Deciphering the “obesity paradox” in the elderly: A systematic review and meta‐analysis of sarcopenic obesity
Abstract
Summary: Aging and obesity are two global concerns in public health. Sarcopenic obesity (SO), defined as the combination of age‐related sarcopenia and obesity, has become a pressing issue. This systematic review and meta‐analysis summarize the current clinical evidence relevant to SO. PubMed, Embase, and Web of Science were searched, and 106 clinical studies with 167,151 elderlies were included. The estimated prevalence of SO was 9% in both men and women. Obesity was associated with 34% reduced risk of sarcopenia (odds ratio [OR] 0.66, 95% CI 0.48–0.91; p < 0.001). The pooled hazard ratio (HR) of all‐cause mortality was 1.51 (95% CI 1.14–2.02; p < 0.001) for people with SO compared with healthy individuals. SO was associated with increased risk of cardiovascular disease and related mortality, metabolic disorders, cognitive impairment, arthritis, functional limitation, and lung diseases (all ORs > 1.0, p < 0.05). The attenuated risk of sarcopenia in elderlies with obesity (“obesity paradox”) was dependent on higher muscle mass and strength. Apart from unifying the diagnosis of SO, more research is needed to subphenotype people with obesity and sarcopenia for individualized treatment. Meanwhile, the maintenance of proper body composition of muscle and fat may delay or attenuate the adverse outcomes of aging.
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Among adults, BMI has been used to assess overweight status independent of age or sex, though its cut-offs for the elderly are debated.
“Among adults, BMI has been used to assess overweight status independent of age or sex [28], though its cut-offs for the elderly are debated [30].”
From Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity (2024) · cites this paper as [30]
Persons with more body fat at a lower BMI than considered obese by WHO cut-offs, termed sarcopenic obesity, are at higher risk of type 2 diabetes with relative excess adiposity.
“Consequently, persons with more body fat at a lower BMI than considered obese by WHO cut-offs, termed “sarcopenic obesity” [30], are at higher risk of type 2 diabetes with a relative excess adiposity, but would not be successfully identified if screened by WHO BMI criteria.”
From Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity (2024) · cites this paper as [30]
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- Authors
- Liu, C., Wong, P. Y., Chung, Y. L., Chow, S. K., Cheung, W. H., Law, S. W., Chan, J. C. N., & Wong, R. M. Y.
- Affiliations
- Chinese University of Hong Kong (HK)
- Corresponding author
- Wong, Ronald Man Yeung
- ORCID
- Venue
- Obesity Reviews
- Publisher
- Wiley
- Published
- 2022-11-28
- Volume
- 24
- Issue
- 2
- Pages
- e13534-e13534
- ISSN
- 1467-7881 (ISSN-L)
- 1467-789X
- OpenAlex
- W4310209091
- Cited by
- 247
- References
- 133
- Citations by year
- 2026: 61 · 2025: 92 · 2024: 70 · 2023: 24
- FWCI
- 6.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obesity Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- sarcopenic obesity, obesity paradox, sarcopenia, aging, older adults, all-cause mortality, cardiovascular disease, cognitive impairment, functional limitations, muscle mass, muscle strength, body composition, prevalence
- MeSH terms
- Aged, Aging, Body Composition, Cardiovascular Diseases, Female, Humans, Male, Obesity, Sarcopenia
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