High and moderate adherence to Mediterranean lifestyle is inversely associated with overweight, general and abdominal obesity in children and adolescents: The MediLIFE-index

Several lifestyle factors, such as diet and exercise, have been linked to pediatric obesity. However, relatively few studies have considered them simultaneously, as a pattern. To investigate the associations between students' lifestyle and overweight, general, and abdominal obesity, an a priori Mediterranean lifestyle index (ie, MediLIFE-index) was created. We hypothesized that students' characteristics and their probability to be overweight or obese would be lower towards a better adherence to a Mediterranean lifestyle pattern. This study included 174 209 students aged 6 to 18 years from all geographical regions of Greece who participated in the 2014-2015 EYZHN study. The total range of MediLIFE-index was 0-8 (higher values indicating greater adherence to the Mediterranean lifestyle). Index values were thereafter divided into three groups according to its textiles (a) 'non-adherent'; (b) 'moderately adherent'; and (c) highly adherent to the Mediterranean lifestyle. The mean standard deviation of the MediLIFE-index was 5.1 +/- 1.6. Students with higher scores had lower BMI and waist circumference (all P < .001). Those who were highly adherent compared to those who were non-adherent were associated with lower likelihood of being overweight, obese or abdominal obese, by 6% (OR 0.94, 95% CI 0.92, 0.98), 30% (OR 0.70, 95% CI 0.67, 0.75) and 20% (OR 0.80, 95% CI 0.77, 0.83), respectively. The optimal discriminating value of the index for overweight was 4.5 (78% sensitivity and 80% specificity), while for obese/abdominal obese was 3.5 (82% sensitivity and 85% specificity). A useful tool was developed in order to identify children and adolescents with increased odds of being overweight, obese, or abdominal obese based on their lifestyle. (C) 2019 Elsevier Inc. All rights reserved.