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Article(id=1321169906847040325, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169839390053177, articleNumber=null, orderNo=null, doi=10.11847/zgggws1146134, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1728662400000, receivedDateStr=2024-10-12, revisedDate=1738684800000, revisedDateStr=2025-02-05, acceptedDate=1744387200000, acceptedDateStr=2025-04-12, onlineDate=1792921051941, onlineDateStr=2026-10-25, pubDate=1749484800000, pubDateStr=2025-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921051941, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921051941, creator=13701087609, updateTime=1792921051941, updator=13701087609, issue=Issue{id=1321169839390053177, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='6', pageStart='641', pageEnd='768', issueExtLink='null', onlineDate='null', pubDate='1749484800000', pubDateStr='2025-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921035859, creator='13701087609', updateTime=1792921035859, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=666, endPage=672, ext={EN=ArticleExt(id=1321169907056755526, articleId=1321169906847040325, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Anemia prevalence and associated factors among students benefiting from the rural compulsory education nutrition improvement program in Jilin province in 2023: a cross-sectional study, columnId=1321169841071969084, journalTitle=Chinese Journal of Public Health, columnName=Special Report – Focusing on Child Health and Development, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the anemia status and its influencing factors among students in the Nutrition Improvement Program areas of Jilin province, and to provide a reference for formulating targeted nutrition improvement measures.

Methods

A stratified cluster sampling method was used to select a total of 2 258 primary school students (grade 3 and above) and junior high school students from two key monitoring counties implementing the "Rural Compulsory Education Student Nutrition Improvement Program" in Jilin province in 2023. Questionnaires, physical examinations, and hemoglobin tests were conducted. The chi-square test and multivariate binary logistic regression analysis were used to analyze the anemia status and its influencing factors among the students.

Results

The anemia prevalence among primary and secondary school students in the Nutrition Improvement Program areas of rural Jilin province was 6.55%, all of which were mild (3.63%) and moderate anemia (2.92%). The anemia prevalence in girls (8.97%) was higher than that in boys (4.25%), and the difference was statistically significant (χ2 = 20.534, P < 0.001). Among boys, the detection rates of anemia differed significantly among students with different nutritional statuses and snacking frequencies (P < 0.05). Among girls, the detection rates of anemia differed significantly among students with different maternal education levels, school stages, age groups, whether they had diarrhea in the past two weeks, whether they had menstruated, frequency of dairy product consumption, snacking frequency, whether they liked the food provided by the school, whether they usually had leftover food, and daily snack expenditure (P < 0.05). Multivariate binary logistic regression analysis showed that, compared with the corresponding reference groups, overweight and obesity were protective factors against anemia in boys, while snacking 3-6 times per week was a risk factor for anemia. Consuming dairy products 3-6 times a week and ≥ 1 pack (200 mL/pack) daily were protective factors against anemia in girls, while having menstruated and having a mother with a primary school education or below were risk factors for anemia in girls. The risk of anemia in boys and girls in Dunhua city was 6.091 times and 3.309 times higher than that in Da'an city, respectively.

Conclusions

There are gender differences in the prevalence of anemia among students in the Nutrition Improvement Program areas of Jilin province. The influencing factors of anemia and the detection rates of anemia also vary by region. Individualized nutritional intervention measures are needed to improve the anemia status of students.

, authors=Hongli CUI, Xingang ZHANG, Liwei ZHANG, Bo LUAN, Sijie LIU, authorsList=Hongli CUI, Xingang ZHANG, Liwei ZHANG, Bo LUAN, Sijie LIU, authorCompany=null, correspAuthors=Sijie LIU, authorNote=null, correspAuthorsNote=
LIU Sijie, E-mail:
, copyrightStatement=Copyright © 2025 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1321169907962725195, articleId=1321169906847040325, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=吉林省2023年农村义务教育学生营养改善计划地区学生贫血状况及影响因素分析, columnId=1321169841432679230, journalTitle=中国公共卫生, columnName=专题报道 —— 关注儿童健康成长, runingTitle=null, highlight=null, articleAbstract=
目的

探讨吉林省营养改善计划地区学生贫血状况及其影响因素，为制定有针对性的营养改善措施提供参考依据。

方法

采用分层整群抽样方法，在吉林省2023年实施“农村义务教育学生营养改善计划”的2个重点监测县，抽取小学三年级及以上小学生和初中生共2 258人作为调查对象，进行问卷调查、体格检查和血红蛋白检测，采用χ2检验和多因素二分类logistic回归分析学生贫血状况及其影响因素。

