Link/Page Citation
Author(s): Ying Xu [1]; Xiaoyi Bi [1,2]; Tingting Gao [1,3]; Titi Yang [1]; Peipei Xu [1]; Qian Gan [1]; Juan Xu [1]; Wei Cao [1]; Hongliang Wang [1]; Hui Pan [1]; Zhibin Ren [1]; Chunjie Yin [4]; Qian Zhang (corresponding author) [1,*]
1. Introduction
Childhood and adolescence are key periods of growth and development and are also critical periods for cultivating healthy dietary behaviors. With economic development in recent years, the nutritional status of rural Chinese children has continuously improved [1]. However, the nutritional knowledge of children is still relatively insufficient, which affects their physical and intellectual development [2,3]. There is evidence from studies in some countries that school-based nutrition and health education can effectively improve nutrition knowledge and develop healthy dietary behaviors in children [4,5,6,7]. For instance, Vered et al. conducted a school-based nutrition knowledge intervention for six months in children aged 4–7 years in Israeli schools of low socioeconomic status, which significantly improved nutrition knowledge and increased the food variety of children in the intervention group [8].
Chinese children have experienced a dramatic shift from traditional dietary patterns (mainly grains, vegetables, and tubers) to Western dietary patterns (mainly desserts, fast food, and meat) [9]. The consumption of beverages has become increasingly common among Chinese children aged 6–17 years [10]. Therefore, it is imperative to strengthen the nutrition and health education of rural children. The China Youth Development Foundation promoted and implemented the Hope Kitchen Plan in rural schools in Guangxi and Hubei Province from 2018 to 2020. This study aimed to evaluate the effects of school-based nutrition and health education on children’s nutrition knowledge, dietary behaviors, dietary intake, and nutritional status.
2. Materials and Methods
2.1. Participants
Three counties were selected for this study: Zigui County in Hubei Province and Du‘an County and Long‘an County in Guangxi Province, China. The GDP of these three counties was CHY 36,682.85 (USD 5451.07), CHY 16,468.00 (USD 2447.14), and CHY 24,169.00 (USD 3591.51) per person in 2018, respectively, while the national average GDP was CHY 65,534.00 (USD 9738.35) [11,12].
A total of 15 rural primary schools were selected, including four schools in Long’an county, five schools in Zigui County, and six schools in Du’an County. Nine schools were selected as the intervention group. Six schools were recruited as the control group. These schools were similar in size, school facilities, and student composition to the schools in the intervention group. There were two control schools in each county and two intervention schools in Long’an county, three intervention schools in Zigui County, and four intervention schools in Du’an County.
All children from grades 2 to 4 (8–10 years) were recruited at baseline. There were 2655 children (grades 2–4), 2567 children (grades 3–5), and 2503 children (grades 4–6) in September 2018, September 2019, and December 2020, respectively. The reason for being unable to follow up (5.7%) was the graduation of children. A total of 2066 children who participated in all three surveys were selected. Children had the right to refuse to participate in the study, and no one refused to participate (Figure 1).
2.2. Intervention Methods
Children in the intervention schools were provided nutrition education with nutrition and health courses as the main measure for two consecutive academic years from September 2018, after the baseline survey, to June 2020, before the final survey. Nutrition and health education courses were taught to children by professionally trained teachers as daily courses. We also carried out nutrition-related activities on campus. The main interventions included the following.
* A nutrition class series of textbooks (including two student books and one teacher book) and electronic courseware were used to provide nutrition and health courses for two consecutive academic years in the intervention schools, with one 40 min class every two weeks and five to six classes per semester. The main contents of the textbooks included food, nutrients, and dietary behaviors.
* Organizing unified training for teachers of nutrition courses, including four face-to-face training sessions and three online training sessions in total. The main contents included basic knowledge of nutrition, interpretation of the Chinese Dietary Guidelines, nutrition deficiency and dietary prevention for rural children, and the national nutrition policy for children.
* Holding the nutrition class competition for teachers, the nutrition class essay, painting and speech competitions for children, the Healthy Life Weekly Notes during winter and summer holidays, and other nutrition promotion and education activities.
* Providing physical activity resources that can improve the convenience and enthusiasm of children participating in sports such as basketball and skipping rope.
* Organizing children plating vegetables themselves, which not only improved children’s awareness of increasing intake of fresh fruits and vegetables but also became a labor practice base for students to understand nature.
Children in the control schools received their usual curriculum and did not receive any intervention in the nutrition education or physical activities.
2.3. Data Collection
Data related to the date of birth, sex, grade, area, nutritional knowledge, dietary intake, dietary behaviors, and physical activities were collected using a student questionnaire based on the China National Nutrition and Health Surveillance [13]. Children completed the questionnaires by themselves after the investigators explained them to the children in detail. Data were collected at baseline, after the first and second years.
Nutrition knowledge: The questionnaire consisted of 10 questions. Each correct response was assigned one point, and an incorrect or no answer was assigned 0 points. The total knowledge score ranged from 0 to 10 points with a higher score indicating a higher level of nutrition knowledge.
Dietary intake: The questionnaire consisted of five questions, including milk and egg consumption, the frequency of consumption of meat and fruits, and the variety of vegetables consumed in the past week. The total dietary intake score ranged from 0 to 15 points. A higher score indicates a healthier dietary intake (see Table 1).
Dietary behaviors: The questionnaire consisted of four questions on the frequency of eating breakfast, snacks, beverages, and plain water in the past week. The total score for dietary behaviors ranged from 0 to 12 points. Higher scores indicate healthier dietary behaviors.
The children’s fasting height and weight were examined early in the morning. Weight was measured to the nearest 0.1 kg in light indoor clothing, and height was measured without shoes to the nearest 0.1 cm. Body mass index (BMI) (kg/m[sup.2]) was calculated by dividing weight (kg) by height squared (m[sup.2]). Nutritional status was based on BMI by age and sex and divided into stunting, wasting, normal, bodyweight, and obesity. Malnutrition, including stunting and wasting, was screened according to the Chinese Screening Standard for Malnutrition in School Children and Adolescents (WS/T456-2014) [14]. Overweight and obesity screening was conducted according to the Chinese Screening for Overweight and Obesity among school-age children and adolescents (WS/T586-2018) [15].
