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Article(id=1325502446834954413, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325502070660407522, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025112, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1704643200000, receivedDateStr=2024-01-08, revisedDate=1710950400000, revisedDateStr=2024-03-21, acceptedDate=null, acceptedDateStr=null, onlineDate=1793954009969, onlineDateStr=2026-11-06, pubDate=1748102400000, pubDateStr=2025-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793954009969, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793954009969, creator=13701087609, updateTime=1793954009969, updator=13701087609, issue=Issue{id=1325502070660407522, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='5', pageStart='609', pageEnd='760', issueExtLink='null', onlineDate='null', pubDate='1748102400000', pubDateStr='2025-05-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793953920283, creator='13701087609', updateTime=1793953920283, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=642, endPage=646, ext={EN=ArticleExt(id=1325502447183081646, articleId=1325502446834954413, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Association of dining locations with nutritional status among Chinese children aged 6-17 years, columnId=1259565862625862592, journalTitle=Chinese Journal of School Health, columnName=Student Nutrition, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the association of eating dining locations and their association with nutritional status among Chinese children aged 6-17 years, so as to provide reference for guiding children's reasonable diet.

Methods

Stratified random cluster sampling was used to select children aged 6 to 17 years from 28 cities and rural areas of 14 provinces in East, North, Central, South, Southwest, Northwest, Northeast of China, and a total of 52 535 children were included in the study from 2019 to 2021. Information including dining locations, demographic characteristics, dietary intakes and physical activity were collected through a questionnaire survey. Fasting body height and weight were measured in the morning. Unordered multiclass Logistic regression analysis was conducted to assess the relationship between dining locations and nutritional status in children.

Results

Regarding children's dining locations, 66.3% ate breakfast at home, 25.8% ate breakfast at school, 7.9% ate breakfast outside (small dining tables, restaurants, stalls, etc.); 67.7% ate dinner at home, 29.0% ate dinner at school, 3.3% ate dinner outside; and 63.6% ate lunch at school, 30.8% ate lunch at home, 5.7% ate lunch outside. The prevalence rates of overweight/obesity and undernutrition were 28.6% and 9.3%, respectively. The adjusted multiclass Logistic regression analysis (controlling for age, region, parental education, household income, total energy intake, and moderate-to-vigorous physical activity) demonstrated that, compared to eating at home, school-based breakfast and dinner consumption was associated with significantly lower overweight/obesity risks for both genders (boys: breakfast OR=0.70, 95%CI=0.65-0.75; dinner OR=0.80, 95%CI=0.74-0.86; girls: breakfast OR=0.89, 95%CI=0.82-0.96; dinner OR=0.88, 95%CI=0.81-0.95), whereas eating lunch away from home significantly increased overweight/obesity risks (boys: OR=1.32, 95%CI=1.17-1.48; girls: OR=1.43, 95%CI=1.26-1.62), with all associations being statistically significant (P < 0.05). After adjusting for confounding factors, boys who ate breakfast away from home showed a significantly reduced risk of undernutrition (OR=0.80, 95%CI=0.66-0.97), while those consuming lunch away from home had an increased risk (OR=1.26, 95%CI=1.01-1.57) (P < 0.05).

Conclusions

The choice of dining locations for children is becoming more diverse, and a relatively high proportion of children eat meals outside the home and at school. Eating out have a higher risk of malnutrition for children. School feeding may be beneficial to children's physical health.

, authors=Yimeng FU1, Qian GAN1, Titi YANG1, Juan XU1, Peipei XU1, Wei CAO1, Hongliang WANG1, Ruihe LUO1, Hui PAN1, Zhifang WANG1, Wenxin SUN1, Zhenyu YANG1, Wenhua ZHAO1, Qian ZHANG*, 1, 2, authorsList=Yimeng FU, Qian GAN, Titi YANG, Juan XU, Peipei XU, Wei CAO, Hongliang WANG, Ruihe LUO, Hui PAN, Zhifang WANG, Wenxin SUN, Zhenyu YANG, Wenhua ZHAO, Qian ZHANG, authorCompany=null, correspAuthors=Qian ZHANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School 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=1325502449225707695, articleId=1325502446834954413, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=中国6~17岁儿童就餐地点与营养状况的关系, columnId=1259565866560119750, journalTitle=中国学校卫生, columnName=学生营养, runingTitle=null, highlight=null, articleAbstract=
目的

