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Journal of the American College of Nutrition, Vol. 26, No. 3, 264-271 (2007)
Published by the American College of Nutrition

Evaluation of Energy, Nutrient and Dietary Fiber Intakes of Adolescent Males

Tanja C. Schenkel, MSc, RD, Nancy K.A. Stockman, MSc, RD, Jessica N. Brown, BSc and Alison M. Duncan, PhD, RD

Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, CANADA

Address correspondence to: Alison M. Duncan, PhD, RD, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, CANADA. E-mail: amduncan{at}uoguelph.ca


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 ACKNOWLEDGMENTS
 REFERENCES
 
Objective: The minimal data available on the current energy, nutrient and dietary fiber intakes of adolescent males challenges the development of effective nutrition education programs. There is a need for research into the current intakes of adolescent males and in particular their relation to the current Dietary Reference Intakes (DRIs). The primary objective of this study was to assess the diet of adolescent males and relate energy, nutrient and dietary fiber intakes to the DRIs. Secondary objectives were to relate energy, macronutrient and dietary fiber intakes to body mass index (BMI)-for-age percentile categories as well as to explore vitamin/mineral supplement use and soft drink consumption.

Methods: Three-day food records were completed by 180 healthy adolescent males for analysis of energy, nutrient and dietary fiber intakes from food and supplements. Following adjustment for intra-individual variability, nutrient intake percentile distributions were related to the DRIs. Energy, macronutrient and dietary fiber intakes were compared among BMI-for-age percentile categories and diets were evaluated for vitamin/mineral supplement use and soft drink consumption.

Results: Median intakes for percent energy from carbohydrate, fat and protein were within the Accepted Macronutrient Distribution Ranges. Intakes of micronutrients with Estimated Average Requirement values indicated that greater than 50% of subjects consumed inadequate amounts of vitamin A and vitamin B6, and greater than 75% of subjects consumed inadequate amounts of magnesium, phosphorus and zinc. Subjects classified as overweight had significantly lower energy and carbohydrate intakes compared with subjects classified as having an acceptable body weight. The prevalence of vitamin/mineral supplement use was 16.1% and 67% of subjects reported daily consumption of soft drinks.

Conclusion: Results of this study reveal that adolescent males are consuming the recommended amounts of macronutrients but may be at risk for consuming inadequate levels of specific micronutrients. Nutrition education programs should consider targeting select micronutrients to improve nutritional intakes of adolescent males.

Key words: dietary assessment, adolescent males, nutrient intakes, dietary reference intakes, vitamin/mineral supplement use, soft drink consumption


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
MATERIALS AND METHODS
 RESULTS
 ACKNOWLEDGMENTS
 REFERENCES
 
Adolescence is a dynamic period consisting of numerous physiological and psychosocial changes [1, 2]. Food choices can be influenced by several factors including growing independence, increased involvement in social life, need for peer acceptance, dissatisfaction with body image and influence from the media [1–4]. Adolescent eating behaviors have been characterized by a greater tendency to skip meals, increased consumption of meals outside the home, greater reliance on ready-to-eat foods, increased snacking and greater interest in dieting [1–4]. These factors, along with higher energy and nutrient needs to support growth and development, make adolescence a nutritionally vulnerable period within the lifecycle [1].

It is well accepted that dietary habits developed during adolescence can carry into adulthood [5, 6]. Furthermore, intakes of specific nutrients during adolescence can influence future risk of chronic disease, including type 2 diabetes, cardiovascular disease, cancer and osteoporosis [6–12]. Related to this is the increasing prevalence of obesity in adolescents [7, 13], which also increases the risk of adult obesity [14, 15]. Given the many health implications of adolescent nutrition, there is a clear need to study the dietary intakes of adolescents.

Dietary assessment studies of adolescent males, conducted in numerous countries such as Germany [15], Spain [16], Switzerland [9] and the United States [17–20], have reported intakes below recommendations for dietary fiber [9, 18] and within recommendations for carbohydrate [9, 15], fat [20] and protein [9, 15]. Other studies of adolescent males within specific countries have reported high intakes of fat [9, 15, 17] and low intakes of vitamin A [9, 16], vitamin E [9, 16, 19], niacin [9], calcium [9, 12, 20], iron [9] and magnesium [19], all relative to national recommendations.

