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ORIGINAL RESEARCH ARTICLE

Association between adherence to the Mediterranean diet and sarcopenia among US adults: A cross-sectional study

Dichun Lv1,2 ,  Jialan Chen1 ,  Yuanyuan Wang3 ,  Gaochenzi Tao4 ,  Zikun Xie1 ,  Chengkai Wu5,6 ,  Tao Li1 ,  Jia Li1 ,  Donghong Guo1* ,  Jian Wang1*
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1 Division of Orthopaedic Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
2 The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
3 Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
4 Department of Gynecology, Guangzhou Haizhu District Changgang Street Community Service Center, Guangzhou, Guangdong, China
5 School of Public Health, Southern Medical University, Guangzhou, China
6 School of Health Management, Southern Medical University, Guangzhou, China
OTE, 025330010 https://doi.org/10.36922/OTE025330010
Received: 15 August 2025 | Revised: 19 November 2025 | Accepted: 20 November 2025 | Published online: 12 December 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Sarcopenia, a progressive loss of muscle mass and function associated with aging, has become an increasingly important public health concern worldwide. Research has demonstrated that the relationship between adherence to the Mediterranean diet and muscle mass is generally positive; however, findings regarding its association with sarcopenia have been inconsistent. To investigate whether adherence to the Mediterranean diet is associated with sarcopenia prevalence, we analyzed data from adults aged 20 years and older in the National Health and Nutrition Examination Survey from 2011 to 2018, with a sample size of 17,110 adults. Multivariable-adjusted logistic regression analysis was employed. The robustness of our results was assessed using several methods, including subgroup analysis, weighted quantile sum (WQS) regression, and sensitivity analysis. Results revealed that participants with higher adherence to the Mediterranean diet were less likely to have sarcopenia. In the adjusted model, the protective effect remained significant (p=0.006). Subgroup analysis indicated that this protective effect might be more pronounced among individuals aged 45 years and older, and independent of body mass index. We used WQS regression and logistic regression to assess individual components of the Mediterranean diet and found that fish and nuts had the highest weights and showed significant associations. Sensitivity analysis confirmed the robustness of the results. In conclusion, higher adherence to the Mediterranean diet is associated with a lower prevalence of sarcopenia. In the absence of effective pharmacological treatments, it may serve as a promising nutritional intervention for preventing and managing sarcopenia. Further validation through prospective studies is needed.

Keywords
Mediterranean diet
Sarcopenia
Cross-sectional research
National health and nutrition examination survey
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
References
  1. Sayer AA, Cooper R, Arai H, et al. Sarcopenia. Nat Rev Dis Primers. 2024;10(1):68. doi: 10.1038/s41572-024-00550-w

 

  1. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. doi: 10.1093/ageing/afy169

 

  1. The State of Food Security and Nutrition in the World 2024. Rome: FAO, IFAD, UNICEF, WFP, WHO; 2024. doi: 10.4060/cd1254en

 

  1. Robinson SM, Reginster JY, Rizzoli R, et al. Does nutrition play a role in the prevention and management of sarcopenia? Clin Nutr. 2018;37(4):1121-1132. doi: 10.1016/j.clnu.2017.08.016

 

  1. Welch AA, Scott J, Cameron D, Yates M. Are dietary patterns relevant for reducing the risk of fractures and sarcopenia? Curr Osteoporos Rep. 2025;23(1):7. doi: 10.1007/s11914-024-00899-7

 

  1. Davis C, Bryan J, Hodgson J, Murphy K. Definition of the mediterranean diet; a literature review. Nutrients. 2015;7(11):9139-9153. doi: 10.3390/nu7115459

 

  1. Lees M, Carson B. The potential role of fish-derived protein hydrolysates on metabolic health, skeletal muscle mass and function in ageing. Nutrients. 2020;12(8):2434. doi: 10.3390/nu12082434

 