分析中国6~17岁儿童就餐地点及其与营养状况的关系，为引导儿童合理膳食提供参考依据。

方法

采用分层随机整群抽样方法，于2019—2021年抽取华东、华北、华中、华南、西南、西北和东北地区14个省(自治区、直辖市)28个城市和农村的52 535名6~17岁儿童作为调查对象，通过问卷调查方法收集儿童三餐就餐地点以及人口学基本信息、膳食摄入和身体活动情况等，测量晨起空腹身高、体重。采用无序多分类Logistic回归模型分析就餐地点与儿童营养状况的关系。

结果

66.3%的儿童在家、25.8%在学校、7.9%在外(小饭桌、餐饮、摊点等)吃早餐，67.7%的儿童在家、29.0%在学校、3.3%在外吃晚餐，63.6%的儿童在学校、30.8%在家、5.7%在外吃午餐。儿童超重肥胖和营养不足检出率分别为28.6%和9.3%。多分类Logistic回归分析结果显示，调整年龄、地区、父母文化程度、家庭总收入、总能量摄入和中高强度身体活动时间等混杂因素后，与在家吃早餐、晚餐相比，在学校吃早餐或晚餐的男生和女生发生超重肥胖的风险均较低(男：OR值分别为0.70, 0.80，95%CI分别为0.65~0.75，0.74~0.86；女：OR值分别为0.89，0.88，95%CI分别为0.82~0.96，0.81~0.95)，在外吃午餐男生和女生发生超重肥胖的风险较高(OR值分别为1.32，1.43，95%CI分别为1.17~1.48，1.26~1.62)(P值均 < 0.05)。调整混杂因素后，在外吃早餐的男生发生营养不足的风险降低(OR=0.80, 95%CI=0.66~0.97)，在外吃午餐的男生发生营养不足的风险增高(OR=1.26, 95%CI=1.01~1.57)(P值均 < 0.05)。

结论

儿童就餐地点多样化，在外和在学校就餐儿童的比例较高，且在外就餐的儿童发生营养不良的风险更高，学校供餐可能有利于保持儿童体格健康。

, authors=付一萌1, 甘倩1, 杨媞媞1, 许娟1, 徐培培1, 曹薇1, 王宏亮1, 罗瑞鹤1, 潘慧1, 王志芳1, 孙文鑫1, 杨振宇1, 赵文华1, 张倩*, 1, 2, authorsList=付一萌, 甘倩, 杨媞媞, 许娟, 徐培培, 曹薇, 王宏亮, 罗瑞鹤, 潘慧, 王志芳, 孙文鑫, 杨振宇, 赵文华, 张倩, authorCompany=null, correspAuthors=张倩, authorNote=

付一萌(1999-)，女，河北承德人，在读硕士，主要研究方向为学生营养

, correspAuthorsNote=
张倩，E-mail：
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(in Chinese), articleTitle=null, refAbstract=null), Reference(id=1325502460625826096, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325502446834954413, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=26, rfOrder=39, authorNames=null, journalName=null, refType=null, unstructuredReference=谢亚宏. 学校供餐帮助贫困儿童改善营养不良[N]. 人民日报, 2023-04-12(015)., articleTitle=null, refAbstract=null), Reference(id=1325502462274187569, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325502446834954413, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=26, rfOrder=40, authorNames=null, journalName=null, refType=null, unstructuredReference=XIE Y H. School meals help poor children to improve malnutrition[N]. People's Daily, 2023-04-12(015). 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Comparison of three meal location compostion among Chinese children aged 6-17 years with different demographic characteristics in China

