WRITE UPS - MISCELLANEOUS: (OB) - Nutrition And Anemia In Adolescents


·        Energy requirement in adolescent girls      = 2300-2800 calories/day.

·        Calculation of energy required:

Sleeping@8 hours X 0.93calories                 = 7.4 calories.

Light exercise@8 hours X 2.43 calories         = 19.4 calories.

Active exercise@2 hours X 4.14 calories       = 8.3 calories.

Sitting@6 hours. X 1.43 calories                  = 8.6 calories.

Total                                                         = 43.7 calories.

43.7 calories/Kg X 60                                  = 2,622 calories





= 2/1/2 gm/ kg  (Puberty)


= 1 gm/kg (Adults)

Vit A           

= 5000 IU          (13-20yrs.)


= 1.3 mg.           (13.15 Yrs.)


= 1.2 mg.           (16-20 Yrs.)


= 2.0 mg           (13-15 Yrs.)


= 1.8 mg.            (16-20 yrs.)


= 13 mg.           (13-20 yrs.)


= 12 mg              (16-20 Yrs.)

Vit.   C     

= 80 mg             (13-20 yrs.)

Vit.   D     

= 400 mg           (up to 20 yrs.)

Vit.   E     

= 25 mg.             

Vit.   K     

= 1 mg.  


= 1-1.4 gm/day.    


= 1.1.5 gm/day.  


= 15 mg/day.      (13-20 yrs.)


= 1.to 2 mg daily. Adults   


=  0.05 mg/kg. Body wt. Children 


= 0.002- 0.004 mg/kg.   



     It was in 1st Century AD in the Roman Imperial age there was a rural town of Locus Feronice.  In 7th Century in Lombard necropolis of Viccola they found a peculiar bony lesion called Cribra oribitalia and Cribra carnie. These hyperostotive lesions were attributed to iron deficiency. It was chiefly   found in adolescents. The chiefs of these towns started measures to reverse these changes. They tried many ways, which also included iron rich foods for young adolescents. It therefore seems obvious that adolescent anemia has caught the interest of the world nearly 2000 years ago.

Prevalence of anemia in different physiological groups of women-


No.  Mean Hb % Anemia@






250           9.8+1.65 60.5

Preschoolers (1-5 yrs.)  

150           9.6+1.75 47.57

School children                          


Adolescent girls                            

288           12.2+4.23 25.2

Non pregnant                            

1083         11.2+4.23   56.8



*  Lactating mothers                    

864         11.0+3.95 58.1

(<6 months)                       



444         11.1+2.38 48.2

(>45 years)




@  Hb <11 g/dl for preschoolers and infants

           < 12 g/dl for non pregnant and adolescents











Following table gives the iron and folic acid requirements in different physiological states and extent of deficiency in the population.

TABLE: Recommended dietary allowances of iron. Folic acid and B 12 and the extent of deficit




Actual    Intake         

Deficiency status in women* (%)

Iron (mg)












Folic acid (ug)






B-12 (ug)                              Non-pregnant    Pregnant          










*  Levels of ferritin <10μg/dl, RBC folate <100 ml and B1-12 < 100 pg/ml indicate deficiency.   

Source: Recommended Dietary Allowances for Indian ICMR  1989.


Blood carries the pigment called hemoglobin, which is a major carrier of oxygen to all tissues in the body Measurement of hemoglobin by single finger prick is the simplest method of identifying anemia. Clinically extreme pallor, flat or spoon shaped nails, pale conjunctive/tongue would only reveal moderate/ severe anemia. Mild anemia can be identified only by Hb estimation.

 Normally, in an adult woman, the hemoglobin level should be above 12g/dl. A level above 1lg/dl during pregnancy is satisfactory. Below 6g/dl is considered as severe anemia since most of the functions get affected resulting in various clinical problems. A good peripheral smear with MCHC value could in many cases give an idea regarding the type of anemia. A dimorphic picture is more common due to dual deficiency of iron and folate. Measurements of serum ferritin and folic acid are possible only in well-established centers. A stool examination may reveal worm infestation. Careful history of blood loss due to piles or menorrhagia is important.


