An Investigation of University Students' Changes Occurred in Some Body Composition Measurements in Two Years

The aim of this study is to examine the changes in the body composition of university students at the beginning and the end of the two-year period. Body weight, waist circumference, hip circumference, fat ratio, muscle ratio, waist-hip ratio and body mass index parameters of university students were measured at the beginning of the first year and at the end of the second year. In the analysis of all the parameters Will Coxon Test was used. Significance was determined at p>0.05 level. In the body weight, waist circumference and fat ratio parameters of the volunteers there was a statistically significant difference between the pretest-posttest values of female students (p 0.05). On the other hand, there was a statistically significant difference in the pretest-posttest values of both sexes in muscle ratio, waist-hip ratio and BMI parameters (p<0.05). Both increases and decreases were observed between the parameters of the volunteers measured at the beginning and the end of the two-year period. It was determined that the body mass index values decreased and normalized in both girls and boys, waist-hip ratio was in the risk group in both girls and boys similarly, and the girls were in the risky group regarding the waist circumference values. The findings revealed that following these parameters, which are the significant indicators of well-being, and taking necessary precautions play a critical role in the case of a health problem which may emerge in the future.


Introduction
Obesity is characterized by the fact that the energy taken with the nutrients to the body is more than the energy spent and the body fat mass increases compared to the lean body mass (WHO, 2000, p. 1-252;Donohoue, 2004, p. 173-177;Kokino et al., 2006, p. 47-54). The incidence of obesity is increasing in alarming levels in both developed and developing countries in the world. Because the prevalence of overweightness and obesity increases day by day in our country as in the other countries of the world, it is emphasized as the most important health problem for both media and doctors (Kaya, & Özçelik, 2005, p. 164-168;Çayır et al., 2011, p. 13-19;Satman, 2011, p. 1-36). Obesity is also associated with chronic diseases such as cardiovascular diseases, some types of cancer and type 2 diabetes (Flegal et al., 2005(Flegal et al., , p. 1861(Flegal et al., -1867, and becomes a huge burden on health systems (Wolf, & Colditz, 1996, p. 466-469).
The poor level of health that occurs due to obesity usually occurs in the older ages. However, the causes of poor health level can develop in childhood, youth or adulthood. The transition period from adolescence to adulthood is a critical period in weight gain (Gordon-Larsen et al., 2004, p. 569-575). The youth period is known as the most dynamic period for the individual and society. For the individual, the youth period is the process of transition from childhood to adulthood and the character formation through socialization. This process involves the biological, psychological and social development of the teenager, which will shape his entire life. Thus, the young affects the society they live in and is affected by the problems of that society, and actively participates in social development and events. This situation becomes more important during the age of 17 and after, which coincides with the university years. University life is the years when there are important changes in the lives of young people (Tuğut, & Bekar, 2007, p. 17-26).
Problems such as fatness or obesity are experienced due to nutritional disorders caused by collective eating, economic difficulties, irregular eating habits, constant meal skipping, unhealthy food preferences encountered during university education (Özütürker, &Özer, 2016, p. 63-73). The weight gained at an early age increases in the following years and causes the obesity development and accordingly the increase of risk factors. Therefore, body composition analysis in children and adolescents has an important role in obesity development and treatment (Kaya, & Özçelik, 2005, p. 164-168).
When nursing students defined as young population are taken into consideration, the applications to be planned specifically for this age group are essential for the future society to be healthy. During their university years, individuals leave their families, become open to environmental factors and can make their choices freely. This situation causes students to develop a lifestyle that will negatively affect their health. It is observed that young people often carry this lifestyle they have acquired after the education. Excess weight and obesity caused by an unhealthy lifestyle can only be prevented by individuals changing their habits positively (Tedik, & Hacıalioğlu, 2017).
One of the most important issues on obesity is to determine and keep track of the body composition of the people and to take necessary interventions before obesity develops. Therefore, the aim of this study is to examine the changes in the body composition of university students at the beginning and the end of the two-year period.

Method
Participants 20 male students (mean height = 179.20±10.39 cm, mean body weight = 76.07±21.69 kg, mean BMI = 23.43±4.25 kg/m 2 , mean age = 23.00±1.49 years), and 20 female students who study at the nursing department (mean height = 166.80±4.89 cm, mean body weight = 74.10±9.28 kg, mean BMI = 24.90±3.02 kg/m 2 , mean age of 22.20±1.44 years) were randomly selected and voluntarily participated in the present study. All parameters were measured at the beginning of the first year and at the end of the second year by the same researcher. The study was approved by the Ethical Committee of Bilecik Şeyh Edebali University (2020-6/9) and conducted in accordance with the World Medical Association Helsinki Declaration.

Anthropometric Measurements
Body Height Measurement; Body height of the players was measured using a stadiometer (Holtain, UK). The measurements were taken while the person's body weight was evenly distributed on both legs, with the head in the "Frankfort Horizontal Plan" position, with the arms on the side of the body, with the palms facing the legs and in bare feet (Akın et al., 2004, p. 161-167).

