Sex as a moderator of body composition following a randomized controlled lifestyle intervention among Latino youth with obesity
Kiley B. Vander Wyst
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
Search for more papers by this authorMicah L. Olson
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona
Search for more papers by this authorColleen S. Keller
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
Search for more papers by this authorErica G. Soltero
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
Search for more papers by this authorAllison N. Williams
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
Search for more papers by this authorArmando Peña
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
Search for more papers by this authorStephanie L. Ayers
Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona
Search for more papers by this authorJustin Jager
T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Phoenix, Arizona
Search for more papers by this authorCorresponding Author
Gabriel Q. Shaibi
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona
Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona
Correspondence
Gabriel Q. Shaibi, Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ 85004.
Email: [email protected]
Search for more papers by this authorKiley B. Vander Wyst
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
Search for more papers by this authorMicah L. Olson
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona
Search for more papers by this authorColleen S. Keller
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
Search for more papers by this authorErica G. Soltero
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
Search for more papers by this authorAllison N. Williams
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
Search for more papers by this authorArmando Peña
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
Search for more papers by this authorStephanie L. Ayers
Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona
Search for more papers by this authorJustin Jager
T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Phoenix, Arizona
Search for more papers by this authorCorresponding Author
Gabriel Q. Shaibi
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona
Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona
Correspondence
Gabriel Q. Shaibi, Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ 85004.
Email: [email protected]
Search for more papers by this authorFunding information: National Institute of Diabetes and Digestive and Kidney Diseases, Grant/Award Number: R01 DK10757901; National Institute on Minority Health and Health Disparities, Grant/Award Numbers: P20MD002316, U54MD002316
Summary
Background
Body composition differences between males and females emerge during adolescence and continue throughout adulthood; however, whether sex moderates body composition changes in adolescents with obesity after an intervention is unknown.
Objective
To examine sex as a moderator of changes in adiposity following lifestyle intervention.
Methods
A total of 136 Latino youth with obesity (BMI% 98.2 ± 1.3) aged 14 to 16 years old were randomized to either a 12-week lifestyle intervention (27 males/40 females) or control (35 males/34 females) group. The intervention included nutrition education (1 h/wk) and moderate-to-vigorous physical activity (3 h/wk). Anthropometric data (body mass index [BMI], BMI%, waist circumference, total body fat, and fat-free mass) were obtained pre- and post-intervention. Sex differences were examined by general linear models with significance determined at P < .05 for the F-statistic.
Results
Sex did not moderate changes in BMI (F1,115 = 0.01, P = .9), BMI% (F1,115 = 0.14, P = .7), or waist circumference (F1,117 = 1.1, P = .3). Sex significantly moderated changes in body fat percent (F1,117 = 5.3, P = .02), fat mass (F1,116 = 4.5, P = .04), and fat-free mass (F1,116 = 4.3, P = .04). Intervention males compared with females had greater relative reductions in fat percent (−4.1 ± 0.8% vs −1.2 ± 0.7%, P = .02) and fat mass (−5.0 ± 1.1 kg vs −1.5 ± 0.9 kg, P = .02) and gained more fat free mass (3.6 ± 0.9 kg vs 0.5 ± 0.8 kg, P = .02) when compared with same sex controls.
Conclusion
Males and females exhibited a differential response to lifestyle intervention for percent fat, fat mass, and fat-free mass indicating that sex-specific improvements in body composition favours males over females.
CONFLICT OF INTEREST
The authors have no conflicts of interest relevant to this article to disclose.
REFERENCES
- 1Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity Among Adults and Youth: United States, 2015–2016. NCHS Data Brief. Hyattsville, MD; 2017. doi:https://doi.org/10.1017/S1368980017000088
- 2Ogden CL, Carroll MD, Lawman HG, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA - JAMA. 2016; 315(21): 2292-2299. https://doi.org/10.1001/jama.2016.6361.
- 3Pettitt DJ, Talton J, Dabelea D, et al. Prevalence of diabetes in U.S. youth in 2009: the SEARCH for diabetes in youth study. Diabetes Care. 2014; 37(2): 402-408. https://doi.org/10.2337/dc13-1838.
- 4Pan JJ, Fallon MB. Gender and racial differences in nonalcoholic fatty liver disease. World J Hepatol. 2014; 6(5): 274-283. https://doi.org/10.4254/wjh.v6.i5.274.
- 5Betancourt-Garcia MM, Arguelles A, Montes J, Hernandez A, Singh M, Forse RA. Pediatric nonalcoholic fatty liver disease: the rise of a lethal disease among Mexican American Hispanic children. Obes Surg. 2017; 27(1): 236-244. https://doi.org/10.1007/s11695-016-2440-5.
