The aim of the review was to evaluate which diets are associated with higher TMAO levels. Several studies have shown that plasma and urinary levels of trimethylamine N-oxide (TMAO) are a reliableindicator of cardiovascular disease risk. Diet certainly has a strong influence on TMAO levels, but there is stilluncertainty about which diet is the most effective in reducing this risk factor. PubMed, Web of Science and Scopus were searched for studies that were published up until July 1, 2021 usingspecific keywords. In total, 447 studies were evaluated, of which papers on individual foods or supplements, orconducted in children, in vitro or in animal model studies were excluded. Twenty-five studies were included in thisreview. Three studies showed that caloric restriction and (visceral) weight loss improve TMAO levels. Six out ofeight studies revealed beneficial effects of plant-based diets on plasma or urinary TMAO concentrations. Most ofthe studies demonstrated that a diet high in protein, particularly of animal origin, such as diets rich in fish or redmeat, have negative effects on TMAO levels. Most studies that have evaluated the relationship between diet andplasma or urinary concentrations of TMAO seem to indicate that plant-based diets (Mediterranean, vegetarian andvegan) are effective in improving TMAO levels, while animal-based diets appear to have the opposite effect.Further long-term studies are needed to assess whether vegetarian or vegan diets are more effective than theMediterranean diet in reducing TMAO levels.