## 3 Results
### Study Characteristics  
#### 3.3.1 Quantitative Synthesis  
Ten of twelve included studies [40; 41; 43; 44; 45; 46; 47; 48; 50] reported statistically significant improvements in at least one outcome following combined nutrition and physical activity interventions. Blood pressure outcomes showed improvements in six of eight studies. [PERSON] et al. [47] found significant SBP and DBP reductions (SBP: 128 \(\pm\) 9.19 vs. 124.69 \(\pm\) 5.72 mmHg; DBP: 77.26 \(\pm\) 7.67 vs. 72.77 \(\pm\) 4.97 mmHg, \(p\) \(<\) 0.05) with hypertension prevalence decreasing from 85.7% to 16.3% versus increasing from 77.6% to 81.6% in controls. [PERSON] et al. [50] observed inter-group differences of \(-\)6.0 mmHg for SBP and \(-\)4.0 mmHg for DBP. [PERSON] et al. [48] demonstrated adjusted mean SBP difference of \(-\)1.41 mmHg (95% CI: \(-\)2.44 to \(-\)0.38). [PERSON] et al. [44] found age-specific SBP improvements in 10-12-year group (intervention effect \(-\)0.23, 95% CI: \(-\)0.43, \(-\)0.02). Additional improvements were reported by [PERSON] et al. [40] and [PERSON] et al. [43] in specific subgroups. [PERSON] et al. [49] and [PERSON] et al. [51] found non-significant between-group differences. Figure 2: Risk of bias assessment for included studies using the Cochrane Collaboration tool [40; 41; 42; 43; 44; 45; 46; 47; 48; 49; 50]. Each row represents one study, and each column represents a different bias domain. Green circles with “+” indicate low risk of bias, red circles with “\(-\)” indicate high risk of bias, and yellow circles with “\(2\)” indicate unclear risk of bias. **Note. **_D1–Randomization Process_: Bias arising from the randomization process, including allocation sequence generation and concealment; _D2–Deviations from Intended Interventions_: Bias due to deviations from intended interventions, including issues with blinding of participants and personnel; _D3–Missing Outcome Data_: Bias due to missing outcome data and how missing data were handled; _D4–Measurement of Outcome_: Bias in measurement of the outcome, including blinding of outcome assessors; _D5–Selection of Reported Results_: Bias in selection of the reported result, including selective outcome reporting. Glucose metabolism markers were evaluated in five studies [41; 45; 49; 50; 51] with limited success. Only [PERSON] et al. [41] reported significant inter-group glucose reduction of \(-0.20\) mmol/L (95% CI: \(-0.24\), \(-0.16\), \(p<0.05\)). Insulin levels were assessed in four studies [41; 45; 49; 51], with no significant between-group differences found in any of the studies. Similarly, HOMA-IR was evaluated in three studies [45; 49; 51], with no statistically significant intervention effects reported. On the other hand, lipid profile outcomes showed improvements in three of seven studies. [PERSON] et al. [41] reported total cholesterol reduction of \(-0.32\) mmol/L (95% CI: \(-0.34\), \(-0.30\)) but HDL decrease of \(-0.09\) mmol/L. [PERSON] et al. [42] achieved annual cholesterol decreases of \(-1.7\) mg/dL (Westchester) and \(-1.0\) mg/dL (Bronx) over 5-6 years. [PERSON] et al. [46] and [PERSON] et al. [43] found improvements in specific subgroups. [PERSON] et al. [49], [PERSON] et al. [50], and [PERSON] et al. [51] observed no significant between-group changes. Anthropometric measures demonstrated improvements in seven of twelve studies. [PERSON] et al. [41] reported BMI reduction of \(-0.3\) kg/m\({}^{2}\) (95% CI: \(-0.4\), \(-0.2\)), BMI z-score reduction of \(-0.14\), body fat reduction of \(-0.8\)%, and waist circumference reduction of \(-0.5\) cm. [PERSON] et al. [50] found substantial differences including BMI reduction of \(-1.61\) kg/m\({}^{2}\), BMI-SDS of \(-0.31\), and waist circumference reduction of \(-6.0\) cm. [PERSON] et al. [48] achieved BMI z-score improvement of \(-0.133\) and BMI reduction of \(-0.42\) kg/m\({}^{2}\). Additional significant improvements were reported by [PERSON] et al. [44], [PERSON] et al. [47], [PERSON] et al. [45], and [PERSON] et al. [43].