EXERCISE AND QUALITY OF LIFE
Volume 7, Issue 1, June 2015
UDC 796.012.1-057.87:613.12
POSTURAL AND NUTRITIONAL STATUS OF STUDENTS FROM URBAN AND
SUBURBAN ENVIRONMENT
Ksenija Radaković, Branka Protić-Gava, Tijana Šćepanović, Mića Radaković, Maja Batez
and Milan Kojić
Faculty of Sport and Physical Education, University of Novi Sad, Serbia
Abstract
Monitoring postural and nutritional status is very useful for sheding light on problems in the
process of growth and development of children. The aim of this study was to determine the
difference in postural status of younger-aged school children of urban and suburban
environment according to their nutrition.
Research sample included 497 male and female pupils from Novi Sad (251) and suburban
environment (246), aged 11 and 12. Postural status was assessed using the method of
somatoscopy and nutrition level with BMI calculator. The relation between the category of
nutrition and the incidence of postural disorders was tested using a chi-square test at the
significance level of p≤0.05.
The results show a statisticaly significant difference in pupils in terms of sagittal spine plane,
chest and feet according to their nutritional status. Lordotic bad posture (p=0.008), right
lumbar scoliosis (p=0.007), high arch foot (p=0.043) and flat feet (p=0.007) were the most
frequent postural disorders in the normal weight pupils. The incidence of kypholordotic
posture
(p=0.005) and flat-chest
(p=0.002) was significantly higher among pupils from
suburban environment. The incidence of kypholordotic posture (p=0.012) was significantly
higher in over-nourished pupils from the suburban environment.
Postural disorders and nutritional abnormalities significantly increase in children of the urban
and suburban environment. Therefore, it is necessary to provide adequate conditions and
include them in an organized physical exercise in order to prevent the occurrence of postural
disorders and disorders of the nutritional status.
Key words: postural disorders, nutritional status, elementary school, urban and suburban
environment.
Introduction
Monitoring nutritional status represents a manifold useful activity because it
indicates the adequacy of the process of growth and development of children, helps in
understanding the current, and may serve as a prognostic factor for their future health.
Nutritional status of children can be evaluated based on clinical examination, laboratory
procedures and anthropometric measurements (Zdravkovic, 2001). Disorders of nutritional
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status go in two directions: on one side is malnutrition, which represents a personal,
individual and general social problem of economically underdeveloped world countries, and
on the other is obesity, which is becoming a growing social-health problem of the modern
world (Markovic et al., 2008).
Unhealthy diet and lack of physical activity represent one of the main causes of
certain diseases and postural disorders (World Health Organization, 2002). Based on this
report for 2001, the World Health Organization adopted the act on the Global strategy on
healthy diet, physical activity and health
(World Health Organization,
2004), which
emphasizes the importance of adopting the habit of regular physical activity as early as the
childhood age. Unfortunately, the adoption of bad habits is already evident in children of
school age. Hypokinesia first leads to the weakening of the energy exchange, then the basic
physiological system and locomotor apparatus of a growing organism. The consequence of
the aforementioned causes is the occurence of bad posture, which, not timely corrected,
becomes a deformity. Postural disorders of the locomotor system can occur at any age,
although there are certain periods in which the organism is more susceptible. These are the
periods in which children are especially vulnerable, such as the period of starting school, so
one should be extremely cautious when participating in their upbringing (Protic-Gava &
Romanov, 2008).
The prevalence of obesity over the past two decades has been growing, both in the
smaller and industrially developed countries (Centers for Disease Control and Prevention,
2012). Namely, the number of obese children and adolescents has tripled in the last three
decades. Health problems caused by obesity during childhood can cause social and
psychological problems that can worsen during adulthood (Dean & Flett, 2002). Therefore,
the primary task is to discover bad posture and deformity in the early stages, and do
everything to prevent its further development (Gojkovic, 2011).
The aim of this study was to analyze the frequency of postural disorders among
primary school pupils in Novi Sad and the suburban areas according to the category of their
nutritional status.
