Exploring the Complexities of Sarcopenic Obesity and Nutritional Approaches for Promoting Healthy Aging: a Literature Review

Michelle Ruth Natalie -  Faculty of Medicine, Tarumanagara University, Jakarta, Indonesia
Alexander Halim Santoso* -  Department of Nutrition, Faculty of Medicine, Tarumanagara University, Jakarta, Indonesia



The ongoing global demographic transition towards an aging population indicates that the proportion of individuals aged 60 and above is expected to reach 21% by the year 2050, with more than 5% of this group being 80 or older. As a result of this shift in demographics towards an increasingly elderly population, there has been a noticeable increase in the occurrence of a medical condition known as sarcopenic obesity. This academic paper thoroughly examines the existing body of literature by consolidating information from various reputable sources. The primary focus of this review is to investigate the implementation of therapies related to obesity, sarcopenia, and nutrition. The data for this assessment was systematically collected by conducting an extensive search of electronic databases, encompassing research publications and review papers. It is crucial to acknowledge that traditional measures like body weight and body mass index are not advisable for assessing body composition in older adults because they cannot distinguish between adipose tissue and muscle mass. Sarcopenia is closely linked to inadequate dietary intake, while obesity results from excessive energy consumption, creating an imbalance between daily energy intake and expenditure. When formulating a nutritional strategy to address sarcopenic obesity, it is essential to consider dual goals. The primary goal is to ensure a proper intake of nutrients that promotes the growth of skeletal muscle mass or reduces the risk of muscle loss. At the same time, it is crucial to achieve balance by advocating for sufficient nutrition and energy intake to prevent the accumulation of excess fat tissue.


Keywords: Sarcopenic Obesity, Elderly Population, Nutritional Therapeutic

Kata Kunci : Sarcopenic Obesity, Elderly Population, Nutritional Therapeutic

  1. Backx, E. M. P., Tieland, M., Borgonjen-van den Berg, K. J., Claessen, P. R., van Loon, L. J. C., & de Groot, L. C. P. G. M. (2016). Protein intake and lean body mass preservation during energy intake restriction in overweight older adults. International Journal of Obesity, 40(2), 299–304. https://doi.org/10.1038/ijo.2015.182
  2. Barazzoni, R., Bischoff, S., Boirie, Y., Busetto, L., Cederholm, T., Dicker, D., Toplak, H., Van Gossum, A., Yumuk, V., & Vettor, R. (2018). Sarcopenic Obesity: Time to Meet the Challenge. Obesity Facts, 11(4), 294–305. https://doi.org/10.1159/000490361
  3. Bouchonville, M. F., & Villareal, D. T. (2013). Sarcopenic obesity. Current Opinion in Endocrinology, Diabetes & Obesity, 20(5), 412–419. https://doi.org/10.1097/01.med.0000433071.11466.7f
  4. Chen, L.-K., Woo, J., Assantachai, P., Auyeung, T.-W., Chou, M.-Y., Iijima, K., Jang, H. C., Kang, L., Kim, M., Kim, S., Kojima, T., Kuzuya, M., Lee, J. S. W., Lee, S. Y., Lee, W.-J., Lee, Y., Liang, C.-K., Lim, J.-Y., Lim, W. S., … Arai, H. (2020). Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. Journal of the American Medical Directors Association, 21(3), 300-307.e2. https://doi.org/10.1016/j.jamda.2019.12.012
  5. Christensen, K., Doblhammer, G., Rau, R., & Vaupel, J. W. (2009). Ageing populations: the challenges ahead. The Lancet, 374(9696), 1196–1208. https://doi.org/10.1016/S0140-6736(09)61460-4
