Agarwal Rashmi, Salas-Salvadó Jordi, Davila-Cordova Estefanía, Shyam Sangeetha, Fernández de la Puente María, Azurmendi Maite Pérez, Babio Nancy, Salas-Huetos Albert
Department of Biochemistry and Biotechnology, Universitat Rovira i Virgili, Human Nutrition Unit, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental (ANUT-DSM), Reus, Spain.
Department of Biochemistry and Biotechnology, Universitat Rovira i Virgili, Human Nutrition Unit, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental (ANUT-DSM), Reus, Spain; Institute of Health Research Pere Virgili (IISPV), Reus, Spain; CIBER Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain.
Adv Nutr. 2025 May 24;16(8):100454. doi: 10.1016/j.advnut.2025.100454.
Environmental pollution, sedentary lifestyles, and unhealthy dietary patterns have been hypothesized as the main modifiable factors of human semen quality decline. The study aimed to assess the associations between an a priori-defined Mediterranean diet (MedDiet) adherence and semen quality parameters or medically assisted reproductive (MAR) outcomes in males. A systematic review was conducted with studies from PubMed, Embase, or Scopus databases until October 2024. A priori-defined MedDiet adherence was considered as exposure and conventional semen quality parameters as the primary outcomes. Secondary outcomes included MAR outcomes, reproductive hormone concentrations, and sperm DNA fragmentation. A quality assessment was performed using the NHLBI tool. Meta-analysis was conducted following Cochrane guidelines. A subgroup analysis was done for healthy participants and those from fertility clinics separately. A sensitivity analysis was performed to check the influential studies. A qualitative analysis was performed on 11 eligible articles (n = 2558 individuals). Data from 9 observational studies showed a positive association between the adherence to MedDiet and semen volume (1/9), sperm concentration (5/9 studies), count (5/9), total motility (5/9), progressive motility (4/9), vitality (1/9), normal morphology (2/9), or follicular stimulating hormone (1/9). Among these, the links between MedDiet adherence and MAR outcomes were prospectively explored only in 1 study, which reported no association. A total of 8 studies were eligible for meta-analysis (n = 1835 individuals). Total MedDiet adherence showed a significant positive association with sperm count (24.37 M spz.; 1.30-47.44; I = 89%), total motility (8.81%; 2.26-15.37; I = 88%), progressive motility (7.49%; 1.47-13.50; I = 86%), and normal morphology (1.02%; 0.21-1.82; I = 77%). Evidence from 2 randomized clinical trial evaluating the effect of MedDiet on semen parameters aligns with the primary results. Evidence from observational studies and clinical trials shows potential benefit of adhering to a MedDiet in terms of seminal quality parameters, but not fertility outcomes. This study was registered at PROSPERO as CRD42024584003.
环境污染、久坐不动的生活方式和不健康的饮食模式被认为是导致人类精液质量下降的主要可改变因素。本研究旨在评估男性对预先定义的地中海饮食（MedDiet）的依从性与精液质量参数或医学辅助生殖（MAR）结局之间的关联。我们对来自PubMed、Embase或Scopus数据库截至2024年10月的研究进行了系统综述。将预先定义的MedDiet依从性视为暴露因素，将传统精液质量参数作为主要结局。次要结局包括MAR结局、生殖激素浓度和精子DNA碎片化。使用美国国立心肺血液研究所（NHLBI）工具进行质量评估。按照Cochrane指南进行荟萃分析。分别对健康参与者和来自生育诊所的参与者进行亚组分析。进行敏感性分析以检查有影响力的研究。对11篇符合条件的文章（n = 2558人）进行了定性分析。9项观察性研究的数据显示，MedDiet依从性与精液量（1/9）、精子浓度（5/9项研究）、计数（5/9）、总活力（5/9）、前向运动活力（4/9）、存活率（1/9）、正常形态（2/9）或促卵泡生成素（1/9）之间存在正相关。其中，仅在1项研究中前瞻性探索了MedDiet依从性与MAR结局之间的联系，该研究报告无关联。共有8项研究符合荟萃分析条件（n = 1835人）。总体MedDiet依从性与精子计数（24.37M个精子/毫升；1.30 - 47.44；I² = 89%）、总活力（8.81%；2.26 - 15.37；I² = 88%）、前向运动活力（7.49%；1.47 - 13.50；I² = 86%）和正常形态（1.02%；0.21 - 1.82；I² = 77%）呈显著正相关。两项评估MedDiet对精液参数影响的随机临床试验的证据与主要结果一致。观察性研究和临床试验的证据表明，坚持MedDiet在精液质量参数方面有潜在益处，但对生育结局无影响。本研究已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42024584003。
