湖南省农村营养改善计划地区6~15岁学生贫血及影响因素

胡冀; 付中喜; 李开宇; 王非; 谭雅卿; 陈艳华

doi:10.16835/j.cnki.1000-9817.2022.06.026

湖南省农村营养改善计划地区6~15岁学生贫血及影响因素

doi: 10.16835/j.cnki.1000-9817.2022.06.026

湖南省疾病预防控制中心学校卫生科，长沙 410005

详细信息

作者简介:
胡冀(1982-)，女，湖南桂阳人，硕士，主管医师，主要从事学校卫生工作

通讯作者:
陈艳华，E-mail：30463659@qq.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R153.2 R725.5
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出版历程
- 收稿日期: 2022-02-14
- 修回日期: 2022-04-02
- 网络出版日期: 2022-06-23
- 刊出日期: 2022-06-25

Trends and risk factors of anaemia among the nutrition improvement program for rural compulsory education students aged 6-15 years, Hunan Province

School Health Department, Hunan Provincial Center for Disease Control and Prevention, Changsha (410005), China

摘要

摘要: 目的了解湖南省2012—2021年“农村义务教育学生营养改善计划”实施地区6~15岁学生贫血的流行规律及影响因素，为更好地实施营养改善计划提供支撑和建议。方法采用整群随机抽样的方法，在湖南省实施营养改善计划以及开展重点监测的县抽取义务教育学生，进行身高、体重、血红蛋白、饮食习惯、健康知识知晓情况的调查。结果湖南省从2012年实施营养改善计划以来，贫血率从12.8%下降到9.3%；血红蛋白平均体积浓度从133.9 g/L下降到130.0 g/L；每天保证吃肉的学生、每次能吃到3个乒乓球大小肉量的学生分别从20.4%，21.4%逐年递增到47.3%，47.3%；每天能吃3种以上蔬菜的学生除2016和2019年达到39.1%和32.6%，其他年份均未超过30%；每次能吃够3个乒乓球及以上蔬菜量的学生从19.5%递增到39.6%；每天不吃零食的学生从13.1%增加到76.9%；每天不喝饮料的学生从36.5%增加到90.7%。女生、12岁及以上学生、不能保证每天都吃肉、每次吃肉量不足1个乒乓球、每次吃蔬菜以及水果的量不足3个乒乓球、每天吃蔬菜种类少于3种的学生、生长发育迟缓的学生更容易发生贫血，且各年份学生贫血发生的影响因素有所不同。结论农村义务教育学生营养改善计划的实施在一定程度上改善了湖南农村地区义务教育阶段学生的营养状况，然而贫血现象依然存在。应不断提升学生健康素养，有针对性地开展科学合理膳食的分类指导和干预。
- 营养政策 /
- 贫血 /
- 回归分析 /
- 学生 /
- 农村人口
Abstract: Objective To investigate the prevalence of anemia among students aged 6-15 years old participated in the Nutrition Improvement Program for Rural Compulsory Education Program in 2012-2021 in Hunan Province, and to explore associated factors. Methods A cluster random sampling method was used. The survey was conducted among compulsory education students who came from counties in Hunan Province where nutrition improvement plan and key surveillance were carried out. Height and weight were measured, hemoglobin, dietary habits and health knowledge were collected. Results Since the implementation of nutrition improvement plan in 2012, the anemia rate decreased from 12.8% to 9.3%, the average hemoglobin content decreased from 133.9 g/L to 130.0 g/L. The proportion of students eating meat every day increased from 20.4% to 47.3%. Students eating three or more servings of table tennis ball-size of meal increased from 21.4% to 47.3%. The proportion of students eating more than three kinds of vegetables per day was 39.1% in 2016 and 32.6% in 2019, and less than 30% in other years. The proportion of students eating three or more servings of table tennis ball-size of vegetables increased from 19.5% to 39.6%, and the proportion of students eating snack less than once a day increased from 13.1% to 76.9%. The proportion of students drinking beverages less than once a day increased from 36.5% to 90.7%. Girls, older than 12 years, not eating meat every day, and who eat less than 1 serving of table tennis ball-size of meat, eat less than 3 servings of table tennis ball-size of vegetables and fruit at one time, and who eat less than 3 kinds of vegetables every day, and those who grow slowly had higher risk of anemia. Potential factors of anemia in students varied by survey year. Conclusion The implementation of the compulsory education has improved the nutritional status of compulsory education students in rural areas of Hunan Province, but anemia still occurs. Potential factors associated with childhood anemia are changing. Child health literacy education should adapt to the changing social and economic enviornment, as well as lifestyles. Targeted and appropriate nutritional education and intervention are greatly needed.
- Nutrition policy /
- Anemia /
- Regression analysis /
- Students /
- Rural population
注释:

