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]
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.


Group n’s
G1: 16
G2: 16

Age, yrs, mean (SD)
G1: 11.5 (2.1)
G2: 12.4 (2.4)

Females %
G1: 23.1
G2: 53.3

White %: NR

BMI z-score, median [IQR]
G1: 2.1 (1.9, 2.3)
G2: 2.2 (1.8, 2.4)

ACQ score, median [IQR]
G1: 1.14 (0.43, 1.57)
G2: 0.57 (0.29, 0.86)

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
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:
At 10 weeks
BMI z-score change, median (IQR)
G1: -0.2 (-0.4, -0.1)
G2: 0.0 (-0.1, 0.0)

ACQ change, median (IQR)
G1: -0.4 (-0.7, 0.0)
G2: 0.1 (0.0, 0.6)

CRP change, mg/L, median (IQR)
G1: -0.4 (-0.5, 0.4)
G2: 0.7 (-0.1, 1.9)

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

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)

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)
G1: aerobic exercises, every other day, 4 sessions a week, for 8 weeks; diet and medical contacts NR
G2: none

Intervention adherence:
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]
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.

Female %: 49

Group n’s
G1: 26
G2: 25

Age, yrs, mean (SD)
G1: 14 (0.7)
G2: 14 (0.3)

BMI z-score, mean (SD)
G1: 2.18 (0.3)
G2: 2.17 (0.2)

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
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)

Carbohydrate, % of total caloric intake, median (IQR)
G1: 51 (11)
G2: 68 (32)

Fat, % of total caloric intake, median (IQR)
G1: 30 (3)
G2: 42 (15)

Protein, % of total caloric intake, median (IQR)
G1: 15 (4)
G2: 10 (3)
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).
ACQ, Asthma control questionnaire; ATS, American thoracic society; BMI, Body mass index; CDC, Centers for Disease Control and Prevention; CRP, C-reactive protein;ERV, Expiratory reserve volume; FEV1: Forced expiratory volume in one second; GINA, Global initiative for asthma; IQR, Interquartile range; NR; Not reported; NS, Not significant; PAQLQ[S], Standardized Pediatric asthma quality of life questionnaire; SE, Standard deviation.
Table 4: Characteristics of RCTs for weight loss or maintenance interventions in children/adolescents with asthma.