小学生营养素养及食物消费干预效果评价

冯靖雯; 丁彩翠; 宫伟彦; 王良友; 仇玉洁; 刘爱玲

doi:10.16835/j.cnki.1000-9817.2023.03.007

小学生营养素养及食物消费干预效果评价

doi: 10.16835/j.cnki.1000-9817.2023.03.007

1.
中国疾病预防控制中心营养与健康所，北京 100050
2.
浙江省台州市疾病预防控制中心慢性非传染性疾病防治科

基金项目:

中国营养学会-百胜餐饮健康基金项目 CNS- YUM2019A13

详细信息

作者简介:
冯靖雯(1997-)，女，河南洛阳人，在读硕士，主要研究方向为营养与健康教育

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: R151.4 G478.5
计量
- 文章访问数: 976
- HTML全文浏览量: 470
- PDF下载量: 88
- 被引次数: 0
出版历程
- 收稿日期: 2022-08-01
- 修回日期: 2022-12-02
- 刊出日期: 2023-03-25

Evaluation of the effectiveness of healthy school canteen intervention on nutritional literacy and dietary behavior among primary school students

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

摘要

摘要: 目的探索基于营养健康食堂建设的综合干预对用餐小学生营养素养、食物消费及食堂建设相关行为及态度的影响，为学校营养健康食堂建设提供建议。方法选取台州市一所小学作为干预组，另一所条件相当的小学作为对照组，采用整群随机抽样选取2所学校五年级320名学生(干预组163名，对照组157名)，干预组在学校开展为期5个月基于营养健康食堂建设的综合干预，包括健康就餐环境打造、菜品改良、厨师培训、营养健康教育等；对照组不进行任何干预。干预前后分别进行问卷调查。结果干预前，干预组与对照组的技能均值及营养素养总得分、多种食物摄入频率、食堂建设相关行为及态度差异均无统计学意义(P值均>0.05)。干预后，干预组每天摄入蔬菜、奶制品、鱼/禽/蛋/瘦肉的比例分别提高19.63，15.95，19.63百分点(χ²值分别为15.25，9.14，13.93，P值均 < 0.01)；干预组看过宣传材料的比例(95.71%)高于对照组(84.71%)、非常赞同提供低盐低油低糖菜品的比例(74.85%)高于对照组(48.41%)(χ²值分别为11.04，23.73，P值均 < 0.01)。结论基于营养健康食堂的综合干预能够提高学生营养素养，改善学生饮食结构，建议采取“家校联动”形式开展大样本、多地区、长期的营养健康食堂建设。
- 营养调查 /
- 饮食 /
- 干预性研究 /
- 学生
Abstract: Objective To explore the effectiveness of healthy school canteen intervention on nutritional literacy, food consumption, as well as attitude towards school canteen. Methods A primary school in Taizhou City was selected as the intervention school, and another comparable primary school was selected as the control one. A total of 320 students (163 in the intervention group and 157 in the control group) received a comprehensive intervention based on the construction of a healthy school canteen in the school, incluling healthy dining environment, food impravement, chef training, nutrition and health education, while the control group did not receive any intervention. Questionnaires survey was administered to both groups before and after the intervention. Results Before the intervention, no significant differences were found in the total scores of skills and nutrition literacy, frequency of food intake, behaviors and attitudes related to canteen construction between the two groups(P>0.05). Daily intake of vegetables, dairy products, fish/poultry/eggs/lean meat increased by 19.63, 15.95 and 19.63 percentage point respectively (χ²=15.25, 9.14, 13.93, P < 0.01). The proportion of students reporting have read related intervention materials in the intervention group(95.71%) was higher than the control group(84.71%) (χ²=11.04, P < 0.01). The students in favor of low-salt, low-oil and low-sugar dishes in the intervention group (74.85%) was higher than in the control group(48.41%) (χ²=23.73, P < 0.01). Conclusion Based on the comprehensive intervention of nutrition and health canteens can improve students' nutrition literacy and dietary structure. It is recommended to adopt the form of "home-school linkage" to carry out the construction of large-sample, multi-regional and long-term nutrition and health canteens.
- Nutrition surveys /
- Diet /
- Intervention studies /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 干预前后两组学生营养素养及各维度得分比较(x±s)

Table 1. Comparison of nutritional literacy scores before and after the intervention(x±s)

