Status and associations of nutritional and dietary behaviors of school-age children in poor areas of western China
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摘要:
目的 了解中国西部贫困地区学生营养与饮食行为现状及其关联，为中学生营养不良持续改善策略提供参考。 方法 2020年10—12月对陕西和四川共3个贫困县1 887名小学生进行体格测量和饮食行为问卷调查，采用混合效应模型分析营养状况与饮食行为的相关性。 结果 1 887名学生生长迟缓、消瘦、超重肥胖、中心型肥胖检出率分别为1.8%，6.6%，27.7%，24.5%，省份间差异均有统计学意义(χ2值分别为94.76，46.05，109.96，80.50，P值均 < 0.05)。陕西、四川学生超重肥胖检出率分别为32.8%，4.9%；生长迟缓和消瘦检出率陕西为0.4%，4.7%，四川为8.1%，14.7%。1 160名学生饮食行为分析结果显示每天吃早餐、蛋、奶等的学生比例偏低；关联分析结果显示，每天吃早餐与学生超重肥胖风险呈负相关(OR=0.26，P < 0.05)，每周食用外卖和在食堂就餐2~6次与学龄儿童消瘦均呈正相关(OR值分别为2.51，2.82，P值均 < 0.05)。 结论 中国西部贫困地区小学生存在营养不足和营养过剩并存情况，且呈现地区差异。应采取针对性措施改善学生营养状况。 Abstract:Objective To investigate the status of nutrition and dietary behaviors and their associations in school-age children in poor areas of western China, to provide clues for sustainable improvement strategies of malnutrition among primary school students in rural revitalization. Methods A total of 1 887 school-age students from 3 poverty-stricken counties in Shaanxi and Sichuan provinces were investigated by physical examination and questionnaire survey during October to December in 2020. Mixed-effects model was used to analyze associations between nutritional status and dietary behaviors. Results The prevalence of stunting, wasting, overweight and obesity, and central obesity among 1 887 students were 1.8%, 6.6%, 27.7%, 24.5%, respectively, and the differences between two provinces were statistically significant (χ2=94.76, 46.05, 109.96, 80.50, P < 0.05). The prevalence of overweight and obesity of students in Shaanxi and Sichuan were 32.8% and 4.9%, respectively. The prevalence of stunting and wasting were 0.4% and 4.7% in Shaanxi, and 8.1% and 14.7% in Sichuan, respectively. Among 1 160 students with complete dietary data, the proportions of students who ate breakfast, eggs, and milk daily were low, and eating breakfast daily was negatively associated with overweight and obesity(OR=0.26, P < 0.05), and eating out and eating in canteen were positively associated with wasting(OR=2.51, 2.82, P < 0.05). Conclusion School-age children in poor areas of western China are facing double burden of malnutrition, and there are significant regional differences. Future targeted interventions should be made to improve these students' nutritional status. -
Key words:
- Nutritional status /
- Food habits /
- Body mass index /
- Child /
- Poverty areas
1) 利益冲突声明 所有作者声明无利益冲突。2) 吴妍与高利旺为共同第一作者。 -
表 1 中国西部贫困地区不同特征学生营养状况检出率比较
Table 1. Comparison of nutritional status of students with different characteristics in poor areas of western China