Within Canada, there are minimal data available on the energy and nutrient intakes of adolescent males, largely since individuals younger than 18 years old were not included in the Canadian Nutrition Survey [21] or the more recent provincial surveys [22–25]. Some exceptions include the Ontario Health Survey [26–27], a report from Ontario indicating food intakes of adolescent males were within the Canadian Food Guide to Healthy Eating recommendations [28] and a report from Quebec indicating fat intakes of adolescent males were >35% of total energy [12].

Overall, there is a need for more studies assessing the diets of adolescent males, particularly within Canada. The need for dietary assessment studies within North America is particularly timely due to the existence of the Dietary Reference Intakes (DRIs) [29–34], a set of four values that replace the Canadian Recommended Nutrient Intakes [35] and the United States Recommended Dietary Allowances [36]. Thus, the primary objective of this study was to determine the dietary intakes of energy, nutrients and dietary fiber of a sample of adolescent males and relate these intakes to the DRIs. Secondary objectives were to relate energy, macronutrient and dietary fiber intakes to body weight categories as well as to explore the prevalence of vitamin/mineral supplement use and soft drink consumption.


   MATERIALS AND METHODS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 ACKNOWLEDGMENTS
 REFERENCES
 
The study protocol was approved by the University of Guelph Human Research Ethics Board and the Research Committees of local high schools.

Subject Recruitment
Healthy adolescent males between 14 and 18 years old were recruited from the local community. This age range was studied to be consistent with the established DRI values for this age group. To facilitate recruitment, study coordinators contacted teachers from various local high schools and leaders of local community groups (i.e. boy scouts, cadets, after-school sports groups) to inform them about the study. Subjects were then recruited through the schools and community groups and those interested in participating were provided with an information packet that outlined all aspects of the study. Written informed consent was obtained from the subject or a parent or legal guardian if the subject was younger than 18 years old.

Study Orientation Sessions
Every subject attended a study orientation session that detailed all aspects of the study with a focus on specific instructions for completion of accurate food records. Instructional handouts, food models and measuring instruments were used to maximize comprehension. Subjects were instructed to use common household measures to estimate portion sizes and to maximize detail including brand names, quantities and food preparation methods.

Subjects were then provided with forms to record all food and beverages consumed for three consecutive days including two weekdays and one weekend day. To increase compliance and accuracy, every subject received two phone calls from a study coordinator during their 3-day food record period. Subjects were encouraged to contact the study coordinators with any questions about their food records. A separate form was also provided to record current consumption of vitamin/mineral supplements including the specific nutrient(s), brand name and frequency of consumption.

Subject Follow-Up Visits
Once 3-day food records and vitamin/mineral supplement information forms were complete, subjects met individually with a study coordinator to review their forms for completeness. Body weight was measured without shoes or heavy clothing (sweaters, jackets) using a calibrated scale and height was measured against a wall using a standard measuring tape. Body mass index (BMI) (body weight [kg]/height [m2]) was then calculated and BMI-for-age percentiles were determined [37] for classification into the following body weight categories as outlined by the Centre for Disease Control and Prevention: underweight (<5th percentile), acceptable body weight (5th to <85th percentile), at risk for overweight (85th to <95th percentile) or overweight (≥95th percentile) [38].

Data and Statistical Analysis
Food records were analyzed for energy, nutrients (carbohydrate, protein, total fat, saturated fat, cholesterol, vitamin A, vitamin C, thiamin, riboflavin, niacin, vitamin B6, vitamin B12, iron, magnesium, phosphorus, zinc, pantothenic acid, calcium, sodium, potassium) and dietary fiber using NutriBase IV Clinical EditionTM 2001. This database of over 30,000 foods is based on nutrient information from the United States Department of Agriculture Standard Reference, Release 13 Nutrient Database and also contains 4,668 food items for up to 115 food components from the Canadian Nutrient Files.

