A six decades long follow-up on body size in adolescents from Zagreb, Croatia (1951–2010)

This article appeared in a journal published by Elsevier. The attachedcopy is furnished to the author for internal non-commercial researchand education use, including for instruction at the authors institution

and sharing with colleagues.

Other uses, including reproduction and distribution, or selling orlicensing copies, or posting to personal, institutional or third party

websites are prohibited.

In most cases authors are permitted to post their version of thearticle (e.g. in Word or Tex form) to their personal website orinstitutional repository. Authors requiring further information

regarding Elsevier’s archiving and manuscript policies areencouraged to visit:

http://www.elsevier.com/authorsrights

http://www.elsevier.com/authorsrights

Author's personal copy

A six decades long follow-up on body size in adolescents fromZagreb, Croatia (1951–2010)

Matea Zajc Petranovic a, Zeljka Tomas a, Nina Smolej Narancic a,Tatjana Skaric-Juric a,*, Andrea Vecek b, Jasna Milicic a

a Institute for Anthropological Research, Gajeva 32, 10000 Zagreb, Croatiab Institute of Public Health, Mirogojska 16, 10000 Zagreb, Croatia

1. Introduction

Global epidemic of childhood and adolescent obesityis one of the most serious public health problems since itis associated with both immediate and long-term effectson health and well-being. Excessive body mass inchildhood and adolescence was proved to be linked withobesity in adults as well as with the occurrence ofcardiovascular and metabolic diseases in very earlyadulthood (Freedman, 2002; Must and Anderson, 2003;Burke et al., 2005).

Prevalence of obesity is rapidly rising in many low- andmiddle-income developing countries, especially in urbansettings (WHO, 2013), whereas data from the developedcountries are inconsistent. For instance, over the past 30years obesity in the USA has doubled in children andtripled in adolescents and still rises (Ogden et al., 2012),while the increase in childhood obesity in Western Europehas halted in some countries and in others it shows alevelling off trend (Sjoberg et al., 2008; Peneau et al., 2009;Salanave et al., 2009; Aeberli et al., 2010). This stabilizationmight not be equal among all sociodemographic groups,possibly due to differences in socioeconomic status (Lienet al., 2010). Unfortunately, data on childhood obesitytrends for Eastern Europe are scarce, especially for theperiod of last 10 years, but studies generally suggest amoderate increase in the prevalence of obesity (Popławskaet al., 2006; Vignerova et al., 2007; Chrzanowska et al.,2007).

Economics and Human Biology 13 (2014) 155–164

A R T I C L E I N F O

Article history:

Received 8 January 2013

Received in revised form 21 August 2013

Accepted 30 September 2013

Available online 9 October 2013

Keywords:

Body Mass Index

Height

Weight

Secular trend

Gross Domestic Product

A B S T R A C T

Most studies analysing the influence of socioeconomic deterioration on body size focus on

the impact of food shortages and diseases on the growth in early childhood. To evaluate

how socioeconomic conditions influence the growth during the adolescence, we tracked

the body size of 15–19 year-olds over the last sixty years covering the socialist period

(1951–1990), the war (1991–1995) and the transition to capitalistic economy. This study

of Zagreb, Croatia, adolescent population provides information on the secular trend in

height, weight and Body Mass Index (BMI) and examines their relation with Real Gross

Domestic Product. From 1951 to 2010 the girls’ height approximately increased by 6.2 cm

and weight by 6.8 kg, while the boys’ height increased by 12.2 cm and weight by 17.3 kg.

Prior to 1991 mean BMI in girls was higher than in boys, but from 1991 on, the

interrelation between the sexes has been opposite, possibly mirroring the cultural trends

that started in mid-1970s and reflecting higher sensitivity of boys to the socioeconomic

changes. In conclusion, the secular trend in body size over the investigated period reflects

the positive economic trends interrupted by the war. The recent increase in BMI

corresponds to the country’s economic recovery and indicates the ‘‘nutrition transition’’.

� 2013 Elsevier B.V. All rights reserved.

Abbreviations: WHO, World Health Organization; BMI, Body Mass

Index; GDP, Gross Domestic Product; IBP, International Biological Pro-

gram; CDC, Center for Disease Control.

* Corresponding author. Tel.: +385 1 5535 135.

E-mail address: [email protected] (T. Skaric-Juric).

Contents lists available at ScienceDirect

Economics and Human Biology

jo u rn al ho m epag e: h t tp : / /ww w.els evier .c o m/lo cat e/ehb

1570-677X/$ – see front matter � 2013 Elsevier B.V. All rights reserved.

http://dx.doi.org/10.1016/j.ehb.2013.09.002


The usual problem with data on childhood obesitytrends in Europe is that they were not gathered in aconsistent way across the continent: while researchersfrom most countries gathered and measured largenationally representative samples, some of the otherspresented the data on self-reported measures and/or smallsamples (Lien et al., 2010). Therefore, the varying quality ofdata makes it very hard to compare numbers from countryto country. Furthermore, there are problems in compara-tive analyses of the reported data within countries thathave undergone political and economic transition lately,such as Croatia. During the socialism the idea of healtheducation of the population rendered extensive surveyseasier than today. It was Andrija Stampar, the Croatianphysician, one of the founders of the World HealthOrganization and the public health leader who not onlyestablished public health institutions in the formerYugoslavia, but also developed the public health educa-tional programmes oriented towards the practical aspectsof public health training and aligned them with the socialneeds. His ideas laid the foundation for a large nationalstudy of growth and development carried out in the entireCroatian population of school children and youth in thesecond half of the 20th century, the comprehensivenessand response rate of which cannot be reached nowadays.

Additional problem in tracking relation between bodydevelopment and socioeconomic factors are inconsisten-cies in economic data management, inflation and change ofcurrencies which made calculation and estimation ofeconomic indicators difficult, as well as the possibility ofdata manipulation in order to present country as moreprosperous than it really was.

As a part of the former socialistic federation ofYugoslavia, which consisted of seven now autonomouscountries, Croatia has a unique economic and politicalposition in Europe which provides a possibility of a specialperspective on the influence of both economic transitionand modern lifestyle on childhood obesity. The aim of thisstudy was to present the secular trends in BMI, as well as inheight and weight, of urban adolescents from Zagreb, thecapital of Croatia, over the 60-year-period (1951–2010) inthe context of major socioeconomic and political changes.In order to evaluate the interrelation between these threeindicators of growth and their individual relations withsocioeconomic changes, we analyzed them in parallel.

