Prevalence of sarcopenic obesity in older stroke rehabilitation patients and association with outcomes: a meta-analysis and systematic review

Body composition is closely linked to functional recovery in older stroke patients, yet the specific impact of sarcopenic obesity (SO) on rehabilitation outcomes remains unclear. This study aims to evaluate the prevalence of SO in this population and its influence on clinical prognosis, exploring potential gender differences. A systematic literature search was conducted across PubMed, Embase, the Cochrane Library, Web of Science, CINAHL, and the CBM database to identify studies on SO in older stroke patients. The search was updated to October 30, 2026, with no language restrictions. Data regarding the prevalence of SO and associated prognostic outcomes during older stroke rehabilitation were extracted and synthesized. Eleven studies were included, comprising seven cohort studies and four cross-sectional studies involving 4,731 patients. Meta-analysis revealed a prevalence of SO in older stroke rehabilitation patients of 10.3% (95% CI: 6.4% to 14.2%). SO was significantly associated with poorer Functional Independence Measure (FIM) motor scores at discharge (MD = -8.99, 95% CI: -15.84 to -2.15, P = 0.01). Subgroup analysis by gender revealed that SO had no significant effect on FIM-motor scores at discharge for male patients (MD = -7.16, 95% CI: -15.46 to 1.14, P = 0.09); while it had a significant negative effect on female patients (MD = -13.95, 95% CI: -26.59 to -1.31, P = 0.03). Furthermore, SO was significantly associated with longer length of stay (LOS) (MD = 17.96, 95% CI: 4.28 to 31.65, P = 0.01). Subgroup analysis by gender revealed that SO had no significant effect on LOS in male patients (MD = 13.69, 95% CI: -6.75 to 34.12, P = 0.19), but exerted a significant negative impact on female patients (MD = 44.11, 95% CI: 11.01 to 77.21, P = 0.009). SO was identified in approximately 10.3% of older stroke rehabilitation patients, although prevalence estimates may vary considerably depending on study characteristics and diagnostic criteria. SO was associated with poorer functional outcomes and prolonged hospital stay, with exploratory subgroup analyses suggesting a potential sex difference. However, given the observational nature of the included studies, and further prospective studies from diverse geographic populations are warranted to confirm the results.