Three-day average intakes from food and supplements were calculated and in order to estimate usual intake distributions for comparison to the DRIs, they were adjusted for intra-individual variability using the method outlined by the National Research Council [39]. Data were log-transformed prior to repeated measures analysis of variance (ANOVA) to obtain estimates of intra-individual variability for the adjustment procedure [39, 40]. Percentile distributions were then computed for comparison with the appropriate DRI values.

Energy intakes were related to the Estimated Energy Requirement (EER) and macronutrient intakes were compared to the Acceptable Macronutrient Distribution Ranges (AMDRs) [33]. Energy, macronutrient and dietary fiber intakes were compared among BMI-for-age percentile body weight categories using ANOVA followed by the Tukey's test for multiple comparisons.

For nutrients with Estimated Average Requirement (EAR) values, the EAR Cut-Point Method was applied to intake percentile distributions to estimate prevalence of inadequacy as determined by the percentage of subjects with nutrient intakes less than the EAR [40]. For dietary fiber and nutrients with Adequate Intake (AI) values, median intakes were related to the AI, however, no assessment of inadequate intake was performed [40]. Finally, median intakes were determined for nutrients without DRI values.

Prevalence of vitamin/mineral supplement use was determined using the definition of use as daily consumption of at least one vitamin/mineral supplement. Nutrient intakes from food only were compared between vitamin/mineral supplement users and non-users using unpaired t-tests and a Bonferroni correction for multiple comparisons.

Soft drink consumption was evaluated through quantification of 3-day average daily amounts of regular carbonated soft drinks consumed followed by classification into volume categories including: 0 mL, 1–499 mL, 500–999 mL and ≥1000 mL. Energy, macronutrient and dietary fiber intakes were then compared among the soft drink volume categories using ANOVA followed by the Tukey's test for multiple comparisons. All statistical analyses were performed using the Statistical Analysis System [41] with p < 0.05 considered statistically significant.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
ACKNOWLEDGMENTS
 REFERENCES
 
A total of 180 healthy adolescent males completed the study. Subjects had an average age of 15.3 ± 1.21 years, body weight of 69.6 ± 16.4 kg, height of 174.5 ± 10.3 cm and BMI of 22.7 ± 4.22 kg/m2 (mean ± SD). The distribution of subjects among body weight categories revealed that 66% (n = 119) of subjects were classified as having an acceptable body weight, 19% (n = 34) were at risk for overweight and 15% (n = 27) were considered overweight. Table 1 presents further analysis indicating that subjects classified as overweight had significantly lower energy (p = 0.0027) and carbohydrate (p = 0.0003) intakes compared with subjects classified as having an acceptable body weight.


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  		Table 1. Energy, Nutrient and Dietary Fiber Intakes in Relation to Body Mass Index (BMI)-for-Age Percentile Body Weight Categories (n = 180)*{dagger}

 
Median energy intake was 2542 kilocalories (kcal) with >90% of subjects with intakes less than the EER of 3152 kcal [33]. Fig. 1 illustrates the distribution of average daily macronutrient intake in relation to the AMDRs and indicates that median intakes (52%, 33% and 15% for carbohydrate, fat and protein, respectively) were all within their respective AMDRs.


Figure 1
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  		Fig. 1. Distribution of Macronutrient Intakes Expressed as Percent of Energy (n = 180). The AMDRs are 45–65% for carbohydrate, 25–35% for fat and 10–30% for protein [33].

 
The estimated usual intake percentile distributions for nutrients with EAR values are presented in Table 2. Results revealed that ≤25% of subjects consumed inadequate amounts of thiamin, riboflavin, vitamin B12 and iron; >25% but <50% of subjects consumed inadequate amounts of vitamin C and niacin; >50% but <75% of subjects consumed inadequate amounts of vitamin A and vitamin B6; and >75% of subjects consumed inadequate amounts of magnesium, phosphorus and zinc.