  1. Barber TM, Kabisch S, Pfeiffer AFH, Weickert MO. The effects of the mediterranean diet on health and gut microbiota. Nutrients. 2023;15(9):2150. doi: 10.3390/nu15092150

 

  1. Tagtow A, Rahavi E, Bard S, Stoody EE, Casavale K, Mosher A. Coming together to communicate the 2015- 2020 dietary guidelines for Americans. J Acad Nutr Diet. 2016;116(2):209-212. doi: 10.1016/j.jand.2015.12.010

 

  1. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: Meta-analysis. BMJ. 2008;337:a1344. doi: 10.1136/bmj.a1344

 

  1. Granic A, Sayer AA, Robinson SM. Dietary patterns, skeletal muscle health, and sarcopenia in older adults. Nutrients. 2019;11(4):745. doi: 10.3390/nu11040745

 

  1. Rodacki CL, Rodacki AL, Pereira G, et al. Fish-oil supplementation enhances the effects of strength training in elderly women. Am J Clin Nutr. 2012;95(2):428-436. doi: 10.3945/ajcn.111.021915

 

  1. Itsiopoulos C, Mayr HL, Thomas CJ. The anti-inflammatory effects of a Mediterranean diet: A review. Curr Opin Clin Nutr Metab Care. 2022;25(6):415-422. doi: 10.1097/MCO.0000000000000872

 

  1. Haß U, Herpich C, Kochlik B, Weber D, Grune T, Norman K. Dietary inflammatory index and cross-sectional associations with inflammation, muscle mass and function in healthy old adults. J Nutr Health Aging. 2022;26(4):346-351. doi: 10.1007/s12603-022-1753-4

 

  1. Abete I, Konieczna J, Zulet MA, et al. Association of lifestyle factors and inflammation with sarcopenic obesity: Data from the PREDIMED‐Plus trial. J Cachexia Sarcopenia Muscle. 2019;10(5):974-984. doi: 10.1002/jcsm.12442

 

  1. Coelho-Júnior HJ, Calvani R, Picca A, et al. Combined aerobic training and mediterranean diet is not associated with a lower prevalence of sarcopenia in Italian older adults. Nutrients. 2023;15(13):2963. doi: 10.3390/nu15132963

 

  1. Ganapathy A, Nieves JW. Nutrition and sarcopenia-what do we know? Nutrients. 2020;12(6):1755. doi: 10.3390/nu12061755

 

  1. Zhan JJ, Hodge RA, Dunlop AL, et al. Dietaryindex: A user-friendly and versatile R package for standardizing dietary pattern analysis in epidemiological and clinical studies. Am J Clin Nutr. 2024;120(5):1165-1174. doi: 10.1016/j.ajcnut.2024.08.021

 

  1. Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009;119(8):1093-1100. doi: 10.1161/CIRCULATIONAHA.108.816736

 

  1. Dominguez LJ, Veronese N, Smith L, et al. Associations between adherence to the mediterranean diet and incident sarcopenia in prospective cohort studies. Nutrients. 2025;17(2):313. doi: 10.3390/nu17020313

 

  1. Studenski SA, Peters KW, Alley DE, et al. The FNIH sarcopenia project: Rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci. 2014;69(5):547-558. doi: 10.1093/gerona/glu010

 

  1. Liccini AP, Malmstrom TK. Frailty and sarcopenia as predictors of adverse health outcomes in persons with diabetes mellitus. J Am Med Dir Assoc. 2016;17(9):846-851. doi: 10.1016/j.jamda.2016.07.007

 

  1. Han P, Yu H, Ma Y, et al. The increased risk of sarcopenia in patients with cardiovascular risk factors in Suburb- Dwelling older Chinese using the AWGS definition. Sci Rep. 2017;7(1):9592. doi: 10.1038/s41598-017-08488-8

 

  1. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860-867. doi: 10.1038/nature01322

 

