© Borgis - New Medicine 1/2006, s. 7-10
Elżbieta Trafalska, Andrzej Grzybowski
Characteristics of the nutrition mode in young women with body mass deficiencies
Nutrition, Hygiene and Epidemiology Unit, Department of Hygiene and Epidemiology, Medical University of Łódź, Łódź, Poland
Head of Department: Professor Andrzej Grzybowski MD, PhD
Summary
SUMMARY
Introduction: Underweight and malnutrition connected with it could have negative effects on health, especially in young organisms.
The aim of the study was the assessment of nutrition in a group of young underweight women, including energy and nutrient intake as well as the type and frequency of meals.
Material and method: The study concerned a group of 198 female students of Łódź Medical University aged between 20 and 26 years. We estimated basic anthropometric measurements and daily intake data by the 24-hour recall method.
Results: In the studied group 12.6% of women were underweight. Their daily food rations were not balanced with requirements, but the energy and nutrient value was higher than in the diets of women with normal weight. They contained less animal protein, saturated fatty acids and cholesterol. Underweight women had higher frequency of meals and snacks intake. The lower frequency of first breakfast intake and the higher frequency of second breakfast, tea and supper intake were noted.
Conclusions: The mode of nutrition of underweight women was incorrect, but better than in the group of female students with normal weight.
Introduction
Correct mode of nutrition protects against both nutritional deficiencies and overloads and ensures proper development and maturation of the organism. Body mass deficiency and deficiency-related malnutrition can result in negative health effects, especially in young people. The deficiency problem more often affects young females, who usually take great care of their figures, and under constant pressure from the media in promoting fashionable looks, they may [consciously or not] act against their own health [1, 2, 3, 4].
Numerous studies indicate systematic percentage growth of young women with deficient body mass [4, 5, 6, 7, 8, 9]. Simultaneously there have been noted many irregularities in the mode of nutrition in school and university students in Poland [6, 9, 10, 11, 12, 13]. Thus arises the necessity of constant monitoring of nutrition and nutritional status of those population groups and of educational programmes.
Aim
The objective was to assess the nutrition mode of young women with body mass deficiencies, with regard to energy and nutrient intake as well as the kind and the frequency of meals.
Material and method
The study was conducted in autumn of 2004 on a group of female students of the Medical University of Łódź. The study group comprised 198 women aged between 20 and 26 years [mean age 23.6 ± 1.2 years].
The mode of nutrition assessment was based on the data gathered during a triple 24-hour dietary intake recall interview. The nutritional value of daily food rations was assessed by „Dieta 2.0” software, using the Institute of Food and Nutrition database of 1998 [14]. The results concerning the quantities of energy and nutrient intake were compared with the safety standards for people of moderate physical activity [1].
The mode of nutrition was analysed in a subgroup of women with body mass deficiencies as compared with women of regular weight and height proportions. The body mass assessment was made on the basis of a simplified anthropometric examination, covering body mass measurement [kg], body height measurement [cm] and BMI calculated accordingly [kg/m2]. The results were interpreted according to WHO standards, where body mass deficiency starts with BMI below 18.5 kg/m2 [BMI 17.0-18.49 kg/m2 – I° of body mass deficiency; BMI <17.0 kg/m2 – II° of body mass deficiency] [15].
Statistical analysis of the results was performed using Statistica 5.0 PL software, with the calculations of mean trait values [median] and trait variation [first and third quartile, quadrant deviation]. The mean value differentiation was assessed using variance analysis [Chi-square independence test].
Results
In the studied group [n=198] 25 subjects [12.6%] were underweight; 23 women [11.4%] with I° of body mass deficiency, and 2 women [1.2%] with II° of body mass deficiency. Others had regular body mass/weight proportions and served as controls.
Mean body mass value in a subgroup of underweight women was 51.6 kg, mean body height was 170.0 cm, and BMI was 17.9 kg/m2 [control group values were respectively: 58.4 kg, 167.0 cm and 21.0 kg/m2].
The underweight students had significantly higher energy intake [1992.3 kcal – 90.5% of the standard] than the controls [1683.0 kcal – 76.5% of the standard]. Higher caloric supply was related to higher supply of the majority of basic nutrients [Table 1], but a detailed analysis of those diets indicated their characteristic traits: prevalence of vegetable components [vegetable protein, total carbohydrates, dietary fibre, mono- and polyunsaturated fatty acids] over animal product components [animal protein, saturated fatty acids and cholesterol]. The greater caloricity of the underweight women´s diets did not arise from a simple dependence, i.e. „greater intake – greater supply”, but from a different choice of food products and their diets´ characteristics.