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人口统计学指标选项人数统计值早餐地点午餐地点晚餐地点
家学校在外家学校在外家学校在外
性别男26 23417 404(66.3)6 641(25.3)2 189(8.3)8 139(31.0)16 581(63.2)1 511(5.8)17 858(68.1)7 445(28.4)931(3.6)
女26 30117 405(66.2)6 934(26.4)1 962(7.5)8 024(30.5)16 818(63.9)1 459(5.6)17 714(67.4)7 778(29.6)809(3.1)
Z/χ2值0.35-0.80-1.33
P值0.730.420.19
年龄/岁6~813 74011 551(84.1)1 158(8.4)1 031(7.5)5 417(39.4)7 425(54.0)898(6.5)12 724(92.6)706(5.1)310(2.3)
9~1112 79410 420(81.4)1 304(10.2)1 070(8.4)4 726(36.9)7 209(56.4)859(6.7)11 412(89.2)976(7.6)406(3.2)
12~1413 0097 999(61.5)3 760(28.9)1 250(9.6)3 434(26.4)8 970(69.0)605(4.7)7 779(59.8)4 867(37.4)363(2.8)
15~1712 9924 839(37.3)7 353(56.6)800(6.2)2 586(19.9)9 798(75.4)608(4.7)3 657(28.2)8 674(66.8)661(5.1)
Z/χ2值6 681.321 034.0715 354.74
P值< 0.01< 0.01< 0.01
地区城市25 87019 125(73.9)4 494(17.4)2 251(8.7)9 082(35.1)14 245(55.1)2 543(9.8)19 643(75.9)5 084(19.7)1 143(4.4)
农村26 66515 684(58.8)9 081(34.1)1 900(7.1)7 081(26.6)19 157(71.8)427(1.6)15 929(59.7)10 139(38.0)597(2.3)
Z/χ2值-31.95-5.57-36.39
P值< 0.01< 0.01< 0.01
父亲文化小学及以下6 1822 776(44.9)2 963(47.9)443(7.2)1 281(20.7)4 640(75.1)261(4.2)2 841(46.0)3 155(51.0)186(3.0)
程度初中及高中/中职32 85521 352(65.0)8 804(26.8)2 699(8.2)10 158(30.9)20 902(63.6)1 795(5.5)21 784(66.3)10 011(30.5)1 060(3.2)
大专及以上13 49810 681(79.1)1 808(13.4)1 009(7.5)4 724(35.0)7 860(58.2)914(6.8)10 947(81.1)2 057(15.2)494(3.7)
Z/χ2值1 877.89246.932 251.12
P值< 0.01< 0.01< 0.01
母亲文化小学及以下7 7423 321(42.9)3 853(49.8)568(7.3)1 682(21.7)5 785(74.7)275(3.6)3 443(44.5)4 080(52.7)219(2.8)
程度初中及高中/中职31 65920 958(66.2)8 055(25.4)2 646(8.4)9 940(31.4)19 990(63.2)1 727(5.5)21 400(67.6)9 247(29.2)1 012(3.2)
大专及以上13 13410 530(80.2)1 667(12.7)937(7.1)4 541(34.6)7 625(58.1)968(7.4)10 729(81.7)1 896(14.4)509(3.9)
Z/χ2值2 502.66201.942 791.46
P值< 0.01< 0.01< 0.01
家庭年总收< 512 7617 315(57.3)4 555(35.7)891(7.0)3 698(29.0)8 345(65.4)719(5.6)7 433(58.3)4 969(38.9)359(2.8)
入/万元5~ < 1012 5778 778(69.8)2 825(22.5)974(7.7)4 273(34.0)7 536(60.0)768(6.1)8 934(71.0)3 237(25.7)406(3.2)
≥1013 71010 243(74.7)2 279(16.6)1 188(8.7)4 292(31.3)8 723(63.6)695(5.1)10 520(76.7)2 697(19.7)493(3.6)
未报13 4878 473(62.8)3 916(29.0)1 098(8.1)3 900(28.9)9 476(65.1)789(5.9)8 685(64.4)4 320(32.0)482(3.6)
Z/χ2值805.7478.711 050.99
P值< 0.01< 0.01< 0.01
), ArticleFig(id=1325502455949177095, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325502446834954413, language=CN, label=表1, caption=