Methods
The sample of respondents included 251 pupils from primary schools in Novi Sad (PS
"First Vojvodina Brigade", PS "Zarko Zrenjanin" and PS "Petefi Sandor") and 246 pupils
from suburban primary schools (PS "Miroslav Antic" Futog, PS "Sveti Sava'' Rumenka, and
PS "Djura Jaksic" Kac), aged 11 and 12. The pupils were divided into subsamples - urban and
suburban areas, and by gender - male respondents (270) and female respondents (227).
To determine the postural status we used the modified method of Napoleon Wolanski
according to Radisavljevic, which means observing the body segments in the sagittal and
frontal plane (Protic-Gava & Scepanovic, 2012).
Posture of the individual body segments was evaluated by the following assessments:
zero (0) - normal physiological status, one (1) - less deviation from normal physiological
status, two (2) - larger deviation from the normal physiological status (Radosavljevic, 2001).
4
While monitoring the posture of the body segments in order to determine the postural
status, the respondents took a natural upright position, with the view directed forward, with
arms relaxed beside the body. The respondents were minimally dressed and barefoot. The
observation was carried out from a distance of 2-3 meters from the lateral, rear and front side
(Sabo, 2006).
The nutrition status of the respondents was identified by the body mass index (BMI),
for which it was necessary to measure the body height in centimeters (converted to meters)
and body weight in kilograms. Body mass index was calculated as the ratio of body weight in
kg square body height in meters - BMI = BW/BH2 - kg/m2 (Medved, 1987), using the
criteria proposed by the World Health Organization (Ogden et al., 2002). Values below 5
percentile suggested malnutrition, values between 5 and 85 percentiles - normal nutrition,
values above 95 percentiles - overweight.
The obtained results were processed in SPSS version
20. For determining the
differences in postural status of pupils according to the category of nutrition, we used the
nonparametric method of chi-square test.
5
Results
Tables 1 and 2 show the numerical and percentage distribution of postural disorders
of the spine, chest and lower extremities in the total sample of respondents.
Table 1. Numerical and percentage distribution of postural spinal disorders in the total sample
of respondents
Assessments of postural disorders
Extremely bad
Good posture (0)
Bad posture (1)
Total
posture (2)
Postural
diorders
Number
%
Number
%
Number
%
Number
%
Kyphosis
401
80.7%
90
18.1%
6
1.2%
497
100%
Lordosis
378
76.1%
101
20.3%
18
3.6%
497
100%
Kypho-lordosis
426
85.7%
60
12.1%
11
2.2%
497
100%
Flat back
447
89.9%
46
9.3%
4
0.8%
497
100%
Winged
165
33.2%
263
52.9%
69
13.9%
497
100%
scapulae
Left
chest
438
88.1%
57
11.5%
2
0.4%
497
100%
scoliosis
Right
chest
443
89.1%
51
10.3%
3
0.6%
497
100%
scoliosis
Left
lumbar
485
97.6%
12
2.4%
0
0.0%
497
100%
scoliosis
Right lumbar
486
97.8%
11
2.2%
0
0.0%
497
100%
scoliosis
Left
chest-
493
99.2%
4
0.8%
0
0.0%
497
100%
lumbar scoliosis
Right
chest-
484
97.4%
13
2.6%
0
0.0%
497
100%
lumbar scoliosis
Compensatory
489
98.4%
8
1.6%
0
0.0%
497
100%
scoliosis L/R
Compensatory
486
97.8%
10
2.0%
1
0.2%
497
100%
scoliosis L/R
6
Tabela 2. Numerical and percentage prevalence of postural disorders of chest and lower
extremities in the total sample of respondents
Assessments of postural disorders
Extremely bad
Good posture (0)
Bad posture (1)
Total
Postural
posture (2)
disorders
Numbe
Numbe
Numbe
Numbe
r
%
r
%
r
%
r
%
Concave chest
86.3
12.7
100
429
%
63
%
5
1.0%
497
%
Protruding
93.2
100
chest
463
%
31
6.2%
3
0.6%
497
%
Flat chest
93.2
100
463
%
26
5.2%
8
1.6%
497
%
„X“ legs
54.7
37.8
100
272
%
188
%
37
7.4%
497
%
„O“ legs
92.0
100
457
%
36
7.2%
4
0.8%
497
%
Leg
97.6
100
hyperexstensio
485
12
2.4%
0
0.0%
497
%
%
n
Flat foot
27.4
53.1
19.5
100
136
%
264
%
97
%
497
%
Concave foot
98.6
100
490
%
3
0.6%
4
0.8%
497
%
Chart
1 shows the percentage prevalence of nutritional status of the total sample of
respondents.
