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Article(id=1259565860453213114, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1259565853893378510, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2026094, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1764000000000, receivedDateStr=2025-11-25, revisedDate=1768060800000, revisedDateStr=2026-01-11, acceptedDate=null, acceptedDateStr=null, onlineDate=1778233502734, onlineDateStr=2026-05-08, pubDate=1774368000000, pubDateStr=2026-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1778233502734, onlineIssueDateStr=2026-05-08, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1778233502734, creator=13701087609, updateTime=1778233502734, updator=13701087609, issue=Issue{id=1259565853893378510, tenantId=1146029695717560320, journalId=1256213402557890569, year='2026', volume='47', issue='3', pageStart='319', pageEnd='416', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1778233501170, creator=13701087609, updateTime=1778233964926, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1259567799123493033, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1259565853893378510, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1259567799123493034, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1259565853893378510, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=327, endPage=331, ext={EN=ArticleExt(id=1259565866404930499, articleId=1259565860453213114, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Analysis of undernutrition and associated factors among left-behind and non-left-behind primary and secondary school students in the Nutrition Improvement Program areas in central and western China, columnId=1259565862625862592, journalTitle=Chinese Journal of School Health, columnName=Student Nutrition, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the prevalence of undernutrition and its associated factors among left-behind and non-left-behind primary and secondary school students in the Nutrition Improvement Program for Rural Compulsory Education Students (NIPRCES) areas of central and western China, so as to provide evidence for improving the nutritional status of children and adolescents.

Methods

A survey was conducted among 123 782 students selected by random cluster sampling method in grades 3-9 from NIPRCES in central (Hebei, Shanxi, Heilongjiang, Jilin, Anhui, Jiangxi, Henan, Hunan, Hubei, and Hainan) and western (Gansu, Guangxi, Inner Mongolia, Ningxia, Tibet, Shaanxi, Guizhou, Sichuan, Xinjiang, the Xinjiang Production and Construction Corps, Yunnan, Qinghai, and Chongqing) China in 2023. Anthropometric measurements and questionnaires were used to assess nutritional and dietary status. The prevalence of undernutrition was compared between left-behind and non-left-behind students by Chi-square test, and associated factors were analyzed by three-level Logistic mixed effects model.

Results

The prevalence of undernutrition was 8.5% (4 326) in left-behind students and 8.1% (5 905) in non-left-behind students. Three-level Logistic mixed-effect model analysis showed that whether left-behind or non-left-behind, the undernutrition rates of primary and secondary students in western regions were higher than those of students in central regions [OR(95%CI)=1.72(1.57-1.87), 2.25(2.07-2.43)]; the undernutrition risk was lower for those whose fathers had a cultural level of high school or above [OR(95%CI)=0.69(0.62-0.77), 0.90(0.82-0.98)] or junior high school [OR(95%CI)=0.72(0.66-0.79), 0.92(0.85-0.99)] compared to those with primary school or below; picky eating or selective eating increased the risk of undernutrition [OR(95%CI)=2.36(2.07-2.68), 2.28(2.04-2.55)], and primary and secondary school students without nutritional content in health education classes had higher rates of undernutrition [OR(95%CI)=1.12(1.03-1.23), 1.09(1.01-1.17)](all P < 0.05).

Conclusion

The prevalence of undernutrition is slightly higher in left-behind primary and secondary students than in non-left-behind primary and secondary students in central and western NIPRCES areas, with variations across different characteristics.

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目的

了解中国中西部“农村义务教育学生营养改善计划”(NIPRCES)地区留守与非留守中小学生营养不足状况及其相关因素，为改善中国儿童青少年营养状况提供信息。

方法

采用身体测量和问卷调查方法调查2023年中国中西部NIPRCES地区(中部地区：河北、山西、黑龙江、吉林、安徽、江西、河南、湖南、湖北、海南; 西部地区：甘肃、广西、内蒙古、宁夏、西藏、陕西、贵州、四川、新疆、新疆生产建设兵团、云南、青海、重庆)，随机整群抽取160个重点监测县的三至九年级123 782名中小学生营养及饮食等状况，采用χ2检验比较留守与非留守中小学生营养不足率，采用三水平Logistic混合效应模型分析其相关因素。

