東盟學校營養(yǎng)套餐的最低標準和指南（英）

MinimumStandardsGuidelinesforASEANSchoolNutritionPackage

i

MinimumStandardsandGuidelines

fortheASEANSchoolNutritionPackage

TheAssociationofSoutheastAsianNations(ASEAN)wasestablishedon8August1967.TheMemberStatesareBruneiDarussalam,Cambodia,Indonesia,LaoPeople'sDemocraticRepublic,Malaysia,Myanmar,Philippines,Singapore,ThailandandVietNam.

TheASEANSecretariatisbasedinJakarta,Indonesia.

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MinimumStandardsandGuidelinesforASEANSchoolNutritionPackageJakarta,ASEANSecretariat,August2024

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Suggestedcitation

ASEAN,WFPandUNICEF.2024.MinimumStandardsandGuidelinesforASEANSchoolNutritionPackage.Jakarta;UNICEF.

Photographycredits

Coverpage:?UNICEF/UN0311099/Verweij

pagexi:?UNICEF/2019/Ijazah

page1:?WorldFoodProgramme/2021/Shells

page2:?WorldFoodProgramme/2015/Maentz

page3:?UNICEF/UN0445448/Lister

page15:?WorldFoodProgramme/2015/Maentz

page16:?UNICEF/UN0311098/Verweij

page19:?WorldFoodProgramme/2017/Skullerud

page28:?UNICEFMalaysia/2018

page29:?UNICEF/2021/Fauzan

page31:?WorldFoodProgramme/2015/Maentz

page32:?UNICEFCambodia/2017/Khoy

page37:?UNICEF/UN04247/Estey

page42:?UNICEF/2020/Ijazah

page43:?WorldFoodProgramme/2021/Lopez

page46:?UNICEFThailand/2021/PreechapanichThisreportwasprintedwithsupportfromUNICEF.PrintedinJakarta,Indonesia

MinimumStandardsandGuidelinesforASEANSchoolNutritionPackage

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Contents

Acknowledgementsiii

Glossaryviii

Acronymsx

1Introduction2

1.1Purpose 2

1.2Intendedaudience 2

2RationalefortheASEANSchoolNutritionPackage4

2.1Regionalreturnsoninvestinginthenutritionofschool-agechildren 5

2.2Regionalburdenofmalnutritionamongschool-agechildren 5

2.3Driversofmalnutritioninschool-agechildren 8

2.4SchoolsareacriticalplatformforimprovingnutritioninASEANregion 13

2.5Regionalharmonizedguidelinesonschoolnutrition 13

3FrameworkfortheASEANSchoolNutritionPackage16

4MinimumstandardsfortheSchoolNutritionPackage20

4.1Integratedschool-basednutritionactivities 21

4.2Nutritiousfoodsanddiets 23

4.3Healthyfoodenvironments 31

4.4Schoolhealthandnutritionservices 34

4.5Nutritionliteracy 35

4.6Physicalactivity 39

4.7Monitoring,enforcementandevaluation 40

4.8Enablingenvironment 41

5Schoolnutritioninresponsetoshocks44

5.1Impactofshocksonfoodandnutritionsecurity 45

Annex48

Annex1:Schoolnutritionframeworks,standardsandguidelines 49

Annex2:Fivekeystothesafepreparationandhandlingoffood 52

Annex3:SchoolfoodenvironmentactionsacrossASEANMemberStates 53

Annex4:NutritioneducationactionswithinASEANMemberStates 54

Annex5:PhysicaleducationperweekamongstudentsinASEANMemberStates 55

Annex6:Laws,policiesandregulationsonmandatorystandardsinschools 56

Annex7:Additionalcountry-specificcaseexamplesonminimumstandards 57

References58

MinimumStandardsandGuidelinesforASEANSchoolNutritionPackage

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Listoffigures

Figure1:Prevalenceofthinnessandoverweight(includingobesity)inchildren(5–19yearsofage),2016.6

Figure2:Trendinoverweight(includingobesity)(BMI-for-age>+1SD)prevalenceingirls(5-19yearsofage),

1976-2016 6

Figure3:Trendinoverweight(includingobesity)(BMI-for-age>+1SD)prevalenceinboys(5–19yearsof

age),1976–2016 7

Figure4:Proportionofschool-agechildrenwithanaemia 7

Figure5:Percentageofchildren(13–17years)whoatefruitsandvegetablesfiveormoretimesperday 9

