Abstract: Objective To assess the effect of a comprehensive school-based intervention on weight status and eating behaviors among primary school students in poverty alleviation areas in western China,in order to provide reference for improving the nutritional preoblems of children in impoverished area. Methods Six primary school students in grades 2 - 5 were selected from three poverty alleviation counties in Shaanxi and Sichuan province,and a baseline survey and whole-cluster randomised controlled intervention study were conducted from November 2020 to June 2022,with 18-month malnutrition prevention and control and unhealthy lifestyle behavior improvement in the intervention group and myopia prevention and control education in the control group.A total of 1 160 students were included at baseline and 1 079 were followed up at the end,with 602 and 477 participants in the intervention and control groups,respectively.Physical examination and frequency of eating behavior questionnaires were administered to the students,and mixed-effects models were used to assess the effect of the intervention. Results After the intervention,the risks of overweight/obesity (OR=0.60) and wasting (OR=0.47) in the intervention group were reduced compared with those in the control group(P＜0.05).Regional stratified analysis showed that the risk of overweight/obesity (OR=0.54) and wasting (OR=0.31) was reduced in the intervention group in Shaanxi compared with that in the control group (P＜0.05).The results of dietary behavior showed that the average weekly frequency of egg (β=0.41),milk (β=0.84) and fruit (β=0.43) intake in the intervention group was higher than that in the control group after the intervention(P＜0.05).The results in the two provinces were different,with an increase in the frequency of egg (β=0.36 and 0.54,respectively) and milk (β=0.96 and 0.64,respectively) intake in the intervention group compared with that in the control group in both Shaanxi and Sichuan(P＜0.05);the frequency of fried food (β=0.50) and candy (β=0.64) intake increased in the Sichuan intervention group compared with the control group(P＜0.05). Conclusions Comprehensive school-based interventions can reduce the risk of obesity and wasting,and improve the weight status and dietary intake of students in rural poverty alleviation areas in China,but there are regional differences in the effectiveness of interventions.

Key words: poverty alleviation areas, primary school students, weight status, dietary behaviors

摘要： 目的 评估以学校为基础的综合干预措施对西部脱贫地区小学生体重状态及饮食行为的影响,为改善脱贫地区儿童双重营养不良问题提出参考。方法 在陕西和四川两省共3个脱贫县选择6所小学2～5年级学生,于2020年11月-2022年6月开展基线调查和整群随机对照干预研究,干预组进行为期18个月的营养不良防控及不健康生活行为改善,对照组开展近视防控宣教。基线纳入学生1 160名;终期随访1 079名,干预组和对照组分别602和477名。对学生进行体格测量和问卷调查,采用混合效应模型评估干预效果。结果 干预后,干预组超重/肥胖(OR=0.60)和消瘦(OR=0.47)发生风险较对照组降低(P＜0.05)。地区分层结果显示,陕西干预组超重/肥胖(OR=0.54)和消瘦(OR=0.31)发生风险较对照组降低(P＜0.05)。饮食行为结果显示,干预后干预组平均每周蛋类(β=0.41)、奶类(β=0.84)和水果(β=0.43)摄入频次均高于对照组(P＜0.05);两省结果不同,陕西、四川干预组蛋类(β=0.36、0.54)和奶类(β=0.96、0.64)摄入频次均较对照组增加(P＜0.05);四川干预组油炸食品(β=0.50)和糖果(β=0.64)摄入频次较对照组增加(P＜0.05)。结论 以学校为基础的综合干预措施可以降低学生肥胖和消瘦发生风险,改善我国西部农村脱贫地区学生体重状态及膳食摄入,但干预效果存在地区差异。

关键词: 脱贫地区, 小学生, 体重状态, 饮食行为