Revision of the Healthy Lifestyle-Diet Index and association of the revised index with obesity and iron deficiency in schoolchildren: The Healthy Growth Study

2 Abstract Background: The Healthy Lifestyle-Diet Index (HLD-index) previously designed to assess the degree of adherence to dietary and lifestyle guidelines for primary schoolchildren was revised according to new recommendations. �he 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. The R-HLD-index total score ranged between 0 and 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 healthier lifestyle and better diet quality. After adjusting for potential confounders, logistic regression analysis showed that the increase in the R-HLD-index score by one unit was associated with 6% lower odds of being obese. 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 other healthcare professionals when assessing diet quality and lifestyle patterns of primary schoolchildren. Higher scores of this index were found to be significantly associated with a lower level of children's weight status but not with ID.