WHO clarify adolescent nutrition measures with supplementary guidelines

By Will Chu

- Last updated on GMT

The World Health Organisation (WHO) has made available a set of guidelines that call for actions for improving adolescent nutrition via targeted supplementation and antenatal nutritional care.

The guidelines—an extension to existing WHO recommendations on adolescent health​—further highlights the need for nutrition-specific and nutrition sensitive interventions for adolescents providing further evidence and research gaps in its advice.

“Assuring optimal nutrition among adolescents requires coordinated actions across multiple sectors,”​ said the guideline said.

“Evidence-informed actions exist to address malnutrition in all its forms, characterized by the coexistence of undernutrition along with overweight, obesity or risk factors for diet-related noncommunicable diseases in adolescence and adulthood.”

Among the guideline’s main recommendations is the idea that additional micronutrients can be provided through fortification of staple foods and targeted supplementation in adolescents

These staple foods include maize flour and corn meal fortified with vitamins and minerals.

“Fortification of maize flour and corn meal with iron is recommended to prevent iron deficiency in populations, particularly vulnerable groups such as children and women,”​ the guideline said.

“Fortification of maize flour and corn meal with folic acid is recommended to reduce the risk of occurrence of births with neural tube defects.”

Iodine deficiency prevention

Additionally the fortification of food-grade salt with iodine was advised as a way to prevent and control iodine deficiency disorders

The report believed all food-grade salt, used in household and food processing, should be fortified with iodine as a safe and effective strategy for the prevention and control of iodine deficiency disorders in populations living in stable and emergency settings.

Iron was mentioned a number of times in its recommendations, with supplemental approaches discussed for menstruating adult women, adolescent girls, preschool and school age children.

The use of multiple micronutrient powders was recommended for point-of-use fortification of foods consumed by pregnant women

However, its routine use during pregnancy was not recommended as an alternative to standard iron and folic supplementation during pregnancy for improving maternal and infant health outcomes.

According to WHO, malnutrition during adolescence manifests in three broad groups of conditions.

These are undernutrition (wasting, stunting or chronic undernutrition and thinness or underweight); micronutrient deficiency or excess (inadequate or excessive intake of vitamins or minerals); and overweight or obesity.

The latter increases the risk for diet-related NCDs such as heart disease, stroke, diabetes and some cancers.

“Micronutrient malnutrition is high among adolescents, specifically iron, iodine or vitamin A deficiency, and contributes substantially to overall reduced health.”

Nutrition in pregnancy

The guidelines also touched upon provisions needed for the preconception and antenatal nutritional care in adolescents.

Amongst undernourished populations, balanced energy and protein dietary supplementation was recommended for pregnant women to reduce the risk of stillbirths and small-for-gestational-age neonates.

In addition, high-protein supplementation was not recommended for pregnant women to improve maternal and perinatal outcomes, as were multiple micronutrient supplementation.

“For pregnant women with high daily caffeine intake (more than 300 mg per day), lowering daily caffeine intake during pregnancy is recommended to reduce the risk of pregnancy loss and lowbirth-weight neonates,” ​said the report.

With global figures that estimate around 11% of births occur among girls between the ages of 15 and 19 years, WHO said that, “Adequate nutrition before and during pregnancy is essential for meeting maternal and foetal growth needs, optimal birth outcomes, and reducing the risk of later NCDs”.

“When a growing adolescent becomes pregnant, there is competition for nutrients between the mother and the foetus.

“This can result in cessation of the prospective mother’s linear growth and increase her risk of stunting, and can also lead to foetal growth restriction and low birthweight.”

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