【作者】 张燕；

【导师】 胡小琪；

【作者基本信息】 中国疾病预防控制中心 ， 营养与食品卫生学， 2014， 硕士

【摘要】 研究背景儿童青少年正处于生长发育的关键时期,需要获得充足的营养以维持生长发育、生命活动和学习等。蛋白质和微量营养素摄入不足造成的营养不良与微量营养素缺乏,严重阻碍儿童的体格和智力发育。研究目的本研究通过分析农村义务教育学生营养改善计划(以下简称“学生营养改善计划”)基线数据,了解各重点监测县“学生营养改善计划”的工作形式和特点,学校供餐情况、学生营养知识水平及学生膳食营养状况等,探究学生营养状况的影响因素,为“学生营养改善计划”工作提供科学依据和数据支持。研究方法这是一项横断面调查。在“学生营养改善计划”试点地区,选择46个重点监测县,每个县抽取20%～30%的小学和初中,每所学校按年级分层,以教学班为单位随机整群抽样,从小学一年级到初中三年级,每个年级抽取1-2个班,确保每个年级达到40人左右,男女生基本各半。对所有学生进行身高、体重测量。每个县选取360名中小学生进行血红蛋白测定。通过县问卷收集县的经济状况、补助经费情况、采用的供餐方式、其他的营养改善措施等;学校问卷收集学校性质、学校所在地、学校的“一补”情况、供餐情况、健康教育课情况以及驱虫药物服用情况等;对小学三年级及以上的小学生和初中生进行问卷调查,收集学生基本信息、家庭社会经济状况、食物摄入、以及学生营养知识等。采用多重线性回归分析和多层Logistic回归模型分别以县、学校和学生为单位分析营养不良和贫血的影响因素。研究结果本次共调查了 46个县,6125所学校和30912名中小学生。中西部农村地区7～15岁儿童身高、体重均明显低于2010年体质调研的结果。6～15岁儿童的营养不良率为17.7%,随年龄增加营养不良率有增加的趋势(P<0.05),男生营养不良率(19.2%)高于女生(16.1%)。总体贫血率为15.4%,女生贫血率(16.0%)高于男生(14.7%),12岁及以上男女学生贫血率均比较高。54.5%的县学生营养不良率在15%以上,其中西部地区的县学生营养不良率多在15%以上。多重线性回归分析结果显示,参加“学生营养改善计划”的小学和初中,寄宿生制学生比例高的县学生营养不良率高于寄宿制学生比例低的县。46.3%的县学生贫血率在15%上,学生贫血率比较高的县也多集中在西部贫困地区。但是以县为单位分析,发现影响整个县学生贫血率的有意义的因素。学校在村里的学生营养不良率在15%以上的学校比例(53.7%)高于在乡镇所在地(43.5%)和县城(30.8%)的学校(P<0.05)。提供开水的学校学生营养不良率超过15%的比例(45.9%)低于不提供开水的学校(61.3%)(P<0.05)。不上健康教育课、上课频率不足1次/2周的学校学生营养不良率超过15%的比例(63.4%、55.5%)高于上健康教育课、每2周至少上1次健康教育课的学校(47.7%、46.5%)(P<0.05)。多重线性回归结果分析结果显示,是否有省地方补助经费,学校在村里,是否有食堂,是否上健康教育课等因素是学校水平上学生营养不良率的影响因素。有食堂的学校学生贫血率超过15%的比例(32.3%)低于无食堂的学校(51.2%),差异有统计学意义(P<0.05)。提供开水的学校学生贫血率超过15%的比例(29.7%)略低于不提供开水的学校(38.1%),但是差异无统计学意义。多重线性回归分析未发现有实际意义的影响因素。中西部学生所在家庭规模比较大,53.1%的学生家庭人口数在4人以上。留守儿童比例比较高,父母至少一方在外打工的比例为49%。距离学校较远,48.7%的学生步行到学校的时间超过30分钟,41.9%的学生在校寄宿。中西部中小学生肉、蛋、奶、豆制品和新鲜蔬菜的摄入量均比较低,未达到中国居民膳食指南中建议量的比例比较高。学生营养知识水平比较低。多层Logistic回归模型结果显示,年龄、性别、家庭人口数和营养知识得分是营养不良的影响因素。12岁及以上的学生发生营养不良的风险是12岁以下学生的1.57倍,男生发生营养不良的风险是女生的1.57倍,家庭人口数在4人以上的学生发生营养不良的风险是家庭人口数不超过4人的学生的1.09倍,营养知识得分不满5分的学生发生营养不良的风险是营养知识得分为5分及以上学生的1.12倍。学校水平上,有省地方补助经费的地区发生营养不良的风险是无省地方补助经费学校的0.7倍,不上健康教育课的学校发生营养不良的风险是上健康教育课的1.38倍。不能保证每天吃早餐的学生贫血率比较高。肉、蛋、奶、豆制品和新鲜蔬菜的摄入量达到中国居民膳食指南建议量的学生贫血率比较低。但是多层Logistic回归模型分析结果显示,仅学生年龄、性别对贫血的影响有统计学意义。12岁及以上学生发生贫血的风险是12岁以下学生的1.8倍,男生发生贫血的风险是女生的0.84倍。结论中西部贫困农村义务教育学生生长发育水平仍低于普通农村和城市地区学生,营养不良和贫血患病率较高。学校食堂条件有限,供餐能力未能达到学生的需求。部分学校未开设健康教育课,健康教育课上课频率比较低。中西部学生膳食营养状况仍比较差,动物性食物和新鲜蔬菜的摄入量较低,学生营养知识水平相对较低,影响学生健康成长。中小学生营养不良受年龄、性别、家庭人口数和营养知识水平等影响,同时与学校是否开设健康教育课等因素相关。更多还原

