Cardiovascular disease risk factor profiles in children with celiac disease on gluten-free diets

AIM:To describe the cardiovascular disease(CVD)risk factors in a population of children with celiac disease(CD)on a gluten-free diet(GFD).METHODS:This cross-sectional multicenter study was performed at Schneider Children’s Medical Center of Israel(Petach Tiqva,Israel),and San Paolo Hospital(Milan,Italy).We enrolled 114 CD children in serologic remission,who were on a GFD for at least one year.At enrollment,anthropometric measurements,blood lipids and glucose were assessed,and compared to values at diagnosis.The homeostasis model assessment-estimated insulin resistance was calculated as a measure of insulin resistance.RESULTS:Three or more concomitant CVD risk factors[body mass index,waist circumference,low density lipoprotein(LDL)cholesterol,triglycerides,blood pressure and insulin resistance]were identified in 14%of CD subjects on a GFD.The most common CVD risk factors were high fasting triglycerides(34.8%),elevated blood pressure(29.4%),and high concentrations of calculated LDL cholesterol(24.1%).On a GFD,four children(3.5%)had insulin resistance.Fasting insulin and HOMA-IR were significantly higher in the Italian cohort compared to the Israeli cohort(P<0.001).Children on a GFD had an increased prevalence of borderline LDL cholesterol(24%)when compared to values(10%)at diagnosis(P=0.090).Trends towards increases in overweight(from 8.8%to 11.5%)and obesity(from 5.3%to 8.8%)were seen on a GFD.CONCLUSION:This report of insulin resistance and CVD risk factors in celiac children highlights the importance of CVD screening,and the need for dietary counseling targeting CVD prevention.

Preventable head and facial injuries by providing free bicycle helmets and education to preschool children in a head start program

The objectives of the study were to determine helmet use rates, incidence rates (IRs) of head and facial injuries for population attributable fraction (PAF) estimation, and to elucidate the magnitude of and changes in PAFs as the result of helmet use changes among preschool children. A study consisting of cross-sectional (survey) and longitudinal (follow-up) component was designed by including a randomly selected group of participants (n = 322) from 10 Head Start sites provided with free bicycle helmets along with a subgroup of prior helmet owners (n = 68) from the other random group (n = 285). All participants received bicycle helmet education. Helmet use surveys were conducted in May (1st Survey) and November 2008 (2nd Survey). The helmet owners were followed up to determine IRs, and incidence rate ratios (IRRs) for head and facial injuries. PAFs were computed using IRs as well as helmet use rates and IRRs. Helmet use rates increased significantly from the 1st to the 2nd Survey. The mean follow-up person-time was 5 months. The IRs for head, face (all portions), and face (upper/mid portions) injuries were higher in non-helmeted than helmeted riders. By using IRs, PAFs for the 3 injuries among the riders in both groups of helmet owners were 77%, 22%, and 32% respectively. The PAFs for each of the above injuries decreased by about 10% as helmet use rates increased. The magnitude of and changes in preventable head and facial injuries following free bicycle helmet distribution and education among helmeted riders was elucidated in this Head Start preschool children population.

Cardiometabolic risk factors in children with celiac disease on a gluten-free diet

Celiac disease(CD) is an immune-mediated systemic condition evoked by gluten and related prolamines in genetically predisposed subjects. It is characterised by a variable combination of gluten-dependent clinical symptoms, CDspecific antibodies, HLA-DQ2 and HLA-DQ8 haplotypes, and enteropathy. The only therapy of CD consists of a life-long gluten free diet(GFD). Strict GFD adherence results in full clinical, serological and histological remission, avoiding long-term complications in CD patients. However, this diet is not without problems. Gluten free products have high levels of lipids, sugar and salt to improve food palatability and consistency, and subjects with CD show an excessive consumption of hypercaloric and hyperlipidic foods to compensate dietetic restriction. GFD may therefore have a negative impact on cardiometabolic risk factors such as obesity, serum lipid levels, insulin resistance, metabolic syndrome, and atherosclerosis. In adults, some studies have suggested that GFD have a beneficial effect on cardiovascular profile, whereas others have shown an atherogenic effect of GFD. In children, very few studies are available on the issue. Thus, the aim of the present narrative review was to analyze the current clinical evidence on the impact of GFD on cardiometabolic risk factors in children with CD.

