***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background —The prevalence of obesity in both adults and children is increasing rapidly . Obesity in children is independently associated with arterial endothelial dysfunction and wall thickening , key early events in atherogenesis that precede plaque formation . Methods and Results —To evaluate the reversibility of obesity-related arterial dysfunction and carotid intima-media thickening by dietary and /or exercise intervention programs , 82 overweight children ( body mass index , 25±3 ) , 9 to 12 years of age , were r and omly assigned to dietary modification only or diet plus a supervised structured exercise program for 6 weeks and subsequently for 1 year . The prospect ively defined primary end points were ultrasound-derived arterial endothelial function ( endothelium-dependent dilation ) of the brachial artery and intima-media thickness of common carotid artery . At 6 weeks , both interventions were associated with decreased waist-hip ratio ( P < 0.02 ) and cholesterol level ( P < 0.05 ) as well as improved arterial endothelial function . Diet and exercise together were associated with a significantly greater improvement in endothelial function  than diet alone ( P = 0.01 ) . At 1 year , there was significantly less thickening of the carotid wall ( P < 0.001 ) as well as persistent improvements in body fat content and lipid profiles in the group continuing an exercise program . Vascular function was significantly better in those children continuing exercise ( n=22 ) compared with children who withdrew from the exercise program ( n=19 ) ( P < 0.05 ) . Conclusions —Obesity-related vascular dysfunction in otherwise healthy young children is partially reversible with diet alone or particularly diet combined with exercise training at 6 weeks , with sustained improvements at 1 year in those persisting with diet plus regular exercise We report 10-year treatment outcomes for obese children in 4 r and omized treatment studies . At 10 years , 34 % decreased percentage overweight by 20 % or more , and 30 % were not obese . Significant effects were observed when parents and children were targeted and reinforced for weight loss in comparison with nontargeted controls and for children given lifestyle or aerobic exercise in comparison with a calisthenics control . Thirty-four percent of the variance in change in percentage overweight was predicted from sex , baseline percentage overweight , self-monitoring weight , meals eaten at home , and family and friends ' support for eating and exercise . Results show long-term changes in children depend on the treatment , and evidence converges on the importance of the family and other sources of support for eating and activity change OBJECTIVE The purpose of this pilot novel chiropractic health education intervention was to gather preliminary evidence regarding possible benefits from recreational youth soccer and nutrition education in overweight women . A secondary purpose was to determine whether some nutrition knowledge is an independent predictor of changes in body mass index ( BMI ) . METHODS A quiz developed and vali date d on separate age and sex appropriate blinded cohorts was used on study participants -22 volunteers of 57 eligible fourth- grade , overweight female Mississippi public school students . At the beginning of a 5-month study period , a 15-minute baseline nutrition intervention , grounded in Social Cognitive Theory and based on the United States Department of Agriculture 's " My Tips for Families " information , was applied in a chiropractic clinic . Subjects were then r and omized to 2 months of recreational soccer ( n = 14 ) or waiting list control ( n = 8) . RESULTS No preintervention differences were found in height , weight , BMI , or age . Higher follow-up BMI scores were found in both groups , and no significant differences between groups were found , possibly because of the small sample sizes and the short 8-week soccer intervention period . Gains in nutrition knowledge were sustained ( P < .002 ) ; however , there was no association between nutrition knowledge and follow-up BMI ( r = -.185 ; P < .462 ) . CONCLUSIONS Minimal nutrition education alone may be an ineffective intervention for overweight children . The study provides an example of how youth soccer may benefit overweight children The role of insulin in the regulation of blood pressure was evaluated in 50 obese adolescents before and after a 20-week weight loss program .  