Научные статьи \ Прикладные науки. Медицина. Технология \ Mедицинские науки \ Гигиена в целом. Личная гигиена и здоровье

Comparative analysis of body composition of females from three European countries

Автор: Ćopić N., Petronijević S., Ferrando-Terradez I., Bertaccini M.E., Prebeg G.

Журнал: Sport Mediji i Biznis @journal-smb

Статья в выпуске: 3 vol.11, 2025 года.

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The aim of this study was to examine differences in body composition among girls from three European countries (Serbia, Italy, and Spain). Based on age, participants were divided into two categories: the first group included girls aged 15–19 years, while the second group consisted of those aged 20–24 years. The first group comprised a total of 113 participants (50 from Serbia, 24 from Spain, and 39 from Italy), whereas the second group included 167 participants (50 from Serbia, 81 from Spain, and 36 from Italy). Body composition was assessed using the InBody 230 device, which enabled the assessment of the following variables: body height, body weight, BMI, body fat percentage, muscle mass percentage, and waist-hip ratio. In the age group 15-19 years, results showed statistically significant differences among the countries in body height (p < 0.05) and waist-hip ratio (p < 0.05). In the age group 20–24 years, statistically significant differences were observed in all measured variables. Overall, the results indicate that differences in body composition among girls from Serbia, Italy, and Spain are more pronounced in the older age group (20–24 years) compared to the younger group (15–19 years), which is likely a consequence of cultural, lifestyle, and training factors, while also underscoring the importance of monitoring body composition during growth and maturation.

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Obesity, health, exercise, Serbia, Spain, Italy

Короткий адрес: https://sciup.org/170211427

IDR: 170211427 | УДК: 613.25-055.2(460:450:497.11); 613.72-055.2 | DOI: 10.58984/smb2503025c

Текст научной статьи Comparative analysis of body composition of females from three European countries

Obesity is one of the main health problems faced by modern society (Abarca-Gómez et al., 2017; Organization, 2016). It develops as a result of excessive intake of energy-providing nutrients. The consequence is the accumulation of fat deposits in the body beyond the level considered normal for age, sex, and body type (Ilić, Mu-min, & Harhaji, 2003;

Barlett, Puhl, Hodgson, and Buskirk (1991) note that gender differences begin to appear after the age of 10. The transition period refers to the stage of life from late adolescence to full physical and psychosocial maturation into adulthood, lasting from ages 16 to 26. During this period, gender differences are also present, favoring the male population (Doknić, 2018). In adulthood, women are twice as likely to develop severe obesity (BMI ≥35 kg/m²) (Di Cesare et al., 2019). In women, higher body fat in kilograms and greater lean body mass have been recorded. In addition, during postmenopause, the risk further increases due to a decline in estrogen levels, leading to increased fat tissue, reduced muscle mass, and deterioration of overall health (Appelman, van Rijn, Ten Haaf, Boersma, & Peters, 2015;

According to the World Health Organization (WHO, 2022) report for the European region, the adult obesity rate (overweight + obesity) across much of Europe is close to 60% for the period 2022–2025. Regarding the female population in the studies conducted in 2022, high rates were reported in countries such as Ireland, Romania, and Croatia, while Spain and Italy ranked among the highest (Pellegrino et al., 2023).

Simple measurements for assessing body composition, such as skinfold thickness and body mass index (BMI), are easy to perform but carry a significant margin of error. Other methods require participant cooperation, sophisticated equipment, and skilled examiners. The most reliable method for assessing body composition is bioelectrical impedance analysis using the InBody 230 (Copic, Dopsaj, Ivanovic, Nesic, & Jaric, 2014; Ferrando-Terradez et al., 2023). BIA provides more reliable measurements of body composition, including body weight, total body water, fat mass, muscle mass, body fat percentage, and BMI.

Obesity is a 21st-century pandemic, with its impact being most significant among the youngest populations. Early prevention of obesity can help avoid many of its consequences. Comparative data from European countries come from various studies and sometimes employ different methodologies (e.g., age-standardized BMI, selfreported weights, sample-based studies), so direct comparisons are not always precise. For this reason, the aim of the present study is to examine differences in body composition among girls from three European countries (Serbia, Italy, and Spain), providing a basis for further recommendations to improve children's health.