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  		Table 2. Estimated Usual Intake Percentile Distribution for Nutrients With EAR* Values (n = 180)

 
The estimated usual intake percentile distributions for dietary fiber and nutrients with AI values are presented in Table 3. The median intakes for dietary fiber, pantothenic acid, calcium and potassium were below their corresponding AI values whereas the median intake for sodium was above its AI value. The median intakes for saturated fat and cholesterol (nutrients evaluated without DRI values) were 29.4 g and 240.2 mg, respectively.


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  		Table 3. Estimated Usual Intake Percentile Distribution for Dietary Fiber and Nutrients With AI* Values (n = 180)

 
The prevalence of vitamin/mineral supplement use was 16.1% with the most frequently consumed supplements being multi-vitamins/minerals followed by vitamin C (Table 4). Comparison of energy and nutrient intakes from food only between vitamin/mineral supplement users and non-users revealed no significant differences with the exception of higher intakes of vitamin B6 (p = 0.0201) and vitamin B12 (p = 0.0318) among vitamin/mineral supplement users (data not shown).


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  		Table 4. Type and Frequency of Vitamin/Mineral Supplement Use (n = 29)

 
Fig. 2 illustrates the proportion of subjects within each soft drink consumption volume category. Energy and carbohydrate intakes were significantly greater for subjects consuming ≥1000 mL of soft drinks/day when compared with subjects within all other soft drink consumption categories (p < 0.05 for all comparisons; data not shown). There were no significant differences in protein, fat or dietary fiber intakes among soft drink volume categories (data not shown).


Figure 2
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  		Fig. 2. Frequency of Daily Soft Drink Consumption (n = 180).

 

   DISCUSSION
 
The purpose of this study was to relate the energy, nutrient and dietary fiber intakes of a sample of 14–18 year old adolescent males to the currently established DRI values, as well as to explore body weight, vitamin/mineral supplement use and soft drink consumption within this age and gender group. This study adds to the existing literature through its comparison of intake values to the DRI values and its provision of information about body weight classifications, supplement use and soft drink consumption to serve as a basis for future research in larger study samples.

The exploration of body weight in the current study revealed that 15% of subjects were classified as overweight and 19% of subjects classified as at risk for overweight. These values are comparable to the rates of 15.5% and 19% of 12–19 year old males classified as overweight and at risk for overweight, respectively, in the 1999–2000 United States National Health and Nutrition Examination Survey (NHANES) [42]. Recent studies highlight the potential concern of these values through evidence that the prevalence of overweight adolescents is increasing [10, 42, 43], that overweight children are at high risk of becoming overweight adults [10, 43, 44] and that overweight adolescents have an increased risk of developing type 2 diabetes [10] and cardiovascular disease [44].

The median energy intake of 2542 kcal in the current study is comparable to the mean intake of 2865 kcal consumed by adolescent males in previous research between 1988 and 1994 (NHANES III data) [20]. Of note is that overall trends of decreasing energy intake by adolescent males over time [20] contradict the currently observed increase in their prevalence of overweight [10, 42, 43]. A possible explanation for this contradiction is the common dietary assessment methodological limitation of under-reporting [45]. Under-reporting is a potential explanation for the observation of lower energy intakes among subjects categorized as overweight in the current study, especially since related data in adults has identified BMI as the main predictor of under-reporting [46]. Although not addressed in the current study, the observed discrepancy between lower energy intakes and higher body weight could also be explained by less physical activity, particularly since studies have reported decreased physical activity among adolescents [47, 48].

Median macronutrient intakes were all within their respective AMDRs [33] in the current study. The observed carbohydrate intake of 52% of energy is comparable to previous studies in adolescent males [9, 15, 49], while the observed fat intake of 33% of energy is less than an Ontario report indicating that >53% of adolescent males consumed >38% of energy from fat [26, 27]. Data from multiple NHANES indicate a decrease in consumption of fat and saturated fat by adolescents over time [15, 20, 50], which is consistent with data from United States Department of Agriculture surveys revealing a decrease in fat intakes of adolescent males from 39% to 33% of energy between 1965 and 1996 [48]. Finally, the observed protein intake of 15% of energy is slightly higher than previous studies reporting intakes ranging from 13.4 to 14.0% of energy [9, 15, 48] and the observed median dietary fiber intake of 13.1 g is consistent with previous studies reporting relatively low dietary fiber consumption among adolescents [9, 18, 48, 49, 51, 52].