Body Weight Parameters Measurement;
Body weight parameters (body weight, body fat percentage, muscle ratio) was measured by Tanita MC780 (Japan) brand body fat analyzer. Measurements were taken before breakfast, without any nutrients. Measurements were made while participants were wearing shorts and Tshirts. The metal parts of the platform that touch the hands and feet are wiped with a damp cloth after each player leaves the platform (Işın, & Melekoğlu, 2019, p. 80-86).
Waist and Hip Circumference Measurement; Hip circumference of the volunteers was measured after they are requested to breath normally in standing upright position, with feet 12-15 cm apart and weight evenly distributed. Hip circumference was measured as the maximum distance around the posterior and anterior gluteal region by the symphysis pubis, with a tape. Measurements were recorded to the nearest 0.1 cm (Akpınar et al., 2007).
Classification according to waist circumference was carried out on the following criteria: in women; less than 80 cm were considered normal, between 80-88 cm constituted the risky group who are prone to obesity, and the those over 88 cm were considered obese, and in men; less than 94 cm were considered normal, 94-102 cm constituted obesity prone risk group and those over 102 cm were considered obese (WHO, 2008, p. 20-27).
Waist -Hip Ratio (WHR); After taking the waist and hip circumference measurements of the volunteer (WHO, 2008, p. 20-27), WHR was formulated as follows: While the waist hip ratio that is lower than 0.90 is normal in men, it is the risky if it is above 0.90; in women on the other hand, below 0.85 is considered normal, while 0.85 and above are considered as risky waist hip ratio (WHO, 2008, p. 20-27 In the international obesity classification of the World Health Organization, those whose Body Mass Index categories are below 18.5 are "underweight", those between 18.5 and 24.9 are "normal", those between 25.0 and 29.9 are "overweight", those above 30.0 are "obese" (WHO, 2008, p. 20-27).

Statistical Analysis
SPSS 23 (SPSS Inc., Chicago, IL, USA) package program was used for statistical analysis of the data obtained from the current study. The homogeneity of the variance of the data was tested using the Levene's Test and the normality of the distribution was tested with the Shapiro-Wilk Test. Willcoxon Test was used in the analyses of all parameters. Significance was determined at p> 0.05 level. Arithmetic mean, standard deviation and percentage values of the obtained data in the study are also presented.

Results
Age, height, body weight, waist circumference, hip circumference, body fat ratio, body muscle ratio, waisthip ratio and body mass index values of the volunteers participating in the study are presented in the table below.  While 65% of male students were found to be "normal", 25% were overweight and 5% were obese in the preliminary measurements, 70% of them were "normal" and 15% were overweight in the last measurements. In the preliminary measurements, 30% of female students were found to be "normal", 65% of them were "overweight", and in the final measurements 65% of them were "normal" and 30% of them were "overweight". While the waist hip ratio of 6% of male students was over ≥0.90 in the preliminary measurements, the waist hip ratio of 11% of them in the last measurements was above ≥0.90. On the other hand, 19% of female students had a waist-hip ratio above ≥0.85, while 17% of them had a ratio above ≥0.85 during the last measurements. While 5% of male students were at risk group in preliminary measurements, this rate increased to 10% in the final measurements. Again, while 15% of male students were in high risk group, this rate decreased to 5% in the last measurements. On the other hand, while 15% of female students were in the risky group in preliminary measurements, this rate rises to 40% in the final measurements. Again, while 70% of the female students were in the high risk group in the preliminary measurements, 50% of them were in the same group in the final measurements. While a statistically significant difference was found between the pre-test and post-test results of female students in body weight, waist circumference and fat ratio parameters (p <0.05), there was no difference in male students (p> 0.05). There was a statistically significant difference in the pretest-posttest values of both sexes in muscle ratio, waist-hip ratio and BMI parameters (p <0.05).

