Mediterranean Diet and Multidimensional Healthy Ageing: A Narrative Review

Background: As populations age, maintaining health and function in later life has become a public-health concern, and diet is among the most accessible strategies to support it. This narrative review examines the evidence on the Mediterranean diet and healthy ageing, assesses its strength across domains, and integrates data on mechanisms, outcomes, and determinants of adherence. Methods: PubMed and Scopus were searched for English-language literature published from the beginning of 2020 to June 2026, including observational studies, meta-analyses, randomised trials, and reviews, with foundational earlier sources retained where relevant. Results: Higher adherence was consistently associated with better cognitive, physical, and cardiometabolic outcomes, supported by biologically plausible mechanisms. The evidence was weakest for sarcopenia and successful ageing, consistent but mostly observational for cognition and frailty, and strongest in the cardiometabolic domain, where randomised trials exist. Socioeconomic, cultural, and age-related factors shaped adherence in older adults, meaning those most likely to benefit often face the greatest challenges. Most of the evidence was observational, which limits causal inference, and varying definitions and populations largely confined to Mediterranean regions limit generalisability. Conclusions: The Mediterranean diet is a low-risk, well-justified component of a healthy-ageing approach, provided its promotion is equitable and its claims remain proportionate to the evidence.