RESEARCH PAPER Revised Healthy Lifestyle-Diet Index and associations with obesity and iron deficiency in schoolchildren: The Healthy Growth Study Y. Manios,* G. Moschonis,* C. Papandreou,* E. Politidou,* A. Naoumi,* D. Peppas,* C. Mavrogianni,* C. Lionis† & G. P. Chrousos‡ on behalf of the ‘Healthy Growth Study’ group *Department of Nutrition and Dietetics, Harokopio University, Athens, Greece †Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece ‡First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children’s Hospital, Athens, Greece Keywords diet, iron deficiency, lifestyle patterns, obesity, primary schoolchildren. Correspondence Y. Manios, Harokopio University of Athens, Department of Nutrition and Dietetics, 70, El. Venizelou Avenue, 17671 Kallithea, Athens, Greece. Tel.: +30 210 9549156 Fax: +30 210 9514759 E-mail: manios@hua.gr How to cite this article Manios Y., Moschonis G., Papandreou C., Politidou E., Naoumi A., Peppas D., Mavrogianni C., Lionis C. & Chrousos G.P. on behalf of the ‘Healthy Growth Study’ group. (2013) Revised Healthy Lifestyle-Diet Index and associations with obesity and iron deficiency in schoolchildren: The Healthy Growth Study. J Hum Nutr Diet. doi:10.1111/jhn.12183 Abstract Background: The Healthy Lifestyle-Diet Index (HLD-index), previously developed to assess the degree of adherence to dietary and lifestyle guide- lines for primary schoolchildren, was revised according to updated recom- mendations. Τhe association of the revised HLD-index (R-HLD-index) with obesity and iron deficiency (ID) was also examined. Methods: A representative sample of 2660 primary schoolchildren from Greece (9–13 years old) participating in the ‘Healthy Growth Study’ was examined. Twelve components related to dietary and lifestyle patterns were used to develop the R-HLD-index. Scores from 0 up to 4 were assigned to each one of these components, giving a total score ranging from 0 to 48. The associations between the R-HLD-index, obesity and ID were examined via logistic regression analysis. Results: The total score of the R-HLD-index calculated for each one of the study participants was found to range between 2 and 32 units, with higher scores being indicative of a healthier lifestyle and better diet quality. After adjusting for potential confounders, logistic regression analysis showed that an increase in the R-HLD-index score by one unit was associated with 6% lower odds for obesity. However, no significant association was observed between the R-HLD-index score and ID. Conclusions: The R-HLD-index may be a useful tool for public health pol- icy makers and healthcare professionals when assessing diet quality and life- style patterns of primary schoolchildren. Identification of children with lower scores in the R-HLD-index and its individual components could guide tailored made interventions targeting specific children and behaviors. Introduction Increasing obesity prevalence is of major global public health concern (Lavie et al., 2009), whereas, at the same time, iron deficiency (ID) affects a great proportion of childhood population worldwide (Zimmermann & Hur- rell, 2007). Dietary patterns, including the high consump- tion of energy-dense but nutrient-poor foods, have been reported as significant risk factors for both childhood obesity and ID (Nead et al., 2004). More specifically, the positive energy balance, as a result of an increased con- sumption of energy-dense, high-fat and low-fibre foods in combination with low physical activity levels, is the main risk factor for childhood obesity (Moreno et al., 2013). Furthermore, a higher consumption of foods with an increased content of nutrients that inhibit the intestinal absorption of dietary nonhaeme iron (e.g. calcium in dairy, phytates in cereals, etc.), combined with a lower consumption of foods rich in nutrients that enhance die- tary nonhaeme iron bioavailability (e.g. vitamin C in cit- 1 ª 2013 The British Dietetic Association Ltd. Journal of Human Nutrition and Dietetics