RELATIONSHIP BETWEEN LIFESTYLE AND NUTRITIONAL STATUS AMONG ADOLESCENT

To prevent excess weight, the eating habits and lifestyle among adolescence arouse great interest in public health. The aim of this study is to analyze the lifestyle and nutritional status of this age, also to determine the difference between the habits of the students that attend the Medical and Technical school and to find out that knowing about the importance of a healthy lifestyle would have an effect on everyday habits. The research was conducted as a cross-sectional study in a Medical school and a Technical school in Vojvodina. The research instrument was a questionnaire, which is anonymous and voluntary, filled out by 209 students, aged 14-18 years. Analysis of the data was analyzed by the statistical package SPSS. We used descriptive statistics and statistical significance between the two schools was tested using the Pearson χ2 test. Students of the technical school don’t think about health, but they are physically more active. They have a higher percentage of overweight students (18%). The students of the Medical school are thinking about health, physically less active, and have a higher percentage of underweight students (10%). With appearance is satisfied with 44% of respondents. One-third believes that they have overweight and should lose a weight. The knowledge about the importance a healthy lifestyle in students of medical school affect consciousness in selecting foods, the desire to control their own weight, but does not influence to the regular physical activity.


INTRODUCTION
In the world and also here the problems of improper diet and physical inactivity in high school are present.Inadequate nutrition of young people seriously compromises their physical and mental development, reduces learning capacity and worsens eating habits that affect the prevalence of disease, not only in adolescence but also in adulthood.As a result of inadequate nutrition, being overweight and obesity can be found in 20-30% of children and adolescents in Europe (WHO, 2004).Most worrying is the fact that obese children remain obese in adulthood, and are prone to and often suffer from non-contagious chronic diseases (cardiovascular disease, cancer, diabetes) these are responsible for 86% of deaths and 77% of diseases in Europe (Ilić, 2010).Certain dietary changes and physical activity can prevent the cases of cardiovascular diseases and diabetes up to 60% (Despotović, Ilić, Irgutinović & Marković, 2013).
A healthy lifestyle is most commonly defined as engaging in physical exercise, sports and recreation, and active lifestyle defined by the quantity of exercise.However, lifestyle is a multidimensional measures of behavior, and can not be defined only by physical activity, because it was determined by other behaviors that are associated with health, especially healthy diet (Markus, 2012).Proper diet and regular physical activity are the basis of a healthy lifestyle, these are behaviors that improve health, and as such should be adopted at a young age (World Health Organization, 2005).
However, the entire system of nourishment in schools are not based on the principles of proper nutrition, instead it is left to the economic interests of individuals.Everything that is offered to young people in the immediate vicinity of the school is far from what would be a healthy meal at school (Bogar & Kosić-Bibić, 2013).It is in adolescence, that young people consume more food outside the home, usually irregularly, they tend to skip meals, usually breakfast."Fast food" meals are frequent outside the home, a lot of snacking between meals, drinking sweetened drinks, eating sandwiches as alternatives for school lunches.Such a diet is poor in fruits and vegetables, as well as high quality sources of protein which leads to deficiencies such as diseases or excessive energy intake.Many adolescents are unhappy with their appearance, and adolescence is also a period when young people begin to go on diets (Ilić, 2010;Cvijović, 2011).
Cultural influences on physical activity are great.Time for rest and work is increasingly carried out in inactivity, because children while watching television, playing video games, spending time on the computer, using means of transport only moving from one sitting position to another (Lešović, 2014).
The importance of health education and learning about proper nutrition and the positive effects of physical activity have been recognized by the education system.Although it has not been integrated into the educational plan of every elementary and high school, in medical schools thanks to the specificity of subject (such as Hygiene with health upbringing during the 2 nd year, Health Care internal and surgical patients during the 3 rd and 4 th year and Medical biochemistry during the 4 th year of schooling) it is mostly learned, so the students of the medical are better informed in comparison to other schools (The curriculum for the field work: Health and social services).
The goal of this paper is to examine the lifestyle among adolescent, to examine the difference in lifestyles of students attending the medical and technical school, to discover the extent to which knowledge about the importance of proper nutrition and physical activity affects the way of life.
The specific objectives of the research was to determine the nutritional status by using body mass index, and to discover what is the opinion of high school students on their own weight and whether they think about their health when choosing a diet.
The main hypothesis is that a larger number of students feed incorrectly, which results in increased body weight and dissatisfaction with their own body weight.The specific hypothesis is that students at medical schools pay more attention to choosing healthy foods and to regularly engage in physical activity as a result of a specific curriculum, as well as detailed knowledge about certain diseases and thereof their prevention.

