The prognostic significance of obesity in sarcopenic adults is controversial. This
systematic review and meta-analysis aimed to investigate the effect of additional
obesity on health outcomes in sarcopenia. MEDLINE, EMBASE, Scopus and CENTRAL were
systematically searched for studies to compare health outcomes of adults with sarcopenic
obesity (SO) to those of sarcopenic non-obese (SNO) adults. We also considered the
methods of assessing obesity. Of 15060 records screened, 65 papers were included (100612
participants). Older community-dwelling SO adults had 15% lower mortality risk than
the SNO group (hazard ratio, HR: 0.85, 95% confidence interval 0.76, 0.94) even when
obesity was assessed by measurement of body composition. Additionally, meta-regression
analysis revealed a significant negative linear correlation between the age and the
HR of all-cause mortality in SO vs. SNO community-dwelling adults, but not in severely
ill patients. Compared with SNO, SO patients presented lower physical performance,
higher risk for metabolic syndrome, but similar cognitive function, risk of falls
and cardiovascular diseases. Age-related obesity, SO and later fat loss leading to
SNO represent consecutive phases of biological aging. Additional obesity could worsen
the health state in sarcopenia, but above 65 years SO represents a biologically earlier
phase with longer life expectancy than SNO.