中国不同人口统计学特征6~17岁儿童三餐就餐地点构成比较

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人口统计学指标选项人数统计值早餐地点午餐地点晚餐地点
家学校在外家学校在外家学校在外
性别男26 23417 404(66.3)6 641(25.3)2 189(8.3)8 139(31.0)16 581(63.2)1 511(5.8)17 858(68.1)7 445(28.4)931(3.6)
女26 30117 405(66.2)6 934(26.4)1 962(7.5)8 024(30.5)16 818(63.9)1 459(5.6)17 714(67.4)7 778(29.6)809(3.1)
Z/χ2值0.35-0.80-1.33
P值0.730.420.19
年龄/岁6~813 74011 551(84.1)1 158(8.4)1 031(7.5)5 417(39.4)7 425(54.0)898(6.5)12 724(92.6)706(5.1)310(2.3)
9~1112 79410 420(81.4)1 304(10.2)1 070(8.4)4 726(36.9)7 209(56.4)859(6.7)11 412(89.2)976(7.6)406(3.2)
12~1413 0097 999(61.5)3 760(28.9)1 250(9.6)3 434(26.4)8 970(69.0)605(4.7)7 779(59.8)4 867(37.4)363(2.8)
15~1712 9924 839(37.3)7 353(56.6)800(6.2)2 586(19.9)9 798(75.4)608(4.7)3 657(28.2)8 674(66.8)661(5.1)
Z/χ2值6 681.321 034.0715 354.74
P值< 0.01< 0.01< 0.01
地区城市25 87019 125(73.9)4 494(17.4)2 251(8.7)9 082(35.1)14 245(55.1)2 543(9.8)19 643(75.9)5 084(19.7)1 143(4.4)
农村26 66515 684(58.8)9 081(34.1)1 900(7.1)7 081(26.6)19 157(71.8)427(1.6)15 929(59.7)10 139(38.0)597(2.3)
Z/χ2值-31.95-5.57-36.39
P值< 0.01< 0.01< 0.01
父亲文化小学及以下6 1822 776(44.9)2 963(47.9)443(7.2)1 281(20.7)4 640(75.1)261(4.2)2 841(46.0)3 155(51.0)186(3.0)
程度初中及高中/中职32 85521 352(65.0)8 804(26.8)2 699(8.2)10 158(30.9)20 902(63.6)1 795(5.5)21 784(66.3)10 011(30.5)1 060(3.2)
大专及以上13 49810 681(79.1)1 808(13.4)1 009(7.5)4 724(35.0)7 860(58.2)914(6.8)10 947(81.1)2 057(15.2)494(3.7)
Z/χ2值1 877.89246.932 251.12
P值< 0.01< 0.01< 0.01
母亲文化小学及以下7 7423 321(42.9)3 853(49.8)568(7.3)1 682(21.7)5 785(74.7)275(3.6)3 443(44.5)4 080(52.7)219(2.8)
程度初中及高中/中职31 65920 958(66.2)8 055(25.4)2 646(8.4)9 940(31.4)19 990(63.2)1 727(5.5)21 400(67.6)9 247(29.2)1 012(3.2)
大专及以上13 13410 530(80.2)1 667(12.7)937(7.1)4 541(34.6)7 625(58.1)968(7.4)10 729(81.7)1 896(14.4)509(3.9)
Z/χ2值2 502.66201.942 791.46
P值< 0.01< 0.01< 0.01
家庭年总收< 512 7617 315(57.3)4 555(35.7)891(7.0)3 698(29.0)8 345(65.4)719(5.6)7 433(58.3)4 969(38.9)359(2.8)
入/万元5~ < 1012 5778 778(69.8)2 825(22.5)974(7.7)4 273(34.0)7 536(60.0)768(6.1)8 934(71.0)3 237(25.7)406(3.2)
≥1013 71010 243(74.7)2 279(16.6)1 188(8.7)4 292(31.3)8 723(63.6)695(5.1)10 520(76.7)2 697(19.7)493(3.6)
未报13 4878 473(62.8)3 916(29.0)1 098(8.1)3 900(28.9)9 476(65.1)789(5.9)8 685(64.4)4 320(32.0)482(3.6)
Z/χ2值805.7478.711 050.99
P值< 0.01< 0.01< 0.01
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中国6~17岁儿童就餐地点与营养状况的关系
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付一萌 1 , 甘倩 1 , 杨媞媞 1 , 许娟 1 , 徐培培 1 , 曹薇 1 , 王宏亮 1 , 罗瑞鹤 1 , 潘慧 1 , 王志芳 1 , 孙文鑫 1 , 杨振宇 1 , 赵文华 1 , 张倩 *, 1, 2
中国学校卫生 | 学生营养 2025,46(5): 642-646
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中国学校卫生 |学生营养 2025 , 46 (5) : 642 -646
中国6~17岁儿童就餐地点与营养状况的关系
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付一萌1, 甘倩1, 杨媞媞1, 许娟1, 徐培培1, 曹薇1, 王宏亮1, 罗瑞鹤1, 潘慧1, 王志芳1, 孙文鑫1, 杨振宇1, 赵文华1, 张倩*, 1, 2
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微量元素与营养重点实验室
通讯作者:
张倩，E-mail：
作者简介:

付一萌(1999-)，女，河北承德人，在读硕士，主要研究方向为学生营养

Association of dining locations with nutritional status among Chinese children aged 6-17 years
Yimeng FU1, Qian GAN1, Titi YANG1, Juan XU1, Peipei XU1, Wei CAO1, Hongliang WANG1, Ruihe LUO1, Hui PAN1, Zhifang WANG1, Wenxin SUN1, Zhenyu YANG1, Wenhua ZHAO1, Qian ZHANG*, 1, 2
Affiliations
  • 1National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing(100050), China
出版时间: 2025-05-25 doi: 10.16835/j.cnki.1000-9817.2025112
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摘要
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目的

分析中国6~17岁儿童就餐地点及其与营养状况的关系，为引导儿童合理膳食提供参考依据。

方法

采用分层随机整群抽样方法，于2019—2021年抽取华东、华北、华中、华南、西南、西北和东北地区14个省(自治区、直辖市)28个城市和农村的52 535名6~17岁儿童作为调查对象，通过问卷调查方法收集儿童三餐就餐地点以及人口学基本信息、膳食摄入和身体活动情况等，测量晨起空腹身高、体重。采用无序多分类Logistic回归模型分析就餐地点与儿童营养状况的关系。