Methods

Subjects

The study included 280 female participants from three European countries (Serbia – Belgrade, Italy - Parma, Spain - Valencia). Participants from each country were divided into two age groups: adolescents aged 15 to 19 years and young adults aged 20 to 24 years. In the adolescent group, there were 50 participants from Serbia (16.72 ± 1.51 years), 24 from Spain (18.75 ± 0.71 years), and 39 from Italy (16.39 ± 1.61 years). The young adult group consisted of 50 participants from Serbia (22.04 ± 1.31 years), 81 from Spain (21.88 ± 1.44 years), and 36 from Italy (21.78 ± 0.99 years). All participants were healthy, with no known medical conditions that could affect the measurement results. Prior to the study, participants were fully informed about the procedures and voluntarily signed written consent to participate. The research protocol was reviewed and approved by the Human Research Ethics Committee of the University of Valencia (protocol number 1944476). The study is registered in ClinicalTrials.gov (NCT05467280). All participants provided written informed consent in accordance with the principles of the Declaration of Helsinki.

Testing Protocol

Body composition measurements were conducted during a single experimental session. All assessments took place in the morning, between 8:00 and 11:00 a.m., following the participants’ normal daily routines. All participants were previously instructed to avoid intense physical activity for at least 48 hours and to refrain from eating for two hours prior to the measurement. Body composition measurements in all three countries were carried out in 2022 using bioelectrical impedance analysis with the InBody 230. To ensure maximum reliability, participants were tested in underwear and were required to remove all metal jewelry, following the recommendation to avoid food intake for at least two hours before assessment. After entering basic data, participants stood on the device's metal footplates and held the handles with built-in electrodes, keeping their arms slightly away from the body at an approximate angle of 20° during the measurement. The InBody 230 body-composition analyzer demonstrates excellent repeatability and measurement precision, with reported test–retest reliability values reaching an ICC of 0.9995. When evaluated against DXA, which is considered the reference method, BIA measurements showed very strong agreement, with intraclass correlation coefficients ranging from 0.96 to

Variables

• Body Height (BH) – Measurements were performed using a Martin anthropometer, which has a measurement accuracy of 0.1 cm (Norton et al., 2000);
• Body Weight – Body mass was measured using bioelectrical impedance analysis (InBody 230), with a measurement accuracy of 0.1 kg;
• BMI – Body mass index (BMI), expressed in kg/m²;
• Body Fat (%) – Body fat percentage, expressed as %;
• Muscle mass (%) - Muscle mass percentage, expressed as %;
• Waist-hip ratio - Waist circumference (cm)/hip circumference (cm).

Statistical analyses

A descriptive statistical analysis provided means, standard deviation (SD), minimum (Min) and Maximum (Max). Differences between countries were assessed using oneway analysis of variance (ANOVA) to determine the presence of statistically significant differences in the measured variables. In cases where ANOVA indicated a statistically significant difference for a specific variable, an LSD post hoc test was conducted to identify within-group differences. The threshold for statistical significance was set at a 95% confidence level, p = 0.05. All statistical analyses were performed using Microsoft Office Excel (Microsoft Corp., Seattle, WA, USA) and SPSS for Windows, Release 17.0 (IBM, Armonk, NY, USA).

Results

Table 1 presents the descriptive statistics, including the arithmetic mean (Mean), standard deviation (SD), as well as the minimum (Min) and maximum (Max) values for all analyzed variables in both age groups of participants from Serbia, Spain, and Italy.

