Infancy through Adolescence

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Proper physical growth and appropriate cognitive development depend on adequate nutrition. Infants and young children with severe iron deficiency anemia were found to have significantly lower verbal and full-scale IQ scores and lower achievement test scores in arithmetic and writing than non-iron-deficient infants, even 10 years after treatment (Lozoff et al., 2000). An increase in behavioral problems was also reported, although this could not be directly linked to the preceding iron deficiency. In the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994), 7.2% of 12- to 16-year-old girls had iron deficiency, but only 1.5% demonstrated anemia (Halterman et al., 2001). Adolescent iron-deficient girls scored significantly lower math scores compared with non-iron-deficient girls. Vitamin D deficiency and insufficiency in children and adolescents has been reported worldwide, including North America (Wagner and Greer, 2008). Mealtime also represents a time for social interaction within the family unit, whether this is the bonding of mother and child during breastfeeding or discussion of the day's events during dinnertime.

Although malnutrition is still a problem in the United States, inappropriate nutrition, especially calorie-nutrient imbalance leading to overweight and obesity, has become commonplace. Recent NHANES studies demonstrate that the prevalence of overweight (BMI >95%) in girls 2 to 19 years old increased from 13.8% in 1999-2000 to 16% in 2003-2004, and the prevalence of overweight in boys 2 to 19 years old increased from 14% to 18.2% (Ogden et al., 2006). Increased pediatric BMI is associated with high blood pressure, sleep apnea, asthma, polycystic ovarian syndrome, type 2 diabetes, gastroesophageal reflux, and orthopedic problems (Benson et al., 2009). A nationwide survey of more than 6000 children and adolescents found that at least 30% consumed "fast food" on a typical day. These children consumed more total fat, total carbohydrate, more added sugars and sugar-sweetened beverages, less milk, and fewer fruits and nonstarchy vegetables than children who did not eat fast food (Bowman, 2004). The odds of having a BMI of 85th percentile or higher was more than four times that for 10- to

15-year-old children viewing more than 5 hours of television per day compared with those watching for 0 to 2 hours (Gortmaker et al., 1996). A survey of low-income preschool children in New York State found that children with a TV set in their bedroom watched 4.8 hours more TV/video than those without a bedroom TV. In this group the prevalence of child overweight (BMI >85%) was associated with an odds ratio of 1.06 for each additional hour per day of TV/video viewed (Dennison et al., 2002). Frequent television viewing can lead to decreased activity, excessive snacking on high-calorie junk foods, and subsequent obesity (Dietz and Gortmaker, 1985). In contrast, dieting in pursuit of the media's representation of the ideal woman can lead to eating disorders, such as bulimia or anorexia. The CDC has proposed 24 strategies to prevent obesity in the United States, including increasing the availability of healthier food and beverage choices, restricting the availability of less healthy foods and beverages in public service areas, and increasing the amount of physical activity in schools (Khan et al., 2009).

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