Prevalence of functional gastrointestinal disorders in children with celiac disease on different types of gluten-free diets

BACKGROUND Functional gastrointestinal disorders(FGIDs)are common during the pediatric age.FGIDs are not related to biochemical or structural abnormalities.However,since they have a high prevalence,several studies have evaluated an overlap between FGIDs and organic diseases.Individuals with celiac disease(CD)have been shown to be at an increased risk for functional abdominal pain,even if they adhere well to a gluten-free diet(GFD).Little information is available for the pediatric age group.The aims of our study were to evaluate the prevalence of FGIDS in CD children 1 year after diagnosis and to compare the prevalence of FGIDs in CD children on a GFD with processed foods compared with those on a GFD with natural products.AIM To assess the prevalence of FGIDs in children with CD after 1 year of follow-up and to compare the prevalence of FGIDs in children with CD on a GFD with processed foods and in children on a GFD with natural products.METHODS We recruited pediatric patients aged 1-18 years with a new CD diagnosis.Participants were randomized to two groups:Group A on a GFD with processed foods(diet 1);and group B on a GFD with natural products(diet 2).Clinical monitoring,diet assessment and the questionnaire on pediatric gastrointestinal symptoms-Rome IV version were performed at diagnosis(T0)and after 12 mo of follow-up(T1).Dietary intake was assessed using a 3-d food diary record.Data from the diaries were evaluated using WinFood nutrient analysis software.We assessed the prevalence of FGIDs at T1 and the correlation with the type of GFD.RESULTS We registered 104 CD children,with 55 patients in group A(53.0%)and 49 patients in group B(47.0%).Initially,30 of the 55(54.5%)CD children were symptomatic in group A,while 25 of 49(51.0%)were symptomatic in group B.At T1,in spite of a low or negative serology for CD,FGIDs prevalence was 10/55(18.0%)in group A and 8/49(16.3%)in group B,with no statistically significant difference between the two groups(P=0.780).At T1 the macro-and micronutrient intake was similar across the two groups with no significant differences in nutrient analysis.However,in both groups at T1 we found that a lower prevalence of FGIDs(P=0.055)was associated with an inferior caloric(odds ratio=0.99,95%confidence interval:0.99-1.00)and fat(odds ratio=0.33,95%confidence interval:0.65-0.95)intake.CONCLUSION Our results showed that CD children on a GFD have gastrointestinal symptoms with an elevated prevalence of FGIDs.Our study suggests that developing FGIDs may be linked to caloric intake and percentage of food fat,but it does not change between a GFD with processed foods or a GFD with natural products.However,long-term monitoring is required to evaluate a correlation between FGIDs and various types of GFDs.

Physical Activity in Pre-school Children:Role of the Teacher during Free Play

It has become evident over the past decade that the lack of PA(physical activity)is a major concern for the population at large CDC(Center for Disease Control).This lack is a major reason for the increase in overweight and obese children(USDHHS,2014).The CDC and the American Heart Association recommend children need at least 60 minutes of play time that is not scheduled PA.The purpose of this research was to examine whether children’s PA will increase if teacher activity increases during unstructured free play time.Students’PA was determined by using the SOPLAY(system for observing play and leisure activity in youth-children).SOPLAY is a validated tool for directly observing PA and associated environmental characteristics in free play settings(e.g.,recess and lunch at school).SOPLAY provides objective data on the number of participants and their PA levels during play and leisure opportunities in targeted areas.Children and teachers in a West Texas Lab School(mean age=4.3 years)on a university campus were studied.Control group data(males=13,female=15)were analyzed and MVPA(moderate to vigorous physical activity)was calculated.Data showed that children spent only 30%of their free-time in the recommended intensity levels.Teachers’(n=5)overall metabolic equivalents(METs)were recorded at 1.13.The experimental group(males=11,female=13)recorded teachers’(n=6)METs at 2.47 and children MVPA at 44%.Both the MVPA and METs were significantly different(p<0.001).The value and importance of unstructured play time are important for children as well as the teachers.Children need time to be creative and explore during play and teachers use this free time for various activities including cognitive breaks or administrative work.A stronger push to get teachers moving should be made as this slight increase in METs produces a significant increase in children’s PA.

