The Mediterranean Diet and Inflammatory Bowel Disease: A Comprehensive Systematic Review and Meta‐Analysis

Introduction Diet significantly influences the progression of inflammatory bowel disease (IBD). The Mediterranean diet (MD), characterized by high consumption of fruits, vegetables, healthy fats, lean proteins, and limited intake of processed foods, is recommended as adjunctive therapy. This meta‐analysis is aimed at evaluating existing data on dietary management in ulcerative colitis (UC) and assessing the effectiveness of MD in achieving symptomatic remission or improvement in IBD patients compared with other dietary interventions. Methods Following Cochrane and PRISMA guidelines, we compared MD with alternative dietary interventions in IBD patients. Randomized controlled trials (RCTs) were identified through comprehensive database searches up to November 2024. Data were analyzed using RevMan Web, employing a random‐effects model. Results Four RCTs involving a total of 339 IBD patients were included in this analysis. Among these, 167 patients (UC and CD) received the MD, whereas 172 followed non‐Mediterranean diets (NMD). The MD was associated with a statistically significant improvement in clinical remission compared with NMD (RR 1.18, p = 0.02). In subgroup analyses, clinical remission was not statistically different in UC (RR 1.15, 95% CI: 0.94–1.41, p = 0.78) or CD (RR 1.22, 95% CI: 1.00–1.47, p = 0.05). When compared specifically with a regular diet, MD significantly reduced both CRP levels (MD −2.66, p < 0.00001) and fecal calprotectin (MD −229.46, p = 0.008). Specifically, within the UC population, MD significantly decreased CRP and fecal calprotectin levels. Discussion Our findings indicate that the MD significantly benefits IBD management, especially UC, as demonstrated by notable reductions in inflammatory markers. Benefits in CD remain unclear despite prior evidence. Future research should clarify benefits across patient subgroups and address adherence challenges.