{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:17:20Z","timestamp":1790601440333,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,5,15]],"date-time":"2017-05-15T00:00:00Z","timestamp":1494806400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2017,6]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>To explore the effects of a multicomponent\u2013multilevel school\u2010based educational intervention on the nutritional habits and abdominal obesity indices of a representative adolescent sample.<\/jats:p><\/jats:sec>Materials and methods<\/jats:title>A representative sample of 1610 adolescents aged 12\u201317 years in 23 public high schools of three municipalities in the Attica region in Greece participated in a programme funded by the European Union (August 2013\u2013August 2014). Participants underwent dietary assessment with the use of the Mediterranean Diet Quality Index in children and adolescents (KIDMED<\/jats:styled-content>), blood pressure (BP<\/jats:styled-content>) assessment and screening for general and abdominal obesity by measuring body mass index, waist circumference (WC<\/jats:styled-content>) and waist\u2010to\u2010height ratio (WH<\/jats:styled-content>tR), at baseline and following a 6\u2010month school\u2010based intervention. The intervention involved nutritional education, physical activity and body image awareness using a multilevel approach to the adolescent participants, their parents, school teachers and health staff.<\/jats:p><\/jats:sec>Results<\/jats:title>Analysis included 1032 adolescents (mean age \u00b1 SD<\/jats:styled-content> 14\u00b71 \u00b1 1\u00b76 years). Following intervention, mean KIDMED<\/jats:styled-content> score \u00b1 SD<\/jats:styled-content> increased significantly from 5\u00b76 \u00b1 2\u00b74 to 5\u00b78 \u00b1 2\u00b74 (P<\/jats:italic> = 0\u00b7004). Higher percentage of boys (P<\/jats:italic> = 0\u00b7028) and younger adolescents (P<\/jats:italic> < 0\u00b7001) had optimal KIDMED<\/jats:styled-content> scores \u2265 8. Significant decreases were observed in overweight and obesity (P<\/jats:italic> = 0\u00b7033), mean systolic (P<\/jats:italic> = 0\u00b7049) and diastolic (P<\/jats:italic> < 0\u00b7001) BP<\/jats:styled-content>, WC<\/jats:styled-content> (P<\/jats:italic> < 0\u00b7001) and WH<\/jats:styled-content>tR (P<\/jats:italic> < 0\u00b7001). WC<\/jats:styled-content> decreased as the KIDMED<\/jats:styled-content> score increased (P<\/jats:italic> = 0\u00b7020). Living with both parents (P<\/jats:italic> = 0\u00b7036), higher maternal (P<\/jats:italic> = 0\u00b7039) and paternal (P<\/jats:italic> = 0\u00b7004) education and having a younger father (P<\/jats:italic> = 0\u00b7034) were associated with better adherence to Mediterranean diet, post\u2010intervention.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Increased adherence to MD<\/jats:styled-content> was associated with decreased WC<\/jats:styled-content>, indicating a potential of multicomponent\u2013multilevel school\u2010based interventions to combat adolescent abdominal obesity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.12760","type":"journal-article","created":{"date-parts":[[2017,4,13]],"date-time":"2017-04-13T16:04:01Z","timestamp":1492099441000},"page":"447-455","source":"Crossref","is-referenced-by-count":60,"title":["Mediterranean diet decreases adolescent waist circumference"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1001-0926","authenticated-orcid":false,"given":"Flora","family":"Bacopoulou","sequence":"first","affiliation":[{"name":"Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care First Department of Pediatrics School of Medicine National and Kapodistrian University of Athens, \u2018Aghia Sophia\u2019 Children's Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Landis","sequence":"additional","affiliation":[{"name":"Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care First Department of Pediatrics School of Medicine National and Kapodistrian University of Athens, \u2018Aghia Sophia\u2019 Children's Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasios","family":"Rentoumis","sequence":"additional","affiliation":[{"name":"Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care First Department of Pediatrics School of Medicine National and Kapodistrian University of Athens, \u2018Aghia Sophia\u2019 Children's Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artemis","family":"Tsitsika","sequence":"additional","affiliation":[{"name":"Adolescent Health Unit Second Department of Pediatrics School of Medicine National and Kapodistrian University of Athens \u2018P. and A. Kyriakou\u2019 Children's Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasiliki","family":"Efthymiou","sequence":"additional","affiliation":[{"name":"Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care First Department of Pediatrics School of Medicine National and Kapodistrian University of Athens, \u2018Aghia Sophia\u2019 Children's Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,5,15]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-1363"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.107.159228"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2005.10.001"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/72.2.490"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2013.05.019"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.09.073"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.168.22.2449"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/138.10.1951"},{"key":"e_1_2_8_10_1","first-page":"2390","article-title":"Kidmed test; prevalence of low adherence to the mediterranean diet in children and young; a systematic review","volume":"32","author":"Garc\u00eda Cabrera S","year":"2015","journal-title":"Nutr Hosp"},{"key":"e_1_2_8_11_1","unstructured":"Organisation for Economic Co\u2010operation and Development.Obesity update.2014. 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