结果

留守与非留守中小学生营养不足率分别为8.5%(4 326名)与8.1%(5 905名)。三水平Logistic混合效应模型分析显示，无论留守还是非留守中小学生，西部地区的中小学生营养不足率均高于中部地区者[OR值(95%CI)分别为1.72(1.57~1.87)，2.25(2.07~2.43)]，父亲文化程度为高中及以上[OR值(95%CI)分别为0.69(0.62~0.77)，0.90(0.82~0.98)]或初中[OR值(95%CI)分别为0.72(0.66~0.79)，0.92(0.85~0.99)]学生低于父亲文化程度为小学及以下者，挑食或偏食均增加营养不足发生风险[OR值(95%CI)分别为2.36(2.07~2.68)，2.28(2.04~2.55)]，健康教育课无营养内容的中小学生营养不足率更高[OR值(95%CI)分别为1.12(1.03~1.23)，1.09(1.01~1.17)](P值均 < 0.05)。

结论

中国中西部NIPRCES地区留守中小学生营养不足率略高于非留守中小学生，且不同特征中小学生间存在差异。

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许娟，E-mail:
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胡昕(2000-)，女，山东省人，在读硕士，主要研究方向为学生营养与健康

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胡昕(2000-)，女，山东省人，在读硕士，主要研究方向为学生营养与健康

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胡昕(2000-)，女，山东省人，在读硕士，主要研究方向为学生营养与健康

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Comparison of malnutrition detection rates between left-behind children and non-left-behind primary and secondary school students in different groups

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项留守非留守
人数营养不足人数χ2值P值人数营养不足人数χ2值P值
性别女24 5451 562(6.4)279.92< 0.0136 1252 357(6.5)237.86< 0.01
男26 3092 764(10.5)36 8033 548(9.6)
学段小学30 3052 787(9.2)45.85< 0.0143 9563 644(8.3)5.540.02
初中20 5491 539(7.5)28 9722 261(7.8)
地区中15 9171 187(7.5)32.77< 0.0121 4501 631(7.6)115.00< 0.01
西34 9373 139(9.0)50 9964 229(8.3)
是否住宿是20 8271 716(8.2)3.240.0727 2152 229(8.2)0.510.48
否30 0272 610(8.7)45 7133 676(8.0)
父亲文化程度小学及以下16 3571 481(9.1)21.71< 0.0125 0002 085(8.3)9.740.01
初中24 0212 065(8.6)28 8222 373(8.2)
高中及以上10 476780(7.4)19 1061 447(7.6)
是否挑食或偏食否46 3183 753(8.1)108.91< 0.0167 1435 215(7.8)123.89< 0.01
是4 536573(12.6)5 785690(11.9)
每周吃肉类频次≤426 0242 149(8.3)4.240.0435 5522 789(7.8)5.930.02
≥524 8302 177(8.8)37 3763 116(8.3)
每周吃奶及奶制品/包≤432 5622 810(8.6)1.760.1943 8383 617(8.3)3.490.06
≥518 2921 516(8.3)29 0902 288(7.9)
每天吃新鲜蔬菜/种≤114 9851 326(8.8)3.200.0821 0171 641(7.8)3.320.07
≥235 8693 000(8.4)51 9114 264(8.2)
每周吃水果频次≤433 3542 853(8.6)0.280.6043 8183 566(8.1)0.250.63
≥517 5001 473(8.4)29 1102 339(8.0)
每周吃零食频次≤441 8403 479(8.3)11.14< 0.0160 7084 838(8.0)7.940.01
≥59 014847(9.4)12 2201 067(8.7)
健康教育课是否有有34 1822 787(8.2)18.35< 0.0146 9213 631(7.7)18.35< 0.01
营养内容无10 480994(9.5)16 8411 519(9.0)
膳食补助主要供餐模式学校食堂39 7483 355(8.4)2.080.1554 1464 378(8.1)2.920.09
企业或家庭6 630595(9.0)10 543905(8.6)
), ArticleFig(id=1259565900391375091, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1259565860453213114, language=CN, label=表1, caption=

