Association between Mediterranean Diet and Development of Multiple Sclerosis: A Systematic Review and Meta‐Analysis

Fatemeh Shakouri; Morteza Lotfi; Ali Rostami; Mahnaz Talebi; Sarvin Sanaie; Amirreza Naseri

doi:10.1002/brb3.71205

journal article Open Access Jan 29, 2026

Association between Mediterranean Diet and Development of Multiple Sclerosis: A Systematic Review and Meta‐Analysis

Fatemeh Shakouri

Brain and Behavior Vol. 16 No. 2 · Wiley

View at Publisher Save 10.1002/brb3.71205

Abstract

ABSTRACT

Background
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. Given the conflicting evidence regarding the impact of adherence to the Mediterranean diet (MedDiet) on MS development and the lack of a systematic review on this topic, this study aimed to examine this association.

Methods
Following the PRISMA and JBI methods, a search of electronic databases was conducted through PubMed, Embase, Web of Science, and Scopus up to March 2024. Clinical original studies assessing the association between the MedDiet adherence and MS development were included. Risk of bias was evaluated using JBI critical appraisal tools. Meta‐analyses were performed using CMA4 software.

Results

Out of 202 screened records, eight studies, including five case‐control and three cohort studies, met the inclusion criteria. Retrospective evidence from three case‐control studies suggested that MedDiet adherence is associated with decreased odds of MS, whereas cohort studies showed no significant relationship. Based on the meta‐analysis, there was a significant association between high adherence to the MedDiet and reduced odds of MS (fixed‐effect OR: 0.275, 95% CI: 0.11‐0.72,
p
‐value <0.01, least MedDiet adherence as the reference).

Discussion
Although the meta‐analysis showed a significant inverse association between higher adherence to the MedDiet and the odds of MS, the overall body of evidence does not provide strong support for a preventive role of the MedDiet. Considering the limited number of included studies, the predominantly retrospective design, the high risk of bias in several studies, and the substantial observed heterogeneity, further well‐designed prospective studies are needed.

Topics

No keywords indexed for this article. Browse by subject →

References

54

[1]

10.1016/b978-0-323-95343-6.00003-0

[2]

10.1097/wco.0000000000000622

[3]

10.1038/s41598-025-07429-0

[4]

10.1016/j.jocn.2024.110990

[5]

Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria

Xavier Montalban, Christine Lebrun-Frénay, Jiwon Oh et al.

The Lancet Neurology 10.1016/s1474-4422(25)00270-4

[6]

Diagnosis and Treatment of Multiple Sclerosis

Marisa P. McGinley, Carolyn H. Goldschmidt, Alexander D. Rae-Grant

JAMA 10.1001/jama.2020.26858

[7]

10.1001/jama.2022.14236

[8]

10.1016/j.msard.2021.102816

[9]

Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition

Clare Walton, Rachel King, Lindsay Rechtman et al.

Multiple Sclerosis Journal 10.1177/1352458520970841

[10]

Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment

Maha Haki, Haeder A. AL-Biati, Zahraa Salam Al-Tameemi et al.

Medicine 10.1097/md.0000000000037297

[11]

Multiple sclerosis: molecular pathogenesis and therapeutic intervention

Imane Boutitah-Benyaich, Herena Eixarch, Javier Villacieros-Álvarez et al.

Signal Transduction and Targeted Therapy 10.1038/s41392-025-02415-4

[12]

10.1177/11795735221092516

[13]

10.1016/j.orcp.2024.11.005

[14]

10.1159/000549446

[15]

The Mediterranean diet and health: a comprehensive overview

M. Guasch‐Ferré, W. C. Willett

Journal of Internal Medicine 10.1111/joim.13333

[16]

10.1007/s00394-022-02885-0

[17]

10.1093/gerona/glx227

[18]

The Mediterranean diet and health: a comprehensive overview

M. Guasch‐Ferré, W. C. Willett

Journal of Internal Medicine 10.1111/joim.13333

[19]

10.1007/s00394-022-02885-0

[20]

10.1038/s41467-023-42523-9

[21]

10.3390/nu15102348

[22]

10.3390/nu15081844

[23]

10.1016/j.numecd.2019.11.003

[24]

10.3945/jn.112.164616

[25]