Figure6:Percentageofschoolchildren(13–17years)consumingfastfoodatleastonceaweek 9

Figure7:Percentageofschoolchildren(13–17years)whousuallydrankcarbonatedsoftdrinksoneormore

timesperday(%) 10

Figure8:Provisionofcleandrinkingwaterinschools 11

Figure9:Prevalenceofinadequatephysicalactivityamongschool-agechildren(13–17years) 11

Figure10:Proportionofschool-agechildren(13–17years)whoparticipateinsedentaryactivity≥3hoursper

day 12

Figure11:Schoolenrolmentrateinprimaryandsecondaryschool 13

Figure12:SchoolNutritionPackageframework 17

Listofboxes

Box1:Keyglobalframeworksandguidanceonschoolnutrition 14

Box2:Healthy,balanceddietforschoolchildren 23

Box3:Whatisimprovedsanitation? 33

MinimumStandardsandGuidelinesforASEANSchoolNutritionPackage

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Acknowledgements

ThedesignatedrepresentativesfromASEANMemberStates,WFPandUNICEFandASEANSecretariatjointlycontributedtothedevelopmentoftheMinimumStandardsandGuidelinesforASEANSchoolNutritionPackage.

Theprocessesinvolvedwerethedevelopmentandfinalizationoftheconceptnoteandreportoutline;drafting,review,andfinalizationoftheGuidelinesandMinimumStandards;andcoordinationwithASEANMemberStates,authorsandcontributorstothereport.ThesewereundertakenwiththeoverallguidanceofleadcountryIndonesia,throughtheMinistryofHealth,togetherwithco-leadcountryVietNam,throughtheNationalInstituteofNutritionoftheMinistryofHealth,withoverallcoordinationbytheHealthDivisionoftheASEANSecretariat.

TheGuidelineswereapprovedbytheASEANHealthCluster(AHC)1onPromotingHealthyLifestylesandendorsedbytheASEANSeniorOfficialsMeetingonHealthDevelopment(SOMHD);andadoptedbytheASEANHealthMinistersMeeting(AHMM).

Theoveralldrafting,contentandtechnicalassistanceforthedevelopmentoftheGuidelineswasledbyJorisvanHees,SophiaDunnandVasundharaBijalwan(SchoolHealthandNutritionConsultantsofWFPRegionalBureauforAsiaandthePacific)underthesupervisionofAnusaraSinghkumarwong(RegionalNutritionistatWFPRegionalBureauforAsiaandthePacific)andFionaWatson(SchoolHealthandNutritionConsultantofUNICEFEastAsiaandPacificRegionalOffice).WewouldalsoliketoextendthankstoourcolleaguesAlisonFeeley(NutritionSpecialist,UNICEFEastAsia&PacificRegionalOffice)andVeraMayer(RegionalSchoolFeedingAdvisor,WFPRegionalBureauforAsiaandthePacific)whoprovidedtheirexpertisetofurtherenrichtheguidelines.BrittaSchumacher(formerSeniorRegionalNutritionAdviseratWFPRegionalBureauforAsiaandthePacific)andRolandKupka(RegionalNutritionAdviser,UNICEFEastAsia&PacificRegionalOffice)providedoverallguidanceandleadershiptotheprocess.ThedocumentsalsoreceivedvaluableinputsfromexpertsinFAO,WHO,andAlive&Thrive.

TheGuidelineswereeditedbyJuliaD'Aloisioandthedesign,layoutandgraphicswerepreparedbyCoriPark,followingtheASEANcorporatedesignmanual.

TheGuidelinesreceivedfeedbackfromtheASEANMemberStatesduringitsconsultationprocess.

ContributorsfromtheCoreTechnicalWorkingGroup

LeadCountry:

Indonesia

LovelyDaisy

Director,NutritionandMaternalandChildHealthDirectorate,MinistryofHealth

RrWeniKusumaningrum

AssistantDirectorinSchoolageand

adolescentHealth,NutritionandMaternalandChildHealthDirectorate,MinistryofHealth

HeraNurlita

SeniorNutritionist,NutritionandMaternalandChildHealthDirectorate,MinistryofHealth

TiskaYumeida

SeniorNutritionist,NutritionandMaternalandChildHealthDirectorate,MinistryofHealth