This study was approved by the Ethics Committee of the China Center for Disease Control and Prevention. All participants provided informed consent prior to participating in the study.
2.4. Statistical Analyses
All statistical analyses were performed using SAS (SAS 9.4 for Windows, SAS Institute, Inc., Cary, NC, USA). Means ± SDs were used to describe quantitative data, and qualitative data were summarized as percentages.
This study measured each subject for three consecutive years; therefore, the three measurements of the same subject were not independent. A multilevel model was used to evaluate the effect of the intervention, and time was used as a level 1 variable to explain the difference in outcome indicators of the control group at baseline in the first and second year. Taking the individual as the level 2 variable, we included the group in the model as a fixed effect to explain the difference in outcome indicators between the intervention and control groups at baseline. The interaction effect between time and group explains the effects of the intervention. All p-values < 0.05 were considered to indicate statistical significance.
3. Results
3.1. The Characteristics of the Participants
A total of 2066 children were enrolled in this study, which included 1077 boys and 989 girls at baseline. There were 1563 children in the intervention group and 503 children in the control group. The average age of children was 9.0 years at baseline. The number of children in grades 2, 3, and 4 was 682 (33.0%), 662 (32.0%), and 722 (35.0%), respectively. There were 837 (40.5%), 875 (42.4%), and 354 (17.1%) children in Zigui County, Du Unk County, and Long Unk County, respectively. The number of children whose physical activity times were 0–30, 30–60, and =60 min/day was 603 (29.2%), 722 (35.0%), and 741 (35.9%), respectively (see Table 2).
3.2. Comparison of Nutrition Knowledge, Dietary Intake, and Dietary Behavior Scores at Baseline, First, and Second Year
3.2.1. Nutrition Knowledge
The correct rate of nutrition knowledge at baseline was 10.0–73.5% in the intervention group, compared with 6.0–69.8% in the control group. After the two-year nutrition and health courses, the correct rate in first and second year was 14.6–84.5% and 21.2–93.0% in the intervention group, respectively. In the second year, except for the correct rate of the nutritional characteristics of coarse grains (-13.0%), the correct rate of other nutrition knowledge in the intervention group increased compared with the baseline, with an increasing range of 5.1–39.8% (see Table 3).
The nutrition knowledge score in the intervention group was increased by 1.01 and 0.64 points in the first and second years, compared with the control group (0.70 and 0.57 points), respectively (Figure 2). The results of the multilevel model showed that the interaction effect between time and group was statistically significant in the first year (p < 0.05) and marginally significant in the second year (p = 0.068) (Table 4).
3.2.2. Dietary Intake
Table 5 presents the differences (intervention versus control) from baseline to the second year in milk and egg consumption, frequency of meat and fruit consumption, and variety of vegetables among children. The multilevel model showed that the interaction effect between time and group of milk, meat, eggs, and vegetables was statistically significant in the second year (p < 0.05). The frequency of fruit consumption in the intervention group increased compared to the baseline, but there was no statistical significance in the interaction effect between time and group of fruits (p > 0.05).
The dietary intake score in the intervention group was increased by 0.33 and 0.13 points in the first and second years compared with the control group (-0.04 and 0.05 points), respectively (Figure 3). The results of the multilevel model showed that the interaction effect between time and dietary intake group was statistically significant in the first and second year (p < 0.05) (Table 6).
3.2.3. Dietary Behaviors
Table 7 presents the differences (intervention versus control) from baseline to the second year in the frequency of breakfast, snack, beverage, and plain water consumption among children. The multilevel model showed that the interaction effect between time and breakfast group was statistically significant in the first year but not in the second year (p < 0.05). There was no statistically significant interaction effect between time and group of snacks, beverages, or plain water (p > 0.05) (Table 7).
The dietary behavior score in the intervention group was increased by 0.19 and 0.15 points in the first and second years compared with the control group (0.11 and 0.13 points, respectively) (Figure 4). There was no statistically significant interaction effect between time and group of dietary behaviors (p > 0.05) (Table 8).
3.3. Comparison of Height, Weight, BMI, and Nutritional Status at Baseline, First, and Second Year
The proportion of stunting was 6.1% in the intervention group and 10.3% in the control group at baseline and 3.1% and 7.6% in the second year, respectively. The proportion of obesity was 8.0% in the intervention group and 3.4% in the control group at baseline and 7.7% and 3.8% in the second year, respectively (Figure 5 and Figure 6). The results of the multilevel model showed that there was no significant difference in the interaction effect between time and height, weight, BMI, and nutritional status between the intervention and control groups (p > 0.05) (Table 9 and Figure 5 and Figure 6).
4. Discussion
The present study evaluated the effectiveness of school-based nutrition and health education on nutrition knowledge, dietary intake, dietary behaviors, and nutritional status among rural Chinese children. The results of this study suggest that school-based nutrition and health education may have a positive effect on nutrition knowledge, the frequency of eating breakfast, and dietary intake, including meat, eggs, milk, and vegetables, but not on nutritional status.