The rapid industrialization which started after theWorld War II (WWII) led to the growth of Gross DomesticProduct (GDP) and better living standard, especially whencompared to the other European socialist countries, forinstance, Bulgaria or Romania. During the period from1950 to 1980, the growth of Croatian economy wasconsiderable, and, as a result, the country reached amoderate level of industrial development. However, thiscentrally planned economic model was not successful inthe long run, so the economic growth was halted in 1980s:the crisis was manifested in the rise of unemployment rate,great external debt and hyperinflation which negativelyreflected on the living standard (Druzic, 2004; Raguz et al.,2012).

Shift to the free market economy started in 1990 inparallel with large socio-political changes in Croatia. More

specifically, after the change of Croatia’s constitutionalsystem to a multi-party system and democratic elections,according to the results of the referendum on indepen-dence in 1991, the new Croatian government declaredindependence from the former Yugoslavia. The privatiza-tion had barely begun when the war broke out in 1991.Economic infrastructure was directly affected by theCroatian War of Independence and sustained massivedamage, particularly in 1991 and 1992 (Koren et al., 2007;Druzic, 2004).

Zagreb is the largest city of the Republic of Croatia andthe only metropolitan area in Croatia with population ofover one million. The transport connections, concentrationof industry, educational and scientific institutions andindustrial tradition underlie its leading economic position inCroatia. Zagreb is the seat of the central government, stateadministrative bodies and almost all government minis-tries. GDP of Zagreb contributes to the total national GDP by30% and this level has been fairly constant, from 26 to 31%,through the past two decades (Turcic and Turcic, 2013).

The data we present are the results of several cross-sectional surveys conducted in the adolescent populationof Zagreb: the first five surveys were organized by the teamfrom Andrija Stampar School of Public Health, Zagreb(Prebeg et al., 1995), while the three last ones wereorganized by the team from the Institute for Anthro-pological Research, Zagreb. The anthropometric variableswere analyzed in relation to real GDP for the overall 60-year-period. In addition, the data collected pre-war, in1991, and post-war, in 1997, gave us the opportunity toevaluate possible direct influence of war-accompanyingsocioeconomic deterioration on changes in BMI.

2. Methods

The first five surveys of Zagreb schoolchildren includedin this study were organized and conducted by the AndrijaStampar School of Public Health (Prebeg et al., 1995). Theheight and weight of these subjects, aged 7–19 years, weremeasured in 1951, 1964, 1973, 1982, and in 1991. In 1951,authors reported that the total school population wassurveyed; in 1964 the sample amounted to 32,400subjects, representing about one-third to one-half of allschool attendees in the respective age groups. The lastthree investigations were based on random stratifiedsamples amounting to about 10% of the total population in1973 and 1982, and to about 5% of schoolchildren in 1991.The authors did not specify the stratification in 1964, but in1973 it was done by type of schools with differenteducational standards: grammar schools, medium voca-tional schools, or schools for skilled workers.

Due to the reform in secondary schooling that tookplace in 1977, it was impossible to follow the attendees inthe same type of schools in further investigations becausethe classification into three school types was withdrawn.According to the new programme, all schools weredirected towards obtaining certain qualifications. Thenew regulation defined duration of secondary educationon 3 years for skilled workers or on 4 years for everyoneelse. However, in 1982 authors tried to include pupils fromschools which, by educational level and supposed social

M. Zajc Petranovic et al. / Economics and Human Biology 13 (2014) 155–164156

https://www.researchgate.net/publication/47155246_Availability_of_data_assessing_the_prevalence_and_trends_of_overweight_and_obesity_among_European_adolescents?el=1_x_8&enrichId=rgreq-97db0a11-2a15-4546-ac0b-b5742b2c528d&enrichSource=Y292ZXJQYWdlOzI1ODM0NzMyOTtBUzo5NzM2MDYzMzkyNTY0NkAxNDAwMjIzOTkzMTUx


grouping, were most similar to those involved in the 1973investigation. Thus they considered the sample represen-tative for the population of Zagreb’s schools. In 1991 theinvestigation was performed in the same schools. Disabledpupils and those with chronic diseases were excluded fromall surveys.

The total number of 15- to 19-year-old-examinees wasas following: in 1951 – 4734 girls and 7234 boys; in 1964 –7139 girls and 8886 boys; in 1973 – 2752 girls and 1491boys; in 1982 – 2055 girls and 1969 boys; and in 1991 –1381 girls and 1516 boys.

Over the last two decades, three surveys of secondaryschool adolescents from Zagreb, Croatia, were carried outby a team of trained experts from the Institute forAnthropological Research. The 1990/1991 survey (infurther text we will refer to it as the 1991 survey) focusedon growth and development differences of children andyouth between former Yugoslav republics (only thesubsample from Zagreb, Croatia, is considered here), the1997 survey focused on determining the indices ofphysical and psychomotor status of the Croatian childrenand youth, and the 2009/2010 survey (in further text 2010survey) focused on the anthropometric assessment ofnutritional status as well as on secular trend in growth anddevelopment for the Croatian population. Since surveyswere conducted with different foci, the number ofexaminees differs from survey to survey.

Each of these three surveys was conducted in foursecondary schools randomly stratified from the list of totalschools in Zagreb. All the pupils from these schools,representing urban adolescent population, were invited toparticipate. The response rate varied from 53% of the totalpupils of a given age from schools randomly selected in the1991 survey, to 68% in 1997 survey and finally 43% in the2010 survey. From database that contains the results ofthese surveys, we extracted all 15- to 19-year-old subjects:there were 3441 adolescents, 1858 girls and 1583 boys.Forty-three girls were excluded due to refusing toparticipate in weight measuring (1.2% of total sampleand 2.3% of total female sample).

The first, 1991 survey, included 528 girls and 550 boys,the second one, the 1997 survey, 887 girls and 624 boys,and the third one, the 2010 survey, included 399 girls and405 boys. In 1991, there were 41 secondary schools inZagreb with a total of 49,692 pupils (24,586 girls), so oursample amounts to 9.7% of schools and 2.2% of pupils. In1997, 48,401 pupils (24,015 girls) attended 73 secondaryschools in Zagreb: thus, our sample represents 5.5% ofschools and 3.1% of adolescents attending secondaryschools that school year. In the school year 2009/2010,there were 101 secondary schools with 38,179 pupils(15,367 girls) so our sample represents 3.96% of all schoolsand 2.1% of schoolchildren. All legally adult (18+ years)participants signed informed consent, but if they wereunder-aged, it was necessary that their parents also signwritten permissions. The Ministry of Health and theMinistry of Science, Education and Sports of the Republicof Croatia, as well as the Ethics Committee of the Institutefor Anthropological Research, approved the study protocol.

The study protocol consisted of an interview designedcorresponding to the interest of the particular survey and

short anthropometry. Only a subset of obtained data ispresented here. Short anthropometry was undertakenfollowing standard IBP recommendations (Weiner andLourie, 1981), using standard equipment. Height wasmeasured to the nearest 0.1 cm with a wall-mountedstadiometer. Body weight was measured to the nearest0.1 kg with a portable scale. For these anthropometricmeasurements, subjects wore light athletic clothing and noshoes. Body Mass Index (BMI) was calculated as weight inkilograms divided by squared height in metres (kg/m2).The data on BMIs from the 1991 and the 2010 surveys havenot been published until now, while BMI data from the1997 survey were, but only partially (Smolej Narancicet al., 2005).

Each age group was categorized by the mid-point of anage range. For example, the group of adolescents who were15 years old included all aged between 14.50 years and15.49 years, and so forth. There were five age groups, 15–19 years, for both boys and girls. The differences betweensurveys in weight and BMI, were tested using the Mann-Whitney rank non-parametric test due to non-normaldistribution, and the differences in height were testedusing One-way ANOVA. The individual values of height,weight and BMI were converted to Z-scores using theinteractive database based on CDC nutritional reference ofbody size and body composition (Frisancho, 2008). Further,the subjects were divided into six age- and sex-specificstandard BMI categories (<5th percentile, 5th–15thpercentile, 15th–50th percentile, 50th–85th percentile,85th–95th percentile, >95th percentile) defined by thesame CDC reference database. The differences betweensurveys in the prevalence of adolescents in CDC definedpercentile groups were analyzed using the x2-test.

In order to provide a description of the secular trendfrom 1951 until 1991, we also converted the age- and sex-specific mean height and weight of adolescents fromPrebeg’s surveys to Z-scores according to the same, CDCreferent data (Frisancho, 2008).

Weighted t-test was used to compare mean heights andweights by age group between 1951 survey and 2010survey in order to assess the significance of secular gains.Although some departures from normality were detected,the two sample t-test is considered fairly robust for validityagainst non-normality (Zar, 1999). Absolute and relative(%) differences in mean height and weight by age groupwere calculated to assess the secular gain from the mid20th century until 2010.

Since we did not have the original BMIs of Prebeg’sadolescents, we calculated mean BMI from mean weightand height data, according to the standard BMI formula, foreach of the five age groups. This approach is not a standardone, but the validity of results calculated from mean valuesis affirmed by the approximate formula of non-linearfunctions of independent random variables (Rektorys,1969). To provide additional validation of this approach,the same equation was used to calculate mean BMIs for allage groups in our three surveys and all results were verysimilar to those calculated by standard method fromindividual weight and height data: they differed only in thesecond decimal place (p = ns). However, this method is notappropriate for precise calculation of standard deviation so

M. Zajc Petranovic et al. / Economics and Human Biology 13 (2014) 155–164 157


in the further text we will use mean Z-standardized BMIvalues only to provide rough description of the secular trendfrom 1951 until 2010, but we will not test them statistically.Additionally, the first survey of this study coincides with thelast Prebeg’s survey, so we found the most appropriate toponder the samples and weight arithmetic means for thesame age and sex groups of these two surveys.

Real Gross Domestic Product (GDP), included torepresent socioeconomic conditions in Croatia through1951–2010 period, was estimated from the CroatianBureau of Statistics data according to constant 2000 prices(Raguz et al., 2012).

All the analyses were performed by SPSS/PASWStatistics 18.0 statistical package for Windows (SPSS Inc.,Chicago, IL, USA), with statistical significance set atp < 0.05. Figures were created using the Stata 10.0 (StataCorporation, College Station, TX, USA).

3. Results

The data on height, weight and BMI according to sex,age and survey are presented in Tables 1–3 for the period

from 1991 to 2010. Mean height did not change in boys,while in girls it declined significantly only in 15-year-oldsfrom 2010, when compared with the peers from the 1991survey (Table 1). In comparison with the 1991 survey, in1997 median weight significantly decreased in 18-year-oldboys, while the differences in girls were not statisticallysignificant. However, when comparing the 2010 with the1997 survey, we detected a significant increase in medianweight in 18-year-olds of both sexes, in 19-year-old girls,as well as in 15- and 17-year-old boys. Increase in medianweight was also significant over the 20-year period in 15-and 18-year-old boys, while the differences between girlsdid not reach statistically significant level (Table 2).

In comparison with the 1991 results, in 1997 medianBMI decreased significantly in 18-year-old girls and in 17-and 18-year-old boys: the average decrease within agegroups for BMI was 0.43 kg/m2, 0.80 kg/m2 and 0.52 kg/m2,respectively. When the 2010 survey results were com-pared with the 1997 survey, we detected significantlyincreased median BMI in most age groups – the onlyexception were 16-year-old boys and girls. Over the periodof 20 years, from 1991 to 2010, median BMI significantly

Table 1

Secular trend in height (cm) of Zagreb adolescents from 1991 to 2010 by age groups (15-19 years).

Age groups 1991 survey 1997 survey 2010 survey F p Sign. diff.*

N Mean � SD N Mean � SD N Mean � SD

Adolescent girls

15 � 0.5 121 167.7 � 5.8 184 167.0 � 5.8 82 165.2 � 5.8 4.676 0.01 y

16 � 0.5 113 167.6 � 6.0 233 167.2 � 6.1 99 165.9 � 5.5 2.128 0.12

17 � 0.5 123 167.0 � 6.5 199 166.5 � 5.8 107 165.9 � 6.1 1.02 0.36

18 � 0.5 119 167.1 � 6.3 198 166.4 � 6.3 73 165.0 � 5.2 2.582 0.08

19 � 0.5 53 167.0 � 6.1 73 165.9 � 6.1 38 165.7 � 5.8 0.85 0.43

Adolescent boys

15 � 0.5 117 176.3 � 6.6 118 176.3 � 6.8 77 176.5 � 7.2 0.034 0.97

16 � 0.5 122 177.8 � 6.8 160 178.2 � 6.4 93 178.2 � 8.2 0.164 0.85

17 � 0.5 108 179.5 � 6.8 161 180.6 � 7.1 103 179.8 � 6.5 0.897 0.41

18 � 0.5 133 180.7 � 6.9 130 180.0 � 6.5 97 179.8 � 7.3 0.669 0.51

19 � 0.5 70 180.7 � 6.6 55 179.9 � 7.3 36 180.9 � 7.3 0.315 0.73

* The differences between surveys were tested using One-way ANOVA and post hoc comparisons were made using Scheffe‘s test.y p < 0.01 between 1991 and 2010 surveys.

