Caspian Journal of Internal Medicine
Babol University of Medical Sciences
Wed, Sep 23, 2026
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Volume 17, Issue 4 (Autumn 2026)
Caspian J Intern Med 2026, 17(4): 0-3 |
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Afshar F, Afshar M A, Sepidarkish M. Sarcopenic Obesity in Clinical Practice: A Narrative Review of Diagnostic Challenges, Biochemical Pathways, and Therapeutic Strategies. Caspian J Intern Med 2026; 17 (4)
URL: http://caspjim.com/article-1-5134-en.html
URL: http://caspjim.com/article-1-5134-en.html
Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran , Mahdi.sepidarkish@gmail.com
Abstract: (70 Views)
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.
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.
Keywords: Sarcopenic Obesity, Sarcopenia, Obesity, Inflammation, Insulin Resistance, Resistance Training, Dietary Proteins
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Received: 2026/05/9 | Accepted: 2026/07/21 | Published: 2026/09/9
Received: 2026/05/9 | Accepted: 2026/07/21 | Published: 2026/09/9
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