Table 1. Descriptive statistics of the main characteristics

		15-19 years					20-24 years
	Country	Mean	SD	Min	Max	N	Mean	SD	Min	Max	N
Body	Serbia	169.88	5.74	157	186	50	169.00	5.97	156	180	50
Height	Spain	161.22	7.35	146.8	177.8	24	162.42	6.02	150.3	175.5	81
(cm)	Italy	162.79	6.51	147	176	39	165.83	5.78	150	178	36
Body	Serbia	61.97	11.13	40	95.3	50	65.01	9.35	49.7	89.3	50
Weight	Spain	60.02	9.61	43.2	81.9	24	61.66	11.88	44	102.1	81
(kg)	Italy	57.15	9.67	43.4	77.1	39	58.2	8.48	44	75.9	36
BMI	Serbia	21.46	3.73	16	33.4	50	22.78	3.25	16.8	34	50
(kg/m²)	Spain	23.04	3.09	18.5	29.1	24	23.38	4.48	16.4	38.9	81
(kg/m²)	Italy	21.53	3.17	15.2	28.7	39	21.1	2.74	16.9	27.9	36
Body Fat (%)	Serbia	25.82	8.83	3.00	47.5	50	27.69	7.33	9.7	48.9	50
Body Fat (%)	Spain	28.34	10.15	3.00	42.3	24	29.47	9.97	3.00	50	81
	Italy	26.03	8.32	4.4	47.9	39	23.91	6.91	10.4	42	36
Muscle	Serbia	40.7	5.10	28.46	56.21	50	39.86	4.14	28.22	50.95	50
mass	Spain	39.4	6.65	30.49	57.28	24	38.6	5.92	27.19	56.87	81
(%)	Italy	40.3	4.57	28.12	52.28	39	41.62	3.91	31.51	49.06	36
Waist-	Serbia	0.88	0.06	0.75	1.03	50	0.90	0.05	0.79	1.03	50
Hip	Spain	0.86	0.06	0.71	0.98	24	0.87	0.07	0.71	1.03	81
Ratio	Italy	0.83	0.06	0.76	0.95	39	0.83	0.05	0.76	1.02	36

In Table 2, the results of the one-way analysis of variance (ANOVA) showed statistically significant differences between countries in the variables Body Height (F = 20.71, p < 0.01) and waist-hip ratio (F = 8.2, p < 0.01) among participants aged 15–19 years. These results for the age group 15–19 years indicate that body composition variables are relatively homogeneous.

Table 2. Analysis of variance among participants from Serbia, Italy, and Spain for the 15–19-year age group

ANOVA

Between Groups	Sum of Squares	df	Mean Square	F	Sig.
Between Groups	1683.92	2	841.96	20.72	0.000
Body Height (cm) Within Groups	4469.77	110	40.63
Total	6153.7	112
Between Groups	509.25	2	254.63	2.38	0.097
Body Weight (kg) Within Groups	11744.36	110	106.77
Total	12253.61	112
Between Groups	45.42	2	22.71	1.94	0.148
BMI (kg/m²) Within Groups	1284.94	110	11.68
Total	1330.35	112
Between Groups	112.31	2	56.16	0.7	0.499
Body Fat (%) Within Groups	8822.29	110	80.2
Total	8934.6	112
Between Groups	0.06	2	0.03	8.2	0.000
Waist-Hip Ratio Within Groups	0.41	110	0
Total	0.47	112
Between Groups	27.36	2	13.68	0.49	0.616
Muscle mass (%) Within Groups	3088.04	110	28.07
Total	3115.39	112

In Table 3, the results of the one-way analysis of variance (ANOVA) showed statistically significant differences between countries for all variables among participants aged 20–24 years. Statistically significant differences were observed in body height, body mass, BMI, body fat percentage, waist-hip ratio, and muscle mass percentage (p < 0.05), indicating distinct anthropo-morphological profiles among participants from Serbia, Spain, and Italy. The largest statistically significant differences were found in body height (F = 19.23, p < 0.01) and waist-hip ratio (F = 14.2, p < 0.01), where the group effect was most pronounced.

