Addressing micronutrient deficiencies associated with the double burden of childhood malnutrition in China, a combined food system framework

解决与中国儿童营养不良双重负担相关的微量营养素缺乏问题，综合粮食系统框架

• 批准号: BB/T008989/1
• 负责人: Yun Yun Gong
• 金额: $ 128.31万
• 依托单位: University of Leeds
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=BB%2FT008989%2F1
• 关键词: Addressing; micronutrient; deficiencies; associated; double

The double burden of malnutrition (DBM) is a concept that describes the increasing prevalence of both undernutrition and overnutrition within the same communities, especially in low- and middle-income countries (LMICs). Both of these elements of malnutrition contribute to the burden of disease. Common to both are deficiencies in micronutrients (MND) such as iron, zinc, and vitamins, all of which are needed for healthy growth and development as well as maintaining general health and productivity. In China, despite rapid economic development, tens of millions living in rural poor communities lack food diversity and are frequently nutrient deficient, whilst urban populations show a rapid rise of obesity owing to unhealthy diets and imbalanced energy intake. Such micronutrient deficiencies (MND) associated with DBM are particularly problematic in children. Within the "Nutrition First" program under the "Healthy China 2030" national development strategies, interventions such as Ying Yang Bao (YYB), a soybean-based micronutrient supplementation package targeted at children, and biofortified crops with enriched micronutrients iron, zinc, and vitamin A etc., together with nutrition education and food diversity have been developed. These have been shown to be effective at improving nutrition in children affected by malnutrition/MND. However, outside of nutrition trials there is a challenge to promote uptake of these interventions. Combining expertise from the UK and China on nutrition and food systems, the focus of the current research is to determine the barriers to uptake of such interventions and to explore novel approaches to promoting their uptake, with the overall aim of improving child nutrition and health. Food is a key part of Chinese culture. Some foods that are considered to be healthful, such as sweet potato, millet, etc., have gone out of fashion and are seen as food for the poor. On the other hand, there may be an inherent resistance to unfamiliar food items for children such as YYB, and concerns about safety of food and biofortification. We will test the acceptance of context specific interventions in children in different age groups. In children from deprived areas, the benefits of early exposure to YYB for enhanced acceptance will be tested in children aged 6 months to 2 years old. Acceptance of biofortified foods (zinc+/iron+ wheat and b-carotene+ sweet potato) will be tested in nursery and school children based on the early exposure and uptake hypothesis. For urban school children at risk of obesity, the intervention will focus on increasing the diversity and optimising the nutrient content of the diet. Feasibility testing of an enhanced diet diversity, food supplementation and biofortification, and nutritional knowledge education will be studied using a survey method at school, family and community levels. Our research will engage with local communities, families and particularly mothers, to explore the determinants of malnutrition and MND, and the social and cultural barriers to uptake of nutrition interventions. When barriers to and drivers of uptake have been identified, photographic exhibitions using a story-telling approach to highlight positive messages will be used to promote the interventions in local communities, with social media campaigns to spread the word and promote engagement. We will develop a scalable food system-based intervention package for malnutrition/MND, and build this into the national food and health policies and guidelines. We will broaden the potential beneficiaries of the nutrition interventions by engaging with experts in Vietnam through communication and capacity-building activities.

营养不良的双重负担(DBM)是一个概念，描述了营养不良和营养过剩在同一社区日益普遍，特别是在低收入和中等收入国家(LMIC)。营养不良的这两个因素都增加了疾病的负担。两者的共同之处是缺乏微量营养素(MND)，如铁、锌和维生素，所有这些都是健康生长和发育以及维持一般健康和生产力所必需的。在中国，尽管经济发展迅速，但生活在农村贫困社区的数千万人缺乏食物多样性，经常营养不良，而由于不健康的饮食和能量摄入不平衡，城市人口的肥胖率迅速上升。这种与DBM相关的微量营养素缺乏症(MND)在儿童中尤其成问题。在“健康中国2030”国家发展战略下的“营养第一”计划范围内，制定了干预措施，如针对儿童的大豆微量营养素补充包(YYB)，以及含有丰富微量营养素铁、锌和维生素A等的生物强化作物，以及营养教育和食物多样性。事实证明，这些措施在改善营养不良/多动症儿童的营养方面是有效的。然而，在营养试验之外，促进对这些干预措施的接受是一个挑战。结合英国和中国在营养和食品系统方面的专业知识，当前研究的重点是确定采用此类干预措施的障碍，并探索促进采用此类干预措施的新方法，总体目标是改善儿童营养和健康。食物是中国文化的重要组成部分。一些被认为是健康的食物，如红薯、小米等，已经过时了，被视为穷人的食物。另一方面，对YYB等儿童不熟悉的食物可能存在内在的抵触，以及对食品安全和生物强化的担忧。我们将测试不同年龄段的儿童对特定背景干预措施的接受程度。在贫困地区的儿童中，将在6个月至2岁的儿童中测试早期接触YYB以提高接受度的好处。将根据早期接触和摄取假说，在幼儿园和学龄儿童中测试对生物强化食品(锌+/铁+小麦和b-胡萝卜素+红薯)的接受程度。对于有肥胖风险的城市学童，干预措施将侧重于增加饮食的多样性和优化营养含量。将在学校、家庭和社区各级采用调查方法，研究加强饮食多样性、食物补充剂和生物强化以及营养知识教育的可行性。我们的研究将涉及当地社区、家庭，特别是母亲，以探索营养不良和MND的决定因素，以及采取营养干预措施的社会和文化障碍。在确定了接受的障碍和驱动因素后，将利用摄影展览，使用讲故事的方法突出积极信息，在当地社区宣传干预措施，并通过社交媒体运动传播这一信息和促进参与。我们将制定一套可扩展的基于食品系统的营养不良/MND干预方案，并将其纳入国家粮食和卫生政策和指南。我们将通过沟通和能力建设活动与越南专家接触，扩大营养干预措施的潜在受益者。

项目成果

Evaluating the effectiveness of school garden-based programme in addressing knowledge, attitudes and practices on nutrition and diet of school children aged 3-18: a systematic review

评估学校菜园计划在解决 3-18 岁学童营养和饮食知识、态度和实践方面的有效性：系统评价

• DOI: 10.1017/s0029665121003463
• 发表时间: 2021
• 期刊: Proceedings of the Nutrition Society
• 影响因子: 7
• 作者: Chan C

Evaluating the impacts of school garden-based programmes on diet and nutrition-related knowledge, attitudes and practices among the school children: a systematic review

评估学校菜园计划对学童饮食和营养相关知识、态度和实践的影响：系统评价

• DOI: 10.21203/rs.3.rs-1359057/v1
• 发表时间: 2022
• 作者: Gong Y

Prevalence, determinants, intervention strategies and current gaps in addressing childhood malnutrition in Vietnam: a systematic review

越南儿童营养不良的患病率、决定因素、干预策略和当前差距：系统评价

• DOI: 10.21203/rs.3.rs-3227610/v1
• 发表时间: 2023
• 作者: Mondon C

Additional file 1 of Evaluating the impacts of school garden-based programmes on diet and nutrition-related knowledge, attitudes and practices among the school children: a systematic review

附加文件 1：评估学校菜园计划对学童饮食和营养相关知识、态度和做法的影响：系统评价

• DOI: 10.6084/m9.figshare.20155654
• 发表时间: 2022
• 作者: Chan C