不同组别留守与非留守中小学生营养不足检出率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项留守非留守
人数营养不足人数χ2值P值人数营养不足人数χ2值P值
性别女24 5451 562(6.4)279.92< 0.0136 1252 357(6.5)237.86< 0.01
男26 3092 764(10.5)36 8033 548(9.6)
学段小学30 3052 787(9.2)45.85< 0.0143 9563 644(8.3)5.540.02
初中20 5491 539(7.5)28 9722 261(7.8)
地区中15 9171 187(7.5)32.77< 0.0121 4501 631(7.6)115.00< 0.01
西34 9373 139(9.0)50 9964 229(8.3)
是否住宿是20 8271 716(8.2)3.240.0727 2152 229(8.2)0.510.48
否30 0272 610(8.7)45 7133 676(8.0)
父亲文化程度小学及以下16 3571 481(9.1)21.71< 0.0125 0002 085(8.3)9.740.01
初中24 0212 065(8.6)28 8222 373(8.2)
高中及以上10 476780(7.4)19 1061 447(7.6)
是否挑食或偏食否46 3183 753(8.1)108.91< 0.0167 1435 215(7.8)123.89< 0.01
是4 536573(12.6)5 785690(11.9)
每周吃肉类频次≤426 0242 149(8.3)4.240.0435 5522 789(7.8)5.930.02
≥524 8302 177(8.8)37 3763 116(8.3)
每周吃奶及奶制品/包≤432 5622 810(8.6)1.760.1943 8383 617(8.3)3.490.06
≥518 2921 516(8.3)29 0902 288(7.9)
每天吃新鲜蔬菜/种≤114 9851 326(8.8)3.200.0821 0171 641(7.8)3.320.07
≥235 8693 000(8.4)51 9114 264(8.2)
每周吃水果频次≤433 3542 853(8.6)0.280.6043 8183 566(8.1)0.250.63
≥517 5001 473(8.4)29 1102 339(8.0)
每周吃零食频次≤441 8403 479(8.3)11.14< 0.0160 7084 838(8.0)7.940.01
≥59 014847(9.4)12 2201 067(8.7)
健康教育课是否有有34 1822 787(8.2)18.35< 0.0146 9213 631(7.7)18.35< 0.01
营养内容无10 480994(9.5)16 8411 519(9.0)
膳食补助主要供餐模式学校食堂39 7483 355(8.4)2.080.1554 1464 378(8.1)2.920.09
企业或家庭6 630595(9.0)10 543905(8.6)
), ArticleFig(id=1259565902136205559, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1259565860453213114, language=EN, label=Tab.2, caption=

Logistic regression analysis of factors related to nutritional insufficiency in left-behind and non-left-behind primary and secondary school students

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量选项留守(n=50 854)非留守(n=72 208)
β值Wald χ2值OR值(95%CI)β值Wald χ2值OR值(95%CI)
性别女1.001.00
男0.116.991.11(1.03~1.21)*0.020.321.02(0.95~1.09)
学段小学1.001.00
初中-0.1411.500.87(0.80~0.94)*0.010.151.01(0.95~1.08)
地区中1.001.00
西0.54150.751.72(1.57~1.87)*0.81392.252.25(2.07~2.43)*
父亲文化程度小学及以下1.001.00
初中-0.115.840.90(0.82~0.98)*-0.095.110.92(0.85~0.99)*
高中及以上-0.3741.790.69(0.62~0.77)*-0.3253.650.72(0.66~0.79)*
是否挑食或偏食否1.001.00
是0.86171.002.36(2.07~2.68)*0.82209.512.28(2.04~2.55)*
每周吃肉类/次≤41.001.00
≥50.094.891.09(1.01~1.18)*0.010.181.01(0.95~1.08)
每周吃零食/次≤41.001.00
≥50.071.581.07(0.96~1.19)0.083.341.09(0.99~1.18)
健康教育课是否有有1.001.00
营养内容无0.126.671.12(1.03~1.23)*0.095.461.09(1.01~1.17)*
), ArticleFig(id=1259565902484332795, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1259565860453213114, language=CN, label=表2, caption=

