BACKGROUND: Physical development can be considered as an indicator of the overall health status of the youth population. Currently, it appears that the increasing trend of the prevalence of obesity among children and youths has stopped in a number of countries worldwide. Studies point to the fact that adolescence is a critical period for the development of obesity. Body mass index (BMI) seems to be an orientation parameter in the assessment of prevalence of obesity which is not sufficient for more accurate identification of at risk individuals. The purpose of this study was to evaluate association between BMI percentile zones as health-risk for being overweight and obese and body composition indicators in high-school students from the Prešov (Slovakia) region. METHODS: A non-randomized cross-sectional study in high school students from the Prešov (Slovakia) region was conducted. The research sample consisted of 1014 participants (boys n = 466, girls n = 549). Body composition was measured using direct segmental multi-frequency bioelectrical impedance analysis (DSM-BIA). To examine the association between obesity and selected body composition indicators, Kruskal-Wallis ANOVA and Eta(2) were used. The relationship between selected body composition indicators and percentile BMI zones was determined using the Kendall tau correlation. RESULTS: In groups with different BMI percentile zones (normal weight, overweight, obese), ANOVA showed significant differences for girls and boys (p ˂.05) with high effect size (η(2) ˂.26) in body weight, body fat mass index, body fat percentage, fat free mass index, fat-free mass percentage, visceral fat area, waist-to-hip ratio, waist circumference, protein mass and mineral mass. The highest degree of correlation among boys was between BMI values indicating overweight and obesity and fat free mass index and waist circumference, respectively (τ = .71, τ = .70, respectively). In girls, the highest correlation was found between classification of BMI percentile zones and waist circumference (t = .78). CONCLUSION: The characteristics of body composition are very useful determinants of health and nutrition status. Our data revealed a direct association between BMI value and chosen body composition indicators. The most accurate indicator of overweight and obesity in our study appears to be waist circumference for both male and female population.

Department of Educology of Sports Faculty of Sports University of Prešov 17th November street No 13 Prešov Slovak Republic

Department of Kinesiology Faculty of Sports Studies Masaryk University Kamenice 5 Brno Czech Republic

Department of Sport Kinanthropology Faculty of Sports University of Prešov 17th November street No 13 Prešov Slovak Republic

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Newell A, Zlot A, Silvey K, Arail K. Addressing the obesity epidemic: A genomics perspective. Prev Chronic Dis. 2007, http://www.cdc.gov/pcd/issues/2007/. Accessed 10 May 2014. PubMed PMC

World Health Organization (WHO) Waist circumference and waist-hip ratio: report of a WHO expert consultation. Geneva, 8–11 December 2008. Geneva: WHO; 2011.

Garza C, Onis M. A new international growth reference for young children. Am J Clin Nutr. 1999;70:169–72. PubMed

Gorstein J, Sullivan K, Yip R, de Onis M, Trowbridge F, Fajans P, et al. Issues in the assessment of nutritional status using anthropometry. Bull World Health Organ. 1994;72:273–83. PubMed PMC

Hediger ML, Overpeck MD, Kuczmarski RJ, Ruan WJ. Associations between infant breastfeeding and overweight in young children. JAMA. 2001;285:2453–60. doi: 10.1001/jama.285.19.2453. PubMed DOI

Novakova J, Hamade J, Sevcikova L. Body development of children and youths in the Slovak Republic: Results of the 6th national anthropometric survey in 2001. Bratislava: Public Health Authority of the Slovak Republic; 2004.

Wabitsch M, Moss A, Kromeyer-Hauschild K. Unexpected plateauing of childhood obesity rates in developed countries. BMC Medicine. 2014;12:17. doi: 10.1186/1741-7015-12-17. PubMed DOI PMC

Olds T, Maher C, Zumin S, Péneau S, Lioret S, Castetbon K, et al. Evidence that the prevalence of childhood overweight is plateauing: data from nine countries. Int J Pediatr Obes. 2011;6:342–60. doi: 10.3109/17477166.2011.605895. PubMed DOI

Moliner-Urdiales D, Ruiz JR, Ortega FB, Rey-Lopez JP, Vincent-Godriquez G, Espana-Romero V, et al. Association of objectively assessed of psychical activity with total and central body fat in Spanish adolescents. Int J Obes. 2009;33:1126–35. doi: 10.1038/ijo.2009.139. PubMed DOI