结果

66.3%的儿童在家、25.8%在学校、7.9%在外(小饭桌、餐饮、摊点等)吃早餐，67.7%的儿童在家、29.0%在学校、3.3%在外吃晚餐，63.6%的儿童在学校、30.8%在家、5.7%在外吃午餐。儿童超重肥胖和营养不足检出率分别为28.6%和9.3%。多分类Logistic回归分析结果显示，调整年龄、地区、父母文化程度、家庭总收入、总能量摄入和中高强度身体活动时间等混杂因素后，与在家吃早餐、晚餐相比，在学校吃早餐或晚餐的男生和女生发生超重肥胖的风险均较低(男：OR值分别为0.70, 0.80，95%CI分别为0.65~0.75，0.74~0.86；女：OR值分别为0.89，0.88，95%CI分别为0.82~0.96，0.81~0.95)，在外吃午餐男生和女生发生超重肥胖的风险较高(OR值分别为1.32，1.43，95%CI分别为1.17~1.48，1.26~1.62)(P值均 < 0.05)。调整混杂因素后，在外吃早餐的男生发生营养不足的风险降低(OR=0.80, 95%CI=0.66~0.97)，在外吃午餐的男生发生营养不足的风险增高(OR=1.26, 95%CI=1.01~1.57)(P值均 < 0.05)。

结论

儿童就餐地点多样化，在外和在学校就餐儿童的比例较高，且在外就餐的儿童发生营养不良的风险更高，学校供餐可能有利于保持儿童体格健康。

饮食习惯  /  营养状况  /  回归分析  /  儿童
Objective

To analyze the association of eating dining locations and their association with nutritional status among Chinese children aged 6-17 years, so as to provide reference for guiding children's reasonable diet.

Methods

Stratified random cluster sampling was used to select children aged 6 to 17 years from 28 cities and rural areas of 14 provinces in East, North, Central, South, Southwest, Northwest, Northeast of China, and a total of 52 535 children were included in the study from 2019 to 2021. Information including dining locations, demographic characteristics, dietary intakes and physical activity were collected through a questionnaire survey. Fasting body height and weight were measured in the morning. Unordered multiclass Logistic regression analysis was conducted to assess the relationship between dining locations and nutritional status in children.

Results

Regarding children's dining locations, 66.3% ate breakfast at home, 25.8% ate breakfast at school, 7.9% ate breakfast outside (small dining tables, restaurants, stalls, etc.); 67.7% ate dinner at home, 29.0% ate dinner at school, 3.3% ate dinner outside; and 63.6% ate lunch at school, 30.8% ate lunch at home, 5.7% ate lunch outside. The prevalence rates of overweight/obesity and undernutrition were 28.6% and 9.3%, respectively. The adjusted multiclass Logistic regression analysis (controlling for age, region, parental education, household income, total energy intake, and moderate-to-vigorous physical activity) demonstrated that, compared to eating at home, school-based breakfast and dinner consumption was associated with significantly lower overweight/obesity risks for both genders (boys: breakfast OR=0.70, 95%CI=0.65-0.75; dinner OR=0.80, 95%CI=0.74-0.86; girls: breakfast OR=0.89, 95%CI=0.82-0.96; dinner OR=0.88, 95%CI=0.81-0.95), whereas eating lunch away from home significantly increased overweight/obesity risks (boys: OR=1.32, 95%CI=1.17-1.48; girls: OR=1.43, 95%CI=1.26-1.62), with all associations being statistically significant (P < 0.05). After adjusting for confounding factors, boys who ate breakfast away from home showed a significantly reduced risk of undernutrition (OR=0.80, 95%CI=0.66-0.97), while those consuming lunch away from home had an increased risk (OR=1.26, 95%CI=1.01-1.57) (P < 0.05).

Conclusions

The choice of dining locations for children is becoming more diverse, and a relatively high proportion of children eat meals outside the home and at school. Eating out have a higher risk of malnutrition for children. School feeding may be beneficial to children's physical health.

