Xu Shan, Tu Siying, Hao Xiaoyu, Chen Xiangjun, Pan Da, Liao Wang, Wu Ruipeng, Yang Ligang, Xia Hui, Wang Shaokang, Sun Guiju
Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China.
Clinical Medical Research Center for Plateau Gastroenterological Disease of Xizang Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang 712082, China.
Nutrients. 2025 Apr 29;17(9):1504. doi: 10.3390/nu17091504.
Sarcopenic obesity (SO), a pathological syndrome characterized by the co-existence of diminished muscle mass and excessive adipose accumulation, significantly compromises the quality of life in older adults. The purpose of this study was to systematically evaluate the efficacy of exercise, nutritional interventions, and neuromuscular electrical stimulation (NMES) in preventing and managing SO in middle-aged and older adults. A comprehensive search was conducted across PubMed, Web of Science, Embase, Cochrane Library, and CNKI for randomized controlled trials (RCTs) until January 2025. Meta-analyses were performed using the random-effects model and fixed-effects model based on the degree of heterogeneity and calculating the mean differences (MD) with 95% confidence intervals (CI). Subgroup analyses compared the intervention types. Twenty-nine RCTs (1622 participants) were included. Exercise interventions significantly reduced the body fat percentage (MD = -2.79%, 95% CI: -3.94, -1.64, < 0.001, = 74%), fat mass (MD = -6.77 kg, 95% CI: -11.48, -2.06, = 0.005, = 98%), waist circumference (MD = -2.05 cm, 95% CI: -3.64, -0.46, = 0.01, = 0%) and LDL-C (MD: -7.45 mg/dL, 95% CI: -13.82, -1.07, = 0.02, = 0%), while improving handgrip strength (MD = 2.35 kg, 95% CI: 1.99, 2.70, < 0.001, = 52%) and gait speed (MD = 0.19 m/s, 95% CI: 0.13, 0.24, < 0.001, = 89%). Mixed training outperformed resistance-only regimens in reducing the body fat percentage and enhancing functional outcomes. NMES reduced the body fat percentage (MD = -2.01%, 95% CI: -3.54, -0.48, = 0.01, = 93%) and waist circumference (MD = -1.72 cm, 95% CI: -2.35, -1.09, < 0.001, = 0%) while increasing the Skeletal Muscle Index (MD = 0.26 kg/m, 95% CI: 0.22, 0.29, < 0.001, = 38%). Synergy with nutritional supplementation amplified these effects. Nutritional interventions modestly improved total fat-free mass (MD = 0.77 kg, 95% CI: 0.04, 1.50, = 0.04, = 0%) and handgrip strength (MD = 1.35 kg, 95% CI: 0.71, 2.00, < 0.001, = 0%) but showed no significant impact on the metabolic markers (TG, TC, glucose, hemoglobin, and HOMA-IR). Exercise, particularly multimodal regimens combining aerobic and resistance training, is the cornerstone for improving body composition and physical function in SO. NMES serves as an effective adjunct for accelerating fat loss, while nutritional strategies require integration with exercise or prolonged implementation to yield clinically meaningful outcomes. Future research should prioritize standardized diagnostic criteria and long-term efficacy assessments of multimodal interventions.
肌少症肥胖（SO）是一种以肌肉量减少和脂肪过度堆积并存为特征的病理综合征，严重影响老年人的生活质量。本研究的目的是系统评估运动、营养干预和神经肌肉电刺激（NMES）在预防和管理中老年人SO方面的疗效。截至2025年1月，在PubMed、科学网、Embase、考克兰图书馆和中国知网进行了全面检索，以查找随机对照试验（RCT）。根据异质性程度，使用随机效应模型和固定效应模型进行荟萃分析，并计算95%置信区间（CI）的平均差值（MD）。亚组分析比较了干预类型。纳入了29项RCT（1622名参与者）。运动干预显著降低了体脂百分比（MD = -2.79%，95% CI：-3.94，-1.64，<0.001，I² = 74%）、脂肪量（MD = -6.77 kg，95% CI：-11.48，-2.06，P = 0.005，I² = 98%）、腰围（MD = -2.05 cm，95% CI：-3.64，-0.46，P = 0.01，I² = 0%）和低密度脂蛋白胆固醇（MD：-7.45 mg/dL，95% CI：-13.82，-1.07，P = 0.02，I² = 0%），同时提高了握力（MD = 2.35 kg，95% CI：1.99，2.70，<0.001，I² = 52%）和步速（MD = 0.19 m/s，95% CI：0.13，0.24，<0.001，I² = 89%）。在降低体脂百分比和增强功能结局方面，混合训练优于仅进行阻力训练的方案。NMES降低了体脂百分比（MD = -2.01%，95% CI：-3.54，-0.48，P = 0.01，I² = 93%）和腰围（MD = -1.72 cm，95% CI：-2.35，-1.09，<0.001，I² = 0%），同时增加了骨骼肌指数（MD = 0.26 kg/m²，95% CI：0.22，0.29，<0.001，I² = 38%）。与营养补充剂协同使用可放大这些效果。营养干预适度改善了总去脂体重（MD = 0.77 kg，95% CI：0.04，1.50，P = 0.04，I² = 0%）和握力（MD = 1.35 kg，95% CI：0.71，2.00，<0.001，I² = 0%），但对代谢指标（甘油三酯、总胆固醇、血糖、血红蛋白和稳态模型评估的胰岛素抵抗指数）无显著影响。运动，特别是结合有氧和阻力训练的多模式方案，是改善SO患者身体成分和身体功能的基石。NMES是加速脂肪减少的有效辅助手段，而营养策略需要与运动相结合或长期实施才能产生具有临床意义的结果。未来的研究应优先制定标准化诊断标准和多模式干预的长期疗效评估。
Zotero 插件
