Nutritional Strategies for Sarcopenic Obesity: A Systematic Literature Review

Abstract

Background: Sarcopenic obesity (SO) is the coexistence of excess adiposity with low skeletal muscle mass and impaired muscle function. It is increasingly recognised as a distinct clinical entity with compounded metabolic, functional and mortality risk. Nutritional management is difficult because the central intervention for obesity, energy restriction, can accelerate the loss of the very tissue whose preservation is the therapeutic priority.

Objective: To synthesise and critically appraise evidence on nutritional strategies for the prevention and management of SO, to compare findings across related reviews and primary trials, and to derive a practical, evidence-graded framework.

Methods: A PRISMA 2020-guided structured review was designed, covering consensus statements, systematic reviews, meta-analyses, randomised controlled trials and mechanistic studies. Evidence was organised by nutritional domain: energy balance, protein quantity and distribution, amino acid quality, micronutrients and fatty acids, dietary patterns, pharmacotherapy interfaces and combined exercise. A multi-perspective analytical approach (clinical, physiological, methodological, public-health, equity and digital) was applied.

Results: Across the evidence base, a moderate energy deficit combined with protein intake of roughly 1.0–1.5 g/kg/day, evenly distributed across meals, and with supervised resistance-based exercise, yields the most consistent preservation of lean mass and improvement of physical function. Leucine-enriched whey protein, vitamin D repletion and omega-3 fatty acids show supportive but heterogeneous evidence. Intermittent fasting and incretin-based weight-loss therapies demand explicit muscle-protection strategies. Definitional heterogeneity remains the dominant barrier to evidence synthesis.

Conclusion: Nutritional strategies for SO should be multicomponent, protein-adequate, deficit-moderate and exercise-anchored, and delivered through equitable, culturally adapted care models. Standardised diagnostic criteria and trials using SO-specific endpoints are the priority research needs.