WHO European Childhood Obesity Surveillance Initiative: School Nutrition Environment and Body Mass Index in Primary Schools

International Journal of Environmental Research and Public Health

Trudy M.A. Wijnhoven⁷  Joop M.A. van Raaij¹⁰  Agneta Sjrg¹²  Nazih Eldin⁸  Agneta Yngve⁶  Marie Kunešová²  Gregor Starc⁹  Ana I. Rito³  Vesselka Duleva¹³  Maria Hassapidou^4,7  Éva Martos^1,7  Iveta Pudule^7,14  Ausra Petrauskiene^7,11  Victoria Farrugia Sant𠆚ngelo^5,7  Ragnhild Hovengen^7,15  João Breda⁷ 

[1] National Institute for Food and Nutrition Science, Albert Florian Út 3/a, 1097 Budapest, Hungary; E-Mail:;Obesity Management Centre, Institute of Endocrinology, Narodni 8, 11694 Prague 1, Czech Republic; E-Mail:;National Health Institute Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon, Portugal; E-Mail:;Department of Nutrition and Dietetics, Alexander Technological Educational Institute of Thessaloniki, P.O. Box 14561, 54101 Thessaloniki, Greece; E-Mail:;Primary Health Care Department, 7 Harper Lane, Floriana FLR 1940, Malta; E-Mail:;School of Hospitality, Culinary Arts and Meal Science, Örebro University, Campus Grythyttan, P.O. Box 1, SE-712 60 Grythyttan, Sweden; E-Mail:;Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark; E-Mail:;Health Promotion Department, Health Service Executive, Railway Street, Navan, County Meath, Ireland; E-Mail:;Faculty of Sport, University of Ljubljana, Gortanova 22, 1000 Ljubljana, Slovenia; E-Mail:;Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; E-Mail:;Department of Preventive Medicine, Lithuanian University of Health Sciences, Eiveniu Str. 4, 50009 Kaunas, Lithuania; E-Mail:;Department of Food and Nutrition and Sport Science, University of Gothenburg, P.O. Box 300, SE-405 30 Gothenburg, Sweden; E-Mail:;Department of Food and Nutrition, National Centre of Public Health and Analyses, 15 Akad. Ivan Evstatiev Geshov Blvd., 1431 Sofia, Bulgaria; E-Mail:;Centre for Disease Prevention and Control, 22 Duntes Street, LV-1005 Riga, Latvia; E-Mail:;Department of Health Statistics, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, N-0403 Oslo, Norway; E-Mail:

关键词: school policy;    monitoring;    healthy school environment;    nutrition;    physical activity;    overweight;    primary schools;    Europe;   

DOI  :  10.3390/ijerph111111261

来源: mdpi

【 摘 要 】

Background: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention. Objective: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries. Methods: Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children’s weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children’s BMI/A Z-scores was calculated. Results: Large between-country differences were found in the availability of food items on the premises (e.g., fresh fruit could be obtained in 12%−95% of schools) and school nutrition environment scores (range: 0.30−0.93). Low-score countries (Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (≥0.70) countries were Ireland, Malta, Norway, Portugal, Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI/A Z-scores were positive (range: 0.20−1.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI/A Z-score was not observed. Conclusions: Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the “unhealthy” school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies.

【 授权许可】

CC BY   
© 2014 by the World Health Organization; licensee MDPI, Basel, Switzerland.