干预前后	组别	人数	统计值	认知			技能				总均分
干预前后	组别	人数	统计值	理念	知识	均值	选择食物	制作食物	摄入食物	均值	总均分
干预前	干预组	163		61.88±14.86	79.72±10.13	77.44±8.89	70.97±11.28	65.71±13.55	74.10±11.02	72.00±7.93	73.76±7.43
	对照组	157		65.14±15.42	75.24±9.99	73.95±9.31	71.15±11.99	70.00±13.97	75.58±11.01	72.96±9.16	73.27±8.38
			t值	-1.92	3.82	3.29	-0.13	-2.77	-1.18	-0.94	0.51
			P值	0.06	< 0.01	< 0.01	0.89	0.01	0.24	0.35	0.61
干预后	干预组	163		75.15±18.63	86.42±9.98	84.97±9.76	80.93±11.05	78.31±15.08	82.69±10.17	81.41±9.36	82.50±8.69
	对照组	157		68.79±14.13	77.83±10.65	76.66±10.11	75.27±13.63	69.87±15.77	74.83±12.57	74.29±10.49	75.01±9.37
			t值	3.45	7.45	7.48	4.08	4.89	6.16	6.42	7.41
			P值	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01

下载: 导出CSV

表 2 干预前后两组学生食物消费频率构成

Table 2. The frequency of food comsumption before and after the intervention in two groups

干预前后	组别	人数	统计值	早餐		粗杂粮		蔬菜		水果		奶制品		鱼/禽/蛋/瘦肉
干预前后	组别	人数	统计值	每天	0~6次/周	每天	0~6次/周	每天	0~6次/周	每天	0~6次/周	每天	0~6次/周	每天	0~6次/周
干预前	干预组	163		151(92.64)	11(6.75)	90(55.21)	73(44.79)	97(59.51)	65(39.88)	107(65.64)	55(33.74)	92(56.44)	70(42.94)	85(52.15)	77(47.24)
	对照组	157		142(90.45)	13(8.28)	80(50.96)	75(47.77)	98(62.42)	56(35.67)	98(62.42)	55(35.03)	89(56.69)	63(40.13)	98(62.42)	56(35.67)
			χ²值	0.29		0.41		0.47		0.14		0.10		4.04
			P值	0.59		0.52		0.49		0.71		0.75		0.04
干预后	干预组	163		154(94.48)	9(5.52)	110(67.48)	53(32.51)	129(79.14)	34(20.86)	118(72.39)	45(27.61)	118(72.39)	45(27.61)	117(71.78)	46(28.22)
	对照组	157		148(94.27)	9(5.73)	90(57.32)	67(42.68)	117(74.52)	40(25.48)	116(73.89)	41(26.11)	106(67.52)	51(32.48)	116(73.89)	41(26.11)
			χ²值	< 0.01		3.52		0.96		0.09		0.91		0.18
			P值	0.96		0.06		0.33		0.76		0.34		0.67
注：()内数字为构成比/%；部分项目存在缺失值。

下载: 导出CSV

表 3 干预对小学生食物消费频率影响的净效应(n=320)

Table 3. Net effect of the intervention on the frequency of food consumption(n=320)

食物消费种类	β值	标准误	Wald χ²值	P值	OR值(OR值95%CI)
早餐	-0.19	0.65	0.09	0.77	0.83(0.23~2.94)
粗杂粮	0.29	0.32	0.81	0.37	1.34(0.71~2.52)
蔬菜	0.42	0.35	1.41	0.23	1.52(0.76~3.04)
水果	-0.16	0.35	0.22	0.64	0.85(0.43~1.67)
奶制品	0.31	0.34	0.83	0.36	1.36(0.70~2.61)
鱼/禽/蛋/瘦肉	0.35	0.34	1.08	0.30	1.43(0.73~2.78)

下载: 导出CSV

表 4 干预前后两组学生健康食堂建设相关行为及态度构成比较

Table 4. Comparison of behaviors and attitudes of healthy canteen construction before and after the intervention with the two groups

干预前后	组别	人数	统计值	是否看过食堂摆放的营养健康宣传材料		对食堂提供低盐低油低糖菜品的态度			对食堂整体满意度
干预前后	组别	人数	统计值	看过	没看过/ 没摆放	非常赞同	赞同	无所谓/ 不赞同	满意	一般	不满意
干预前	干预组	163		122(74.85)	41(25.15)	56(34.36)	59(36.20)	48(29.45)	117(71.78)	36(22.09)	10(6.13)
	对照组	157		136(86.62)	19(12.10)	59(37.58)	58(36.94)	40(25.48)	124(78.98)	24(15.29)	8(5.10)
			χ²值	8.63		0.70			2.67
			P值	< 0.01		0.70			0.26
干预后	干预组	163		156(95.71)	7(4.29)	122(74.85)	26(15.95)	15(9.20)	132(80.98)	27(16.56)	4(2.45)
	对照组	157		133(84.71)	24(15.29)	76(48.41)	50(31.85)	31(19.75)	133(84.71)	17(10.83)	7(4.46)
			χ²值	11.04		23.73			2.98
			P值	< 0.01		< 0.01			0.23
注：()内数字为构成比/%；部分项目存在缺失值。

下载: 导出CSV

参考文献(23)