 GENERAL: Iron is important to carry oxygen and essential for fetal growth, brain function, muscle activity, protection from infection etc. Folic acid and B-12 are essential for cell growth and for rapidly growing tissues like the fetus or growing children. If there is iron deficiency the blood does not carry enough oxygen and vital tissues like brain muscles etc. suffer from lack of oxygen and there is a decrease in their function.  Some of the manifestations of anemia are dullness, lack of concentration, reduced activity, and fatigue-all leading to poor performance at school and at work.   

POOR WORK CAPACITY:  In the adult man of woman, anemia results in poor work output since the work capacity is reduced considerably due to muscle fatigue. Also lack of concentration in work results in mistakes, sometimes-fatal ones. All these have significant effect on productivity especially in the industrial and agricultural sectors.


ORAL IRON: Oral iron is the treatment of choice fro anemia. For preventing anemia, low does of iron are adequate. Based on this principle, the national anemia prophylaxis programme has been functioning since 1971, wherein pregnant women are administered iron/folic acid ( 60 mg and 500 μg) supplements for at least 100 days ( National Anemia Prophylaxis Programme 1971). However, the programme has not been very successful due to (a) lack of awareness and realization of the consequences of anemia (b) a poor distribution system, and (c) irregular intake by the beneficiary. If the programme is implemented successfully, anemia control can be a major achievement in the coming decade with resultant decrease in mortality and morbidity.

 In definite anemia the amount of iron should be two to three times the prophylactic dose and given in a divided dose schedule for proper absorption. Higher does of iron is associated with problems of intolerance and side effects such as nausea, vomiting, pain in abdomen, constipation or diarrhea. 

BLOOD TRANSFUSION: It is the treatment of choice in severe anemia in conditions where there is serious limitation of time, especially during the third trimester of pregnancy to combat severe anoxia and cardiac failure. Exchange transfusion with fresh blood is given when there is cardiac failure Exchange transfusion with fresh blood is given when there is cardiac failure and hypervolemia. Frusemide and dioxins would be useful adjuvant during blood transfusion. Supportive therapy should follow the transfusion.

DIETARY MANIPULATION: Whereas supplementation with iron is the commonest mode of correcting and preventing anemia. It can act only as a short-term measure since one cannot go on taking tablets indefinitely to correct the insufficiency in diet. Since iron and folic acid and intake is related both to the quantity and quality of the diet, intake of adequate calories in terms of cereal-pulse combination is an essential step towards maintaining iron balance right from childhood.

 In addition, in rural and slum areas, improvement in sanitation, and personal hygiene are needed   to control worm infestation. De-worming done regularly and treating the underlying cause will help in reducing the incidence of anemia and improve the efficacy of iron supplements.


 In view of widespread iron deficiency and also ineffective distribution of iron folic acid tablets through the anemia prophylaxis programme due to logistic reasons, it is important to improve the availability of iron in the diet.

 Also fortification of foods with iron would act as a long-term measure to improve the iron balance in the entire population. Salt has been found to be the most suitable vehicle for this purpose since it is universally consumed, cheap and centrally produced. Initial trials have proved the efficacy of the iron fortified salt in improving the iron status of the rural population. Now the Government of India is trying to provide iron-fortified salt on a mass scale. However, till it becomes universally available, it is essential that the anemia Control Programme and increased the dose of iron to 100 mg from the existing 60mg.

 It is important that frequent surveys to assess the extent of anemia by hemoglobin measurement are done to assess the impact of various iron supplementation programmes especially in the vulnerable groups like preschool and school children, adolescent girls and pregnant women. A pregnant woman should have her hemoglobin checked at least 3-4 times during pregnancy. Correction of anoxia is of prime importance.



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