Analysis of vitamin A level and its influencing factors among students in monitoring area of nutritional health status of students in 2021
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摘要:
目的 分析2021年“农村义务教育学生营养改善计划”(简称“学生营养改善计划”)监测地区中小学生维生素A水平及影响因素。 方法 血清维生素A浓度0.2~0.3 μg/mL定义为维生素A边缘性缺乏,<0.2 μg/mL定义为维生素A缺乏,将维生素A边缘缺乏和缺乏合并为维生素A不足。对“学生营养改善计划”监测地区6~17岁中小学生开展问卷调查、体格检测和实验室检查,分析其维生素A水平及影响因素。 结果 45 702名中小学生维生素A的均值为0.37(0.31,0.44) μg/mL,维生素A边缘缺乏率为18.3%,缺乏率为1.0%。不同性别、年龄组、学校所在地的中小学生维生素A营养状况存在差异。多因素logistic回归分析模型分析结果显示6~<9岁年龄组(OR=3.892, 95% CI: 3.303~4.587, P<0.001)、学校位于农村(OR=1.148, 95% CI: 1.072~1.229, P<0.001)、父母一方及以上在外务工(OR=1.234, 95% CI: 1.153~1.321, P<0.001)、母亲文化程度在高中及以下(OR=1.169, 95% CI: 1.046~1.306, P=0.006)、无法保证每天都喝奶(OR=1.155, 95% CI: 1.075~1.240, P<0.001)、蔬菜摄入<4种/d(OR=1.081, 95% CI: 1.006~1.163, P=0.034)的中小学生维生素A不足的风险增加。 结论 2021年“学生营养改善计划”学生营养健康状况监测地区中小学生维生素A边缘缺乏率较高,且低年龄段儿童更易发生维生素A边缘缺乏或维生素A缺乏。母亲文化程度、奶类和蔬菜摄入情况等是维生素A缺乏的潜在影响因素,需社会予以关注和重视。 Abstract:Objective To analyze the vitamin A levels and influencing factors among students in the monitoring areas of the Nutritional Improvement Program for Rural Compulsory Education Students in 2021. Methods Serum vitamin A concentration 0.2-0.3 μg/mL is defined as marginal vitamin A deficiency, < 0.2 μg/mL is defined as vitamin A deficiency, > 0.3 μg/mL is defined as vitamin A insufficient. In the monitoring area of the Nutritional Improvement Program, questionnaire surveys, physical examinations, and laboratory tests were conducted on primary and secondary school students aged 6-17 and their vitamin A levels and influencing factors were analyzed. Results Totally 45 702 primary and secondary school students were included in this study. The average of serum vitamin A level was 0.37 (0.31-0.44) μg/mL, the marginal deficiency rate was 18.3%, and the deficiency rate was 1.0%. Differences in vitamin A nutritional status were observed across different genders, ages, and school locations. Logistic regression model revealed that students aged 6- < 9 years (OR=3.892, 95% CI: 3.303-4.587, P < 0.001), whose schools are located in rural areas (OR=1.148, 95% CI: 1.072-1.229, P < 0.001), parents working outside (OR=1.234, 95% CI: 1.153-1.321, P < 0.001) and students with lower maternal education levels (OR=1.169, 95% CI: 1.046-1.306, P=0.006), students who could not guarantee to drink milk every day (OR=1.155, 95% CI: 1.075-1.240, P < 0.001) and consume less than 4 kinds of vegetables per day (OR=1.081, 95% CI: 1.006-1.163, P=0.034) have an increased risk of vitamin A deficiency. Conclusions The prevalence of marginal vitamin A deficiency among students in monitoring areas in 2021 was still high, especially among younger children. Maternal education level, intake of milk and vegetables are potential influencing factors of vitamin A deficiency, which need to be paid attention to by all sectors of society. -
Key words:
- Vitamin A /
- Primary and middle school student /
- Influencing factors
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表 1 2021年学生营养健康状况监测地区中小学生基本特征
Table 1. Basic characteristics of students in monitoring area of nutritional health status of students in 2021
特征Feature 合计Total 男生Male 女生Female 人数
Number of people构成比/%
Proportion/%人数
Number of people构成比/%
Proportion/%人数
Number of people构成比/%
Proportion/%合计Total 45 702 100.0 22 982 50.3 22 720 49.7 年龄组/岁 ① Age group/years ① 6~<9 7 892 17.3 3 938 17.2 3 954 17.4 9~<12 15 179 33.3 7 597 33.1 7 582 33.4 12~<15 15 340 33.6 7 701 33.6 7 639 33.7 15~17 7 187 15.8 3 690 16.1 3 497 15.5 地区 ① Area ① 东部Eastern 8 354 18.4 4 196 18.4 4 158 18.5 中部Central 13 962 30.8 7 066 31.0 6 896 30.6 西部Western 23 015 50.8 11 533 50.6 11 482 51.9 学校所在地 ① School location ① 城市Urban 20 373 45.2 10 245 45.2 10 128 45.2 农村Rural 24 736 54.8 12 438 54.8 12 298 54.8 营养状况 ① Nutritional status ① 生长迟缓Growth retardation 293 0.8 158 0.9 135 0.8 消瘦Under weight 2 463 6.8 1 397 7.8 1 066 5.9 正常Normal weight 25 055 69.6 11 626 64.8 13 429 74.3 超重Overweight 4 678 13.0 2 625 14.6 2 053 11.4 肥胖Obesity 3 530 9.8 2 145 11.9 1 385 7.6 注:①部分数据缺失。
Note: ① Partial data missing.表 2 2021年学生营养健康状况监测地区中小学生血清维生素A水平(μg/mL)
Table 2. Serum vitamin A level of students in monitoring area of nutritional health status of students in 2021 (μg/mL)
特征Feature 合计 ①
Total ①男生 ①
Male ①女生 ①
Female ①Z值
valueP值
value合计Total 0.37(0.31,0.44) 0.37(0.31,0.43) 0.37(0.32,0.44) 8.485 <0.001 年龄组/岁Age group/years 6~<9 0.34(0.29,0.40) 0.34(0.28,0.39) 0.34(0.29,0.40) -0.740 0.460 9~<12 0.35(0.30,0.41) 0.35(0.30,0.41) 0.36(0.31,0.42) 3.984 <0.001 12~<15 0.39(0.33,0.46) 0.38(0.32,0.45) 0.40(0.34,0.46) -3.020 0.003 15~17 0.41(0.34,0.48) 0.41(0.35,0.49) 0.40(0.34,0.47) 2.580 0.010 H值value 2 836.997 1 490.593 1 395.332 P值value <0.001 <0.001 <0.001 地区Area 东部Eastern 0.38(0.32,0.46) 0.49(0.38,0.54) 0.38(0.32,0.46) 1.505 0.133 中部Central 0.36(0.31,0.43) 0.36(0.30,0.52) 0.36(0.31,0.43) 4.393 <0.001 西部Western 0.37(0.31,0.44) 0.37(0.31,0.43) 0.38(0.32,0.44) 7.646 <0.001 H值value 282.205 159.737 128.465 P值value <0.001 <0.001 <0.001 学校所在地School location 城市Urban 0.37(0.32,0.44) 0.37(0.31,0.44) 0.38(0.32,0.44) 4.390 <0.001 农村Rural 0.36(0.31,0.44) 0.36(0.30,0.43) 0.37(0.31,0.44) 7.364 <0.001 Z值value 7.892 47.533 4.198 P值value <0.001 <0.001 <0.001 营养状况Nutritional status 生长迟缓Growth retardation 0.34(0.29,0.41) 0.33(0.28,0.40) 0.33(0.28,0.40) 3.377 0.001 消瘦Under weight 0.35(0.30,0.41) 0.35(0.30,0.41) 0.35(0.30,0.41) -0.284 0.780 正常Normal weight 0.36(0.31,0.43) 0.36(0.30,0.42) 0.36(0.30,0.42) -10.691 <0.001 超重Overweight 0.38(0.32,0.45) 0.38(0.32,0.45) 0.38(0.32,0.45) 1.208 0.227 肥胖Obesity 0.39(0.33,0.45) 0.38(0.33,0.45) 0.38(0.33,0.45) 1.892 0.059 H值value 437.337 308.882 181.072 P值value <0.001 <0.001 <0.001 注:①以M(P25,P75)表示。