Table 1. Mean energy and basic nutrient intake in subjects.
| Energy/nutrients | Underweight women | Women with regular weight | p |
| Me | QD | Q1-Q3 | Me | QD | Q1-Q3 |
Energy (kcal)
Total protein (g)
mmmanimal protein (g)
mmmvegetable protein (g)
Total fat (g)
SFA (g)
MUFA (g)
PUFA (g)
mmmcholesterol (mg)
Total carbohydrates (g)
mmmsaccharose (g)
mmmdietary fibre (g) | 1992.3
70.8
36.6
27.9
62.9
20.2
23.0
6.7
146.8
321.1
55.5
23.9 | 529.6
13.2
11.9
5.4
23.3
12.7
9.9
4.2
98.6
85.5
26.7
4.7 | 1541-2600
85.2-84.7
30.2-54.1
24.1-34.9
39.3-86.0
14.8-40.2
13.7-33.6
4.1-12.5
88.4-285.6
210.7-381.8
38.1-91.6
18.0-27.5 | 1683.0
57.6
36.9
20.0
56.5
22.7
22.0
6.5
163.8
221.2
51.5
16.7 | 396.9
15.1
12.6
5.1
5.1
20.2
7.6
8.6
61.7
67.5
23.1
4.9 | 1217-2011
45.0-75.2
25.7-50.9
15.3-25.6
36.5-76.9
15.4-30.6
13.0-30.2
3.8-9.5
113.5-236.9
165.8-300.8
30.8-77.0
12.1-22.0 | 0.01
NS
NS
0.001
NS
NS
NS
NS
NS
0.001
NS
0.01 |
SFA – saturated fatty acids, MUFA – monounsaturated fatty acids, PUFA – polyunsaturated fatty acids, Me – median, Q1, Q3 – first, third quartile, QD – quartile deviation, p – coefficient of statistical significance (NS – not significant).
The data in Tables 2 and 3 demonstrate similar dependences within the vitamin and mineral supply – daily food rations of the women with body mass deficiencies compared with the diets of the women with regular body mass indicated higher vitamin and mineral content, with statistical significance in the different intakes of vitamin A [beta-caroten included], vitamin C, folic acid and iron.
Table 2. Mean vitamin intake in subjects.
| Vitamins | Underweight women | Women with regular weight | p |
| Me | QD | Q1-Q3 | Me | QD | Q1-Q3 |
Vitamin A (?g)
retinol (?g)
ß-carotene (?g)
Vitamin E (mg)
Thiamin (mg)
Riboflavin (mg)
Niacin (mg)
Vitamin B6 (mg)
Vitamin C (mg)
Folates (?g)
Vitamin B12 (?g) | 1112.4
308.7
3328.1
8.9
1.1
1.6
13.4
1.6
125.2
283.2
2.3 | 625.8
171.0
3526.6
2.2
0.3
0.4
3.2
0.4
58.9
89.5
0.8 | 672.9-1924.6
174.8-516.8
1527.0-8580.3
6.9-11.3
0.8-1.4
1.2-2.0
11.1-17.5
1.3-2.2
82.8-200.6
214.3-393.4
1.7-3.4 | 696.2
269.0
2168.9
6.9
0.9
1.4
10.7
1.2
66.1
213.5
2.2 | 508.5
124.3
2652.1
2.7
0.2
0.3
3.9
0.4
42.0
59.9
0.9 | 387.2-1404.3
164.2-412.8
706.9-6011.1
4.7-10.2
0.7-1.2
1.0-1.7
8.2-16.0
0.9-1.7
35.5-119.6
161.0-280.9
1.5-3.3 | 0.01
NS
0.01
NS
NS
NS
NS
NS
0.01
0.01
NS |
Me – median, Q1, Q3 – first, third quartile, QD – quartile deviation, p – coefficient of statistical significance (NS – not significant).
Table 3. Mean mineral intake in subjects.
| Mineral components | Underweight women | Women with regular weight | p |
| Me | QD | Q1-Q3 | Me | QD | Q1-Q3 |
Sodium (mg)
Potassium (mg)
Calcium (mg)
Phosphorus (mg)
Magnesium (mg)
Iron (mg)
Zinc (mg)
Copper (mg) | 3025.9
3353.7
703.1
1125.1
293.4
11.9
9.2
1.3 | 689.3
507.2
239.7
208.3
37.6
2.2
1.9
0.2 | 2408.9-3787.5
2652.8-3667.2
532.3-1011.7
1042.0-1460.7
256.2-331.4
9.3-13.7
7.6-11.5
1.0-1.5 | 2386.1
2560.2
608.9
980.9
251.4
8.6
8.1
0.9 | 680.3
659.5
218.8
256.4
57.6
2.2
1.6
0.2 | 1780.5-3141.3
2006.5-3325.5
415.9-853.5
800.6-1313.5
193.7-308.9
6.8-11.2
6.4-9.7
0.7-1.2 | NS
NS
NS
NS
NS
0.01
NS
NS |
Me – median, Q1, Q3 – first, third quartile, QD – quartile deviation, p – coefficient of statistical significance (NS – not significant).
