Vitamin A nutritional status and associated factors among primary and middle school students in Chongqing
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摘要:
目的 了解重庆市6~17岁中小学生维生素A营养状况，并分析维生素A缺乏的影响因素，为后续研究和制定营养改善措施提供科学依据。 方法 于2016—2017年，通过多阶段分层与人口成比例整群随机抽样方法在重庆市选择3个农村点和3个城市点，抽取1 508名6~17岁儿童青少年，开展问卷调查和实验室检测，采用SPSS 25.0进行统计分析。 结果 学生维生素A浓度均值为(1.45±0.42)μmol/L，维生素A缺乏率和亚临床缺乏率分别为0.46%，13.46%。二元Logistic回归分析结果表明，超重及肥胖(OR=0.51)、母亲文化程度为高中及以上(OR=0.35)、大城市、白蛋白四分位数为Q3和Q4的学生与维生素A缺乏呈负相关，每天不吃肉(OR=2.05)、C反应蛋白四分位数为Q3(OR=2.12)和Q4(OR=4.54)的学生与维生素A缺乏呈正相关(P值均 < 0.05)。 结论 重庆市6~8岁中小学生维生素A亚临床缺乏率较高。建议通过加强营养教育、保障合理膳食、必要时使用营养强化食品或营养强化剂等手段进行改善。 Abstract:Objective To examine the vitamin A status of children and adolescents aged between 6-17 years old in Chongqing, and to analyze the influencing factors of vitamin A deficiency, providing a scientific basis for nutritional improvement measures. Methods From 2016 to 2017, a multi-stage random sampling method was used to select approximately 1 508 children and adolescents aged between 6-17 years old from three rural and three urban locations in Chongqing. This study carried out a questionnaire survey and laboratory testing, and the statistical analysis was performed using SPSS version 25.0. Results The mean vitamin A level was (1.45±0.42)μmol/L, while the prevalence of vitamin A deficiency and the subclinical deficiency rate were 0.46% and 13.46%, respectively. The binary Logistic regression analysis revealed that the following factors were associated with a lower risk of vitamin A deficiency: overweight and obese students(OR=0.51); students whose mothers had a high school education or above(OR=0.35, P=0.01); students from big cities; and higher quartile albumin levels (Q3 and Q4). Students who did not eat meat each day(OR=2.05), students aged 6-8 years old, and students with C-reactive protein in the third (OR=2.12) and fourth (OR=4.54) higher quartiles were at a higher risk of vitamin A deficiency. Conclusion The subclinical vitamin A deficiency rate was relatively high among children aged 6-17 years old in Chongqing. Measures including nutritional education, reasonable diets, and nutritionally fortified food or fortifiers should be used when necessary. -
Key words:
- Vitamin A /
- Vitamin A deficiency /
- Nutritional status /
- Regression analysis /
- Child /
- Adolescent
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表 1 重庆市不同组别中小学生维生素A水平比较(x±s, μmol/L)
Table 1. Distribution characteristics of vitamin A levels in children aged 6-17 years in Chongqing(x±s, μmol/L)
组别 选项 人数 维生素A水平 t/F值 P值 性别 男 760 1.45±0.43 0.39 0.69 女 748 1.45±0.41 地区 大城市 534 1.66±0.46 910.18 < 0.01 中小城市 249 1.35±0.32 普通农村 265 1.45±0.43 贫困农村 460 1.26±0.31 年龄/岁 6~8 378 1.26±0.30 63.58 < 0.01 9~11 465 1.42±0.39 12~14 372 1.52±0.44 15~17 293 1.65±0.48 
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表 2 重庆市不同组别中小学生维生素A缺乏和亚临床缺乏检出率比较
Table 2. Analysis of factors affecting vitamin A nutritional status of children aged 6-17 years in Chongqing
