Underweight, overweight and obesity in girls at the age of 7-19 years from the Lubelskie Province in the years

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1 Prace oryginalne / Original articles Pediatric Endocrinology, Diabetes and Metabolism 20, 19, 1, ISSN X Underweight, overweight and obesity in girls at the age of 7-19 years from the Lubelskie Province in the years Niedowaga, nadwaga i otyłość dziewcząt w wieku 7-19 lat z województwa lubelskiego w latach Agnieszka Wasiluk, Jerzy Saczuk, Mirosław Zalech The Jozef Pilsudski University of Physical Education in Warsaw, Faculty of Physical Education and Sport in Biala Podlaska, Poland Abstract Introduction: Increasing disproportions in the economic status of the Polish population are tangibly reflected in differences in the nutritional status of children and adolescents. Aim of the study: The objective of this study was to determine changes in the population size of girls with proper BMI values and their peers with underweight, overweight and obesity in a twenty-year time span. Material and methods: The survey conducted in 1986 covered girls, whereas that conducted twenty years later covered 9540 girls. Measurements were taken of body height and body mass of the girls, which enabled calculating values of their Body Mass Index (BMI). Pursuant to guidelines of the International Task Force, girls with the 3 rd degree underweight (gr. I), with the 2 nd degree underweight (gr. II), with the 1 st degree underweight (gr. III), with proper BMI values (gr. IV), with overweight (gr. V), and with obesity (gr. VI) were selected from the biological material. The statistical significance of differences between mean values achieved in the year 1986 and 2006 was verified with the Student s t-test for independent variables. The statistical significance of differences between the number of girls classified to each group in respect of the whole population surveyed in the year 1986 and 2006 was determined with the χ² test. Results: In the investigated twenty-year period, analyses demonstrated an increased incidence of body mass deficiency and excess in the surveyed girls. Greater differences between the generations in the incidence of underweight, overweight and obesity were observed in the urban girls, compared to their rural peers. In addition, more significant differences in body mass deficiency and excess were noted in the youngest girls from schools of the Lubelskie Province. Conclusions: It may, therefore, be speculated that the differences in the economic status of Lubelskie Province inhabitants influenced a lower number of girls with appropriate BMI values as well as increased percentages of girls with body mass deficiency and excess. Key words: BMI, girls, the secular trend Streszczenie Wprowadzenie: Wraz z pogłębiającymi się dysproporcjami w statusie ekonomicznym polskiego społeczeństwa uwidaczniają się różnice w stanie odżywienia dzieci i młodzieży. Cel pracy: Celem niniejszej pracy było określenie zmian, jakie zaszły w ciągu 20 lat w wielkości populacji dziewcząt o właściwych proporcjach wagowo-wzrostowych i ich rówieśniczek z niedowagą, nadwagą i otyłością. Materiał i metody: W roku 1986 zbadano dziewcząt, w tym 7859 mieszkanek miast i 9727 mieszkających na wsi. Dwadzieścia lat później wykorzystano wyniki badań 9540 uczennic, w tym 4865 stanowiły mieszkanki miast i 4675 pochodziło ze wsi. Dziewczęta były w wieku wieku 7-18 lat. Zmierzono wysokość i masę ciała, a następnie obliczono wskaźnik masy ciała (BMI). Na podstawie zaleceń International Task Force z materiału badawczego wyselekcjonowano dziewczęta z 3 stopniem niedowagi (gr. I), 2 stopniem niedowagi (gr. II), 1 stopniem niedowagi (gr. III), o prawidłowych proporcjach wagowo-wzrostowych (gr. IV), z nadwagą (grupa V) i otyłością (gr. VI). Istotność statystyczną różnic pomiędzy średnimi uzyskanymi w 1986 i 2006 roku weryfikowano testem t-studenta dla danych niezależnych. Istotność statystyczną różnic pomiędzy liczbą dziewcząt zakwalifikowanych do każdej z grup względem całej badanej populacji w 1986 roku i 2006 roku określono przy pomocy testu χ². Wyniki: W analizowanym dwudziestoleciu odnotowano wzrost częstości występowania niedoboru i nadmiaru masy ciała u ocenianych uczennic. Większe zmiany międzypokoleniowe w częstości występowania niedowagi, nadwagi i otyłości zaobserwowano u mieszkanek miast względem ich rówieśniczek ze wsi. Ponadto większe różnice w niedoborze i nadmiarze masy ciała zauważono u najmłodszych uczennic szkół województwa lubelskiego. Wnioski: Można przypuszczać, iż różnice w statusie ekonomicznym mieszkańców Lubelszczyzny wpłynęły na zmniejszenie liczby dziewcząt o prawidłowych proporcjach wagowo-wzrostowych oraz zwiększenie odsetka uczennic z niedoborem i nadmiarem masy ciała. Słowa kluczowe: BMI, dziewczęta, trend sekularny 11