结果

吉林省农村义务教育学生营养改善计划地区的中小学生贫血率为6.55%，均为轻度（3.63%）和中度贫血（2.92%），女生贫血率（8.97%）高于男生（4.25%），差异有统计学意义（χ2=20.534，P<0.001 ）。在男生中，不同营养状况、吃零食频次的学生贫血检出率差异均有统计学意义（均P<0.05）；在女生中，不同母亲文化程度、学段、年龄组，过去2周内是否出现腹泻、是否来过月经、食用奶制品频次、吃零食频次、是否喜欢吃学校提供的食物情况、平时是否剩饭（菜）、每天买零食花费不同的学生贫血检出率差异均有统计学意义（均P<0.05）。多因素二分类logistic回归分析结果显示，与相应参照组比较，男生超重肥胖是贫血的保护因素，每周吃零食频率3～6次是患贫血的危险因素。女生食用奶及奶制品每周3～6次、每天≥1包（200 mL/包）是贫血的保护因素，来过月经、母亲文化程度小学及以下是女生患贫血的危险因素。敦化市男生和女生贫血患病风险分别是大安市的6.091倍和3.309倍。

结论

吉林省实施学生营养改善地区的学生贫血患病率存在性别差异，不同性别学生贫血影响因素不同，贫血检出率也存在地区差异，需制定个性化营养干预措施改善学生贫血状况。

, authors=崔红丽, 张新刚, 张丽薇, 栾博, 刘思洁*, *, authorsList=崔红丽, 张新刚, 张丽薇, 栾博, 刘思洁, authorCompany=null, correspAuthors=刘思洁, authorNote=

崔红丽（1989—），主管医师，硕士，研究方向：学生营养监测

, correspAuthorsNote=
刘思洁，E-mail：
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Distribution of anemia among students of different sexes

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项目调查人数贫血轻度贫血中度贫血
例数%例数%例数%
男生1 154494.25272.34221.91
女生1 104998.97554.98443.99
合计2 2581486.55823.63662.92
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不同性别学生贫血分布情况

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项目调查人数贫血轻度贫血中度贫血
例数%例数%例数%
男生1 154494.25272.34221.91
女生1 104998.97554.98443.99
合计2 2581486.55823.63662.92
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Distribution of anemia detection among students with different characteristics

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项目男生贫血女生贫血合计
人数检出率/%χ2值P值人数检出率/%χ2值P值人数检出率/%χ2值P值
地区　　　　　　　　
　大安市61.0925.730<0.001295.4715.259<0.001353.2437.114<0.001
　敦化市437.12　　7012.20　　1139.59
营养状况　　　　　　　　
　正常326.2310.4260.005659.330.3050.859978.009.7920.008
　营养不足45.33　　58.06　　96.57
　超重肥胖132.30 a　　298.41　　424.61
母亲文化程度　　　　　　　　
　小学及以下72.792.4850.4763314.67 a15.3920.002408.407.3880.061
　初中234.73　　357.09　　585.92
　高中/中专/技校115.58　　2010.31　　317.93
　大专学历及以上63.82　　74.52
　　134.35
父亲文化程度
　小学及以下62.741.8040.6142512.507.3620.061317.992.7930.425
　初中264.81499.53757.66
　高中/中专/技校94.69105.24195.22
　大专学历及以上84.94106.29196.29
学段
　小学314.811.1280.307294.8626.897<0.001604.8313.388<0.001
　初中183.54　　7013.81　　888.66
年龄组/岁　　　　　　　　
　 8～9134.922.3880.311103.97 a20.298<0.001234.677.8930.019
　10～12244.90367.63 a606.65
　13～15123.005313.95659.09
过去2周内，是否出现腹泻　　　　　　　　
　是35.360.0070.934918.375.550.0181211.434.2710.039
　否464.19　　908.53　　1366.32
是否来过月经（仅女生）　　　　　　　　
　是　　　　7713.4629.369<0.001
　否　　　　224.14　　
), ArticleFig(id=1321169912299635579, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169906847040325, language=CN, label=表2, caption=

不同特征学生贫血检出情况分布

, figureFileSmall=null, figureFileBig=null, tableContent=
项目男生贫血女生贫血合计
人数检出率/%χ2值P值人数检出率/%χ2值P值人数检出率/%χ2值P值
地区　　　　　　　　
　大安市61.0925.730<0.001295.4715.259<0.001353.2437.114<0.001
　敦化市437.12　　7012.20　　1139.59
营养状况　　　　　　　　
　正常326.2310.4260.005659.330.3050.859978.009.7920.008
　营养不足45.33　　58.06　　96.57
　超重肥胖132.30 a　　298.41　　424.61
母亲文化程度　　　　　　　　
　小学及以下72.792.4850.4763314.67 a15.3920.002408.407.3880.061
　初中234.73　　357.09　　585.92
　高中/中专/技校115.58　　2010.31　　317.93
　大专学历及以上63.82　　74.52
　　134.35
父亲文化程度
　小学及以下62.741.8040.6142512.507.3620.061317.992.7930.425
　初中264.81499.53757.66
　高中/中专/技校94.69105.24195.22
　大专学历及以上84.94106.29196.29
学段
　小学314.811.1280.307294.8626.897<0.001604.8313.388<0.001
　初中183.54　　7013.81　　888.66
年龄组/岁　　　　　　　　
　 8～9134.922.3880.311103.97 a20.298<0.001234.677.8930.019
　10～12244.90367.63 a606.65
　13～15123.005313.95659.09
过去2周内，是否出现腹泻　　　　　　　　
　是35.360.0070.934918.375.550.0181211.434.2710.039
　否464.19　　908.53　　1366.32
是否来过月经（仅女生）　　　　　　　　
　是　　　　7713.4629.369<0.001
　否　　　　224.14　　
), ArticleFig(id=1321169912379327356, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169906847040325, language=EN, label=Tab.3, caption=