  6. Chuang, S.-Y., Hsu, Y.-Y., Chen, R. C.-Y., Liu, W.-L., & Pan, W.-H. (2016). Abdominal Obesity and Low Skeletal Muscle Mass Jointly Predict Total Mortality and Cardiovascular Mortality in an Elderly Asian Population. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 71(8), 1049–1055. https://doi.org/10.1093/gerona/glv192
  7. Cruz-Jentoft, A. J., Baeyens, J. P., Bauer, J. M., Boirie, Y., Cederholm, T., Landi, F., Martin, F. C., Michel, J.-P., Rolland, Y., Schneider, S. M., Topinková, E., Vandewoude, M., & Zamboni, M. (2010). Sarcopenia: European consensus on definition and diagnosis. Age and Ageing, 39(4), 412–423. https://doi.org/10.1093/ageing/afq034
  8. Curioni, C. C., & Lourenço, P. M. (2005). Long-term weight loss after diet and exercise: a systematic review. International Journal of Obesity, 29(10), 1168–1174. https://doi.org/10.1038/sj.ijo.0803015
  9. Damms-Machado, A., Weser, G., & Bischoff, S. C. (2012). Micronutrient deficiency in obese subjects undergoing low calorie diet. Nutrition Journal, 11(1), 34. https://doi.org/10.1186/1475-2891-11-34
  10. Deer, R. R., & Volpi, E. (2015). Protein intake and muscle function in older adults. Current Opinion in Clinical Nutrition and Metabolic Care, 18(3), 248–253. https://doi.org/10.1097/MCO.0000000000000162
  11. Després, J.-P., Nadeau, A., Tremblay, A., Ferland, M., Moorjani, S., Lupien, P. J., Thériault, G., Pinault, S., & Bouchard, C. (1989). Role of Deep Abdominal Fat in the Association Between Regional Adipose Tissue Distribution and Glucose Tolerance in Obese Women. Diabetes, 38(3), 304–309. https://doi.org/10.2337/diab.38.3.304
  12. Destra, E., Anggraeni, N., Firmansyah, Y., & Santoso, A. H. (2023). Waist to hip ratio in Cardiovascular Disease Risk : A Review of the Literature. MAHESA : Malahayati Health Student Journal, 3(6), 1770–1781. https://doi.org/10.33024/mahesa.v3i6.10595
  13. Destra, E., Frisca, F., Santoso, A. H., & Firmansyah, Y. (2022). Hubungan Asupan Makanan Cepat Saji dengan Angka Kejadian Hipertensi pada Orang Dewasa dengan Aktifitas Fisik Ringan Hingga Sedang. Jurnal Medika Hutama, 3(03 April), 2525–2529.
  14. Donini, L. M., Busetto, L., Bauer, J. M., Bischoff, S., Boirie, Y., Cederholm, T., Cruz-Jentoft, A. J., Dicker, D., Frühbeck, G., Giustina, A., Gonzalez, M. C., Han, H.-S., Heymsfield, S. B., Higashiguchi, T., Laviano, A., Lenzi, A., Parrinello, E., Poggiogalle, E., Prado, C. M., … Barazzoni, R. (2020). Critical appraisal of definitions and diagnostic criteria for sarcopenic obesity based on a systematic review. Clinical Nutrition, 39(8), 2368–2388. https://doi.org/10.1016/j.clnu.2019.11.024
  15. Freiberger, E., Goisser, S., Porzel, S., Volkert, D., Kemmler, W., Sieber, C., & Bollheimer, C. (2015). Sarcopenic obesity and complex interventions with nutrition and exercise in community-dwelling older persons – a narrative review. Clinical Interventions in Aging, 1267. https://doi.org/10.2147/CIA.S82454
  16. Gao, Q., Mei, F., Shang, Y., Hu, K., Chen, F., Zhao, L., & Ma, B. (2021). Global prevalence of sarcopenic obesity in older adults: A systematic review and meta-analysis. Clinical Nutrition, 40(7), 4633–4641. https://doi.org/10.1016/j.clnu.2021.06.009
  17. Gowd, V., Xie, L., Zheng, X., & Chen, W. (2019). Dietary fibers as emerging nutritional factors against diabetes: focus on the involvement of gut microbiota. Critical Reviews in Biotechnology, 39(4), 524–540. https://doi.org/10.1080/07388551.2019.1576025
  18. Gunaidi, F. C., Destra, E., Frisca, F., & Santoso, A. H. (2022). Hubungan indeks massa tubuh dan lingkar pinggang dengan kejadian hipertensi pada orang dewasa dengan aktivitas ringan hingga sedang. Jurnal Medika Hutama, 3(04 Juli), 2992–2996.
