Adipose dysfunction, lipid dysregulation, and adipokines in sarcopenia: a systematic review and meta-analysis with sex-specific analyses

BACKGROUND: Sarcopenia is increasingly recognised as a systemic metabolic disorder involving lipid dysregulation, adipose tissue dysfunction, and adipokine imbalance. However, there is a lack of quantitative synthesis with sex-specific analyses. METHODS: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, Cochrane Library, CNKI, WanFang, and VIP for studies published from January 2015 to December 2024 that compared lipid panels, adipokines, adiposity, muscle indices, and inflammatory markers in sarcopenic and non-sarcopenic adults. Random-effects meta-analyses and meta-regression were performed. Heterogeneity was assessed using I2 statistics, and publication bias was evaluated with funnel plots and Trim-and-Fill procedures. RESULTS: Fifty-two studies (N > 30 000) met the inclusion criteria. Sarcopenia was associated with a modest increase in LDL-C (SMD = 0.13; P = .0022), particularly in females (SMD = 0.46). HDL-C levels significantly increased in females (SMD = 6.71; P = .03). No significant changes were observed for triglycerides, total cholesterol, adiponectin, or leptin. Waist circumference increased significantly (SMD = 5.82 cm; P = .25), and muscle indices (SMI, ASMI, SMM) were lower in sarcopenia. Inflammatory markers (TNF-α, IL-6, IL-8) showed no significant associations. Subgroup analyses revealed significant effects by sex, measurement methods, and sarcopenia definitions, with meta-regression indicating these factors influenced lipid marker changes. CONCLUSION: This meta-analysis integrates lipid fractions, adipokines, adiposity markers, and sex-specific differences in sarcopenia. Our findings highlight the significant rise in HDL-C in females and suggest the need for sex-targeted interventions. Further longitudinal studies are needed to clarify causality and refine clinical practice in sarcopenia management. The protocol was registered on PROSPERO (CRD42024626636).