NyimasSeptianiWulandari

Nutritionist,NutritionandMaternalandChildHealthDirectorate,MinistryofHealth

MinimumStandardsandGuidelinesforASEANSchoolNutritionPackage

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Co-leadCountry:

VietNam

TranThanhDuongMD.,PhD

Director,NationalInstituteofNutrition

TranKhanhVanMD.,MPH.,PhD

HeadofMicronutrientsDepartment,NationalInstituteofNutrition

BuiThiNhungMD.,PhD,

HeadofSchoolandOccupationalNutrition,NationalInstituteofNutrition

BruneiDarussalam

Dr.ErninaRani

SeniorMedicalOfficer,HealthPromotion

Centre,MinistryofHealth

Dr.FaezahAmin

MedicalOfficer,HealthPromotionCentre,MinistryofHealth

RoseyatiYaakub

SeniorDietitian,HealthPromotionCentre,MinistryofHealth

RusydiahSudin

HealthEducationOfficer,HealthPromotionCentre,MinistryofHealth

Cambodia

Ms.CheaMary

Manager,NationalNutritionProgramme,

NationalMaternalandChildHealthCenter,MinistryofHealth

LaoPeople’sDemocraticRepublic

Dr.PhonesavanhKeonakhone

DirectorGeneralCentreofNutrition,MinistryofHealth

VilasithMikhasith.MPH

DeputyHeadTrainingUnitCentreofNutrition,MinistryofHealth

Malaysia

Ms.RusidahSelamatDirector,NutritionDivision,MinistryofHealth

Ms.ZaitonDaud

DeputyDirector(FamilyNutrition),NutritionDivision,MinistryofHealth

Mr.NazliSuhardiIbrahim

DeputyDirector(CommunityNutrition&InterNutrition),NutritionDivision,Ministryof

Health

Ms.NorizaZakaria

SeniorPrincipleAssistantDirector,PolicyandGlobalNutritionSector,Nutrition

Division,MinistryofHealth

Ms.RashadibaIbrahimRahman

SeniorPrincipleAssistantDirector,BabyandChildrenNutritionUnder5YearsOldSector,NutritionDivision,MinistryofHealth

Ms.FatimahSulong

SeniorPrincipleAssistantDirector,Industry’sCollaborationSector,NutritionDivision,

MinistryofHealth

Ms.JunidahRaib

SeniorPrincipleAssistantDirector,MaternalandWomenofReproductiveAgeNutritionSector,NutritionDivision,MinistryofHealth

Ms.SitiAdibahAb.Halim

PrincipleAssistantDirector,ChildrenandAdolescentSector,NutritionDivision,

MinistryofHealth

Ms.AinanNasrinaIsmail

PrincipleAssistantDirector,AdultandElderlyNutritionalSector,NutritionDivision,MinistryofHealth

Ms.TehWaiSiew

PrincipleAssistantDirector,NutritionSurveillanceSector,NutritionDivision,MinistryofHealth

Ms.NurLianaAbdulLatiff

SeniorAssistantDirector,Institutional

NutritionSector,NutritionDivision,MinistryofHealth

Ms.NorHanisahZaini

SeniorAssistantDirector,PolicyandGlobalNutritionSector,NutritionDivision,MinistryofHealth

MsFaridahMalikShaari

DeputyDirector,FoodSafetyandQualityDivision,MinistryofHealth

MinimumStandardsandGuidelinesforASEANSchoolNutritionPackage

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MsNorlidaZulkafly

PrincipalAssistantDirector,FoodSafetyandQualityDivision,MinistryofHealth

MsNurAnisMohdSani

PrincipalAssistantDirector,FoodSafetyandQualityDivision,MinistryofHealth

Mr.HairunizadHaron

AssistantDirector,StudentAffairs

ManagementSector,SchoolManagementDivision,MinistryofEducation

Ms.SitiAishaSenawiAssistantDirector,StudentAffairs

ManagementSector,SchoolManagementDivision,MinistryofEducation

Myanmar

Dr.AyeMyaMyaKyaw

DeputyDirector(Nutrition),DepartmentofPublicHealth,MinistryofHealth,Myanmar

Dr.HninDarliWin

AssistantDirector(Nutrition),DepartmentofPublicHealth,MinistryofHealth,Myanmar

Philippines

AzucenaM.Dayanghirang,MD,MCH,CESOIII

AssistantSecretaryandExecutiveDirectorIV,NationalNutritionCouncil

EllenRuthF.Abella

NutritionOfficerIVandOfficer-in-Charge,NationalNutritionCouncil

JasmineAnneDF.Tandingan

NutritionOfficerIII,NationalNutritionCouncil

Singapore

DrChowWaiLeng

Director,DiseasePolicy&StrategyDivision,MinistryofHealth

MsGuoSiqi

SeniorAssistantDirector(Non-

CommunicableDiseases),DiseasePolicy&StrategyDivision,MinistryofHealth

MrBrandonNg

SeniorManager(Non-CommunicableDiseases),DiseasePolicy&StrategyDivision,MinistryofHealth