Note: ① M(P25,P75).表 3 2021年学生营养健康状况监测地区中小学生血清维生素A缺乏情况
Table 3. Serum vitamin A deficiency of students in monitoring area of nutritional health status of students in 2021
特征Feature 维生素A边缘型缺乏
Marginal vitamin A deficiency维生素A缺乏
Vitamin A deficiency维生素A不足
Insufficient vitamin A人数(占比/%)
Number of people (proportion/%)χ2值
valueP值
value人数(占比/%)
Number of people (proportion/%)χ2值
valueP值
value人数(占比/%)
Number of people (proportion/%)χ2值
valueP值
value合计Total 8 361 (18.3) 461 (1.0) 8 822 (19.3) 性别Gender 58.468 <0.001 4.311 0.038 62.574 <0.001 男Male 4 516 (19.7) 254 (1.1) 4 770 (20.8) 女Female 3 845 (16.9) 207 (0.9) 4 052 (17.8) 年龄组/岁 ① Age group/years ① 1 247.270 <0.001 92.311 <0.001 1 333.684 <0.001 6~<9 2 190 (27.8) 134 (1.7) 2 324 (29.4) 9~<12 3 389 (22.3) 196 (1.3) 3 585 (23.6) 12~<15 2 007 (13.1) 94 (0.6) 2 101 (13.7) 15~17 752 (10.5) 36 (0.5) 788 (11.0) 地区 ① Area ① 92.942 <0.001 11.403 0.003 92.633 <0.001 东部Eastern 1 283 (15.4) 62 (0.7) 1 345 (16.1) 中部Central 2 856 (20.5) 125 (0.9) 2 981 (21.4) 西部Western 4 167 (18.1) 261 (1.1) 4 428 (19.2) 学校所在地 ① School location① 79.239 <0.001 24.186 <0.001 94.465 <0.001 城市Urban 3 390 (16.6) 150 (0.7) 3 540 (17.4) 农村Rural 4 901 (19.8) 296 (1.2) 5 197 (21.0) 营养状况 ① Nutritional status ① 223.503 <0.001 6.756 0.149 228.456 <0.001 生长迟缓Growth retardation 77 (26.3) 4 (1.4) 81 (27.6) 消瘦Under weight 622 (25.3) 28 (1.1) 650 (26.4) 正常Normal weight 5 013 (20.0) 278 (1.1) 5 291 (21.1) 超重Overweight 686 (14.7) 43 (0.9) 729 (15.6) 肥胖Obesity 470 (13.3) 24 (0.7) 494 (14.0) 注:①部分数据缺失。
Note: ① Partial data missing.表 4 维生素A不足影响因素的多因素logistic回归分析
Table 4. Multivariate logistic regression analysis of influencing factors of vitamin A deficiency
因素Factors β值
valuesx Wald χ2值
valueOR值value (95% CI) P值
value性别Gender 男Male 1.000 女Female -0.268 0.034 63.841 0.765(0.716~0.817) <0.001 年龄组/岁Age group/years 15~17 1.000 6~<9 1.359 0.083 263.248 3.892(3.303~4.587) <0.001 9~<12 1.005 0.053 356.968 2.733(2.462~3.033) <0.001 12~<15 0.290 0.055 27.926 1.336(1.200~1.488) <0.001 地区Area 东部Eastern 1.000 中部Central 0.286 0.051 31.031 1.331(1.204~1.472) <0.001 西部Western 0.249 0.049 26.438 1.283(1.167~1.411) <0.001 学校所在地School location 城市Urban 1.000 农村Rural 0.138 0.035 15.754 1.148(1.072~1.229) <0.001 营养状况Nutritional status 生长迟缓Growth retardation 1.000 消瘦Under weight 0.087 0.168 0.268 1.091(0.784~1.519) 0.605 正常Normal weight 0.255 0.060 17.885 1.291(1.147~1.453) <0.001 超重Overweight -0.452 0.056 64.867 0.636(0.570~0.710) <0.001 肥胖Obesity -0.727 0.067 116.126 0.483(0.424~0.552) <0.001 父母在外务工情况Parents working outside 双方均未在外务工Neither 1.000 一方及以上在外务工One or more 0.211 0.035 36.845 1.234(1.153~1.321) <0.001 母亲文化程度Maternal education 大专及以上Junior college or above 1.000 高中及以下High school and below 0.156 0.057 7.612 1.169(1.046~1.306) 0.006 奶类摄入情况Frequency of milk intake 每天1次及以上Once or more per day 1.000 无法保证每天都喝Less than once a day 0.144 0.040 15.680 1.155(1.075~1.240) <0.001 蔬菜摄入情况/(种·d-1) Vegetable intake /(kinds·d-1) ≥4 1.000 <4 0.078 0.040 4.475 1.081(1.006~1.163) 0.034 -
