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

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. : © The Author(s) 2026.