留守与非留守中小学生营养不足相关因素Logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量选项留守(n=50 854)非留守(n=72 208)
β值Wald χ2值OR值(95%CI)β值Wald χ2值OR值(95%CI)
性别女1.001.00
男0.116.991.11(1.03~1.21)*0.020.321.02(0.95~1.09)
学段小学1.001.00
初中-0.1411.500.87(0.80~0.94)*0.010.151.01(0.95~1.08)
地区中1.001.00
西0.54150.751.72(1.57~1.87)*0.81392.252.25(2.07~2.43)*
父亲文化程度小学及以下1.001.00
初中-0.115.840.90(0.82~0.98)*-0.095.110.92(0.85~0.99)*
高中及以上-0.3741.790.69(0.62~0.77)*-0.3253.650.72(0.66~0.79)*
是否挑食或偏食否1.001.00
是0.86171.002.36(2.07~2.68)*0.82209.512.28(2.04~2.55)*
每周吃肉类/次≤41.001.00
≥50.094.891.09(1.01~1.18)*0.010.181.01(0.95~1.08)
每周吃零食/次≤41.001.00
≥50.071.581.07(0.96~1.19)0.083.341.09(0.99~1.18)
健康教育课是否有有1.001.00
营养内容无0.126.671.12(1.03~1.23)*0.095.461.09(1.01~1.17)*
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中国中西部营养改善计划地区留守与非留守中小学生营养不足及相关因素分析
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胡昕 1 , 王文斌 1 , 曹薇 1, 2 , 王宏亮 1 , 陈慕磊 3 , 刘瑶 4 , 杨媞媞 1 , 潘慧 1 , 罗瑞鹤 1 , 张建芬 1 , 张倩 1, 2 , 许娟 1
中国学校卫生 | 学生营养 2026,47(3): 327-331
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中国学校卫生 | 学生营养 2026, 47(3): 327-331
中国中西部营养改善计划地区留守与非留守中小学生营养不足及相关因素分析
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胡昕1, 王文斌1, 曹薇1, 2, 王宏亮1, 陈慕磊3, 刘瑶4, 杨媞媞1, 潘慧1, 罗瑞鹤1, 张建芬1, 张倩1, 2, 许娟1
作者信息
  • 1中国疾病预防控制中心营养与健康所，北京 100050
  • 2国家卫生健康委员会公共营养与健康重点实验室
  • 3中国疾病预防控制中心教育培训处
  • 4中国疾病预防控制中心公共卫生管理处

    • 胡昕(2000-)，女，山东省人，在读硕士，主要研究方向为学生营养与健康

通讯作者:

许娟，E-mail:
Analysis of undernutrition and associated factors among left-behind and non-left-behind primary and secondary school students in the Nutrition Improvement Program areas in central and western China
Xin HU1, Wenbin WANG1, Wei CAO1, 2, Hongliang WANG1, Mulei CHEN3, Yao LIU4, Titi YANG1, Hui PAN1, Ruihe LUO1, Jianfen ZHANG1, Qian ZHANG1, 2, Juan XU1
Affiliations
  • National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
出版时间: 2026-03-25 doi: 10.16835/j.cnki.1000-9817.2026094
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摘要
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目的

了解中国中西部“农村义务教育学生营养改善计划”(NIPRCES)地区留守与非留守中小学生营养不足状况及其相关因素，为改善中国儿童青少年营养状况提供信息。

方法

采用身体测量和问卷调查方法调查2023年中国中西部NIPRCES地区(中部地区：河北、山西、黑龙江、吉林、安徽、江西、河南、湖南、湖北、海南; 西部地区：甘肃、广西、内蒙古、宁夏、西藏、陕西、贵州、四川、新疆、新疆生产建设兵团、云南、青海、重庆)，随机整群抽取160个重点监测县的三至九年级123 782名中小学生营养及饮食等状况，采用χ2检验比较留守与非留守中小学生营养不足率，采用三水平Logistic混合效应模型分析其相关因素。