Distribution of anemia among students with different dietary behaviors

, figureFileSmall=null, figureFileBig=null, tableContent=
项目男生贫血女生贫血合计
人数检出率/%χ2值P值人数检出率/%χ2值P值人数检出率/%χ2值P值
食用奶及奶制品的频次/包
　每周≤2205.954.1960.1234413.7912.7980.002649.7715.984<0.001
　每周3～6154.27　　266.99a　　416.01
　每天≥1143.00　　297.02a　　435.14
食用肉类的频次/次　　　　　　　　
　每周≤294.130.1360.9342911.893.5270.934388.232.8960.235
　每周3～6214.06　　397.72　　605.87
　每天≥1194.53　　318.73　　506.46
食用水果的频次/次
　每周≤283.310.8620.6502212.875.3050.070307.830.9510.621
　每周3～6174.87256.81426.23
　每天≥1244.26529.19767.22
食用蛋类的频次/次
　每周≤2205.453.4390.1794311.384.7280.118639.247.6490.002
　每周3～6204.45338.13536.61
　每天≥192.66237.19325.11
食用蔬菜的频次
　基本不吃00.003.5340.17125.880.4910.78222.382.8400.242
　每天1～2种304.01659.25957.00
　每天≥3种195.38328.72517.65
吃零食的频次/次　　　　　　　　
　每周≤2172.6510.2300.006508.311.1540.562675.397.4480.024
　每周3～6236.97 a　　3310.41　　568.66
　每天≥194.92　　168.65　　256.79
喜欢吃学校提供的食物吗？　　　　　　　　
　不喜欢10.765.6280.0601314.13a6.3560.042146.253.6170.164
　一般155.64　　3512.07　　508.99
　喜欢295.51　　387.62　　676.54
平时吃饭时会剩饭（菜）吗？　　　　　　　　
　是164.530.1030.7494611.565.1160.024628.265.3170.021
　否334.12　　537.51　　865.71
每天花多少钱买零食/元　　　　　　　　
　<193.560.6340.889115.24a14.8940.002204.3213.2190.004
　1 ～3.9204.71　　287.51a　　486.02
　4 ～6.993.88　　208.20　　296.09
　≥7114.51　　4014.44　　519.79
), ArticleFig(id=1321169912471602045, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169906847040325, language=CN, label=表3, caption=

不同饮食行为情况学生贫血状况分布

, figureFileSmall=null, figureFileBig=null, tableContent=
项目男生贫血女生贫血合计
人数检出率/%χ2值P值人数检出率/%χ2值P值人数检出率/%χ2值P值
食用奶及奶制品的频次/包
　每周≤2205.954.1960.1234413.7912.7980.002649.7715.984<0.001
　每周3～6154.27　　266.99a　　416.01
　每天≥1143.00　　297.02a　　435.14
食用肉类的频次/次　　　　　　　　
　每周≤294.130.1360.9342911.893.5270.934388.232.8960.235
　每周3～6214.06　　397.72　　605.87
　每天≥1194.53　　318.73　　506.46
食用水果的频次/次
　每周≤283.310.8620.6502212.875.3050.070307.830.9510.621
　每周3～6174.87256.81426.23
　每天≥1244.26529.19767.22
食用蛋类的频次/次
　每周≤2205.453.4390.1794311.384.7280.118639.247.6490.002
　每周3～6204.45338.13536.61
　每天≥192.66237.19325.11
食用蔬菜的频次
　基本不吃00.003.5340.17125.880.4910.78222.382.8400.242
　每天1～2种304.01659.25957.00
　每天≥3种195.38328.72517.65
吃零食的频次/次　　　　　　　　
　每周≤2172.6510.2300.006508.311.1540.562675.397.4480.024
　每周3～6236.97 a　　3310.41　　568.66
　每天≥194.92　　168.65　　256.79
喜欢吃学校提供的食物吗？　　　　　　　　
　不喜欢10.765.6280.0601314.13a6.3560.042146.253.6170.164
　一般155.64　　3512.07　　508.99
　喜欢295.51　　387.62　　676.54
平时吃饭时会剩饭（菜）吗？　　　　　　　　
　是164.530.1030.7494611.565.1160.024628.265.3170.021
　否334.12　　537.51　　865.71
每天花多少钱买零食/元　　　　　　　　
　<193.560.6340.889115.24a14.8940.002204.3213.2190.004
　1 ～3.9204.71　　287.51a　　486.02
　4 ～6.993.88　　208.20　　296.09
　≥7114.51　　4014.44　　519.79
), ArticleFig(id=1321169914149323646, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169906847040325, language=EN, label=Tab.4, caption=

Multifactorial logistic regression analysis of anemia-influencing factors in boys

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素比较组参照组β ${S_{\bar x}}$Wald χ2值P值OR值95%CI
常量–2.5550.28779.0430.0000.078
地区敦化市大安市1.8070.44416.526<0.0016.0912.549～14.555
营养状况营养不足正常–0.1800.5550.1060.7450.8350.282～2.476
超重肥胖–0.9970.3408.6020.0030.3710.190～0.718
吃零食的频次/次每周3～6每周≤20.7660.3355.2470.0222.1521.117～4.147
每天≥10.2850.4300.4400.5081.3290.573～3.088
), ArticleFig(id=1321169914237404031, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169906847040325, language=CN, label=表4, caption=

男生贫血影响因素多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素比较组参照组β ${S_{\bar x}}$Wald χ2值P值OR值95%CI
常量–2.5550.28779.0430.0000.078
地区敦化市大安市1.8070.44416.526<0.0016.0912.549～14.555
营养状况营养不足正常–0.1800.5550.1060.7450.8350.282～2.476
超重肥胖–0.9970.3408.6020.0030.3710.190～0.718
吃零食的频次/次每周3～6每周≤20.7660.3355.2470.0222.1521.117～4.147
每天≥10.2850.4300.4400.5081.3290.573～3.088
), ArticleFig(id=1321169914312901504, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169906847040325, language=EN, label=Tab.5, caption=

Multifactorial logistic regression analysis of anemia influence in girls

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素比较组参照组β ${S_{\bar x}}$Wald χ2值P值OR值95%CI
常量–4.2250.86323.962<0.0010.015
地区敦化市大安市1.1120.28914.089<0.0013.3091.725～5.355
食用奶及奶制品的频次/（200 mL/包）每周3～6包每周≤2包–0.6040.2984.0950.0430.5470.305～0.981
每天≥1包–0.8060.3077.8660.0050.4230.232～0.722
是否来过月经是否0.9450.3796.2160.0132.5731.224～5.408
母亲文化程度小学及以下大专及以上1.4900.6455.3340.0214.4361.253～15.706
初中0.9250.6332.1370.1442.5220.730～8.715
高中/中专/技校0.8360.6741.5400.2152.3070.616～8.636
), ArticleFig(id=1321169914392593281, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169906847040325, language=CN, label=表5, caption=

女生贫血影响多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素比较组参照组β ${S_{\bar x}}$Wald χ2值P值OR值95%CI
常量–4.2250.86323.962<0.0010.015
地区敦化市大安市1.1120.28914.089<0.0013.3091.725～5.355
食用奶及奶制品的频次/（200 mL/包）每周3～6包每周≤2包–0.6040.2984.0950.0430.5470.305～0.981
每天≥1包–0.8060.3077.8660.0050.4230.232～0.722
是否来过月经是否0.9450.3796.2160.0132.5731.224～5.408
母亲文化程度小学及以下大专及以上1.4900.6455.3340.0214.4361.253～15.706
初中0.9250.6332.1370.1442.5220.730～8.715
高中/中专/技校0.8360.6741.5400.2152.3070.616～8.636
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吉林省2023年农村义务教育学生营养改善计划地区学生贫血状况及影响因素分析
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崔红丽 , 张新刚 , 张丽薇 , 栾博 , 刘思洁 *, *
中国公共卫生 | 专题报道 —— 关注儿童健康成长 2025,41(6): 666-672
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中国公共卫生 |专题报道 —— 关注儿童健康成长 2025 , 41 (6) : 666 -672
吉林省2023年农村义务教育学生营养改善计划地区学生贫血状况及影响因素分析
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崔红丽, 张新刚, 张丽薇, 栾博, 刘思洁*, *
作者信息
  • 吉林省疾病预防控制中心，长春 130062
通讯作者:
刘思洁，E-mail：
作者简介:

崔红丽（1989—），主管医师，硕士，研究方向：学生营养监测

Anemia prevalence and associated factors among students benefiting from the rural compulsory education nutrition improvement program in Jilin province in 2023: a cross-sectional study
Hongli CUI, Xingang ZHANG, Liwei ZHANG, Bo LUAN, Sijie LIU
Affiliations
  • Jilin Provincial Center for Disease Control and Prevention, Changchun 130062, China
    • Corresponding Author:
    LIU Sijie, E-mail:
出版时间: 2025-06-10 doi: 10.11847/zgggws1146134
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摘要
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目的