Countries worldwide have attached importance to nutrition and health education for children [16,17]. The World Health Organization proposed the Nutrition Friendly Schools Initiative in 2006, advocating comprehensive measures of school-based nutrition and health education [18]. In recent years, a wide range of nutrition education interventions have also been carried out for children in countries such as the United States, China, and France, which effectively improved children’s nutrition knowledge [7,8,9,10,19]. Marwa et al. conducted a 6-month school-based nutrition intervention on Syrian refugee children aged 6–14 years in Bekaa, Lebanon. The intervention included educational courses and the provision of local healthy snacks. They found that dietary knowledge in the intervention group (ß = 1.22, 95% CI: 0.54–1.89) increased significantly compared to the control group (p < 0.05) [4]. Our research also observed that nutrition knowledge increased by 1.01 points in the intervention group in the first year compared with 0.70 points in the control group (p < 0.05), suggesting that school-based nutrition and health education may contribute to the comprehension of children’s nutrition knowledge. However, we found that awareness of the nutritional characteristics of coarse grains decreased. The possible cause was the low intake of coarse grains in rural Chinese children, making them pay less attention to relevant nutrition knowledge. The intake of coarse grains in rural children aged 6–11 years was only 12.1 g/d in the Report on Nutrition and Chronic Diseases of Chinese Residents (2020) [20], which is much lower than the recommended intake of 30–70 g/day for this age group in the Chinese Dietary Guidelines for School-Aged Children [21]. Our results revealed that the teaching contents and methods should be adjusted according to the dietary characteristics of subjects; therefore, nutrition education on coarse grains needs to be further strengthened in the future.
A reasonable dietary structure is critical to ensure children’s nutrition and health. Our study observed that only 44.4%, 14.3%, and 28.3% of children in the intervention group consumed meat, eggs, and milk every day at baseline, which was far below the recommended intake and frequencies [22]. After two years of nutrition and health education, children’s milk and egg consumption, the frequency of meat consumption, and the variety of vegetables consumed in the intervention group improved and were significantly higher than those the control group in the second year. Our results are consistent with those of other studies in the United States, Asia, and Iran [22,23,24]. This indicates that nutrition and health education can contribute to a rational diet for children.
Breakfast can provide the body with essential nutrients and energy, which is important for the health of children [25]. Our study found that nutritional knowledge related to breakfast and the frequency of eating breakfast improved after the intervention. This showed that the improvement of children’s nutrition knowledge can improve their dietary behaviors to a certain extent. Nevertheless, 21.3% of the intervention group and 33.2% of the control group still failed to eat breakfast every day of second year. Other studies have revealed that skipping or eating breakfast irregularly may not only lead to malnutrition in children but also increase the risk of obesity and other related chronic diseases [26,27,28]. Therefore, education on the importance of breakfast among rural children should be further enhanced.
Similar to the results observed in South Africa and Asia [29,30], our results showed that the behavior of consuming snacks and beverages did not significantly improve after the intervention. This may be related to the current widespread consumption of snacks and beverages among Chinese children [31]. Reports on the consumption of sugar-sweetened beverages by Chinese children have pointed out that the production and consumption of beverages in China have increased rapidly in recent years [32]. In addition, poor self-control in children is also a major cause of snack and beverage consumption [33]. It may also be influenced by family and societal factors such as personal preferences, advertising, and marketing [34].
There were no significant differences in BMI and nutritional status between the intervention and control groups in this study. The United States, Australia, and many European countries have widely adopted school-based interventions to reduce weight by improving children’s nutrition knowledge and changing lifestyles, but their effectiveness is different [35,36]. A recent systematic review showed that school-based prevention interventions are mildly effective in reducing BMI in children. These latest studies tend to be more comprehensive and longer and include more factors, such as environmental modification, diet improvement, and parental support [37]. The different results may be related to the lack of intervention for other factors and confounders in our study. The detailed reasons for this difference require further discussion.
This study has several strengths and limitations. The strengths of this study include having a relatively large sample size, a design with a comparison group, and high adherence rates. One limitation was that the intervention only lasted for two years and did not observe the long-term influence on children’s dietary behaviors and nutritional status.
5. Conclusions
Our findings suggest a promising impact of integrated nutrition health education on nutrition knowledge, the frequency of eating breakfast, and dietary intake of meat, eggs, milk, and vegetables of rural Chinese children.
It is still necessary to explore scientific and long-term nutrition knowledge and behavioral intervention models for children and adolescents. Future studies are needed to test the feasibility of scaling up such nutritional interventions and also to evaluate their long-term impact on children’s dietary behaviors and nutritional status.
Author Contributions
Conceptualization, Y.X., Q.Z., Z.R. and C.Y.; methodology, Y.X. and X.B.; formal analysis, Y.X. and T.G.; investigation, Q.Z., T.G., T.Y., P.X., Q.G., J.X., H.W. and H.P.; data curation, W.C.; writing—original draft preparation, Y.X.; writing—review and editing, Y.X. and Q.Z.; project administration, Q.Z., T.Y., P.X. and Q.G. All authors have read and agreed to the published version of the manuscript.
Institutional Review Board Statement
Not applicable.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
Data available on request due to privacy restrictions. The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy.
Conflicts of Interest
The authors declare no conflict of interest.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Acknowledgments
We thank all the participants in our study and all the staff working for the Hope Kitchen Plan in rural schools in Guangxi and Hubei Province.
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Figures and Tables
Figure 1: Flow diagram of participation. [Please download the PDF to view the image]
Figure 2: Changes in mean score for children’s nutrition knowledge in first and second year from baseline. Vertical bars indicate standard deviations. [Please download the PDF to view the image]
Figure 3: Changes in mean score for children’s dietary intake in first and second year from baseline. Vertical bars indicate standard deviations. [Please download the PDF to view the image]
Figure 4: Changes in mean score for children’s dietary behaviors in first and second year from baseline. Vertical bars indicate standard deviations. [Please download the PDF to view the image]
Figure 5: Changes in proportion for children’s stunting and wasting in first and second year from baseline. Multilevel model was used to evaluate the effect of the intervention after adjusting for physical activity. Stunting: group effect, p < 0.05. Wasting: time effect (two years), p < 0.05. Others all p > 0.05. [Please download the PDF to view the image]
Figure 6: Changes in proportion for children’s overweight and obesity in first and second year from baseline. Multilevel model was used to evaluate the effect of the intervention after adjusting for physical activity. Overweight: group effect: p < 0.05; time effect (two years): p < 0.05. Obesity: group effect, p < 0.05. Others all p > 0.05. [Please download the PDF to view the image]
Table 1: Points assigned to each variable of dietary intake and dietary behaviors.