Moreno L, DeHenauw S, Gonzalez-Gross M, Kersting M, Molnar D, Gottrand F, et al. Design and implementation of the healthy lifestyle in Europe by nutrition in adolescence cross-sectional study. Int J Obes. 2008;32:4–11. doi: 10.1038/ijo.2008.177. PubMed DOI

Otteavere C, Huybrecht J, Benser J, De Bourdeaudhuij I, Cuenca-Garcia M, Dallongeville J, et al. Clustering patterns of physical activity, sedentary and dietary behavior among European adolescents - the Helena study. BMC Public Health. 2011;11:328. doi: 10.1186/1471-2458-11-328. PubMed DOI PMC

Cassano PA, Rosner B, Vokonas PS, Weiss ST. Obesity and body fat distribution in relation to the incidence of non-insulin-dependent diabetes mellitus: a prospective cohort study of men in the normative aging study. Am J Epidemiol. 1992;136:1474–86. doi: 10.1093/oxfordjournals.aje.a116468. PubMed DOI

Srinivasan SR, Bao W, Wattigney WA, Berenson GS. Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: the Bogalusa Heart Study. Metabolism. 1996;45:235–40. doi: 10.1016/S0026-0495(96)90060-8. PubMed DOI

Velasquez-Mieyer P, Perez-Faustinelli S, Cowan P. Identifying children at risk for obesity, type II diabetes, and cardiovascular disease. Diabetes Spectrum. 2005;18:213–20. doi: 10.2337/diaspect.18.4.213. DOI

Ribeiro J, Guerra S, Pinto A, Oliveira J, Durate J, Mota J. Overweight and obesity in children and adolescents: relationship with blood pressure, and physical activity. Ann Hum Biol. 2003;30:203–13. doi: 10.1080/0301446021000054587. PubMed DOI

Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics. 2004;113:475–82. doi: 10.1542/peds.113.3.475. PubMed DOI

Prentice AM, Jebb SA. Beyond body mass index. Obes Rev. 2001;2:141–7. doi: 10.1046/j.1467-789x.2001.00031.x. PubMed DOI

Rothman KJ. BMI - related errors in the measurement of obesity. Int J Obes. 2008;32(Suppl 3):56–59. doi: 10.1038/ijo.2008.87. PubMed DOI

Malina RM, Katzmarzyk PT. Validity of the body mass index as an indicator of the risk and presence of overweight in adolescents. Am J Clin Nutr. 1999;70(Suppl 1):131–136. PubMed

Reilly JJ, Dorosty AR, Emmett PM. Identification of the obese child: adequacy of the body mass index for clinical practice and epidemiology. Int J Obes Relat Metab Disord. 2000;24:1623–7. doi: 10.1038/sj.ijo.0801436. PubMed DOI

Going SB, Lohman TG, Cussler EC, Williams DP, Morrison JA, Horn PS. Percent body fat and chronic disease risk factors in U.S. children and youth. Am J Prev Med. 2011;41(Suppl 2):77–86. doi: 10.1016/j.amepre.2011.07.006. PubMed DOI

Mala L, Maly T, Zahalka F, Bunc V. Fitness assessment. Body composition. Prague: Charles University in Prague, Karolinum press; 2014.

Karelis AD, Chamberland G, Aubertin-Leheudre M, Duval C, Ecological mobility in Aging and Parkinson (EMAP) group Validation of a portable bioelectrical impedance analyzer for the assessment of body composition. Appl Physiol Nutr Metab. 2013;38(1):27–32. doi: 10.1139/apnm-2012-0129. PubMed DOI

VonHurst PR, Walsh DCI, Conlon CA, Ingram M, Krug R, Stonehouse W. Validity and reliability of bioelectrical impedance analysis to estimate body fat percentage against air displacement plethysmography and dual-energy X-ray absorptiometry. Nutrition & Dietetics. 2015

Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gomez JM, et al. Bioelectrical impedance analysis-part I: review of principles and methods. Clin Nutr. 2004;23:1226–43. doi: 10.1016/j.clnu.2004.06.004. PubMed DOI

Dittmar M. Reliability and variability of bioimpedance measures in normal adults: effects of age, gender, and body mass. Am J Phys Anthropol. 2003;122:361–70. doi: 10.1002/ajpa.10301. PubMed DOI

Heyward VH, Stolarczyk LM. Applied body composition assessment. Champaign, IL: Human Kinetics; 1996. p. 21-43.

Thomas JR, Nelson JK. Research methods in physical activity. 4th ed. Champaign, IL: Human Kinetics; 2001.