组别 选项 人数 缺乏和亚临床缺乏人数 χ2值 P值 组别 选项 人数 缺乏和亚临床缺乏人数 χ2值 P值 性别 男 760 118(15.53) 3.28 0.07 每天奶类摄入/g 不吃 513 102(19.88) 25.40 < 0.01 女 748 92(12.30) ≤100 512 64(12.50) 地区 大城市 534 30(5.62) 55.01 < 0.01 >100 483 44(9.11) 中小城市 249 36(14.46) 每天蛋类摄入/g 不吃 287 57(19.86) 10.67 0.01 普通农村 265 45(16.98) < 30 614 80(13.03) 贫困农村 460 99(21.53) ≥30 607 73(12.03) 年龄/岁 6~8 378 88(23.28) 41.32 < 0.01 每天蔬菜摄入/g < 50 343 67(19.53) 13.73 < 0.01 9~11 465 58(12.47) 50~ < 100 300 44(14.67) 12~14 372 43(11.56) 100~ < 200 384 42(10.94) 15~17 293 21(7.17) ≥200 481 57(11.85) 体型 正常 1 150 164(14.26) 7.71 0.02 每天水果摄入/g 不吃 552 74(14.18) 0.47 0.79 消瘦 95 20(21.05) < 50 424 62(14.62) 超重肥胖 263 26(9.89) ≥50 562 74(13.17) 父亲文化程度 小学以下 140 29(20.71) 15.34 0.00 C反应蛋白 Q1 396 34(8.59) 29.80 < 0.01 小学 311 53(17.04) Q2 378 41(10.85) 初中 604 85(14.07) Q3 357 55(15.41) 高中及以上 453 43(9.49) Q4 377 80(21.22) 母亲文化程度 小学以下 187 37(19.79) 34.93 < 0.01 白蛋白 Q1 381 72(18.90) 33.87 < 0.01 小学 333 68(20.42) Q2 382 73(19.11) 初中 564 76(13.48) Q3 381 37(9.71) 高中及以上 424 29(6.84) Q4 364 28(7.69) 每天肉类摄入/g 不吃 178 37(20.79) 11.45 0.01 铁蛋白 Q1 377 49(13.00) 8.79 0.03 < 40 420 52(12.38) Q2 377 64(16.98) 40~75 366 58(15.85) Q3 377 59(15.65) >75 544 63(11.58) Q4 377 38(10.08) 注： C反应蛋白Q1为0.01~0.07 mg/L，Q2为0.08~0.17 mg/L，Q3为0.18~0.47 mg/L，Q4为0.48~40.18 mg/L; 白蛋白Q1为36.40~46.40 g/L，Q2为46.50~48.40 g/L，Q3为48.50~50.40 g/L，Q4为50.50~59.00 g/L; 铁蛋白Q1为2.80~45.70 ng/mL，Q2为45.83~66.95 ng/mL，Q3为66.97~94.30 ng/mL，Q4为94.33~389.00 ng/mL。()内数字为检出率/%。
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表 3 重庆市中小学生维生素A缺乏影响因素的Logistic回归分析(n=1 508)
Table 3. Logistic regression analysis of factors affecting vitamin A deficiency in children aged 6-17 years in Chongqing(n=1 508)
自变量 选项 β值 标准误 Wald χ2值 P值 OR值(OR值95%CI) 地区 中小城市 0.77 0.31 6.13 0.01 2.16(1.17~3.97) 普通农村 0.66 0.33 4.07 0.04 1.94(1.02~3.69) 贫困农村 1.28 0.31 17.19 < 0.01 3.60(1.97~6.60) 年龄组/岁 9~11 -0.78 0.21 13.57 < 0.01 0.46(0.31~0.70) 12~14 -1.05 0.30 12.64 < 0.01 0.35(0.20~0.62) 15~17 -1.45 0.36 16.11 < 0.01 0.23(0.12~0.48) 体型 消瘦 0.53 0.31 2.92 0.09 1.69(0.93~3.09) 超重肥胖 -0.67 0.25 7.32 0.01 0.51(0.31~0.83) 母亲文化程度 小学 0.03 0.28 0.01 0.92 1.03(0.60~1.78) 初中 -0.54 0.29 3.51 0.06 0.58(0.33~1.03) 高中及以上 -1.04 0.39 7.30 0.01 0.35(0.17~0.75) 每天肉类摄入/g 40~75 0.12 0.23 0.26 0.61 1.12(0.72~1.75) < 40 0.25 0.25 1.02 0.31 1.29(0.79~2.11) 不吃 0.72 0.32 5.11 0.02 2.05(1.10~3.81) C反应蛋白 Q2 0.24 0.26 0.85 0.36 1.27(0.76~2.21) Q3 0.75 0.25 8.76 < 0.01 2.12(1.29~3.48) Q4 1.51 0.25 36.22 < 0.01 4.54(2.77~7.43) 白蛋白 Q2 -0.08 0.21 0.13 0.71 0.93(0.61~1.40) Q3 -0.87 0.25 12.17 < 0.01 0.42(0.26~0.68) Q4 -1.13 0.28 16.42 < 0.01 0.32(0.19~0.56) 注： C反应蛋白Q1为0.01~0.07 mg/L，Q2为0.08~0.17 mg/L，Q3为0.18~0.47 mg/L，Q4为0.48~40.18 mg/L; 白蛋白Q1为36.40~46.40 g/L，Q2为46.50~48.40 g/L，Q3为48.50~50.40 g/L，Q4为50.50~59.00 g/L; 铁蛋白Q1为2.80~45.70 ng/mL，Q2为45.83~66.95 ng/mL，Q3为66.97~94.30 ng/mL，Q4为94.33~389.00 ng/mL。
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