探讨吉林省营养改善计划地区学生贫血状况及其影响因素，为制定有针对性的营养改善措施提供参考依据。

方法

采用分层整群抽样方法，在吉林省2023年实施“农村义务教育学生营养改善计划”的2个重点监测县，抽取小学三年级及以上小学生和初中生共2 258人作为调查对象，进行问卷调查、体格检查和血红蛋白检测，采用χ2检验和多因素二分类logistic回归分析学生贫血状况及其影响因素。

结果

吉林省农村义务教育学生营养改善计划地区的中小学生贫血率为6.55%，均为轻度（3.63%）和中度贫血（2.92%），女生贫血率（8.97%）高于男生（4.25%），差异有统计学意义（χ2=20.534，P<0.001 ）。在男生中，不同营养状况、吃零食频次的学生贫血检出率差异均有统计学意义（均P<0.05）；在女生中，不同母亲文化程度、学段、年龄组，过去2周内是否出现腹泻、是否来过月经、食用奶制品频次、吃零食频次、是否喜欢吃学校提供的食物情况、平时是否剩饭（菜）、每天买零食花费不同的学生贫血检出率差异均有统计学意义（均P<0.05）。多因素二分类logistic回归分析结果显示，与相应参照组比较，男生超重肥胖是贫血的保护因素，每周吃零食频率3～6次是患贫血的危险因素。女生食用奶及奶制品每周3～6次、每天≥1包（200 mL/包）是贫血的保护因素，来过月经、母亲文化程度小学及以下是女生患贫血的危险因素。敦化市男生和女生贫血患病风险分别是大安市的6.091倍和3.309倍。

结论

吉林省实施学生营养改善地区的学生贫血患病率存在性别差异，不同性别学生贫血影响因素不同，贫血检出率也存在地区差异，需制定个性化营养干预措施改善学生贫血状况。

贫血  /  学生  /  影响因素  /  回归分析  /  营养改善计划  /  吉林省
Objective

To investigate the anemia status and its influencing factors among students in the Nutrition Improvement Program areas of Jilin province, and to provide a reference for formulating targeted nutrition improvement measures.

Methods

A stratified cluster sampling method was used to select a total of 2 258 primary school students (grade 3 and above) and junior high school students from two key monitoring counties implementing the "Rural Compulsory Education Student Nutrition Improvement Program" in Jilin province in 2023. Questionnaires, physical examinations, and hemoglobin tests were conducted. The chi-square test and multivariate binary logistic regression analysis were used to analyze the anemia status and its influencing factors among the students.

Results

The anemia prevalence among primary and secondary school students in the Nutrition Improvement Program areas of rural Jilin province was 6.55%, all of which were mild (3.63%) and moderate anemia (2.92%). The anemia prevalence in girls (8.97%) was higher than that in boys (4.25%), and the difference was statistically significant (χ2 = 20.534, P < 0.001). Among boys, the detection rates of anemia differed significantly among students with different nutritional statuses and snacking frequencies (P < 0.05). Among girls, the detection rates of anemia differed significantly among students with different maternal education levels, school stages, age groups, whether they had diarrhea in the past two weeks, whether they had menstruated, frequency of dairy product consumption, snacking frequency, whether they liked the food provided by the school, whether they usually had leftover food, and daily snack expenditure (P < 0.05). Multivariate binary logistic regression analysis showed that, compared with the corresponding reference groups, overweight and obesity were protective factors against anemia in boys, while snacking 3-6 times per week was a risk factor for anemia. Consuming dairy products 3-6 times a week and ≥ 1 pack (200 mL/pack) daily were protective factors against anemia in girls, while having menstruated and having a mother with a primary school education or below were risk factors for anemia in girls. The risk of anemia in boys and girls in Dunhua city was 6.091 times and 3.309 times higher than that in Da'an city, respectively.

Conclusions

There are gender differences in the prevalence of anemia among students in the Nutrition Improvement Program areas of Jilin province. The influencing factors of anemia and the detection rates of anemia also vary by region. Individualized nutritional intervention measures are needed to improve the anemia status of students.

