Systematic review and meta-analysis of biomarkers of sarcopenia and sarcopenic obesity

Sarcopenia and sarcopenic obesity (SO) are geriatric syndromes characterized by reduced skeletal muscle mass and impaired muscle strength, whose specific biomarkers and underlying mechanisms remain unclear. This study aimed to conduct a meta-analysis and literature review on the associations between biomarkers and sarcopenia/SO by collecting relevant publications over the past 15 years. We intended to further identify the shared and differential biomarkers of these disorders, thereby revealing their distinct pathophysiological processes and providing a basis for precise diagnosis and targeted intervention.

A comprehensive literature search was performed in PubMed, Embase databases for all publications from December 2010 to December 2025. We included English articles describing the associations between serum biomarkers and sarcopenia/SO, including cross-sectional studies, prospective cohort studies, and retrospective case studies, with no restrictions on race, population, or sample size. Literature screening was conducted in accordance with predefined inclusion and exclusion criteria. Relevant study data were extracted, and the quality of included studies was assessed. The mean difference and 95% confidence interval were used to calculate the pooled effect size.

A total of 43 English articles investigating the associations between biomarkers and sarcopenia/SO were finally included. Compared with non-sarcopenic patients, sarcopenic patients had elevated serum levels of C-reactive protein (CRP), interleukins, tumor necrosis factor, cystatin C, blood urea nitrogen, and high-density lipoprotein cholesterol (HDL-C). In contrast, higher serum levels of vitamin D, alanine transaminase, albumin, hemoglobin, TG, uric acid, blood glucose, and fasting insulin were associated with a lower incidence of sarcopenia. No significant differences were observed in WBC count, platelet count, aspartate transaminase, alkaline phosphatase, bilirubin, total cholesterol (TC), creatinine, erythrocyte sedimentation rate, low-density lipoprotein cholesterol (LDL-C), or thyroid-stimulating hormone levels between sarcopenic and non-sarcopenic patients. Compared with healthy individuals, SO patients had higher serum levels of CRP, LDL-C, TC, TG, WBC, creatinine, uric acid, fasting blood glucose, and fasting insulin, while higher levels of HDL-C and vitamin D were associated with a lower risk of SO. SO patients had lower TG levels than patients with simple obesity, with no significant differences in CRP, HDL-C, LDL-C, TC, vitamin D, blood glucose, or interleukin-6 levels between the 2 groups.