The sample of variables and instruments
Data was obtained by interviewing.The survey was conducted during the school year of 2015/16., with the participation of.The survey was completely anonymous, the students filled it out voluntarily.To share the survey, the written consent of the school directors was obtained.
For research was used a questionnaire (Ilić, 2010;Despotović, Ilić, Irgutinović & Marković, 2013), which in addition to general demographic data, contains questions about the anthropometric parameters, the frequency of physical activity (1.Once a day 2. Two or three times a week, 3. Once a week, 4. Less than once a week 5. Never), the thinking about health and holding diet (1.No, 2. No, but I should , 3. No, because I need to gain weight, 4. Yes), and the attitude towards own body (1.Extremly too thin, 2. Too thin, 3. Good body weight 4. A little fat, 5. Extremly overweight)

Data processing
The analysis was done in SPSS 20.0 software package.For statistical analysis of the data descriptive methods and non-parametric analysis, statistical significance between the two schools and gender were tested using the method of cross tables and Pearson's χ2 test (Chi-square test).

RESULTS
In Table 1, 2 and 3 are shown, the basic descriptive parameters age, body weight, body height, and body mass index (BMI) of respondent by sex and age.In Figure 1 is shown the structure by sex and age.According to this research results of our students are 8.6% underweight (BMI 18.5), 7.5% of men and 9.8% of women, 10% of medical students and 6% of technical school students.
Normal weight (BMI 18.5-24.9)had 74.6% of students, 71% of men and 78.4% of girls.In the higher percentage of technical school students (75.5%).
Overweight (BMI 25-29.9)was 15.3% of students, 20.5% of men and 9.8% of girls (p=0.024).There is no difference in the incidence of overweight and schools.Obese (BMI 30 and over) was 1.4% of the students, 0.9% of men and 1.9% women, who were identified as students of technical school.Distribution of BMI by age is shown in Figure 2. When choosing food for breakfast healthiness is still considered by 30.1% of students.More frequently by medical students (32.8%) than technical school (26.7%) students.Sometimes does it 49.3% of the respondents, more women (51%).While 20% of the respondents never thinks about healthiness at breakfast, more men and students of technical schools (41%).
When choosing foods for dinner healthiness is still considered by 40% of the students, more often by girls, and by students of the medical school (47%) than the technical school students (31%), with statistically correlation p=0.039.On average 40% of respondents occasionally thinks about healthiness and their choice of food for lunch and dinner.
Physical activity daily is done by 32.5% of children, 45% of boys and 20% girls (p=0.001).This includes 39% of students from the technical school (p=0.038).Exercise 2-3 times a week is done by 40% of them, mainly girls (44.9%).Almost 15.3% exercises less than once a week or never trains (Figure 3).With their appearance 44% of respondents was satisfied, 57% of boys and 30% girls, with statistical significant correlation p=0.001.One-third believes that is overweight (50% of girls and 19.6% of boys), and that they should lose weight (Figure 4).While 12.4% of respondents (19.6% girls) already hold a diet, 15% of medical school students and 9% of technical school students.
Students that are overweight engage in physical activity 2-3 times a week (43.8%) and daily (40.6%), they are aware that they have excess weight, and that they should lose weight, and 28% are on a diet.It is positive that they recognize the importance of daily or at least regular physical activity, and thus attempt to reduce or maintain weight.Obese children are less physically active and exercise only once a week (66.7%).Some of them they think should lose weight, while there are those who are satisfied with their current weight, however none of the obese children are holding a diet.There is a correlation between the position of one's own body weight and body mass index (p=0.000),and also with dieting (p=0.032)(Table 4).

