Caspian Journal of Internal Medicine

en Sarcopenic Obesity in Clinical Practice: A Narrative Review of Diagnostic Challenges, Biochemical Pathways, and Therapeutic Strategies Internal Internal Review Article Review Article Background: Sarcopenic obesity (SO), the coexistence of age-related muscle loss and excess adiposity, creates a synergistic interaction that increases disability, metabolic complications, and mortality. Obesity may mask underlying muscle wasting, contributing to underdiagnosis. This review provides a focused synthesis of diagnostic, mechanistic, and therapeutic aspects of SO. Methods: This focused narrative review searched MEDLINE (PubMed), Scopus, and the Cochrane Library through April 2026 for relevant guidelines, meta-analyses, systematic reviews, and representative randomized trials. Evidence selection was purposive rather than protocol-driven; no PRISMA flow diagram, duplicate screening, formal risk-of-bias assessment, or GRADE evaluation was performed. Results: Diagnosis requires assessment of impaired skeletal muscle status and excess adiposity. We propose a pragmatic two-step case-finding approach using simple clinical measures, including calf circumference and handgrip strength, followed, when indicated, by confirmatory body-composition assessment. This author-derived synthesis of consensus recommendations has not been externally validated. Chronic low-grade inflammation, insulin resistance, mitochondrial dysfunction, and disrupted myokine-adipokine crosstalk contribute to disease progression. Progressive resistance training combined with protein intake has the strongest clinical support. Caloric restriction without sufficient protein and muscle-preserving exercise may increase lean-mass loss. GLP-1-based anti-obesity therapies can reduce both fat and lean mass and therefore warrant individualized monitoring in patients at risk of sarcopenia. Conclusions: SO is underrecognized because excess adiposity can conceal low muscle reserves. The proposed two-step approach is a pragmatic, unvalidated case-finding framework rather than a replacement for consensus criteria. Resistance exercise and adequate protein intake remain central to management, while muscle-preserving strategies and functional monitoring should accompany weight-loss interventions.   Sarcopenic Obesity, Sarcopenia, Obesity, Inflammation, Insulin Resistance, Resistance Training, Dietary Proteins 0 3 http://caspjim.com/browse.php?a_code=A-10-2566-2&slc_lang=en&sid=1 Fatemeh Afshar f.afshar.med2020@gmail.com 100319475328460058144 0009-0001-6749-9040 No School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran Mohammad Amin Afshar mohamadamin.afshar1380@gmail.com 100319475328460058145 0009-0001-6604-3666 No School of Medicine, Babol University of Medical Sciences, Babol, Iran Mahdi Sepidarkish Mahdi.sepidarkish@gmail.com 100319475328460058146 100319475328460058146 Yes Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran