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Table 1 Summary of articles describing sex differences in diurnal rhythmicity

From: Is HPA axis reactivity in childhood gender-specific? A systematic review

Author (year) Sample size Age Sampling points Sampling medium Results
Adam (2010) 230 17.04 ± 0.36 years 6×/day on 3 days Saliva Lower diurnal cortisol curves in boys
Bae (2015) 138 (70 controls) 10.7 ± 1.7 years 3×/day on 3 days Saliva Higher levels at awakening, 30 min after awakening, and higher total daily output in girls; levels in the evening and diurnal slope: no sex differences
Barbosa (2012) 145 8-10 yr group: 9.0 ± 0.8 years; 11-14 yr group: 11.9 ± 1.0 years Saliva No sex differences, higher diurnal decline in children aged 11-14 years old
Bartels (2003) 360 12 years 4×/day on 2 days Saliva No sex differences; pubertal status not assessed
Carrion (2002) 31 Mean: 10.9 years 4×/day on 3 days Saliva No sex differences; pubertal status not associated with reactivity
Doom (2013) 110 9.42 ± 0.88 years 3×/day on 5 days Saliva No sex differences; pubertal status not assessed
Fransson (2014) 157 14–16 years 4× (including CAR) Saliva Steeper decline in girls
Garcia (1990) 76 (21 controls) 11.2 ± 0.37 years 3 hourly during 24 h Blood No sex differences; pubertal status not assessed
Haen (1984) 64 1 month to 15 years 6 hourly (4×) Blood No sex differences; pubertal status not assessed
Jones (2006) 140 7–9 years Saliva No sex differences; pubertal status not assessed
Kelly (2008) 2995 15.4 ± 0.32 years 2×, 30 min apart in the morning Saliva Steeper decline in girls
Kjolhede (2014) 342 9.5 ± 1.9 years 3×/day on 4 days Saliva No sex differences; pubertal status not assessed
Knutsson (1997) 235 2.2–18.5 years Blood No sex differences, except for higher values in girls at pubertal stage 2
Kuhlman (2015) 121 12.8 ± 2.3 years 4×/day on 2 days Saliva No impact of sex on cortisol at awakening or linear decline, but boys showed less deceleration of the diurnal decline between dinner and bedtime
Lumeng (2014) 331 3–4 years 3×/day on 3 days Saliva No sex differences; pubertal status not assessed
Martikainen (2013) 252 8.1 ± 0.3 years Saliva Higher morning cortisol in girls; no sex difference in nadir
Matchock (2007) 120 Boys: 9, 11, or 13 years; girls: 8, 10, or 12 years 6× (including CAR) Saliva Cortisol peak occurred later in boys than girls during later puberty. Higher morning cortisol in boys at pubertal stage 2. AUCg: no effect of sex but significant pubertal stage effect
Michels (2012) 385 5–10 years 4× (including CAR) Saliva No sex differences except for somewhat steeper decline in girls (p = 0.30)
Morin-Major (2016) 88 14.5 ± 1.8 years 4×/day on 2 days Saliva Higher AUC in girls
Netherton (2004) 129 12.8 ± 0.19 years 2×/day on 4 days Saliva Mid-post pubertal girls have higher morning cortisol than boys. No sex differences in variance across the 4 days
Osika (2007) 84 9.9 ± 0.55 years 5× (including CAR) Saliva No sex differences; pubertal status not assessed
Rosmalen (2005) 1768 11.08 ± 0.55 years 3× (including CAR) Saliva Higher morning cortisol levels in girls, no sex differences in evening cortisol, already present in prepubertal children. Age or pubertal status not associated with cortisol levels
Ruttle (2013) 346 11, 13, and 15 years 3×/day on 3 days Saliva Steeper slope in girls at ages 11 and 13 and in longitudinal analyses; higher cortisol levels in girls throughout the day at age 15
Shirtcliff (2012) 357 9, 11, 13, and 15 years 3×/day on 3 days Saliva Steeper slopes, more curvature in girls. Advancement through puberty: rhythm becomes flatter, especially in girls
Susman (2007) 111 Boys: 9, 11, or 13 years; girls: 8, 10, or 12 years 6× (including CAR) Saliva No sex differences; pubertal status not associated with reactivity
Tzortzi (2009) 21 10–14 years 20× (including CAR) Saliva No sex differences; pubertal status not assessed
Vaillancourt (2008) 154 147 ± 9.07 months 2×/day on 3 days Saliva Higher morning levels in girls on Saturday, multilevel regression: consistently higher production in girls
Vanaelst (2013) 355 5–10 years 4×/day on 2 days (including CAR) Saliva No sex differences; pubertal status not assessed
Williams (2013) 27 9.13 ± 1.41 years 3×/day on 2 days (including CAR) Saliva Boys exhibited flatter slopes than girls