- 6Miller JM, Kaylor MB, Johannsson M, Bay C, Churilla JR. Prevalence of metabolic syndrome and individual criterion in US adolescents: 2001-2010 national health and nutrition examination survey. Metab Syndr Relat Disord. 2014; 12(10): 527-532. https://doi.org/10.1089/met.2014.0055.
- 7Johnson WD, Kroon JJM, Greenway FL, Bouchard C, Ryan D, Katzmarzyk PT. Prevalence of risk factors for metabolic syndrome in adolescents. Arch Pediatr Adolesc Med. 2009; 163(4): 371-377. https://doi.org/10.1001/archpediatrics.2009.3.
- 8Wolf RM, Long D. Pubertal development. Pediatr Rev. 2016; 37(7): 292-300. https://doi.org/10.1542/pir.2015-0065.
- 9Khan L. Puberty: onset and progression. Pediatr Ann. 2019; 48(4): e141-e145. https://doi.org/10.3928/19382359-20190322-01.
- 10Mauvais-Jarvis F. Sex differences in metabolic homeostasis, diabetes, and obesity. Biol Sex Differ. 2015; 6(1): 1-9. https://doi.org/10.1186/s13293-015-0033-y.
- 11Staiano AE, Broyles ST, Gupta AK, Katzmarzyk PT. Ethnic and sex differences in visceral, subcutaneous, and total body fat in children and adolescents. Obesity. 2013; 21(6): 1251-1255. https://doi.org/10.1002/oby.20210.
- 12Kuk JL, Lee SJ. Sex and ethnic differences in the relationship between changes in anthropometric measurements and visceral fat in adolescents with obesity. J Pediatr. 2019; 1-7: 121-127. https://doi.org/10.1016/j.jpeds.2019.05.052.
- 13Goran MI, Shaibi GQ, Weigensberg MJ, Davis JN, Cruz ML. Deterioration of insulin sensitivity and beta-cell function in overweight Hispanic children during pubertal transition: a longitudinal assessment. Int J Pediatr Obes. 2006; 1(3): 139-145. https://doi.org/10.1080/17477160600780423.
- 14Goran MI, Gower BA. Longitudinal study on pubertal insulin resistance. Diabetes. 2001; 50: 2444-2450.
- 15Burt Solorzano CM, McCartney CR. Obesity and the pubertal transition in girls and boys. Reproduction. 2010; 140(3): 399-410. https://doi.org/10.1530/rep-10-0119.
- 16Nadeau KJ, Anderson BJ, Berg EG, et al. Youth-onset type 2 diabetes consensus report: current status, challenges, and priorities. Diabetes Care. 2016; 39(9): 1635-1642. https://doi.org/10.2337/dc16-1066.
- 17Kuk JL, Lee S, Heymsfield SB, Ross R. Waist circumference and abdominal adipose tissue distribution: influence of age and sex. Am J Clin Nutr. 2005; 81(6): 1330-1334.
- 18Lee SJ, Libman I, Hughan K, et al. Effects of exercise modality on insulin resistance and ectopic fat in adolescents with overweight and obesity: a randomized clinical trial. J Pediatr. 2019; 206: 91-98.e1. https://doi.org/10.1016/j.jpeds.2018.10.059.
- 19Deldin A, Kuk JL, Lee S. Influence of sex on the changes in regional fat and skeletal muscle mass in response to exercise training in adolescents with obesity. Child Obes. 2019; 15(3): 216-222. https://doi.org/10.1089/chi.2018.0329.
- 20Soltero EG, Olson ML, Williams AN, et al. Effects of a community-based diabetes prevention program for Latino youth with obesity: a randomized controlled trial. Obes (Silver Spring). 2018; 26(12): 1856-1865. https://doi.org/10.1002/oby.22300.Effects.
- 21Williams AN, Konopken YP, Keller CS, et al. Culturally-grounded diabetes prevention program for obese Latino youth: rationale, design, and methods. Contemp Clin Trials. 2017; 54: 68-76. https://doi.org/10.1016/j.cct.2017.01.004.
- 22Ahmed ML, Ong KK, Dunger DB. Childhood obesity and the timing of puberty. Trends Endocrinol Metab. 2009; 20(5): 237-242. https://doi.org/10.1016/j.tem.2009.02.004.
- 23Larson RW, Moneta G, Richards MH, Holmbeck G. Changes in adolescents' daily interactions with their families from ages 10 to 18: disengagement and transformation. Adolesc their Fam Struct Funct Parent-Youth Relations. 2013; 32(4): 118-128. https://doi.org/10.1037//0012-1649.32.4.744.
- 24Gutin B, Barbeau P, Owens S, et al. Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents. Am J Clin Nutr. 2002; 75(5): 818-826. https://doi.org/10.1093/ajcn/75.5.818.
- 25Walter-Kroker A, Kroker A, Mattiucci-Guehlke M, Glaab T. A practical guide to bioelectrical impedance analysis using the example of chronic obstructive pulmonary disease. Nutr J. 2011; 10(1): 2-9. https://doi.org/10.1186/1475-2891-10-35.
- 26Petersen A, Crockett L, Richards M, Boxer A. A self-report measure of pubertal status: reliability, validity, and initial norms. J Youth Adolesc. 1988; 17(2): 117-133.
- 27Carskadon MA, Acbbo CA. Self-administered sting scale for development. J Adolesc Heal E P Bradley Hosp. 1993; 14: 190-195.
- 28Buscot M-J, Thomson RJ, Juonala M, et al. BMI trajectories associated with resolution of elevated youth BMI and incident adult obesity. Pediatrics. 2018; 141(1):e20172003. https://doi.org/10.1542/peds.2017-2003.
- 29Eissa MA, Dai S, Mihalopoulos NL, Day RS, Harrist RB, Labarthe DR. Trajectories of fat mass index, fat free-mass index, and waist circumference in children: Project HeartBeat! Am J Prev Med. 2009; 37(1 SUPPL): S34-S39. https://doi.org/10.1016/j.amepre.2009.04.005.
- 30De Miguel-Etayo P, Moreno LA, Santabárbara J, et al. Body composition changes during a multidisciplinary treatment programme in overweight adolescents: EVASYON study. Nutr Hosp. 2015; 32(6): 2525-2534. https://doi.org/10.3305/nh.2015.32.6.9663.
- 31Parks EP, Zemel B, Moore RH, Berkowitz RI. Change in body composition during a weight loss trial in obese adolescents. Pediatr Obes. 2014; 9(1): 26-35. https://doi.org/10.1038/jid.2014.371.
- 32Ranucci C, Pippi R, Buratta L, et al. Effects of an intensive lifestyle intervention to treat overweight/obese children and adolescents. Biomed Res Int. 2017; 2017: 1-11. https://doi.org/10.1155/2017/8573725.
- 33Barreira E, Novo A, Vaz JA, Pereira A. Dietary program and physical activity impact on biochemical markers in patients with type 2 diabetes: a systematic review. Aten Primaria. 2018; 50(10): 590-610. https://doi.org/10.1016/j.aprim.2017.06.012.
- 34Perreault L, Ma Y, Dagogo-Jack S, et al. Sex differences in diabetes risk and the effect of intensive lifestyle modification in the diabetes prevention program. Diabetes Care. 2008; 31: 1416-1421. https://doi.org/10.1007/BF02612712.
- 35Savoye M, Shaw M, Dziura J, et al. Effects of a weight management program on body composition and metabolic parameters in overweight children: a randomized controlled trial. JAMA. 2007; 297(24): 2697-2704. https://doi.org/10.1001/jama.297.24.2697.
- 36Keyserling TC, Samuel-Hodge CD, Pitts SJ, et al. A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the heart healthy Lenoir project. BMC Public Health. 2016; 16(1): 1-22. https://doi.org/10.1186/s12889-016-3370-9.
- 37 The Look AHEAD Research Group. Long term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes: four year results of the look AHEAD trial. Arch Intern Med. 2010; 170(17): 1566-1575. https://doi.org/10.1001/archinternmed.2010.334.Long.
- 38Martínez-Vizcaíno V, Sánchez-López M, Notario-Pacheco B, Salcedo-Aguilar F, Solera-Martínez M, Franquelo-Morales P, López-Martínez S, García-Prieto JC, Arias-Palencia N, Torrijos-Niño C, Mora-Rodríguez R, Rodríguez-Artalejo F Gender differences on effectiveness of a school-based physical activity intervention for reducing cardiometabolic risk: a cluster randomized trial. Int J Behav Nutr Phys Act 2014; 11(154): 1–11. doi:https://doi.org/10.1186/s12966-014-0154-4
- 39Green CA, Yarborough BJH, Leo MC, et al. The STRIDE weight loss and lifestyle intervention for individuals taking antipsychotic medications: a randomized trial. Am J Psychiatry. 2014; 172(1): 1-11. https://doi.org/10.1176/appi.ajp.2014.14020173.
- 40Abbasi A, Juszczyk D, van Jaarsveld CHM, Gulliford MC. Body mass index and incident type 1 and type 2 diabetes in children and young adults: a retrospective cohort study. J Endocr Soc. 2017; 1(5): 524-537. https://doi.org/10.1210/js.2017-00044.
- 41Juonala M, Magnessen CG, Berenson GS, et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. NEJM. 2011; 365: 1876-1885.
- 42Arslanian S, Suprasongsin C. Insulin sensitivity, lipids, and body composition in childhood: is “syndrome X” present? J Endocrinol Metab. 1996; 81(3): 1058-1062.
- 43Ling JCY, Mohamed MNA, Jalaludin MY, Rampal S, Zaharan NL, Mohamed Z. Determinants of high fasting insulin and insulin resistance among overweight/obese adolescents. Sci Rep. 2016; 6: 1-10. https://doi.org/10.1038/srep36270.
- 44Hübers M, Geisler C, Plachta-Danielzik S, Müller MJ. Association between individual fat depots and cardio-metabolic traits in normal- and overweight children, adolescents and adults. Nutr Diabetes. 2017; 7(5): 1-8. https://doi.org/10.1038/nutd.2017.20.
- 45Staiano AE, Gupta AK, Katzmarzyk PT. Cardiometabolic risk factors and fat distribution in children and adolescents. J Pediatr. 2014; 164(3): 560-565. https://doi.org/10.1016/j.jpeds.2013.10.064.
- 46Kuk JL, Ross R. Influence of sex on total and regional fat loss in overweight and obese men and women. Int J Obes (Lond). 2009; 33(6): 629-634. https://doi.org/10.1038/ijo.2009.48.
- 47SoJung L, Kuk JL. Changes in fat and skeletal muscle with exercise training in obese adolescents: comparison of whole-body MRI and dual energy X-ray absorptiometry. Obes (Silver Spring). 2013; 21(10): 2063-2071.
- 48McCurley JL, Crawford MA, Gallo LC. Prevention of type 2 diabetes in U.S. Hispanic youth: a systematic review of lifestyle interventions. Am J Prev Med. 2017; 53(4): 519-532. https://doi.org/10.1016/j.amepre.2017.05.020.
- 49Lenhart CM, Hanlon A, Kang Y, Daly BP, Brown MD, Patterson F. Gender disparity in structured physical activity and overall activity level in adolescence: evaluation of youth risk behavior surveillance data. ISRN Public Health. 2012; 2012: 1-8. https://doi.org/10.5402/2012/674936.
10.5402/2012/674936 Google Scholar
- 50Lawler M, Heary C, Nixon E. Variations in adolescents' motivational characteristics across gender and physical activity patterns: a latent class analysis approach. BMC Public Health. 2017; 17(1): 1-13. https://doi.org/10.1186/s12889-017-4677-x.
- 51Davis JN, Ventura EE, Shaibi GQ, et al. Interventions for improving metabolic risk in overweight Latino youth. Int J Pediatr Obes. 2010; 5(5): 451-455. https://doi.org/10.3109/17477161003770123.
- 52Wells JCK, Williams JE, Chomtho S, et al. Pediatric reference data for lean tissue properties: density and hydration from age 5 to 20 y. Am J Clin Nutr. 2010; 91(3): 610-618. https://doi.org/10.3945/ajcn.2009.28428.
- 53Deurenberg P. Limitations of the bioelectrical impedance method for the assessment of body fat in severe obesity. Am J Clin Nutr. 1996; 64: 449S-452S.
- 54Sergi G, De Rui M, Stubbs B, Veronese N, Manzato E. Measurement of lean body mass using bioelectrical impedance analysis: a consideration of the prons and cons. Aging Clin Exp Res. 2017; 29(4): 591-597.
- 55Wan CS, Leung K, Ward LC, et al. Bioelectrical impedance analysis to estimate body composition, and change in adiposity, in overweight and obese adolescents: comparison with dual-energy X-ray absorptiometry. BMC Pediatr. 2014; 14(1): 1-10. https://doi.org/10.1186/1471-2431-14-249.
- 56Tewari N, Awad S, Macdonald IA, Lobo DN. A comparison of three methods to assess body composition. Nutrition. 2018; 47: 1-5. https://doi.org/10.1016/j.nut.2017.09.005.
- 57Lee LW, Liao YS, Lu HK, et al. Validation of two portable bioelectrical impedance analyses for the assessment of body composition in school age children. PLoS One. 2017; 12(2): 1-14. https://doi.org/10.1371/journal.pone.0171568.
- 58Nguyen TT, Jayadeva V, Cizza G, et al. Challenging recruitment of youth with type 2 diabetes into. Clin Trials. 2013; 71(2): 233-236. https://doi.org/10.1038/mp.2011.182.doi.
- 59Zeitler P, Chou HS, Copeland KC, Geffner M. Clinical trials in youth-onset type 2 diabetes: needs, barriers, and options. Curr Diab Rep. 2015; 15(5): 1-8. https://doi.org/10.1007/s11892-015-0597-2.
Citing Literature
