目的 评估以学校为基础的综合干预措施对西部脱贫地区小学生体重状态及饮食行为的影响,为改善脱贫地区儿童双重营养不良问题提出参考。方法 在陕西和四川两省共3个脱贫县选择6所小学2～5年级学生,于2020年11月-2022年6月开展基线调查和整群随机对照干预研究,干预组进行为期18个月的营养不良防控及不健康生活行为改善,对照组开展近视防控宣教。基线纳入学生1 160名;终期随访1 079名,干预组和对照组分别602和477名。对学生进行体格测量和问卷调查,采用混合效应模型评估干预效果。结果 干预后,干预组超重/肥胖(OR=0.60)和消瘦(OR=0.47)发生风险较对照组降低(P＜0.05)。地区分层结果显示,陕西干预组超重/肥胖(OR=0.54)和消瘦(OR=0.31)发生风险较对照组降低(P＜0.05)。饮食行为结果显示,干预后干预组平均每周蛋类(β=0.41)、奶类(β=0.84)和水果(β=0.43)摄入频次均高于对照组(P＜0.05);两省结果不同,陕西、四川干预组蛋类(β=0.36、0.54)和奶类(β=0.96、0.64)摄入频次均较对照组增加(P＜0.05);四川干预组油炸食品(β=0.50)和糖果(β=0.64)摄入频次较对照组增加(P＜0.05)。结论 以学校为基础的综合干预措施可以降低学生肥胖和消瘦发生风险,改善我国西部农村脱贫地区学生体重状态及膳食摄入,但干预效果存在地区差异。
Abstract
Objective To assess the effect of a comprehensive school-based intervention on weight status and eating behaviors among primary school students in poverty alleviation areas in western China,in order to provide reference for improving the nutritional preoblems of children in impoverished area. Methods Six primary school students in grades 2 - 5 were selected from three poverty alleviation counties in Shaanxi and Sichuan province,and a baseline survey and whole-cluster randomised controlled intervention study were conducted from November 2020 to June 2022,with 18-month malnutrition prevention and control and unhealthy lifestyle behavior improvement in the intervention group and myopia prevention and control education in the control group.A total of 1 160 students were included at baseline and 1 079 were followed up at the end,with 602 and 477 participants in the intervention and control groups,respectively.Physical examination and frequency of eating behavior questionnaires were administered to the students,and mixed-effects models were used to assess the effect of the intervention. Results After the intervention,the risks of overweight/obesity (OR=0.60) and wasting (OR=0.47) in the intervention group were reduced compared with those in the control group(P＜0.05).Regional stratified analysis showed that the risk of overweight/obesity (OR=0.54) and wasting (OR=0.31) was reduced in the intervention group in Shaanxi compared with that in the control group (P＜0.05).The results of dietary behavior showed that the average weekly frequency of egg (β=0.41),milk (β=0.84) and fruit (β=0.43) intake in the intervention group was higher than that in the control group after the intervention(P＜0.05).The results in the two provinces were different,with an increase in the frequency of egg (β=0.36 and 0.54,respectively) and milk (β=0.96 and 0.64,respectively) intake in the intervention group compared with that in the control group in both Shaanxi and Sichuan(P＜0.05);the frequency of fried food (β=0.50) and candy (β=0.64) intake increased in the Sichuan intervention group compared with the control group(P＜0.05). Conclusions Comprehensive school-based interventions can reduce the risk of obesity and wasting,and improve the weight status and dietary intake of students in rural poverty alleviation areas in China,but there are regional differences in the effectiveness of interventions.
关键词
脱贫地区 /
小学生 /
体重状态 /
饮食行为
Key words
poverty alleviation areas /
primary school students /
weight status /
dietary behaviors
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参考文献
[1] 刘婕妤,钟盼亮,马宁,等.2010-2019年中国7~18岁汉族儿童青少年营养不良的流行趋势[J].中华预防医学杂志,2023,57(4):470-478.
Liu JY,Zhong PL,Ma N,et al.Prevalence trends of malnutrition among Han Chinese children and adolescents aged 7-18 years in China,2010—2019[J].Chin J Prev Med,2023,57 (4):470-478.(in Chinese)
[2] 董彦会,陈力,刘婕妤,等.1985-2019年中国7~18岁儿童青少年超重与肥胖的流行趋势及预测研究[J].中华预防医学杂志,2023,57(4):461-469.
Dong YH,Chen L,Liu JY,et al.Study on the prevalence trend and prediction of overweight and obesity among children and adolescents aged 7-18 years in China,1985—2019[J].Chin J Prev Med,2023,57(4):461-469.(in Chinese)
[3] 史文平.西部农村学生营养知识与饮食行为调查[J].生物学教学,2018,43(1):72-73.
Shi WP.Survey on nutritional knowledge and dietary behavior of rural students in western China[J].Teaching Biology,2018,43(1):72-73.(in Chinese)
[4] Herlitz L,Macintyre H,Osborn T,et al.The sustainability of public health interventions in schools: A systematic review[J].Implement Sci,2020,15(1):4.