Table 2

Secular trend in weight (kg) of Zagreb adolescents from 1991 to 2010 by age groups (15–19 years).

Age groups 1991 survey 1997 survey 2010 survey Sign. diff.*

N Mean � SD Median N Mean � SD Median N Mean � SD Median

Adolescent girls

15 � 0.5 121 58.3 � 8.4 56.5 184 57.2 � 8.1 56.3 82 58.6 � 10.0 55.7

16 � 0.5 113 58.9 � 7.2 59.0 233 58.3 � 8.0 58.0 99 59.2 � 10.5 58.3

17 � 0.5 123 58.4 � 8.0 57.5 199 56.8 � 6.8 55.0 107 59.1 � 10.0 58.1

18 � 0.5 119 59.5 � 7.0 58.5 198 57.9 � 7.3 57.3 73 60.5 � 8.7 58.3 ^

19 � 0.5 53 58.7 � 7.4 59.0 73 57.4 � 8.3 56.5 38 63.3 � 13.7 61.1 ^

Adolescent boys

15 � 0.5 117 65.7 � 10.4 65.0 118 63.7 � 9.1 62.3 77 70.9 � 12.3 69.8 ^,y

16 � 0.5 122 68.4 � 9.7 67.0 160 68.1 � 10.1 67.0 93 70.3 � 11.7 68.9

17 � 0.5 108 71.3 � 9.4 70.0 161 69.6 � 9.8 68.5 103 73.5 � 12.5 72.4 ^

18 � 0.5 133 72.1 � 8.2 71.0 130 69.9 � 9.7 69.7 97 77.0 � 15.1 74.3 G—,^,y

19 � 0.5 70 72.1 � 9.8 71.3 55 71.5 � 11.5 70.0 36 75.4 � 10.6 75.45

* The differences between surveys were tested using the Mann–Whitney rank test.

G— p < 0.05 between 1991 and 1997 surveys.^ p < 0.05 between 1997 and 2010 surveys.y p < 0.05 between 1991 and 2010 surveys.



increased in 18- and 19-year-olds of both sexes, as well asin 15-year-old boys (Table 3).

The prevalence of adolescents within the CDC definedBMI, weight and a height age-per-sex percentile categoriesis presented in Table 4. Significant differences in BMI andweight percentile categories between surveys were foundin both sexes, while height differed significantly only ingirls. According to the CDC referent values, the percentilecategories up to 15th percentile for height, weight and BMIwere under-represented in both sexes and in all threesurveys. The CDC 50th–85th category was over-abundantfor all three variables in boys, and for height and weight ingirls. The categories above 85th percentile of height wereover-represented in both sexes and in all surveys. In the

upper extreme BMI CDC category, the prevalence of bothgirls and boys was lower than expected in 1991 and 1997,but in 2010 it increased 3.5-fold in girls and a 3.7-fold inboys in comparison with 1997. Thus, the prevalence ofboys within the above 95th percentile BMI categoryreached almost 9% (Table 4).

The data regarding the secular trend in the Z-standardized mean height and Body Mass Index in relationto changes in Gross Domestic Product (GDP) are shown inFigs. 1 and 2. The continuous 30-year-growth in GDP,which started after the World War II, stopped in 1982 afterwhich GDP maintained its level until 1990. Starting from1991, GDP passed through a major downfall that lasteduntil the 1996, which was followed by a period of rapid

Table 3

Secular trend in BMI (kg/m2) of Zagreb adolescents from 1991 to 2010 by age groups (15–19 years).

Age groups 1991 survey 1997 survey 2010 survey Sign. diff.*

N Mean � SD Median N Mean � SD Median N Mean � SD Median

Adolescent girls

15 � 0.5 121 20.70 � 2.60 20.16 184 20.50 � 2.71 19.96 82 21.44 � 3.16 20.79 ^

16 � 0.5 113 20.81 � 2.09 20.63 233 20.86 � 2.71 20.53 99 21.55 � 3.49 21.02

17 � 0.5 123 20.93 � 2.61 20.39 199 20.47 � 2.12 20.37 107 21.43 � 3.09 21.08 ^

18 � 0.5 119 21.32 � 2.10 20.96 198 20.89 � 2.36 20.56 73 22.21 � 2.94 21.59 G—,^,y

19 � 0.5 53 21.03 � 2.55 20.57 73 20.82 � 2.70 20.19 38 23.03 � 4.72 21.87 ^,y

Adolescent boys

15 � 0.5 117 21.09 � 2.72 20.52 118 20.45 � 2.44 20.32 77 22.77 � 3.82 22.19 ^,y

16 � 0.5 122 21.60 � 2.61 21.05 160 21.40 � 2.78 20.99 93 22.10 � 3.09 21.64

17 � 0.5 108 22.12 � 2.52 21.88 161 21.32 � 2.58 20.89 103 22.71 � 3.52 22.38 G—,^

18 � 0.5 133 22.08 � 2.25 21.86 130 21.56 � 2.69 21.21 97 23.79 � 4.29 22.74 G—,^,y

19 � 0.5 70 22.03 � 2.29 21.83 55 22.02 � 2.67 21.78 36 23.05 � 3.04 23.32 ^,y

* The differences between surveys were tested using the Mann–Whitney rank test.

G— p < 0.05 between 1991 and 1997 surveys.^ p < 0.05 between 1997 and 2010 surveys.y p < 0.05 between 1991 and 2010 surveys.

Table 4

Prevalence of adolescents in CDC-defined percentile categories according to their height, weight and BMI values.

