Efficacy of Mediterranean diet interventions on children and adolescents affected by overweight or obesity: a systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: Overweight and obesity in children and adolescents is a global health issue with increasing prevalence. The Mediterranean diet (Med diet) is an extensively studied dietary pattern with benefits on various health conditions such as cardiovascular disease, diabetes mellitus and obesity in adult populations but the evidence on children and adolescents remains limited. The aim of this systematic review and meta-analysis is to collect, assess, and synthesize evidence from randomized controlled trials (RCTs) on the efficacy of Med diet on anthropometric and cardiometabolic parameters in children and adolescents with excess body weight. METHODS: Three electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Scopus) and references in relevant studies and systematic reviews were searched. Random-effects meta-analysis models were used to synthesize study effect estimates. Heterogeneity was assessed using the I 2. The quality of evidence was evaluated using the Cochrane Risk of Bias tool v2.0. RESULTS: Five RCTs involving 330 children and adolescents affected by overweight or obesity were included. Mean study duration was 12 weeks (range: 8-16 weeks). Compared with the control group, Med diet was significantly associated with lower body mass index (BMI) (Standardized mean difference [SMD] = -0.26, 95% confidence intervals [CI] = -0.49 to -0.03, I 2 = 0%) and lower systolic blood pressure (SMD = -0.48, 95% CI = -0.87 to -0.09, I 2 = 45.9%). No statistically significant associations were observed for any other anthropometric or cardiometabolic parameter studied. Regarding risk of bias, all RCTs were judged to have some concerns for each outcome assessed. CONCLUSION: This systematic review suggests that Med diet could have a potentially beneficial effect on the reduction of BMI among youths with excess body weight. Nevertheless, further research, with greater methodological rigor, higher participation rates and longer follow-up is needed. SYSTEMATIC REVIEW REGISTRATION: This systematic review and meta-analysis is registered with PROSPERO (CRD420251143115).