[1] Wiseman EM, Dadon BE, Reifen R. The vicious cycle of vitamin a deficiency: a review[J]. Crit Rev Food Sci Nutr, 2017, 57(17): 3703-3714. DOI: 10.1080/10408398.2016.1160362. [2] Song P, Wang J, Wei W, et al. The prevalence of vitamin A deficiency in Chinese children: a systematic review and Bayesian meta-analysis[J]. Nutrients, 2017, 9(12): 1285. DOI: 10.3390/nu9121285. [3] Stevens GA, Bennett JE, Hennocq Q, et al. Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys[J]. Lancet Glob Health, 2015, 3(9): e528-e536. DOI: 10.1016/S2214-109X(15)00039-X. [4] Unit W H O N, UNICEF. Global prevalence of vitamin Adeficiency in populations at risk 1995-2005: WHO global database on vitamin Adeficiency[J]. World Health Organization, 2005, in press(2): 10-29. DOI: 10.1080/00918369.2015.1112193. [5] Bailey RL, West Jr KP, Black RE. The epidemiology of global micronutrient deficiencies[J]. Ann Nutr Metab, 2015, 66(Suppl 2): 22-33. DOI: 10.1159/000371618. [6] 中华人民共和国国家卫生健康委员会疾病预防控制局. 中国居民营养与慢性病状况报告(2020年)[M]. 北京: 人民卫生出版社, 2021: 41.National Health Committee of People's Republic of China Disease Prevention and Control Bureau. Report on the nutrition and chronic diseases status of Chinese residents 2020[M]. Beijing: People's Medical Publishing House, 2021: 41. [7] 王迪, 胡小琪, 徐培培, 等. 2016年"学生营养改善计划"试点地区学生维生素A营养状况分析[J]. 中国健康教育, 2019, 35(4): 295-299. DOI: 10.16168/j.cnki.issn.1002-9982.2019.04.002.Wang D, Hu XQ, Xu PP, et al. Status analysis on vitamin A among students in students nutrition improvement program in 2016[J]. Chinese Journal of Health Education, 2019, 35(4): 295-299. DOI: 10.16168/j.cnki.issn.1002-9982.2019.04.002. [8] 程茅伟, 张杰, 彭飞, 等. 恩施市贫困农村中小学生2012—2021年维生素A和维生素D营养状况及与身高的相关性[J]. 中国学校卫生, 2023, 44(1): 40-42. DOI: 10.16835/j.cnki.1000-9817.2023.01.009.Cheng MW, Zang J, Peng F, et al. Nutritional status on vitamin A, vitamin D and its relation with height among primary and middle school students in poor rural areas of Enshi from 2012 to 2021[J]. Chin J Sch Health, 2023, 44(1): 40-42. DOI: 10.16835/j.cnki.1000-9817.2023.01.009. [9] 许颖, 苏艳琦, 郎会利, 等. 抚顺地区6 766例0~14岁儿童血清维生素A水平调查研究[J]. 中国儿童保健杂志, 2020, 28(2): 211-214. DOI: 10.11852/zgetbjzz2019-0463.Xu Y, Su YQ, Lang HL, et al. Investigation on vitamin A level in 6766 children aged 0 to 14 years in Fushun[J]. Chin J Child Health Care, 2020, 28(2): 211-214. DOI: 10.11852/zgetbjzz2019-0463. [10] 高蓉, 喻颖杰, 郭丹丹, 等. 北京市6-13岁儿童维生素A营养水平及影响因素[J]. 中国食物与营养, 2019, 25(6): 78-82. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWY201906018.htmGao R, Yu YJ, Guo DD, et al. Vitamin A nutrition level and its influencing factors in children aged 6-13 in Beijing[J]. Food and Nutr China, 2019, 25(6): 78-82. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWY201906018.htm [11] Reddy GB, Shalini T, Ghosh S, et al. Prevalence of vitamin A deficiency and dietary inadequacy in Indian school-age children and adolescents[J]. Eur J Nutri, 2022, li(1): 197-209. DOI: 10.1007/s00394-021-02636-7. [12] Stevens GA, Bennett JE, Hennocq Q, et al. Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys[J]. Lancet Glob Health, 2015, 3(9): e528-e536. DOI: 10.1016/S2214-109X(15)00039-X. [13] De Queiroz D, Paiva AA, Pedraza DF, et al. Vitamin A deficiency and associated factors in children in urban areas[J]. Revista de Saúde Pública, 2013, 47: 248-256. DOI: 10.1590/S0034-8910.2013047002906. [14] 李强, 臧文斌. 父母外出对留守儿童健康的影响[J]. 经济学, 2010, 9(4): 341-360. https://www.cnki.com.cn/Article/CJFDTOTAL-JJXU201101015.htmLi Q, Zang WB. The influence of parents going out on the health of left-behind children[J]. Economics, 2010, 9(4): 341-360. https://www.cnki.com.cn/Article/CJFDTOTAL-JJXU201101015.htm [15] 赵晨晓, 董志勇. 父母外出务工与农村留守儿童健康——基于CFPS微观证据的考察[J]. 湖北社会科学, 2021, (2): 59-65. DOI: 10.3969/j.issn.1003-8477.2021.02.008Chen XG, Dong ZY. Parents' migrant work and the health of left-behind children in rural areas: an investigation based on CFPS micro-evidence[J]. Hubei Social Sciences, 2021, (2): 59-65. DOI: 10.3969/j.issn.1003-8477.2021.02.008. [16] 叶立娜, 李文芳, 郭慧, 等. 汉川市农村学龄期留守儿童营养健康状况调查[J]. 中国妇幼保健, 2014, 29(16): 2565-2567. DOI: 10.7620/zgfybj.j.issn.1001-4411.2014.16.39.Ye LN, Li WF, Guo H, et al. Investigation on nutrition and health status of rural school-age left-behind children in Hanchuan City[J]. Maternal and Child Health Care in China, 2014, 29(16): 2565-2567. DOI: 10.7620/zgfybj.j.issn.1001-4411.2014.16.39. [17] 孙波, 葛恒明, 李忠典, 等. 农村5岁以下留守儿童膳食营养现况[J]. 中国校医, 2010, 24(8): 625-626, 628. https://www.cnki.com.cn/Article/CJFDTOTAL-XIYI201008043.htmSun B, Ge HM, Li ZD, et al. Dietary nutrition status of left-behind children under 5 years old in rural areas[J]. Chin J School Doctor, 2010, 24(8): 625-626, 628. https://www.cnki.com.cn/Article/CJFDTOTAL-XIYI201008043.htm [18] 马冠生, 张帆. 培养健康饮食行为远离儿童肥胖[J]. 中国儿童保健杂志, 2023, 31(1): 10-14. DOI: 10.11852/zgetbjzz2022-1199.Ma GS, Zhang F. Cultivate healthy dietary behavior and keep away from childhood obesity[J]. Chin J Child Health Care, 2023, 31(1): 10-14. DOI: 10.11852/zgetbjzz2022-1199. [19] 邓英琴, 潘莉, 史卫群. 儿童血清维生素A、D水平与肥胖的相关性研究[J]. 反射疗法与康复医学, 2022, 3(6): 58-60, 67. https://www.cnki.com.cn/Article/CJFDTOTAL-FSKF202206017.htmDeng YQ, Pan L, Shi WQ. Correlation analysis of serum vitamin A, vitamin D levels and obesity in Children[J]. Reflexology and Rehabilitation Medicine, 2022, 3(6): 58-60, 67. https://www.cnki.com.cn/Article/CJFDTOTAL-FSKF202206017.htm