The Effect of Diet and Dietary Supplements on Iron Status of Active Females: A Systematic Review and Meta-analysis of Interventional Trials.

Abstract

Iron deficiency is reported in about 15-35% of all female athletes. In addition to oral iron supplements, food-based approaches and dietary supplements have gained interest in preventing and treating iron deficiency in the active female population. This systematic review and meta-analysis aimed to evaluate the effect of diet and dietary supplement interventions on iron status, performance, and inflammatory markers in active females of reproductive age. The search was conducted using PubMed, Scopus, CINAHL, Embase, and Rehabilitation & Sports Medicine Source up to March 2026. Interventional trials that examined the impact of diet or dietary supplements on at least one biomarker of iron status in active females of reproductive age were included. All meta-analyses were conducted in R version 2025.05.0 + 496 using the metafor package. Separate random-effects meta-analyses were performed for hemoglobin and ferritin outcomes. Oral iron supplementation in the form of ferrous sulfate resulted in a significant increase in hemoglobin (mean difference [MD] = 0.42 g/dL; 95% confidence interval [CI]: 0.10 to 0.74; p = 0.0109; I² = 56.6%) and ferritin (MD = 12.61 ng/mL; 95% CI: 8.29 to 16.92; p < 0.0001; I² = 57.38%). Meta-analysis revealed that ferrous sulfate supplementation significantly improved hemoglobin and ferritin levels in active females. PROSPERO registration no. CRD42024554679.