Food habits  /  Nutritional status  /  Regression analysis  /  Child
付一萌, 甘倩, 杨媞媞, 许娟, 徐培培, 曹薇, 王宏亮, 罗瑞鹤, 潘慧, 王志芳, 孙文鑫, 杨振宇, 赵文华, 张倩. 中国6~17岁儿童就餐地点与营养状况的关系. 中国学校卫生, 2025 , 46 (5) : 642 -646 . DOI: 10.16835/j.cnki.1000-9817.2025112
Yimeng FU, Qian GAN, Titi YANG, Juan XU, Peipei XU, Wei CAO, Hongliang WANG, Ruihe LUO, Hui PAN, Zhifang WANG, Wenxin SUN, Zhenyu YANG, Wenhua ZHAO, Qian ZHANG. Association of dining locations with nutritional status among Chinese children aged 6-17 years[J]. Chinese Journal of School Health, 2025 , 46 (5) : 642 -646 . DOI: 10.16835/j.cnki.1000-9817.2025112
正文
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就餐地点可通过提供的食物种类、就餐氛围等影响食物选择，国内外相关研究发现，摄入的能量和营养素因就餐地点的不同有所差异，进而对儿童的营养状况产生影响[1]。近年来，我国餐饮业迅速发展，儿童在外就餐比例持续增高，2015—2017年中国居民营养与健康状况监测显示，6~11和12~17岁儿童过去7 d在家以外的地方就餐的比例相对较高，分别为69.7%和84.6%[2]。同时，我国儿童青少年营养状况存在营养不足与超重肥胖并存的现象，尤其是超重肥胖儿童比例迅速增长，已成为一个严重的公共卫生问题。2015年我国6~17岁儿童超重肥胖率为19%，比2012年增加3.2%[3]。超重肥胖不仅会影响儿童体格发育和身心健康，还会增加成年后高血压、糖尿病等多种慢性病的发生风险[4-6]。本研究利用“中国0~18岁儿童营养与健康系统调查与应用”项目数据，对我国6~17岁儿童的三餐就餐地点进行分析，探讨就餐地点与营养状况的关系，为引导儿童合理膳食提供参考。
1　对象与方法
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1.1　对象
本研究数据来自科技部科技基础资源调查专项“中国0~18岁儿童营养与健康系统调查与应用”项目，该项目采用分层随机整群抽样方法，于2019—2021年在中国7个区域(华东、华北、华中、华南、西南、西北和东北)，按各省0~18岁人口数排序后，采用系统随机抽样方法，每个区域各抽取2个省，共抽取14个省；将各省内的所有区县分为城市和农村2层，每层内随机抽取1个区或县作为调查点，共抽取28个城市和农村调查点；每个调查点抽取4所小学、4所初中参与调查[7-8]，每所学校各个年级分别抽取1~2个班，整班纳入。本研究选取其中6~17岁儿童作为调查对象，经数据清理后，共纳入52 535名学生。其中男生26 234名(49.9%)，女生26 301名(50.1%)；城市学生25 870名(49.2%)，农村学生26 665名(50.8%)；6~8岁学生13 740名(26.2%)，9~11岁12 794名(24.4%)，12~14岁13 009名(24.8%)，15~17岁12 992名(24.7%)。研究方案已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：NO.2019-011)，儿童及家长均签署知情同意书。
1.2　调查方法
1.2.1　问卷调查
采用问卷调查的方式收集调查对象的基本信息和就餐地点信息。所有问卷由“中国0~18岁儿童营养与健康系统调查与应用”项目组统一编制，并经专家论证和调查后修订。个人一般情况问卷和家长一般情况问卷在调查员的指导下由学生自行填写，食物频率调查问卷和身体活动调查问卷采用调查员对调查对象进行面对面询问的方式填写。个人一般情况问卷内容包括儿童性别、出生日期、调查点类型(城市/农村)和三餐就餐地点。就餐地点为过去一个月内一日三餐(早、午、晚餐)通常就餐地点，分为在家、学校、在外(小饭桌/餐馆/摊点/快餐店和外卖/订餐/盒饭买回家吃)3组。家长一般情况问卷内容包括儿童父母的文化程度、家庭总收入等基本信息。
食物频率调查问卷内容包括儿童过去一个月内所有食物的摄入频率和平均每次摄入量，计算出各类食物每日摄入量(每日摄入量=每日摄入频率×平均每次摄入量)，以《中国食物成分表标准版(第6版)》[9]为标准，计算每种食物的能量摄入量，最后计算得到个体平均每日总能量摄入量。按照儿童每日摄入总能量的三分位数将其从低到高依次分为T1、T2和T3组。通过“身体活动调查问卷”收集儿童中高强度身体活动时间，要求儿童回忆并填写过去一周的身体活动情况，将每天中高强度身体活动时间分为 < 30，30~ < 60和≥60 min 3组。
