Mediterranean Diet and athletic performance in elite and competitive athletes: a systematic review and meta-analysis

Aims: Mediterranean Diet (MedDiet) may represent the reference dietary pattern for athletes. Our aim was to study whether MedDiet could be associated with any changes in performance in adult athletes practicing different types of sport at various levels of competition. Data synthesis: A systematic literature review (PROSPERO n. CRD42023459039) was performed based on the PRISMA method. The search was conducted in PubMed/Medline, Scopus, Web of Science, and the Cochrane Library in October 2024. Competitive/elite healthy adult athletes performing at least 6 h/week. The risk of bias was assessed using the RoB 2.0 Cochrane tool for randomised-controlled trials, Robins-I tool for non-randomised studies and the Newcastle Ottawa Scale for the observational studies. A meta-analysis was conducted. 9 studies were included in this review (192 participants, mainly males), 5 of them had a cross-sectional design. The sample size ranged from 10 to 43 athletes performing different sports. 5 studies reported an impact of MedDiet on athletic performance; of these, 4 studies reported a positive effect. MedDiet adherence was positively related to anaerobic/aerobic power, explosive strength, and indirectly associated with body fat percentage. Reported adherence to MedDiet varied from low to high. The meta-analysis showed no MedDiet effect on the performance outcomes [SMD 0.00 (CI -0.26; 0.25)]. Conclusions: The findings of this review suggest a general positive influence of the MedDiet on athletic performance, supporting its role as a beneficial dietary pattern for athletes. Quantitative analysis did not confirm these results, probably due to the few studies included, their heterogeneity and low-to-moderate quality.