[1]	国家卫生健康委疾病预防控制局. 中国居民营养与慢性病状况报告[M]. 北京: 人民卫生出版社, 2021. Disease Prevention and Control Bureau of National Health Commission of the PRC. Nutrition and chronic disease status report of Chinese residents[M]. Beijing: People's Medical Publishing House, 2021. (in Chinese)
[2]	中国营养学会. 中国学龄儿童膳食指南(2022)[M]. 北京: 人民卫生出版社, 2022. Chinese Nutrition Society. Dietary guidelines for school-age children in China (2022)[M]. Beijing: People's Medical Publishing House, 2022. (in Chinese)
[3]	魏潇琪, 于冬梅, 琚腊红, 等. 2015—2017年中国6岁及以上居民在外就餐行为[J]. 卫生研究, 2022, 51(1): 7-11. https://www.cnki.com.cn/Article/CJFDTOTAL-WSYJ202201001.htm WEI X Q, YU D M, JU L H, et al. Eating out behavior of residents aged 6 and above in China from 2015 to 2017[J]. J Hyg Res, 2022, 51(1): 7-11. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-WSYJ202201001.htm
[4]	刘爱玲, 丁钢强. 中国居民营养与健康状况监测报告之八: 2010—2013年行为和生活方式[M]. 北京: 人民卫生出版社, 2019. LIU A L, DING G Q. Nutrition and health status survey report of Chinese residents No. 8: behavior and lifestyle 2010-2013[M]. Beijing: People's Medical Publishing House, 2019. (in Chinese)
[5]	傅华. 健康教育学[M]. 北京: 人民卫生出版社, 2017. FU H. Science of health education[M]. Beijing: People's Medical Publishing House, 2017. (in Chinese)
[6]	谈立峰, 孙樨陵, 许强强, 等. 以健康食堂为载体的营养健康促进模式的干预效果评价[J]. 中华健康管理学杂志, 2014, 8(3): 184-188. doi: 10.3760/cma.j.issn.1674-0815.2014.03.010 TAN L F, SUN X L, XU Q Q, et al. Efficacy evaluation of health canteen based-nutritional health promotion[J]. Chin J Health Manage, 2014, 8(3): 184-188. (in Chinese) doi: 10.3760/cma.j.issn.1674-0815.2014.03.010
[7]	谈立峰, 孙樨陵, 许强强, 等. 高校教职工公共营养知识、态度和行为(KAP)的健康食堂干预效果评价[J]. 现代预防医学, 2015, 42(6): 994-998. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201506013.htm TAN L F, SUN X L, XU Q Q, et al. The efficacy evaluation on the intervention of public nutritional knowledge, attitude and practice(KAP) in the healthy canteen among the college teaching and administrative staffs[J]. Mod Prev Med, 2015, 42(6): 994-998. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201506013.htm
[8]	TEO C H, CHIN Y S, LIM P Y, et al. Impacts of a school-based intervention that incorporates nutrition education and a supportive healthy school canteen environment among primary school children in Malaysia[J]. Nutrients, 2021, 13(5): 1712. doi: 10.3390/nu13051712
[9]	赵宏, 李斌, 刘燕, 等. 青海藏区寄宿制学校教师和食堂从业人员营养健康教育干预效果评价[J]. 中国学校卫生, 2015, 36(4): 518-520. http://www.cjsh.org.cn/article/id/zgxxws201504012 ZHAO H, LI B, LIU Y, et al. Intervention effect evaluation of Tibetan boarding school teachers and canteen workers' nutritional health education in Qinghai Province[J]. Chin J Sch Health, 2015, 36(4): 518-520. (in Chinese) http://www.cjsh.org.cn/article/id/zgxxws201504012
[10]	姜文婕, 向伦辉, 沈燕华, 等. 上海市宝山区中小学食堂从业人员食品卫生知识与行为干预效果评价[J]. 中国健康教育, 2018, 34(9): 843-844, 855. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJK201809019.htm JIANG W J, XIANG L H, SHEN Y H, et al. Effect evaluation on intervention activities related to food hygiene knowledge and behaviors among schools cafeteria workers in Baoshan District, Shanghai[J]. Chin J Health Educ, 2018, 34(9): 843-844, 855. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJK201809019.htm
[11]	LIU T, SU X, LI N, et al. Development and validation of a food and nutrition literacy questionnaire for Chinese school-age children[J]. PLoS One, 2021, 16(1): e0244197. doi: 10.1371/journal.pone.0244197
[12]	国民营养健康指导委员会. 关于印发《餐饮食品营养标识指南》等3项指南的通知[A/OL]. (2020-12-04)[2022-06-28]. http://www.nhc.gov.cn/sps/s7885u/202012/95a58c9edaa645e1adab956e278c2794.shtml. National Nutrition and Health Steering Committee of the PRC. Notice on printing and distributing three guidelines, including the Guidelines for Nutritional Labeling of Catering Food[A/OL]. (2020-12-04)[2022-06-28]. http://www.nhc.gov.cn/sps/s7885u/202012/95a58c9edaa645e1adab956e278c2794.shtml. (in Chinese)
