Introduction Sustainable dietary patterns are increasingly promoted to improve human health while reducing environmental impacts. However, their implications for nutritional status and health outcomes in pediatric populations remain unclear. Objective This systematic review aims to synthesize the available evidence on the association between dietary patterns evaluated with sustainability-oriented indexes and nutrition-related outcomes in children and adolescents. Methods A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted up to January 3rd, 2026, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and with prospective registration in PROSPERO. Observational and interventional human studies involving participants aged 0-18 years were included if they assessed sustainable dietary patterns or sustainability-related dietary metrics and reported nutrition-related outcomes. Results Ten studies met the inclusion criteria, revealing a heterogeneous body of evidence characterized by substantial variability in study design, age groups, sustainability metrics, and outcome definitions. Most studies focused on anthropometric indicators, primarily body weight and body mass index (BMI), whereas fewer investigated broader outcomes such as cardio-metabolic health or nutrition-related behaviors. Associations between sustainable dietary patterns and anthropometric outcomes were inconsistent across studies and age groups, with more favorable findings observed mainly in later childhood, adolescence, and long-term follow-up, and predominantly null results in early childhood. Evidence from intervention studies was limited and mixed, with only one intervention demonstrating a significant difference in weight-related outcomes between intervention and control groups, indicating that environmentally sustainable dietary patterns do not necessarily translate into a negative energy balance sufficient to induce weight loss. Discussion and Conclusion Overall, sustainable dietary patterns did not consistently translate into lower body weight or BMI, suggesting that sustainability-oriented diets should not be interpreted primarily as weight-loss strategies in pediatric populations. More consistent associations were found with cardio metabolic indicators such as waist circumference, metabolic syndrome (MeS), and ideal cardiovascular health (ICH). These findings suggest that the potential health benefits of sustainable diets in children and adolescents extend beyond body weight alone, highlighting the need for high-quality longitudinal and interventional studies across all pediatric life stages. Systematic review registration http://www.crd.york.ac.uk/PROSPERO/view/CRD420251272851 .
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