  1. Aboukhater D, Morad B, Nasrallah N, et al. Inflammation and hypertension: Underlying mechanisms and emerging understandings. J Cell Physiol. 2023;238(6):1148-1159. doi: 10.1002/jcp.31019

 

  1. Libby P, Nahrendorf M, Swirski FK. Leukocytes link local and systemic inflammation in ischemic cardiovascular disease. J Am Coll Cardiol. 2016;67(9):1091-1103. doi: 10.1016/j.jacc.2015.12.048

 

  1. Schaap LA, Pluijm SMF, Deeg DJH, et al. Higher inflammatory marker levels in older persons: Associations with 5-year change in muscle mass and muscle strength. J Gerontol A Biol Sci Med Sci. 2009;64A(11):1183-1189. doi: 10.1093/gerona/glp097

 

  1. Guo B, Liu X, Si Q, et al. Associations of CBC-Derived inflammatory indicators with sarcopenia and mortality in adults: Evidence from Nhanes 1999∼2006. BMC Geriatr. 2024;24(1):432. doi: 10.1186/s12877-024-05012-2

 

  1. Xu W, Mu D, Wang Y, Wang Y, Wang C, Zhang X. Association between oxidative balance score and sarcopenia in US adults: NHANES 2011–2018. Front Nutr. 2024;11:1342113. doi: 10.3389/fnut.2024.1342113

 

  1. Jackson MJ, Pye D, Palomero J. The production of reactive oxygen and nitrogen species by skeletal muscle. J Appl Physiol. 2007;102(4):1664-1670. doi: 10.1152/japplphysiol.01102.2006

 

  1. Liu D, Wang S, Liu S, Wang Q, Che X, Wu G. Frontiers in sarcopenia: Advancements in diagnostics, molecular mechanisms, and therapeutic strategies. Mol Aspects Med. 2024;97:101270. doi: 10.1016/j.mam.2024.101270

 

  1. Livshits G, Kalinkovich A. A cross-talk between sestrins, chronic inflammation and cellular senescence governs the development of age-associated sarcopenia and obesity. Ageing Res Rev. 2023;86:101852. doi: 10.1016/j.arr.2023.101852

 

  1. Ticinesi A, Nouvenne A, Cerundolo N, Parise A, Mena P, Meschi T. The interaction between Mediterranean diet and intestinal microbiome: Relevance for preventive strategies against frailty in older individuals. Aging Clin Exp Res. 2024;36(1):58. doi: 10.1007/s40520-024-02707-9

 

  1. Lv W, Lin X, Shen H, et al. Human gut microbiome impacts skeletal muscle mass via gut microbial synthesis of the short‐chain fatty acid butyrate among healthy menopausal women. J Cachexia Sarcopenia Muscle. 2021;12(6):1860-1870. doi: 10.1002/jcsm.12788

 

  1. Ticinesi A, Mancabelli L, Tagliaferri S, et al. The gut-muscle axis in older subjects with low muscle mass and performance: A proof of concept study exploring fecal microbiota composition and function with shotgun metagenomics sequencing. Int J Mol Sci. 2020;21(23):8946. doi: 10.3390/ijms21238946

 

  1. Huang CH, Okada K, Matsushita E, et al. Dietary patterns and muscle mass, muscle strength, and physical performance in the elderly: A 3-year cohort study. J Nutr Health Aging. 2021;25(1):108-115. doi: 10.1007/s12603-020-1437-x

 

  1. Karlsson M, Becker W, Michaëlsson K, Cederholm T, Sjögren P. Associations between dietary patterns at age 71 and the prevalence of sarcopenia 16 years later. Clin Nutr. 2020;39(4):1077-1084. doi: 10.1016/j.clnu.2019.04.009

 

  1. Cervo MMC, Scott D, Seibel MJ, et al. Adherence to Mediterranean diet and its associations with circulating cytokines, musculoskeletal health and incident falls in community-dwelling older men: The Concord Health and Ageing in Men Project. Clin Nutr. 2021;40(12):5753-5763. doi: 10.1016/j.clnu.2021.10.010