  19. Hector, A. J., Marcotte, G. R., Churchward-Venne, T. A., Murphy, C. H., Breen, L., von Allmen, M., Baker, S. K., & Phillips, S. M. (2015). Whey Protein Supplementation Preserves Postprandial Myofibrillar Protein Synthesis during Short-Term Energy Restriction in Overweight and Obese Adults. The Journal of Nutrition, 145(2), 246–252. https://doi.org/10.3945/jn.114.200832
  20. Holly, J. M. P., Biernacka, K., & Perks, C. M. (2019). Systemic Metabolism, Its Regulators, and Cancer: Past Mistakes and Future Potential. Frontiers in Endocrinology, 10, 65. https://doi.org/10.3389/fendo.2019.00065
  21. Ji, T., Li, Y., & Ma, L. (2022). Sarcopenic Obesity: An Emerging Public Health Problem. Aging and Disease, 13(2), 379. https://doi.org/10.14336/AD.2021.1006
  22. Kaufman, D. W., Kelly, J. P., Rosenberg, L., Anderson, T. E., & Mitchell, A. A. (2002). Recent Patterns of Medication Use in the Ambulatory Adult Population of the United States. JAMA, 287(3), 337. https://doi.org/10.1001/jama.287.3.337
  23. Kim, H., Kim, M., Kojima, N., Fujino, K., Hosoi, E., Kobayashi, H., Somekawa, S., Niki, Y., Yamashiro, Y., & Yoshida, H. (2016). Exercise and Nutritional Supplementation on Community-Dwelling Elderly Japanese Women With Sarcopenic Obesity: A Randomized Controlled Trial. Journal of the American Medical Directors Association, 17(11), 1011–1019. https://doi.org/10.1016/j.jamda.2016.06.016
  24. Kim, J. E., O’Connor, L. E., Sands, L. P., Slebodnik, M. B., & Campbell, W. W. (2016). Effects of dietary protein intake on body composition changes after weight loss in older adults: a systematic review and meta-analysis. Nutrition Reviews, 74(3), 210–224. https://doi.org/10.1093/nutrit/nuv065
  25. Li, X., Huang, S., Jiao, A., Yang, X., Yun, J., Wang, Y., Xue, X., Chu, Y., Liu, F., Liu, Y., Ren, M., Chen, X., Li, N., Lu, Y., Mao, Z., Tian, L., & Xiang, H. (2017). Association between ambient fine particulate matter and preterm birth or term low birth weight: An updated systematic review and meta-analysis. Environmental Pollution (Barking, Essex : 1987), 227, 596–605. https://doi.org/10.1016/j.envpol.2017.03.055
  26. 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. (2023). Deciphering the “obesity paradox” in the elderly: A systematic review and meta‐analysis of sarcopenic obesity. Obesity Reviews, 24(2). https://doi.org/10.1111/obr.13534
  27. Lunenfeld, B., & Stratton, P. (2013). The clinical consequences of an ageing world and preventive strategies. Best Practice & Research Clinical Obstetrics & Gynaecology, 27(5), 643–659. https://doi.org/10.1016/j.bpobgyn.2013.02.005
  28. Ma, J., Hwang, S., McMahon, G. M., Curhan, G. C., Mclean, R. R., Murabito, J. M., & Fox, C. S. (2016). Mid‐adulthood cardiometabolic risk factor profiles of sarcopenic obesity. Obesity, 24(2), 526–534. https://doi.org/10.1002/oby.21356
  29. Malafarina, V., Uriz-Otano, F., Iniesta, R., & Gil-Guerrero, L. (2013). Effectiveness of Nutritional Supplementation on Muscle Mass in Treatment of Sarcopenia in Old Age: A Systematic Review. Journal of the American Medical Directors Association, 14(1), 10–17. https://doi.org/10.1016/j.jamda.2012.08.001
  30. Masanes Toran, F., Culla, A., Navarro-Gonzalez, M., Navarro-Lopez, M., Sacanella, E., Torres, B., & Lopez-Soto, A. (2012). Prevalence of sarcopenia in healthy community-dwelling elderly in an urban area of Barcelona (Spain). The Journal of Nutrition, Health & Aging, 16(2), 184–187. https://doi.org/10.1007/s12603-011-0108-3