[5] 崔春霞,许金华,宋壮志,等.内蒙古农村学生营养改善计划地区营养宣传教育效果评价[J].中国学校卫生,2019,40(9):1393-1396.
Cui CX,Xu JH,Song ZZ,et al.Evaluation of the effect of nutrition publicity and education in the nutrition improvement program for rural students in Inner Mongolia[J].Chin J Sch Health,2019,40(9)1393-1396.(in Chinese)
[6] 中华人民共和国国家卫生健康委员会.学龄儿童青少年超重与肥胖筛查WS/T 586-20[S].北京:中国标准出版社,2018.
National Health Commission of the People's Republic of China.Screening for overweight and obesity in school-age children and adolescents WS/T 586-20[S].Beijing:China Standard Press,2018.(in Chinese)
[7] 中华人民共和国国家卫生健康委员会.学龄儿童青少年营养不良筛查WS/T 456-2014[S].北京:中国标准出版社,2014.
National Health Commission of the People's Republic of China.Screening for malnutrition in school-aged children and adolescents WS/T 456-2014[S].Beijing:China Standard Press,2014.(in Chinese)
[8] De Buhr E,Tannen A.Parental health literacy and health knowledge,behaviours and outcomes in children:A cross-sectional survey[J].BMC Public Health,2020,20(1):1096.
[9] 马福昌,周敏茹,星吉,等.青海省重点监测地区中小学生营养改善项目效果评价[J].中国学校卫生,2017,38(11):1712-1714.
Ma FC,Zhou MR,Xing J,et al.Evaluation of the effect of nutrition improvement program for primary and secondary school students in key monitoring areas of Qinghai Province[J].Chin J Sch Health,2017,38(11):1712-1714.(in Chinese)
[10] Schippers MC,Ioannidis JPA,Joffe AR.Aggressive measures,rising inequalities,and mass formation during the COVID-19 crisis: An overview and proposed way forward[J].Front Public Health,2022,10:950965.
[11] Du W,Liu L,Ma Y,et al.Analysis of the gut microbiome in obese native Tibetan children living at different altitudes:A case-control study[J].Front Public Health,2022,10:963202.
[12] 候芳,陈艳琳,郭青,等.新冠肺炎疫情期间学龄前儿童饮食行为及家庭影响因素分析[J].中国学校卫生,2021,42(2):237-239,244.
Hou F,Chen YL,Guo Q,et al.Analysis of dietary behaviors and family influencing factors of preschool children during the new coronary pneumonia epidemic[J].Chin J Sch Health,2021,42(2):237-239,244.(in Chinese)
[13] De Vogli R,Buio MD,De Falco R.Effects of the COVID-19 pandemic on health inequalities and mental health: Effective public policies[J].Epidemiol Prev,2021,45(6):588-597.
[14] Jones N,Baird S,Abu Hamad B,et al.Compounding inequalities:Adolescent psychosocial wellbeing and resilience among refugee and host communities in Jordan during the COVID-19 pandemic[J].PLoS One,2022,17(2):e0261773.
[15] Steyn NP,De Villiers A,Gwebushe N,et al.Did health kick,a randomised controlled trial primary school nutrition intervention improve dietary quality of children in low-income settings in South Africa?[J].BMC Public Health,2015,15:948.
[16] Zahid N,Khadka N,Ganguly M,et al.Associations between child snack and beverage consumption,severe dental caries,and malnutrition in Nepal[J].Int J Environ Res Public Health,2020,17(21):7911.
[17] 邓艳红,王明.云南省部分地区学校青少年饮食行为调查[J].卫生软科学,2021,35(12):82-88.
Deng YH,Wang M.Survey on dietary behavior of adolescents in schools in some areas of Yunnan Province[J].Soft Science of Health,2021,35(12):82-88.(in Chinese)
[18] Li B,Adab P,Cheng KK.The role of grandparents in childhood obesity in China-evidence from a mixed methods study[J].Int J Behav Nutr Phys Act,2015,12:91.
[19] 赵广英,魏煌忠,程郁离.隔代抚养与学龄前流动儿童肥胖的相关性研究[J].中国学校卫生,2018,39(1): 57-59.
Zhao GY,Wei HZ,Cheng YL.A study on the correlation between intergenerational parenting and obesity in preschool migrant children[J].Chin J Sch Health,2018,39(1):57-59.(in Chinese)
[20] Di Renzo L,Gualtieri P,Pivari F,et al.Eating habits and lifestyle changes during COVID-19 lockdown:An Italian survey[J].J Transl Med,2020,18(1):229.
[21] Pujia R,Ferro Y,Maurotti S,et al.The effects of COVID-19 on the eating habits of children and adolescents in Italy:A pilot survey study[J].Nutrients,2021,13(8):2641.
[22] Pietrobelli A,Pecoraro L,Ferruzzi A,et al.Effects of COVID-19 lockdown on lifestyle behaviors in children with obesity living in Verona,Italy:A longitudinal study[J].Obesity (Silver Spring),2020,28(8):1382-1385.
基金
全民营养科研基金(CNS-NNSRG2019-97)
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