Sarcopenic obesity: definition, cause and consequences
Open accessAbstract
PURPOSE OF REVIEW: Older obese persons with decreased muscle mass or strength are at special risk for adverse outcomes. We discuss potential pathways to muscle impairment in obese individuals and the consequences that joint obesity and muscle impairment may have on health and disability. Tantamount to this discussion is whether low muscle mass or, rather, muscle weakness should be used for the definition. RECENT FINDINGS: Excess energy intake, physical inactivity, low-grade inflammation, insulin resistance and changes in hormonal milieu may lead to the development of so-called 'sarcopenic obesity'. It was originally believed that the culprit of age-related muscle weakness was a reduction in muscle mass, but it is now clear that changes in muscle composition and quality are predominant. We propose that the risk of adverse outcomes, such as functional limitation and mortality, is better estimated by considering jointly obesity and muscle strength rather than obesity and muscle mass and the term 'sarcopenic obesity' should be revisited. SUMMARY: Recognition of obese patients who have associated muscle problems is an essential goal for clinicians. Further research is needed to identify new target for prevention and cure of this important geriatric syndrome.
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Possible mechanisms for reduced muscle mass and strength in sarcopenic obesity include type II fibre atrophy, motor neuron loss, collagen deposition and fibre necrosis.
“A number of mechanisms might explain the reduction of muscle mass and strength in sarcopenic obesity, including type II muscle fibre atrophy, reduction in motor neurons, collagen deposition and fibre necrosis67–70.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [70]
In “Searching for a definition based on pathophysiology and associated risk” (page unavailable), the paper identifies reduced fibre size and number, increased collagen, and motor-unit changes as contributors to declining muscle quality. “Age-related changes in body composition” (page unavailable) also names loss of alpha-motor units. It does not specify type II fibre atrophy or identify fibre necrosis as a mechanism. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSarcopenic obesity is characterized by high fat mass, low muscle mass, low muscle strength, and low physical function.
“Patients with SO have high fat mass, low muscle mass, low muscle strength, and low physical function.”
From The critical role of oxidative stress in sarcopenic obesity (2021) · cites this paper as [2]
Sarcopenic obesity primarily develops in older people, mainly over 60 years old.
“Sarcopenic obesity (SO) is a combination of obesity and sarcopenia that primarily develops in older people.”
From The critical role of oxidative stress in sarcopenic obesity (2021) · cites this paper as [2]
The proportions of visceral fat and intramuscular fat increase with age, reaching a peak between 60 and 75 years old, as the proportion of subcutaneous fat decreases.
“The proportions of visceral fat and intramuscular fat also increase with age, reaching a peak between 60 and 75 years old, as the proportion of subcutaneous fat decreases.[ 9 ]”
From Pathogenesis of sarcopenia and the relationship with fat mass: descriptive review (2022) · cites this paper as [9]
When muscle damage and obesity coexist, they act synergistically on the risk of mortality, metabolic disorders, and quality of life.
“Therefore, it is reasonable to speculate when muscle damage and obesity coexist, they act synergistically on the risk of mortality, metabolic disorders, and quality of life (47, 51).”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [51]
Not all older adults with obesity have sarcopenia because excess body weight usually stimulates muscle and bone mechanoreceptors, triggering growth factor synthesis and muscle formation.
“Of note, not all older adults with obesity will exhibit sarcopenia, as excess body weight usually stimulates muscle (and bone) mechanoreceptors, triggering growth factor synthesis that leads to muscle formation11.”
From Sarcopenic obesity in older adults: a clinical overview (2024) · cites this paper as [11]
In patients with physical inactivity, sarcopenic obesity is frequently observed due to muscle loss and a sedentary lifestyle.
“In patients with physical inactivity sarcopenic obesity is frequently observed due to muscle loss and a sedentary lifestyle.[ 8 ]”
From Exercise approaches in obese individuals with physical limitations (2026) · cites this paper as [8]
Twelve weeks of resistance training in sarcopenic obesity can increase muscle mass by up to 8%.
“Twelve weeks of resistance training in sarcopenic obesity can increase muscle mass by up to 8%.”
From Exercise approaches in obese individuals with physical limitations (2026) · cites this paper as [8]
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“In this context, criteria for sarcopenia based on the amount of lean mass lower than expected for a given fat mass using residuals from regressionmodels and the ratio between appendicular lean mass (ALM) and appendicular fat mass (AFM) have been proposed [1,2].”
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- Authors
- Stenholm, S., Harris, T. B., Rantanen, T., Visser, M., Kritchevsky, S. B., & Ferrucci, L.
- Affiliations
- National Institute on Aging (US)
- National Institutes of Health (US)
- University of Jyväskylä (FI)
- Amsterdam Public Health (NL)
- Wake Forest University Health Sciences (US)
- Corresponding author
- Ferrucci, Luigi
- ORCID
- Venue
- Current Opinion in Clinical Nutrition and Metabolic Care
- Published
- 2008-11
- Volume
- 11
- Issue
- 6
- Pages
- 693-700
- ISSN
- 1363-1950 (ISSN-L)
- PMC
- PMC2633408
- OpenAlex
- W2157300817
- Cited by
- 1,070
- References
- 112
- Citations by year
- 2026: 16 · 2025: 38 · 2024: 63 · 2023: 80 · 2022: 74 · 2021: 94 · 2020: 83 · 2019: 77 · 2018: 68 · 2017: 62 · 2016: 70 · 2015: 87 · 2014: 66 · 2013: 75 · 2012: 46
- FWCI
- 2.50
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Current Opinion in Clinical Nutrition & Metabolic Care (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- PubMed Central (acceptedVersion)
- Jyväskylä University Digital Archive (University of Jyväskylä) (submittedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- VU Research Portal (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Ministero della Salute
- National Institutes of Health
- National Institute on Aging (N01AG-821336, N01[AG]916413, Z01AG000015, P30AG021332)
- National Institute on Minority Health and Health Disparities (263-MD-916413, 263MD 821336, R01MD009164)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Muscle Physiology and Disorders
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Keywords
- sarcopenic obesity, muscle weakness, muscle mass, muscle quality, muscle composition, older adults, obesity, physical inactivity, insulin resistance, low-grade inflammation, functional limitations, mortality, geriatric syndromes
- MeSH terms
- Aged, Aging, Female, Health Status, Humans, Male, Muscular Atrophy, Obesity, Risk Factors, Exercise, Comorbidity, Muscle, Skeletal, Muscle Strength
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