Chart
1. The percentage prevalence of nutrition categories of the total number of
respondents
10,9 %
6,6 %
15,9 %
Malnourish
ed
66,6 %
7
Table 4. Numerical and percentage prevalence of nutrition categories of the respondents in
urban and suburban areas
Area
Total
Urban
Suburban
Nutrition status
% by
% u by
% by
% by
% by
% by
N
N
N
ITM
area
ITM
area
ITM
area
Malnuurishment
16
48.5%
6.4%
17
51.5%
6.9%
33
100%
6.6%
Normal
176
53.2%
70.1%
155
46.8%
63%
331
100%
66.6%
nourishment
Over-
42
55.7%
16.7%
37
46.8%
15%
79
100%
15.9%
nourishment
Obesity
17
31.5%
6.8%
37
68.5%
15%
54
100%
10.9%
Total
251
50.5%
100%
246
49.5%
100%
497
100%
100%
χ2=9.037
df=3
p=0.029
The research results show statistically significant differences in postural status between urban
and suburban respondents only in the categories of normal and over-nourished respondents.
In normal weight respondents (Table 4), statistically significant differences were present in
the sagittal plane
(lordosis, kypho-lordosis and flat chest), frontal plane
(right lumbar
scoliosis), and feet (flat and concave foot). In over-nourished respondents the differences are
manifested only in kypho-lordosis (Table 5).
Table 5. Numerical and percentage prevalence and difference in postural status of
the
respondents in urban and suburban areas according to normal nourishment
Normal nourishment
Urban area
Suburban area
Good
Bad
Extremely
Good
Bad
Extremely
Postural
posture
posture
bad
posture
posture
bad
χ2
p
disorders
number
number
posture
number
number
posture
(%)
(%)
number
(%)
(%)
number
(%)
(%)
134
41
1
135
17
3
Lordosis
χ2=9.641
p=0.008
(76.1%)
(23.3%)
(0.6%)
(87.1%)
(11%)
(1.9%)
Kypho
-
164
11
1
126
27
2
χ2=10.760
p=0.005
lordosis
(93.2%)
(6.2%)
(0.6%)
(81.3%)
(17.4%)
(1.3%)
Right
168
8
0
155
0
0
lumbar
χ2=7.220
p=0.007
(95.5%)
(4.5%)
(0.0%)
(100%)
(0.0%)
(0.0%)
scoliosis
170
6
0
134
16
5
Flat chest
χ2=12.527
p=0.002
(96.6%)
(3.4)
(0.0%)
(86.5%)
(10.3%)
(3.2%)
40
101
35
59
76
20
Flat foot
χ2=9.976
p=0.007
(22.7%)
(57.4%)
(19.9%)
(38.1%)
(49%)
(12.9%)
Concave
169
3
4
155
0
0
χ2=6.298
p=0.043
foot
(96.7%)
(1.7%)
(2.3%)
(100%)
(0.0%)
(0.0%)
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Table 6. Numerical and percentage prevalence and difference in postural status of the
respondents in urban and suburban areas according to over-nourishment
Over-nourishment
Urban area
Suburban area
Good
Bad
Extrem
Good
Bad
Extreme
Postural
p
posture
posture
ely bad
posture
posture
ly
bad
χ2
disorders
number
number
posture
number
number
posture
(%)
(%)
number
(%)
(%)
number
(%)
(%)
39
25
9
Kypho
-
3
0
3
(92.9%
(67.6%
(24.3%
χ2=8.781
0.012
lordosis
(7.1%)
(0.0%)
(8.1%)
)
)
)
Disscusion
The study was conducted in order to analyze the frequency of postural disorders
among primary school pupils of Novi Sad and suburbs according to the category of their
nutritional status.
