Gut Microbiota as a Mediator of Sarcopenic Obesity: Mechanisms, Modifiable Factors, and Healthcare Burden

Sarcopenic obesity is closely associated with gut microbiota dysbiosis, chronic inflammation, oxidative stress, and impaired muscle metabolism. The gut–muscle–adipose axis is increasingly recognized as a key mechanism linking obesity and sarcopenia. Nutritional strategies, probiotics, prebiotics, postbiotics, and exercise may modulate gut microbiota composition and improve muscle function, metabolic health, healthy aging, and healthcare outcomes. ABSTRACT Sarcopenic obesity (SO) is condition characterized by coexistence of reduced skeletal muscle mass and increased body fat mass. Several factors contribute to development of SO, including aging, chronic inflammation, oxidative stress, physical inactivity, obesity, inadequate nutrition, and gut dysbiosis. Currently, there is no definitive treatment protocol for SO; existing management strategies primarily focus on alleviating symptoms and improving quality of life through lifestyle modifications. The gut microbiota plays a significant role in the development of SO through dysbiosis, while restoration of microbial balance may contribute to the alleviation of clinical symptoms. In SO, Akkermansia, Escherichia, and Bifidobacterium have been reported as prominent gut microbial signatures. Therapeutic approaches for SO include nutritional and exercise interventions, biotics (probiotics, prebiotics, synbiotics, and postbiotics), protein and vitamin supplementation, and dietary patterns such as ketogenic and MIND diets. These strategies may contribute to SO management through the gut–muscle axis by modulating gut microbiota composition and influencing metabolic mechanisms such as inflammation, energy metabolism, and muscle protein synthesis. This review examines the relationship between SO and the gut microbiota, the mechanisms underlying the gut–muscle axis, and microbiota-based therapeutic approaches, highlighting the importance of evidence-based strategies for managing the health burden associated with this condition.