Association between adherence to the Mediterranean diet and risk of sarcopenia: a systematic review and dose-response meta-analysis of observational studies.
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Abstract
Background: Epidemiological studies have investigated the potential association between adherence to the Mediterranean diet and risk of sarcopenia, with inconsistent results.
Objective: The current systematic review and meta-analysis was conducted to synthesize available evidence regarding the association between adherence to the Mediterranean diet and risk of sarcopenia.
Methods: This review followed PRISMA guidelines and was registered in PROSPERO (CRD420251145903). A comprehensive literature search was conducted in four electronic databases, including ISI Web of Science, PubMed, Embase, China National Knowledge Infrastructure (CNKI) from database inception to July 2025. Random-effects model was applied to calculate the pooled odd ratios (ORs) and 95% confidence intervals (CIs) for the highest versus lowest categories of Mediterranean diet score in relation to sarcopenia risk. The Cochran's Q test and I-squared (I2) statistic were used to detect the sources of heterogeneity among the included studies.
Results: Seven observational studies (3 cohort and 4 cross-sectional studies) with 9,709 participants were included. The results showed that high adherence to the Mediterranean diet was significantly associated with a reduced risk of sarcopenia (OR = 0.81; 95%CI:0.71-0.92, P = 0.002), with substantial heterogeneity (I2 = 70.2%; Pheterogeneity=0.002). Dose-response analysis showed an inverse linear association between adherence to the Mediterranean diet and risk of sarcopenia (OR = 0.873; 95% CI:0.846-0.901, Pdose-response<0.001, Pnonlinearity=0.369). Subgroup analyses revealed an inverse association between adherence to the Mediterranean diet and risk of sarcopenia in the subgroups of sample size < 1000 (OR = 0.34, 95%CI: 0.20-0.58, P < 0.001), questionnaire/food record (OR = 0.83; 95%CI:0.77-0.89, P < 0.001), and posteriori method defining Mediterranean diet(OR = 0.35; 95%CI: 0.19-0.62, P < 0.001), with less evidence of heterogeneity.
Conclusions: Our study suggested that high adherence to the Mediterranean diet was associated with a 19% reduced risk of sarcopenia. Further large prospective studies and randomized controlled trials are needed to affirm these findings.
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