Discussion
With developing methods, studies on obesity and body compositions show a significant increase. Studies conducted in different parts of the world have revealed that the ratio of fat in body composition has been increasing, and as a result, there are significant growth in various health problems (Kaya, & Özçelik, 2005, p. 164-168;Evans et al., 2012, p. 1-7;Mushonga et al., 2014, p. 30-33;Zileli et al., 2016, p. 549-562 ).
In the diagnosis and evaluation of obesity, there are various methods used to evaluate the amount and distribution of body fat. Among these, anthropometric measurements (Bioelectrical Impedance Analysis (BIA), body mass index, waist and hip circumference measurement) are the most commonly used for their low cost and easy applicability. These methods differ from each other in terms of their applicability, costs and accuracy. Therefore, these methods can be used together for more objective results in obesity risk assessment (Yıldırım et al., 2017, p. 20-33). BMI is a simple measure of determining obesity, but it is not the only measure. Waist circumference is another parameter that needs to be checked for health. Handling the BMI together with the waist-hip ratio may yield more valuable results in terms of diseases (Ergün, & Erten, 2004, p. 57-61;Akpınar et al., 2007, p. 387-393;Booth et al., 2000Booth et al., , p. 1058Booth et al., -1061. The World Health Organization also states that assessing BMI, waist circumference and waist hip ratio together can offer advantages. (WHO, 2008, p. 20-27). In a study conducted on young adults, it was emphasized that the BMI, waist circumference and waist-hip ratio, which were found to be high, may lead to cardiovascular diseases in the following years (Azizi et al., 2004, p. 887-897). Therefore, in our study, a general evaluation was made according to the data obtained from different methods.
When the data published by TÜİK in 2015 is analysed, the changes observed in the rates of obese individuals over the age of 15 are as follows; The obesity rate in males, which was 12.3% in 2008, increased to 13.2% in 2010, to 13.7% in 2012 and to 15.3% in 2014. Obesity rates in women increased from 18.5% in 2008 to 21% in 2010 and decreased to 20.9% in 2012. In 2014, it was determined as 24.5% with a very high increase. Considering these two tables, the proportion of overweight men in Turkey is higher than women each year, but in obesity classification women have higher proportions than men (TUİK, 2015, p. 1-2.). These data are in line with our findings.
Regarding the health problems and economic burden caused by obesity, the importance of early diagnosis is quite obvious. In terms of the problems which may arise in the future, the determination and follow-up of students' obesity related parameters are very important. In order to prevent undesirable future problems with respect to public health, the current state of the students' body compositions should be revealed and followed periodically.
Obesity, which can be seen at any age and increases with age (Yıldırım et al., 2017), is rapidly growing among university students. As a result of this increase and the health problems it caused, the importance of the subject has been emphasized in every environment. However, these problems do not attract the attention of the society sufficiently owing to the lifestyle changes brought about by modern life and the lack of studies on obesity among university students (Tedik, & Hacıalioğlu, 2017).
In the present study it was found out that the body weight of boys remained the same, the values of waist circumference decreased, hip circumference values decreased, fat ratio decreased, muscle ratio values increased, waist-hip ratio values increased, body mass index values decreased. On the other hand, it was determined that girls' body weight decreased, waist circumference values decreased, hip circumference values decreased, fat ratio values decreased, muscle ratio values increased, waist-hip ratio values decreased, body mass index values decreased (Table 5). The findings of our study are similar to the literature. Ergün and Erten (2004), in their study which was conducted on Ankara Medical Faculty 2 nd year students and investigated the weight, height, and BMI values and waist circumference among male and female students, found that more than 10.5% of them were overweight and 1.5% were obese. According to waist circumference, obesity was found to be 3.1% in women and 1.4% in men.  in his study examining the changes in body mass index in the 1 st and 6 th grade students of Ankara University Faculty of Medicine discovered that preobesity which was 12.2% in the 1 st grade increased to 18.4% in the 6 th grade, and while obesity in the 1 st grade was 3.1% and it icreased to 3.8% in the 6 th grade.
When Tedik and Hacıalioğlu (2017) examined their nursing students according to their BMI; they found that 65% of the students were normal weight, about 19% were overweight and 16.2% were obese. Accordingly, he recommended that overweight students who are at risk should be identified with early diagnosis and that healthy lifestyle behaviors should be improved in these students and thus obesity should be prevented. Yıldırım et al. (2017) in their study conducted on university students found that according to their BMI values, 24.87% of women and 33.53% of men had body weight above normal, according to waist circumference values, 40.67% of women and 20.81% of men were at risk group, and according to their body fat percentage values 30.62% of women and 20.23% of men were in the risky group. In their study, Yılmaz and Aksoy (2018) determined that 23.2% of the nursing students had BMI values between 25.0-40.0 and stigmatized themselves because of their weight. Korkmaz et al. (2019) emphasized that 19.1% of nursing students were overweight and 9% were obese, and in order to protect and improve their health, education programs should be created.
As a result, some increases and decreases were observed in the parameters of the volunteers measured at the beginning and end of the two-year period. It was found that the body mass index values decreased and normalized in both girls and boys, the ratio of waist-hip in the girls and boys put them in the risky group, and also according to the waist circumference values, the girls were in the risky group (Table 2, 3,4). The findings revealed that following these parameters, which are the significant indicators of well-being, and taking necessary precautions play a critical role in the case of a health problem which may emerge in the future. Nursing students who are at risk while continuing their routine lives should exhibit healthy lifestyle behaviors. We are in the opinion that nursing students who will serve the society to protect and improve health should be more careful about their body compositions in terms of both their health and social roles.

Ethical Declaration
In the writing process of the study titled "An Investigation of University Students' Changes Occurred in Some Body Composition Measurements in Two Years", there were followed the scientific, ethical and the citation rules; was not made any falsification on the collected data and this study was not sent to any other academic media for evaluation.