High Adherence to the Mediterranean Diet and Its Association with Diminished Ovarian Reserve: a Case-Control Study

<h2>Abstract</h2><h3>Background and aim</h3> While recent research has highlighted the impact of dietary components on reproductive health, the relationship between dietary quality indices and the risk of diminished ovarian reserve (DOR) remains largely unexplored. Therefore, this study sought to examine the link between adherence to the Mediterranean diet (MedDiet) adherence and the likelihood of developing DOR. <h3>Methods</h3> This case-control study involved 370 women aged 18–45, comprising 120 women with DOR and 250 healthy women matched for age and body mass index (BMI). Dietary intake was assessed using a validated food frequency questionnaire (FFQ), and adherence to the MedDiet was evaluated on a 9-point scale. Anti-Müllerian hormone (AMH) levels were determined from serum samples, while antral follicle count (AFC) was measured through transvaginal ultrasound. The relationship between MedDiet adherence and the risk of DOR was examined using multivariable-adjusted binary logistic regression analysis. <h3>Results</h3> Participants were classified into tertiles of MedDiet adherence (cases: n=40, 55, and 25; controls: n=75, 136, and 39 for low, moderate, and high adherence, respectively). The study results demonstrated a negative association between the MedDiet adherence and the odds of DOR, even after adjusting for potential confounding factors such as physical activity and energy intake (OR: 0.89; 95% CI: 0.62–0.94; P_trend = 0.033). Additionally, this relationship remained statistically significant after further adjustments for fat mass (OR: 0.83; 95% CI: 0.69–0.90; P_trend = 0.011). <h3>Conclusion</h3> A higher MedDiet adherence may potentially lower the risk DOR. Nonetheless, further research, particularly with prospective study designs, is essential to validate these findings.