title: Effect of childhood obesity prevention programs on blood pressure: a systematic review and meta-analysis.
abstract: BACKGROUND
  Childhood overweight and obesity are associated with elevated blood pressure (BP). However, little is known about how childhood obesity lifestyle prevention programs affect BP. We assessed the effects of childhood obesity prevention programs on BP in children in developed countries.
  
  
  RESULTS
  We searched databases up to April 22, 2013, for relevant randomized, controlled trials, quasi-experimental studies, and natural experiments. Studies were included if they applied a diet or physical activity intervention(s) and were followed for ≥ 1 year (or ≥ 6 months for school-based intervention studies); they were excluded if they targeted only overweight/obese subjects or those with a medical condition. In our meta-analysis, intervention effects were calculated for systolic BP and diastolic BP with the use of weighted random-effects models. Of the 23 included intervention studies (involving 18 925 participants), 21 involved a school setting. Our meta-analysis included 19 studies reporting on systolic BP and 18 on diastolic BP. The pooled intervention effect was -1.64 mm Hg (95% confidence interval, -2.56 to -0.71; P=0.001) for systolic BP and -1.44 mm Hg (95% confidence interval, -2.28 to -0.60; P=0.001) for diastolic BP. The combined diet and physical activity interventions led to a significantly greater reduction in both systolic BP and diastolic BP than the diet-only or physical activity-only intervention. Thirteen interventions (46%) had a similar effect on both adiposity-related outcomes and BP, whereas 11 interventions (39%) showed a significant desirable effect on BP but not on adiposity-related outcomes.
  
  
  CONCLUSIONS
  Obesity prevention programs have a moderate effect on reducing BP, and those targeting both diet and physical activity seem to be more effective.
authors.affiliation: Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Bloomberg School of Public Health, Baltimore, MD (L.C., Y. Wu, Y. Wang); Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China (L.C.); Departments of Health, Behavior, and Society (Y. Wu) and Health Policy and Management (R.F.W., J.B.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (J.B.S.); School of Nursing, University of Texas at Austin (M.T.K.); and Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York (Y. Wang).
authors.forename: Li
authors.initials: L
authors.lastname: Cai
authors.forename: Yang
authors.initials: Y
authors.lastname: Wu
authors.forename: Renee F
authors.initials: RF
authors.lastname: Wilson
authors.forename: Jodi B
authors.initials: JB
authors.lastname: Segal
authors.forename: Miyong T
authors.initials: MT
authors.lastname: Kim
authors.forename: Youfa
authors.initials: Y
authors.lastname: Wang
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D002648:Child; D006801:Humans; D006973:Hypertension / Q000503:physiopathology* / Q000517:prevention & control*; D008019:Life Style; D009765:Obesity / Q000503:physiopathology* / Q000517:prevention & control*; D040242:Risk Reduction Behavior
keywords: blood pressure; meta-analysis; obesity; pediatrics; prevention