MsJamaicaTan

Manager(Non-CommunicableDiseases),

DiseasePolicy&StrategyDivision,MinistryofHealth

MsVasukiUtravathy

Director,SchoolHealthandOutreach,HealthPromotionBoard

MsChristinaLow

DeputyDirector(EducationalInstitutions),SchoolHealthandOutreach,Health

PromotionBoard

MsEunicePang

DeputyDirector,Policy&Strategy

Development,HealthPromotionBoard

DrTanChingTing

MasterSpecialist,Pre-SchoolEducationBranch,SchoolsDivision,Ministryof

Education

MsChngMiangLynDerlynn

SeniorCurriculumSpecialist,Nutrition&

FoodScience,SciencesBranch,CurriculumPlanning&DevelopmentDivision1,MinistryofEducation

MsYeowWeiChengIrene

SeniorAssistantDirector/SeniorSpecialist,Physical,Sports&OutdoorEducation

Branch,StudentDevelopmentCurriculumDivision2,MinistryofEducation

Ms.SaipinChotivichien,MD.PhD.Director,BureauofNutrition,Departmentof

Thailand

Health,MinistryofPublicHealth

Ms.PattamapornAksornchu,PhD

Nutritionist,SeniorProfessionalLevel,

BureauofNutrition,DepartmentofHealth,MinistryofPublicHealth

Ms.NarttayaUngkanavinNutritionist,ProfessionalLevel,Bureauof

Nutrition,DepartmentofHealth,MinistryofPublicHealth

MinimumStandardsandGuidelinesforASEANSchoolNutritionPackage

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Ms.KhanitthaRahothanPublicHealthTechnicalOfficer,Professional

Level,DivisionofPhysicalActivityand

Health,DepartmentofHealth,MinistryofPublicHealth

PussdeePrasitsombut

PublicHealthTechnicalOfficer,Practitionerlevel,BureauofFoodandWaterSanitation,DepartmentofHealth,MinistryofPublic

Health

Mr.PasinPiriyahaphan

ForeignRelationsOfficer,PractitionerLevel,

CenterforInternationalCooperation,

DepartmentofHealth,MinistryofPublicHealth

ContributorsfromPartnersandInternationalOrganizations

WFP(Partner)

FilippoDibari

SeniorRegionalNutritionAdvisor,RegionalBureauforAsiaandthePacific

AnusaraSinghkumarwong

RegionalNutritionist,RegionalBureauforAsiaandthePacific

VasundharaBijalwan

SchoolHealthandNutritionConsultant,RegionalBureauforAsiaandthePacific

JorisvanHees

SchoolHealthandNutritionConsultant,RegionalBureauforAsiaandthePacific

SophiaDunn

SchoolHealthandNutritionConsultant,RegionalBureauforAsiaandthePacific

VeraMayer

RegionalSchoolFeedingAdvisor,RegionalBureauforAsiaandthePacific

UNICEF(Partner)

RolandKupka

RegionalNutritionAdviser,UNICEFEastAsia&PacificRegionalOffice

FionaWatson

Consultant,UNICEFEastAsiaandPacificRegionalOffice

AlisonFeeley

NutritionSpecialist,UNICEFEastAsiaandPacificRegionalOffice

Alive&Thrive

Dr.PaulZambrano

AssociateDirector(Technical),Alive&ThriveEastAsiaPacific

Dr.NguyenThanhTuan

RegionalTechnicalAdvisorin

Measurement,LearningandEvaluation,Alive&ThriveEastAsiaPacific

FAO

MelissaVargas

TechnicalAdviser,NutritionGuidelinesandStandards,FAOHeadquarters

LuanaSwensson

PolicySpecialistforSustainablePublicProcurement,FAOHeadquarters

FatimaHachem

TeamLeader,NutritionEducationandConsumerAwarenessGroup,FAO

Headquarters

AndreaPoloGalante

SeniorNutritionConsultant(formerFAO)