| Variable | Points | |
|---|---|---|
Dietary intake | ||
1 | Milk consumption | Less than 1 bag/week = 0; 1–3 bags/week = 1 point; 4–6 bags/week = 2 points; 1 bag/day and above = 3 points |
2 | Meat consumption frequency | Less than 1 time/week = 0; 1–3 times/week = 1 point; 4–6 times/week = 2 points; 1 time/day and above = 3 points |
3 | Egg consumption | Less than 1/week = 0; 1–3/week = 1 point; 4–6/week = 2 points; 1/day and above = 3 points |
4 | Vegetable consumption variety | Less than 1 kind/week = 0; 1 kind/day = 1 point; 2 kinds/day = 2 points; 3 kinds/day and above = 3 points |
5 | Fruit consumption frequency | Less than 1 time/week = 0; 1–3 times/week = 1 point; 4–6 times/week = 2 points; 1 time/day and above = 3 points |
Dietary behaviors | ||
6 | Breakfast consumption frequency | 1–2 days/week = 0; 3–4 days/week = 1 point; 5–6 days/week = 2 points; everyday = 3 points |
7 | Snack consumption frequency | Less than 1 time/week = 3 points; 1–3 times/week = 2 points; 4–6 times/week = 1 point; 1 time/day and above = 0 |
8 | Beverage consumption frequency | Less than 1 time/week = 3 points; 1–3 times/week = 2 points; 4–6 times/week = 1 point; 1 time/day and above = 0 |
9 | Plain water consumption | Less than 1 cup/day = 0; 1–2 cups/day = 1 point; 3–4 cups/day = 2 points; 5 cups/day and above = 3 points |
Note: The volume of milk is 250 mL. The weight of an egg is 50~60 g. The volume of a cup of water is about 300 mL.
Table 2: Comparison of characteristics of children from the intervention group and control group at baseline.
| Total Sample (n = 2066) | Control (n = 503) | Intervention (n = 1563) | |
|---|---|---|---|
Age (years), mean ± SD | 9.0 ± 1.04 | 9.2 ± 1.11 | 8.9 ± 1.01 |
Gender, n (%) | |||
Male | 1077 (52.1) | 268 (53.3) | 809 (48.2) |
Female | 989 (47.9) | 235 (46.7) | 754 (51.8) |
Grade, n (%) | |||
Two | 682 (33.0) | 180 (35.8) | 502 (32.1) |
Three | 662 (32.0) | 139 (27.6) | 523 (33.5) |
Four | 722 (35.0) | 184 (36.6) | 538 (34.4) |
County, n (%) | |||
Zigui County | 837 (40.5) | 172 (34.2) | 665 (42.6) |
Du‘an County | 875 (42.4) | 240 (47.7) | 635 (40.6) |
Long‘an county | 354 (17.1) | 91 (18.1) | 263 (16.8) |
Physical activity, n (%) | |||
0–30 min/d | 603 (29.2) | 196 (39.0) | 407 (26.0) |
30–60 min/d | 722 (35.0) | 146 (29.0) | 576 (36.9) |
=60 min/d | 741 (35.9) | 161 (32.0) | 580 (37.1) |
Table 3: Comparison of correct rate of children’s nutrition knowledge between the intervention group and control group (%).
| Baseline | First Year | Second Year | Change (Baseline-Second Year) | |||||
|---|---|---|---|---|---|---|---|---|
| Control | Intervention | Control | Intervention | Control | Intervention | Control | Intervention | |
Health is not only the absence of disease but also good psychological and social adaptability [sup.#,@,@@] | 30.8 | 45.0 | 58.3 | 67.1 | 73.2 | 84.8 | 42.4 | 39.8 |
The most abundant protein is meat, poultry, fish and eggs [sup.@,@@] | 26.8 | 30.5 | 42.3 | 47.7 | 62.2 | 63.6 | 35.4 | 33.1 |
The best source of calcium is milk [sup.@@,]* | 37.6 | 40.4 | 41.7 | 52.3 | 58.4 | 62.1 | 20.8 | 21.8 |
Iron deficiency anemia can be prevented by eating more lean meat and vegetables[sup.@,@@] | 48.7 | 49.3 | 62.8 | 63.1 | 70.0 | 75.5 | 21.3 | 26.2 |
A nutritious breakfast should include four types of food [sup.#,@@,]** | 6.0 | 10.0 | 6.8 | 14.6 | 10.3 | 25.7 | 4.3 | 15.7 |
China recommends that school-age children drink more than 300 g of milk and dairy products every day [sup.#,@,]*[sup.,]** | 21.5 | 16.1 | 10.9 | 17.0 | 16.7 | 21.2 | -4.8 | 5.1 |
Fresh vegetables and fruits cannot be substituted for each other [sup.@,@@,]** | 51.7 | 54.3 | 65.0 | 68.1 | 68.8 | 79.8 | 17.1 | 25.5 |
Coarse grains have more comprehensive nutritional characteristics than fine grains [sup.@,]** | 66.4 | 65.4 | 53.9 | 56.9 | 63.0 | 52.4 | -3.4 | -13.0 |
Obese children are more prone to hypertension, hyperlipidemia, and other diseases: yes [sup.@@,]*[sup.,]** | 69.8 | 66.6 | 73.4 | 80.4 | 83.3 | 87.5 | 13.5 | 20.9 |
Food not less likely to deteriorate when put in the refrigerator [sup.#,@,@@] | 64.4 | 73.5 | 78.7 | 84.5 | 85.5 | 93.0 | 21.1 | 19.5 |
Note: A multilevel model was used to evaluate the effect of the intervention. Group effect: [sup.#]p < 0.05; time effect: [sup.@] one year p < 0.05; [sup.@@] two years p < 0.05; time × group effects: * p < 0.05; ** two years p < 0.05.