  31. Mathus-Vliegen, E. M. H., Basdevant, A., Finer, N., Hainer, V., Hauner, H., Micic, D., Maislos, M., Roman, G., Schutz, Y., Tsigos, C., Toplak, H., Yumuk, V., & Zahorska-Markiewicz, B. (2012). Prevalence, Pathophysiology, Health Consequences and Treatment Options of Obesity in the Elderly: A Guideline. Obesity Facts, 5(3), 460–483. https://doi.org/10.1159/000341193
  32. Ng Tang Fui, M., Prendergast, L. A., Dupuis, P., Raval, M., Strauss, B. J., Zajac, J. D., & Grossmann, M. (2016). Effects of testosterone treatment on body fat and lean mass in obese men on a hypocaloric diet: a randomised controlled trial. BMC Medicine, 14(1), 153. https://doi.org/10.1186/s12916-016-0700-9
  33. No Title. (n.d.). https://doi.org/10.24411/0042-8833-2019-10001
  34. Paddon-Jones, D., & Leidy, H. (2014). Dietary protein and muscle in older persons. Current Opinion in Clinical Nutrition and Metabolic Care, 17(1), 5–11. https://doi.org/10.1097/MCO.0000000000000011
  35. Pasarica, M., & Topping, D. (2017). An Evidence-Based Approach to Teaching Obesity Management to Medical Students. MedEdPORTAL : The Journal of Teaching and Learning Resources, 13, 10662. https://doi.org/10.15766/mep_2374-8265.10662
  36. Porter Starr, K. N., McDonald, S. R., & Bales, C. W. (2014). Obesity and Physical Frailty in Older Adults: A Scoping Review of Lifestyle Intervention Trials. Journal of the American Medical Directors Association, 15(4), 240–250. https://doi.org/10.1016/j.jamda.2013.11.008
  37. Russell, C., Jones, M., O’Shea, D., Simpson, K., Mitchell, A., & Laurenson, I. (2018). Challenges in the Diagnosis of Leptospirosis Outwith Endemic Settings: A Scottish Single Centre Experience. Journal of the Royal College of Physicians of Edinburgh, 48(1), 9–15. https://doi.org/10.4997/jrcpe.2018.102
  38. Studenski, S. A., Peters, K. W., Alley, D. E., Cawthon, P. M., McLean, R. R., Harris, T. B., Ferrucci, L., Guralnik, J. M., Fragala, M. S., Kenny, A. M., Kiel, D. P., Kritchevsky, S. B., Shardell, M. D., Dam, T.-T. L., & Vassileva, M. T. (2014). The FNIH Sarcopenia Project: Rationale, Study Description, Conference Recommendations, and Final Estimates. The Journals of Gerontology: Series A, 69(5), 547–558. https://doi.org/10.1093/gerona/glu010
  39. Tilinca, M. C., Tiuca, R. A., Burlacu, A., & Varga, A. (2021). A 2021 Update on the Use of Liraglutide in the Modern Treatment of ‘Diabesity’: A Narrative Review. Medicina, 57(7), 669. https://doi.org/10.3390/medicina57070669
  40. Waters, D. L., Ward, A. L., & Villareal, D. T. (2013). Weight loss in obese adults 65years and older: A review of the controversy. Experimental Gerontology, 48(10), 1054–1061. https://doi.org/10.1016/j.exger.2013.02.005
  41. Weinheimer, E. M., Sands, L. P., & Campbell, W. W. (2010). A systematic review of the separate and combined effects of energy restriction and exercise on fat-free mass in middle-aged and older adults: implications for sarcopenic obesity. Nutrition Reviews, 68(7), 375–388. https://doi.org/10.1111/j.1753-4887.2010.00298.x
  42. Zamboni, M., Mazzali, G., Fantin, F., Rossi, A., & Di Francesco, V. (2008). Sarcopenic obesity: A new category of obesity in the elderly. Nutrition, Metabolism and Cardiovascular Diseases, 18(5), 388–395. https://doi.org/10.1016/j.numecd.2007.10.002
  43. Zhang, X., Xie, X., Dou, Q., Liu, C., Zhang, W., Yang, Y., Deng, R., & Cheng, A. S. K. (2019). Association of sarcopenic obesity with the risk of all-cause mortality among adults over a broad range of different settings: a updated meta-analysis. BMC Geriatrics, 19(1), 183. https://doi.org/10.1186/s12877-019-1195-y