课间牛奶鸡蛋加餐对云南农村小学生体成分及骨密度的影响

张妍; 张文彬; 宫伟彦; 宋超; 周莹; 丁彩翠; 袁帆; 陈征; 仇玉洁; 刘爱玲

doi:10.16835/j.cnki.1000-9817.2025288

课间牛奶鸡蛋加餐对云南农村小学生体成分及骨密度的影响

doi: 10.16835/j.cnki.1000-9817.2025288

张妍¹,
张文彬²,
宫伟彦¹,
宋超¹,
周莹¹,
丁彩翠¹,
袁帆¹,
陈征¹,
仇玉洁¹,
刘爱玲^1, ,

1.
中国疾病预防控制中心营养与健康所, 北京 100050
2.
中国人民武装警察部队湖南省总队医院

基金项目:

中国乡村发展基金会项目 2021-105

详细信息

作者简介:
张妍(1981-), 女, 山西忻州人, 硕士, 副研究员, 主要从事营养与健康教育工作

通讯作者:
刘爱玲, E-mail: liual@ninh.chinacdc.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R155.1 R726.8
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- 被引次数: 0
出版历程
- 收稿日期: 2025-05-15
- 修回日期: 2025-06-24
- 刊出日期: 2025-10-25

Impact of milk and egg supplementation on body composition and bone mineral density of rural primary school students in Yunnan Province

1.
National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China

摘要

摘要: 目的探讨课间牛奶鸡蛋加餐对云南农村小学生体成分及骨密度的影响, 为制定针对性的营养干预策略提供参考。方法 2023年12月采用整群抽样方法选取云南省景谷县和施甸县各4所小学一至三年级学生为干预组(662名), 另从同县小学中按规模、学生人数匹配的原则各选择2所寄宿小学作为对照组(455名)。干预组在校园上午大课间或下午课间每日补充200 mL牛奶和50 g鸡蛋, 于2023年4月开始, 干预8个月；对照组不改变饮食行为。于2023年4和12月, 采用生物电阻抗法测量体成分, 双能X线吸收法测定桡骨远端骨密度, 运用倍差法分析干预效果。结果干预组与对照组小学生体脂率、骨骼肌质量和去脂体重终期测量值较基线均显著升高, 牛奶鸡蛋干预净效应无统计学意义(校正前后P值均>0.05)；干预组小学生骨密度增加0.02 g/cm², 牛奶鸡蛋干预对骨密度影响净效应有统计学意义(β=0.02, 95%CI=0.00~0.04), 模型校正后净效应仍有统计学意义(β=0.02, 95%CI=0.00~0.04)(P值均 < 0.05)。分亚组看, 干预对女生(β=0.02, 95%CI=0.00~0.04)、走读生(β=0.04, 95%CI=0.01~0.07)、营养状况为正常的学生(β=0.02, 95%CI=0.00~0.04)效果均有统计学意义(P值均 < 0.05)。干预对体成分指标影响均无统计学意义(P值均>0.05)。结论课间牛奶鸡蛋加餐可增加云南农村小学生的骨密度。建议农村学龄儿童应增加牛奶和鸡蛋的摄入, 以促进身体生长发育。
- 饮食习惯 /
- 干预性研究 /
- 身体成分 /
- 骨密度 /
- 学生
Abstract: Objective To investigate the impact of milk and egg supplementation on body composition and bone mineral density of rural primary school students in Yunnan Province, so as to provide a reference for developing targeted nutritional intervention strategies. Methods In December 2023, a cluster sampling method was adopted to select students from grades one to three in four primary schools each from Jinggu and Shidian countys of Yunnan Province, as the intervention group (662 students). Additionally, two boarding primary schools were selected from each county based on the principle of matching scale and student numbers as the control group (455 students). Starting from April 2023, the intervention group received 200 mL milk and 50 g eggs during the break on school days for 8 months, while the control group maintained their usual diet behavior. Body composition was measured by using bioelectrical impedance analysis, and distal radial bone mineral density was assessed via dual-energy X-ray absorptiometry in April and December 2023. The intervention effects were analyzed by using a difference-in-differences approach. Results The final measurements of body fat percentage, skeletal muscle mass and fat-free mass of the intervention group and the control group of primary school students were significantly higher than the baseline values, and the net effect of milk and egg intervention on these body composition indicators was not statistically significant (P>0.05, both before and after adjustment). In contrast, bone mineral density increased significantly by 0.02 g/cm² in the intervention group. The net intervention effect on bone mineral density was statistically significant (β=0.02, 95%CI=0.00-0.04), and remained significant after model adjustment (β=0.02, 95%CI=0.00-0.04) (both P < 0.05). Subgroup analysis showed statistically significant effects of the intervention among girls (β=0.02, 95%CI=0.00-0.04), day students (β=0.04, 95%CI=0.01-0.07), and students with normal nutritional status (β=0.02, 95%CI=0.00-0.04) (all P < 0.05). No significant effect of milk and egg supplementation was observed on body composition indicators (all P < 0.05). Conclusions Milk and egg supplementation can improve bone mineral density among rural primary school students in Yunnan Province. It is recommended that rural school-aged children should increase intake of milk and eggs to support growth and development.
- Food habits /
- Intervention studies /
- Body composition /
- Bone density /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 不同亚组干预组和对照组学生干预前后体脂率变化情况及干预净效应比较(x ±s，%)

