Abstract: Sarcopenia represents a major health challenge in aging societies, yet effective interventions remain limited. As a core approach for gut microbiota reconstruction, fecal microbiota transplantation (FMT) has achieved groundbreaking progress in sarcopenia in recent years. Current evidence has preliminarily established a causal relationship between gut dysbiosis and sarcopenia. FMT has shown clear efficacy in animal models, and recent clinical studies have also reported positive results. This review systematically summarizes the preclinical and clinical evidence of FMT in sarcopenia, along with its underlying mechanisms. Based on the available evidence, we propose that FMT can improve skeletal muscle mass and function through multiple targets, including the regulation of microbial metabolites, restoration of the intestinal barrier, suppression of chronic inflammation, and enhancement of mitochondrial function. As key functional bacterial strains continue to be identified, FMT is expected to evolve into a precise, standardized targeted intervention, emerging as a novel therapeutic strategy for the prevention and treatment of sarcopenia.

Key words: sarcopenia, fecal microbiota transplantation, gut microbiota, gut-muscle axis, mechanism