| Study Cited, Design, Primary Outcome, Setting, Quality Rating |
Inclusion Criteria, Group Size, Baseline Characteristics, Retention at Primary Assessment Time Point |
Intervention Groups, Component Details |
Treatment Duration, Total Intervention Contacts, Intervention Adherence |
Results |
Jensen et al. [24]
RCT, ITT
Systemic and airway inflammation, lung function, and ACQ were primary outcomes.
Australia, Medical center
Duration: 10 weeks
Quality: Good |
Inclusion criteria: ages 8-17 yrs, BMI z-score ≥1.64 SD score, with asthma diagnosed by a physician.
N=32
Group n’s
G1: 16
G2: 16
Age, yrs, mean (SD)
G1: 11.5 (2.1)
G2: 12.4 (2.4)
P NS
Females %
G1: 23.1
G2: 53.3
P NS
White %: NR
BMI z-score, median [IQR]
G1: 2.1 (1.9, 2.3)
G2: 2.2 (1.8, 2.4)
P NS
ACQ score, median [IQR]
G1: 1.14 (0.43, 1.57)
G2: 0.57 (0.29, 0.86)
P=0.026
Retention %:
G1: 81.3
G2: 93.8 |
G1: Weight loss intervention
Diet: a 500 kcal/day energy reduction from individually calculated age- and gender- appropriate energy requirements.
Behavior: identification and resolution of barriers; goal setting; self-monitoring was encouraged.
G2: Wait-list control
Delayed intervention |
Intervention: 10 weeks
Contacts:
G1: a total of 11 in-person or phone contacts (7 in-person counselling sessions in week 1, 2, 3, 4, 6, 8, and 10 and phone contacts in alternative weeks)
G2: none
Intervention adherence:
NR |
At 10 weeks
BMI z-score change, median (IQR)
G1: -0.2 (-0.4, -0.1)
G2: 0.0 (-0.1, 0.0)
P=0.014
ACQ change, median (IQR)
G1: -0.4 (-0.7, 0.0)
G2: 0.1 (0.0, 0.6)
P=0.004
CRP change, mg/L, median (IQR)
G1: -0.4 (-0.5, 0.4)
G2: 0.7 (-0.1, 1.9)
P=0.037
There was no significant change in dynamic lung function, within or between groups. Static lung function, ERV increased significantly within the intervention group (L, median [IQR], 0.7 [0.0, 1.0]), but not significantly different from the control (P=0.355). Airway and systemic inflammation did not change within the intervention group. |
El-Kader et al. [25]
RCT, whether ITT NR
Measures of systemic inflammation were primary outcomes (interpreted by reviewer)
Saudi Arabia, Medical center
Duration: 8 weeks (interpreted by reviewer)
Quality: Poor |
Inclusion criteria: ages 12-18 yrs, 30≤BMI≤35, with bronchial asthma
N=80
Female %: 47.5
Age, yrs, mean (SD): 13.86 (3.21)
White %: NR
Group n’s
G1: 40
G2: 40
Weight, kg, mean (SD)
G1: 65.32 (4.17)
G2: 63.52 (5.48)
P NR
Retention %: NR |
G1: Weight reduction intervention
Diet: low calorie diet that provides an energy deficit of about 250 kcal/day;15% as protein, 30-35% as fat, and 50-55% as carbohydrate
Physical activity: aerobic exercises monitored by a physical education expert
Medical: medical treatment
G2: Control
Diet: no intervention
Physical activity: no intervention
Medical: Same as G1 |
Intervention: 8 weeks (interpreted by reviewer)
Contacts:
G1: aerobic exercises, every other day, 4 sessions a week, for 8 weeks; diet and medical contacts NR
G2: none
Intervention adherence:
NR |
At the end of the study
BMI, kg/m2, mean (SD)
G1: 27.15 (2.38)
G2: 32.14 (2.16)
P < 0.05
TNF-alpha, pg/mL, mean (SD)
G1: 3.56 (1.12)
G2: 4.31 (1.41)
P < 0.05
IL-6, pg/mL, mean (SD)
G1: 1.85 (0.76)
G2: 2.30 (0.75)
P < 0.05
IL-8, pg/mL, mean (SD)
G1: 12.14 (3.72)
G2: 15.65 (4.11)
P < 0.05
Leptin, ng/mL, mean (SD)
G1: 26.98 (4.50)
G2: 31.02 (4.84)
P < 0.05
Adiponectin, μg/mL, mean (SD)
G1: 14.72 (3.21)
G2: 10.76 (2.85)
P < 0.05
Compared to baseline, the intervention group significantly decreased values of tnf-alpha, IL-6, IL-8, Leptin, and BMI and increased adiponectin (all P < 0.05). The changes in the control group were not significant. |
Luna-Pech et al. [26]
RCT, ITT
PAQLQ[S] was a primary outcome (interpreted by reviewer)
Mexico, Medical center
Duration: 28 weeks
Quality: Good |
Inclusion criteria: ages 12-16 yrs, BMI ≥95th percentile of the CDC BMI-for-age growth charts, with asthma according to GINA, in a stable phase of asthma, in the pubertal sage of the Tanner scale (stage 2-3), skin prick testing for allergy positive for at least one allergen, FEV1 >80% from the predicted value for age and height according to the ATS guidelines.
N=58
Female %: 49
Group n’s
G1: 26
G2: 25
Age, yrs, mean (SD)
G1: 14 (0.7)
G2: 14 (0.3)
P NS
BMI z-score, mean (SD)
G1: 2.18 (0.3)
G2: 2.17 (0.2)
P NS
Retention %: 88 |
G1: Intervention
Diet: normocaloric diet based on normal requirements for height; 10-15% proteins, 50-60% carbohydrates, 25-30% fat, with a daily meal pattern of breakfast (25% of daily caloric intake), lunch (30%), snack (15-20%), and dinner (25-30%).
Behavior: same as G2, plus recommendations on variations in the menu based on exchange lists.
G2: Control (free diet)
Diet: no intervention
Behavior: at bi-weekly follow-up visits, staff established an action plan with participants in case of worsened asthma symptoms. |
Intervention: 28 weeks
Contacts:
G1: bi-weekly follow up visits with normocaloric diet assessed
G2: bi-weekly follow up visits (no diet was assessed)
Intervention adherence at 28 weeks:
Energy, kcal/day, mean (SD)
G1: 2231 (231)
G2: 3243 (278)
P=0.001
Carbohydrate, % of total caloric intake, median (IQR)
G1: 51 (11)
G2: 68 (32)
P=0.001
Fat, % of total caloric intake, median (IQR)
G1: 30 (3)
G2: 42 (15)
P=0.01
Protein, % of total caloric intake, median (IQR)
G1: 15 (4)
G2: 10 (3)
P=0.09 |
At 28 weeks
BMI z-score, mean (SD)
G1: 1.66 (0.2)
G2: 2.12 (0.3)
P < 0.01
Weight change, kg, mean (SD)
G1: -2.5 (1.3)
G2: 1.6 (1.3)
P < 0.03
Change in PAQLQ[S] scores: [numbers NR] G1 achieved a significant improvement in PAQLQ[S] scores compared with controls, and this difference was achieved both in the overall score and all its subdomains (P < 0.002 for all).
Compared with G2, G1 had significantly fewer acute asthma events requiring short-acting β-agonists (17 vs. 39, P < 0.02) and nighttime awakenings (11 vs. 26, P < 0.001). |
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