PT  - JOURNAL ARTICLE
AU  - Francesco Recchia
AU  - Chit K. Leung
AU  - Angus P. Yu
AU  - Welton Leung
AU  - Danny J. Yu
AU  - Daniel Y. Fong
AU  - David Montero
AU  - Chi-Ho Lee
AU  - Stephen H.S. Wong
AU  - Parco M. Siu
TI  - Dose–response effects of exercise and caloric restriction on visceral adiposity in overweight and obese adults: a systematic review and meta-analysis of randomised controlled trials
AID  - 10.1136/bjsports-2022-106304
DP  - 2023 Jan 20
TA  - British Journal of Sports Medicine
PG  - bjsports-2022-106304
4099  - http://bjsm.bmj.com/content/early/2023/01/26/bjsports-2022-106304.short
4100  - http://bjsm.bmj.com/content/early/2023/01/26/bjsports-2022-106304.full
AB  - Objective To determine and compare the dose–response effects of exercise and caloric restriction on visceral adipose tissue in overweight and obese adults, while controlling for the weekly energy deficit induced by the interventions.Methods PubMed, Embase, CINAHL and Web of Science were searched for randomised controlled trials comparing exercise or caloric restriction against eucaloric controls in overweight or obese adults. The primary outcome was the change in visceral fat measured by CT or MRI. Meta-analyses and meta-regressions were performed to determine the overall effect size (ES) and the dose–dependent relationship of exercise and caloric restriction on visceral fat. Heterogeneity, risk of bias and the certainty of evidence were also assessed.Results Forty randomised controlled trials involving 2190 participants were included. Overall, exercise (ES −0.28 (−0.37 to −0.19); p<0.001; I2=25%) and caloric restriction (ES −0.53 (−0.71 to −0.35); p<0.001; I2=33%) reduced visceral fat compared with the controls. Exercise demonstrated a dose–response effect of −0.15 ((−0.23 to −0.07); p<0.001) per 1000 calories deficit per week, whereas the effect of caloric restriction was not dose-dependent (ES 0.03 (−0.12 to 0.18); p=0.64). Most of the studies showed a moderate risk of bias.Conclusions These findings support the dose–dependent effects of exercise to reduce visceral fat in overweight and obese adults. Caloric restriction did not demonstrate a dose–response relationship, although this may be attributed to the smaller number of studies available for analysis, compared with exercise studies.PROSPERO registration number CRD42020210096.Data available upon request.