 

  1. Kirk B, Cawthon PM, Arai H, et al. The conceptual definition of sarcopenia: Delphi consensus from the global leadership initiative in sarcopenia (GLIS). Age Ageing. 2024;53(3):afae052. doi: 10.1093/ageing/afae052

 

  1. Wilkinson DJ, Piasecki M, Atherton PJ. The age-related loss of skeletal muscle mass and function: Measurement and physiology of muscle fibre atrophy and muscle fibre loss in humans. Ageing Res Rev. 2018;47:123-132. doi: 10.1016/j.arr.2018.07.005

 

  1. Cacciatore S, Calvani R, Marzetti E, et al. Low adherence to mediterranean diet is associated with probable sarcopenia in community-dwelling older adults: Results from the longevity check-up (Lookup) 7+ project. Nutrients. 2023;15(4):1026. doi: 10.3390/nu15041026

 

  1. Cho MR, Lee S, Song SK. A review of sarcopenia pathophysiology, diagnosis, treatment and future direction. J Korean Med Sci. 2022;37(18):e146. doi: 10.3346/jkms.2022.37.e146

 

  1. Cruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet. 2019;393(10191):2636-2646. doi: 10.1016/S0140-6736(19)31138-9

 

  1. Batsis JA, Villareal DT. Sarcopenic obesity in older adults: Aetiology, epidemiology and treatment strategies. Nat Rev Endocrinol. 2018;14(9):513-537. doi: 10.1038/s41574-018-0062-9

 

  1. Prado CM, Batsis JA, Donini LM, Gonzalez MC, Siervo M. Sarcopenic obesity in older adults: A clinical overview. Nat Rev Endocrinol. 2024;20(5):261-277. doi: 10.1038/s41574-023-00943-z

 

  1. Kim J, Lee Y, Kye S, Chung YS, Kim KM. Association of vegetables and fruits consumption with sarcopenia in older adults: The Fourth Korea National Health and Nutrition Examination Survey. Age Ageing. 2015;44(1):96-102. doi: 10.1093/ageing/afu028

 

  1. Reid-McCann RJ, Brennan SF, McKinley MC, McEvoy CT. The effect of animal versus plant protein on muscle mass, muscle strength, physical performance and sarcopenia in adults: Protocol for a systematic review. Syst Rev. 2022;11(1):64. doi: 10.1186/s13643-022-01951-2

 

  1. Putra C, Konow N, Gage M, York C, Mangano K. Protein source and muscle health in older adults: A literature review. Nutrients. 2021;13(3):743. doi: 10.3390/nu13030743

 

  1. Feyesa I, George ES, Scott D, et al. Nut intake, functional limitations, and quality of life in older adults: Findings from NHANES 2003–2012. J Cachexia Sarcopenia Muscle. 2025;16(4):e70022. doi: 10.1002/jcsm.70022

 

  1. Du Q, Lu Y, Hu F, et al. Dietary diversity and possible sarcopenia among older people in China: A nationwide population-based study. Front Nutr. 2023;10:1218453. doi: 10.3389/fnut.2023.1218453

 

  1. Martínez-González MÁ, Hernández Hernández A. Effect of the Mediterranean diet in cardiovascular prevention. Rev Esp Cardiol (Engl Ed). 2024;77(7):574-582. doi: 10.1016/j.rec.2024.01.006

 

  1. Georgoulis M, Georgousopoulou EN, Chrysohoou C, Pitsavos C, Panagiotakos DB. Longitudinal trends, determinants, and cardiometabolic impact of adherence to the mediterranean diet among greek adults. Foods. 2022;11(16):2389. doi: 10.3390/foods11162389

 

  1. Mazza E, Ferro Y, Pujia R, et al. Mediterranean diet in healthy aging. J Nutr Health Aging. 2021;25(9):1076-1083. doi: 10.1007/s12603-021-1675-6
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