When compared with 10 nonobese adolescents , the obese subjects had significantly higher systolic , diastolic , and mean arterial pressures ( p = 0.005 ) , an elevated 24-hour urinary sodium excretion ( p = 0.002 ) , an elevated fasting insulin concentration ( p = 0.001 ) , and an abnormal insulin response to an oral  glucose tolerance test ( sum of the insulins at 0 , 1 , and 2 hours post-oral glucose load ; p = 0.001 ) . We also observed a significant correlation between systolic and diastolic blood pressure ( age and sex normalized ) and body weight ( r = 0.57 , p less than 0.01 and r = 0.7 , p less than 0.01 ) , fasting insulin ( r = 0.49 , p less than 0.01 and r = 0.54 , p less than 0.01 ) , and sum of insulins ( r = 0.42 , p less than 0.01 and r = 0.46 , p less than 0.01 ) . To study the effect of weight loss on the relationship between blood pressure and insulin , the obese subjects were r and omly assigned to three groups : 15 to a diet and behavior change group , 18 to a diet , behavior change , and exercise group , and 17 to an obese control group . Compared with the obese control group , the two weight loss groups each experienced a significant decrease in insulin ( p less than 0.01 ) , sum of the insulins ( p less than 0.01 ) , and blood pressure ( p less than 0.01 ) . The decrease in blood pressure during the weight loss program significantly correlated with the change in both insulin and body weight . ( ABSTRACT TRUNCATED AT 250 WORDS Background —The effects of diet and diet plus exercise training on muscle vasodilatation during physiological maneuvers in obese children are unknown . We tested the hypothesis that ( 1 ) blood pressure ( BP ) and forearm vascular conductance ( FVC ) responses during h and grip exercise and mental stress would be altered in obese children and ( 2 ) diet plus exercise training would restore BP and FVC responses during exercise and mental stress in obese children . Methods and Results —Thirty-nine obese children ( aged 10±0.2 years ) were r and omly divided into 2 groups : diet plus exercise training ( n=21 ; body mass index [ BMI ] = 28±0.5 kg/m2 ) and diet ( n=18 ; BMI = 30±0.4 kg/m2 ) . Ten age-matched lean control children ( BMI = 17±0.5 kg/m2 ) were also studied . Forearm blood flow was measured by venous occlusion plethysmography . BP was monitored noninvasively . H and grip exercise was performed at 30 % maximal voluntary contraction for 3 minutes . Stroop color word test was performed for 4 minutes . Baseline BP was significantly higher and FVC was significantly lower in obese children .  During exercise and mental stress , BP responses were significantly higher and FVC responses were significantly lower in obese children . Diet and diet plus exercise training  significantly reduced body weight  . Diet and diet plus exercise training  significantly decreased BP levels during exercise and mental stress . Diet plus exercise training , in contrast to diet alone , significantly increased FVC responses during exercise ( 3.7±0.3 versus 5.6±0.4 U ; P=0.01 ) and mental stress ( 3.5±0.5 versus 4.5±0.4 U ; P=0.02 ) . After diet plus exercise training , BP and FVC responses during exercise and mental stress were similar between obese children and the control group . Conclusions —Obesity exacerbates BP responses and impairs FVC responses during exercise and mental stress in children . Diet and exercise training restore BP and FVC responses in obese children Aims : To evaluate effects of a low energy diet , with or without strength training , on blood lipid profile in obese children . Methods : Eighty two obese children were enrolled into a six week dietary programme , and were r and omly allocated to a training group or a non-training group . The training group underwent regular exercise sessions with emphasis on strength training . Results : Height increased significantly , with a non-significant reduction in body mass index . Fat free mass increased significantly in the training group . Serum total cholesterol was significantly reduced in both groups . The LDL : HDL ratio significantly decreased in the training group . Conclusion : Results support the potentially beneficial effects of both diet and physical training . Further and longer term evaluation of such programmes is required PURPOSE To date , no study has examined the synergistic effects of a nutrition and combination of aerobic and strength training ( CAST ) on both adiposity and metabolic parameters in overweight Latina adolescent females . The goal was to assess if a 16-wk nutrition plus CAST pilot study had stronger effects on reducing adiposity and on improving glucose/insulin