Association of sarcopenic obesity with cognitive dysfunction and dementia: a systematic review and meta-analysis

Currently, the association of sarcopenic obesity (SO) with cognitive dysfunction and dementia remains unclear. This study aims to investigate their potential association.

PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were systematically searched until 30 December 2024. Observational studies investigating the association of SO with cognitive dysfunction and dementia were included. A random-effects model was applied for meta-analysis.

Seventeen studies with 274,996 participants were included, of which 11 were included in quantitative analyses. The pooled odds ratio for cognitive dysfunction in patients with SO versus non-SO was 1.71 (95% CI: 1.39-2.11, p < 0.001, I² = 90.7%). Subgroup analyses showed consistent associations across study design, geographic region, cognitive dysfunction subtypes, and obesity criteria. Significant results were also observed in males (OR = 1.80, 95% CI: 1.07-3.03, p = 0.028), general populations (OR = 1.95, 95% CI: 1.50-2.54, p < 0.001), sarcopenia defined by muscle function and/or mass (OR = 1.67, 95% CI: 1.35-2.07, p < 0.001) or muscle function alone (OR = 2.31, 95% CI: 1.14-4.69, p = 0.020), and cognitive assessment via clinical records (OR = 1.68, 95% CI: 1.21-2.33, p = 0.002) or scales (OR = 1.74, 95% CI: 1.37-2.21, p < 0.001).

SO appears associated with cognitive dysfunction. However, due to high heterogeneity, very low certainty of evidence, and potential biases, these results should be interpreted cautiously. Future high-quality prospective studies are needed to validate this conclusion. PROSPERO registration number: CRD420251011745.