The Relationship Between the Mediterranean Dietary Pattern and Exercise and Sport Performance—A Scoping Review

<b>Background/Objectives:</b> Athletes seek healthy diets for their health and performance. The Mediterranean Diet (MedDiet) has been widely studied for its health benefits. We conducted a scoping review of the scientific literature for studies reporting on the relationship between MedDiet adherence and performance and health outcomes in athletes. <b>Methods</b>: Five bibliographic databases were searched from inception to December 2023. We included studies with any competing, recreational, professional, elite, or occupational athlete (of any age) who played a physical sport as part of a team or as an individual, in which the MedDiet was used as an intervention, or adherence was measured. A total of 7993 unique records were identified, screened, and assessed for eligibility. <b>Results</b>: A total of 32 studies were included: 23 observational studies, 6 randomised controlled trials, and 3 quasi-experimental studies. Almost all studies (n = 31) were conducted in Mediterranean countries. Anthropometrics (n = 19) and body composition (n = 12) were the two most measured outcomes. There was a wide range of athlete ages and calibres and great variability in the outcomes reported; however, there were limited reports for each outcome. Only one RCT reported on specific sport-related performance outcomes. Three RCTs provided individualised dietary recommendations for macronutrients based on sports nutrition guidelines, but only two of them assessed macronutrient intake. <b>Conclusions</b>: This is the first scoping review of MedDiet adherence on outcomes related to sport. We found a limited evidence base across different sports and athletes, with few studies conducted outside of Mediterranean countries. Importantly, more intervention studies are needed to provide high-level causal evidence on the impact of the MedDiet pattern on performance and health outcomes in athletes.