Dr.WarrenLee

SeniorNutritionOfficer,FAORegionalOfficeforAsiaandthePacific

WHO

Dr.JuliawatiUntoro

TechnicalleadnutritionofWHORegionalOfficefortheWesternPacific

MinimumStandardsandGuidelinesforASEANSchoolNutritionPackage

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ContributorsfromASEANSecretariat

HealthDivision

FerdinalFernando,MD,MDM

AssistantDirectorandHeadofHealth

Division,HumanDevelopmentDirectorate,ASEANSocio-CulturalCommunity

Department

LinaRospita

ProgrammeCoordinatorforNutrition/Senior

NutritionConsultant,HealthDivision,

HumanDevelopmentDirectorate,ASEANSocio-CulturalCommunityDepartment

EducationDivision

AmaliaM.Serrano

SeniorOfficer,EducationDivision,HumanDevelopmentDirectorate,ASEANSocio-CulturalCommunityDepartment

FoodandAgricultureDivision

GemilangHaifaKhairinissa

Officer,Food,AgricultureandForestry

Division,SectoralDevelopmentDirectorate,ASEANEconomicCommunityDepartment

MinimumStandardsandGuidelinesforASEANSchoolNutritionPackage

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Glossary

Anaemia:Apathologicalconditioncharacterizedbylowlevelsofhaemoglobinorpooroxygencarryingcapacityoftheredbloodcells.Anaemiaisanindicatorofpoornutrition,healthandwell-being.1

Adolescence:Thetransitionalphaseofgrowthanddevelopmentbetweenchildhoodandadulthood.

Adolescentsaredefinedasthosebetweentheagesof10and19years.Theagerangesof10–14yearsand15–19yearsarereferredtoasearlyadolescenceandlateadolescence,respectively.2

Bodymassindex:Ameasureforindicatingnutritionalstatusandanacceptedmeasureofadiposity.2Itiscalculatedasweightinkg/heightinmetres.BMIisgender-andage-specific.BMI-for-ageisbasedontheWHOchildandadolescentgrowthstandards.3

Fastfood:Foodthatcanbepreparedquicklyandeasilyandissoldinrestaurantsandsnackbarsasaquickmealortobetakenout.4

Foodsafety:Allmeasurestoensurethatfoodwillnotcauseharmtotheconsumerwhenitisprepared

and/oreatenaccordingtoitsintendeduse.5Inthecontextofschoolmeals,foodsafetyreferstoconditionsandpracticesthatensurefoodisnotcontaminatedwithphysical,chemicaland/orbiologicalhazardsthat

couldcauseharmtoconsumers.Itencompassesthewholeprocessoffoodproduction,selection,handling,storage,preparation,serviceandconsumptionofthefoodinwaysthatpreventcontamination.

Food-baseddietaryguidelines:Context-specificadviceandprinciplesonhealthydietsandlifestyles.Guidelinestypicallyproposeasetofrecommendationsregardingthefoods,foodgroupsanddietary

patternsthatarerequiredforoptimalhealthandtopreventchronicdisease.Theyarerootedinsound

evidenceandrespondtoacountry’spublichealthandnutritionpriorities,foodproductionandconsumptionpatterns,socioculturalinfluences,foodcompositiondataandaccessibility,amongotherfactors.6

Food-basedstandards:Specificquantities,portionsorrangesoffoods/foodgroupsthatshouldbe

included/excludedinameal/snack.Thesemayalsostipulatefrequencyofprovisionand/orrestrictionorprohibitionofcertainfoods.Theymaybeinlinewithnationalfood-baseddietaryguidelinesorotherfood/mealrecommendations.6

Healthydiet:Highintakeofminimallyprocessedfoods,suchasfruits,nuts,seeds,non-starchy

vegetables,beans/legumes,oilsfromtheseplants,wholegrains,yoghurtandfish;moderateintakeofunprocessedredmeats,poultry,eggsandmilk;avoidanceofrefinedstarchesandsugars,processedmeatsandotherultra-processedfoodshighinsodium,addedsugarsortrans-fats.7

Home-grownschoolmeals:Schoolfeedingmodelsthataredesignedtoprovidechildreninschoolswithsafe,diverseandnutritiousfood,sourcedlocallyfromsmallholders.Aschoolfeedingprogrammecanbeconsideredas“home-grown”evenifonlyaproportionoffoodispurchasedlocallyfromsmallholder

farmers,providedthatlocalpurchasessupportandfosterlocalagricultureandfoodmarkets.6