Generation N (sample size) Percentile categories according to the CDC referent population

<5th 5th–15th 15th–50th 50th–85th 85th–95th >95th p

Adolescent girls (15–19 years)

Height 1991 528 0.4 2.8 18.5 42.3 17.9 18.1 <0.05

1997 887 0.7 2.5 22.8 39.3 20.3 14.4

2010 399 0.8 2.3 27.3 42.6 17.0 10.0

Weight 1991 528 0.6 3.6 26.3 54.6 13.4 1.5 <0.05

1997 887 1.8 4.2 32.8 50.4 9.4 1.5

2010 399 1.3 3.3 26.1 50.9 14.0 4.5

BMI 1991 528 1.5 7.4 44.6 40.1 5.7 0.8 <0.05

1997 887 3.8 8.6 43.6 39.1 3.8 1.0

2010 399 1.5 7.5 34.6 43.1 9.8 3.5

Adolescent boys (15–19 years)

Height 1991 550 0.5 2.7 21.1 42.7 16.5 16.4 ns

1997 624 0.2 2.9 20.2 41.7 19.4 15.7

2010 405 0.5 2.5 25.1 36.0 18.5 17.5

Weight 1991 550 0.9 2.0 22.4 51.3 17.6 5.8 <0.05

1997 624 1.0 3.2 27.9 47.4 16.5 4.0

2010 405 0.5 2.5 18.7 43.8 20.2 14.3

BMI 1991 550 2.4 6.2 34.2 45.5 9.3 2.5 <0.05

1997 624 3.8 9.1 38.1 38.6 7.9 2.4

2010 405 3.0 4.4 25.9 43.6 14.3 8.9

* The differences between surveys were tested using x2-test.



growth. In the period from 1951 to 1991, steady growth inheight was observed in both sexes (Fig. 1). However, from1991 on, we observed the trend of slight decline in girls,and levelling off in boys. The increase in mean heightbetween the first, the 1951 survey, and the last, the 2010survey, was statistically significant in all age groups and inboth sexes (all p < 0.001, Table 5).

Similar to height data, the steady growth of weight wasalso observed in both sexes from 1951 to 1991 (data notshown) but in 1997 the inflection was detected: this surveywas preceded by a significant deterioration of livingconditions, presumably a consequence of the War (1991–1995), as indicated by drop in GDP. Along with a rapidgrowth in GDP from 1997 on, the weight in 2010substantially increased. The increase in mean weightbetween 1951 and 2010 was statistically significant in allage groups and in both sexes (Table 5). The changes of theCDC Z-standardized BMI were minimal through the 60-year-period in girls, while secular trend in boys was ofsimilar direction as in weight (Fig. 2).

An additional interesting finding was a difference in thetrend of secular changes between the sexes noted on Z-standardized height, weight and BMI: the weight andheight increased in parallel in both sexes, but the slopes ofthe regression lines were steeper in boys than in girls,

causing the intersection of the lines in the late 1980s (datanot shown). After the 1980s, the Z-standardized height andweight of boys exceeded those of girls, as did the Z-standardized BMI.

4. Discussion

This study, conducted in urban adolescent Croatianpopulation, provides information on the secular trend inheight, weight and BMI over the last sixty years. Our resultssuggest that the growth changes in both sexes mirroredsocioeconomic conditions characterized by the economicups and downs throughout this period, with the mostprominent ones having occurred in the transitional periodfrom socialism to capitalism, and especially during andafter the Croatian War of Independence (1991–1995).

4.1. Trends in body growth and GDP across 60 years (1951–

2010)

In spite of the rise in the prevalence of overweight andobese children and adolescents in many parts of the worldover the last six decades, in 2000s this increase has haltedin some countries of Western Europe, while in others thetrend is levelling off although not within all sociodemo-

Fig. 1. Secular trend of CDC-standardized height by age groups in correspondence to real chained GDP series (in constant 2000 kunas) from 1951 to 2010.

Note: 1 EUR = 7.57 kuna; 1 USD = 5.79 kuna (Midpoint Exchange Rates of the Croatian National Bank on 7th May 2013). Total population size according to the

2011 Census = 4,290,612.



graphic groups (Marques-Vidal et al., 2008; Ji and Chen,2008; Peneau et al., 2009; Salanave et al., 2009; Sjoberget al., 2008; Aeberli et al., 2010; Lien et al., 2010; Lee et al.,2011). Data from Eastern Europe are limited, but generallysuggest a moderate increase in the prevalence of obesity(Vignerova et al., 2007; Chrzanowska et al., 2007).

We showed that the weight (data not presented) andthe BMI of Croatian adolescents positively followed trendin GDP throughout the investigated 60-year-period: whenGDP grew, mean weight and mean BMI also grew, andwhen GDP declined, both mean weight and BMI declinedas well. The comparison of economic prosperity, presentedby GDP, with adolescents’ mean height provides differentresults: in parallel with the period of the continuous GDPgrowth from 1951 on, the mean height showed positivetrend which continued even in 1980s, when GDP washalted. In 1991 GDP reversed, but from 1996 on, it has beenrapidly growing. From 1991 on, a trend of slight decrease inmean height was detected in girls, as well as a plateau inboys. In spite of the variation in rate and direction ofchanges during the period from 1951 until 2010, there wassignificant overall increase in mean weight and height inadolescents of both sexes.

During the same period, similar trends in adolescentswere detected in some other populations as well (Bi and Ji,2005; Kagawa et al., 2011). In China researchers detected astagnation or reversal of the height and weight trend in

some age groups during periods of long-run famine, forexample, during the ‘‘Cultural Revolution’’ that almostcaused a breakdown of economy and led to the worseningof the living conditions (Bi and Ji, 2005). The secular trendin Japan was investigated for even a longer period, from1900 to 2000: in addition to the overall increment in heightand weight in course of 100 years, during the WWII, bothweight and height declined in many but not in all agegroups, and authors presume it was related to the foodshortage (Kagawa et al., 2011).

The reversal of Z-standardized mean height, weight,and BMI interrelation between sexes is also interesting: infour surveys conducted prior to 1991, the mean values ofall these variables were higher in girls than in boys, whilefrom 1991 onwards the opposite is true. The higher meanBMI as well as the higher prevalence of overweight andobesity in girls than in boys are typical for most Westerncountries (Bundred et al., 2001; Chinn and Rona, 2001).However, more pronounced positive BMI trend in boysthan in girls, as in our study, was also detected in some ex-socialist Eastern European countries, namely Poland, theCzech Republic and Lithuania (Chrzanowska et al., 2007;Vignerova et al., 2007). Some authors found a correlationbetween the absence in positive secular trend in BMI ofadolescent girls and their exposure to mass media whichemphasize thinness as a Western standard of beauty inwomen, emerging from the transition to free market

Fig. 2. Secular trend of CDC-standardized BMI by age groups in correspondence to real chained GDP series (in constant 2000 kunas) from 1951 to 2010. Note:

1 EUR = 7.57 kuna; 1 USD = 5.79 kuna (Midpoint Exchange Rates of the Croatian National Bank on 7th May 2013). Total population size according to the 2011

Census = 4,290,612.



economic systems in these nations (Vignerova et al., 2007;Contento et al., 2003). As already mentioned, formerYugoslav Republic of Croatia was a socialist country butwith elements of capitalism which included open flow ofinformation, ideas, goods and culture. First articles promot-ing ‘‘western view’’ of healthy living, offering advice on howto stay young and healthy, were published in 1970s: theypromoted usage of saunas and gyms (that were nottraditionally present) as well as exercise – for instance,American actress’s Jane Fonda bestseller on aerobic. In 1976,the process of electrification of all Croatian households wascompleted, which led to the increase in sales of TVs withnumerous commercials for cosmetic brands and entertain-ment shows like beauty contests on (Duda, 2009). Due to thedissatisfaction with one’s own body accompanying pubertalmaturation, adolescent girls tend to be more receptive ofthis kind of pressure and are more likely to engage instrategies for losing weight. It seems that the pubertal statusdoes not have such an effect on body image of boys (Zellneret al., 2007). The higher prevalence of overweight andobesity in men compared to women was also observed inthe adult population of Croatia (18+ years) (Fister et al.,2009), but with some regional differences (Smolej Narancicand Zagar, 2000).

