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Consensus: Malnutrition in adolescent girls has devastating effects on population health

Leaders from 17 countries are working to improve the health and nutritional well-being of adolescent girls and young women

A 2016 report from the United Nations chronicled the life of a typical 10-year-old girl based on where she lives around the world, and it’s not pretty. 

Many of the girls are on the brink of adolescence, but, depending on where they live, can face a future of forced early marriage, early motherhood and lack of opportunities. Motherhood in childhood has devastating consequences for the health and well-being of the mother and future generations, due in large part to something that has received shocking little attention: malnutrition in adolescent women.

It is estimated that some 3.5 million women and children die each year from undernutrition, and more than one-third of the diseases in children worldwide are caused by malnutrition.

Kent Thornburg, Ph.D.
Kent Thornburg, Ph.D. (OHSU)

“The battle for the health and well-being of adolescent women is being fought on many fronts in the global health world,” says Kent Thornburg, Ph.D., director of the OHSU Moore Institute for Nutrition & Wellness. “If we help women and children to gain access to nutritious foods and to eat healthier diets, health will be improved for the entire population.”

Thornburg and colleagues at OHSU have been studying maternal nutrition’s role in the Developmental Origins of Health and Disease for decades. Their groundbreaking research has demonstrated that poor nutrition during pregnancy and childhood has devastating generational effects that effectively shape the health of future generations through a process known as epigenetics.

In 2015, leaders from 17 countries across the world gathered at OHSU to call attention to the problem of poor nutrition during adolescence. Together, field program directors and scientists with expertise in nutrition developed the following evidence-based recommendations for programs and interventions for adolescent women, published today in the Annals of the New York Academy of Sciences:

  1. Elevate the urgency of poor nutrition among adolescent girls and young women to a high international priority.
  2. Raise the visibility, social status and health status of adolescent girls around the world.
  3. Address knowledge gaps in the biology of adolescence and define appropriate nutrition.
  4. Improve nutritional health of adolescent girls and young women, and their offspring.

Their consensus statement, detailed in the full report, focuses on how scientists and field program workers can work together to tackle malnutrition. A recent Save the Children report showed that the majority of nutrition policies and interventions in developing countries target pregnant and nursing women, and children up to age 2 but ignore the developing adolescent.

Thornburg emphasizes that the rate that a fetus grows in the womb depends on the nutrition from mother's diet and her existing body tissues. Adolescent girls simply haven't developed to the point that their bodies can provide the nutrition needed to grow a healthy baby. Therefore, adolescent pregnancies are dangerous for mother and baby.

In the end, the fetus doesn’t get enough nutrients from the mother. That means that babies can be born small, will be prone to more infections, will often perform worse in school and are at a higher risk for chronic diseases.  

“Adolescent girls are often overlooked and their nutritional status has not been well-studied,” says Nancy F. Krebs, M.D., first author and professor of pediatrics at the University of Colorado School of Medicine. “In order to break the intergenerational cycle of malnutrition in many populations, the global health community has to pay more attention to the nutrition of adolescent girls.”

The recommendations are straightforward and commonsense. How to implement them is much more complex, however, because many of the barriers to adequate nutrition for adolescent girls and young women are cultural and social in nature. 

Addressing the concerns articulated in the consensus statement, the authors note, will require that research scientists, health care providers, policy-makers, nutrition program implementers, and community leaders work together to ensure that the latest research can be translated into effective local interventions.

Girls have been the most neglected sector of societies around the world. The authors acknowledge that a number of global and regional movements are working to increase the empowerment of girls. Those movements have at their heart the recognition that societal health and economic development are linked to the health and well-being of girls and young women.

It is tempting to think that nutrition for girls is a problem only in low- and middle-income countries. However, many adolescents in the U.S. suffer from a different form of malnutrition - too many calories, but too few nutrients. While the teen birthrate in the U.S. has been declining, a recent article in The New York Times reports that adolescent girls can marry in most states in the U.S.  Such marriages often lead to early pregnancies that stunt the growth of the mother and provide inadequate nutrition to the growing baby. 

The paper published today recommends bold actions because the need is urgent. Leaders at the summit agreed that improving the health and nutritional well-being of adolescent girls and young women is a daunting task, but with a high return on investment. Elevating the status of adolescent girls around the world would have a profound effect on the health and economic well-being of women for generations to come.

Kent Thornburg, Ph.D., is director of the OHSU Moore Institute for Nutrition & Wellness, director of the OHSU Knight Cardiovascular Institute Center for Developmental Health, and the M. Lowell Edwards Chair and professor of medicine (cardiovascular medicine) in the OHSU School of Medicine.

Nancy F. Krebs, M.D., is a professor of pediatrics, section head for Nutrition, and chair of the Department of Pediatrics Promotions Committee at the University of Colorado School of Medicine, and associate affiliate in the department of Food Science and Human Nutrition at Colorado State University. 


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