Table 3. Analysis of variance among participants from Serbia, Italy, and Spain for the 20–24-year age group

ANOVA

Between Groups		Sum of Squares	df	Mean Square	F	Sig.
	Between Groups	1363.26	2	681.63	19.23	0.000
	Body Height (cm) Within Groups	5813.45	164	35.45
	Total	7176.7	166
	Between Groups	981.48	2	490.74	4.45	0.013
	Body Weight (kg) Within Groups	18091.34	164	110.31
	Total	19072.82	166
	Between Groups	129.36	2	64.68	4.45	0.013
UH nj	BMI (kg/m²) Within Groups	2385.47	164	14.55
>	Total	2514.83	166
N	Between Groups	768.3	2	384.15	5.14	0.007
О CM	Body Fat (%) Within Groups	12259.53	164	74.75
	Total	13027.82	166
	Between Groups	0.1	2	0.05	14.2	0.000
	Waist-Hip Ratio Within Groups	0.58	164	0
	Total	0.68	166
	Between Groups	230.92	2	115.46	4.53	0.012
	Muscle mass (%) Within Groups	4176.36	164	25.47
	Total	4407.28	166

In the 15–19 year age group, statistically significant differences were observed in body height and waist-hip ratio between the countries studied. Girls from Serbia were significantly taller compared to their peers from Spain (p = 0.000) and Italy (p = 0.000), while the difference between Spain and Italy was not significant (Table 4). Regarding the waist-hip ratio, participants from Serbia had slightly higher values compared to those from Italy (p = 0.000), indicating a statistically significant difference.

Table 4. LSD post hoc analysis – differences between Serbia, Spain, and Italy for the 15–19-year age group

Multiple Comparisons (15-19 years)

95% Confidence Interval

LSD ^ean Std. Error Sig.

^{Difference (I-J)} Lower Bound Upper Bound

Body Height (cm)

_{S bi} Spain 8.6633^* 1.583 0.000 5.526 11.800

^Serbia Italy 7.0851^* 1.362 0.000 4.386 9.784

Spain Italy -1.5782 1.654 0.342 -4.856 1.699

WaistHip Ratio

_{S bi} Spain 0.02630 0.015 0.086 -0.004 0.056

^Serbia Italy 0.05277^* 0.013 0.000 0.027 0.079

Spain Italy 0.02647 0.016 0.098 -0.005 0.058

In the 20–24-year age group, more pronounced differences were identified in the analyzed variables between countries compared to the younger age category (Table 5). As in the younger group, differences in body height were observed among all three countries, with the greatest difference found between participants from Serbia and Spain (p = 0.000). Body mass was significantly higher in participants from Serbia compared to those from Italy (p = 0.003), while no significant differences were found between the other country pairs. Regarding BMI, participants from Italy differed significantly from those from Spain (p = 0.003) and Serbia (p = 0.046). Waisthip ratio values were higher in participants from Serbia compared to those from both other countries (p = 0.000), indicating more pronounced central obesity. Concerning body fat percentage, participants from Italy had the lowest values and differed significantly from those from Serbia (p = 0.048) and Spain (p = 0.002). Additionally, participants from Italy differed significantly from those from Spain in muscle mass percentage (p = 0.03), while no difference was observed compared to participants from Serbia.

Table 5. LSD post hoc analysis – differences between Serbia, Spain, and Italy for the 20–24-year age group

LSD

Multiple Comparisons (20-24 years)

95% Confidence Interval Mean

Std. Error Sig.

Difference (I-J)

