Multifactorial Mechanisms and Therapeutic Role of the Gut Microbiota in Sarcopenic Obesity: Role of Lifestyle and Gut Microbiota–Derived Metabolites

Sarcopenic obesity (SO), a pathological interplay of muscle atrophy and excessive adiposity, poses increasing health risks in aging individuals. This review elucidates the multifactorial role of the gut microbiota (GM) in SO pathogenesis, emphasizing novel mechanisms linking GM dysbiosis to impaired muscle-lipid homeostasis. We emphasize how a Western diet and a sedentary lifestyle contribute to alterations in the GM composition, leading to changes in metabolic products, such as reduced short-chain fatty acids and increased production of lipopolysaccharides (LPS). These changes drive systemic inflammation, increased intestinal permeability, and metabolic dysfunction in adipose tissue and skeletal muscle. Emerging interventions, including next-generation probiotics, prebiotics, and glucagon-like peptide-1 receptor agonists (GLP-1RAs), demonstrate therapeutic potential. Our synthesis highlights GM as a pivotal therapeutic target, suggesting that personalized strategies combining microbiota modulation, dietary optimization, and exercise can be used to counteract SO. This work provides mechanistic insights into translational applications, offering a roadmap for innovative, microbiota-centric interventions to improve aging-related metabolic and muscle health.