Sarcopenic obesity in cirrhosis: prognostic value and future perspectives

Sarcopenic obesity (Sa-O) is an emerging prognostic factor in patients with cirrhosis, yet its diagnostic criteria and clinical significance remain incompletely defined. This narrative review synthesizes evidence from the past five years on the pathogenesis, diagnostic criteria, and prognostic implications of Sa-O in cirrhosis. Diagnostic criteria were categorized according to their definitions of sarcopenia and obesity, and the clinical utility of assessment tools was evaluated. Prognostic value was examined across seven clinical domains. Existing evidence indicates that Sa-O is associated with increased mortality and adverse post-transplant outcomes. Limited data suggest potential links with classic cirrhosis complications, while cardiovascular events remain underexplored as primary endpoints. Current studies on acute-on-chronic liver failure focus on sarcopenia or obesity in isolation rather than their coexistence. Health-related quality of life and the integration of Sa-O into established prognostic score models are rarely addressed. In summary, Sa-O should be recognized as a key prognostic factor in cirrhosis and represents a modifiable target for early lifestyle intervention.