组别 选项 人数 生长迟缓 消瘦 超重肥胖 中心型肥胖 检出人数 χ2值 P值 检出人数 χ2值 P值 检出人数 χ2值 P值 检出人数 χ2值 P值 性别 男 981 17(1.7) 0.05 0.82 68(6.9) 0.43 0.51 312(31.8) 17.05 < 0.01 293(29.9) 31.36 < 0.01 女 906 17(1.9) 56(6.2) 211(23.3) 170(18.8) 省份 四川 346 28(8.1) 94.76 ＜0.01 51(14.7) 46.05 ＜0.01 17(4.9) 109.96 ＜0.01 20(5.8) 80.50 ＜0.01 陕西 1 541 6(0.4) 73(4.7) 506(32.8) 443(28.8) 地区 清涧 1 149 5(0.4) 94.81 < 0.01 62(5.4) 49.24 < 0.01 374(32.6) 110.15 < 0.01 317(27.6) 83.77 < 0.01 子洲 392 1(0.3) 11(2.8) 132(33.7) 126(32.1) 冕宁 346 28(8.1) 51(14.7) 17(4.9) 20(5.8) 学校 1 214 2(0.9) 98.32 < 0.01 12(5.6) 54.09 < 0.01 78(36.5) 116.08 < 0.01 77(36.0) 104.73 < 0.01 2 935 3(0.3) 50(5.4) 296(31.7) 240(25.7) 3 201 1(0.5) 6(3.0) 59(29.4) 52(25.9) 4 191 0 5(2.6) 73(38.2) 74(38.7) 5 98 6(6.1) 19(19.4) 6(6.1) 11(11.2) 6 248 22(8.9) 32(12.9) 11(4.4) 9(3.6) 年级 一 160 0 10.97 0.05 6(3.8) 9.68 0.09 51(31.9) 14.80 0.01 43(26.9) 7.68 0.18 二 370 5(1.4) 36(9.7) 88(23.8) 79(21.4) 三 401 14(3.5) 28(7.0) 99(24.7) 89(22.2) 四 399 7(1.8) 24(6.0) 123(30.8) 111(27.8) 五 405 7(1.7) 22(5.4) 106(26.2) 97(24.0) 六 152 1(0.7) 8(5.3) 56(36.8) 44(29.0) 注：学校1~6分别代表 6所学校；()内数据为检出率/%。 
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表 2 中国西部贫困地区学生饮食行为与营养状况关联性分析(n=1 160)
Table 2. Analysis of the associations between dietary behaviors and nutritional status of students in poor areas of western China(n=1 160)
自变量 选项 消瘦 超重肥胖 中心型肥胖 生长迟缓 OR值(95%CI) P值 OR值(95%CI) P值 OR值(95%CI) P值 OR值(95%CI) P值 每天吃早餐 是 0.96(0.12~1.99) 0.97 0.26(0.10~0.65) < 0.01 0.32(0.13~0.81) 0.02 - 每周吃新鲜水果/次 ≤1 1.33(0.49~3.57) 0.57 0.73(0.39~1.35) 0.31 0.68(0.36~1.28) 0.23 7.51(0.65~87.21) 0.12 2~6 0.97(0.46~2.03) 0.94 0.82(0.57~1.18) 0.29 0.78(0.54~1.14) 0.20 4.19(0.48~36.49) 0.19 每周吃外卖/次 2~6 2.51(1.08~5.82) 0.03 1.04(0.58~1.86) 0.90 1.18(0.65~2.13) 0.59 1.11(0.12~9.98) 0.93 ≥7 2.90(0.53~2.23) 0.99 1.09(0.06~2.12) 0.95 1.12(0.06~20.4) 0.94 - 每周吃油炸食品/次 2~6 0.92(0.52~1.63) 0.78 1.12(0.79~1.57) 0.52 1.27(0.89~1.80) 0.18 1.61(0.61~4.25) 0.33 ≥7 0.63(0.07~5.55) 0.68 0.83(0.29~2.42) 0.74 1.02(0.35~3.00) 0.97 - 每周在食堂就餐/次 2~6 2.82(1.38~3.73) ＜0.01 1.04(0.69~1.57) 0.83 1.16(0.76~1.77) 0.48 8.94(0.39~57.36) 0.82 ≥7 0.03(0.39~2.56) 0.99 1.34(0.44~4.14) 0.61 1.66(0.54~5.12) 0.38 - 每周在食品摊就餐/次 2~6 1.03(0.52~2.03) 0.94 0.80(0.54~1.18) 0.26 0.70(0.47~1.05) 0.09 0.60(0.16~2.33) 0.46 ≥7 2.64(0.28~4.77) 0.39 0.93(0.20~4.33) 0.93 0.96(0.20~4.62) 0.96 3.30(0.85~8.01) 0.07 注：采用混合效应模型，调整混杂因素为年龄、性别、父母职业、父母学历、户籍类型、家庭收入；每天吃早餐以否为对照，每周吃新鲜水果频率以每天吃为对照，每周外卖、油炸食品、食堂就餐、食品摊就餐频率均以≤1次为对照。
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