anemia  /  students  /  influencing factors  /  regression analysis  /  nutrition improvement plan  /  Jilin province
崔红丽, 张新刚, 张丽薇, 栾博, 刘思洁. 吉林省2023年农村义务教育学生营养改善计划地区学生贫血状况及影响因素分析. 中国公共卫生, 2025 , 41 (6) : 666 -672 . DOI: 10.11847/zgggws1146134
Hongli CUI, Xingang ZHANG, Liwei ZHANG, Bo LUAN, Sijie LIU. Anemia prevalence and associated factors among students benefiting from the rural compulsory education nutrition improvement program in Jilin province in 2023: a cross-sectional study[J]. Chinese Journal of Public Health, 2025 , 41 (6) : 666 -672 . DOI: 10.11847/zgggws1146134
正文
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贫血作为一种全球范围内广泛存在的公共卫生问题，任何年龄段人群均可发生，儿童青少年群体正处于生长发育的关键时期，尤为值得关注[1–3]。贫血不仅导致儿童青少年体力下降、学习能力受限，还可能对其免疫系统造成损害，增加感染风险，甚至可能影响其成年后的健康状况[4–5]。为改善农村学生营养状况，2011 年起国务院启动了农村义务教育学生营养改善计划，为贫困地区学生提供营养补助，以提高学生健康水平。 本研究以2023年吉林省农村义务教育学生营养改善计划重点监测县义务教育阶段的2 258名学生为研究对象，探讨吉林省学生贫血状况及其影响因素，为儿童青少年贫血预防提供科学依据。
1　对象与方法
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1.1　对象
2023年吉林省学生营养改善计划地区学生营养健康状况监测2个重点监测县分别是白城市大安市和延边州敦化市。采用分层随机整群抽样方法，选择县城有代表性的小学和初中各1所，农村有代表性的小学和初中各3所作为重点监测学校。兼顾学校食堂供餐和企业（单位）供餐模式比例和区域分布，每个重点监测县共8所学校开展学生的重点监测工作。每个学校按照年级分层抽样，每个年级抽取1～2个班级，约40人，男女生各半。选择小学3年级及以上小学生和初中生作为本次调查的研究对象，对象年龄为7～17岁，由于7、16、17岁人数较少，缺少代表性，剔除以上3个年龄的学生，选取年龄在8～15岁的2 258名学生作为研究对象，其中男生1 154人，占51.11%，女生1 104人，占48.89%。本项目经过中国疾病预防控制中心营养与健康所伦理委员会审批（批件号：2021-018），所有学生均在家长签署知情同意书后参加本项调查。
1.2　方法
所有学生均在早晨空腹状态下进行身高和体重测量，采用统一的仪器和测量方法。身高测量使用机械式身高坐高计，精确度为0.1 cm；体重测量使用电子体重计，精确度为0.1 kg。学生问卷调查采用中国疾病预防控制中心营养所统一编制的“农村学生营养健康监测学生调查表”，由经过统一培训的调查员对学生进行面对面问卷调查。问卷内容包括一般情况、饮食情况和饮食行为。饮食行为方面，学生对学校食物偏好评估采用自我报告方式，学生根据个人口味和偏好选择对学校食物的喜好程度，选项包括“喜欢”“一般”和“不喜欢”。此外，问卷还涉及营养知识的评估。血红蛋白检测样本采集学生早晨空腹的指尖末梢血，使用HemoCue® Hb 201+血红蛋白分析仪（瑞典HemoCue公司）进行血红蛋白含量检测；检测前各监测点按照要求进行盲样考核，合格后方可进行血红蛋白检测工作。参与学生问卷、体格检查及血红蛋白检测的调查员均为卫生或相关专业的技术人员，且在监测工作开始前接受统一系统培训，确保熟练掌握监测方法，并经过考核合格后方可参与相关监测工作。
1.3　诊断标准
根据身高和体重的测量结果，计算体质量指数（BMI），BMI=体重（kg）/[身高（m）]2。按照我国卫生行业标准《学龄儿童青少年营养不良筛查：WS/T456—2014》筛查学生营养不良[6]（包括生长迟缓和消瘦）。按照我国卫生行业标准《学龄儿童青少年超重与肥胖筛查：WS/T 586—2018》[7]筛查学生超重肥胖。以WHO制定的贫血诊断标准作为参考值：5～11岁儿童Hb<115 g/L、12～14岁儿童Hb<120 g/L、≥15岁男生Hb<130 g/L、≥15岁女生（非孕妇）Hb<120 g/L诊断为贫血。贫血严重程度分级：轻度贫血（110 g/L≤Hb<界值）；中度贫血（80 g/L≤Hb≤109 g/L）；重度贫血（Hb<80 g/L）[8]。
1.4　统计分析
采用SPSS 27.0软件进行统计分析。调查对象的基本情况、饮食行为情况及贫血状况，采用χ2检验比较不同组间患病率差异。采用多因素二元logistic回归模型分析贫血的影响因素（向后逐步法，α入=0.05，α出=0.10），检验水准α=0.05（双侧）。
2　结　果
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2.1　基本情况（表1）