Number of school-aged children with postural and nutritional disorders is increasing,
which can result in serious problems if not removed in time. The nutritional status of children
and young people is the subject of interest of many researchers (Freedman et al., 2007).
Postural and nutritional disorders of children carry a risk of various health problems (Stanisic
et al.,
2005). A large percentage of children with postural and nutritional disorders is
confirmed by the results of this study, where over 30% of respondents have a nutritional
disorder, and over 50% of children have some of the postural disorders.
Relations between anthropological characteristics and postural status suggest that
obese children have more postural disorders, especially of the feet, overweight and obese
children have in time lower motor development, and have shown that 12-year old children,
with a pronounced longitudinal dimensionality, are more susceptible to the spinal
deformities, and with more subcutaneous fat tissue and circular dimensionality is more
susceptible to foot deformity - flat foot (Djokic & Stojanovic, 2010).
Compared with children from urban areas, it is assumed that children from suburban
and rural areas are deprived of many types of entertainment, and that their daily motor
activity is significantly more intensive and more efficient. Daily chores of rural school
children should require physical activity throughout the day, so their physical status, as a rule,
has less deviations from normal. Research conducted on a sample of children from urban and
rural schools point to dramatically lower percentage of postural disorders in children from
rural areas, and flat foot is a postural disorder rarely seen in children from rural areas
(Zivkovic & Karaleic, 1996).
Based on these results it can be concluded that the results of our study do not match
the aforementioned study because the results show that children from suburban area have
equal percentage of postural disorders compared to their peers in urban areas, and in some
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segments even higher percentage of postural disorders, such as kypho-lordosis, flat chest and
"X" leg, whereas the respondents from urban areas have better posture of these segments.
Research and evaluation of nutrition and posture status of respondents aged 11 to 12,
shows a statistically significant difference in the aggregate assessment of posture in the
respondents according to the BMI. Excellent (14.4%), very good (23.2%) and good posture
(60%) of the body was found in the respondents in the category of normal nutritional status
(Protic-Gava, Scepanovic, & Batez, 2015).
Children need to actively engage in physical activity, as early as possible in order to
work on the prevention and elimination of obesity, malnutrition and postural disorders
(Demesi & Mikov, 2012). Research shows that children with better motor skills have less or
no postural disorders (Madic, 2006).
The American Heart Association and the American College of Sports Medicine
recommend that children and young people should participate in 60-minute physical activity
of moderate intensity on a daily basis in order to achieve positive health effects (Siljak,
2008).
This study, which was conducted in order to analyze the postural status of urban and
suburban pupils, and detect differences according to their nutritional status, was based on the
assumption that the respondents from suburban areas would have less postural and nutritional
disorders (Protic-Gava & Krneta, 2010). However, the respondents from urban and suburban
areas had the same percentage of postural disorders in certain segments, spine, while in some
segments the respondents from suburban areas had poorer nutritional status (more obese
respondents).
Based on the obtained results it can be concluded that statistically significant
differences between the respondents from urban and suburban areas exist only in certain
segments of the spine and feet in the category of normal and over-nourished pupils. There
were no statistically significant differences in postural status in malnourished and obese
respondents. The category of normal nourished respondents revealed statistically significant
differences in lordotic poor posture and flat feet in favor of the respondents from suburban
areas. Postural disorders of kypho-lordosis and a flat chest were found in more respondents
from suburban areas. In the category of over-nourished respondents, a statistically significant
difference between urban and suburban respondents was found only in the postural disorder
of kypho-lordosis in favor of the respondents from urban areas.
According to these results it can be concluded that more attention should be paid to
children from suburban and rural areas and provide them with equal conditions for physical
activity and sport as children from urban areas have. This would avoid increasing postural
nutritional disorders in children from less urban areas.
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