Assessment of Nutritional Trends and Program Implementation Under the Nutrition Improvement Program

Background: The Nutrition Improvement Program has been implemented in China for over a decade; however, its assessment in Hubei Province has not yet been systematically reported. This study evaluated the implementation outcomes of the Rural Compulsory Education Students' Nutrition Improvement Program in Hubei Province. Methods: A multi-stage cluster sampling design with stratification by school type was used. Standardized questionnaires were administered to schools, districts, and students to assess the food environment, nutrition policies, and dietary behaviors. Anthropometric and biochemical measurements were collected from all participants in 2014 and 2023. Results: A total of 24 schools across six counties in Hubei Province were surveyed at two time points, comprising 8619 students (4388 in 2014 and 4231 in 2023). Between 2014 and 2023, the proportion of students in the Nutrition Improvement Program reporting satisfaction with school meals increased significantly, and average nutritional knowledge scores improved. Nevertheless, several deficiencies persisted: menus remained poorly aligned with dietary guidelines, food variety was limited, full-time nutrition or health teachers were scarce, and absolute levels of nutritional knowledge remained low. In 2023, the prevalence of undernutrition, overweight/obesity, and anemia among program participants was 9.5%, 15.9%, and 12.2%, respectively. Compared with girls, boys had higher rates of undernutrition and overweight/obesity and a lower anemia rate; the same pattern was observed in primary school students relative to junior high school students. Compared with 2014, the nutritional profile shifted markedly (p < 0.001). Undernutrition and anemia declined by 7.4 and 4.9 percentage points, respectively, whereas overweight/obesity increased by 6.9 percentage points. Conclusions: From 2014 to 2023, students in the Nutrition Improvement Program of Hubei Province experienced observable changes in nutritional status: the primary nutritional concern had shifted from undernutrition to overnutrition, and the prevalence of anemia has generally decreased, while it has increased in some areas. However, given the observational nature of the repeated cross-sectional design, causal inference regarding the program's impact was not supported.