Effects of adherence to a Mediterranean diet on body weight in postmenopausal women: a systematic review

IMPORTANCE: The Mediterranean diet (MedDiet) is characterized by high consumption of whole grains, fruits, vegetables, olive oil, and fish, and adherence has been recognized as a strategy for improving metabolic health. The postmenopausal period is associated with a decline in estrogen levels, contributing to increased cardiometabolic risk, weight gain, and reduced quality of life. OBJECTIVE: To assess the efficacy of adherence to the MedDiet on weight loss in postmenopausal women. EVIDENCE REVIEW: A systematic literature search was performed in PubMed, Embase, and the Cochrane Library for studies published up to January 2026. Search terms included "Mediterranean diet," "postmenopausal women," and "postmenopausal." Randomized controlled trials and observational studies relating to the MedDiet and postmenopausal women were included. Screening, data extraction and analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the inclusion and exclusion criteria. FINDINGS: Three studies (two randomized controlled trials and one observational), including 282 participants, were analyzed. The studies differed in design, intervention protocols, participant characteristics, and follow-up duration. Thus, these methodological and clinical differences were considered when interpreting the findings and may have contributed to the heterogeneity observed in the studies. CONCLUSIONS AND RELEVANCE: The different design, limited number of studies and their small sample sizes may have limited the strength of evidence, making the detection of long-term benefits difficult. In qualitative synthesis, the included studies showed mixed findings, with no consistent superiority of MedDiet across weight, fat mass, or lean mass outcomes. MedDiet counseling alone, without explicit energy restriction or other structured weight-management strategies, should not be assumed to produce clinically meaningful reductions in body weight or fat mass.