LIST OF ABBREVIATIONS

%BF: Percentage of body fat.

%HGS: Percentage of handgrip strength adjusted to reference values.

AMA: Arm muscle area.

BMI: Body mass index.

ENSIN: Colombian National Survey of Nutritional Situation in 2010.

HGS: Handgrip strength. IDF: International Diabetes Federation.

IPAQ: International physical activity questionnaire.

PC: Physical condition.

UC: Universidad de Caldas, Colombia.

WC: Waist circumference.

Despite the preventive efforts made by the local government, Colombia has an epidemiological situation dominated by a growing prevalence of changeable risk factors for cardiovascular diseases in young adults, such as obesity, physical inactivity, alcohol consumption, and smoking habits ^1,2.

This situation has been revealed in the last Colombian National Survey of Nutritional Situation in 2010 (ENSIN, for its initials in Spanish), which showed a raise in obese and overweight people from 45.9% to 51.2% between 2005 and 2010 in those aged between 18 to 64 years, with higher rates in women (55.2% versus 45.6%). Moreover, the highest prevalence of abdominal obesity was seen in men of urban area (52.5%). In addition, an alarming rate of sedentary life style was also found. About this important factor in obesity, it was found that 46.5% of people aged 18-64 years did not meet the 150 minutes per week of regular exercise as recommended ¹.

This situation was reported by the Food and Agriculture Organization (FAO) in 2001 for Colombia and by ENSIN in 2010 ^1,3. These reports establish that Colombians consume 20 percent of their energy from sweeteners because a raise in soda drinks consumption from 4% to 15% from 1985 to 1995 ³. Even more, there was a raise in the consumption of saturated fats from 4% to 10% of the population, in the period comprehended between the years of 1964 and 1998. Besides, 71.9% of people do not consume fruits and vegetables daily ¹.

University years represent a period of high responsibility in different aspects of life. Food choice and practice of healthy lifestyles acquired in childhood usually change ⁴. College students have long periods of inactivity and tend to reach unhealthy eating habits such as skipping meals, eating small amounts of vegetables, fruits and fish. Instead of healthy food, they have an increased the intake of energy-dense food that are high in fat ⁵, salt and sugars but low in vitamins, minerals and vital micronutrients ^6-9.

There are three reasons that influence the food choice in this population: migration to another city with subsequent family uprooting, less available money and time, and the fact that many of them do not have experience choosing, planning and cooking their own food ^4,8.

It is common for university students do not have the intake of many nutrients required ¹⁰. Meal and snacking pattern have been shown to give effects on body weight, cognition, cardiovascular outcomes, lipid profiles and carbohydrate tolerance ⁷, leading to a rise in prevalence of chronic non-transmissible diseases and negative effects in academic performance ¹¹.

Universidad de Caldas (UC), according to state politics, supports the permanence and graduation of vulnerable students by offering them a food subsidy. It consists in giving lunch during weekdays through university restaurants. Students are selected according to their socioeconomic status and afterwards they have an evaluation of their nutritional status.

Thus, the objective of this article is to show the evaluation results of the nutritional status and level of physical fitness of college students in a public university, having assistance from a nutritional program.

Study design and sample

A descriptive cross-sectional study was carried out, enrolling undergraduate students from the UC. Inclusion criteria were: full time registered students attending to the feeding program, without pregnancy or physical limitations. Ethical considerations for health research studies (Declaration of Helsinki of the World Medical Association) were taken into account. Also, the approval was obtained from the Research Committee of the University.

Data collection

Anthropometric measurements were made according to Lohman et al. (12). Weight was determined using a digital scale PP2000 IcobDetecto® -±0.1 kg- (A&D Company, Ltd. Japan) and height through a digital Seca 235 Heightronic® stadiometer -±0.1 kg, ±0.01 cm- (SHORR productions U.S.A). For estimation of percentage of body fat (%BF) in biceps, triceps, subscapula and suprailiac skinfolds were measured three times using a Skyndex, System I® caliper -±0.1 mm- (Caldwell, Justiss & Co. Inc., USA). Arm circumference was measured twice at a midpoint between the acromion and olecranon bones ¹³. Waist Circumference (WC) was also measured twice at midpoint between the lower rib and the iliac crest using a fiberglass tape ¹. Handgrip strength (HGS) was obtained using a Baseline® hydraulic dynamometer -±1 kg- (Fabrication Enterprises Inc., USA) according to parameters of American Association of Hand Therapists ¹⁴.

Physical condition (PC) was estimated by the Harvard Step Test (HST), using a metronome Yamaha® (Yamaha Corp. Japan) and two chronometers Polar® (CASIO Inc., USA). The height of the bench was 35 cm for females and 40 cm for males ¹⁵.

