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  • Systematic Review
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Epidemiology and Population Health

Sarcopenic obesity and risk of cardio-cerebrovascular disease and mortality: a systematic review and meta-analysis

International Journal of Obesity (2025)Cite this article

Subjects

Abstract

Background

Sarcopenic obesity, characterized by reduced muscle mass and excessive fat, has not been adequately studied regarding its impact on cardio-cerebrovascular disease (CCVD) and related mortality.

Objective

This systematic review and meta-analysis aimed to evaluate the relationship between sarcopenic obesity, CCVD risk, and associated mortality.

Methods

We searched PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, WANFANG DATA, Technology Journal Database, and Chinese Biological Medical Database, considering articles from inception to April 1, 2024. Two researchers independently screened the literature, evaluated study quality, and extracted data. Both fixed- and random-effects models were used to pool the estimates of odds ratios (ORs). Publication and sensitivity bias analyses tested the robustness of associations.

Results

A total of 28 studies, comprising 575,942 participants, were included. The results demonstrated a significant association between sarcopenic obesity and an increased risk of CCVD (OR: 2.06, 95% CI: 1.70–2.48, I² = 71%; p < 0.001). Subgroup analyses further indicated that sarcopenic obesity defined by combined measures of muscle mass, muscle strength, and body mass index was associated with a 9.22-fold increased risk of CCVD, and a 2.10-fold increased risk of cardiovascular disease, but no significant association with the risk of stroke was observed. In contrast, when assessing CCVD mortality, seven studies found no significant overall association (OR: 1.58, 95% CI: 0.99–2.53, I² = 92%; p = 0.05). However, in subgroup analyses, significant associations emerged in studies with larger sample sizes (≥5000 participants; OR: 1.76, 95% CI: 1.37–2.27, p < 0.01) and longer follow-up durations (≥10 years; OR: 1.54, 95% CI: 1.16–2.04, p < 0.01).

Conclusions

Sarcopenic obesity is associated with an increased risk of CCVD, and its long-term impact on CCVD mortality may be more evident in studies with larger sample sizes and extended follow-up periods. These findings underscore the need for well-designed prospective studies employing standardized diagnostic criteria and adequate follow-up to confirm the observed associations and clarify their clinical significance.

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Fig. 1: Flow diagram of the search.
Fig. 2: Quality assessment of the included studies (risk of bias graph).
Fig. 3: Forest plot of the association between sarcopenic obesity and cardio-cerebrovascular disease.

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Funding

The work was supported by the Capital Clinical Diagnosis and Treatment Technology Research and Translational Application Project (Grant No. Z201100005520006) and the Nursing Research Project of the Affiliated Hospital of Guizhou Medical University (Grant No. gyfyhl-2024-A20).

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Author notes

  1. These authors contributed equally: Yuhong Luo, Lingzhi Shu.

Authors and Affiliations

  1. Xuanwu Hospital, Capital Medical University, Beijing, China

    Yuhong Luo, Yanqiu Wang, Xinyu Zhao, Mengya Han, Yuhua Liu, Yan Xu & Binru Han

  2. School of Nursing, Capital Medical University, Beijing, China

    Yuhong Luo, Yanqiu Wang, Xinyu Zhao, Mengya Han, Yuhua Liu, Yan Xu & Binru Han

  3. Department of Nursing, Affiliated Hospital of Guizhou Medical University, Guiyang, China

    Lingzhi Shu

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  1. Yuhong Luo
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Contributions

Study concept and design: Yuhong Luo, Lingzhi Shu, and Binru Han. Acquisition of data: Xinyu Zhao, Mengya Han, Yuhua Liu, and Yan Xu. Analysis and interpretation of data: Yuhong Luo and Lingzhi Shu. Preparation of manuscript: Yuhong Luo, Lingzhi Shu, and Yanqiu Wang. The contributions of Yuhong Luo and Lingzhi Shu to this study were equal. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Binru Han.

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Luo, Y., Shu, L., Wang, Y. et al. Sarcopenic obesity and risk of cardio-cerebrovascular disease and mortality: a systematic review and meta-analysis. Int J Obes (2025). https://doi.org/10.1038/s41366-025-01909-z

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