Table 4: Test of the fixed effects of various factors of nutrition knowledge score.
| Effect | Type | ß * | SE [sup.#] | T-Value | p-Value |
|---|---|---|---|---|---|
Intercept | 0.083 | 51.16 | <0.001 | ||
Group | Intervention | 0.096 | 2.10 | 0.007 | |
Control | Ref. | ||||
Time | Second Year | 0.111 | 15.40 | <0.001 | |
First Year | 0.113 | 5.97 | <0.001 | ||
Baseline | Ref. | ||||
Time × Group | Second Year × Intervention | 0.128 | 1.83 | 0.068 | |
Second Year × Control | |||||
First Year × Intervention | 0.129 | 2.44 | 0.015 | ||
First Year × Control | |||||
Baseline × Intervention | Ref. | ||||
Baseline × Control |
Note: * ß, coefficient. [sup.#] SE, standard error.
Table 5: Comparison of milk consumption; the frequency of meat, egg, and fruit consumption; and the variety of vegetables of children in the past week between the intervention group and control group (%).
| Consumption/Frequency/Variety | Baseline | First Year | Second Year | |||
|---|---|---|---|---|---|---|
| Control | Intervention | Control | Intervention | Control | Intervention | |
Milk [sup.#,@,]** | ||||||
Less than 1 bag/week | 14.3 | 7.9 | 7.6 | 11.4 | 6.0 | 3.8 |
1–3 bags/week | 45.5 | 51.2 | 47.7 | 38.8 | 53.5 | 39.2 |
4–6 bags/week | 19.5 | 12.5 | 22.7 | 13.5 | 26.6 | 18.4 |
1 bag/day and above | 20.7 | 28.3 | 22.1 | 36.3 | 13.9 | 38.6 |
Meat [sup.@,@@,]*[sup.,]** | ||||||
Less than 1 time/week | 1.8 | 2.7 | 3.6 | 2.0 | 1.2 | 1.5 |
1–3 times/week | 39.0 | 36.6 | 45.5 | 40.2 | 37.6 | 30.5 |
4–6 times/week | 12.7 | 16.3 | 19.7 | 18.1 | 24.7 | 23.8 |
1 time/day and above | 46.5 | 44.4 | 31.2 | 39.7 | 36.6 | 44.1 |
Eggs *[sup.,]** | ||||||
Less than 1/week | 11.9 | 6.5 | 10.5 | 6.5 | 8.3 | 4.4 |
1–3/week | 54.3 | 61.9 | 62.4 | 52.0 | 62.8 | 49.6 |
4–6/week | 20.1 | 17.2 | 17.3 | 21.2 | 18.5 | 29.4 |
1/day and above | 13.7 | 14.3 | 10.7 | 20.4 | 10.3 | 16.6 |
Vegetables [sup.#,@,@@,]** | ||||||
Less than 1 kind/week | 1.4 | 0.3 | 1.2 | 0.8 | 0.2 | 0.4 |
1 kind/day | 18.3 | 9.0 | 13.5 | 6.5 | 9.5 | 3.9 |
2 kinds/day | 27.6 | 20.7 | 24.9 | 19.3 | 25.8 | 21.8 |
3 kinds/day and above | 52.7 | 70.1 | 60.4 | 73.4 | 64.4 | 73.9 |
Fruits [sup.#] | ||||||
Less than 1 time/week | 3.0 | 1.7 | 3.0 | 3.0 | 3.0 | 2.2 |
1–3 times/week | 55.5 | 42.6 | 49.5 | 36.6 | 47.5 | 37.5 |
4–6 times/week | 20.5 | 25.9 | 29.4 | 28.7 | 27.6 | 28.6 |
1 time/day and above | 21.1 | 29.8 | 18.1 | 31.7 | 21.9 | 31.7 |
Note: Multi-level model was used to evaluate the effect of the intervention after adjusting the nutrition knowledge score. Group effect: [sup.#]p < 0.05; time effect: [sup.@] one year p < 0.05; [sup.@@] two years p < 0.05; time × group effects: * p < 0.05; ** two years p < 0.05.
Table 6: Test of the fixed effects of various factors of dietary intake score.
| Effect | Type | ß * | SE [sup.#] | T-Value | p-Value |
|---|---|---|---|---|---|
Intercept | 0.104 | 83.94 | <0.001 | ||
Group | Intervention | 0.120 | 5.95 | <0.001 | |
Control | Ref. | ||||
Time | Second Year | 0.138 | 1.19 | 0.235 | |
First Year | 0.140 | -0.77 | 0.441 | ||
Baseline | Ref. | ||||
Time × Group | Second Year × Intervention | 0.159 | 3.45 | <0.001 | |
Second Year × Control | |||||
First Year × Intervention | 0.160 | 2.68 | 0.007 | ||
First Year × Control | |||||
Baseline × Intervention | Ref. | ||||
Baseline × Control |
Note: After adjusting for the nutrition knowledge score, group effect p < 0.05; time effect p > 0.05; time × group effect p < 0.05. * ß, coefficient. [sup.#] SE, standard error.
Table 7: Comparison of the frequency of breakfast, snack, beverage, and plain water consumption of children in the past week between the intervention group and control group (%).
