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Impact of Dietary and Exercise Interventions on Weight Change and Metabolic Outcomes in Obese Children and Adolescents:  A Systematic Review and Meta-analysis of Randomized Trials

Mandy Ho, MSc, BHs, APD, RN1,3; Sarah P. Garnett, PhD, M Nutr&Diet, BSc, RNutr, APD1,2,3; Louise A. Baur, MBBS, BSc, PhD, FRACP2,3; Tracy Burrows, PhD, BHs, AdvAPD4; Laura Stewart, PhD, BSc, BA, RD, RNutr5,6; Melinda Neve, PhD, BND, APD4; Clare Collins, PhD, BSc, Dip Nutr&Diet, Dip Clin Epi, FDAA4
[+] Author Affiliations
1Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, Australia
2Kids Research Institute, The Children’s Hospital at Westmead, Sydney, Australia
3The Children’s Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
4Priority Research Centre in Physical Activity and Nutrition, School of Health Sciences, Faculty of Health, University of Newcastle, Newcastle, Australia
5Paediatric Overweight Service Tayside, Perth Royal Infirmary, Perth, Scotland
6The Children’s Weight Clinic, Edinburgh, Scotland
JAMA Pediatr. 2013;167(8):759-768. doi:10.1001/jamapediatrics.2013.1453.
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Importance  Diet and exercise represent the mainstays of obesity treatment. No systematic review has been conducted comparing the effect of dietary and exercise intervention in reducing metabolic risks in overweight children.

Objective  To compare the effects of diet-only intervention with those of diet plus exercise or exercise only on weight loss and metabolic risk reduction in overweight children.

Evidence Review  English-language articles from 1975 to 2010 available from 7 databases were reviewed. One person searched the databases. Two independent reviewers assessed abstracts and articles against the following eligibility criteria: randomized controlled trials conducted in overweight and obese children aged 18 years or younger, comparing dietary intervention with a diet plus exercise program or an exercise-only program. Study quality was critically appraised by 2 reviewers using established criteria. The main outcome measures were body mass index, body fat percentage, lean body mass, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, fasting glucose, and fasting insulin.

Findings  Fifteen studies were identified and included. Based on the small number of short-term trials currently available, both diet-only and diet plus exercise interventions resulted in weight loss and metabolic profile improvement. However, the addition of exercise to dietary intervention led to greater improvements in levels of high-density lipoprotein cholesterol (3.86 mg/dL [to convert to millimoles per liter, multiply by 0.0259]; 95% CI, 2.70 to 4.63), fasting glucose (−2.16 mg/dL [to convert to millimoles per liter, multiply by 0.0555]; 95% CI, −3.78 to −0.72), and fasting insulin (−2.75 μIU/mL [to convert to picomoles per liter, multiply by 6.945]; 95% CI, −4.50 to −1.00) over 6 months. The diet-only intervention caused greater reductions in levels of triglycerides (at the end of active intervention) and low-density lipoprotein cholesterol (at subsequent follow-up).

Conclusions and Relevance  This review provides insights into the impact of dietary and exercise interventions on metabolic risk reduction in the pediatric population. However, further studies are required to confirm the evidence with rigorous design, appropriate sample size, longer duration of follow-up, and better strategies to improve compliance and achieve long-term sustainability.

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Figures

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Figure 1.
Flowchart for Identification of Trials for Inclusion in the Systematic Review and Meta-analyses
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Figure 2.
Meta-analysis of Studies Comparing Diet Plus Exercise and Diet-Only Interventions Using Change in Body Mass Index at the End of Active Intervention

CAST indicates aerobic and strength training; IV, inverse variance; and ST, strength training. Body mass index is calculated as weight in kilograms divided by height in meters squared.

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Figure 3.
Meta-analysis of Studies Comparing Diet Plus Exercise and Diet-Only Interventions, With Changes in Triglycerides (A), HDL-C (B), and LDL-C (C) at the End of Active Intervention as Outcomes

IV indicates inverse variance. To convert triglycerides from millimoles per liter to milligrams per deciliter, divide by 0.0113. To convert high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) from millimoles per liter to milligrams per deciliter, divide by 0.0259.

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Figure 4.
Meta-analysis of Studies Comparing Diet Plus Exercise and Diet-Only Interventions, With Changes in Fasting Glucose (A) and Fasting Insulin (B) at the End of Active Intervention as Outcomes

CAST indicates aerobic and strength training; IV, inverse variance; and ST, strength training. To convert glucose from millimoles per liter to milligrams per deciliter, divide by 0.0555. To convert fasting insulin from picomoles per liter to micro–international units per milliliter, divide by 6.945.

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