结果

留守与非留守中小学生营养不足率分别为8.5%(4 326名)与8.1%(5 905名)。三水平Logistic混合效应模型分析显示，无论留守还是非留守中小学生，西部地区的中小学生营养不足率均高于中部地区者[OR值(95%CI)分别为1.72(1.57~1.87)，2.25(2.07~2.43)]，父亲文化程度为高中及以上[OR值(95%CI)分别为0.69(0.62~0.77)，0.90(0.82~0.98)]或初中[OR值(95%CI)分别为0.72(0.66~0.79)，0.92(0.85~0.99)]学生低于父亲文化程度为小学及以下者，挑食或偏食均增加营养不足发生风险[OR值(95%CI)分别为2.36(2.07~2.68)，2.28(2.04~2.55)]，健康教育课无营养内容的中小学生营养不足率更高[OR值(95%CI)分别为1.12(1.03~1.23)，1.09(1.01~1.17)](P值均 < 0.05)。

结论

中国中西部NIPRCES地区留守中小学生营养不足率略高于非留守中小学生，且不同特征中小学生间存在差异。

营养政策  /  营养状况  /  回归分析  /  学生
Objective

To investigate the prevalence of undernutrition and its associated factors among left-behind and non-left-behind primary and secondary school students in the Nutrition Improvement Program for Rural Compulsory Education Students (NIPRCES) areas of central and western China, so as to provide evidence for improving the nutritional status of children and adolescents.

Methods

A survey was conducted among 123 782 students selected by random cluster sampling method in grades 3-9 from NIPRCES in central (Hebei, Shanxi, Heilongjiang, Jilin, Anhui, Jiangxi, Henan, Hunan, Hubei, and Hainan) and western (Gansu, Guangxi, Inner Mongolia, Ningxia, Tibet, Shaanxi, Guizhou, Sichuan, Xinjiang, the Xinjiang Production and Construction Corps, Yunnan, Qinghai, and Chongqing) China in 2023. Anthropometric measurements and questionnaires were used to assess nutritional and dietary status. The prevalence of undernutrition was compared between left-behind and non-left-behind students by Chi-square test, and associated factors were analyzed by three-level Logistic mixed effects model.

Results

The prevalence of undernutrition was 8.5% (4 326) in left-behind students and 8.1% (5 905) in non-left-behind students. Three-level Logistic mixed-effect model analysis showed that whether left-behind or non-left-behind, the undernutrition rates of primary and secondary students in western regions were higher than those of students in central regions [OR(95%CI)=1.72(1.57-1.87), 2.25(2.07-2.43)]; the undernutrition risk was lower for those whose fathers had a cultural level of high school or above [OR(95%CI)=0.69(0.62-0.77), 0.90(0.82-0.98)] or junior high school [OR(95%CI)=0.72(0.66-0.79), 0.92(0.85-0.99)] compared to those with primary school or below; picky eating or selective eating increased the risk of undernutrition [OR(95%CI)=2.36(2.07-2.68), 2.28(2.04-2.55)], and primary and secondary school students without nutritional content in health education classes had higher rates of undernutrition [OR(95%CI)=1.12(1.03-1.23), 1.09(1.01-1.17)](all P < 0.05).

Conclusion

The prevalence of undernutrition is slightly higher in left-behind primary and secondary students than in non-left-behind primary and secondary students in central and western NIPRCES areas, with variations across different characteristics.