| Consumption/ Frequency | Baseline | First Year | Second Year | |||
|---|---|---|---|---|---|---|
| Control | Intervention | Control | Intervention | Control | Intervention | |
Breakfast [sup.#,@,]* | ||||||
1–2 days/week | 9.5 | 6.1 | 12.5 | 7.8 | 6.2 | 4.7 |
3–4 days/week | 5.0 | 5.1 | 11.7 | 5.6 | 8.0 | 5.1 |
5–6 days/week | 15.7 | 12.1 | 15.7 | 12.0 | 19.1 | 11.5 |
Everyday | 69.8 | 76.7 | 60.0 | 74.7 | 66.8 | 78.7 |
Snacks | ||||||
Less than 1 time/week | 8.7 | 8.1 | 6.0 | 5.6 | 6.4 | 4.9 |
1–3 times/week | 11.9 | 12.9 | 13.1 | 14.2 | 13.5 | 12.9 |
4–6 times/week | 65.2 | 67.6 | 65.8 | 67.4 | 70.6 | 70.2 |
1 time/day and above | 14.1 | 11.5 | 15.1 | 12.8 | 9.5 | 12.0 |
Beverages [sup.#,@@] | ||||||
Less than 1 time/week | 6.6 | 6.7 | 3.2 | 4.3 | 2.0 | 2.2 |
1–3 times/week | 8.5 | 9.9 | 9.5 | 9.7 | 6.6 | 5.9 |
4–6 times/week | 65.0 | 68.3 | 65.0 | 67.4 | 69.0 | 69.0 |
1 time/day and above | 19.9 | 15.1 | 22.3 | 18.6 | 22.5 | 22.9 |
Plain water [sup.#,@] | ||||||
Less than 1 cup/day | 5.2 | 1.6 | 2.8 | 1.9 | 2.0 | 2.4 |
1–2 cups/day | 25.6 | 22.3 | 18.1 | 19.3 | 19.9 | 14.1 |
3–4 cups/day | 27.0 | 31.0 | 28.8 | 25.0 | 37.0 | 31.2 |
5 cups/day and above | 42.1 | 45.0 | 50.3 | 53.9 | 41.2 | 52.4 |
Note: Multilevel model was used to evaluate the effect of the intervention after adjusting the nutrition knowledge score. Group effect: [sup.#]p < 0.05; time effect: [sup.@] one year p < 0.05; [sup.@@] two years p < 0.05; time × group effects: * p < 0.05.
Table 8: Test of the fixed effects of various factors of dietary behavior score.
| Effect | Type | ß * | SE [sup.#] | T-Value | p-Value |
|---|---|---|---|---|---|
Intercept | 0.076 | 108.69 | <0.001 | ||
Group | Intervention | 0.088 | 2.15 | 0.032 | |
Control | Ref. | ||||
Time | Second Year | 0.100 | 2.67 | 0.008 | |
First Year | 0.102 | 1.01 | 0.311 | ||
Baseline | Ref. | ||||
Time × Group | Second Year × Intervention | 0.114 | 1.67 | 0.094 | |
Second Year × Control | |||||
First Year × Intervention | 0.116 | 0.66 | 0.510 | ||
First Year × Control | |||||
Baseline × Intervention | Ref. | ||||
Baseline × Control |
Note: After adjusting for the nutrition knowledge score, group effect: p > 0.05; time effect: p > 0.05; time × group effect: p > 0.05. * ß, coefficient. [sup.#] SE, standard error.
Table 9: Comparison of height, weight, and BMI of children between intervention group and control group.
| Baseline | First Year | Second Year | Change (Baseline-Second Year) | |||||
|---|---|---|---|---|---|---|---|---|
| Control | Intervention | Control | Intervention | Control | Intervention | Control | Intervention | |
Height (cm) [sup.@,@@] | ||||||||
Male | 127.42 ± 6.83 | 128.10 ± 6.93 | 133.37 ± 7.97 | 133.19 ± 9.09 | 141.06 ± 9.27 | 141.26 ± 8.86 | 6.79 ± 8.07 | 6.58 ± 7.07 |
Female | 127.70 ± 8.10 | 127.26 ± 7.73 | 134.34 ± 9.31 | 133.77 ± 8.64 | 142.61 ± 10.03 | 142.52 ± 8.82 | 7.38 ± 8.02 | 7.65 ± 8.10 |
Weight (kg) [sup.#,@,@@] | ||||||||
Male | 25.99 ± 5.17 | 27.29 ± 6.58 | 29.32 ± 7.02 | 30.38 ± 12.35 | 35.59 ± 8.89 | 36.74 ± 9.46 | 4.79 ± 6.17 | 4.71 ± 5.55 |
Female | 25.32 ± 5.47 | 25.82 ± 5.90 | 28.85 ± 6.86 | 29.07 ± 7.28 | 36.11 ± 8.65 | 36.57 ± 8.94 | 5.35 ± 6.27 | 5.40 ± 6.20 |
BMI (kg/m[sup.2]) [sup.@@] | ||||||||
Male | 15.91 ± 2.12 | 16.48 ± 2.85 | 16.32 ± 2.54 | 18.31 ± 2.16 | 17.68 ± 2.86 | 18.18 ± 3.14 | 0.88 ± 1.54 | 0.85 ± 1.38 |
Female | 15.38 ± 1.99 | 15.78 ± 2.37 | 15.79 ± 2.18 | 16.05 ± 2.66 | 17.53 ± 2.60 | 17.77 ± 2.91 | 1.07 ± 1.54 | 1.00 ± 1.44 |
Note: Multilevel model was used to evaluate the effect of the intervention after adjusting for physical activity. Group effect: [sup.#]p < 0.05; time effect: [sup.@] one year p < 0.05; [sup.@@] two years p < 0.05. Note: Values are presented as mean ± SD.
Author Affiliation(s):
[1] Chinese Center for Disease Control and Prevention, NHC Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Beijing 100050, China
[2] Beijing Tongzhou District Center for Disease Control and Prevention, Beijing 101199, China
[3] Beijing Shunyi District Center for Disease Control and Prevention, Beijing 101300, China
[4] School of Public Health, Xinjiang Medical University, Urumqi 830017, China
Author Note(s):
[*] Correspondence: zhangqian7208@163.com; Tel.: +86-10-6623-7133
DOI: 10.3390/nu14193997
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No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2023 Gale, Cengage Learning. All rights reserved.
FAQs
Effect of School-Based Nutrition and Health Education for Rural Chinese Children.? ›
The results showed that some of adolescents' knowledge, attitudes and behaviour in relation to nutrition improved significantly after this 6-month nutrition education, which demonstrates that this nutrition education program is effective to promote adolescents' nutrition in rural areas of China.