2 Niedowaga, nadwaga i otyłość dziewcząt w wieku 7-19 lat... Pediatric Endocrinology, Diabetes and Metabolism 20, 19, 1 Introduction The civilisation progress in various countries in Europe and around the world leads to changes in the lifestyle of the whole societies. Achievements and realisations of human thought are accompanied by numerous side effects. The most dangerous one is a decrease in physical activity, which, in turn, increases the risk of overweight and obesity [1, 2]. Such a lifestyle has led, inter alia, to the increase in the number of overweight children and children with excessive adiposity especially in well-developed countries in the last twenty years [3-6]. Excessive body mass also exerts a negative influence on the level of physical activity of children and youth [7, 8]. It is very often stressed that obesity is the reason for the development of numerous health problems such as myocardial ischemia, hypertension, type 2 diabetes, large intestine or prostate tumours, etc. [9, 10]. However, underweight is in a close relation with bronchitis and pneumonia, asthma, improper functioning of digestive system and emotional problems [11]. These two decades in Poland constituted a period of rapid changes and socio-economic transformations. In this period there appeared a new social class of wealthy people but at the same time a significant part of the society became impoverished, which was caused, inter alia, by the liquidation of many workplaces and the increasing unemployment. Together with larger disproportions in the economic status of the Polish society, differences in the nutritional state of children and youth were more visible [12]. This problem is observed both in the areas with higher economic indicators and in regions with a slower development pace [-17]. Therefore, it seems interesting to define the pace at which changes in the body build of young female inhabitants of economically under-developed areas occur. Thus, the aim of the work is to define changes which occurred in the period of twenty years in the population of girls from Lublin region with proper weight-height proportions and their peers who are underweight, overweight and obese. Material and methods In 1985 and 1986 the research on children and youth inhabiting Biala Podlaska, Chelm, Zamosc and Lublin regions was carried out within Key Problem After the administrative reform of the country beginning in 1998 these areas were included in the Lublin region. One hundred forty schools were randomly selected from the list of educational institutions obtained from the Regional Education Authorities trying to sustain equal numbers in all regions. In this study the results of observations of girls aged 7-18 (including 7859 urban and 9727 rural females) were used. The measurements were made in the same schools in 2005 and 2006 within statutory research of the University. In this study, the results of 9540 female students aged 7-18 (including 4865 urban and 4675 rural girls) were used. There were fewer girls at the second stage of the research due to the educational reform which was introduced in Local authorities closed many small schools and some of the remaining ones were reorganised, which made it difficult to carry out observations. The research was conducted in accordance with the rules included in the Declaration of Helsinki and was accepted by the Senate Commission of Ethics at the University. Data concerning the date of birth and living conditions of the examined girls were collected with the use of a questionnaire. Anthropometric measurements were made according to the accepted anthropometric techniques (IBP). On the basis of the measurements of body height and weight the BMI was calculated (weight in kilograms divided by height in meters squared). Girls with the 3 rd degree of underweight (group I), the 2 nd degree of underweight (group II), the 1 st degree of underweight (group III), with proper weight-height proportions (group IV) as well as overweight girls (group V) and obese girls (group VI) were selected from the research material. The norm was established by taking away all underweight, overweight and obese students from the whole research group. The recommendations of the International Task Force based on the limit values established by Cole et al. [18, 19] served as the basis for assigning to the aforementioned groups (tab. I). The obtained numbers made it possible to calculate the percentage of underweight, overweight and obese girls both for the whole material and for groups taking into consideration the place of living (city, village) and different stages of education (7-9 lower primary school, primary school, -15 lower-secondary school, upper-secondary school). Table I. The limit values established by Cole et al. for girls [18, 19] Tabela I. Graniczne wartości wskaźnika masy ciała (BMI) według Cole a i wsp. dla dziewcząt [18, 19] 12 3 rd degree / 3 stopień 2 rd degree / 2 stopień 1 rd degree / 1 stopień Przedział normy

