Aim: To examine whether secular trends in adiposity and blood lipid profile of Greek children manifested equally among individuals from urban and rural provin ces. Methods: Cretan boys (aged 12.1 ±2.3 y) from urban and rural areas of Cret e were recruited in 1982 (n = 277 and 251, respectively) and 2002 (n = 440 and 1 80, respectively). Height, weight, and body mass index (BMI), as well as plasma lipid concentrations were measured and compared across cohorts (1982 vs 2002) an d regions (urban vs rural) by two-way analysis of covariance (adjusted for age) with interaction. Results: Temporal changes in height (positive), weight (posit ive), and BMI (positive) manifested equally in children from urban and rural pro vinces, as no interaction was detected. Similar results were obtained for triacy lglycerol (positive), low-density lipoprotein cholesterol (LDL-C, positive) an d high-density lipoprotein cholesterol (negative) concentrations. A significant interaction was observed only for total cholesterol (TC), which increased from 1982 among rural (by 6.2%, p < 0.05) but not among urban boys. In all other ins tances, regional differences in 1982 persisted in 2002. More specifically, child ren from urban provinces were taller, heavier, and had higher BMI values than th ose from rural areas, while they also had higher LDL-C concentrations, whether nowadays or 20 y ago. Regional differences in TC in 1982 were not apparent in 20 02. Conclusion: These findings suggest that changes in anthropometric characteri stics and plasma lipids during the past 20 y have occurred largely in parallel a mong urban and rural Cretan children, and they emphasize the importance of devel oping a common national strategy for the prevention and treatment of childhood o besity in Greece. Aim: To examine whether secular trends in adiposity and blood lipid profile of Greek children manifested equally among individuals from urban and rural provin ces. Methods: Cretan boys (aged 12.1 ± 2.3 y) from urban and rural areas of Crete were were recruited in 1982 (n = 277 and 251, respectively) and 2002 (n = 440 and 1 80, respectively). Height, weight, and body mass index (BMI), as well as plasma lipid concentrations were measured and compared across cohorts (1982 vs 2002 ): an d regions (urban vs rural) by two-way analysis of covariance (adjusted for age) with interaction. Results: Temporal changes in height (positive), weight (posit ive), and BMI (positive) manifested equally in children from urban and rural pro vinces, as no interaction was detected. Similar results were for triacy lglycerol (positive), low-density lipoprotein cholesterol (LDL-C, positive) an d high-density lipoprotein cholesterol was observed only for tot al cholesterol (TC), which increased from 1982 among rural (by 6.2%, p <0.05) but not among urban boys. In all other ins tances, regional differences in 1982 persisted in 2002. More specifically, child ren from urban provinces were taller, heavier, and had higher BMI values ​​than th ose from rural areas, while they also had higher LDL-C concentrations, whether nowadays or 20 y ago. Regional differences in TC in 1982 were not apparent in 20 02. Conclusion: These findings suggest that changes in anthropometric characteri stics and plasma lipids during the past 20 y have occurred largely in parallel a mong urban and rural Cretan children, and they emphasize the importance of devel oping a common national strategy for the prevention and treatment of childhood o besity in Greece.