【Abstract】 BackgroundChildren and adolescents are at a critical period of growth.They need adequate nutrition to sustain growth,life and study.Inadequate intake of protein and micronutrients,is likely to cause malnutrition and micronutrient deficiency,that is a serious impediment to children’s physical and mental development.ObjectivesThis study analyzes the baseline data of Nutrition Improvement Plan for Rural Compulsory Education Students,to understand the various forms and features of nutrition improvement work,forms of school feeding,the students nutrition knowledge and dietary status,to explore factors affecting nutritional status,and provide scientific basis and data support for rural Nutrition Improvement Plan.MethodsThis study was a cross-sectional study.In pilot areas of Nutrition Improvement Plan for Rural Compulsory Education Students,selected key monitoring county,each county to extract 20%to 30%of elementary and junior high school,each school stratified by grade,and selected 1-2 classes in each grade.There were 40 students in each grade,boys and girls each half.All the students measured the height and weight.Each county selected 360 schoolchildren measuring hemoglobin.We collected economic conditions of counties,grant funding,the feeding methods and other measures to improve nutrition by questionnaires.Using school questionnaire collected nature of the school,location,feeding conditions,health education classes,etc.We also conducted a questionnaire survey to collect basic information,family socioeconomic status,food intake,and student nutrition knowledge of pupil on the third grade and above,and junior school students.On the county level,school level and student level,using multiple linear regression and multilevel logistic regression model analyzed factors of malnutrition and anemia,respectively.Results46 counties,6,125 schools and 30,912 school children have been investigated.The height and weight of 7 to 15 years old children in rural in midwest were significantly lower than the results of 2010 National Student Physical Fitness and Health Survey.Malnourished children aged 6 to 15 was 17.7%.Malnutrition rates increased with age increasing(P<0.05).Boys’ malnutrition rate(19.2%)was higher than girls’(16.1%).Girls’ anemia rate(16.0%)was higher than boys’(14.7%).Anemia rate of aged 12 and older students was relatively high.54.5%county had high malnutrition rate,above 15%.And these counties were mainly concentrated in the western region.Multiple linear regression analysis showed that there was higher malnutrition rate in some counties with a high proportion of boarders than those with low proportion of boarders.46.3%counties had high rate of anemia,above 15%.And these counties were mainly concentrated in the western region,too.But on the county level,meaningful factors of anemia rates were not found.There were more village school(53.7%)with malnutrition rates above 15%,than school in the town(43.5%)and county(30.8%)(P<0.05).Among providing water schools,there were a lower proportion(45.9%)which malnutrition rate was above 15%than those not providing water(61.3%)(P<0.05).Establishing health education course,or at least one lesson of health education every 2 weeks were good to reduce malnutrition rate.The results of multiple linear regression analysis showed that if there were provincial local grant funding the malnutrition would be lower,the school in the village is a risk factor of malnutrition,establishing health education course was a protect factor of malnutrition.There was lower anemia rate among schools having a canteen than those not having canteen(P<0.05).If schools provided hot water,they would have low anemia rate,but the difference was not statistically significant.However,multiple linear regression analysis showed that meaningful factors of anemia were not found.In Midwest,students’ family is relatively large,53.1%students in the families with four more people.Relatively high proportion of children left behind,49%students were at least one parent working outside.48.7%students need more than 30 minutes walking to school,41.9%students were boarders.Students’ intake of meat,eggs,milk,soy products and fresh vegetables were relatively low,did not meet the Dietary Guidelines.Student nutrition knowledge level is relatively low.Multilevel Logistic regression results showed that age,gender,family size and nutrition knowledge scores were factors of malnutrition.The malnutrition risk among over 12 year old students was 1.57 times of students under 12 years old.Boys’ risk of malnutrition is girls’ 1.57 times.Big family had higher risk of malnutrition than small family(OR=1.09).And nutrition knowledge score not above 5 point was a risk factor(OR=1.12).On school level,provincial grant funding and establishing health education course were protected factor of malnutrition.Students who didn’t eat breakfast daily had high anemia rate.Students’ anemia rate was relatively low,which their intake of meat,eggs,milk,soy products and fresh vegetables reached Chinese dietary guidelines recommended amount..But multilevel Logistic regression analysis showed that only the student’s age,gender were factors of anemia.Students over the age of 12 had a higher risk of anemia than students under 12 years old(OR=1.8).Boys’ risk of anemia is girls’ 0.84 times.ConclusionsThe Midwest rural compulsory education students’ growth level is still lower than students in ordinary rural and city,malnutrition and anemia prevalence rate is high.The school canteen has limited conditions,feeding ability failed to meet the needs of students.Some schools don’t offer health education,and the frequency of health education class is low.Dietary nutrition status of students in the Midwest is still relatively poor,the intake of animal foods and fresh vegetables is low,students’nutrition knowledge level is relatively low,all of those affect the healthy growth of students.Malnutrition is influenced by age,gender,family population and nutrition knowledge level,and related with school health education lessons.While the students’anemia rate is correlated with age,sex factors.更多还原