What is the effect of dietary consumption on nutrition outcome among under five children in rural Malawi? ›In the bivariate results, the current study found that the under-nutrition condition among the children under-five in rural Malawi is significantly explained by inadequate consumption of animal proteins, fruits and vegetables, and in addition to partly and significantly by carbohydrates for wasting (WHZ <-2) and ...
Why are school based nutrition programs important? ›Benefits of NE
Offering NE in schools at all age levels helps prepare students for critical life skills and life-long healthy habits. Children who develop healthy habits at an early age are more likely to be well, stay well, and do well in school.
Nutritional deficiencies prior to school entry have the potential to impact upon cognitive outcomes in school-aged and adolescent children. For instance, clinical research has found an association between early life vitamin B12 deficiency and reduced scores on cognitive tests in adolescence.
How does nutrition affect a child's development? ›During childhood, under-nutrition can cause kids to have lesser energy and interest during learning, which negatively affects their cognitive development and academic performance. It also affects physical growth and maturation, and body height and weight.
What are 4 implications for children as a result of a poor diet? ›being underweight, overweight or obese. constipation or changes in bowel habits. being pale or lethargic. tooth decay.
What are the factors affecting the nutritional status for children under five? ›Gender, birth order, and immunization status of child are significantly associated with nutritional status. This study showed that prevalence of malnutrition was less among those who received supplementary nutrition as compared to ones who did not.
What is the importance of nutrition education in school for kids and society? ›Research shows that nutrition education can teach students to recognize how healthy diet influences emotional well-being and how emotions may influence eating habits. However, because schools face many demands, school staff can consider ways to add nutrition education into the existing schedule.
What role do nutrition education programs play in the community? ›Nutrition education programs and resources encourage individuals and families in communities across the country to make healthier choices regarding the types of foods for purchase and consumption.
How does nutrition impact school success? ›Good Nutrition helps students show up at school prepared to learn. Because improvements in nutrition make students healthier, students are likely to have fewer absences and attend class more frequently. Studies show that malnutrition leads to behavior problems[6], and that sugar has a negative impact on child behavior.
Does improved nutrition in children impact academic achievement? ›
Research has demonstrated that better nutrition is associated with improvements in exam performance, specifically in math. Studies also show that better nutrition supports a student's ability to stay on task.
Does nutrition impact cognitive development of children? ›The developing human brain requires all essential nutrients to form and to maintain its structure. Infant and child cognitive development is dependent on adequate nutrition. Children who do not receive sufficient nutrition are at high risk of exhibiting impaired cognitive skills.
What are the nutrition learning outcomes? ›- Define social, economic, cultural, and environmental influences on food access and dietary choices.
- Evaluate and predict ways in which complex interactions of components of the food system influence human health and nutrition.
- Demonstrate an understanding of public health.
But adding diverse cuisines to your menu at home is important, especially for children, because when kids habitually eat the same dishes they may not get all the necessary nutrients needed for optimal growth and development.
How important is nutrition for growth and development? ›Proper nutrition allows for the vitamins and energy needed to function and grow, but also ensure optimal brain development. Because healthy habits start from childhood, nutrition from an early age impacts your child's current and future weight.
How can nutrition impact a child's social and emotional development? ›The Food-Mood Connection
Nutrients such as folate, vitamin B6 and choline are necessary to synthesize certain brain chemicals, called neurotransmitters, that regulate mood and memory. An imbalance of neurotransmitters is often associated with mood-related conditions like anxiety and depression.
This puts them at risk of poor brain development, weak learning, low immunity, increased infections and, in many cases, death.
What is the impact of poor diet on a child's long-term health and development? ›Children who eat poorly are more likely to develop certain long-term health problems and complications, including: Osteoporosis in later life. Cardiovascular diseases. Growing up eating foods high in fat, sugar, and salt can increase the risk for high cholesterol, high blood pressure, and atherosclerosis as an adult.
What are two nutritional concerns potential problems for children? ›Dietary practices of children and adolescents affect their risk for a number of health problems, including obesity, iron deficiency, and dental caries. Inadequate nutrition also lowers resistance to infectious disease, and may adversely affect the ability to function at peak mental and physical ability.
What are two problems related to nutrition that are common in childhood? ›Food allergies, iron deficiency, tooth decay and constipation are common in the early years.
What are 3 factors affecting nutritional status? ›
Some of the most important factors are: Genetics and gender. Dietary energy concentration. Environmental temperature.
Why do children need nutrition education? ›Nutrition education in early childhood should begin to teach children the relationship between food and health and expose children to a variety of learning experiences about foods to help children develop sound attitudes and knowledge about food, nutrition, and health.
What are 3 reasons why nutrition is important? ›A healthy diet throughout life promotes healthy pregnancy outcomes, supports normal growth, development and ageing, helps to maintain a healthy body weight, and reduces the risk of chronic disease leading to overall health and well-being.
What is the importance of nutrition on mental health of children? ›How are nutrition and mental health linked? Healthy eating helps children and young people cope more effectively with stress, better manage their emotions and get a good sleep – all of which assist learning. Most research about nutrition and mental health has focused on adults.
What does a healthy school nutrition environment provide students? ›A healthy school nutrition environment provides students with nutritious and appealing foods and beverages, consistent and accurate messages about good nutrition, and ways to learn about and practice healthy eating throughout the time children spend on school grounds—including before- and after-school.
What is the primary goal of the nutrition program of the administration for community living? ›The intent of the OAA senior nutrition program is to: reduce food insecurity, hunger, and malnutrition; enhance socialization; and promote the health and well-being of older adults.
How can we improve nutrition in the community? ›- Eat a variety of nutritious foods.
- Eat more vegetables and fruits.
- Eat less processed foods that are often fatty, salty, and sugary.
The research suggests that eating a healthy and nutritious diet can improve mental health1, enhance cognitive skills like concentration and memory2,3 and improve academic performance4.
What are some of the challenges schools face when implementing successful nutrition programs? ›The challenges include funding, making healthy foods that school children would like to eat, and overcome stigma related to consuming school lunch.
