BACKGROUND Sarcopenic obesity is a combination of both sarcopenia and obesity, which potentiate each other and maximize the negative influences of each, such as physical disability, morbidity, or even mortality. OBJECTIVES To describe the criteria used to identify people with sarcopenic obesity and the components of the non-pharmacological interventions used to manage it, and to evaluate the effectiveness of those interventions. METHODS Randomized controlled trials (RCTs) in Cochrane Library, Scopus, EMBASE, PscyINFO, CINAHL and PubMed were searched. The risk of bias was examined using the Cochrane risk of bias tool. The template for intervention description and replication (TIDieR) checklist was used to summarize the intervention components. Meta-analyses were conducted using random-effect models to pool estimates of the effects of the non-pharmacological interventions on body composition, BMI, grip strength, and gait speed. RESULTS Sixteen papers (12 RCTs) with 863 participants were included. Diverse diagnostic criteria were used in the studies. Four categories of interventions were used: exercise (aerobic exercises, resistance exercises and exercise machines), nutritional interventions (supplements or dietary control), combined intervention and electrical acupuncture. Intervention durations varied from 8 to 28 weeks. Meta-analyses revealed that exercise with or without nutritional interventions had significant effects on grip strength (exercise: mean difference (MD): 1.63 kg, 95% confidence interval (CI): 0.94, 2.32, P< 0.00001; exercise + nutrition: MD: 1.24 kg, 95% CI: 0.48, 1.99, P = 0.001) and gait speed (exercise: MD: 0.13 m/s, 95% CI: 0.08, 0.18, P < 0.00001, I2 = 0%; exercise + nutrition: MD: 0.04 m/s, 95% CI: 0.02, 0.06, P = 0.0002). Exercise had significant effects on reducing the percentage of body fat (PBF) compared to usual care (MD: -1.08%, 95% CI: -1.99, -0.17, P = 0.02), while exercise combined with nutritional interventions showed no superiority over exercise solely on decreasing PBF (P = 0.49). Exercise combined with nutritional interventions had significant effects on increasing appendicular skeletal muscle mass (MD: 0.43 kg, 95% CI: 0.20, 0.66, P = 0.0003). Low-caloric high-protein diets showed no superiority over low-caloric low-protein diets in increasing fat-free mass. Subgroup analyses showed that using different formulas to estimate the skeletal muscle mass index may lead to significant differences in determining the effects of exercise on grip strength. CONCLUSION The diagnostic criteria for sarcopenic obesity used in future studies should refer to the latest consensus definition. Exercise tended to be the most effective method of improving grip strength and physical performance (e.g. gait speed). The combined effects of exercise and nutritional interventions on muscle mass and muscle strength require further exploration.

中文翻译：

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非药物干预对少肌症肥胖症管理的有效性：系统评价和荟萃分析。

背景技术肌肉减少症肥胖症是肌肉减少症和肥胖症两者的组合，它们相互促进，并使彼此的负面影响最大化，例如身体残疾，发病率甚至死亡率。目的描述用于鉴定肌少性肥胖患者的标准以及用于管理肌无力肥胖的非药物干预措施的组成部分，并评估这些干预措施的有效性。方法在Cochrane图书馆，Scopus，EMBASE，PscyINFO，CINAHL和PubMed中搜索随机对照试验（RCT）。使用Cochrane偏倚风险工具检查了偏倚风险。干预措施描述和复制模板（TIDieR）清单用于总结干预措施组成部分。使用随机效应模型进行荟萃分析，以汇总非药物干预对身体成分，BMI，握力和步态速度的影响的估计值。结果纳入了863名参与者的16篇论文（12个RCT）。研究中使用了多种诊断标准。使用了四类干预措施：运动（有氧运动，抵抗运动和运动机），营养干预（补充或饮食控制），联合干预和电针灸。干预时间从8周到28周不等。荟萃分析显示，有或没有营养干预的运动对握力都有显着影响（运动：平均差异（MD）：1.63 kg，95％置信区间（CI）：0.94、2.32，P <0.00001；运动+营养：MD ：1.24公斤，95％CI：0.48，1.99，P = 0.001）和步态速度（运动：MD：0.13 m / s，95％CI：0.08，0.18，P <0.00001，I2 = 0％;运动+营养：MD：0.04 m / s，95％CI ：0.02、0.06，P ＝ 0.0002）。与常规护理相比，运动对降低体内脂肪（PBF）的比例具有显着影响（MD：-1.08％，95％CI：-1.99，-0.17，P = 0.02），而运动与营养干预相结合并没有优于仅在减少PBF时进行锻炼（P = 0.49）。运动与营养干预相结合对增加阑尾骨骼肌质量有显着影响（MD：0.43 kg，95％CI：0.20，0.66，P = 0.0003）。低热量高蛋白饮食在增加无脂脂肪方面没有表现出优于低热量低蛋白饮食的优势。亚组分析表明，使用不同的公式估算骨骼肌质量指数可能会导致在确定运动对握力的影响方面存在显着差异。结论未来研究中使用的少肌症肥胖症的诊断标准应参考最新的共识定义。锻炼往往是提高握力和身体机能（例如步态速度）的最有效方法。运动和营养干预对肌肉质量和力量的综合作用需要进一步探索。锻炼往往是提高握力和身体机能（例如步态速度）的最有效方法。运动和营养干预对肌肉质量和力量的综合作用需要进一步探索。锻炼往往是提高握力和身体机能（例如步态速度）的最有效方法。运动和营养干预对肌肉质量和力量的综合作用需要进一步探索。