3 Underweight, overweight and obesity in girls at the age of 7-19 years... Within groups divided according to the calendar age arithmetic mean and standard deviation for the BMI were calculated. Statistical significance of differences between the means obtained in 1986 and 2006 was verified with the use of the Student s t-test for independent data. Statistical significance of differences between the number of girls assigned to each group with regard to the whole research population in 1986 and 2006 was defined with the use of the χ² test. Results In the case of girls living in the Lublin region between 1986 and 2006 the percentage of female students with proper weight-height proportions decreased by In the case of rural inhabitants this difference was 5.32, while among urban inhabitants it was 5.71 (tab. II, tab. III). The biggest statistically significant differences were noted in the youngest group of subjects coming from urban areas (19.27), which simultaneously influenced the results gathered in the group of all the examined students aged 7-9 (15.55). In rural girls the described changes were observed in 8.19 of the subjects. Among older girls, both rural and urban ones, the differences were smaller and statistically insignificant (table 4). Only in the oldest group (16-18-year-olds) the observed changes were significant and reached the level of In this period of 20 years the percentage of female students with underweight increased by 6.. The biggest differences, i.e were noted in girls from upper-secondary schools. Taking into consideration the urbanisation factor, it equalled.94 among rural inhabitants and among their peers from urban areas. The smallest intergenerational changes were observed in primary school pupils. It is alarming that the percentage of female students with the biggest underweight increased significantly. In all the analysed groups these differences were significant, with the biggest ones noted in rural girls aged (2.88) and urban girls aged 7-9 (2.76). It should be highlighted that in the latter group the percentage of underweight increased as much as five times. Smaller intergenerational changes were observed in the group of girls with the 2 nd degree of underweight in which the percentage of subjects in all the analysed groups increased by Significant differences were noted in the youngest and the oldest group, in both cases while calculating the whole material and taking into consideration the size of the place of living. As far as the group of girls with the smallest underweight is concerned, the number of girls examined in 2006 was 3.18 smaller than in In the case of lower primary school pupils and primary school pupils the differences were slight and statistically insignificant, while in older groups according to the Table II. The number and percentage of underweight, overweight and obese girls examined in 1986 Tabela II. Liczba oraz odsetek dziewcząt w grupach niedowagi, nadwagi i otyłości badanych w roku rd degree / 3 stopień 2 nd degree / 2 stopień 1 st degree / 1 stopień Norma All girls examined in 1986 / Wszystkie dziewczęta badane w 1986 roku 7-9 n n n n Urban girls examined in 1986 / Dziewczęta miejskie badane w 1986 roku 7-9 n n n n Rural girls examined in 1986 / Dziewczęta wiejskie badane w 1986 roku 7-9 n n n n

4 Niedowaga, nadwaga i otyłość dziewcząt w wieku 7-19 lat... Pediatric Endocrinology, Diabetes and Metabolism 20, 19, 1 Table III. The number and percentage of underweight, overweight and obese girls examined in 2006 Tabela III. Liczba oraz odsetek dziewcząt w grupach niedowagi, nadwagi i otyłości badanych w roku n n n n n n n n n n n n rd degree / 3 stopień 2 nd degree / 2 stopień 1 st degree / 1 stopień Norma All girls examined in 2006 / Wszystkie dziewczęta badane w 2006 roku Urban girls examined in 2006 / Dziewczęta miejskie badane w 2006 roku Rural girls examined in 2006 / Dziewczęta wiejskie badane w 2006 roku , calendar age a significantly bigger percentage of girls with the 1 st degree of underweight was observed. While analysing the frequency of occurrence of overweight in the collected research material it was observed that from 1986 to 2006 a statistically significant increase in the percentage of overweight students occurred at the first two