title: The Association of Weight Loss and Cardiometabolic Outcomes in Obese Children: Systematic Review and Meta-regression.
abstract: Excess body weight in children is associated with multiple immediate and long-term medical comorbidities. We aimed to identify the degree of reduction in excess body weight associated with cardiometabolic changes (lipid panel, liver function tests, systolic blood pressure (SBP), diastolic blood pressure, glycosylated hemoglobin, and fasting blood glucose) in overweight and obese children.
  
  
  
  We conducted a comprehensive search of MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Scopus through February 12, 2015. We included randomized controlled trials and cohort studies that evaluated interventions to treat pediatric obesity (medication, surgery, lifestyle, and community-based interventions) with ≥ a 6-month follow-up. We used a random effects meta-regression approach to assess the association between body mass index (BMI)/weight and cardiometabolic changes.
  
  
  
  We included 42 studies (37 randomized controlled trials and five cohorts) enrolling 3807 children (mean age, 12.2 years; weight, 74.7 kg; and BMI, 31.7 kg/m2). Studies had overall moderate to low risk of bias. A 1-mm Hg decrease in SBP was significantly associated with a decrease of 0.16 kg/m2 (P = .04) in BMI. A 1-mg/dL increase in HDL was significantly associated with a 0.74-kg decrease in weight (P = .02). A 1-mg/dL decrease in triglycerides was significantly associated with a 0.1-kg decrease in weight (P = .03). The remaining associations were not statistically significant.
  
  
  
  Weight reduction in children is associated with significant changes in several cardiometabolic outcomes, particularly HDL, SBP, and triglycerides. The magnitude of improvement may help in setting expectations and may inform shared decision-making and counseling.
authors.affiliation: Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902.
authors.forename: Tamim
authors.initials: T
authors.lastname: Rajjo
authors.affiliation: Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902.
authors.forename: Jehad
authors.initials: J
authors.lastname: Almasri
authors.affiliation: Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902.
authors.forename: Alaa
authors.initials: A
authors.lastname: Al Nofal
authors.affiliation: Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902.
authors.forename: Wigdan
authors.initials: W
authors.lastname: Farah
authors.affiliation: Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902.
authors.forename: Mouaz
authors.initials: M
authors.lastname: Alsawas
authors.affiliation: Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902.
authors.forename: Ahmed T
authors.initials: AT
authors.lastname: Ahmed
authors.affiliation: Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902.
authors.forename: Khaled
authors.initials: K
authors.lastname: Mohammed
authors.affiliation: Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902.
authors.forename: Amrit
authors.initials: A
authors.lastname: Kanwar
authors.affiliation: Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902.
authors.forename: Noor
authors.initials: N
authors.lastname: Asi
authors.affiliation: Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.affiliation: Division of Preventive, Occupational, and Aerospace Medicine (T.R., J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Mayo Clinic, Rochester, Minnesota 55902; Evidence-Based Practice Center (J.A., W.F., M.A., A.A., K.M., N.A., Z.W., M.H.M.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota 55905; Pediatric Endocrinology (A.A.N.), Sanford Children's Specialty Clinic, University of South Dakota, Sioux Falls, South Dakota 57105; University of Iowa Carver College of Medicine (A.K.), Iowa City, Iowa 52242; and Library Public Services, Mayo Clinic (L.J.P.), Rochester, Minnesota 55902.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D000293:Adolescent; D000410:Alanine Transaminase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002648:Child; D008076:Cholesterol, HDL / Q000378:metabolism; D008078:Cholesterol, LDL / Q000378:metabolism; D050171:Dyslipidemias / Q000378:metabolism; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008111:Liver Function Tests; D050177:Overweight / Q000378:metabolism / Q000628:therapy; D063766:Pediatric Obesity / Q000378:metabolism / Q000628:therapy*; D016896:Treatment Outcome; D014280:Triglycerides / Q000378:metabolism; D015431:Weight Loss; D005723:gamma-Glutamyltransferase / Q000378:metabolism
chemical_list: D000410:Alanine Transaminase; D001219:Aspartate Aminotransferases; D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D014280:Triglycerides; D005723:gamma-Glutamyltransferase; C517652:hemoglobin A1c protein, human