1.2.2　体格测量
测量儿童晨起空腹身高和体重，脱去外套、鞋帽，采用身高坐高计测量身高，采用经过校准的电子体重称测体重，测量结果分别精确到0.1 cm、0.1 kg。身高体重测量均由经过培训的调查员按照标准测量程序进行。计算体质量指数(body mass index, BMI)=体重(kg)/[身高(m)]2。营养不足包括生长迟缓和消瘦，按照《学龄儿童青少年营养不良筛查》(WS/T 456—2014)[10]分性别年龄别身高筛查生长迟缓儿童；排除生长迟缓者后，再按照性别年龄别BMI筛查消瘦。按照《学龄儿童青少年超重与肥胖筛查》(WS/T 586—2018)[11]分性别年龄别BMI筛查超重和肥胖。
1.3　质量控制
所有调查员经过统一标准化培训，经考核合格后参加调查。调查过程中严格按照统一标准和方法，调查问卷现场即时填写，查漏补缺。通过数据平台录入问卷，统一采用双录入模式，由专业人员对数据进行管理和清理。
1.4　统计学分析
采用SAS 9.4软件进行数据清理和统计分析。儿童的基本特征和不同特征儿童的三餐就餐地点采用例数(百分比)进行描述，用χ2检验或Kruskal-Wallis秩和检验进行组间比较。采用无序多分类Logistic回归模型探讨就餐地点与儿童营养状况的关系，因变量为儿童营养状况(正常=0，营养不足=1，超重肥胖=2)，自变量为儿童三餐就餐地点。模型1未控制混杂因素，模型2调整年龄、地区、父母文化程度、家庭总收入、总能量摄入和中高强度身体活动时间等因素。检验水准α=0.05。
2　结果
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2.1　儿童营养状况及三餐就餐地点的分布
52 535名儿童中，营养不足检出率为9.3%(4 911名)，超重肥胖检出率为28.6%(15 051名)。儿童吃早餐的地点分别为66.3%(34 809名)在家、25.8%(13 575名)在学校和7.9%(4 151名)在外；儿童吃午餐的地点分别为30.8%(16 163名)在家、63.6%(33 402名)在学校和5.7%(2 970名)在外；儿童吃晚餐的地点分别为67.7%(35 572名)在家、29.0%(15 223名)在学校和3.3%(1 740名)在外。男生和女生三餐就餐地点构成差异均无统计学意义(P值均>0.05)。城市儿童选择在家吃早餐(73.9%)、午餐(35.1%)和晚餐(75.9%)的比例均高于农村儿童(58.8%，26.6%，59.7%)，差异均有统计学意义(P值均 < 0.05)。不同年龄段、父母文化程度和家庭总收入的儿童三餐就餐地点构成差异均有统计学意义(P值均 < 0.05)。见表1。
2.2　儿童三餐就餐地点与超重肥胖的Logistic回归分析
模型1结果显示，与在家吃早餐、午餐或晚餐相比，在学校吃三餐的男生(OR值分别为0.62，0.93，0.71，95%CI分别为0.58~0.66，0.88~0.98，0.66~0.75)和在学校吃早餐或晚餐女生(OR值分别为0.78，0.77，95%CI分别为0.73~0.84，0.72~0.82)发生超重肥胖的风险降低；在外吃午餐男生(OR=1.38，95%CI=1.23~1.55)和女生(OR=1.47，95%CI=1.30~1.66)发生超重肥胖的风险增加(P值均 < 0.05)。
模型2结果显示，与在家吃早餐、午餐或晚餐相比，在学校吃早餐或晚餐的男生发生超重肥胖的风险较低(OR=0.70, 95%CI=0.65~0.75；OR=0.80, 95%CI=0.74~0.86)，在学校吃早餐或晚餐女生发生超重肥胖的风险较低(OR=0.89, 95%CI=0.82~0.96；OR=0.88, 95%CI=0.81~0.95)；在外吃午餐男生和女生发生超重肥胖的风险较高(OR=1.32, 95%CI=1.17~1.48；OR=1.43, 95%CI=1.26~1.62)(P值均 < 0.05)。
2.3　儿童三餐就餐地点与营养不足的Logistic回归分析
模型1结果显示，与在家吃早餐、午餐或晚餐相比，在外吃早餐的男生发生营养不足的风险降低(OR=0.79，95%CI=0.65~0.96)，在外吃午餐的男生发生营养不足的风险增加(OR=1.29，95%CI=1.03~1.57)；在学校吃早餐、午餐或晚餐女生(OR值分别为0.74，0.87，0.72，95%CI分别为0.65~0.85，0.77~0.98，0.64~0.82)发生营养不足的风险降低(P值均 < 0.05)。模型2结果显示，在外吃早餐的男生发生营养不足的风险降低(OR=0.80, 95%CI=0.66~0.97)，在外吃午餐的男生发生营养不足的风险增高(OR=1.26, 95%CI=1.01~1.57)(P值均 < 0.05)；早餐、午餐或晚餐三餐就餐地点与女生营养不足的关联无统计学意义(OR=0.93~1.12，P值均>0.05)。
3　讨论