Nutrition policy  /  Nutritional status  /  Regression analysis  /  Students
胡昕, 王文斌, 曹薇, 王宏亮, 陈慕磊, 刘瑶, 杨媞媞, 潘慧, 罗瑞鹤, 张建芬, 张倩, 许娟. 中国中西部营养改善计划地区留守与非留守中小学生营养不足及相关因素分析. 中国学校卫生, 2026 , 47 (3) : 327 -331 . DOI: 10.16835/j.cnki.1000-9817.2026094
Xin HU, Wenbin WANG, Wei CAO, Hongliang WANG, Mulei CHEN, Yao LIU, Titi YANG, Hui PAN, Ruihe LUO, Jianfen ZHANG, Qian ZHANG, Juan XU. Analysis of undernutrition and associated factors among left-behind and non-left-behind primary and secondary school students in the Nutrition Improvement Program areas in central and western China[J]. Chinese Journal of School Health, 2026 , 47 (3) : 327 -331 . DOI: 10.16835/j.cnki.1000-9817.2026094
正文
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相关报告显示，2020年我国农村留守儿童有4 177万人，占全部农村儿童的37.9%[1]。留守儿童由于父母照护缺位，其日常膳食喂养与营养摄入状况普遍弱于非留守儿童[2]，使得他们面临更高的营养不足风险[3]，这一问题在我国中西部经济发展相对滞后的地区尤为突出，已成为影响儿童健康发展的重要公共卫生问题。尽管“农村义务教育学生营养改善计划”(nutrition improvement program for rural compulsory education students，NIPRCES)已在中西部地区实施并整体改善了学生营养[4]，但留守与非留守儿童间的营养差距是否依然显著，仍需基于大规模数据进一步明确。为此，本研究利用2023年NIPRCES的监测数据，比较分析中西部NIPRCES地区留守与非留守中小学生的营养不足状况及其相关因素，为完善相关政策，更好促进项目实施地区儿童青少年健康成长提供基础信息。
1　对象与方法
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1.1　对象
研究数据来源于2023年NIPRCES学生营养健康状况监测评估。采用随机整群抽样法，在中西部地区(参考全国NIPRCES领导小组办公室文件[5]，河北、山西、黑龙江、吉林、安徽、江西、河南、湖南、湖北、海南归为中部地区; 甘肃、广西、内蒙古、宁夏、西藏、陕西、贵州、四川、新疆、新疆生产建设兵团、云南、青海、重庆归为西部地区)160个重点监测县的常规监测学校中，结合供餐模式比例与区域分布进行抽样。采用简单随机抽样方法在每个县选取县城小学与初中各1所、农村小学与初中各3所。在小学三年级至初中三年级各年级中抽取1~2个班级，每个班约抽取40名学生，不足40名的班级则全部学生纳入调查。共纳入123 782名中小学生，其中留守50 854名，男生63 112名，小学生74 261名，西部地区学生88 861名。研究通过中国疾病预防控制中心营养与健康所伦理委员会批准(批号：2021-018)，参与调查的中小学生及家长均并签署知情同意书。
1.2　方法
1.2.1　问卷调查
采用四类标准化问卷系统收集多层面数据，其中包括县基本情况表、学校基本情况表、学生调查表和家长调查表，问卷由中国疾病预防控制中心营养与健康所统一编制。(1)县基本情况表通过教育行政部门负责人填写。(2)学校基本情况表由各监测学校主管负责人填报，内容涉及地区差异、学校供餐模式、健康教育相关情况。(3)学生问卷由经过统一培训的调查员在课堂环境下组织学生自主完成，收集学生性别、学段、是否留守等基本人口学特征(留守指父母双方或一方每年有超过6个月外出打工，学生留在农村生活[5])以及肉类、奶类、蔬菜水果、零食饮料等食物摄入信息。(4)家长问卷由学生带回家，由主要监护人填写后回收，内容涵盖父母文化程度、学生饮食行为等情况，既往文献显示父亲文化程度对于儿童营养状况的影响显著[6-7]，本研究仅纳入父亲文化程度。