针对弱视儿童的无障碍阅读设计研究

目的针对弱视儿童因视功能受损而引发的阅读问题,研究辅助弱视儿童的无障碍阅读视觉设计规范。通过改变阅读材料的视觉设计,辅助患儿缓解阅读困难的问题,提升阅读效率。方法首先,使用对照实验法,改变阅读材料的视觉设计形式,记录弱视儿童的阅读时间及其喜爱度。同时,采用单因素方差分析法判断各视觉因素的改变对弱视儿童阅读速率的影响。其次,根据弱视儿童的阅读痛点对材料进行阅读辅助设计,通过访谈法得出各类辅助设计对缓解弱视儿童阅读痛点的可行性。最后,依据前期实验与数据分析对适合弱视儿童使用的视觉设计规范进行总结。结果针对弱视儿童的阅读材料设计,建议使用22~24pt黑体或楷体字,字间距为50~75。使用上文下图或左文右图排版形式,运用简单柔和、边缘清晰的图像设计。在设计中,可使用色彩对字行与关键词进行突出设计,辅助患儿的阅读定位。结论通过研究得出,改变阅读材料视觉设计对提高弱视儿童的阅读速率有显著影响。通过视觉感官信息强化的设计方法,结合辅助阅读设计,可有效缓解弱视儿童在阅读过程中的拥挤现象、视野模糊、阅读跳行等问题,提升弱视儿童的学习效率。

中国癫痫患儿游离丙戊酸群体药动学模型的建立及应用

目的建立丙戊酸(VPA)游离药物在癫痫患儿的群体药代动力学(popPK)模型,为指导癫痫患儿个体化应用VPA提供参考。方法收集中国医科大学附属盛京医院进行VPA血药浓度监测的癫痫患儿血样,利用UPLC-MS/MS检测VPA游离药物浓度。同时收集患儿的人口学信息、生化指标、用药情况等资料,将其作为协变量,考察其对游离VPA药代动力学参数的影响。建模采用一级吸收及消除的药代动力学模型,通过非线性混合效应模型(NONMEM)法建立中国癫痫患儿游离VPA popPK模型并进行验证。参考游离VPA的治疗窗,利用已建立的模型,在不同年龄体重患儿中模拟不同给药剂量下游离药物谷浓度的情况。结果本研究共纳入455例癫痫患儿,收集632个VPA血药浓度数据。通过逐步法,最后筛选出体重、年龄、日剂量为影响游离VPA CL/F的显著协变量,具体公式为CL/F=1.5×(BW/22)^(0.319)×(AGE^(1.24)/AGE^(1.24)+0.322^(1.24))×(DOSE/400)^(0.243),且模型经过验证较为稳定,并参考游离VPA的治疗窗,将模型应用于不同年龄及体重患儿的剂量优化调整。结论本研究所建立的中国癫痫患儿游离VPA群体药动学模型稳定可靠,可为指导VPA的临床个体化用药提供依据。