DISCUSSION
According to the results of studies on the health of the population in Serbia in 2013, they registered an increase in the percentage of obese children (4.9%) compared to 2006 (2.6%).Also a significantly higher percentage of moderately obese (13.2%) and obese (7.5%) children were recorded among children aged 11-14 years (Boričić, et al., 2014).
According to our results, in the sample we are identified 16.7% overweight and obese children, who are a warning about the low quality of their diets and physical inactivity.However, as we don't found an extremely large number of excess weights, we reject the basic hypothesis.
The status of nourishment in our study is somewhat more favorable in comparison to the survey conducted in Bor (central Serbia) among primary school pupils in 2011 (Stanković & Mihajlović, 2011), when they found that normal body weight had 81% of the girls and 3% were underweight, and 16% had excess weight (in our study, we found 9.8% underweight and 11.76% of girls are overweight).68% of boys had normal weight, 7% was underweight and 25% were overweight (in our study we found 7.48% malnourished boys and 21.49% with excess weight).
Observing the schools, we found that students of technical school have a larger percentage of daily physical activity.Here we identified 17.8% overweight and 6.6% underweight students.While, students of the Medical school have a lower percentage and rarely engage in physical activity.Here we identified 15.9% of overweight and 10% of malnourished students.
As for the differences between men and women, we noticed that men are physically more active, mainly satisfied with their weight, only 5% hold a diet.Girls, however, are less frequently (2-3 times per week) engaged in physical activity.Almost 50% of girls considered themselves overweight, and 20% already hold a diet.
Broken down by age, we identified among 15 year olds 21%, among 16 year olds 20.7%, among 17 year olds 12.5% and among 18 year olds 11.1% of respondents with excessive weight.Obviously, the percentage of excessive weight respondents declines with age.
Nutritional status of adolescents is of great interest to public health, in terms of prevention of diseases associated with obesity.The effects of obesity in young people can lead to long-term health problems.It is important to emphasize that physical activity in childhood and adolescence should be constantly stimulated, in which the biggest role has physical education teachers.
The teacher of physical education, through its activities in the school and outside the school, in sports clubs, plays an important role in physical and mental development of children with effect on the personality of young people, directly assisting its formation and development.The teacher makes the students develop skills in accordance with the talent, potential predisposition, influence at the same time educational of their personality (Krasniqi, et al., 2008).
Several studies confirm this fact.Thus, for example, in India examined the effect of daily physical activity beside of regular school hours on body composition in obese men aged 9-15 years (Apte & Rao, 2013).The intervention involved the 5 sessions per week, beside school hours for a period of 50 minutes.After one year, assessed the impact of physical activity on reducing obesity.They found that participants show a significant reduction in body fat (1.0%), reduction of skinfold thickness, too, there was a significant reduction in indicators of central obesity -waist circumference (from 1.8 to 1.1 cm) with respect to their original measurement.This indicates that the potential benefits of 50 minutes daily physical activity justify the introduction in the curriculum of schools, for better health adolecenata.
However, the benefits of regular physical activity could be reach up within the current school program, modification of content.It's been proven in Brazil, where nearly 400 subjects aged 15-17 years involved in research on the impact of physical activity on body composition (Farias, Gonçalves, Morcillo, Guerra-Júnior, & Amancio 2015).The study group is subjected to a specific program of physical activity during the regular physical education classes (aerobic activity, muscle strength exercises, running, jump-ing, sports games and stretching) while the control group attended a conventional program of physical education (sports games through exercise, gymnastics, base of sports).Both groups had a regular two hours of physical education per week, during the school year.The results are reported positive effects of programmed physical activity in the control group (p 0.001) in both sexes, reducing the percentage of fat (mean difference = -5.58%)and waist circumference (-2.33 cm), and an increase in clean weight (+2.05 kg), while the opposite was observed in the control group.This points to the role of physical education teachers, as the just choice of physical activity can achieve reduction of body weight and contribute to the health of adolescents in the context of regular teaching physical education classes.
Also examined was the impact of programmed and self-selected physical activity on physical fitness of adolescents (Neto et al., 2014).One group of students performed physical activity according to their own rhythm in the following sports: basketball, volleyball, handball, football and swimming.While another group of programmed physical activity is performs specified conditional exercise.Training for both groups lasted 60 minutes.Intervention with programmed physical activity showed more changes in physical abilities, the cardiorespiratory state and strength of the lower and upper extremities.
According to previously analyzed, the greatest potential is found in the decision that the state recognizes the importance of prevention hronical noncommunicable diseases through adequate nutrition and regular physical activity from an early age.School sport should contribute to improving public health, but in the analysis of this problem is usually stated that there are a small number of sports sections, which operate non-systematic.Today the little number of school has a regularly organized sport sections, so sport in schools regularly engaged in only 3-5% of the students, and one of the main problems is the existence only 2 hours of physical education per week (Provincial Secretariat for Sports, Vojvodina, Serbia, 2007) However, as it was submitted in the "Strategies for the development of sport school in Vojvodina for the period 2013-2017" highlights, daily physical activity should be incorporated into the curriculum, while this is not achieved, the emphasis should be put to sport in schools should is available as an optional subject, or by providing a variety of free sections of sport within the the school.Also, more emphasis should be placed on school meals.The good and bad habits acquired in childhood remain until the end of life, and improper diet can have significant consequences.The development of eating habits of school children most affected by the parents, but we must point out the impact of the school on the formation of the child's personality and adopting healthy eating habits and behavior.
Special significance have a school meal, because children six or more hours spend in school, and during that time consumed largely unhealthy meals, snacks, fast food and soft drinks, with high fat and concentrated carbohydrates, which can cause overweight (Janković, 2003).Legal provision of adequate, healthy food in the school cafeteria, student dormitories could significantly reduce diseases associated with inadequate nutrition.

CONCLUSION
Only a third of respondents are engaged daily physical activity.Differences in lifestyle among students of medical and technical schools, are reflected primarily in the frequency of physical activity, which is present in higher percentage among students of technical schools and boys.In assessing the nutritional status we found more malnourished students between medical school, while in technical school more obese student.Mostly women believe that they have an excess weight, and the large number from the medical school is already hold uncontrolled diet.Mainly students from medical school think about their health when choosing food.Knowledge about the importance of proper nutrition and physical activity among medical school students affect consciousness in selecting foods, but does not affect regular physical activity.Apparently, the knowledge that nursing students receive in medical schools without practical advice and motivation is not enough to change lifestyle.This is a long process that needs to start at a young age.In addition to families, schools and teachers have a crucial role, promoting healthy lifestyles, the importance of regular activity and the possible consequences of obesity.

Fig. 3 .
Fig.3.The frequency of physical activity by school and sex

Fig. 4 .
Fig.4.The attitude towards one's own body, by school and sex

Table 1 .
Anthropometric characteristics of the study participants

Table 2 .
The descriptive parameters of the subjects according to sex

Table 3 .
The descriptive parameters of the subjects according to the age