Inclusiveprocurement:Adeliberatewayforgovernmentstopurchasegoodsorservicesfromspecificunfavouredorvulnerablesuppliercategoriesinordertoadvancesocialandeconomicdevelopment.8

Marketing:Anyformofcommercialcommunicationormessagethatisdesignedto,orhastheeffectof,

increasingtherecognition,appealand/orconsumptionofparticularproductsandservices.9Itcomprisesanythingthatactstoadvertiseorotherwisepromoteaproductorservice.Thisbroaddefinitionisintendedtocovertherangeofmarketingstrategies,including,butnotlimitedto,advertising(includingadvertisingofcorporatesocialresponsibility),sponsorship,directmarketing(e.g.,mail,text),productplacementand

brandmarketing.

Middlechildhood:Theagerangeof5–9years.10

Nutrient-basedstandards:Specificminimumand/ormaximumquantitiesorrangesofenergyand

nutrientsthatanaveragemeal/snackshouldprovide.Thesearemainlybasedonestimatedindividualdietaryrequirements.6

MinimumStandardsandGuidelinesforASEANSchoolNutritionPackage

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Nutritionliteracy:Thedegreetowhichindividualshavethecapacitytoobtain,processandunderstand

nutritioninformationandtheskillsneededtomakeappropriatenutritiondecisions.11Nutritionliteracyistheultimategoaloffoodandnutritioneducation.

Overweight:Formiddlechildhoodandadolescence,aBMI-for-ageabove+1standarddeviationsoftheWHOgrowthreference(2007)medianforchildrenofthesameageandsex.3

Processedfoods:Foodsthathavebeencommerciallypreparedorpackagedusingbaking,canning,

dryingorfreezing.Mostprocessedfoodshavetwoorthreeingredients.Theyareediblebythemselvesor,moreoften,incombinationwithotherfoods.Thepurposeofprocessingistoincreasethedurabilityof

unprocessedorminimallyprocessedfoodsortomodifyorenhancetheirsensoryqualities.Examplesof

processedfoodsincludebottledvegetables,cannedfish,fruitsinsyrup,cheesesandfreshlymadebreads.12

Recommendeddietaryintake:Sometimesreferredtoasrecommendeddailyintake,istheaveragedailyintakelevelofparticularnutrientthatislikelytomeetthenutrientrequirementsofmosthealthyindividualsinaparticularlifestageorgendergroup.13

School-agechildren:Forthepurposesofthispublication,school-agechildrenaredefinedaschildrenfrom3–18yearsofage.Pre-school-agechildrenarethosefrom3–5yearsofage.However,definitionsvaryacrosssettings.14

Schoolfoodenvironment:Thespaces,infrastructureandconditionsinsideandaroundtheschool

premiseswherefoodisavailable,obtained,purchasedand/orconsumed(forexample,tuckshops,kiosks,canteens,foodvendors,vendingmachines).Italsoincludestheavailabilityoffoodsforconsumption,thenutritionalcontentofthesefoodsandtheinformationavailable,marketingandpromotion(advertisements,branding),foodlabelling,packagingandpricingoffoodsandfoodproducts.15

Schoolmealprogrammes:Programmesthatprovidemealsregularlytoschoolchildren.These

programmesmakeuseofvariousoperationalmodels(includingprocurementandpreparation).Theycanbeimplementedintandemwithcomplementaryinterventions,suchasnutritioneducation,deworming,

supplementation,etc.Alsoreferredtotraditionallyasschoolfeedingprogrammes.6

Schoolnutritionenvironment:Inanimprovedschoolnutritionenvironmentallfiveactionareas(nutritiousfoodsanddiets,healthyschoolfoodenvironments,schoolhealthandnutritionservices,nutritionliteracy

andphysicalactivity)areimplemented.

Sedentarybehaviour:Anywakingbehaviourcharacterizedbyanenergyexpenditure≤1.5metabolicequivalents,whileinasitting,recliningorlyingposture.16

Stunting:Height-for-agebelow-2standarddeviationsoftheWHOgrowthreference(2007)medianforchildrenofthesameageandsex.

Thinness:Inmiddlechildhoodandadolescence,aBMI-for-agebe