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本研究结果显示，我国有超60%的儿童选择在家吃早餐和晚餐、在学校吃午餐，在外就餐的儿童比例为3%~8%。联合国世界粮食计划署近日发布《2022年全球学校供餐状况》报告显示，在国际社会和各国政府的积极努力下，目前学校供餐已惠及全球近4.2亿儿童，相比2020年增加3 000万，占在校儿童总数的41%[12]；中国是全球少数同时在小学和初中阶段提供营养餐的国家，学校供餐规模位居前列。随着餐饮业的快速发展和相关政策的有效实施，儿童就餐地点的选择更加多样化，包括食堂、外卖、中西式餐馆、蛋糕店等[2]。
本研究中，城乡儿童三餐就餐地点存在差异，城市学生在家吃三餐的比例高于农村，而农村学生在学校吃三餐的比例更高。国内研究也有类似的结果[13]，可能是由于我国农村地区义务教育营养改善计划的有效实施，农村提供学校供餐的比例更高[14]。同时城市儿童在外就餐的比例高于农村儿童，可能与地区经济水平和食物的易获得性有关，城市餐饮业的快速发展给儿童提供更多在外就餐的机会[15]。
此外，家庭因素对儿童就餐地点的选择也有很大影响。本研究中父母文化程度高的儿童选择在外吃午餐和晚餐的比例更高，可能由于父母文化水平高的家庭通常家长工作较忙，在外就餐方便快捷，国内研究也发现类似的结果[16-17]。
本研究发现，调整年龄、地区和家庭等混杂因素后，在外吃午餐儿童的超重肥胖率和营养不足率均高于在家，提示在外就餐可能是儿童超重肥胖和营养不足的危险因素之一。国内外均有研究报道在外就餐会增加儿童超重肥胖的风险，如Machado-Rodrigues等[18]对11 656名6~11岁葡萄牙儿童的横断面研究显示，男生超重与在快餐店就餐之间有关联性，在小吃店就餐者比不在小吃店就餐的同龄人超重风险高21%。Ma等[19]对中国15 261名6~18岁儿童的研究也发现，与每周外出就餐少于3次的男生相比，每周外出就餐≥3次的男生超重和肥胖的患病率更高。可能与在外就餐通常食物份量大，能量密度高，并添加较多的油、盐、糖等调味品，导致食物及能量摄入过多有关[20]。午餐在外就餐的男生发生营养不足的风险也增加，在女生中未观察到此关联，结果是否与男女生在外就餐食物选择的差异有关还有待进一步研究。
本研究中，调整年龄、地区和家庭等混杂因素后，在校吃早餐和晚餐的儿童超重肥胖及营养不足的发生率均低于在家就餐儿童。有研究提示，学生餐为满足学龄儿童生长发育，通常由专业人员设计健康核心食物，其营养学特点甚至优于家庭食物[1]。如Au等[21]对5 106名4~15岁美国儿童进行的研究发现，吃学校早餐或午餐的儿童摄入更多健康的食物，增加了膳食纤维和钙的摄入。Boklis-Berer等[22]对12 373名11~19岁巴西儿童进行的研究显示，与每周吃 < 5 d学校膳食的儿童相比，每天吃学校膳食的儿童BMI-Z值降低0.1，超重率降低11%，肥胖率降低24%。我国学校供餐有《学生餐营养指南》(WS/T 554—2017)等标准[23]，近些年也出台多项政策规章促进学校供餐专业化和多样化[24-25]；中国自2011年实施农村义务教育学生营养改善计划以来，为乡村学校供餐提供资金补助，中西部贫困农村中小学生的营养状况逐步改善[26]。
综上所述，在外就餐的儿童患营养不良的风险更高，学校供餐可能是保持儿童健康体格的有效途径之一。今后应对儿童和家长开展选择健康食物能力的宣教，同时有关部门应继续大力推广学校营养供餐，促进儿童健康成长、降低超重肥胖等疾病的发生风险。
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2025年第46卷第5期
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doi: 10.16835/j.cnki.1000-9817.2025112
  • 接收时间：2024-01-08
  • 首发时间：2026-11-06
  • 出版时间：2025-05-25
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  • 收稿日期：2024-01-08
  • 修回日期：2024-03-21
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科技部科技基础资源调查专项项目(2017FY101100)
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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微量元素与营养重点实验室

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species		 占总种数比例
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total species (%)		 属
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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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