kg/day so it is based on the individual's body at that point in their growth
• DRIs for micronutrients


  • Iron: 4-8: 10 mg/day, 9-13: 8 mg/day
  • Zinc: 4-8: 5 mg/day, 9-13: 8 mg/day
  • Calcium: 4-8: 1000 mg/day, 9-13: 1300 mg/day
  • Fiber: 4-8: 25 g/day, 9-13: girls- 26 g/day, boys- 31 g/day
• As bone density decreases, the risk of fractures increases, this is related to lower milk intake
• 20%kcal/day for children 6-11 come from liquid/beverages
• Impact on nutrients: decreased iron, decreased zinc, decreased vitamin b12, increased calcium, decreased fiber, decreased fat
• Kids' soda consumption tends to increase with age, while milk consumption decreases at a time when calcium requirements increase
• Trends in childhood obesity

  • As girls get older, they are more likely to be obese
  • A big increase in the prevalence of obesity between preschool years and school-aged years in boys, remains about the same during adolescence
  • Higher prevalence of obesity in Hispanic and non-Hispanic black adolescents
  • Higher prevalence of obesity in lower income groups
  • Lowest prevalence of obesity in high-income non-Hispanic white, and non-Hispanic Asian
• Short-term effects of being overweight as a child

  • Early puberty
  • Taller
  • Increased bone density, but lower when adjusted for total body weight, skeletal response is not sufficient to compensate for the increased body weight load
  • Hyperlipidemia
  • Increased BP
  • Sleep apnea
  • Insulin resistance
  • Type 2 diabetes
  • Psychological issues/ poor self-esteem
• Long-term effects of being overweight as a child

  • Increased risk for cardiovascular disease
  • Increased risk for some cancers
  • Increased risk for insulin resistance/T2D
  • Increased risk of overweight later in life
  • Psychological and self-esteem issues
• Predictors of childhood overweight/obesity

  • Maternal obesity (#1 predictor)
  • Earlier and faster increase in BMI after age 4
  • Gestation diabetes in mothers with high blood glucose levels while pregnant
  • Low income
  • Low cognitive stimulation
• Reasons for preadolescents to switch to a vegetarian diet


  • Consider vegetarian diets to be healthier
  • Maintain body weight(avoid certain foods)
  • Peer influence
  • Animal lovers/animal rights issues
  • Form of control; challenge parents
  • Internet and media influence
  • Environmental sustainability
• 60 mins physical activity per day is recommended for children in the U.S.
• Improvements implemented in the NSLP in 2012


  • Offering vegetables and fruits every day
  • Offering only low-fat or fat-free milk
  • Limiting kcal based on children's ages
  • Increasing foods made with whole grains
  • Reducing intakes of saturated fat, trans fat, and sodium
• Energy requirements increase for females between each of the three age categories (9-13, 14-18, 19-30)
• Energy requirements increase for males from 9-13 to 14-18 and then decrease for 14-18 to 19-30, with maximum needs earlier at 14-18 rather than females at 19-30
• Both sexes have decreased energy needs after 19 years old
• Protein DRI values


  • 9-13: 0.95 g/kg/d
  • 14-18: 0.85 g/kg/d
  • 19-30: 0.80 g/kg/d
• Females' highest growth is at 9-13, but their protein requirement does NOT reflect this (lowest requirement)
• Males' highest growth is at 14-18, and their protein requirement DOES reflect this (big increase from 9-13 to 14-18)
• Fat should be 25-35% of total calories per day
• Calcium DRI values

  • 9-13: female – 1300, male – 1300 mg/day
  • 14-18: female – 1300, male – 1300 mg/day
  • 19-30: female – 1000, male – 1000 mg/day
• Vitamin D DRI is 15 mcg/day
• Iron DRI values

  • 9-13: female – 8, male – 8 mg/day
  • 14-18: female – 15, male- 11 mg/day
  • 19-30: female – 18, male- 8 mg/day
• Iron is the most common nutrient deficiency in adolescence, and the higher values for females are because of menstruation
• Zinc DRI values

  • 9-13: females – 8, males- 8 mg/day
  • 14-18: females – 9, males -11 mg/day
  • 19-30: females – 8, males – 11 mg/day
• The higher zinc DRI for males is because of fertility and sperm health
• Folate DRI values

  • 9-13: female – 300, male – 300 mcg/day
  • 14-18: female – 400, male – 400 mcg/day
  • 19-30: female – 400, male- 400 mcg/day
• Vitamin C DRI values

  • 9-13: female – 45, male – 45 mg/day
  • 14-18: female – 65, male – 75 mg/day
  • 19-30: female – 75, male – 90 mg/day
• The higher vitamin C DRI for males is because of differences in body size
• Vitamin E DRI values

  • 9-13: females - 11, males – 11 mg/day
  • 14-18: females – 15, males – 15 mg/day
  • 19-30: females- 15, males – 15 mg/day
• Energy DRI values (kcal/day)

  • 9-13: female – 2100, male – 2300
  • 14-18: female – 2350, male – 3150
  • 19-30: female – 2400, male – 3050
• Protein DRI values (g/day)


  • 9-13: female – 34, male – 34
  • 14-18: female – 46, male – 52
  • 19-30: female – 46, male - 56