The higher content of the majority of vitamins and minerals in the diets of underweight women does not indicate total achievement of nutritional standards for those components. Figures 1 and 2 illustrate the fact that in both subgroups of subjects there has been noted a high percentage of food rations with the analysed nutrient content lower than 2/3 of the safe standard. That can be correlated with higher deficiency risk of important components regulating metabolic processes. More deficient rations were noted in the group of women with regular body mass, which indicates a poorer dietary balance. The only exception is the calcium supply – in both subgroups the percentage of deficient rations was the same and amounted to 60%.
Fig. 1. Percentage of daily dietary rations with vitamin content below 2/3 of safe standard.
Fig. 2. Percentage of daily dietary rations with mineral content below 2/3 of safe standard.
Nearly half of the underweight students [44.0%] had 5 meals daily, and 27.9% had 4 meals daily. The controls had 4 [36.4%] and 3 [29.0%] meals daily. Though the underweight women had more frequent meals than the other subgroup, they snacked between meals as often as the controls [80.0% vs 76.6%]. Also, different kinds of meals were noted – the underweight students seldom ate breakfast, but more frequently had second breakfast, tea and supper.
Discussion
During recent years there has been noted a growing percentage of young females with deficient body mass. In 1989, 4.4% of the population of Łódź female medical students had BMI<20.0 kg/m2; in 1995 the percentage reached 14.2. In 2000 a similar percentage of women [11.4%] displayed BMI below 18.5 kg/m2, and in the studied group the percentage was 12.6 [4, 5]. The situation is comparable to other regions of Poland [6, 7, 8, 9].
Body mass deficiency results most often from a low energy and full value protein supply, which leads to fatty tissue reduction, muscle mass decrease and metabolic disorders. Our study revealed different dependences: the diets of underweight women featured greater supply of energy and basic nutrients than the diet rations of the controls. Close analysis of the diets indicated different food composition and vegetable product domination. That led to higher supply of vitamins and minerals, and other health-related components – unsaturated fatty acids, dietary fibre and vegetable protein. One can conclude that the dietary rations of underweight students were more properly balanced with the requirements than those of the controls. However, they were not able to fully attain the nutritional standards; therefore the deficiency risk was as real as in the control group.
Particularly alarming is significant dietary calcium deficiency – despite higher supply of the majority of minerals, calcium [as an animal-derived component] was consumed in an amount similar to that of the controls, and more than half of the studied dietary rations demonstrated calcium deficiency. The nutrition mode of the subjects covers the principles of rational nutrition and has been observed by other authors [11, 12, 13, 16]. The 4-5 meals-a-day plan is highly recommended; however, the habit of constant snacking between meals and high frequency of food intake in the afternoons and evenings is very undesirable.
There are numerous references to studies analysing the intake of energy and nutrients in university students. Most often such assessments are made on total subpopulations, overweight or obese subjects, or people on reducing diets [6, 9, 10, 13]. However, there are few studies analysing the nutrition mode of underweight subjects [6, 17].
Our study results differ from the results of other authors, as they suggest that the underweight women´s diets are more health-oriented. The reasons may be multiple: the objective of good looks and slim figure, perhaps also wider nutritional knowledge and ability to calculate daily dietary rations. The results however describe a small group and come from short-term observations, and therefore they are insufficient as a basis to form conclusions on the subjects´ nutritional and health status. Undoubtedly this is a group of young persons who require detailed observation and monitoring of their nutrition mode and nutritional status, as well as health-oriented education.
Conclusions
1. The dietary rations of underweight women:
– contained more energy, vegetable protein, total carbohydrates, dietary fibre, iron, vitamin A, C and folic acid [the difference is statistically significant]
– contained less animal protein, saturated fatty acids, cholesterol and retinol [the difference is statistically insignificant].
2. Underweight women had higher meal and snack intake.
3. The nutrition mode of underweight women demonstrates more health-oriented features than that of the women with regular weight, but the supply of the majority of nutrients is not balanced with the requirements.
*The study was financed by the Medical University of Łódź from individual research fund no. 502-16-367
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