Nutrition Assessment Of The Effects Of Milk And Egg Supplementation Among Children In Poor Rural Area

BackgroundIn recent 20 years, with development of economy, dietary intake and nutritional status have been greatly improved among Chinese children. However, due to the diversity of natural conditions and unbalanced development of economy in China, nutrition and health status of children remains worrying, especially in poor rural areas. Children’s diet in these areas is simple and unbalanced with lower intake of animal source food, resulting in stunting, malnutrition and micronutrient deficiency. Unreasonable diet could not only affect the physical and mental development severely, but also reduce the labor force in their adulthood and cause negative effect on the development of national economy.Milk and eggs are good source of high-quality protein and micronutrients. Many governments, as well as non-governmental organizations in China have carried out a series of eggs and milk supplementation to improve the nutritional status of children in poor rural areas, but lack assessment of their measures scientifically. The present study assessed the effects of this project, which implemented comprehensive nutrition improvement intervention including supplementing milk and egg to children in Guangxi poor rural area, as well as providing standardized kitchen devices to school canteen, so as to provide scientific basis for improving nutritional status of children in poor rural areas.ObjectivesThis study was undertaken to learn the nutritional status of poor rural students and relevant factors, and to access the impact of nutritional status of rural pupils after a nutrition intervention based on milk and egg supplementation. Furthermore we can learn the probable problems and solutions during the implementation of nutrition improvement and provide scientific basis and advices for governments about improving nutritional status of children in poor rural areas.Subjects and MethodsTotal four schools were randomly selected from four towns in Tianyang County of Guangxi Province as intervention group. Another four familiar schools from the same town were chosen as control group. About 25 students, half male and half female, were selected and stratified by grades from grade one to five. The students from intervention group were given milk and egg every school day at 2:00 pm and the schools were equipped with standard kitchens, and none of the intervention measures was implemented on the control group.We conducted surveys at baseline and one year after intervention. Student questionnaire from grade three to five and 24-hours dietary recall method from grade three to four were investigated. The height, weight of all students and body composition with bioelectrical impedance analysis from grade two to four were measured. Morning fasting venous blood was drawn for students from grade two to grade three to determinate hemoglobin and serum vitamin A. Finger stick blood was collected to determinate hemoglobin for other students. Students’ intelligence from grade three to four were tested with Raven’s Standard Progressive Matrices. The school physical education teachers helped to test the status of long jump and 50*8 meters run. The t-test, logistic regression and rank test were used to analyze the differences between groups and intervention effects, and the significant level is 0.05.Results978 students were measured at baseline from grade one to five,552 students as intervention group and 426 as control group. The average daily energy intake of each student was 2062.5kcal.The ratio for energy of carbohydrates in intervention group (68.0%)was lower than the control one(70.5%), and protein and fat (15.8%,16.2%) were higher than the control group (14.8%,14.6%). The intake of Vitamin A, vitamin B2, vitamin C and Calcium less than 60% of RNI/AI were respectively 53.3%,45.4%, 62.7%,74.2%. There were no significant difference between intervention and control groups except Vitamin A (P>0.05). Students who thought the food at cafeteria delicious and delicious than home were 20.8% and 8.1%. The ratio of students who answered the nutrition question correctly was just 3.1%.After one year intervention the average weight of boys increased (3.6±1.7) kg compared with baseline. It was significantly higher than that of control group [(2.9±1.5) kg] (t=4.40, P<0.001). The BMI increased (0.8±0.7)kg/m2 in intervention group. It was significantly higher than that of control group [(0.6±0.7)kg/m2](t=5.44, P<0.001). The decrease of malnutrition rate of intervention schools (11.8%) was significantly higher than that of the control schools (4.7%, X2=16.90,P<0.001), and the odds ratio was 0.367 (95%CI=0.23-0.59).The boy’s lean body mass of intervention group increased (2.6±1.4) kg, higher than the control group [(2.0±1.2) kg] (t=3.95, P<0.001). The increases of height, body fat and percentage of body fat were not significantly different between intervention and control groups (P>0.05)After intervention, the hemoglobin level, anemia and intelligence were not significantly different between intervention and control groups (P>0.05).The level of serum vitamin A from intervention group increased (28.6±155.9) μg/L, but that in control group decreased (20.3±148.3)μg/L. There was significant intervention effect in serum vitamin A content (t=3.20, P=0.002). After intervention, the distance increments of long jump from intervention group were (10.7±20.0) cm, which were higher than control group. There was no significant intervention effect in 50*8 meters run (P>0.05)After intervention, the percentages of subjects who never felt hungry in the last class at morning and afternoon were 21.6% and 33.8%, which were higher than that in control group (8.0%,12.4%). The intake of milk and egg at school and home were both improved in intervention group. Meanwhile we did not find any distinct changes about other food intake like pork, vegetables and soybeans.ConclusionsAfter one year intervention, comprehensive nutritional intervention including supplementing milk and egg combined with kitchen equipments can effectively improve the nutritional status of the poor rural students. It can promote children’s physical development, the nutritional status of children’s diet, physical condition and hunger. But we have not observed the short-term nutritional intervention could ameliorate the height and intelligence of school-age children, so we should start to improve the nutritional status of the poor rural students persistently.