Lower Bound Upper Bound

Body ^Spain

Serbia

Height Italy

(^cm) Spain Italy

6.5840^* 1.071 0.000 4.470 8.698

3.1667^* 1.301 0.016 0.597 5.736

-3.4173^* 1.193 0.005 -5.772 -1.062

Body Spain

Serbia

Weight Italy

(kg) Spain Italy

3.3523 1.889 0.078 -0.378 7.082

6.8112^* 2.296 0.003 2.278 11.344

3.4590 2.104 0.102 -0.695 7.613

BMI Serbia ^Spain

(kg/m²) ^{a y}

Spain Italy

-0.5978 0.686 0.385 -1.952 0.757

1.6772^* 0.834 0.046 0.031 3.323

2.2750^* 0.764 0.003 0.767 3.783

Spain

Body Serbia

Fat (%) ^Italy

Spain Italy

-1.7794 1.555 0.254 -4.850 1.291

3.7721^* 1.890 0.048 0.041 7.504

5.5515^* 1.732 0.002 2.132 8.971

Waist- Spain

Serbia

Hip Italy

^Ratio Spain Italy

0.03226^* 0.011 0.003 0.011 0.053

0.06883^* 0.013 0.000 0.043 0.094

0.03657^* 0.012 0.002 0.013 0.060

Muscle Spain

Serbia

mass Italy

(%) Spain Italy

1.2592 0.908 0.167 -0.533 3.051

-1.7594 1.103 0.113 -3.937 0.419

-3.0186 * 1.011 0.003 -5.015 -1.023

Discussion

The aim of this study was to compare body composition characteristics of females from three European countries - Serbia, Italy, and Spain - across two age categories (15-19 and 20-24 years). The results clearly indicate that differences between countries exist, but these differences are largely influenced by age. In adolescence (younger group), only a few differences were observed, whereas in early adulthood (older group), more pronounced and consistent differences emerged between participants.

The results of this study show that participants from Italy had, on average, lower BMI, body mass, and body fat percentage, whereas participants from Spain, particularly in the 20–24-year age group, exhibited higher values of these parameters and a more pronounced trend toward overweight. These findings are fully consistent with epidemiological data indicating a significant increase in the prevalence of excess body weight among adolescents and young women in Spain (Sánchez-Cruz, Jiménez-Moleón, Fernández-Quesada, & Sánchez, 2013b). In contrast, Italy - especially the northern and central regions - largely maintains the traditional Mediterranean dietary pattern, which has been shown to be associated with lower body fat percentage and a more favorable metabolic profile (Sofi et al., 2010; Bonaccio et al., 2014).

One of the most significant findings of this study relates to waist-hip ratio (WHR) values, which were highest among participants from Serbia in both age categories. WHR is a key parameter for assessing abdominal obesity and a strong predictor of metabolic risks, independent of BMI (Petrović et al., 2025). A study conducted in the Chianti region of Italy (1998–2000) reported an average WHR of 0.799 among women aged 20–44 years (Bartali se al., 2002). In a representative sample of middleaged, working women in Spain, the average WHR was approximately 0.85 ± 0.06 (Herrero, García, Hanon, Barbero i González, 2022), whereas a study on a sample of women in Serbia recorded an average WHR of 0.78 ± 0.08. Comparisons indicate that participants from Serbia have statistically significantly higher WHR values compared to those from Italy (p = 0.000), which is confirmed by the present study. Studies by Faig (2014) show that the traditional Mediterranean diet is declining faster in Spain than in Italy. The increased consumption of ultra-processed foods, reduced intake of olive oil and fish (Abellan Aleman et al., 2016), higher consumption of sugary drinks among younger generations, and decreasing intake of fresh fruits and vegetables have contributed to Spanish women being among the most overweight in Europe, particularly in younger age groups (Herrera-Ramos et al., 2023). Italy, especially in the south, retains the traditional Mediterranean diet to a greater extent, whereas Serbia has never had a Mediterranean dietary pattern; its traditional diet was based on higher amounts of saturated fats, refined carbohydrates, and industrially processed foods - resulting in a different metabolic obesity profile, with a higher prevalence of abdominal obesity.

Several limitations of the present study should be acknowledged. Although identical measurement protocols were applied across all countries, the sample size can be considered one of the key limitations of this study. In addition, factors influencing body composition, such as quality of life, including dietary habits and levels of physical activity, were not directly assessed and should be incorporated in future research.

Conclusion

The results of this study confirm the presence of significant differences in body composition among females from Serbia, Italy, and Spain, with these differences being more pronounced in early adulthood (20-24 years) than in adolescence (15–19 years). Participants from Serbia are characterized by greater body height and higher waist-hip ratio (WHR) values, indicating a greater predisposition to abdominal obesity. Italian participants exhibit the most favorable body profile, with lower BMI and body fat percentage, which may be associated with the preserved Mediterranean dietary pattern and a more active lifestyle. In contrast, participants from Spain, particularly in the older age group (20-24 years), showed a trend toward higher body mass and body fat. These findings suggest that age, dietary habits, physical activity, and broader socioeconomic factors play a key role in shaping body composition in young women across different European populations .

Acknowledgments

This chapter is derived from the WISE (Women’s Involvement in Steady Exercise) project, which is co-funded by the European Commission through the Erasmus+ Sport programme.

The authors declare no conflict of interest.

Author Contributions: