OBJECTIVE: Excess visceral adipose tissue (VAT) in children with obesity is associated with the development of cardiovascular and metabolic disease. This meta-analysis investigated if lifestyle interventions can reduce VAT in overweight and obese youth. METHODS: PubMed, Cochrane, and PEDro were searched for clinical trials that objectively assessed VAT and included study arms with supervised diet, exercise, or a combination of both. If there was a no-therapy control group, the data of the control group and the intervention groups were used to meta-analyze the data. In all other cases, the preintervention and the postintervention data were used to meta-analyze. Effect sizes were calculated as standardized mean differences or changes of VAT and expressed as Hedges' g. RESULTS: The overall weighted mean effect size on VAT of all included interventions was -0.69 (95% confidence interval (CI) -0.90 to -0.48) (p < 0.001). Subgroup analysis showed that the overall weighted mean effect size of diet-only interventions on VAT was 0.23 (95% CI -0.22 to 0.68) (p = 0.311). Interventions that combined diet and exercise showed a pooled effect size on VAT of -0.55 (95% CI -0.75 to -0.39) (p < 0.001). The pooled effect size of exercise-only interventions on VAT was -0.85 (95% CI -1.20 to -0.57) (p < 0.001). CONCLUSIONS: Supervised exercise-only or combined diet and exercise interventions can reduce VAT in overweight and obese children and adolescents. The strongest effect was found in exercise-only groups. However, high-quality randomized controlled trials describing the effect of supervised dietary interventions on VAT in children are lacking.

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