Heavy alcohol use in adolescents : potential influences on nutritional status

Naude, Celeste Estelle (Stellenbosch : Stellenbosch University, 2012-03)

Thesis (Phd)-- Stellenbosch University, 2012.

Thesis

ENGLISH ABSTRACT: Introduction: Adolescents are recognised as a nutritionally at-risk group, as they have high nutritional demand for growth and development, poor eating behaviour as well as a propensity for unhealthy behaviours. Heavy alcohol use, particularly in the form of binge drinking, is typical for an alarming proportion of school-going adolescents and is a plausible contributor to the nutritional challenges in adolescents, but this has not yet been fully investigated. Aim: This study investigated the potential influences of alcohol use on the nutritional status of adolescents with alcohol use disorders (AUDs), specifically with regards to their eating behaviour and dietary intake, growth and weight status, iron status, as well as vitamin D and calcium status. Methods: Substance use, physical activity, eating behaviour, dietary intake, growth and weight status, iron status and vitamin D and calcium status were assessed and compared in heavy drinking adolescents (meeting DSM-IV criteria for AUDs) (n=81) and in light/non-drinking adolescents without AUDs (non-AUDs)(n=81), matched for age, gender, language, socio-economic status and education. Observed dietary intake distributions were adjusted statistically to obtain usual nutrient intake distributions. Regression-adjusted differences between the groups were assessed using multi-level mixed effects linear regression, adjusting for potential confounders. Results: Lifetime alcohol dose in standard drinks of alcohol was orders of magnitude higher in the AUDs group compared to the non-AUDs group. AUDs adolescents had a binge alcohol use pattern and a “weekends-only” style of alcohol consumption. Poor eating patterns (breakfast skipping and frequent snacking), poor food choices (energy-dense and nutrient-poor foods) and low fruit and vegetable intake (non-AUDs 90 [42.4-153.3]; AUDs 88.3 [30.0-153.0] grams per day) in both groups were reflected in the poor nutritional quality of the diet. More than half of adolescents in both groups were at risk of inadequate intakes of folate (non-AUDs 97.5%; AUDs 98.8%), vitamin C (non-AUDs 65%; AUDs 67.5%), vitamin A (non-AUDs 80%; AUDs 82.5%), vitamin E (non-AUDs 78.8%; AUDs 51.3%), magnesium (non-AUDs 98.8%; AUDs 97.5%), and phosphorus (non-AUDs 76.3%; AUDs 73.8%) and all participants were at risk of inadequate calcium and vitamin D intakes. AUDs adolescents had a greater intake of unhealthy foods (energy-dense nutrient-poor) and a significantly greater energy intake than non-AUDs adolescents (p<0.001) that exceeded energy requirements. AUDs adolescents consumed foods high in unhealthy fats significantly more frequently (p=0.037) than the non-AUDs adolescents and had ensuing greater total fat (p<0.001), saturated fat (p<0.001) and cholesterol (p=0.009) intakes. Frequency of intake of sodium-rich foods was significantly higher in AUDs adolescents (p=0.001) and prevalence of risk of excessive sodium intake was significantly greater in the AUDs adolescents (45%) compared to non-AUDs adolescents (18.8%) (p<0.001). Anthropometric indices of growth and weight status were comparable between the groups and in line with that of the South African adolescent population. Female AUDs adolescents had increased odds (OR 2.42) of being overweight/obese compared to non-AUDs females. Physical activity in both groups was well below the WHO global recommendation. Iron store depletion (serum ferritin < 20 μg/L) was evident in a quarter of adolescents in both groups (non-AUDs 23.5%; AUDs 24.7%), with biochemical iron status measures (serum iron and total iron binding capacity) indicating a greater risk of iron store depletion in the AUDs group. Biochemical vitamin D insufficiency/deficiency (serum 25-hydroxyvitamin D < 30 ng/mL) was prevalent in both groups (non-AUDs 70.4%; AUDs 88.8%), although this was significantly greater in the AUDs group (p=0.013), with significantly lower serum 25-hydroxyvitamin D levels in the AUDs group compared to the non-AUDs group (p=0.038). Conclusions: Heavy alcohol use in the form of binge drinking in adolescents may have the following nutrition-related influences: increased intake of energy; unhealthy fats and sodium, increased risk of overweight/obesity in females; increased risk of iron store depletion; and increased risk of vitamin D insufficiency/deficiency. Persistence of heavy alcohol use, poor food choices and dietary intake may increase the risk for adverse nutrition-related health outcomes in the AUDs adolescents.

AFRIKAANSE OPSOMMING: Inleiding: Adolessente het 'n verhoogde risko vir wanvoeding as gevolg van hul hoë voedingbehoeftes vir groei en ontwikkeling, swak eetgedrag, asook 'n geneigdheid tot verdere ongesonde gedrag. Swaar alkohol gebruik in die vorm van “binge” drinkery kom toenemend onder skoolgaande adolessente voor. Hierdie gedrag kan moontlik bydra tot die verhoogde voeding risiko in dié ouderdomsgroep. Hierdie moontlikheid is egter nog nie ten volle ondersoek nie. Doel: Hierdie studie het die potensiële invloed van alkohol gebruik op die voedingstatus van adolessente met alkohol gebruik versteurings (AGVs) ondersoek, spesifiek met betrekking tot hul eetgedrag en dieetinname, groei en gewigstatus asook yster-, vitamien D- en kalsiumstatus. Metodes: Swaar drinkende adolessente wat voldoen aan DSM-IV kriteria vir AGVs (n=81) en lig/nie-drinkende adolessente sonder AGVs (nie-AGVs) (n=81), wat afgepaar is vir ouderdom, geslag, taal, sosio-ekonomiese status en opvoedingsvlak is gewerf vir deelname aan die studie. Middel gebruik, fisiese aktiwiteit, eetgedrag, dieetinname, groei en gewigstatus, ysterstatus en vitamien D- en kalsiumstatus is tussen die twee groepe vergelyk. Waargenome dieetinname verspreidings is statisties aangepas om gewoontelike nutriëntinname te verkry. Regressie-aangepaste verskille tussen die groepe is met behulp van ’n meervoudige gemengde effekte liniêre regressie model getoets, waartydens daar vir moontlike gestrengelde faktore aangepas is. Resultate: Leeftyd alkohol dosis, gemeet in standaard alkohol drankies, was beduidend hoër in die AGVs groep in vergelyking met die nie-AGVs groep. Alkohol gebruik in die AGVs adolessente het ‘n “binge” patroon en ‘n “slegs naweke” styl getoon. Swak eetgewoontes (oorslaan van ontbyt en gereelde peuselgewoontes), swak voedsel keuses (energie-dig en laag in nutriënte) en lae groente en vrugte inname (nie-AGVs 90.0 [42.4-153.3]; AGVs 88.3 [30.0-153.0] gram per dag), in beide groepe, is gereflekteer in die swak voeding kwaliteit van die dieet. ‘n Risiko vir onvoldoende inname van folaat (nie-AGVs 97.5%; AGVs 98.8%), vitamien C (nie-AGVs 65%; AGVs 67.5%), vitamien A (nie-AGVs 80%; AGVs 82.5%), vitamien E (nie-AGVs 78.8%; AGVs 51.3%), magnesium (nie-AGVs 98.8%; AGVs 97.5%), en fosfor (nie-AGVs 76.3%; AGVs 73.8%) was teenwoordig in meer as helfte van adolessente in beide groepe, asook Inleiding: Adolessente het 'n verhoogde risko vir wanvoeding as gevolg van hul hoë voedingbehoeftes vir groei en ontwikkeling, swak eetgedrag, asook 'n geneigdheid tot verdere ongesonde gedrag. Swaar alkohol gebruik in die vorm van “binge” drinkery kom toenemend onder skoolgaande adolessente voor. Hierdie gedrag kan moontlik bydra tot die verhoogde voeding risiko in dié ouderdomsgroep. Hierdie moontlikheid is egter nog nie ten volle ondersoek nie. Doel: Hierdie studie het die potensiële invloed van alkohol gebruik op die voedingstatus van adolessente met alkohol gebruik versteurings (AGVs) ondersoek, spesifiek met betrekking tot hul eetgedrag en dieetinname, groei en gewigstatus asook yster-, vitamien D- en kalsiumstatus. Metodes: Swaar drinkende adolessente wat voldoen aan DSM-IV kriteria vir AGVs (n=81) en lig/nie-drinkende adolessente sonder AGVs (nie-AGVs) (n=81), wat afgepaar is vir ouderdom, geslag, taal, sosio-ekonomiese status en opvoedingsvlak is gewerf vir deelname aan die studie. Middel gebruik, fisiese aktiwiteit, eetgedrag, dieetinname, groei en gewigstatus, ysterstatus en vitamien D- en kalsiumstatus is tussen die twee groepe vergelyk. Waargenome dieetinname verspreidings is statisties aangepas om gewoontelike nutriëntinname te verkry. Regressie-aangepaste verskille tussen die groepe is met behulp van ’n meervoudige gemengde effekte liniêre regressie model getoets, waartydens daar vir moontlike gestrengelde faktore aangepas is. Resultate: Leeftyd alkohol dosis, gemeet in standaard alkohol drankies, was beduidend hoër in die AGVs groep in vergelyking met die nie-AGVs groep. Alkohol gebruik in die AGVs adolessente het ‘n “binge” patroon en ‘n “slegs naweke” styl getoon. Swak eetgewoontes (oorslaan van ontbyt en gereelde peuselgewoontes), swak voedsel keuses (energie-dig en laag in nutriënte) en lae groente en vrugte inname (nie-AGVs 90.0 [42.4-153.3]; AGVs 88.3 [30.0-153.0] gram per dag), in beide groepe, is gereflekteer in die swak voeding kwaliteit van die dieet. ‘n Risiko vir onvoldoende inname van folaat (nie-AGVs 97.5%; AGVs 98.8%), vitamien C (nie-AGVs 65%; AGVs 67.5%), vitamien A (nie-AGVs 80%; AGVs 82.5%), vitamien E (nie-AGVs 78.8%; AGVs 51.3%), magnesium (nie-AGVs 98.8%; AGVs 97.5%), en fosfor (nie-AGVs 76.3%; AGVs 73.8%) was teenwoordig in meer as helfte van adolessente in beide groepe, asook

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