闽南地区8天~17岁儿童甲状腺功能检测指标参考区间的建立

目的建立闽南地区8天~17岁健康儿童甲状腺功能检测指标的参考区间,为早期预防、诊断和治疗儿童甲状腺疾病提供参考依据。方法选取2019-01/2023-03月在作者医院就诊的8天~17岁的1672名健康儿童为研究对象。按照不同年龄段分为5组:8天<年龄≤1个月组(n=267);1个月<年龄≤1岁组(n=292);1岁<年龄≤5岁组(n=354);5岁<年龄≤9岁组(n=323);9岁<年龄≤17岁组(n=436)。对不同年龄组儿童血清游离三碘甲状腺原氨酸(free triiodothyronine,FT_(3))、血清游离甲状腺素(free thyroxine,FT_(4))和血清促甲状腺激素(thyroid stimulating hormone,TSH)参考区间进行分组,并分析各年龄段儿童FT_(3)、FT_(4)、TSH水平的参考区间。比较不同年龄组不同性别间儿童FT_(3)、FT_(4)和TSH水平的差异。结果本研究确定FT_(3)参考区间为8天<年龄≤1个月儿童FT_(3)血清浓度为1.95~7.66 pmol/L、1岁<年龄≤5岁儿童FT_(3)血清浓度为3.02~8.67 pmol/L、5岁<年龄≤17岁儿童FT_(3)血清浓度为3.86~9.49 pmol/L;FT_(4)血清参考区间为8天<年龄≤1个月儿童FT_(4)血清浓度为9.33~13.46 pmol/L、1岁<年龄≤17岁儿童FT_(4)血清浓度为9.32~16.52 pmol/L;TSH参考区间为8天<年龄≤5岁儿童TSH血清浓度为0.70~6.16 mIU/L、5岁<年龄≤17岁儿童TSH血清浓度为0.40~5.80 mIU/L。本研究分析不同年龄组不同性别间儿童FT_(3)、FT_(4)和TSH水平发现,8天<年龄≤1个月组男童FT_(4)水平高于女童,二者比较差异有统计学意义(P<0.05),其余不同年龄组不同性别间儿童FT_(3)、FT_(4)和TSH水平差异无统计学意义(P>0.05)。结论本研究建立了闽南地区8天~17岁健康儿童甲状腺功能检测指标的参考区间。相较于试剂盒参考区间,本研究确定的针对各年龄段儿童甲状腺功能检测指标的参考区间更具体,可帮助临床更好地把握病情,为临床预防、诊断和治疗儿童甲状腺疾病提供了帮助。

无屏幕编程教育活动对学前儿童计算思维和创造性思维的影响研究

近年来编程教育逐渐延伸至学前阶段,呈现低龄化趋势,但编程教育对学前儿童发展的影响缺乏充分的实证研究。研究以计算思维和创造性思维两项高阶思维为视角,依托无屏幕编程机器人工具,基于5E教学法设计实施系列编程教育活动,采用准实验法考察编程教育对学前儿童发展的影响。研究发现,无屏幕编程教育活动对学前儿童计算思维发展具有显著促进作用,对学前儿童的创造性思维具有部分促进作用,创造性思维的独创性和变通性维度并未得到显著提升。由此建议:理性看待编程教育对学前儿童发展的价值与限度,加强编程教育与幼儿园教育活动的融合创新,优化编程教学设计以更好地促进学前儿童思维发展。

离婚协议赠与子女财产条款的撤销研究

离婚协议中的赠与子女财产条款,附随于双方解除婚姻关系这一法律行为,与身份关系交织密切。此类赠与和父母对子女的抚养义务紧密相关,蕴含了家庭伦理色彩和情感因素。故必须与发生在普通民事主体之间的财产赠与相区别,当事人对于离婚协议里此类条款不享有任意撤销权。由于现行法律未有具体的针对性规范否定赠与方的任意撤销权,可以援引诚实信用原则,发挥民法基本原则填补法律漏洞的作用。赠与方在离婚后、物权变更登记前请求撤销赠与子女财产的行为,违背了诚实信用原则。当事人不讲诚信,置子女利益不顾,若允许其行使任意撤销权,签订离婚协议原希冀带来的各方利益平衡将被打破,难以起到保护弱势一方的作用。

Immune response to vaccines in children with celiac disease

Celiac disease(CD) is an immune-mediated systemic condition evoked by ingestion of gluten and related prolamines in genetically susceptible subjects. The disease is featured by a variable combination of clinical signs, specific antibodies, HLA-DQ2 and HLA-DQ8 haplotypes, and enteropathy. Vaccination is the most potent intervention for infectious disease prevention. Several factors including age, gender, ethnicity, quality and quantity of vaccine antigen, doses, and route of administration can influence immune response to vaccination, although the main cause of variation in the responsiveness among vaccine recipients is host genetic variability. The HLA system has a fundamental role in identifying the antigens introduced into the host with the vaccines and in the development of specific antibodies, and some HLA phenotypes have been associated with a less effective immunological response. The available literature indicates that the immunological response to vaccines in CD children does not differ markedly from that of general population and antibody titres are high enough to provide long-term protection, except for hepatitis B virus vaccine. In this article, we review and discuss the scarce literature in this field in order to provide clinical practice guidelines to achieve the most efficient monitoring of the response to vaccines in pediatric CD patients.

利妥昔单抗联合化疗治疗儿童成熟B细胞淋巴瘤的有效性和安全性的Meta分析

目的 系统评价利妥昔单抗联合化疗治疗儿童成熟B细胞淋巴瘤的有效性和安全性。方法 计算机检索PubMed、Embase、Cochrane Library、中国知网、万方等数据库,由2名研究者分别进行资料提取、质量评价,并交叉核对,检索时限为从建库至2022年7月。收集利妥昔单抗联合化疗对比单纯化疗的研究,以3年无事件生存率(EFS)、不良反应发生率作为结局指标。使用STATA11.0软件进行Meta分析、亚组分析、敏感性分析和发表偏倚分析。结果 共纳入9项研究,包含908例新诊断的儿童成熟B细胞淋巴瘤患者。Meta分析结果显示,与单纯化疗组相比,利妥昔单抗联合化疗组治疗新诊断的儿童成熟B细胞淋巴瘤的3年EFS明显增高(HR=0.37,95%CI:0.24~0.58,P<0.05)。亚组分析显示,利妥昔单抗使用≥6次时利妥昔单抗联合化疗组3年EFS高于单纯化疗组,差异有统计学意义(HR=0.32,95%CI:0.17~0.57,P<0.05);利妥昔单抗使用4次时利妥昔单抗联合化疗组3年EFS与单纯化疗组相比,差异无统计学意义(HR=0.41,95%CI:0.17~1.01,P>0.05)。利妥昔单抗联合化疗组与单纯化疗组≥4级不良反应发生率比较,差异无统计学意义(OR=1.24,95%CI:0.80~1.94,P>0.05),两组≥3级中性粒细胞减少发生率比较,差异无统计学意义(OR=1.34,95%CI:0.62~2.91,P>0.05),两组≥3级感染发生率比较,差异有统计学意义(OR=1.82,95%CI:1.23~2.71,P<0.05)。结论 利妥昔单抗联合化疗可提高儿童成熟B细胞淋巴瘤患者的生存率,应用≥6次利妥昔单抗临床效果更好,总体不良反应发生率较低。

Kindergarten Teachers’Language Modeling Behaviors in Daily Activities and Free Play

Teachers’language modeling behaviors,including frequent conversation,open-ended questions,repetition and extension,self-and parallel talks,and advanced language,have significantly impacted young children’s language learning and development.This study examined 60 classrooms from 20 kindergartens in Guangzhou,China,and analyzed 62 films of daily activities and 57 videos of free play.It aims to address the research gap in existing research that pays little attention to teachers’language modeling behaviors in daily activities and free play.The results indicate that the more frequent teachers’language modeling behaviors,the larger the vocabulary young children use and the better their performance in lexical richness.However,such behaviors in daily activities and free play are infrequent and superficial,failing to guide young children’s language development effectively.To optimize teachers’language modeling behaviors in daily activities and free play,they are expected to establish positive emotional bonds with young children in a kind and respectful manner and receive training.Teachers are also encouraged to frequently communicate and engage in dialogues with young children,create contexts that facilitate the use of language,increase the frequency of stimuli for vocabulary learning,and guide and encourage young children’s advanced language.