4.2. The body growth and GDP from 1991 until 2010

Most studies which aim to assess adolescent growth anddevelopment during adverse socioeconomic conditions,

e.g. war, are focused on analyzing influence of food shortageand famine, and do not examine contribution of overallsocioeconomic deterioration. In addition, regardless of thefact that the adolescent growth spurt is recognized as one ofthe most important periods in human development, moredata is available regarding influence of these factors ongrowth in very early age, as well as on their importance inpredisposing children to various health problems inadulthood, including obesity and accompanying healthrisks (Head et al., 2009; Hughes et al., 2010; Ramezankhaniet al., 2011).

Over the last 20 years in Croatia, the mean height inboys and girls did not significantly change, although in2010 we detected a trend towards lower values of meanheight in girls. In the same period, median weightincreased in boys and median BMI increased in bothsexes, but those findings were not significant in all agegroups. Since the 1997 survey was preceded by the 4-yearCroatian War of Independence which did not cause asevere famine, but definitely led to the worsening of livingconditions, the decrease in median BMI in the 1997 survey,visible in Fig. 2, proved to be significant in older age groups(18- and 19-year-olds).

However, the significant differences in percentiledistributions between 1991, 1997 and 2010 surveys werefound for weight and BMI in both sexes, and for height ingirls when the data were adjusted according to CDCreference population. Additionally, it was shown that theCroatian adolescents from all three recent surveys have

Table 5

The differences in mean height (cm) and weight (kg) between the endpoints of the studied 60-year-period.

Age groups 1951 2010 Difference

N Mean SD N Mean SD

GirlsHeight (cm)

15 � 0.5 1339 157.3 6.4 82 165.2 5.8 7.9*

16 � 0.5 1121 159.0 6.0 99 166.4 6.0 7.4*

17 � 0.5 953 160.0 6.0 107 165.9 6.1 5.9*

18 � 0.5 788 160.3 5.9 73 165.0 5.2 4.7*

19 � 0.5 533 160.5 5.6 38 165.7 5.2 5.2*

Mean 159.4 165.6 6.2

Weight (kg)

15 � 0.5 1339 49.3 7.1 82 58.6 10.0 9.3*

16 � 0.5 1121 52.6 7.2 99 59.7 10.5 7.1*

17 � 0.5 953 54.4 6.8 107 59.1 10.0 4.7*

18 � 0.5 788 55.4 6.7 73 60.5 8.7 5.1*

19 � 0.5 533 55.6 6.6 38 63.3 13.7 7.7*

Mean 53.5 60.2 6.8

BoysHeight (cm)

15 � 0.5 1481 159.2 9.2 77 176.5 7.1 17.3*

16 � 0.5 1607 164.3 9.0 93 178.2 8.2 13.9*

17 � 0.5 1715 168.3 7.9 103 179.8 6.5 11.5*

18 � 0.5 1482 170.8 7.2 95 179.7 7.2 9.0*

19 � 0.5 949 171.7 6.8 36 180.9 6.3 9.2*

Mean 166.9 179.0 12.2

Weight (kg)

15 � 0.5 1481 47.4 8.1 77 70.9 12.3 23.5*

16 � 0.5 1607 52.9 8.7 93 70.3 11.7 17.4*

17 � 0.5 1715 57.1 7.9 103 73.5 12.5 16.4*

18 � 0.5 1482 60.2 7.4 95 75.8 12.8 15.6*

19 � 0.5 949 61.9 6.9 36 75.4 10.6 13.5*

Mean 55.9 73.2 17.3

* The differences between endpoint surveys were tested using weighted t-test. Significance is p < 0.05.



been taller than their USA peers. During the same period,most of the Croatian adolescents were in the above medianCDC percentile categories according to their individualweight and BMI. However, the proportion of adolescents inthe upper extreme BMI category (95th percentile) was notalarming until 2010, when there were as much as 3.5 timesmore obese girls and as much as 3.7 times more obese boysthen in the 1997 survey.

A sharp increase in the prevalence of overweight andobesity which accompanies the economic recovery waspreviously detected in more than 20 countries, forinstance, Argentina, Chile, Egypt, East Germany, etc. (deOnis and Blossner, 2000; Frye and Heinrich, 2003).However, they might have also been influenced by‘‘nutrition transition’’ and childhood obesity epidemicoccurred as a result of rapid globalization and urbaniza-tion. Namely, industrialized agro-food systems establishedby global corporations have made cheap calorie-densefoods, fats, and oils widely available across the world(Brody, 2002). The new global diet characterized by theincrease in fat consumption combined with the increase insedentary lifestyle have been documented both in childrenof poor countries, as well as among impoverished childrenof the other industrialized nations (Schneider, 2000; Sobal,2001). The possibility of linking the increase in BMI withpolarization of society due to the rapid increase in GDP andunequal income distribution across the social groups,which both happened during the political and socio-economic transition in Poland between 1986 and 2001,was noticed in country’s representative sample of 19-year-old Polish males (Kozieł et al., 2004).

On the basis of nutrition questionnaire and anthro-pometry of schoolchildren (7–15 years) from all regions ofCroatia, researchers concluded that a prevalence of obesity,as well as a high calorie diet, is on rise mostly due to badnutritional and lifestyle habits (Antonic-Degac et al., 2004).Our data on prevalence of overweight and obesity inadolescents are in concordance with these findings andsuggest the continuation of this trend.

5. Limitations and advantages of the study

Some aspects of this study must be taken into accountwhen interpreting the results. The first limitation is relatedto the potential effect of differences in sample sizes andresponse rates which is potentially biased in favour ofmore recent samples. While the first survey in 1951encompassed the entire adolescent population of the cityof Zagreb, sample sizes decreased in each successivesurvey, ending with 2010 when sample included 2.1% oftotal adolescent population. In addition, the last threesurveys conducted by the Institute for AnthropologicalResearch team differ in the number of adolescents in agecategories, as a result of different foci of the surveys. Wehave to point out that relatively low response rate mostlyreflected a problem of obtaining the parental writtenconsent on time, and not the unwillingness of adolescentsthemselves to take part in the study.