[13]	于石成, 王琦琦, 张曼晖. 倍差法及其在公共卫生领域中的应用[J]. 疾病监测, 2019, 34(3): 272-277. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJC201903027.htm YU S C, WANG Q Q, ZHANG M H. Application of difference-in-differences in public health[J]. Dis Surv, 2019, 34(3): 272-277. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-JBJC201903027.htm
[14]	WHO. Saving lives, spending less: a strategic response to noncommunicable diseases[EB/OL]. (2018-10-26)[2022-06-28]. https://www.who.int/publications/i/item/WHO-NMH-NVI-18.8.
[15]	李荔, 冯敏, 毕小艺, 等. 成都市某农村学校营养相关指南健康教育干预效果评价[J]. 中国学校卫生, 2021, 42(3): 334-336, 341. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS202103005.htm LI L, FENG M, BI X Y, et al. Evaluation of the effect of health education interventions on nutrition-related guidelines in rural schools in Chengdu[J]. Chin J Sch Health, 2021, 42(3): 334-336, 341. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS202103005.htm
[16]	张民, 许苹. 上海市某地中小学生营养知识、信念与行为干预效果评价[J]. 社区医学杂志, 2017, 15(9): 32-35. https://www.cnki.com.cn/Article/CJFDTOTAL-SQYX201709011.htm ZHANG M, XU P. Intervention effect evaluation of nutritional knowledge, attitudes and practice of primary and secondary school students in Shanghai[J]. J Commun Med, 2017, 15(9): 32-35. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-SQYX201709011.htm
[17]	王玮, 王枫. 基于健康教育的营养计划干预在小学生营养饮食中的应用[J]. 食品安全质量检测学报, 2017, 8(6): 2354-2358. https://www.cnki.com.cn/Article/CJFDTOTAL-SPAJ201706079.htm WANG W, WANG F. Effects of nutritional plan intervention based on health education on nutritional dietary behavior of primary school students[J]. J Food Saf Q, 2017, 8(6): 2354-2358. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-SPAJ201706079.htm
[18]	WOLFENDEN L, NATHAN N, JANSSEN L M, et al. Multistrategic intervention to enhance implementation of healthy canteen policy: a randomised controlled trial[J]. Implement Sci, 2017, 12(1): 6.
[19]	蔡圆圆, 林丹, 高四海, 等. 温州市居民膳食结构及食物消费量调查分析[J]. 现代预防医学, 2020, 47(2): 241-243, 255. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202002012.htm CAI Y Y, LIN D, GAO S H, et al. Investigation and analysis of dietary structure and food consumption amount of Wenzhou residents[J]. Mod Prev Med, 2020, 47(2): 241-243, 255. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202002012.htm
[20]	AUNE D, KEUM N, GIOVANNUCCI E, et al. Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and doseresponse Meta-analysis of prospective studies[J]. BMJ, 2016, 353: i2716.
[21]	教育部办公厅. 关于印发营养与健康学校建设指南的通知[A/OL]. (2021-06-07)[2022-07-04]. http://www.moe.gov.cn/jyb_xxgk/moe_1777/moe_1779/202106/t20210624_539987.html. General Office of Ministry of Education of the PRC. Notice on the issuance of guidelines for the construction of nutrition and health schools[A/OL]. (2021-06-07)[2022-07-04]. http://www.moe.gov.cn/jyb_xxgk/moe_1777/moe_1779/202106/t20210624_539987.html. (in Chinese)
[22]	教育部关于印发《生命安全与健康教育进中小学课程教材指南》的通知[A/OL]. (2021-10-26)[2022-07-04]. http://www.moe.gov.cn/srcs-ite/A26/s8001/202111/t20211115_579815.html. Notice of Ministry of Education on printing and distributing the Guide to Teaching Materials for Life Safety and Health Education into Primary and Secondary School Curriculum[A/OL]. (2021-10-26)[2022-07-04]. http://www.moe.gov.cn/srcsite/A26/s8001/202111/t20211115_579815.html. (in Chinese)
[23]	杨贤, 蒋树新, 王炎炎, 等. 南京江宁区小学生营养KAP调查及干预效果评价[J]. 中国公共卫生, 2016, 32(4): 456-459. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201604012.htm YANG X, JIANG S X, WANG Y Y, et al. Nutrition knowledge-attitude-practice and effects of relevant intervention among pupils in Jiangning District of Nanjing City[J]. Chin J Public Health, 2016, 32(4): 456-459. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201604012.htm