Evans JD. Straightforward Statistics for the Behavioral Sciences. Pacific grove: Brooks/Cole Publishing; 1996.

Roche AF. Growth, maturation and body composition: the Fels Longitudinal Study 1929–1991. Cambridge: Cambridge University Press; 1992.

Bibiloni Mdel M, Pons A, Tur JA. Prevalence of overweight and obesity in adolescents:a systematic review. ISRN Obes. 2013;2013:392747. PubMed PMC

Williams DP, Going SB, Lohman TG, Harsha DW, Srinivasan SR, Webber LS, et al. Body fatness and risk for elevated blood pressure, total cholesterol, and serum lipoprotein ratios in children and adolescents. Am J Publ Health. 1992;82:358–63. doi: 10.2105/AJPH.82.3.358. PubMed DOI PMC

Rolland-Cachera MF. Prediction of adult body composition from infant and child measurements. In: Davies PSW, Cole TJ, editors. Body composition techniques in health and disease. Cambridge: Cambridge University Press; 1995. pp. 100–45.

Zhu S, Wang Z, Shen W, Heymsfıeld SB, Heshka S. Percentage body fat ranges associated with metabolic syndrome risk: results based on the third National Health and Nutrition Examination Survey (1988–1994) Am J Clin Nutr. 2003;78:228–35. PubMed

Ervin RB. Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003–2006. Natl Health Stat Report. 2009;13:1–7. PubMed

Guo SS, Wu W, Chumlea WC, Roche AF. Predicting overweight and obesity in adulthood from body mass index values in childhood and adolescence. Am J Clin Nutr. 2002;76:653–8. PubMed

Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in U.S. children and adolescents, 2007–2008. JAMA. 2010;303:242–9. doi: 10.1001/jama.2009.2012. PubMed DOI

Himes JH. Challenges of accurately measuring and using BMI and other indicators of obesity in children. Pediatrics. 2009;124(Suppl 1):3–22. doi: 10.1542/peds.2008-3586D. PubMed DOI

Oliveira CL, Veiga GV, Sichieri R. Anthropome tric markers for cardiovascular disease risk factors among overweight adolescents. Nutrition Research. 2001;21:1335–45. doi: 10.1016/S0271-5317(01)00325-6. DOI

Janssen I, Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, Bouchard C, et al. Combined influence of body mass index and waist circumference on coronary artery disease risk factors among children and adolescents. Pediatrics. 2005;115:1623–30. doi: 10.1542/peds.2004-2588. PubMed DOI

Pereira PF, Serrano HMS, Carvalho GQ, Ribeiro SMR, Peluzio MCG, Franceschini SCC, et al. Measurements of body fat distribution: assessment of collinearity with body mass, adiposity and height in female adolescents. Rev Paul Pediatr. 2015;33(1):63–71. doi: 10.1016/j.rpped.2014.11.011. PubMed DOI PMC

Ochiai H, Shirasawa T, Nishimura R, Morimoto A, Shimada N, Ohtsu T, et al. Relationship of body mass index to percent body fat and waist circumference among schoolchildren in Japan - the influence of gender and obesity: a population-based cross-sectional study. BMC Public Health. 2010;10:493. doi: 10.1186/1471-2458-10-493. PubMed DOI PMC

Laurson KR, Eisenmann JC, Welk GJ. Development of youth percent body fat standards using receiver operating characteristic curves. Am J Prev Med. 2011;41(Suppl 2):93–9. doi: 10.1016/j.amepre.2011.07.003. PubMed DOI

Owens S, Litaker M, Gutin B. Explaining cardiovascular disease risk factor variability in obese teenagers using measured and predicted values of visceral adipose tissue. Medicine and Sport Science. 2001;44:132–138. doi: 10.1159/000061768. DOI

Sabino PG, Silva BM, Brunetto AF. Nutritional status is related to fat-free mass, exercise capacity and inspiratory strength in severe chronic obstructive pulmonary disease patients. Clinics. 2010;65:599–05. doi: 10.1590/S1807-59322010000600007. PubMed DOI PMC

Schutz Y, Kyle UUG, Pichard C. Fat-free mass index and fat mass index percentiles in Caucasians aged 18–98 y. Int J Obes. 2002;26:953–60. doi: 10.1038/sj.ijo.0801856. PubMed DOI

Harriss DJ, Atkinson G. Update - ethical standards in sport and exercise science research. Int J Sports Med. 2011;32:819–21. doi: 10.1055/s-0031-1287829. PubMed DOI