Do schools teach enough about nutrition? ›The short answer is YES, but nobody has acted on this issue and we continue to see problems with kids' nutrition. Schools play an important role in students' health. Teachers can establish healthy eating habits as well as a healthy lifestyle.
How does good nutrition impact your cognitive learning? ›
Healthy foods also benefit your mind, nourishing cells within your brain that allow for cognitive functioning -- recalling information, learning and perceiving the world around you. Getting enough nutrients in your diet supports cognitive functioning, while nutrient deficiencies or a poor diet decrease cognition.
What are 3 factors that would affect the cognitive development of the child? ›- Nutrition. ...
- Environment. ...
- Maternal-Child Interactions.
Postnatally, nutrients exert an effect on innate immune signal transduction pathways and immune cell development, which influence early allergen sensitivity, promote tolerance towards emerging gut microbiota and ingested antigens, and patterns of host defense against pathogens.
What are the two major types of evaluation in nutrition education? ›Behavioral outcomes are used to assess whether or not the behavioral goals of the program have been met. Health outcomes are physiological measurements, such as blood pressure, body mass index, waist circumference and serum cholesterol.
What are the three components of nutrition education? ›The current paper focuses on the (aforementioned) three commonly acknowledged broad components of nutrition knowledge (knowledge of the relationship between diet and disease, knowledge of the nutrient content of foods and knowledge of dietary guidelines).
Does cultural heritage play a role in your eating habits? ›Eating habits are related to cultural identity and are influenced by cultural and social background. Religious traditions, social class, income, dietary restrictions, and prohibitions are characteristic elements of each culture.
How do culture and ethnicity play a role in dietary intake? ›Different cultures may encourage or frown upon consumption of different foods by individuals who belong to their groups. In addition, ethnicity plays one of the most influential roles in the choices and subsequent selection of foods consumed in certain societies.
How does food affect cultural diversity? ›People also connect to their cultural or ethnic group through food patterns. Food is often used as a means of retaining their cultural identity. People from different cultural backgrounds eat different foods. The areas in which families live and where their ancestors originated influence food like and dislikes.
Why nutrition is essential for the success of sustainable development goals? ›The need for better nutrition was recognised in SDG 2, which aims to “end hunger, achieve food security and improved nutrition, and promote sustainable agriculture. The goal acknowledges that efforts to combat hunger and malnutrition have advanced significantly since 2000.
What is the relationship of nutrition with health growth and development? ›Nutrition is a critical part of health and development. Better nutrition is related to improved infant, child and maternal health, stronger immune systems, safer pregnancy and childbirth, lower risk of non-communicable diseases (such as diabetes and cardiovascular disease), and longevity. Healthy children learn better.
How nutrition impacts the child's behavioral development and grades? ›
Children with insufficient diets are reported to have more problems with health, academic learning, and psychosocial behavior. Malnutrition can result in long-term neural issues in the brain, which can impact a child's emotional responses, reactions to stress, learning disabilities, and other medical complications.
What is the main factor that affects the healthy emotional development of the child? ›Parents and caregivers play the biggest role in social/emotional development because they offer the most consistent relationships for their child. Consistent experiences with family members, teachers and other adults help children learn about relationships and explore emotions in predictable interactions.
What are all of the reasons for poor nutrition worldwide in children under 5 years old? ›Teenage pregnancy, lower maternal education, low birthweight, lack of breastfeeding and personal food preference are also individual determinants of malnutrition of children under the age of 5 years.
What are the effects of poor nutrition on growth and development in children below six years? ›Children with poor eating habits do not consume the adequate amount of nutrients needed for growth and development. These children may consume too few or too many nutrients, which may result in the child being underweight or overweight.
What is the impact of dietary intake on nutritional health? ›A well-balanced diet provides all of the: energy you need to keep active throughout the day. nutrients you need for growth and repair, helping you to stay strong and healthy and help to prevent diet-related illness, such as some cancers.
What is the effect of malnutrition among children in the country? ›Malnutrition can cause permanent, widespread damage to a child's growth, development and well-being. Stunting in the first 1,000 days is associated with poorer performance in school, both because malnutrition affects brain development, and also because malnourished children are more likely to get sick and miss school.
Does poor nutrition affect children's learning? ›Malnutrition can result in long-term neural issues in the brain, which can impact a child's emotional responses, reactions to stress, learning disabilities, and other medical complications.
What are the effects of poor nutrition for children below 3 years? ›- Impaired growth. Each nutrient is important for the growth and development of a toddler. ...
- Dental caries, muscle cramps. ...
- Childhood obesity. ...
- Poor memory and cognitive skills. ...
- Learning disabilities caused by malnutrition.
Eating a wide variety of nutritious foods helps mood, attention and learning. Eating regular meals also helps promote good mood and attention. Including foods that are rich in dietary fibre may also help.
What impact does nutrition have on health in the community? ›A healthy diet helps children grow and develop properly and reduces their risk of chronic diseases. Adults who eat a healthy diet live longer and have a lower risk of obesity, heart disease, type 2 diabetes, and certain cancers.
What are the effects and consequences of nutrition? ›
In the short term, poor nutrition can contribute to stress, tiredness and our capacity to work, and over time, it can contribute to the risk of developing some illnesses and other health problems such as: being overweight or obese. tooth decay. high blood pressure.
What are 3 harmful effects of malnutrition in children? ›- Muscle function. Weight loss due to depletion of fat and muscle mass, including organ mass, is often the most obvious sign of malnutrition. ...
- Cardio-respiratory function. ...
- Gastrointestinal function. ...
- Immunity and wound healing. ...
- Psychosocial effects.
As a result, the brain's cognitive process, motor and language development will be limited and causes a long-term permanent impact on academic performance of children. This study reported that being underweight reduces the academic performance of children by 68%.
What are some effects of malnutrition on the development of school age children? ›Undernutrition in children has been linked to poor mental development and school achievement as well as behavioural abnormalities. However, there is still a debate in the literature regarding whether some of these effects are permanent or reversible.