stages of teaching, and its significant decrease at the following stages. It ought to be stressed that the biggest intergenerational differences were observed in the case of the youngest (12.74) and the oldest (-5.32) girls. Therefore, taking into account the whole material, changes seem to be slight since they totalled to -0.7 in rural inhabitants, while the mean for all the age groups was In the case of urban girls the biggest intergenerational changes concerning overweight occurred in the youngest inhabitants of big cities, where the number of subjects increased by 14.1, while the smallest ones in 16- to 18-yearold girls (-1.08). In students from rural schools, smaller intergenerational differences were observed since, with the mean for all the subjects at the level of -1.58, the biggest increase (by 5.82) occurred in the group of overweight students aged 7-9, while in the group of year-olds a decrease in the number of subjects by 6.5 was noted. Statistically significant differences were found in all the groups from lower primary school and in the oldest students. The biggest significant intergenerational changes in obesity were observed in the oldest and youngest students. In all the analysed age groups the frequency of occurrence of obesity increased most significantly in pupils from lower-primary schools from big cities (by 2.65), which influenced the results obtained by all the female inhabitants of the Lublin region (1.52). In rural girls the difference was In turn, in the group of the oldest girls the percentage of obese subjects decreased by 0.66 (including the difference of among rural girls and 0.7 among urban girls). In the remaining groups the intergenerational changes were slight and the differences were not statistically significant. (tab. II-IV, fig. 1, 2). Discussion Currently it is observed that body height and weight among girls and boys tend to increase, while the number of underweight children and adolescents is decreasing and the number of overweight and obese children is going up. Such alterations are discernible both in developing and developed countries [3, 5-7, 14]. Moreover, it should be highlighted that they occur in urban areas at a higher rate than in rural areas. Such conclusions were drawn by Wang et al. [14] on the basis of the research on older children and adolescents from Brazil, China, Russia and the USA. They claimed that those changes stemmed from differences in eating habits and from a decrease in physical activity. The problem of an increase in body height and weight and in the number of overweight and obese people is gradually

5 Underweight, overweight and obesity in girls at the age of 7-19 years... Table IV. Values of the χ² test for the differences between the number of girls from each of the groups of underweight, overweight and obesity compared to the study population in 1986 and 2006 Tabela IV. Wartości testu χ² dla różnic pomiędzy liczbą dziewcząt zakwalifikowanych do każdej z grup niedowagi, nadwagi i otyłości, względem badanej populacji w roku 1986 i roku rd degree / 3 stopień 2 nd degree / 2 stopień 1 st degree / 1 stopień All girls / Wszystkie dziewczęta Norma * * * * 9.142* * 1, * * 2, * * 4.268* * * * 5.027* * * Rural girls / Dziewczęta wiejskie * * * * 9.142* * * * * * * * * * * Urban girls / Dziewczęta miejskie * 7.968* * * * * * * 7.266* * * 7.806* *statistically significant differences at the level of p 0.05 * różnice istotne statystycznie na poziomie p 0,05 3 stopień niedowagi / 3rd degree 2 stopień niedowagi / 2rd degree 1 stopień niedowagi / 1rd degree całość / all miasto / urban wieś / rural -15 lat (-15 years) -15 lat (-15 years) -15 lat (-15 years) 7-19 lat (7-19 years) Fig. 1. Differences in the prevalence of underweight girls from the Lublin province calculated between the results of 2006 and the results obtained in 1986 Ryc. 1. Różnice w częstości występowania niedowagi u dziewcząt z województwa lubelskiego wyliczone przez porównanie wyników z 2006 roku i rezultatów uzyskanych w 1986 roku more and more noticeable in Poland [, 20-22]. According to Jodkowska et al. [], between 1995 and 2005 the frequency of occurrence of overweight and obesity among adolescent males increased by 2.4 and 1.5, respectively, and by 2.0 in particular BMI categories among females. Girls from eastern Poland also demonstrated an increase in body height and a considerable rise in body weight []. In turn, between 1986 and 2006 the percentage of girls from the Lublin region with proper weight-height proportions decreased, whereas the number of underweight and overweight female adolescents increased. The greatest differences were noted among the youngest girls, particularly in the case of overweight and obesity analyses. In the period of twenty years, the higher the educational stage was, the lower the percentage of over- 15