1.2.2　身高、体重测量
使用电子体重秤测量学生晨起空腹体重，测量结果以kg为单位，精确度为0.1 kg；使用身高坐高计测量学生身高，以cm为单位，精确到0.1 cm。根据身高和体重计算体质量指数(body mass index，BMI)=体重(kg)/[身高(m)]2。
1.2.3　营养状况指标
根据《学龄儿童营养不良筛查》[8]中不同性别儿童年龄别身高界值点判断儿童是否生长迟缓；对于非生长迟缓儿童，其BMI≤同性别年龄别儿童筛查消瘦界值点判断为消瘦。本研究将生长迟缓和消瘦合并为“营养不足”。
1.3　质量控制
在组织管理层面，研究遵循统一技术方案与操作手册，实行国家级培训与督导、省级统筹与终审、县级具体执行的分级责任制。调查前对参与调查人员统一培训，规范问卷调查与体格测量方法。现场实施阶段，所有调查点均使用经校准的统一设备，调查人员在调查期间接受上级专家的现场巡回督导与技术核查。数据管理采用网络直报系统，由调查人员录入统一数据平台，并按统一制定的清理原则进行清理，执行即报即审与省级终审制度，构建了从县到国家的逐级审核与反馈机制。此外，全过程的档案记录与系统化存档确保了所有环节的可追溯性。
1.4　统计学分析
采用SAS 9.4统计软件进行数据清理及统计分析。计数资料采用频数(n)和百分比(%)描述。考虑到抽样设计中存在的数据嵌套结构(学生嵌套于学校，学校嵌套于县)，采用三水平Logistic混合效应模型(Level 1:学生；Level 2:学校；Level 3:县)分析营养不足的相关因素。首先计算组内相关系数，结果显示为8.39%(县级4.15%，校级4.24%)，证实使用多水平模型的必要性。模型以是否营养不足为因变量(否=0，是=1)，单因素分析中有统计学意义的变量为自变量。所有分析均为双侧检验，检验水准α=0.05。
2　结果
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2.1　留守中小学生营养不足率及其相关因素
单因素分析显示，留守中小学生营养不足率为8.5%(4 326名)。不同性别、学段、地区、父亲文化程度、是否挑食或偏食、每周吃肉类频次、每周吃零食频次、健康教育课是否有营养内容的留守中小学生营养不足检出率差异均有统计学意义(P值均 < 0.05)。见表 1。多因素Logistic回归分析显示，男生、西部地区、挑食或偏食、每周吃肉类≥5次、健康教育课无营养内容的中小学生营养不足率相对更高；初中生营养不足率低于小学生，父亲文化程度为“高中及以上”和“初中”的中小学生营养不足率低于“小学及以下”者(P值均 < 0.05)。见表 2。
2.2　非留守中小学生营养不足率及其相关因素
单因素分析显示，8.1%(5 905名)非留守中小学生为营养不足。不同性别、学段、地区、父亲文化程度、是否挑食或偏食、每周吃肉类频次、每周吃零食频次健康教育课是否有营养内容的非留守中小学生营养不足检出率差异均有统计学意义(P值均 < 0.05)。见表 1。多因素Logistic回归分析显示，西部地区、挑食或偏食、健康教育课无营养内容的中小学生营养不足率更高；父亲文化程度为“高中及以上”和“初中”的中小学生营养不足率低于“小学及以下”者(P值均 < 0.05)。见表 2。
2.3　留守与非留守中小学生营养不足状况比较
调查对象营养不足率为8.3%(10 231/123 782)。在调整性别、学段、地区、是否住宿、父亲文化程度、是否挑食或偏食、膳食补助主要供餐模式，以及肉、蔬菜、奶及其制品、零食摄入等可能混杂因素后，留守中小学生营养不足率仍高于非留守中小学生(OR=1.15，95%CI=1.10~1.21，P < 0.05)。
3　讨论
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本研究中留守中小学生营养不足率(8.5%)略高于非留守中小学生(8.1%)。一项Meta分析结果显示，留守儿童消瘦(RR=1.13)和发育迟缓(RR=1.12)的风险高于非留守中小学生[9]。与既往研究相比，本研究中留守与非留守中小学生营养不足率差异小，可能是持续开展的NIPRCES有效改善了计划地区留守中小学生营养水平。2022年张洁怡等[4]关于NIPRCES实施效果的研究显示，NIPRCES实施6年后中小学生生长迟缓率和消瘦率分别降低6.4%和0.7%。在埃塞俄比亚的前瞻性研究中，学校供餐使青少年的身高、体重和BMI显著提升[10]。本研究结果也显示学校供餐出现营养不足的比例低于企业或家庭供餐，中西部地区学校供餐覆盖率已达到75.9%，这一水平可能有效弥补了留守中小学生家庭膳食供给的不足。