上海地区儿童甲状腺功能检测指标参考区间的建立

目的建立上海地区儿童甲状腺功能检测指标——促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)的参考区间。方法选取2014年8月至2015年7月于上海地区9家医院就诊的4 d^17岁健康儿童720名,按年龄分为6组,每组120名。血液收集后离心,血清-20℃冷冻保存,使用贝克曼库尔特Uni Cel Dx I 800免疫分析系统进行测定。依据美国临床实验室标准化协会(CLSI)C28-A3文件及国际临床化学和检验医学联合会(IFCC)的相关要求制定参考区间的合理方法和可靠依据,以非参数法确定TSH、FT3和FT4的95%参考区间(百分位数范围为2.5%~9 7.5%,可信区间为9 0%)。结果各组按年龄段划分参考区间为:A组(4 d~<1个月),TSH 0.53~18.91μIU/m L,FT3 2.42~5.67 pmol/L,FT4 11.85~33.81 pmol/L;B组(1~<12个月),TSH0.7 5~5.7 5μI U/m L,F T3 4.2 1~8.1 6 p m o l/L,F T4 9.4 0~1 9.5 4 p m o l/L;C组(1~<5岁),T S H0.6 3~6.2 0μI U/m L,F T3 3.5 4~6.9 0 p m o l/L,F T4 9.3 2~1 8.4 0 p m o l/L;D组(5~<1 0岁),T S H0.58~5.39μIU/m L,FT3 3.97~7.83 pmol/L,FT4 10.65~19.23 pmol/L;E组(10~<14岁),TSH0.3 9~5.3 6μI U/m L,F T3 4.2 7~8.5 5 p m o l/L,F T4 9.8 0~1 9.6 4 p m o l/L。F组(1 4~1 7岁),T S H0.48~5.06μIU/m L,FT3 3.14~6.15 pmol/L,FT4 9.57~18.27 pmol/L。A组新生儿与相邻的B组参考区间分布比较,差异有统计学意义(Z>3);各组内不同性别间TSH、FT3、FT4水平比较,差异无统计学意义(P>0.05)。结论建立了上海地区4 d^17岁健康儿童按年龄分组TSH、FT3和FT4的参考区间。利用以上参考区间能够解释儿童甲状腺功能的检测结果,有助于诊断、治疗和监测甲状腺功能减低症、甲状腺功能亢进症、甲状腺炎、甲状腺肿及甲状腺肿瘤等疾病。

正常和营养不良儿童血浆游离氨基酸含量

正常人体血浆游离氨基酸(简称血浆氨基酸)浓度对于氨基酸代谢缺陷性疾病,肝、肾等疾病的诊断与治疗以及对儿童营养状况的评价有参考意义。我们于1985年9月～1986年6月对251名正常儿童和39例营养不良儿童测定了15种血浆氨基酸含量。

小儿病毒性心肌炎的氧自由基变化及其相关因素

对 61例病毒性心肌炎 ( VMC)患儿检测了 SOD、GSH— PX、MDA。发现 VMC患儿发病 1周内 SOD、GSH—PX下降 ,MDA升高 ;经大剂量维生素 C治疗后 ,SOD、GSH— PX、MDA于 4～ 6周恢复正常。 SOD、GSH—PX与 CK—MB呈负相关 ;与 EF、FS呈正相关 ;MDA与 CK—MB呈正相关 ,与GSH— PX、SOD呈负相关。MDA升高与否和心电图 ST—T改变有关 ,GSH—PX、SOD降低与否和心电图 ST—T改变无关。

