title: Physical activity mediates the protective effect of the Mediterranean diet on children's obesity status: The CYKIDS study.
abstract: OBJECTIVE
  There is some evidence regarding the association between adherence to the Mediterranean diet (MD) and obesity among adults; to our knowledge, however, no relevant data exist for children. We investigated the association between adherence to the MD and obesity status in children.
  
  
  METHODS
  A national cross-sectional study among 1140 children (mean age 10.7+/-0.98 y) was carried out in Cyprus using stratified multistage sampling design. Body mass index was calculated according to International Obesity Task Force criteria, from parental reference. Adherence to the MD was assessed by the Mediterranean Diet Quality Index for children and adolescents (KIDMED diet score). To test the research hypothesis, a logistic regression analysis was applied with two dependent variable categories of obesity status, normal weight (NW) versus overweight/obese (OW/OB), and the three categories of the KIDMED score independently, after controlling for several potential confounders.
  
  
  RESULTS
  Compared with low MD adherers, children with a high KIDMED score were 80% less likely to be OW/OB (95% confidence interval 0.041-0.976), adjusted for age, gender, parental obesity status, parental educational level, and dietary beliefs and behaviors (model 2). When physical activity was taken into account, however, the aforementioned relation was not significant (model 3; odds ratio 0.20, 95% confidence interval 0.021-1.86). Furthermore, male gender, maternal obesity, and dietary beliefs and behaviors emerged as more significant in predicting obesity in children compared with their KIDMED score.
  
  
  CONCLUSIONS
  Adherence to the MD is inversely associated with obesity in this sample of 9- to 13-y-old children; however, other behaviors, and in particular physical activity, maternal obesity, dietary beliefs and behaviors, seem to be more significant.
authors.affiliation: Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. stalolaz@logosnet.cy.net
authors.forename: Chrystalleni
authors.initials: C
authors.lastname: Lazarou
authors.forename: Demosthenes B
authors.initials: DB
authors.lastname: Panagiotakos
authors.forename: Antonia-Leda
authors.initials: AL
authors.lastname: Matalas
mesh_terms: D015992:Body Mass Index; D002648:Child; D003430:Cross-Sectional Studies; D003535:Cyprus; D038441:Diet, Mediterranean; D015444:Exercise / Q000502:physiology*; D005260:Female; D005518:Food Preferences; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D009043:Motor Activity / Q000502:physiology; D009765:Obesity / Q000178:diet therapy*; D012307:Risk Factors; D012737:Sex Factors