| Objectives:1.To investigate the nutrition knowledge,attitude,practice?KAP?of students and their parents,as well as school lunch and nutrition status among students in primary,middle and high schools of Shanghai,providing more evidence for the amending school lunch guidance.2.Based the above,we selected a primary school and implemented personalized nutrition interventions on students,parents and school to provide more evidence for further application.Methods:1.Investigation on nutrition KAP of students and parentsThe stratified cluster random sampling was applied,students and parents from three primary schools,three middle schools and one high school,total 5389 students and their parents were included to participate the questionnaire investigation.2.Investigation on school lunchThe stratified cluster random sampling was applied,and eight primary schools,five middle schools and five high schools,two combined junior-senior high schools,totally twenty schools,were included for three-day food menu and samples survey.Meanwhile,the seven schools,including three primary schools,three middle schools and one high school,total 5322 students,were selected for 3-day food weight and intake survey.The nutrient analysis software version 2.a?Feihua,Beijing,China?was used to analyze nutrient contents.Both menu and intake evaluation were based on China National Dietary Guideline for School Children?2016?(CNDG-Children 2016for food category and Chinese Dietary Reference Intakes?2013??DRIs-2013?for nutrient assessment.The proportion that supply or intake amount took up in the correspondent recommendation ranging from 80%120%was considered to be reasonable.Meanwhile,students'height and weight were obtained from school health center.The Screening Standard for Malnutrition of School-age Children and Adolescents?WS/T 456-2014?and Body Mass Index Reference Norm for Screening Overweight and Obesity in Chinese Children and Adolescents by?Working Group On Obesity in China,WGOC?were used to screen wasting and overweight/obese students.3.Evaluation on personalized nutrition interventions44 obese students?23 in control group and 21 in intervention group?and 43wasting students?22 in control group and 21 in intervention group?from a primary school in Shanghai were included.The intervention group students and their parents participated in nine-month personalized intervention.The interventions including targeted nutrition education,follow-ups,meal-intervention,WeChat media spreading and on-line nutrition consultancy.The nutrition questionnaires were conducted to all students and parents and the students'height,weight,body fat as well as skinfold thickness were examined before and after the interventionResults:1.The results of KAP showed that the average score for students in nutrition knowledge,attitude was 4.58±1.36,4.97±2.44 respectively,accounting for 76.3%and 62.1%of total scores in each part.The percentage for primary,middle and high school students that eat breakfast every day was 94.4%,81.3%and 62.6%respectively.Most students only had staple food?81.1%?and milk products?75.8%?for their breakfast.Only 24.0%students were satisfied with the school lunch.83.5%students marked their dinner as the most bounteous among all the three meals in a day.The average score for parents in nutrition knowledge,attitude was 6.85±1.60?6.18±1.86respectively,accounting for 68.5%and 77.3%of total scores in each part.Parents'behavior was closely related to their children's dietary.2.The supply of meat and egg for primary schools,middle schools and high schools were 123.4g,101.3g and 135.4g respectively,and 11.4g,28.3g and 13.2g for seafood respectively,of which mostly came from half-processed food instead of fresh seafood.The proportion of fat in total energy was over 30%while the supply of calcium only met 35%to 60%of the recommended,which were mainly plant sources.Plate waste among primary and middle school students was quite common.The greatest amount of food waste was generated from vegetables with 53%,42%and 31%for primary,middle and high school students.Intake of Vitamin A,Vitamin B2,calcium and iron was about 50%of proportion to the recommendation.Livestock&poultry meat and egg followed,as the second dominant proportion of plate waste among all food categories.Hence,the intake of energy and nutrients among primary and middle school students was unsatisfying while reasonable for high school students.All students had overtaken fat but were in a severe shortage of Vitamin A,Vitamin B2,calcium and iron.What's more,the BMI data showed that there were 279 moderate-to-severe wasting students,332 mild wasting students,702 overweight students,and 438 obese students,accounting for 5.2%,6.2%,13.2%and 8.2%of all students,respectively.3.After nine-month intervention,students'scores of intervention group in nutrition knowledge,attitude and behavior were significantly improved by 0.66,0.96 and 1.66respectively?P<0.05?compared to the control group.The change of BMI and body fat was not seen in the statistical way?P>0.05?but has presented a positive decline.The skinfold thickness of triceps and subscapular was better improved in intervention group of both obese and wasting students?P<0.05?.The scores in attitude and behavior of parents from intervention goup also showed a significant improvement,as0.88 and 0.54 respectively?P<0.05?.Conclusion:1.Students from primary schools and middle schools in Shanghai and their parents had a good knowledge of nutrition and took a positive attitude.However,their dietary behavior needs more improvements.2.The food structure of school lunch in Shanghai was unreasonable.The meat and egg was oversupplied while seafood was in shortage,resulting in higher percentage of fat in total energe.Although waste was expected with most lunch items,vegetables were reportedly wasted more than any other food item in the present study.Wasting and obesity situation among students should be paid more attention.3.Personalized nutrition intervention was approved effective for obese and wasting students and their parents.More studies are needed for further extending. |
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