目 的，通过对苏州市中、小学生的体格检查、饮食相关行为调查以及学生、 家长、老师、学校管理者及午餐制作企业员工营养餐可行性问卷调查，了解学生 现有健康水平和存在的主要营养问题，了解大家对营养知识的知晓率及对现有学 校午餐的满意程度，分析学生贫血、消瘦、超重、肥胖与不良饮食行为及膳食的 关系，分析在实施学生营养餐过程中存在的关键问题，探索解决问题的途径和方 案，为苏州市营养餐目标规划、政策制定及组织管理等提供依据。 方 法，采用分群整群抽样方法对苏州市中、小学生进行相关问卷调查和体 格检查。问卷调查，结合苏州市实际情况分别设计调查问卷《苏州市中学生饮食 相关行为调查问卷》及学生、家长、班主任、企业及管理者的《营养餐可行性研 究问卷》，问卷内容包括基本情况、饮食相关行为、营养知识及对实施营养餐的态 度等。体格检查，血红蛋白测定采用 WHO 推荐的氰化高铁血红蛋白，贫血评价标 准根据世界卫生组织关于 6～14 岁小孩的血红蛋白含量分级，以 Hb＜120g/L 判定 为贫血；身高和体重的测量依据《中国学生体质健康状况调查研究手册》规定的 标准进行，测量两次取平均值，按照 BMI=体重(kg)/[身高(m)] 2 计算获得体质指数， 评价标准，18 岁以上消瘦、超重肥胖学生按照卫生部“中国成人超重和肥胖症预 防的控制指南”推荐的标准进行，18 岁以下超重肥胖评价标准采用中国学龄儿童 青少年超重、肥胖筛查体质指数值分类标准进行，7～17 岁消瘦标准采用百分位数 法，以小于标准第五百分位数判断消瘦。 结 果， 1.小学生贫血患病率为 29.9%，6 岁、7 岁是小学生贫血患病率的高发年龄。 2.苏州市学生消瘦、超重和肥胖率较高，分别为 8.7%、6.0%和 3.6%，均为小 学生最高。 3.苏州市中学生排在前三位的健康饮食行为是经常吃早餐、每周喝牛奶及每餐 吃蔬菜，不良饮食行为排在前三位的是有偏食行为、爱吃甜点及路边摊。消瘦组 学生偏食人数比例较高，肥胖组学生爱吃甜点比例人数较高。 4.对现有的学校午餐，学生和家长满意度较低，尤其是学校午餐的口味和品种II 不能满足学生需求。 5.学生、家长、班主任及管理者对于学校实施学生营养餐都表示欢迎，接受度 均达到 90%以上。 6.对于营养餐质量总体要求除安全卫生、营养合理外，主要是品种多、味道好， 可以接受的营养餐价格为 6～7 元，对于营养餐菜谱，选择一大荤一小荤一蔬菜至 三蔬菜谱的人数比例最高。 7.学校供餐单位卫生监督量化分级评定达到 1 级的占大多数，64.9%配备营养 师，从事饮食行业 4 年以上企业占 56%。 结 论，苏州市学生中贫血患病率和肥胖率均处于较高水平，消瘦与超重肥 胖并存，这可能与学生的不良饮食行为率较高，学校午餐的品种和口味等不能满 足学生的需求有关，有必要采取针对性营养干预措施。对于实施学生营养餐，学 生、家长、班主任的接受度均较高，各调查人群对于实施学生营养餐的意义、以 及相关的价格、菜谱、品种和口味、营养宣教等问题认识高度一致，但尚存在一 些不足，在拟定苏州市学生营养餐实施方案解决相关问题后，在苏州市实施学生 营养餐计划将是可行的，这将有助于改善和提高苏州市学生的营养健康水平。 关键词，学生 营养餐 可行性 作 者，李 海 指导老师，傅春玲III Feasibility Study on Student Nutrition Meal in Suzhou City Abstract Objective: To evaluate nutritional and health status in primary and middle school students in Suzhou to find major nutritional prolems and analyze their relation to unhealthy eating behavior and school lunch. To discover possible barrier to put the student nutrition meal plan into pratice in Suzhou and explore ways to solve it from nutrition education, policy setting, surveillance to government management. Methods: The physical examination and survey on eating behavior for the primary school and middle school students in Suzhou City and survey on student nutrition meal feasibility for related people were conducted with stratified cluster sampling method. Special questionnaires were designed for primary school students, middle school students,parents, class advisers, lunch making employers and school administrators respectively. The questionnaires contain basic information, eating behaviors, nutrition knowledge, and attitude on the implementation of student nutrition meals in Suzhou. The examination includes body physical exam and measurement of blood hemoglobin concentration (Hb). Hb was determined with Cyanmethemoglobin method recommended by World Health Organization. Anemia in the study was defined as Hb level below 12.0g/dl in 6～13 years old boys and girls according to WHO standards. Height and weight were measured twice and averaged according to the standard established by “China Health Research Students Handbook.” BMI was calculated as weight (kg) divided by the square of height(m 2 ). Different BMI classification criteria were use for evalution of asarcia, overweight and obesity according to students age. Result: 1. The prevalence of anemia in students from primary school in Suzhou was 29.9% and it was the highest among students aged 6 to 7 years . 2. The prevalence of stunting, overweight and obesity were 8.7%, 3.6% and 3.6% respectively among students in Suzhou. The students in primary school had the highest prevalence for stunting, overweight and obesity. 3. Top three healthy eating behaviors among students in Suzhou city had breakfastIV and vegetables frequently,drank milk every week three unhealthy eating behaviors among students in Suzhou city were food choice and preference for eating sweet food and street food. The proportion of food choice in stunting students was higher than other students while the proportion of preference for sweet food was higher in obesity students than other ones. 4. The satisfaction rate of school lunch provided were low in students and parents, especially as the variety and taste of meal. 5. Student nutritional meal plan were highly agreed by students, parents, class advisers and school administrators, whose acceptance rates were all above 90%. 6. Besides safety assurance and meeting nutritional requirements, the study population pay more attention to meal variety and taste than other qualities. The price they can receive was between 6 to 7 yuan and the dish plan for every meal they liked most were one big serving animal food plus one small serving animal food with one to three kinds of vegetables. 7. Most of school lunch suppliers attained first grade as the assessment from the categorization and quantified classification administration government with 64.9% of school lunch supplies having nutritionist to give nutrition guidance and 56% enterprises with more than 4 years food supply experience. Conclusion: The prevalence of anemia and obesity are high among students in Suzhou City. High prevalence of obesity was accompanied by high prevalence of stunting in students which may atttribute to unhealthy eating behaviors and unacceptable school lunch for little variety and poor taste. These finging suggest a need for proper nutritional interventions promoting healthier eating behaviors. There were high agreement in the awareness of importance, price, variety and taste of students nutritional meals among students, parents, and class advisers although there were still some difficulties. It will be feasible to implement the plan of student nutritional meal to improve and enhance the nutritional health level of students in Suzhou City through carefully working out practical scheme. Key words: Student nutritional meal; Eating behaviors; BMI Written by Hai Li Supervised by Chunlin Fu目 录 引 言 1 第一部分，苏州市学生营养相关疾病、饮食行为及午餐现状的调查 3 第二部分，苏州市学生营养餐可行性研究 21 第三部分，学生营养餐实施方案 36 结 论 47