Overall nutritional state was classified using Body Mass Index (BMI) with cut-off points suggested by the World Health Organization (WHO) ¹⁶. WC was used to assess body fat distribution ¹⁷ Normal WC values recommended for Colombia by ENSIN were < 80 cm for females and < 90 cm for males ¹.

%BF was calculated according to Durnin and Womersley method ¹⁸ and reference values by Gallagher et al. were used ¹⁹. Arm muscle area (AMA) was calculated according the reference from Frisancho values, considering under nutrition below the 10th percentile ^13,20. Percentage of HGS was obtained by using values from Mathiowetz et al. ²¹. Normality was considered as superior to 85% adjusted to sex and age ²². Brohua Index obtained from HST was used to estimate PC ¹⁵.

Statistical analysis

Data were analyzed using XLSTAT statistical 2015 for Windows, and the SPSS version 12.0 software (Inc., Chicago, IL, USA). KolmogorovSmirnov test was used to check the normality of data. Results were presented according to gender as frequencies and percentages for categorical data and means and standard deviations for continuous variables. Mann-Whitney U Test was used to measure differences between genders on different measurements. Spearman coefficient was used to measure correlation between variables. Tests were carried out using a significance value of 0.05.

Nutritional status

It was aimed to determine the nutritional status and physical fitness in Colombian ethnically diverse university students, attending to a feeding program at UC. The results showed a population who endures malnutrition problems in 22.4% of the cases according to BMI. Excess weight exceeded 3.6 times the problems of under nutrition. In comparison to another study among university students in Colombia, where the prevalence of overweight and obesity was 3.6 and 0.9% ²³, the levels of malnutrition in UC are alarming. Moreover, when assessing the %BF, the real health problem was revealed since 46.4% of evaluated subjects had excess of body fat. These numbers are similar to those found by Diniz Araújo ²⁴ in college students in Brazil. In this study, BMI identified only 1 in 2.5 students presenting body fat excess. This is how, once again, it was demonstrated that BMI underestimates health problems associated with body weight. Different studies have shown that BMI does not discriminate the various components of body composition and tends to underestimate rates of obesity and overweight ^25,26. As the general trend in the country, women had higher weight for height than men, (55.1 vs, 45%) ¹. These results are similar to other two studies ^7,27, but differ from most research in which men were more affected by overweight and obesity than women ^9,24,27,30. However, in Chile another research ³¹ did not find differences by sex.

Regarding the abdominal obesity, this study showed that one of each 6.6 students had abdominal obesity. This fact was predominantly in women. Another study reported predominance in women with a prevalence of 23% ². However, some authors found this kind of fat distribution predominantly in men ^5,23,27. In 2010, Martins et al. reported no difference according to sex ²⁹. Nevertheless our results are based on IDF cut-off values made on Asian population rates that are lower than a recent Colombian study ³² in which authors determined values of 91 cm for men and 89 cm for women with a sensitivity of 89% and 78.9% respectively.

Functional indicators

The use of HGS for evaluation of nutritional and functional states has progressively increased. However, despite its low cost and accuracy, it is rarely used in clinical settings in Colombia, even when it has been recognized as a good instrument to find signs of malnutrition ³². In this study, HGS was particularly decreased in men. In addition, some of them had reduced AMA. It was not found recent reports to compare these issues in university students.

30.8% of women and 46.1% of men were classified as having inadequate physical condition. In other studies, all using questionnaires as the International Physical Activity Questionnaire (IPAQ) were found similar percentages, but mainly in females ^23,24,29,31. This may reflect the reports of a sedentary lifestyle in about 79.5% in Colombia ²³ and 86-94% in Chile ^5,31.

These findings and available evidence suggest that college life makes college students vulnerable to cardio-metabolic health risks since they engage in eating and physical activity behaviors that which places them in a situation of food insecurity and may adversely affect their body composition, physical condition and academic achievement ²⁵. This problem has been recognized as a major public health situation. Whether or not these effects are attributable to variations in several factors such as stress, body image perturbation, anxiety and drive for thinness, are still controversial ^33-37.

From thirteen recent studies reviewed and performed in college students, only four (30.8%) evaluated the %BF and eight (61.5%) measured the WC, two (15.38%) evaluated level of physical activity based on subjective tests. None assessed HGS or AMA. Thus, the present study may inform, with greater confidence, nutritional states, body composition and some functional aspects of college students.

Despite these facts explained above, the study has limitations: it was performed with a population chosen for its poor socioeconomic status. The reference values used in this research were made originally for other populations.

RECOMMENDATIONS

Some low-cost, precise, reliable and broadly applicable screening tools are necessary to make a comprehensive nutritional assessment in population field studies and in clinical practice (such as %BF by skin folds, AMA and HGS). Results emphasize the need for healthy nutrition and physical activity courses or programs, either compulsory or optional for first year university students.

INTEREST CONFLICT

The authors declare have neither conflict of interests nor any financial relationships with corporations or with non-profit organizations.