Methods:

Data for the present study were collected as part of the IDEFICS (Identification and prevention of Dietary and lifestyle induced health EFects In Children and infantS) study, which recruited a representative sample of children (n = 16,220 ) ages 2-9 years from study centers in eight European countries. The aim of the study was to investigate the risks and long-term consequences of overweight and obesity in children, which started at the end of 2006 and ran for 5 years. The baseline survey (2007-2008), was followed by an intervention phase and repeated after 2 years on 9,114 children. The intervention focused on diet, physical activity, and stress-coping capacity. It was community-based and integrated throughout various levels of society, for a total of 10 modules: three at community level, six at school level, and one for parents. All materials for the interventions were centrally developed and culturally adapted. Weight, height, waist circumference, and skinfolds were measured at baseline and in 9,114 children of the original cohort after 2 years. Diet was evaluated by a parental questionnaire reporting children’s usual consumption of 43 food items. Adherence to a Mediterranean-like diet was calculated by a food frequency-based Mediterranean Diet Score.