The second limitation lies in the fact that no means forBMI had been reported, nor original data on individualweight and height are available for surveys conducted by

research team from Andrija Stampar School of PublicHealth prior to 1991. Only age category-defined means andstandard deviations for height and weight had beenreported for that period. Therefore, these data were usedin order to roughly describe the 60-year trend in BodyMass Index.

However, the present study has two importantadvantages. The major one is the availability of highquality body height and weight summary data recorded inthe course of 60 years in approximately equal intervals of10 years (once per decade) that allows us to makecomparisons between surveys and track secular changestaking place in adolescent population of Croatia. Secondly,owing to the effort of researchers from the Faculty ofEconomics and Business, University of Zagreb, we had theopportunity to present the dynamics of changes in realGDP across the entire time period relevant for the study(1952–2010). Namely, Raguz et al. (2012) presented theGDP estimates corrected for all inconsistencies incurrency and exchange rate changes, inflation as well asfor the method of GDP calculation which substantiallydiffered within considered period. This provided us withhigh quality and extremely valuable overall tool fortracking economic prosperity for the entire investigatedperiod.

6. Conclusion

Our findings indicate that secular trend of body size inadolescents promptly mirrors socioeconomic and politicalchanges in a sex specific manner. National GDP showed tobe a sensitive marker of socioeconomic conditions as wellas to positively correlate with weight and BMI. Impact ofthe Croatian War of Independence, that took place from1991 to 1995, left its visible traces on both the short-termeffects (decrease in weight and BMI of children at thebeginning of their growth spurt) as well as on the long-term effects (decreased height and increased weight andBMI for children born during the war period). We assumethat recent increase in obesity of Croatian adolescents isrelated to the post-war improvement in living conditions,as indicated by the GDP rise. However, the impact of theWar on today’s adolescents who were toddlers at that timecould not be eliminated.

Sources of support

This study was supported by the Ministry of Science,Education and Sports of the Republic of Croatia (grants:196-1962766-2736 and 196-1962766-2747).

Authors’ contributions

Conception and design was done by – Matea ZajcPetranovic, Zeljka Tomas, Jasna Milicic, Nina SmolejNarancic, Tatjana Skaric-Juric. Acquisition, analysis andinterpretation of data – Matea Zajc Petranovic, ZeljkaTomas, Andrea Vecek, Jasna Milicic. Drafting the article –Matea Zajc Petranovic. Revising it critically for importantintellectual content – Zeljka Tomas, Andrea Vecek, JasnaMilicic, Nina Smolej Narancic, Tatjana Skaric-Juric.



Acknowledgements

We thank to the study participants, their parents and tothe administration and employees of the schools includedin these surveys. We appreciate the help of our friends andcolleagues Maja Barbalic, Ph.D., for critically reading thismanuscript, and Josip Lah for proofreading.

References

Aeberli, I., Ammann, R.S., Knabenhans, M., Molinari, L., Zimmermann, M.B.,2010. Decrease in the prevalence of paediatric adiposity in Switzerlandfrom 2002 to 2007. Public Health Nutrition 13 (6) 806–811.

Antonic-Degac, K., Kaic-Rak, A., Mesaros-Kanjski, E., Petrovic, Z., Capak, K.,2004. Stanje uhranjenosti i prehrambene navike skolske djece u Hrvats-koj. Paediatria Croatica 48 (1) 9–15.

Bi, Z.-W., Ji, C.-Y., 2005. Secular growth changes in body height and weightin children and adolescents in Shandong China between 1939 and2000. Annals of Human Biology 32 (5) 650–665.

Brody, J., 2002. The global epidemic of childhood obesity: poverty urba-nization, and the nutrition transition. Nutrition Bytes 8 (2) 1–8.

Bundred, P., Kitchiner, D., Buchan, I., 2001. Prevalence of overweight andobese children between 1989 and 1998: population based series ofcross sectional studies. British Medical Journal 322, 326–328.

Burke, V., Beilin, L.J., Simmer, K., Oddy, W.H., Blake, K.V., Doherty, D.,Kendall, G.E., Newnham, J.P., Landau, L.I., Stanley, F.J., 2005. Predictorsof body mass index and associations with cardiovascular risk factorsin Australian children: a prospective cohort study. InternationalJournal of Obesity 29 (1) 15–23.

Chinn, S., Rona, R.J., 2001. Prevalence and trends in overweight andobesity in three cross sectional studies of British Children, 1974–1994. British Medical Journal 322, 24–26.

Chrzanowska, M., Koziel, S., Ulijaszek, S.J., 2007. Changes in BMI and theprevalence of overweight and obesity in children and adolescents inCracowPoland, 1971–2000.Economics &HumanBiology 5(3) 370–378.

Contento, I.R., Basch, C., Zybert, P., 2003. Body image, weight, and foodchoices of Latina women and their young children. The Journal ofNutrition Education and Behavior 35 (5) 236–248.

de Onis, M., Blossner, M., 2000. Prevalence and trends of overweightamong preschool children in developing countries. The AmericanJournal of Clinical Nutrition 72, 1032–1039.

Druzic, I., 2004. Resursi i trzista hrvatskog gospodarstva. (Resources andthe Markets of the Croatian Economy).Politicka kultura, Zagreb.

Duda, I., 2009. Pronapeno blagostanje: Svakodnevni zivot i potrosackakultura u Hrvatskoj 1970-ih i 1980-ih. Zagreb, Srednja Europa.

Fister, K., Kolcic, I., Music Milanovic, S., Kern, J., 2009. The prevalence ofoverweight, obesity and central obesity in six regions of Croatia:results from the Croatian Adult Health Survey. Collegium Antropo-logicum 33 (Suppl.) 25–29.

Freedman, D.S., 2002. Clustering of coronary heart disease risk factorsamong obese children. Journal of Pediatric Endocrinology & Metabo-lism 15, 1099–1108.

Frisancho, A.R., 2008. Anthropometric Standards. An Interactive Nutri-tional Reference of Body Size and Body Composition for Children andAdults. The University of Michigan Press, Ann Arbor.

Frye, C., Heinrich, J., 2003. Trends and predictors of overweight andobesity in East German children. International Journal of Obesityand Related Metabolic Disorders 27, 963–969.