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图 1 2012—2021年学生血红蛋白平均水平

Figure 1. Average hemoglobin content of the students from year 2012-2021

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图 2 2012—2021年学生贫血发生率

Figure 2. Anaemia prevalence trends of the students from year 2012-2021

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表 1 营养改善计划地区是否贫血学生营养状况分布比较

Table 1. Coparison of nutritional status distribution among students with and without anemia in the rural nutrition improvement program area

年份	是否贫血	人数	正常	超重	肥胖	生长迟缓	消瘦	χ²值	P值
2012	贫血	263	190(72.2)	17(6.5)	13(4.9)	2(0.8)	41(15.6)	5.36	0.25
	正常	1 788	1 304(72.9)	160(8.9)	68(3.8)	31(1.7)	225(12.6)
	小计	2 051	1 494(72.8)	177(8.6)	81(3.9)	33(1.6)	266(13.0)
2014	贫血	286	219(76.6)	13(4.5)	10(3.5)	5(1.7)	39(13.6)	8.59	0.07
	正常	2 828	2 138(75.6)	246(8.7)	107(3.8)	28(1.0)	309(10.9)
	小计	3 114	2 357(75.7)	259(8.3)	117(3.8)	33(1.1)	348(11.2)
2016	贫血	72	198(72.8)	24(8.8)	12(4.4)	7(2.6)	31(11.4)	7.74	0.10
	正常	3 071	2 229(72.6)	339(11.0)	132(4.3)	28(0.9)	343(11.2)
	小计	3 343	2 427(72.6)	363(10.9)	144(4.3)	35(1.0)	374(11.2)
2019	贫血	345	250(72.5)	22(6.4)	11(3.2)	4(1.2)	58(16.8)	19.16	< 0.01
	正常	3 071	2 269(73.9)	256(8.3)	197(6.4)	14(0.5)	335(10.9)
	小计	3 416	2 519(73.7)	278(8.1)	208(6.1)	18(0.5)	393(11.5)
2021	贫血	418	288(68.9)	38(9.1)	56(13.4)	11(2.6)	25(6.0)	9.80	0.04
	正常	4 049	2 724(66.9)	463(11.4)	618(15.2)	46(1.1)	218(5.4)
	小计	4 481	3 012(67.1)	501(11.2)	674(15.0)	57(1.3)	243(5.4)
合计	贫血	1 584	1 145(72.3)	114(7.2)	102(6.4)	29(1.8)	194(12.2)	32.33	< 0.01
	正常	14 827	10 664(71.9)	1 464(9.9)	1 122(7.6)	147(1.0)	1 430(9.6)
	小计	16 411	11 809(72.0)	1 578(9.6)	1 224(7.5)	176(1.1)	1 624(9.9)
注：()内数字为构成比/%。

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表 2 农村营养改善计划地区学生饮食习惯分布2012—2021年间比较

Table 2. Coparison of the distribution of students' dietary habits in the rural nutrition improvement program area from year 2012-2021

