Nutrition Reviews · Nov 2, 2026
Mediterranean Diet Adherence and Markers of Healthy Aging: A Systematic Review of Biological and Functional Outcomes
By Marino M, Del Bo’ C, Frigerio M et al.
Context: Aging involves molecular, cellular, and functional changes that increase vulnerability to chronic disease, cognitive decline, frailty, and loss of independence. Mediterranean-style dietary patterns are generally rich in plant foods, unsaturated fats, fiber, and bioactive compounds, but their composition varies across studies and may include modified or multicomponent interventions. Objective: This Systematic Review evaluated associations between Mediterranean-style dietary adherence and related interventions and markers of healthy aging, including biological aging biomarkers, cognition, frailty, physical performance, and overall health status. Data Sources: PubMed, Embase, and Scopus were searched for studies published during 2013- 2025. Searches were conducted in April 2025 and updated in August 2025. The review was registered in PROSPERO (CRD420251107773). Data Extraction: Randomized controlled trials (RCTs), prospective cohort studies, and cross-sectional studies in adults were eligible if they assessed Mediterranean-style dietary patterns or interventions and reported aging-related biomarkers or functional outcomes. Two reviewers independently conducted study selection and data extraction. Data Analysis: Eleven studies were included: 5 RCTs, 4 prospective cohort studies, and 2 cross-sectional studies. Greater adherence was associated with better cognitive performance and slower memory decline in some studies. Favorable findings were also reported for telomere dynamics, epigenetic age, and inflammatory biomarkers. Improvements in frailty and physical performance were mainly observed in interventions combining dietary modification with physical activity. Heterogeneity in dietary definitions, adherence measures, intervention components, and outcomes precluded meta-analysis. Conclusions: The evidence suggests that favorable associations exist between Mediterranean-style dietary patterns and selected markers of healthy aging but does not establish uniform or causal effects. Interpretation is limited by methodological heterogeneity, self-reported dietary exposure, and the inclusion of modified or multicomponent interventions. Long-term studies using standardized dietary definitions, harmonized outcomes, objective adherence measures, and designs capable of isolating diet-specific effects are needed. Systematic Review Registration: PROSPERO registration No. [https://www.crd.york.ac.uk/PROSPERO/view/CRD420251107773].