Sex Differences in Pediatric Lifestyle Intervention Effects: Systematic Review and Meta-Analysis

• Published in: Obesity (Silver Spring, Md.) Md.), 2022-11, Vol.30, p.89-89
• Main Authors: Mast, Alexis, Pena, Armando, Bolch, Charlotte, Olson, Micah, Shaibi, Gabriel, Wyst, Kiley Vander
• Format: Article
• Language: English
• Subjects: Gender differences; Intervention; Lifestyles; Males; Meta-analysis; Pediatrics; Systematic review
• ISSN: 1930-7381; 1930-739X

Background: Little is known about sex differences in response to lifestyle in the pediatric population; therefore, we performed a systematic review and meta-analysis to evaluate sex differences in adiposity following lifestyle interventions among children and adolescents. Methods: Electronic databases (PubMed, Web of Science, and MEDLINE/Ovid) were systematically searched from inception through March 2021. Eligibility criteria included: RCTs, published in English, lifestyle intervention with both nutrition and physical activity components, children and adolescents aged 6-18 years old, and at least one measure of adiposity. The overall effect size estimate between groups (intervention - control) was calculated for females and males separately using a random effects model. The estimates for males and females were compared using a meta-regression model with fixed effects. Results: Of 101 full-text articles reviewed, 52 (52%) were included, of which 33 (64%) reported statistically significant intervention effects on adiposity. Four studies (8%) evaluated sex differences in response to lifestyle intervention. Of which, two studies demonstrated significantly greater reductions in adiposity among females, one study found a significant within-group intervention effect for males, and the last study reported a non-significant greater reduction in adiposity for males. Although not significant, the results of the meta-regression models (n=11) indicated males demonstrated a larger (more negative) effect for weight (beta=-0.05, SE=0.18; z=-0.28, p=0.8), BMI z-score (beta=-0.04, SE=0.18; z=-0.23, p=0.82), body fat % (beta=-0.11, SE=0.16; z=-0.67, p=0.51), and waist circumference (beta=-0.30, SE=0.25; z=-1.18, p=0.24). In turn, males showed a non-significant smaller effect for BMI (beta=0.03, SE=0.14; z=0.19, p=0.85). Conclusions: Lifestyle interventions are effective in improving adiposity but few studies examine sex differences, reporting conflicting results. The meta-analysis revealed non-significant sex differences that favored male compared to female youth.