Influence of Food Environment Around Schools on Nutritional Status and Body Mass Index Trajectories Among Children and Adolescents

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Abstract
Objectives: This study aimed to investigate the impact of the food environment surrounding schools on nutritional status and body mass index (BMI) of children and adolescents, offering insights for developing evidence-based policies to promote healthier school surroundings. Methods: Based on 357,782 physical examination records from 140,578 children and adolescents aged 6 to 19 in the Shenzhen Student Health Surveillance System for the 2018–2025 academic years, this study employed latent class mixed models to analyze BMI Z-score trajectory changes among children and adolescents. Furthermore, multinomial logistic regression and logistic regression models were utilized to examine the association between the number of catering points of interest (POIs) near schools, including total number, fast-food restaurants, pastry shops, and beverage stores, and the nutritional status and BMI trajectories of children and adolescents, respectively. Data from Huairou District, Beijing, was used to verify the applicability of the findings in Northern China. Results: 20.71% of children and adolescents in Shenzhen were overweight or obese, and 44.70% were consistently overweight from 2018 to 2025. The increase in catering POIs around schools was significantly associated with nutritional status and overweight trajectory, with pastry shops having a particularly pronounced effect. Each interquartile range (IQR) change in pastry shop was associated with 4.25% (95% CI: 2.96%, 5.56%) increase in the odds of overweight compared with the normal nutritional group, and with 5.03% (95% CI: 3.62%, 6.45%) increase in the odds of the overweight trajectory compared with the normal weight trajectory. Moreover, schools in above-median GDP regions required more attention. A similar association between the number of catering POIs near schools and long-term overweight among children and adolescents was observed in Huairou District, Beijing. Conclusions: The food environment surrounding schools might play a contributory role in shaping the BMI trajectories of children and adolescents. The study emphasized the importance of focusing on the food environment near schools, providing insights for weight management interventions among children and adolescents as well as healthy urban planning.

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