Table 1. Comparison of body fat percentage changes and net effect of intervention among intervention group and control group in different subgroups before and after intervention (x ±s, %)

组别	选项	干预组					对照组					倍差法
组别	选项	人数	基线	终期	d值	P值	人数	基线	终期	d值	P值	β值(95%CI)^#	β值(95%CI)^*
性别	男	324	18.5±6.6	19.4±7.4	0.8	< 0.01	243	18.3±7.1	19.8±8.1	1.5	< 0.01	-0.64(-2.37~1.08)	-0.84(-2.56~0.89)
	女	338	19.2±5.7	20.8±6.2	1.6	< 0.01	212	19.9±6.2	21.8±6.2	1.9	< 0.01	-0.30(-1.77~1.17)	-0.72(-2.21~0.78)
年龄/岁	6	84	18.1±6.1	19.0±6.6	0.8	0.03	43	17.3±5.2	18.5±6.4	1.2	0.01	-0.37(-3.62~2.89)	-0.67(-3.93~2.59)
	7	186	17.6±5.1	18.7±5.9	1.1	< 0.01	117	18.5±6.8	19.9±7.6	1.4	< 0.01	-0.24(-2.29~1.81)	-0.76(-2.90~1.37)
	8	215	19.2±6.3	20.2±7.1	0.9	< 0.01	154	18.6±6.7	20.2±7.1	1.7	< 0.01	-0.74(-2.74~1.26)	-0.93(-2.94~1.08)
	9~10	177	20.2±6.7	21.9±7.2	1.7	< 0.01	141	20.6±6.9	22.6±7.4	2.0	< 0.01	-0.23(-2.44~1.97)	-0.63(-2.96~1.69)
就读方式	住宿	532	19.1±5.0	19.7±6.5	0.6	< 0.01	320	18.8±6.4	19.8±7.1	1.0	< 0.01	-0.46(-1.72~0.81)	-0.79(-2.06~0.47)
	走读	130	18.1±6.0	21.8±7.8	3.7	< 0.01	135	19.7±7.4	22.8±7.7	3.1	< 0.01	0.61(-1.94~3.16)	0.77(-1.86~3.40)
营养状况	营养不足	113	14.9±4.8	15.3±4.4	0.3	0.37	71	14.0±3.3	16.0±3.6	1.9	< 0.01	-1.58(-3.36~0.20)	-1.91(-3.69~-0.13)^a
	正常	485	18.3±4.3	19.6±5.1	1.3	< 0.01	327	17.9±4.2	19.4±5.1	1.5	< 0.01	-0.23(-1.16~0.70)	-0.39(-1.28~0.50)
	超重肥胖	64	31.0±6.7	32.9±7.0	1.9	< 0.01	57	32.2±6.2	34.2±7.2	2.0	< 0.01	-0.05(-3.51~3.41)	-1.26(-4.78~2.26)
合计		662	18.9±6.2	20.1±6.9	1.2	< 0.01	455	19.1±6.7	20.7±7.4	1.7	< 0.01	-0.45(-1.59~0.69)	-0.75(-1.87~0.40)
注：d值为各组终期和基线测量结果差值的均值；^#仅纳入时间变量、分组变量和交互项时，β值(95%CI)为干预对体脂率影响的净效应；^*进一步纳入年级、性别、民族、地区、就读方式、家庭经济状况、饮食情况、身体活动情况等因素后的干预净效应；^aP < 0.05。

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表 2 不同亚组干预组和对照组学生干预前后骨骼肌质量变化情况及干预净效应比较(x ±s，kg)

Table 2. Comparison of skeletal muscle mass changes and net effect of intervention among intervention group and control group in different subgroups before and after intervention (x ±s, kg)

组别	选项	干预组					对照组					倍差法
组别	选项	人数	基线	终期	d值	P值	人数	基线	终期	d值	P值	β值(95%CI)^#	β值(95%CI)^*
性别	男	324	9.9±2.0	10.8±2.2	0.9	< 0.01	243	10.3±2.1	11.1±2.2	0.8	< 0.01	0.11(-0.39~0.62)	0.17(-0.27~0.60)
	女	338	9.5±1.9	10.4±2.2	0.9	< 0.01	212	9.7±1.9	10.4±2.2	0.8	< 0.01	0.17(-0.33~0.66)	0.06(-0.36~0.49)
年龄/岁	6	84	8.1±1.1	8.8±1.2	0.7	< 0.01	43	7.9±1.1	8.5±1.2	0.7	< 0.01	0.04(-0.56~0.64)	0.02(-0.59~0.62)
	7	186	8.7±1.4	9.4±1.5	0.8	< 0.01	117	9.0±1.2	9.8±1.4	0.8	< 0.01	-0.03(-0.48~0.42)	-0.02(-0.49~0.45)
	8	215	9.9±1.6	10.9±1.9	1.0	< 0.01	154	10.1±2.0	10.9±2.2	0.8	< 0.01	0.20(-0.36~0.75)	0.20(-0.36~0.77)
	9~10	177	11.2±2.0	12.3±2.2	1.1	< 0.01	141	11.3±2.0	12.1±2.2	0.9	< 0.01	0.31(-0.34~0.97)	0.32(-0.37~1.01)
就读方式	住宿	532	9.6±1.9	10.6±2.1	1.0	< 0.01	320	9.7±2.0	10.5±2.2	0.8	< 0.01	0.13(-0.27~0.53)	0.06(-0.28~0.41)
	走读	130	10.1±2.2	10.8±2.5	0.7	< 0.01	135	10.7±2.0	11.3±2.2	0.6	< 0.01	0.09(-0.68~0.85)	0.18(-0.48~0.84)
营养状况	营养不足	113	8.1±1.1	8.9±1.3	0.8	< 0.01	71	8.6±1.3	9.1±1.3	0.6	< 0.01	0.28(-0.25~0.81)	0.36(-0.10~0.81)
	正常	485	9.7±1.7	10.6±1.9	0.9	< 0.01	327	9.9±1.7	10.7±1.9	0.8	< 0.01	0.12(-0.23~0.47)	0.08(-0.19~0.35)
	超重肥胖	64	12.1±2.5	13.4±2.9	1.3	< 0.01	57	12.2±2.8	13.3±3.0	1.1	< 0.01	0.21(-1.21~1.63)	-0.05(-1.21~1.10)
合计		662	9.7±2.0	10.6±2.2	0.9	< 0.01	455	10.0±2.0	10.8±2.2	0.8	< 0.01	0.14(-0.22~0.50)	0.10(-0.20~0.40)
注：d值为各组终期和基线测量结果差值的均值；^#仅纳入时间变量、分组变量和交互项时，β值(95%CI)为干预对骨骼肌质量影响的净效应；^*进一步纳入年级、性别、民族、地区、就读方式、家庭经济状况、饮食情况、身体活动情况等因素后的干预净效应；β值(95%CI)对应的P值均>0.05。

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表 3 不同亚组干预组和对照组学生干预前后去脂体重变化情况及干预净效应比较(x ±s，kg)

Table 3. Comparison of fat-free mass changes and net effect of intervention among intervention group and control group in different subgroups before and after intervention(x ±s, kg)

组别	选项	干预组					对照组					倍差法
组别	选项	人数	基线	终期	d值	P值	人数	基线	终期	d值	P值	β值(95%CI)^#	β值(95%CI)^*
性别	男	324	20.1±3.4	21.7±3.8	1.6	< 0.01	243	20.9±3.6	22.2±3.8	1.3	< 0.01	0.24(-0.61~1.09)	0.33(-0.39~1.05)
	女	338	19.5±3.2	21.1±3.7	1.6	< 0.01	212	19.9±3.3	21.2±3.8	1.3	< 0.01	0.31(-0.53~1.15)	0.14(-0.57~0.85)
年龄/岁	6	84	17.1±1.7	18.3±2.0	1.2	< 0.01	43	16.7±1.8	17.9±2.0	1.2	< 0.01	0.08(-0.93~1.08)	0.03(-0.98~1.05)
	7	186	18.1±2.3	19.4±2.5	1.4	< 0.01	117	18.7±2.0	20.0±2.4	1.4	< 0.01	-0.01(-0.77~0.75)	0.01(-0.77~0.80)
	8	215	20.2±2.7	21.9±3.2	1.7	< 0.01	154	20.6±3.3	21.9±3.7	1.3	< 0.01	0.35(-0.58~1.28)	0.36(-0.58~1.31)
	9~10	177	22.3±3.3	24.3±3.7	1.9	< 0.01	141	22.8±3.3	24.1±3.7	1.3	< 0.01	0.60(-0.50~1.70)	0.59(-0.56~1.75)
就读方式	住宿	532	19.7±3.2	21.3±3.6	1.7	< 0.01	320	19.9±3.4	21.3±3.8	1.4	< 0.01	0.23(-0.45~0.91)	0.12(-0.45~0.70)
	走读	130	20.5±3.7	21.7±4.3	1.2	< 0.01	135	21.6±3.4	22.6±3.7	1.0	< 0.01	0.24(-1.05~1.53)	0.39(-0.70~1.49)
营养状况	营养不足	113	17.2±1.9	18.7±2.2	1.5	< 0.01	71	18.1±2.2	19.1±2.2	1.0	< 0.01	0.48(-0.42~1.38)	0.61(-1.55~1.39)
	正常	485	19.9±2.9	21.5±3.2	1.5	< 0.01	327	20.2±2.9	21.5±3.2	1.3	< 0.01	0.25(-0.36~0.85)	0.18(-0.27~0.63)
	超重肥胖	64	23.7±4.1	25.9±4.8	2.2	< 0.01	57	24.1±4.7	26.0±5.0	1.8	< 0.01	0.37(-2.01~2.76)	-0.06(-2.01~1.88)
合计		662	19.8±3.3	21.4±3.7	1.6	< 0.01	455	20.4±3.5	21.7±3.8	1.3	< 0.01	0.28(-0.33~0.88)	0.21(-0.30~0.71)
注：d值为各组终期和基线测量结果差值的均值；^#仅纳入时间变量、分组变量和交互项时，β值(95%CI)干预对去脂体重影响的净效应；^*进一步纳入年级、性别、民族、地区、就读方式、家庭经济状况、饮食情况、身体活动情况等因素后的干预净效应；β值(95%CI)对应的P值均>0.05。

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表 4 不同亚组干预组和对照组学生干预前后桡骨远端骨密度变化情况及干预净效应比较(x ±s，g/cm²)

Table 4. Comparison of bone mineral density changes and net effect of intervention among intervention group and control group in different subgroups before and after intervention (x ±s, g/cm²)

组别	选项	干预组					对照组					倍差法
组别	选项	人数	基线	终期	d值	P值	人数	基线	终期	d值	P值	β值(95%CI)^#	β值(95%CI)^*
性别	男	324	0.42±0.11	0.43±0.11	0.02	< 0.01	243	0.43±0.10	0.43±0.09	0.00	0.95	0.02(-0.01~0.04)	0.02(-0.01~0.04)
	女	338	0.38±0.09	0.39±0.10	0.02	< 0.01	212	0.38±0.10	0.37±0.09	-0.01	0.12	0.02(0.00~0.05)^a	0.02(0.00~0.04)^a
年龄/岁	6	84	0.36±0.01	0.38±0.10	0.03	0.01	43	0.33±0.08	0.35±0.07	0.02	0.10	0.01(-0.04~0.05)	0.01(-0.03~0.05)
	7	186	0.38±0.09	0.40±0.10	0.03	< 0.01	117	0.38±0.08	0.40±0.08	0.02	0.04	0.01(-0.02~0.04)	0.01(-0.01~0.04)
	8	215	0.40±0.10	0.41±0.10	0.01	0.45	154	0.41±0.11	0.40±0.10	-0.01	0.38	0.01(-0.02~0.04)	0.01(-0.01~0.03)
	9~10	177	0.44±0.11	0.45±0.11	0.01	0.24	141	0.44±0.10	0.42±0.10	-0.03	< 0.01	0.03(0.00~0.07)^a	0.03(0.00~0.06)
就读方式	住宿	532	0.39±0.10	0.41±0.11	0.01	< 0.01	320	0.39±0.10	0.39±0.09	0.00	0.86	0.01(-0.01~0.03)	0.01(-0.01~0.03)
	走读	130	0.41±0.10	0.43±0.09	0.03	< 0.01	135	0.43±0.10	0.42±0.08	-0.02	0.06	0.04(0.01~0.07)^a	0.04(0.01~0.07)^a
营养状况	营养不足	113	0.33±0.07	0.36±0.09	0.03	0.01	71	0.34±0.07	0.36±0.09	0.02	0.11	0.00(-0.03~0.04)	0.01(-0.02~0.05)
	正常	485	0.39±0.09	0.41±0.10	0.02	< 0.01	327	0.40±0.09	0.40±0.09	-0.00	0.74	0.02(0.00~0.04)^a	0.02(0.00~0.04)^a
	超重肥胖	64	0.53±0.12	0.51±0.11	-0.02	0.42	57	0.52±0.12	0.47±0.10	-0.04	0.03	0.03(-0.03~0.08)	0.03(-0.02~0.09)
合计		662	0.40±0.10	0.41±0.10	0.02	< 0.01	455	0.40±0.09	0.40±0.10	-0.00	0.35	0.02(0.00~0.04)^a	0.02(0.00~0.04)^a
注：d值为各组终期和基线测量结果差值的均值；^#仅纳入时间变量、分组变量和交互项时，β值(95%CI)为干预对桡骨远端骨密度影响的净效应；^*进一步纳入年级、性别、民族、地区、就读方式、家庭经济状况、饮食情况、身体活动情况等因素后的干预净效应；^aP < 0.05。

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