Objective: To investigate whether insufficient nutritional health knowledge can increase the risk of obesity conferred by the surrounding environment, so as to provide a basis for improving the physical health of primary school students by their knowledge of nutritional health. Methods: From May to June 2017, a stratified cluster random sampling method was used to select 3 669 primary school students from 2 primary schools in Shenyang for anthropometric measurements and a student questionnaire survey. School neighborhood environment data were obtained from geospatial analyses conducted by using SuperMap GIS 9D. A self designed questionnaire based on the Chinese Dietary Guidelines (2016) was used to assess individual nutritional health knowledge levels.The frequency of fruit and vegetable intake was divided into four quartiles ( Q 1- Q 4), and the land use efficiency was divided into three quintiles ( T 1- T 3). Multiple Logistic regression and linear regression analyses were employed to examine the relationships between insufficient nutritional health knowledge, school neighborhood environment, and the frequency of fruit and vegetable intake, body mass index (BMI), and perirenal fat thickness (PrFT) among primary school students. Results: After adjusting for age, sex, place of residence, family annual income, parental education level, and physical activity, multiple Logistic regression analysis showed that higher land use efficiency around school ( T 2 and T 3)( OR =1.37, 2.45), the presence of ≥1 shopping mall ( OR =1.43), and ≥1 fruit and vegetable store ( OR =1.51) were associated with a higher frequency of fruit and vegetable intake ( Q 4) (all P <0.05). Multiple linear regression analysis revealed that students attending schools with higher land use ( T 3: β = -0.72 ), ≥1 shopping mall ( β = -0.45 ), and multiple fruit and vegetable stores ( β =-0.33) had lower PrFT (all P <0.05). Interaction analysis indicated that the positive association between school neighborhood environment and fruit and vegetable intake frequency was attenuated by insufficient nutritional health knowledge [ T 3 land use×insufficient nutritional knowledge score ( OR = 0.05); ≥1 shopping mall × insufficient nutritional knowledge score ( OR =0.06); ≥1 fruit and vegetable store×insufficient nutritional knowledge score( OR =0.07)] (all P < 0.05). The negative association between school neighborhood environment and the extreme quartile of PrFT was attenuated by insufficient nutritional health knowledge [ T 3 land use mix×insufficient nutritional knowledge score ( β =2.31); ≥1 shopping mall×insufficient nutritional knowledge score( β =3.59)](both P <0.05). Conclusions The healthy food environment around schools is negatively correlated with the obesity risk among primary school students.However, the association is affected by their insufficient nutritional knowledge. Comprehensive intervention strategies should be implemented to prevent the prevalence of obesity by addressing both individual and environmental factors influencing dietary habits.

Abstract To understand strategies and experiences for reducing the intake of sugar sweetened beverage (SSBs) among children and adolescents, so as to provide references for formulating relevant policies in China, the study analyzes and synthesizes domestic and international research literature and public policies on SSBs consumption and intake among children and adolescents, the food environment, and childhood obesity and related chronic diseases. It also reviews the prevention and control measures that have been adopted to reduce the intake of SSBs among children and adolescents, such as health education and promotion, restrictions on advertising and marketing, taxation policies, health labeling and packaging requirements, as well as their effectiveness, so as to offer recommendations and references for future prevention and control of childhood and adolescent obesity.