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

Authors

• Emma McCarthy, University of Illinois at Chicago
• Josh P. Pekler, University of Illinois at Chicago
• Tina Tran, Kansas City University
• Lauren E. Deluca, University of Illinois at Chicago
• Trina Fresco, University of Illinois at Chicago
• Jarrad Hampton-Marcell, University of Illinois at Chicago
• Beatriz Penalver Bernabe, University of Illinois at Chicago
• Karrie Hamstra-Wright, University of Illinois at Chicago
• Mary Dawn Koenig, University of Illinois at Chicago
• Danielle Colegrove, University of Illinois at Chicago
• Lisa Tussing-Humphreys, University of Illinois at Chicago

Document Type

Article

Publication Title

Sports Medicine

Abstract

Background: 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.

Objectives: 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.

Data source: The search was conducted using PubMed, Scopus, CINAHL, Embase, and Rehabilitation & Sports Medicine Source up to March 2026.

Data extraction: 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.

Data analysis: 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.

Results: 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%).

Conclusion: Meta-analysis revealed that ferrous sulfate supplementation significantly improved hemoglobin and ferritin levels in active females.

Systematic review registration: PROSPERO registration no. CRD42024554679.

DOI

10.1007/s40279-026-02464-x

Publication Date

6-10-2026

ISSN

1179-2035

Recommended Citation

McCarthy E, Pekler JP, Tran T, Deluca LE, Fresco T, Hampton-Marcell J, Bernabe BP, Hamstra-Wright K, Koenig M, Colegrove D, Tussing-Humphreys L. The Effect of Diet and Dietary Supplements on Iron Status of Active Females: A Systematic Review and Meta-analysis of Interventional Trials. Sports Medicine. 2026; . doi: 10.1007/s40279-026-02464-x.