10.1016/j.msard.2025.106769

[26]

Abbasi H. F.Shakouri R.Mosaddeghi‐Heris et al.2023. “Mediterranean‐Like Diets in Multiple Sclerosis: A Systematic Review.”Revue Neurologique. 10.1016/j.msard.2023.105338

[27]

10.1016/j.msard.2023.105338

[28]

10.1016/j.msard.2025.106739

[29]

10.3390/nu14061150

[30]

10.1016/j.bbi.2024.04.016

[31]

10.1038/s41598-025-19998-1

[32]

10.1016/j.msard.2020.102636

[33]

10.1177/13524585221127414

[34]

10.1080/1028415x.2022.2034241

[35]

Razeghi‐Jahromi S. "A Randomized Controlled Trial Investigating the Effects of a Mediterranean‐Like Diet in Patients With Multiple Sclerosis‐associated Cognitive Impairments and Fatigue" Current Journal of Neurology (2020)

[36]

Aromataris E.andMunn Z. (Editors).2020.BI Manual for Evidence Synthesis.https://synthesismanualjbiglobal.https://doi.org/1046658/JBIMES‐20‐01.

[37]

The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Matthew J Page, Joanne E McKenzie, Patrick M Bossuyt et al.

BMJ 10.1136/bmj.n71

[38]

Rayyan—a web and mobile app for systematic reviews

Mourad Ouzzani, Hossam Hammady, Zbys Fedorowicz et al.

Systematic Reviews 10.1186/s13643-016-0384-4

[39]

Moola S. Z.Munn C.Tufanaru et al.2020. “Chapter 7: Systematic Reviews of Etiology and risk.”E. AromatarisandZ.Munn (Editors)JBI Manual for Evidence Synthesis JBI 2020.https://synthesismanualjbiglobal. 10.46658/jbirm-17-06

[40]

Materljan E. "Multiple Sclerosis and Cancers in Croatia—A Possible Protective Role of the “Mediterranean Diet”" Collegium Antropologicum (2009)

[41]

10.1177/13524585231190342

[42]

10.1177/13524585231181841

[43]

10.1093/jn/nxz089

[44]

10.3390/nu16111746

[45]

10.3390/ijms241915024

[46]

10.1007/s40120-022-00325-z

[47]

10.1177/1352458518807061

[48]

Sedaghat F. "Mediterranean Diet Adherence and Risk of Multiple Sclerosis: A Case‐Control Study" Asia Pacific Journal of Clinical Nutrition (2016)

[49]

10.1038/s41467-023-42523-9

[50]

Effects of Dietary Patterns on Biomarkers of Inflammation and Immune Responses: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Liselot Koelman, Caue Egea Rodrigues, Krasimira Aleksandrova

Advances in Nutrition 10.1093/advances/nmab086

Showing 50 of 54 references

Metrics

1

Citations

54

References

Details

Published: Jan 29, 2026
Vol/Issue: 16(2)
License: View

Authors

F

Fatemeh Shakouri

Student Research Committee Tabriz University of Medical Sciences Tabriz Iran

M

Morteza Lotfi

Student Research Committee Tabriz University of Medical Sciences Tabriz Iran

A

Ali Rostami

Student Research Committee Tabriz University of Medical Sciences Tabriz Iran

M

Mahnaz Talebi

Neurosciences Research Center (NSRC) Tabriz University of Medical Sciences Tabriz Iran

S

Sarvin Sanaie

Research Center for Integrative Medicine in Aging, Aging Research Institute Tabriz University of Medical Sciences Tabriz Iran

A

Amirreza Naseri

Research Center for Evidence‐Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence Tabriz University of Medical Sciences Tabriz Iran; Tabriz USERN Office Universal Scientific Education and Research Network (USERN) Tabriz Iran

Funding

Tabriz University of Medical Sciences Award: 73644

Cite This Article

Fatemeh Shakouri, Morteza Lotfi, Ali Rostami, et al. (2026). Association between Mediterranean Diet and Development of Multiple Sclerosis: A Systematic Review and Meta‐Analysis. Brain and Behavior, 16(2). https://doi.org/10.1002/brb3.71205

Association between Mediterranean Diet and Development of Multiple Sclerosis: A Systematic Review and Meta‐Analysis

You May Also Like