本研究留守与非留守中小学男生营养不足率均高于女生，其中留守中小学生结果与张帅等[11]关于中国7~12岁儿童营养状况的研究结果一致。另一项研究显示，双亲留守及单亲留守儿童中，男生的营养不足率均要高于女生[2]。可能是因为男性因生理特点对于能量、蛋白质的需求高于女性，所以在面临食物营养不足或者饮食质量不高时更易出现能量等缺乏情况[12]。本研究还发现小学生营养不足率高于初中生，与国内相关研究结果一致[13-18]。可能由于小学高年级阶段是儿童生长发育的第二快速增长期，对各种营养素的需求量增加，但此阶段儿童胃容量仍有限，或伴有挑食、偏食行为，导致营养摄入无法满足生理需求[14]。本研究显示西部地区中小学生的营养不足率高于中部地区。高婷婷等[15]针对NIPRCES地区儿童的研究显示西部地区的生长迟缓率高于中部地区(7.1%，3.7%)。可能是由于西部地区经济发展相对滞后，限制了食物的可及性与多样性，增加中小学生营养不足的发生。本研究还显示，父亲文化程度与中小学生营养不足呈负相关，在Kocaadam-Bozkurt等[16]的研究中得到验证。可能是由于父亲文化程度越高，家庭收入和食物购买力越高，可以为儿童提供充足、多样化的营养健康食物[17]。
此外，本研究发现留守中小学生不住宿者营养不足率高于住宿者，非留守中小学生则相反。原因可能在于留守中小学生不住宿时，膳食受监护人营养知识不足、喂养不科学、家庭经济制约[18]，家庭营养照护减弱；住宿时学校提供稳定膳食如营养改善计划[10]，营养更有保障。非留守不住宿中小学生能获得父母科学照料与个性化营养[19]，可能更好地满足生长发育需求。挑食或偏食会影响儿童的营养摄入和饮食质量，从而对生长发育产生负面影响[20-26]。本研究结果显示挑食或偏食儿童营养不足风险更高。加拿大的一项儿童饮食行为研究验证了此关联[21]。但Jani等[22]的研究中并没有发现挑食与儿童营养状况之间的关联。美国的一项系统评价研究发现，在纳入的41项研究中既有表明挑食与营养状况无关的，也有认为挑食与营养不足存在关联[23]，可能与“挑食偏食”的定义和评估标准的差异有关。此外，研究的样本代表性以及横断面设计无法回答挑食与健康问题之间的因果关系均可能影响结果[24-25]。奶类富含钙和优质蛋白质，奶制品摄入对中小学生营养健康，尤其骨骼发育有积极作用。本研究发现奶制品高频摄入会降低中小学生营养不足风险。Herber等[26]发现饮奶会使儿童消瘦、体重过轻、发育迟缓的发生率降低。在孟加拉国农村地区，随着儿童牛奶摄入量增加，其BMI提高，生长迟缓率降低[27]。
本研究也存在一些局限性：(1)问卷调查收集学生的食物摄入种类与频次等信息，可能存在回忆偏倚。(2)研究是横断面调查，无法探索营养不足与相关因素间的因果关系。
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2026年第47卷第3期
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doi: 10.16835/j.cnki.1000-9817.2026094
  • 接收时间：2025-11-25
  • 首发时间：2026-05-08
  • 出版时间：2026-03-25
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  • 收稿日期：2025-11-25
  • 修回日期：2026-01-11
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    1中国疾病预防控制中心营养与健康所，北京 100050
    2国家卫生健康委员会公共营养与健康重点实验室
    3中国疾病预防控制中心教育培训处
    4中国疾病预防控制中心公共卫生管理处

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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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