Wijesinha-Bettoni Ramani, Orito Aya, Löwik Marianne, Mclean Catherine, Muehlhoff Ellen
Food and Agriculture Organization of the United Nations, Rome, Italy.
Food Nutr Bull. 2013 Mar;34(1):75-94. doi: 10.1177/156482651303400109.
To reverse the trend of rising child obesity rates in many middle-income countries, recommendations include increasing fruit and vegetable consumption. Schools can positively impact children's eating behavior, and multicomponent interventions that include the curriculum, school food environments, and parental involvement are most effective.
To find out how fruits and vegetables feature in the dietary guidelines provided to schools, what specific schemes are available for providing these foods, the extent to which nutrition education is included in the curriculum, and how vegetables and fruits are procured in primary schools.
In 2008, a survey questionnaire previously validated and revised was sent electronically to national program managers and focal points for school feeding programs in 58 middle-income countries. The rationale was to obtain information relevant to the entire country from these key informants. The survey response rate was 46%. The information provided by 22 respondents in 18 countries was included in the current study. On average, respondents answered 88% of the questions analyzed in this paper. Of the respondents, 73% worked for the national authority responsible for school food programs, with 45% at the program coordinator or director level.
Few countries have any special fruit and vegetable schemes; implementation constraints include cost and lack of storage facilities. Although 11 of 18 countries have both nutrient-based guidelines and school food guidelines for meals, fruits and vegetables are often not adequately specified.
In some countries, nutrition education, special activities, school gardens, and parental participation are used to promote fruits and vegetables. Specific schemes are needed in some, together with school food guidelines that include fruits and vegetables.
为扭转许多中等收入国家儿童肥胖率不断上升的趋势，建议包括增加水果和蔬菜的消费量。学校可对儿童的饮食行为产生积极影响，包括课程、学校饮食环境和家长参与的多组分干预措施最为有效。
了解水果和蔬菜在提供给学校的饮食指南中如何体现，有哪些提供这些食物的具体方案，课程中纳入营养教育的程度，以及小学如何采购蔬菜和水果。
2008年，一份先前经过验证和修订的调查问卷以电子方式发送给58个中等收入国家的国家项目经理和学校供餐计划协调人。这样做的目的是从这些关键信息提供者那里获取与整个国家相关的信息。调查回复率为46%。本研究纳入了18个国家22名受访者提供的信息。平均而言，受访者回答了本文所分析问题的88%。在受访者中，73%为负责学校供餐计划的国家机构工作，其中45%为项目协调员或主任级别。
很少有国家实施任何专门的水果和蔬菜计划；实施方面的限制包括成本和缺乏储存设施。虽然18个国家中有11个国家既有基于营养素的膳食指南，也有学校膳食指南，但水果和蔬菜的规定往往不够明确。
在一些国家，营养教育、特别活动、校园菜园和家长参与被用来推广水果和蔬菜。一些国家需要制定具体计划，同时制定包括水果和蔬菜的学校膳食指南。