本次研究共纳入调查对象2 258人，贫血检出人数148例，贫血检出率为6.55%，包括轻度贫血82例（3.63%），中度贫血66例（2.92%）。男生贫血检出率（4.25%）低于女生（8.97%），差异有统计学意义（χ2=20.534，P<0.001）。调查对象中大安市1 080人，其中男生550人（50.93%），女生530人（49.07%）；敦化市1 178人，其中男生604人（51.27%），女生574人（48.73%）。学生营养状况中，正常体重1 211人，其中男生514人（42.44%），女生697人（57.56%）；营养不足136人，其中男生74人（54.41%），女生62人（45.59%）；超重肥胖911人，其中男生566人（62.13%），女生345人（37.87%）。小学生1 242人，其中男生645人（51.93%），女生597人（48.07%）；中学生1 016人，其中男生509（50.10%）、女生507人（49.90%）。8～9岁516人，其中男生264人（51.16%），女生252人（48.84%）；10～12岁962人，其中男生490人（50.93%），女生472人（49.06%）；13～15岁780人，其中男生400人（51.28%），女生380人（48.72%）。
2.2　不同特征学生贫血状况分布（表2）
不同营养状况男生贫血率不同，超重肥胖男生的贫血率为2.30%（13/567），低于正常组的6.23%（32/514）和营养不足的5.33%（4/75），且差异有统计学意义（P<0.05）。在女生中，不同地区、母亲文化程度、学段、年龄组，过去2周内是否出现腹泻、是否来过月经，不同组间贫血患病率差异均有统计学意义（均P<0.05）。母亲文化程度是小学及以下的女生贫血率最高，为14.67%（33/225）；初中女生的贫血率为13.81%（70/507），高于小学生的4.86%（29/597）；13～15岁女生贫血率最高，为13.95%（53/380），其次是10～12岁为7.63%（36/472），8～9岁为3.97%（10/252）；过去2周内出现腹泻的学生贫血率为18.37%（9/49），高于未出现腹泻的8.53%（90/1 055）；来过月经的女生贫血率为13.46%（77/572），高于未来过的4.14%（22/532）。不同地区的男生与女生贫血患病率差异均有统计学意义；敦化市地区学生贫血率为9.59%（113/1 178），显著高于大安市的3.24%（35/1 080）。
2.3　不同饮食行为情况学生贫血状况分布（表3）
男生每周吃零食3～6次的贫血率（6.97%）高于每周≤2次的贫血率（2.65%），差异有统计学意义（P<0.05）；女生食用奶及奶制品每周≤2包贫血率（13.79%）高于每周3～6包（6.99%）及每天≥1包（7.02%）；“不喜欢”学校提供的食物的女生贫血率（14.13%）高于“一般”（12.07%）及“喜欢”（7.62%）的女生；平时吃饭剩饭（菜）的女生贫血率（11.56%）高于平时不剩饭（菜）的女生（7.51%）；每天花越多钱买零食的女生贫血率越高，每天花≥7元买零食的贫血率（14.44%）高于1 ～3.9元（7.51%）和<1元（5.24%）组。
2.4　学生贫血影响因素多因素logistic回归分析
2.4.1　男生贫血多因素logistic回归分析（表4）
以男生是否贫血作为因变量（0=否，1=是），将单因素分析中有统计学意义的地区、营养状况、吃零食的频次作为自变量进行多因素二分类logistic回归分析。结果显示，敦化市地区学生贫血患病率是大安市的6.091倍（95%CI=2.549～14.555）；与正常体重相比，超重肥胖的男生（OR=0.371，95%CI=0.190～0.718）更不易患贫血；每周吃3～6次零食（OR=2.152，95%CI=1.117～4.147）是患贫血的危险因素。
2.4.2　女生贫血多因素logistic回归分析（表5）
以女生是否贫血作为因变量（0=否，1=是），将单因素分析中有统计学意义的地区、学段、年龄组、母亲的文化程度、过去2周内是否出现腹泻、食用奶及奶制品的频次、是否喜欢学校提供的食物、平时是否会剩饭（菜）、每天花多少钱买零食、是否来过月经作为自变量进行多因素二分类logistic回归分析。结果显示，敦化市女生的贫血患病风险高于大安市（OR=3.309，95%CI=1.725～5.355）；食用奶及奶制品频率每周3～6包（OR=0.547，95%CI=0.305～0.981）和每天≥1包（OR=0.423，95%CI=0.232～0.722）与每周≤2包的女生相比更不易患贫血；来过月经的女生患贫血的风险高于未来过月经的女生（OR=2.573，95%CI=1.224～5.408）；母亲小学及以下学历（OR=4.436，95%CI=1.253～15.706）是女生患贫血的危险因素。
3　讨　论
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贫血是红细胞数量/血红蛋白浓度低于正常范围下限，不能够运输足够的氧至组织而产生的综合征[9]。铁缺乏是导致贫血最常见的原因，其他还包括维生素A、B12、叶酸缺乏引起的贫血[10–11]。贫血是全球性的公共卫生健康问题，在发展中国家更为显著，其严重性和普遍性不容忽视[12]。学龄儿童是贫血的高危人群之一，贫血对学龄儿童的生长发育和认知发育造成不可逆的负面影响。本研究结果显示，吉林省农村义务教育学生营养改善计划地区的学生整体贫血率为6.55%，均为轻度（3.63%）和中度贫血（2.92%），低于福建省（7.21%）[13]、重庆市（21.64%）[14]、广西壮族自治区（22.30%）[15]学生营养改善计划地区贫血水平，但高于海南省相关调查结果（1.70%）[16]，与2020年中国居民营养与慢性病状况调查[17]青少年贫血率（6.1%）接近。女生的贫血率（8.97%）显著高于男生（4.25%），与国内的其他调查研究结果一致[13, 18]。
