Impact of weight loss on obese children and adolescents with asthma: a systematic review and meta-analysis

This systematic review and meta-analysis aims to evaluate the efficacy of weight management interventions on pulmonary function, asthma control, asthma-specific quality of life, and leptin levels in obese children and adolescents with asthma. Randomized controlled trials (RCTs) and single-group pretest-posttest designs (SGPPDs) involving obese children and adolescents with asthma receiving weight management interventions were identified through systematic searches of six databases (PubMed, Cochrane Library, Web of Science, Embase, CNKI, Wanfang Data) and three trial registries from inception to September 26, 2024. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 (ROB 2.0) tool for RCTs and the Joanna Briggs Institute (JBI) critical appraisal tool for SGPPDs. Nine studies met the inclusion criteria. Meta-analysis of RCTs revealed significant improvements in FEV₁% (MD=4.53, 95% CI: 3.51-5.55) and FVC% (MD=4.91, 95% CI: 4.15-5.67) following weight management interventions. Asthma Control Test (ACT) and Pediatric Asthma-specific Quality of Life Questionnaire (PAQLQ) scores increased by 1.41 (95% CI: 1.11-1.71) and 0.46 (95% CI: 0.07-0.85), respectively. Leptin levels showed a decreasing trend but lacked statistical significance. SGPPD results were similar to RCT findings but with higher heterogeneity. Peter’s regression indicated no publication bias (P>0.05), and sensitivity analysis supported the stability of effect sizes. Weight management positively impacts pulmonary function, asthma control, and asthma-specific quality of life in obese pediatric asthma patients, while its effect on leptin levels requires further exploration. This study provides critical evidence for weight management strategies.本系统综述与荟萃分析旨在评估体重管理干预对合并哮喘的肥胖儿童及青少年的肺功能、哮喘控制情况、哮喘特异性生活质量以及瘦素水平的干预效果。本研究通过系统检索6个数据库（PubMed、Cochrane图书馆、Web of Science、Embase、中国知网（CNKI）、万方数据（Wanfang Data））及3个试验注册平台，检索时限为建库至2024年9月26日，纳入接受体重管理干预的合并哮喘的肥胖儿童及青少年的随机对照试验（Randomized Controlled Trials, RCTs）与单组前后对照试验（single-group pretest-posttest designs, SGPPDs）。采用Cochrane偏倚风险2.0（ROB 2.0）工具评估RCTs的偏倚风险，采用乔安娜·布里格斯研究所（Joanna Briggs Institute, JBI）关键评价工具评估单组前后对照试验的偏倚风险。最终有9项研究符合纳入标准。对RCTs的荟萃分析显示，体重管理干预后，受试者的第一秒用力呼气容积占预计值百分比（FEV₁%）（均差MD=4.53，95%置信区间CI：3.51~5.55）与用力肺活量占预计值百分比（FVC%）（MD=4.91，95%CI：4.15~5.67）均得到显著改善；哮喘控制测试（Asthma Control Test, ACT）评分与儿童哮喘特异性生活质量问卷（Pediatric Asthma-specific Quality of Life Questionnaire, PAQLQ）评分分别提升1.41（95%CI：1.11~1.71）与0.46（95%CI：0.07~0.85）；瘦素水平呈下降趋势，但未达到统计学显著性。单组前后对照试验的结果与RCTs结果相似，但异质性更高。彼得回归检验显示无发表偏倚（P>0.05），敏感性分析证实效应量的稳定性。体重管理干预可对合并哮喘的肥胖儿童及青少年的肺功能、哮喘控制情况与哮喘特异性生活质量产生积极影响，但其对瘦素水平的作用仍需进一步探究。本研究为体重管理策略提供了关键循证依据。