1. Introduction

Physical activity and balanced nutrition are two main components of good health and longelivity. World Health Organisation gave recommendations on physical activity but 70% of people in developed countries do not meet those recommendations (Ostojic, Stojanovic & Milosevic, 2013) and it is estimated that by the end of 2020 noncommunicable diseases will be the cause of 73% of all deaths in the world (Rao et al, 2012). The number of overweight people also increased (Hills, Dengel & Lubans, 2012; Huijig et al 2015), as well as the number of adults and children with cardiovascular and metabolic diseases (Ostojic et al, 2011). Students are particularly at risk because during university years physical activity decreases, weight is gained and eating habits change (Shah, Amirabdollahian & Costa, 2011). Research on physical activity and nutrition of students show that they do not participate regularly in physical activity, and if they do it is usually not enough to benefit health, they eat unhealthful food usually when stressed or bored, late at night or in relation to drinking alcohol (Keating et al, 2005; Nelson et al, 2009; Bhochhibhoya et al, 2014). Data also show increase in consumption of meat, eggs and dairy products and decrease in legumens, friuts and vegetables (Westhoek et al, 2014). Dietary habits of student population usually include sweets, snacks, soft drinks and pastries (Moreno et al, 2012). Their diet and physical activity behaviors are influenced by enrolling on a college and forming new social networks (Harmon et al, 2016), as well as leaving home and creating some new permanent habits (Young, Sturts & Ross, 2015). Knowing this, a question about physical activity and nutrition of students in Vukovar emerged. We wanted to know are they physically active, what kind of food do they choose and how it correlates with their morphological characteristics, since they are physiotherapy students, future educators on healthy way of life.

2. Methods

2.1. Subject Sample

Physiotherapy final year students, 27 females and 13 males, age 20.6±1.3 participated in the research. They were randomly selected. Mean values for body mass index (BMI), lean body mass (LBM), percent body fat (PBF), waist to hip ratio (WHR), weight and height are shown in table 1. Research took place at College “Lavoslav Ružička” in Vukovar during 2015.

2.2. Ouestionnaires

Students were asked to complete a questionnaire on frequency of vegetables, fruit, dairy products, eggs, meat, fish, bread and pastry, grains, drinks, fried food and salt consumption 6 months prior to the research. They had to choose the answer best fitting the frequency of consumption where zero (0) stood for less than one time per week, one (1) – one time per week, two (2) – two to four times per week, three (3) – almost every day, four (4) – two or more times per day). Physical activity was estimated using short IPAQ questionnaire Croatian version. This questionnaire asseses physical activity as a part of every day living. Examinees had to estimate how much time did they spend during the day or week, one week prior to research, doing vigorus or moderate physical activity, how long did they walk, or sit. All the answers regarding physical activity less than 10 minutes were not taken into consideration. Results were calculated in MET minutes. Because of the assumption that a person sleeps 8 hours at night results such as 960 MET minutes of daily activities were expeled. Answers about physical activity like Don't know, Not sure or Didn't do this type of PA were marked as 0.

2.3. Measurements

We measured weight, hight and body circumferences (forearm, arm, leg, waist and hip). The room where the measurements took place was 24°C, air conditioned, and students wore shorts and sleeveless T-shirts. Day before the measurements they engaged in no physical acitivity. They were divided into two groups, and two persons did the measurements, one physiotherapist and one student who noted the results. One group had 17 students and they were measured from 8am until 10am, and the other group had 23 students and they were measured from 1pm until 3pm. They were divided in two groups due to classes schedule. Weight and height were measured using Seca scale, type 700, class III, maximum weight 200kg, minimum weight 1kg with 0.1kg sections and maximum height 200cm with 0.1cm sections. Upper arm, forearm, thigh and shin, waist and hip circumference were measured using measuring tape, maximum lenght 150cm with 0.1cm sections. Before the measurements all the orientation marks on the body were highlighted using a pen. Upper arm circumference was measured on both arms relaxed at side 10cm below acromion in standing position. Forearm circumference was measured in the same way but 10cm below olecranon process. As for the thigh circumference it was also measured in standing position 10 cm below greater trochanter and for the shin circumference over the widest part of it. Waist circumference was measured over the navel and hip circumference over the widest part of both hips. Based on the aquired measures body mass index (BMI), waist to hip ratio (WHR), percent body fat (PBF) and lean body mass (LBM) were calculated. BMI was calculated as weight in kilogrammes divided by height square in metres; WHR as waist circumference divided by hip circumference in centimetres; PBF according to formula by McArdle at al (1981) for females using age, waist circumference + right tigh circumference + right shin cirumference and for males using age, right upper arm circumference + waist circumference + right shin circumference. LBM was calculated using Hume formula (1966) for males 0.3281 x weight in kg + 0.33929 x height in cm – 29.5336 and for females 0.29569 x weight in kg + 0.41813 x height in cm - 43.2933.

2.4. Statistical Analysis

Statistical program MedCalc 10.2.0.0 was used for analysis. Chi square was used to determine differences in frequency of food consumption among sexes (P<0.05). Cluster analysis using Ward's method was applied to group examinees according to the similiarity of answers regarding frequency of food consumption, and Two-way Anova was used to determine differences between morphologic characteristic of groups based on two factors: food and sex (P<0.001). Mann-Whitney test was used to establish differences in physical activity among sexes (P<0.05). Correlation between physical activity and morphologic characteristic was estimated with Pearson's coefficient (P<0.05).

3. Results

Physiotherapy students participated in this research more women (27) than men (13), age 20.6±1.3. Men were taller and heavier than women with higher BMI, LBM and WHR values (table 1.).

Table 1. Mean values of anthropometric measures for men (13) and women (27)

Students were divided into clusters, based on their answers, to determine if correlation between nutrition, morphologic characteristics and sex existed. No correlation was found with nutrition (p>0.05) but did with sex (P<0.001). When we analysed nutrition questionnaire only significant difference found between males and females was regarding the frequency of integral bread, grains (p=0.048) and fish consumption (p=0.041). Eventhough there were no significant differences between men and women regarding frequency of white bread (p=0.80) and cake consumption (p=0.28) bread is eaten daily, but muffins, doughnuts and cakes only once a week. Students (40%) reported eating fat milk, butter and hard cheese once a day and margarine (55%) less than once a week. As for the friut they usually eat apples (37.5%) and regarding vegetables lettuce, tomatoes or peas (50%) two or more times a week. No significant differences were found between men and women (p>0.05). We also found that 60% of all students eat white meat more often than the red meat. Sausages, salami, hot-dog and bacon half of them reported eating less than once a week. Almost half of them also reported eating eggs every day. Many (45%) declared eating fried food very often, but they do not drink cola beverages, or sodas so often. Women (96%) wanted to change their nutrition significantly more (p=0.0043) than men, who were satisfied with the food they eat. Almost all (83%) believed in succesfull change of their nutrition (p=0.49).

When we analysed IPAQ questionnaire we found no significant sex differences regarding physical activity except in category vigorous PA (p<0.05) (table 5.). As for the influence of PA on morphologic characteristic significant correlation was found for walking daily and weekly with weight (p=0.036; p=0.024), LBM (p=0.013; p=0.009), PBF (p=0.009; p=0.008), WHR (p=0.023; p=0.014) for women and vigorous PA and LBM for men (p=0.019; p=0.024).

Table 2. Physical activity in MET minutes – sex differences (*p=0.034; **p=0.030)

4. Discussion

This research found that morphological characteristcs of students correlate with physical activity and with sex, but not with nutrition. Vigorous PA correlates with LBM in men whereas walking correlates with weight, WHR, PBF and LBM in women. There were no significant differences between men and women regarding physical activity except in category vigorous PA. Those changes may be due to the fact that PA was estimated, not measured or contributed to hormones (Cook & Schoeller, 2011) and sex (Larson-Meyer et al, 2012). Hallal et al (2012) and Varela-Mato et al (2012) also found that men are more active than women since men find physical activity more important in weight menagement and health maintenance than women (Elinder, Sundblom & Rosendahl, 2011). Of course, initial results also showed that men were taller and heavier than and women with higher values of BMI and LBM and lower values of PBF than women similar to research by Geer & Shen (2009) and Lakoski et al (2011) on sex differences, body fat and body mass index, who reported that college men tend to have higher LBM and women PBF. This also may be due to hormones, especially testosteron (Plaisance et al, 2009), or age (Taylor et al, 2010) as morphological differences tend to be more obvious with age. Regarding the fact that walking correlates with changes in weight, WHR, PBF and LBM in women is important as it can be a good intervention strategy in prevention metabolic disorders in older age. Some of the experimetal research state that decreasing time spent sitting or standing is better than adding vigorous PA into daily routine (Hamilton, Hamilton & Zderic, 2007). Besides PA nutrition is also important factor in metabolic disorders prevention, especially since we adopt eating habits very soon and it is difficult to change them. No correlation was found between morphological characteristics of students and nutrition in this research. Men and women significantly differ only in frequency of intergral bread, grains and fish consumption. We contributed this to the fact that students completed a questionnaire on frequency of groceries consumption, because there is only one student restaurant in Vukovar and to the influence of region on food choice (El Ansari, Suominen & Samara, 2015; Baldini et al, 2009). For example, Mediterranean diet suggests eating fish and white meat, integral bread, vegetables, fruit as dessert and avoiding margarine (Papadaki et al, 2007) as do Vukovar students. Or, compared to American students who eat a lot of fried food and drink aerated beverages (Racette et al, 2005; Ko, 2007), students from Vukovar eat fried food often also but drink less cola beverages. We also think that the ability to make own decisions regarding food, and eating with friends impact food choices students make (Huang et al, 1994; Sukalakamala & Brittin, 2006).

5. Conclusions

Nutrition has no impact on morphological characteristic of students in this research, and there aren't so many differences between men and women regarding food choices they make. However, physical activity showed correlation with morphological characteristics, especially walking for women, eventhough men reported beeing significantly more active. This could be used in future when planning training programmes for women and men aiming to prevent metabolic disorders or cardiovascular diseases. For more sheered results all students should be included and PA and nutrition sholud be objectively measured.