Global Prevalence of Sarcopenic Obesity Defined by European Society for Clinical Nutrition and Metabolism/European Association for the Study of Obesity Criteria: Systematic Review and Meta-analysis.

BACKGROUND AND AIMS: To estimate the global prevalence of sarcopenic obesity (SO) defined according to the European Society for Clinical Nutrition and Metabolism (ESPEN) and European Association for the Study of Obesity (EASO) criteria. METHODS: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidance and was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Eligible studies were observational studies that reported the prevalence of ESPEN/EASO-defined SO in adults. Case reports, case series, case-control studies, and studies using non-ESPEN/EASO definitions were excluded. MEDLINE via PubMed, the Cochrane Central Register of Controlled Trials, Embase, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, the Physiotherapy Evidence Database, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov were searched through April 10, 2025, without restrictions on geography, language, publication date, publication status, setting, or health status. Hand-searching and citation tracking were also conducted. Independent reviewers screened studies, extracted data, and assessed risk of bias using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Random-effects meta-analysis was used to synthesize proportions with 95% confidence intervals (CIs) and 95% prediction intervals (PIs) using the Freeman-Tukey double arcsine transformation. Subgroup and sensitivity analyses were conducted when data were available. RESULTS: Of 15,981 records, 26 studies including 32,841 participants were included, among whom 3,422 were classified as having SO. The studies were published between 2022 and 2025 and were conducted in 10 countries; 18 used community-based samples and eight used hospital-based samples. Three studies were rated as high quality, 12 as moderate quality, and 11 as low quality. The pooled prevalence of SO was 11% (95% CI, 9% to 14%; 95% PI, 1% to 30%), with substantial heterogeneity (I2 = 98.3%). Subgroup analyses by age category, geographic region, setting, sex, and comorbidity status showed no statistically significant differences. After low-quality studies were excluded, the pooled prevalence was 8% (95% CI, 6% to 12%; 95% PI, 2% to 31%). Egger's test showed no statistical evidence of funnel plot asymmetry. CONCLUSIONS: In the available evidence, the pooled prevalence of ESPEN/EASO-defined SO was 11%, the wide PI, substantial heterogeneity, inclusion of low-quality studies, aggregate-level subgroup data, absence of eligible nursing home or long-term care studies, and uneven geographic coverage suggest that prevalence is context-dependent. Standardized application of the ESPEN/EASO criteria and higher-quality studies in underrepresented populations are needed. REGISTRATION: PROSPERO CRD420251024853.