饮食习惯	选项	2012年 (n=1 272)	2014年 (n=2 168)	2016年 (n=2 072)	2019年 (n=1 910)	2021年 (n=3 349)	χ_趋势²值	P值
每周吃肉情况	每天吃	260(20.4)	311(14.3)	508(24.5)	761(39.8)	1 585(47.3)	755.00	< 0.01
	未能每天吃	894(70.3)	1 683(77.6)	1 471(71.0)	1 051(55.0)	1 712(51.1)	433.19	< 0.01
	基本不吃	118(9.3)	174(8.0)	93(4.5)	98(5.1)	52(1.6)	161.45	< 0.01
每次吃肉量	≥3个乒乓球	139(10.9)	290(13.4)	323(15.6)	362(19.0)	1 189(35.5)	504.17	< 0.01
	1~ < 3个乒乓球	905(71.1)	1 566(72.2)	1 472(71.0)	1 345(70.4)	1 637(48.9)	327.87	< 0.01
	< 1个乒乓球	228(17.9)	312(14.4)	277(13.4)	203(10.6)	523(15.6)	2.29	0.13
每天吃蔬菜种类	≥3种	325(25.6)	415(19.1)	811(39.1)	622(32.6)	529(15.8)	33.03	< 0.01
	< 3种	879(69.1)	1 578(72.8)	1 218(58.8)	1 225(64.1)	2 682(80.1)	59.11	< 0.01
	基本不吃	68(5.3)	175(8.1)	43(2.1)	63(3.3)	138(4.1)	24.04	< 0.01
每次吃蔬菜量	≥3个乒乓球	248(19.5)	454(20.9)	444(21.4)	986(51.6)	1 325(39.6)	446.99	< 0.01
	1~ < 3个乒乓球	925(72.7)	1 535(70.8)	1 492(72.0)	776(40.6)	1 536(45.9)	631.31	< 0.01
	< 1个乒乓球	99(7.8)	179(8.3)	136(6.6)	148(7.7)	488(14.6)	72.45	< 0.01
每周吃水果情况	每天吃			191(9.2)	361(18.9)	753(22.5)	147.23	< 0.01
	未能每天吃			1 441(69.5)	1 386(72.6)	2 465(73.6)	10.00	< 0.01
	基本不吃			440(21.2)	163(8.5)	131(3.9)	407.34	< 0.01
每次吃水果量	≥3个乒乓球			323(15.6)	1 082(56.6)	1 573(47.0)	426.39	< 0.01
	1~ < 3个乒乓球			1 532(73.9)	686(35.9)	1 502(44.8)	353.72	< 0.01
	< 1个乒乓球			217(10.5)	142(7.4)	274(8.2)	6.92	0.01
每天吃零食情况	< 1次	166(13.1)		1 176(56.8)	1 210(63.4)	2 576(76.9)	1 337.35	< 0.01
	1次	380(29.9)		512(24.7)	347(18.2)	603(18.0)	91.06	< 0.01
	≥2次	726(57.1)		384(18.5)	353(18.5)	170(5.1)	1 279.93	< 0.01
每天喝饮料情况	< 1次	464(36.5)		1 143(55.2)	1 580(82.7)	3 037(90.7)	1 716.08	< 0.01
	1次	536(42.1)		560(27.0)	236(12.4)	270(8.1)	810.54	< 0.01
	≥2次	272(21.4)		369(17.8)	94(4.9)	42(1.3)	674.84	< 0.01
注：()内数字为构成比/%，2012，2014年未开展吃水果调查，2014年未开展吃水果、吃零食、喝饮料调查。

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表 3 农村营养改善计划地区学生2012年贫血发生因素Logistic回归分析[OR值(OR值95%CI)]

Table 3. Logistic regression analysis on the incidence of anemia among students in rural areas in 2012[OR(OR95%CI)]

自变量	选项	男生(n=645)	女生(n=627)
每次吃肉量	≥3个乒乓球	1.00	1.00
	< 1个乒乓球	2.32(0.83~6.52)	8.18(1.75~38.14)^**
	1~ < 3个乒乓球	1.62(0.64~4.12)	4.18(0.95~18.50)
每天吃蔬菜种类	≥3种	1.00	1.00
	基本不吃	1.80(0.60~5.36)	5.00(1.63~15.35)^**
	< 3种	1.32(0.71~2.44)	2.37(1.08~5.21)^*
注：P < 0.05，*P < 0.01。

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表 4 农村营养改善计划地区学生2014年贫血发生因素Logistic回归分析[OR值(OR值95%CI)]

Table 4. Logistic regression analysis on the incidence of anemia among students in rural areas in 2014[OR(OR95%CI)]

