Adherence to the Mediterranean Diet Is Associated With a Lower Risk of Obesity in Children Under 18 Years: A Comprehensive Systematic Review and Meta-Analysis.

OBJECTIVE: The Mediterranean Diet (MedDiet) is a plant-rich dietary pattern associated with favourable adiposity profiles, making it a relevant model for studying obesity risk in children and adolescents. This study aims to investigate the association between adherence to the MedDiet and risk of obesity in children and adolescents. METHODS: An extensive search in databases PubMed/Medline, Scopus, Web of Science Core Collection, the Cochrane Library and Google Scholar up to October 2025 was conducted. Cohort studies which reported means and standard deviations for the body mass index (BMI) levels and MedDiet adherence scores, and crude and adjusted odds ratios (OR) for overweight or obesity among the children with high and low adherence to the MedDiet were eligible for inclusion. RESULTS: Twenty three articles (26 studies) met the inclusion criteria. Results demonstrated that the mean BMI levels in children adhering to the MedDiet were significantly lower than those who did not adhere to it (weighted mean difference [WMD] = -0.42 kg/m2, 95% CI: -0.61, -0.23, I2 = 65.15%, p < 0.001). Additionally, results indicated that children with overweight had a lower mean adherence score compared to children with normal weight (WMD = -0.44 scores, 95% CI: -0.76, -0.12, I2 = 85.95%, p < 0.001). CONCLUSION: This meta-analysis highlights that greater adherence to the MedDiet was associated with lower odds of obesity among children and adolescents. However, these findings should be interpreted cautiously because the evidence was entirely cross-sectional, heterogeneity was substantial across several pooled analyses and some estimates were sensitive to exclusion of individual studies.