Mediterranean Diet, Cognition, and Academic Performance in School-Aged Children: A Systematic Review and Meta-Analysis

Abstract Context Cognitive abilities in children, often reflected in their academic performance, predict educational and occupational performance, socioeconomic attainment, health, and longevity. Identification of modifiable factors affecting these abilities can influence multiple spheres across their lifespan. Objective The aim of this review and meta-analysis was to systematically summarize and quantify the existing empirical evidence on associations between adherence to the Mediterranean diet (MD) and cognition outcomes and academic performance in school-aged children (aged 6-19 years). Data Sources PubMed, Scopus, and Web of Science electronic databases were systematically searched in April 2025 for studies, examining cognitive effects of adherence to the MD in childhood. Data Extraction Study screening and risk-of-bias assessment were conducted independently by the authors. Data Analysis Multilevel meta-analyses accounted for dependent observations: individual effect sizes (level 1), nested within studies (level 2), and further comprised various cognition domains (level 3). Of 1140 articles initially identified, 39 studies with a total of 26 307 participants, were reviewed and analyzed. From these studies, we found a positive, small but significant correlation of 0.18 (95% CI, 0.10-0.26) between adherence to the MD and overall cognition in school-aged children. The findings persisted in the meta-analysis of studies with adjusted coefficients (0.12; 95% CI, 0.08-0.17). In subgroup analyses, correlations between adherence to the MD and specific facets of cognition were also small but significant for academic achievement: 0.21 [95% CI, 0.09-0.32], I2 = 82%, for cognitive abilities: 0.12 [95% CI, 0.04-0.19], I2 =63%, and for motivation and learning strategies, 0.35 [95% CI, 0.14-0.52], I2 = 99%. Conclusions Adherence to the MD has a small but significant positive correlation with multiple cognition facets and academic performance in children aged 6-19 years. Promoting the MD may be considered as part of a broader approach to supporting cognitive health and academic success. Systematic Review Registration PROSPERO registration No. [CRD420251049164].