单因素分析中，肉类、蔬菜、水果、蛋类每周摄入频次不同在男生和女生中贫血患病率方面均未见到差异。男生吃零食频次较高患贫血的风险增加，女生不喜欢学校提供的食物、平时吃饭剩饭、买零食花的钱越多贫血检出率较高，可能由于学生选择的零食营养价值较低，同时，爱吃零食间接导致营养丰富的正餐摄入较少[19]。过去由于物质条件相对匮乏及营养知识的认识不足，学生群体普遍面临营养素，尤其是铁质来源摄入不足的问题，这是导致贫血高发的一个重要原因[20]。随着社会经济的持续发展，人们的生活水平和食物消费水平正逐渐提高，肉类等富含铁质食物的摄入量有所增加，儿童青少年不合理的饮食习惯，如喜欢吃零食、挑食、偏食成为了患贫血的主要影响因素。
多因素回归分析结果显示，敦化市的男生和女生贫血患病风险分别是大安市的6.091倍和3.309倍。可能原因是大安市早于敦化市开展学生贫血的监测工作，学生营养配餐等措施得以落实，这凸显营养监测和营养宣教的重要性。男生超重肥胖患贫血发生风险较低，这与国内的其他研究结果一致[15, 21]，超重肥胖的儿童往往倾向于摄入更高能量、更为丰富多样的食物，同时也增加了铁、叶酸、维生素B12等造血关键营养素的摄入量，这些营养素对于预防贫血至关重要。但是不能忽略超重肥胖可能会引发其他健康问题，如增加成年时期肥胖和患心血管疾病、糖尿病等营养相关慢性病的发病风险[22–23]。因此，在提倡合理膳食的同时，也要强调身体活动的必要性，维持吃动平衡的状态。女生食用奶及奶制品是贫血的保护因素，可能原因是奶类中富含有多种微量营养素，尤其是维生素A，有调查证明，维生素A缺乏往往与缺铁性贫血同时存在[24–25]，铁缺乏的人群补充维生素A，即使在铁摄入量不变的情况下，铁的营养状况亦有所改善[26]。另有人群干预试验结果表明，补充牛奶和维生素A可提高血红蛋白和铁蛋白水平，并可提高人体对铁的吸收和利用，从而减少贫血的发生[27–28]。来过月经的女生发生贫血的风险是未来过月经女生的2.573倍，月经期间，女性会有一定量的失血，长期或大量的失血若未能得到及时且有效的铁质补充，就可能导致体内铁储备不足，进而引发缺铁性贫血[29]。其次，青少年生长发育期需铁量增加而摄入量不足，出现机体内铁供需失衡，增加贫血的风险[20]。研究发现，青少年女性在饮食选择上可能受到体重管理压力以及对身体形象等影响[30–31]，这些因素可能导致她们的营养摄入不足，尤其是铁、维生素B12和叶酸等关键营养素。另有研究表明，男性雄激素分泌可促进造血生长因子和造血系统的造血细胞，促进血红蛋白的生成，防止贫血的发生[32]，以上可能是女生贫血率显著高于男生的原因。相较于母亲拥有大专及以上学历的家庭，母亲文化程度为小学及以下的女生患贫血的风险高出4.436倍，这与国内其他的研究结果一致[14, 33]。这主要归因于低文化程度的母亲在健康素养及贫血预防认知上的局限性，可能导致女生在生长发育特别是生理期时营养摄入不均或缺乏，增加患贫血的风险[34]。相反，母亲文化程度较高的家庭，因对贫血防治有更深的认识，且能多渠道获取科学饮食与贫血预防知识，更倾向于采取积极的健康管理措施，确保子女饮食营养均衡[35]。
综上所述，针对2023年吉林省“农村义务教育学生营养改善计划”所覆盖区域，学生贫血状况集中于轻度和中度范畴，但地区间差异显著，男生与女生贫血的影响因素并不相同。未来的营养健康教育策略必须秉持因地制宜、因人而异的精细化原则根据各地区的实际情况与需求，强化营养宣教普及的针对性与实效性，不仅提升全校师生的营养意识，更要细化至家庭层面，形成家校共育的良好氛围。应将高危群体尤其是来月经的女生作为重点干预对象，并积极提倡饮用奶及奶制品，通过实施科学有效的营养干预策略，切实降低贫血发病率。

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2025年第41卷第6期
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doi: 10.11847/zgggws1146134
  • 接收时间：2024-10-12
  • 首发时间：2026-10-25
  • 出版时间：2025-06-10
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  • 收稿日期：2024-10-12
  • 修回日期：2025-02-05
  • 录用日期：2025-04-12
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    吉林省疾病预防控制中心，长春 130062

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刘思洁，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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