The Effect of Diet and Dietary Supplements on Iron Status of Active Females: A Systematic Review and Meta-analysis of Interventional Trials

Background Iron deficiency is reported in about 15–35% of all female athletes. In addition to oral iron supplements, food-based approaches and dietary supplements have gained interest in preventing and treating iron deficiency in the active female population. Objectives This systematic review and meta-analysis aimed to evaluate the effect of diet and dietary supplement interventions on iron status, performance, and inflammatory markers in active females of reproductive age. Data Source The search was conducted using PubMed, Scopus, CINAHL, Embase, and Rehabilitation & Sports Medicine Source up to March 2026. Data Extraction Interventional trials that examined the impact of diet or dietary supplements on at least one biomarker of iron status in active females of reproductive age were included. Data Analysis All meta-analyses were conducted in R version 2025.05.0 + 496 using the metafor package. Separate random-effects meta-analyses were performed for hemoglobin and ferritin outcomes. Results Oral iron supplementation in the form of ferrous sulfate resulted in a significant increase in hemoglobin (mean difference [MD] = 0.42 g/dL; 95% confidence interval [CI]: 0.10 to 0.74; p = 0.0109; I 2 = 56.6%) and ferritin (MD = 12.61 ng/mL; 95% CI: 8.29 to 16.92; p < 0.0001; I 2 = 57.38%). Conclusion Meta-analysis revealed that ferrous sulfate supplementation significantly improved hemoglobin and ferritin levels in active females. Systematic Review Registration PROSPERO registration no. CRD42024554679. :