强有力的营养治理是应对低收入和中等收入国家营养转型问题的关键：各国营养政策综述
Strong nutrition governance is a key to addressing nutrition transition in low and middle-income countries: review of countries' nutrition policies.
作者信息
Sunguya Bruno F, Ong Ken I C, Dhakal Sumi, Mlunde Linda B, Shibanuma Akira, Yasuoka Junko, Jimba Masamine
机构信息
Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo 7-3-1, 113-0033 Hongo Bunkyo-ku, Tokyo, Japan.
出版信息
Nutr J. 2014 Jun 27;13:65. doi: 10.1186/1475-2891-13-65.
UNLABELLED
Nutrition transition necessitates low and middle-income countries (LAMICs) to scale up their efforts in addressing the burdens of undernutrition and overweight/obesity. Magnitudes of undernutrition and overweight are high in LAMICs, but no study has reviewed the existence of nutrition policies to address it. No evidence is also available on the effect of nutrition policies and governance on the undernutrition and overweight/obesity patterns in such countries. We conducted a policy review to examine the presence and associations of nutrition policies and governance with the children's nutrition statuses in LAMICs.
METHODS
We reviewed nutrition policies, nutrition governance, and the trends of nutrition status from LAMICs. We retrieved data on the policies from the global database on the implementation of nutrition actions (GINA). We also retrieved data on the trends of nutrition status and nutrition governance from the nutrition landscape information system (NLiS), and on LAMICs from the World Bank database. We then analyzed the data both descriptively and by using a mixed effects model with random-intercept by country.
RESULTS
Of the 139 LAMICs reviewed, only 39.6% had policies to address both undernutrition and overweight/obesity. A higher proportion of low-income countries (LICs) had policies to address undernutrition compared to that of middle-income countries (MICs) (86.1% vs. 63.1%, p = 0.002), and a low proportion of both had policy to address overweight. Having a nutrition policy that addresses undernutrition was not associated with better nutrition status outcomes. Strong nutrition governance in LAMICS was associated with low magnitudes of stunting (beta = -4.958, p = 0.015); wasting (beta = -5.418, p = 0.003); and underweight (beta = -6.452, p = 0.001).
CONCLUSION
Despite high magnitudes of undernutrition and overweight/obesity in LAMICs, only about one third of them had nutrition policies to address such nutrition transition. Having strong nutrition governance may help to bring down the magnitudes of undernutrition in LAMICs.
未标注
营养转型要求低收入和中等收入国家（LAMICs）加大力度应对营养不良和超重/肥胖负担。LAMICs中营养不良和超重的程度很高，但尚无研究对解决这一问题的营养政策的存在情况进行综述。关于营养政策和治理对这些国家营养不良和超重/肥胖模式的影响也没有证据。我们进行了一项政策综述，以研究营养政策和治理与LAMICs儿童营养状况之间的存在情况及关联。
方法
我们综述了LAMICs的营养政策、营养治理以及营养状况趋势。我们从全球营养行动实施数据库（GINA）中检索政策数据。我们还从营养状况信息系统（NLiS）中检索营养状况和营养治理趋势数据，以及从世界银行数据库中检索LAMICs的数据。然后我们对数据进行描述性分析，并使用按国家随机截距的混合效应模型进行分析。
结果
在接受综述的139个LAMICs中，只有39.6%有应对营养不良和超重/肥胖的政策。与中等收入国家（MICs）相比，低收入国家（LICs）中有更高比例的国家有应对营养不良的政策（86.1%对63.1%，p = 0.002），而两者中应对超重的政策比例都较低。制定应对营养不良的营养政策与更好的营养状况结果无关。LAMICs中强有力的营养治理与较低的发育迟缓发生率相关（β = -4.958，p = 0.015）；消瘦发生率（β = -5.418，p = 0.003）；以及体重不足发生率（β = -6.452，p = 0.001）。
结论
尽管LAMICs中营养不良和超重/肥胖程度很高，但其中只有约三分之一的国家有应对这种营养转型的营养政策。拥有强有力的营养治理可能有助于降低LAMICs中营养不良的程度。
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