营养宣教对小学生午餐剩余情况的改善效果评价

目的:评价营养宣教对不同性别、不同年级小学生在校午餐中各类食物剩余情况的改善效果。方法:采用方便抽样法,于北京市丰台区选取4所中等规模的小学,随机分为干预组和对照组。对干预组学生及其家长进行3个月的营养知识宣教,对照组不采取任何措施。干预前后采用相同方法记录学生午餐各类食物的剩余率。结果:基线调查发现,主食、肉菜、素菜和总剩余率分别为6.3%、6.3%、14.1%和6.4%;女生午餐剩余率高于男生、高年级剩余率高于低年级(P<0.05)。干预后,男生干预组的肉菜剩余率明显低于对照组(P<0.05),干预组随访期素菜剩余率明显低于基线期(P<0.05);女生、低年级组各类食物的剩余率均显著下降(P<0.05);高年级组干预组总剩余率明显高于对照组(P<0.05),干预组随访期仅素菜剩余率明显低于基线期(P<0.05)。结论:营养宣教可显著降低女生和低年级学生各类食物的剩余率,明显改善男生对肉菜和素菜的剩余情况,尚不能证明对高年级学生各类食物剩余率有显著效果。

上海市某区中小学午餐营养质量调查

[目的 ] 了解上海市某区中小学午餐营养质量 ,并提出改进措施。 [方法 ] 对连续 5天午餐食物实样作供给量评估 ,并运用电脑营养分析系统软件 ,进行膳食营养素供给量估算 ,并与RLA相比较。 [结果 ] (1)小学和中学午餐平均热能供给量分别为 5 99.8kcal(占RLA的 85 .7% )和 75 4.4kcal(占RLA的 81.1% ) ,平均每餐蛋白质供给量分别为 2 1.1克 (占RLA的 87.8% )和 2 4.7克 (占RLA的 77.3 % ) ,平均每餐脂肪供给量分别为 15 .9克 (占RLA的6 8.2 % )和 2 5 .5克 (占RLA的 98.8% ) ,平均每餐碳水化物供给量分别为 93 .1克 (占RLA的 94.5 % )和 10 6 .7克(占RLA的 74.9% )。小学和中学平均蛋白质 /脂肪 /碳水化物的热能比分别为 14.1/2 3 .9/6 2 .1和 13 .1/30 .4/5 6 .6。(2 )小学和中学午餐平均钙、锌供给量普遍不足 ,小学午餐铁供给充足 ,而中学供应不足。 (3)中小学午餐中维生素A、B1、B2 和C供给量均不足 ,尤以维生素A为甚。 [结论 ] 该区中小学午餐质量存在食物结构的缺陷 ,需要进一步调整。

邵阳市学龄儿童营养状况与午餐膳食调查与分析

目的了解邵阳市学龄儿童的营养状况和在校午餐膳食情况,以指导学校和家庭合理安排膳食,保证学龄儿童的营养供应。方法采用分层随机整群抽样法,在该市抽取了2119名中小学生进行营养状况调查,采用全血元素分析仪检测人体血液中钙、铁、锌、铜、铅的含量,膳食中的能量和蛋白质、脂肪、碳水化物采用卡路里热量分析仪检测,食物中的钙、铁、锌的含量采用原子吸收光谱法进行检测。结果邵阳市6~15岁的学龄儿童中消瘦、超重、肥胖的人群分别有5.29%、5.24%、2.69%,钙、铁、锌元素缺乏的人群分别为8.31%、9.57%和4.26%。午餐膳食有3种模式,模式A是牛奶+点心,3种产能营养素的比例与平衡膳食模式相符,但能量和营养素供给量远低于膳食营养素参考摄入量(DRIs);模式B是牛奶+膳食,供给食物的数量较多,能量、蛋白质、脂肪、碳水化合物和钙、铁、锌的含量分别为769.54 kcal、27.98 g、38.70 g、75.22 g、211.22 mg、8.25 mg、2.03 mg;模式C为纯膳食,能量和主要营养素的含量介于午餐模式A和B中间,但和模式B均存在碳水化合物比例低、脂肪比例高的问题。3种午餐模式均以谷物为主,但膳食结构不合理,全谷物及杂豆、薯类、水果、坚果等食物摄入的频率和数量都很低,乳制品的摄入量均低于国家推荐的300g·人^(-1)·d^(-1)的标准。结论该市学龄儿童的营养状况待改善,午餐膳食结构不合理,应进行营养教育和干预,促进均衡营养。