自变量	选项	男生(n=1 105)	女生(n=1 063)
每周吃肉情况	每天吃	1.00	1.00
	基本不吃	0.71(0.22~2.31)	0.66(0.26~1.63)
	未能每天吃	1.13(0.49~2.63)	0.50(0.26~1.00)^*
每次吃肉量	≥3个乒乓球	1.00	1.00
	< 1个乒乓球	3.80(1.18~12.28)^*	3.96(1.34~11.72)^*
	1~ < 3个乒乓球	3.18(1.09~9.31)^*	2.32(0.67~7.98)
蛋白质良好来源	知晓	1.00	1.00
	不知晓	3.05(1.47~6.31)^**	2.00(1.12~3.57)^*
如何预防缺铁性贫血	知晓	1.00	1.00
	不知晓	1.12(0.63~2.01)	2.52(1.38~4.61)^*
注：P < 0.05，*P < 0.01。

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表 5 农村营养改善计划地区学生2016年贫血发生因素Logistic回归分析[OR值(OR值95%CI)]

Table 5. Logistic regression analysis on the incidence of anemia among students in rural areas in 2016[OR(OR95%CI)]

自变量	选项	男生(n=1 050)	女生(n=1 022)
年龄/岁	≥15	1.00	1.00
	< 12	0.42(0.11~1.64)	0.20(0.06~0.66)^**
	12~ < 15	0.47(0.13~1.76)	0.35(0.11~1.15)
每次吃肉量	≥3个乒乓球	1.00	1.00
	< 1个乒乓球	71.97(12.56~412.60)^**	68.88(17.71~267.99)^**
	1~ < 3个乒乓球	3.17(0.59~16.98)	3.08(0.90~10.50)
每次吃蔬菜量	≥3个乒乓球	1.00	1.00
	< 1个乒乓球	6.16(1.54~24.58)^*	2.45(0.65~9.21)
	1~ < 3个乒乓球	0.35(0.05~2.39)	2.01(0.35~11.50)
每次吃水果量	≥3个乒乓球	1.00	1.00
	< 1个乒乓球	0.16(0.04~0.68)^*	0.18(0.05~0.69)^*
	1~ < 3个乒乓球	0.09(0.02~0.45)^**	0.02(0.00~0.13)^**
营养水平	正常	1.00	1.00
	生长迟缓	10.58(1.01~111.99)^*	1.46(0.28~7.58)
	消瘦	1.75(0.75~4.09)	0.22(0.04~1.28)
	超重肥胖	1.02(0.38~2.76)	0.40(0.15~1.09)
注：P < 0.05，*P < 0.01。

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表 6 农村营养改善计划地区学生2019年贫血发生因素Logistic回归分析[OR值(OR值95%CI)]

Table 6. Logistic regression analysis on the incidence of anemia among students in rural areas in 2019[OR(OR95%CI)]

自变量	选项	男生(n=969)	女生(n=941)
年龄/岁	≥15	1.00	1.00
	< 12	0.30(0.13~0.67)^**	0.44(0.19~0.99)^*
	12~ < 15	0.33(0.13~0.83)^*	0.67(0.29~1.55)
每周吃肉情况	每天吃	1.00	1.00
	基本不吃	3.16(1.59~6.29)^**	2.06(1.13~3.76)^*
	未能每天吃	1.21(0.23~6.35)	1.82(0.60~5.57)
注：P < 0.05，*P < 0.01。

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表 7 农村营养改善计划地区学生2021年贫血发生因素Logistic回归分析[OR值(OR值95%CI)]

Table 7. Logistic regression analysis on the incidence of anemia among students in rural areas in 2021[OR(OR95%CI)]

自变量	选项	男生(n=1 692)	女生(n=1 657)
年龄/岁	≥15	1.00	1.00
	< 12	0.25(0.06~1.16)	3.20(0.86~11.82)
	12~ < 15	0.55(0.23~1.32)	2.99(1.40~6.42)^**
营养水平	正常	1.00	1.00
	生长迟缓	4.57(1.36~15.39)^*	1.14(0.14~9.17)
	消瘦	1.09(0.56~2.13)	0.68(0.27~1.77)
	超重肥胖	0.74(0.49~1.13)	0.76(0.50~1.15)
注：P < 0.05，*P < 0.01。

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