indices compared with control ( C ) , nutrition only ( N ) , and a nutrition plus strength training ( N + ST ) groups . METHODS In a 16-wk r and omized trial , 41 overweight Latina girls ( 15.2 + /- 1.1 yr ) were r and omly assigned to C ( n = 7 ) , N ( n = 10 ) , N + ST ( n = 9 ) , or N + CAST ( n = 15 ) . All intervention groups received modified carbohydrate nutrition classes ( once a week ) , whereas the N + ST also received strength training ( twice a week ) and the N + CAST received a combination of strength and aerobic training ( twice a week ) . The following were measured before and after intervention : strength by one repetition maximum , physical activity by the 7-d accelerometry and the 3-d physical activity recall , dietary intake by 3-d records , body composition by dual-energy x-ray absorptiometry ( DEXA ) , glucose/insulin indices by oral glucose tolerance test , and intravenous glucose tolerance test with minimal modeling . Across intervention group , effects were tested using ANCOVA with post hoc pairwise comparisons . RESULTS There were significant overall intervention effects for all adiposity measures ( weight , body mass index [ BMI ] , BMI z-scores , and DEXA total body fat ) , with a decrease of 3 % in the N + CAST group compared with a 3 % increase in the N + ST group ( P < or = 0.05 ) . There was also an intervention effect for fasting glucose with the N group increasing by 3 % and the N + CAST group decreasing by 4 % ( P < or = 0.05 ) . CONCLUSION The CAST was more effective than nutrition alone or nutrition plus strength training for reducing multiple adiposity outcomes and fasting glucose in overweight Latina girls . However , further research investigating and identifying intervention approaches that improve both adiposity and insulin indices , particularly in high-risk population s , are warranted OBJECTIVE To evaluate whether a child-centered physical activity program , combined with a parent-centered dietary program , was more efficacious than each treatment alone , in preventing unhealthy weight-gain  in overweight children . STUDY DESIGN An assessor-blinded r and omized controlled trial involving 165 overweight/obese 5.5- to 9.9- year-old children . Participants were r and omly assigned to 1 of 3 interventions : a parent-centered dietary program ( Diet ) ; a child-centered physical activity program ( Activity ) ; or a combination of both ( Diet+Activity ) . All groups received 10 weekly face-to-face sessions followed by 3 monthly relapse-prevention phone calls . Analysis was by intention-to-treat . The primary outcome was change in body mass index z-score at 6 and 12 months ( n=114 and 106 , respectively ) . RESULTS Body mass index z-scores were reduced at 12-months in all groups , with the Diet ( mean [ 95 % confidence interval ] ) ( -0.39 [ -0.51 to 0.27 ] ) and Diet + Activity ( -0.32 , [ -0.36 , -0.23 ] ) groups showing a greater reduction than the Activity group ( -0.17 [ -0.28 , -0.06 ] ) ( P=.02 ) . Changes in other outcomes ( waist circumference and metabolic profile ) were not statistically significant among groups . CONCLUSION Relative body weight decreased at 6 months and was sustained at 12 months through treatment with a child-centered physical activity program , a parent-centered dietary program , or both . The greatest effect was achieved when a parent-centered dietary component was included The purpose of this study was to test the hypothesis that in obese children : 1 ) Ventilatory efficiency ( VentE ) is decreased during grade d exercise ; and 2 ) Weight loss through diet alone ( D ) improves VentE , and 3 ) diet associated with exercise training ( DET ) leads to greater improvement in VentE than by D. Thirty-eight obese children ( 10+/-0.2 years ; BMI > 95th percentile ) were r and omly divided into two study groups : D ( n=17 ; BMI = 30+/-1 kg/m ( 2 ) ) and DET ( n=21 ; 28+/-1 kg/m ( 2 ) ) . Ten lean children were included in a control group ( 10+/-0.3 years ; 17+/-0.5 kg/m ( 2 ) ) . All children performed maximal treadmill 
    Output:
    
Based on the small number of short-term trials currently available , both diet-only and diet plus exercise interventions result ed in weight loss and metabolic profile improvement .
The diet-only intervention caused greater reductions in levels of triglycerides ( at the end of active intervention ) and low-density lipoprotein cholesterol ( at subsequent follow-up ) .
AND RELEVANCE This review provides insights into the impact of dietary and exercise interventions on metabolic risk reduction in the pediatric population .