Identification of specific micronutrients consumed below recommendations in the current study is both consistent and in contrast to previous studies. Similar to the current study are previous observations of low intakes of vitamin A [9, 16], calcium [9, 12,20] and magnesium among adolescent males [19]. On the other hand, the current study's observation that >75% of subjects consumed inadequate amounts of phosphorus and zinc has not been reported previously and is in contrast to a report of adequate zinc intake among 62% of adolescent males (ages 11 to 18 years old) in a previous NHANES report [53]. The observed low intakes of phosphorus and zinc in the current study are also difficult to explain given that soft drink consumption was high (in relation to phosphorus) and protein intakes were within the recommended intake levels (in relation to zinc).

The 16.1% prevalence of vitamin/mineral supplement use in the current study is comparable to previous studies reporting rates of 15.6% among adolescents [54] and 17.6% among grade 8 students [55]. The current study found that vitamin/mineral supplement users consumed significantly higher amounts of vitamin B6 and vitamin B12 from food relative to non-users. Previous research in adolescents has reported significantly lower food intakes of fat [54] and saturated fat [54] as well as significantly higher food intakes of numerous micronutrients [54, 55] among supplements users relative to non-users. Collectively, these results suggest that vitamin/mineral supplement users may consume a more nutritionally adequate diet than supplement non-users.

The majority of subjects in the current study reported daily soft drink consumption, suggesting the need to explore this issue with further research for the potential need to consider soft drink consumption when designing adolescent nutrition programs. The greater energy intake observed among subjects consuming ≥1000 mL of soft drinks/day is consistent with a previously reported positive association between energy intake and soft drink consumption among adolescents [56].

The current study has specific strengths and limitations worth consideration. An important strength is the detail employed in the data collection process. This detail included comprehensive instructions for the completion of 3-day food records provided during the study orientation sessions, the recording of two week days and one weekend day in the 3-day food record to better capture day-of-the-week variation in dietary intakes and the individual subject follow-up visits that included a review of the 3-day food record for completeness and accuracy. Despite this attention to detail, it is likely that under- and over-reporting of dietary intakes still occurred, particularly in this age group where there is a higher likelihood of social pressure. The data collection process was also limited by the lack of data collected on physical activity, thereby limiting the ability to make certain conclusions. Another limitation worth mention is the ability of the subject sample to represent all healthy adolescent males. It is possible that the subject sample was biased toward those that were more likely to participate due to personal motivation and/or support from parents and/or mentors, particularly due to the high subject burden associated with the completion of 3-day food records. There may have also been a subject bias toward certain demographic characteristics, such as ethnicity and socioeconomic status, a possibility that cannot be determined since data were not collected on these variables. Finally and most notably, the sample size of 180 subjects may not be sufficient to adequately represent this population sub-group, and therefore caution must be used when/if generalizing these results to other adolescent males. Although this study has its limitations, the results are still of value, particularly since there is no existing literature that relates nutrient intakes of adolescent males to the current DRI values.

In summary, the current study provides valuable information regarding energy, nutrient and dietary fiber intakes, as well as body weight, vitamin/mineral supplement use and consumption of soft drinks within a sample of adolescent males. The results of this study, although from a relatively small sample of adolescent males, provide a basis for rationalizing more in-depth research into the eating habits of adolescent males. There is a clear need for a better understanding of the nutrient and food intakes of this age and gender group, particularly if nutritional intervention programs are able to best take advantage of this important life transition into adulthood.


   ACKNOWLEDGMENTS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 ACKNOWLEDGMENTS
REFERENCES
 
The authors would like to acknowledge the adolescent volunteers for their participation in this research.

Received February 13, 2006. Accepted May 31, 2006.


   REFERENCES
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 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 ACKNOWLEDGMENTS
 REFERENCES
 

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