Mediterranean diet shows no significant advantage over control diets for inducing remission in inflammatory bowel disease patients

BACKGROUND: The Mediterranean diet is a nutritional approach reported to be beneficial in various diseases. We performed a systematic review about its role in the treatment of inflammatory bowel disease (IBD). METHODS: Electronic databases (PubMed, Embase and Scopus) were searched on 10th February 2025 to identify reports on the use of the Mediterranean diet in the treatment of IBD. We extracted data with respect to clinical response, remission and endoscopic and histological responses with the use of the Mediterranean diet in the treatment of IBD. Pooled clinical response rates and remission rates were calculated. RESULTS: Eight studies were eventually included. Seven studies involving 223 participants provided information about the induction of remission. The pooled clinical remission rate with Mediterranean diet was 0.62 (95% CI = 0.39-0.80, I = 78.6%). A sub-group analysis showed similar remission rates for Crohn's disease (CD) (RR = 0.67, 95% CI = 0.38; 0.87) and ulcerative colitis (0.56, 95% CI = 0.24-0.84), (p = 0.7531). Compared to control diets, Mediterranean diet showed no significant advantage in inducing remission (pooled OR = 0.98, 95% CI = 0.74-1.30, I = 42.9%). No studies reported outcomes for endoscopic or histological responses. CONCLUSION: The Mediterranean diet in conjunction with standard medical therapy is associated with a clinical remission rate of approximately 62% in IBD, with comparable efficacy in CD and ulcerative colitis. The studies on Mediterranean diet are compromized by heterogenous study, definitions of disease activity and outcomes and concurrent use of medical therapies. Further high-quality randomized trials are needed to evaluate the impact of the Mediterranean diet on objective disease markers and long-term outcomes in IBD.