6 Niedowaga, nadwaga i otyłość dziewcząt w wieku 7-19 lat... Pediatric Endocrinology, Diabetes and Metabolism 20, 19, 1 nadwaga / overweight otyłość / obesity całość / all miasto / urban wieś / rural -15 lat ( -15 years) -15 lat (-15 years) -15 lat (-15 years) -10,00-5,00 0,00 5,00 10,00 15,00 20,00 Fig. 2. Differences in the incidence of overweight and obesity in girls from the Lublin province calculated between the results of 2006 and the results obtained in 1986 Ryc. 2. Różnice w częstości występowania nadwagi i otyłości dziewcząt z woj. lubelskiego wyliczone przez porównanie wyników z 2006 roku i rezultatów uzyskanych w 1986 roku 16 weight girls and the higher the proportion of underweight girls. Compared to their urban peers, rural girls demonstrated smaller intergenerational changes. It ought to be emphasised that the greatest (statistically significant) differences were found among female students participating in lower primary school programmes and those from upper-secondary schools, particularly from urban schools. In the case of the oldest girls, their awareness may have been the cause of such changes. These changes may have been brought about by their lifestyle, nutritional habits as well as the fashion for a slim figure, popularised by the mass media. At this point it should be stressed that in 1986 girls from the eastern regions of Poland demonstrated considerably higher levels of adiposity than national norms and girls from big cities [24]. Therefore, the direction of changes may be regarded as positive. The differences observed over 20 years could have been caused by socio-economic changes described in the introduction. Hence, it may be assumed that this stratification contributed to a decrease in the number of girls with proper weight-height proportions and to an increase in the number of underweight and overweight girls. These secular trends probably depend on the place of living. The issue of unemployment was more widespread in urban areas than in rural areas due to the fact that the possession of small farms enabled families to get by. However, an increase in the percentage of younger female students with the 3 rd degree of underweight is disturbing, since, according to Williamson et al. and Wronka, overweight children tend to lose weight with age [25, 26]. In turn, underweight adolescents put on weight as a result of adipose tissue gains. As a consequence, it may lead to improper weightheight proportions in the future. Conclusions On the basis of the data analysis the following conclusions can be drawn: 1. In the period of 20 years an increase in the frequency of occurrence of underweight and overweight among the female students under investigation was observed. 2. Compared to rural females, greater intergenerational changes in the frequency of occurrence of underweight, overweight and obesity were noted among urban females. 3. The greatest differences in underweight and overweight were observed among the youngest female students from Lublin region schools. It may indicate that in the future they are more likely to demonstrate improper weight-height proportions. References 1. Andersen RE, Crepso CJ, Barlett SJ. Relationship of physical activity and television watching with body weight and level of fatness among children: results from the Third National Health and Nutrition Examination Survey. JAMA. 1998;279: Eisenmann JC, Bartee RT, Wang MQ. Physical activity, TV viewing, and weight in U.S. youth: 1999 Youth Risk Behavior Survey. Obes Res. 2002;10: Livingstone B. Epidemiology of childhood obesity in Europe. Eur J Pediatr. 2000;159: suppl 1: Celi F, Bini V, De Giorgi G, et al. Epidemiology of overweight and obesity among children and adolescents in three provinces of central Italy, : study of potential influencing variables. Eur J Clin Nutr. 2003;57: Karayannis D, Yannakoulia M, Terzidou M, et al. Prevalence of overweight and obesity in Greek school aged children and adolescents. Eur J Clin Nutr. 2003;57: Lobstein T, Rugby N, Leach R, in Europe. 3 International Task Force. March 15. Brussels Saczuk J, Olszewska D, Wasiluk A, Olszewski J. Physical fitness of boys with overweight and obesity living in the eastern provinces of Poland. Pol J Public Health. 2011;4: Smolarczyk M, Wiśniewski A, Czajkowska A, et al. The physique and body composition of students studying physical education: a preliminary report. Pediatr Endocrinol Diabetes Metab. 2012;18: Freedman D, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight

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