Prevalence of sarcopenic obesity in adult patients with diabetes and associated factors: a systematic review and meta-analysis

Objective: This systematic review and meta-analysis aimed to estimate the prevalence of sarcopenic obesity (SO) among adults with diabetes and summarize associated factors. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, seven databases, including MEDLINE via PubMed, Cochrane Library, Embase, SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP, were searched from inception to 25 June 2026, for peer-reviewed observational studies published in English or Chinese. Two reviewers independently performed study selection, data extraction, and quality appraisal. For overlapping populations, the most recent and comprehensive report was retained. The pooled prevalence of SO was estimated using a random-effects model in Stata 18.0. Subgroup, sensitivity, and publication bias analyses were performed, and associated factors were summarized descriptively. Results: Thirty-four observational studies published between 2013 and 2026 were included. The pooled prevalence of SO among adults with diabetes was 24% (95% confidence interval: 19-29%), with substantial heterogeneity. Higher prevalence estimates were observed among community-dwelling patients (29%), female patients (28%), individuals in North America (29%), studies using bioelectrical impedance analysis for muscle mass measurement (25%), studies applying criteria based on muscle mass, muscle strength, and physical function (27%), and studies defining obesity by body mass index (25%) or waist circumference (23%). Reported factors associated with SO or SO-related body composition phenotypes included body mass index, fat mass index, limb fat mass, and A Body Shape Index ≥ 0.083; low serum irisin levels (<9.49 ng/mL) and poorer glycemic control or higher glycated hemoglobin levels; and older age, smaller calf circumference, lower handgrip strength, low physical activity, insulin use, and diabetes-related complications. Conclusion: Approximately one quarter of adults with diabetes are affected by SO, indicating a substantial clinical and public health burden. The prevalence of SO varied by patient source, sex, geographic region, assessment method, and diagnostic criteria, highlighting the need for standardized assessment. The reported associated factors suggest that SO is closely associated with adiposity, glycemic metabolism, physical function, and diabetes-related clinical characteristics. These findings support targeted screening, early identification, and integrated management to improve SO detection and reduce potential adverse outcomes. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251274126, identifier PROSPERO (CRD420251274126).