Head, R.F., Gilthorpe, M.S., Ellison, G.T., 2009. Cholesterol levels in laterlife amongst UK Channel Islanders exposed to the 1940–1945 Germanoccupation as children, adolescents and young adults. Nutrition andHealth 20 (2) 91–105.

Hughes, L.A., van den Brandt, P.A., Goldbohm, R.A., de Goeij, A.F., deBruine, A.P., nan Engeland, M., Weijenberg, M.P., 2010. Childhoodand adolescent energy restriction and subsequent colorectal cancerrisk: results from the Netherlands Cohort Study. International Journalof Epidemiology 39, 1333–1344.

Ji, C.Y., Chen, T.J., 2008. Secular changes in stature and body mass index forChinese youth in sixteen major cities, 1950s–2005. American Journalof Human Biology 20, 530–537.

Kagawa, M., Tahara, Y., Moji, K., Nakao, R., Aoyagi, K., Hills, A.P., 2011.Secular changes in growth among Japanese children over 100years (1900–2000). Asia Pacific Journal of Clinical Nutrition 20 (2) ,180-9.

Koren, S., Najbar-Agicic, M., Jakovina, T., 2007. Dodatak udzbenicima zanajnoviju povijest. In: Dubljevic, M. (Ed.), Jedna povijest, vise histor-ija. Documenta, Zagreb, pp. 8–11.

Kozieł, S., Welon, Z., Bielicki, T., Szklarska, A., Ulijaszek, S., 2004. The effectof the economic transition on the body mass index of conscripts inPoland. Economics & Human Biology 2, 97–106.

Lee, H., Lee, D., Guo, G., Harris, K.M., 2011. Trends in body mass index inadolescence and young adulthood in the United States: 1959–2002.Journal of Adolescent Health 49 (6) 601–608.

Lien, N., Henriksen, H.B., Nymoen, L.L., Wind, M., Klepp, K.I., 2010. Avail-ability of data assessing the prevalence and trends of overweight andobesity among European adolescents. Public Health Nutrition 13,1680–1687.

Marques-Vidal, P., Madeleine, G., Romain, S., Gabriel, A., Bovet, P., 2008.Secular trends in height and weight among children and adolescentsof the Seychelles, 1956–2006. BMC Public Health 8, 166.

Must, A., Anderson, S.E., 2003. Effects of obesity on morbidity in childrenand adolescents. Nutrition in Clinical Care 6 (1) 4–11.

Ogden, C.L., Carroll, M.D., Kit, B.K., Flegal, K.M., 2012. Prevalence of obesityand trends in body mass index among US children and adolescents,1999–2010. JAMA 307 (5) 483–490.

Peneau, S., Salanave, B., Maillard-Teyssier, L., Rolland-Cachera, M.F.,Vergnaud, A.C., Mejean, C., Czernichow, S., Vol, S., Tichet, J., Cas-tetbon, K., Hercberg, S., 2009. Prevalence of overweight in 6- to 15-year-old children in central/western France from 1996 to 2006:trends toward stabilization. International Journal of Obesity (Lond)33 (4) 401–407.

Popławska, H., Dmitruk, A., Wilczewski, A., 2006. Changes in body adip-osity in girls and boys from the rural areas of East Poland over a timespan of 20 years. Annals of Human Biology 33 (1) 78–88.

Prebeg, Z., Juresa, V., Kujundzic, M., 1995. Secular growth changes inZagreb schoolchildren over four decades, 1951–1991. Annals ofHuman Biology 20 (2) 99–110.

Raguz, I., Druzic, I., Tica, J., 2012. Impact of the transition on the TFP inCroatia. Feb Working Paper Series 12 (05) , http://econpapers.repec.org/paper/zagwpaper/1205.htm.

Ramezankhani, A., Mehrabi, Y., Mirmiran, P., Azizi, F., 2011. Comparison ofanthropometric and biochemical indices of adolescents born duringand after the Iran-Iraq war; Tehran Lipid and Glucose Study. Archivesof Iranian Medicine 14 (1) 27–31.

Rektorys, K. (Ed.), 1969. Survey of Applicable Mathematics. MIT Press,Cambridge, MA, pp. 1320–1321.

Salanave, B., Peneau, S., Rolland-Cachera, M.F., Hercberg, S., Castetbon, K.,2009. Stabilization of overweight prevalence in French childrenbetween 2000 and 2007. International Journal of Pediatric Obesity4 (2) 66–72.

Schneider, D., 2000. International trends in adolescent nutrition. SocialScience and Medicine 15, 955–967.

Sjoberg, A., Lissner, L., Albertsson-Wikland, K., Marild, S., 2008. Recentanthropometric trends among Swedish school children: evidence fordecreasing prevalence of overweight in girls. Acta Paediatrica 97 (1)118–123.

Smolej Narancic, N., Zagar, I., 2000. Overweight and fatness in DalmatiaCroatia: comparison with the US population reference. CollegiumAntropologicum 24, 411–421.

Smolej Narancic, N., Zivicnjak, M., Skaric-Juric, T., Bisof, V., Barbalic, M.,Rudan, P., 2005. Overweight and obesity among children and ado-lescents in Zagreb Croatia. In: Toth, G. (Ed.), Auxology. Savaria Uni-versity Press, Szombathely, pp. 89–95.

Sobal, J., 2001. Commentary: globalization and the epidemiology ofobesity. International Journal of Epidemiology 30, 1136–1137.

Turcic, I., Turcic jr., I., 2013. Bruto domaci proizvod Republike Hrvatske pozupanijama i regijama 1990, 2000. i 2009. godine. Ekonomski pregled64 (1) 64–81.

Vignerova, J., Humenıkova, L., Brabec, M., Riedlova, J., Blaha, P., 2007.Long-term changes in body weight BMI, and adiposity reboundamong children and adolescents in the Czech Republic. Economics& Human Biology 5 (3) 409–425.

Weiner, J.S., Lourie, J.A., 1981. Practical Human Biology (International Bio-logical Programme Handbook No. 9). Academic Press INC Ltd., London.

WHO, 2013, http://www.who.int/mediacentre/factsheets/fs311/en/ (lastaccessed 22nd July 2013).

Zar, J.H., 1999. Biostatistical Analysis. Prentice-Hall, Inc., Upper SaddleRiver, NJ.

Zellner, K., Ulbricht, G., Kromeyer-Hauschild, K., 2007. Long-term trendsin body mass index of children in Jena Eastern Germany. Economics &Human Biology 5 (3) 426–434.


Documents

A six decades long follow-up on body size in adolescents from Zagreb, Croatia (1951–2010)