title: Systematic review of the effect of individual and combined nutrition and exercise interventions on weight, adiposity and metabolic outcomes after delivery: evidence for developing behavioral guidelines for post-partum weight control.
abstract: BACKGROUND
  Post-partum weight retention contributes to the risk of chronic obesity and metabolic alterations. We conducted a systematic review of randomized controlled trials (RCTs) on the effect of post-partum nutrition and exercise interventions on weight loss and metabolic outcomes.
  
  
  METHODS
  Four electronic databases were searched from inception to January, 2012. Two investigators reviewed titles and abstracts, performed data abstraction on full articles and assessed study quality.
  
  
  METHODS
  We included RCTs comparing nutrition, exercise or combined nutrition and exercise interventions with a control condition. Thirteen studies met our inclusion criteria (N = 1,310 participants). Data were abstracted on study characteristics, intervention components, enrollment period, and length of follow-up. Outcomes of interest included weight, adiposity, cardio-metabolic measures (glucose, lipids) and obesity-related inflammatory markers.
  
  
  RESULTS
  Nine trials compared combined interventions to standard post-partum care; three trials assessed the effect of exercise interventions, one trial evaluated a nutrition-only intervention. Four good quality RCTs on combined interventions had inconsistent findings, with the larger RCT (N = 450) reporting no difference in weight between groups. Four fair-to good quality RCTs reported greater weight loss in the combined intervention group vs. standard care, ranging from 0.17 kg to 4.9 kg. Results from exercise only interventions were inconclusive. Evidence for nutrition only interventions was insufficient. There was insufficient evidence for the effect of post-partum interventions on metabolic risk factors and inflammatory biomarkers.
  
  
  CONCLUSIONS
  Combined nutrition and exercise interventions can achieve weight loss, but evidence is limited due to a small number of trials and limitations in study design.
authors.forename: Alexander Arkin
authors.initials: AA
authors.lastname: Berger
authors.forename: Rachel
authors.initials: R
authors.lastname: Peragallo-Urrutia
authors.affiliation: Department of Obstetrics & Gynecology, Division of Women's Primary Health, 3027 Old Clinic Building, CB # 7570, Chapel Hill, NC, USA. wknichol@med.unc.edu.
authors.forename: Wanda K
authors.initials: WK
authors.lastname: Nicholson
mesh_terms: D050154:Adiposity; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D001835:Body Weight; D004038:Diet, Reducing; D019317:Evidence-Based Medicine; D015444:Exercise; D017408:Guidelines as Topic; D015438:Health Behavior; D006801:Humans; D007249:Inflammation / Q000097:blood; D008055:Lipids / Q000097:blood; D011181:Postnatal Care; D016032:Randomized Controlled Trials as Topic; D061217:Weight Reduction Programs
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids