This study was a systematic review with meta-analysis examining the efficacy of carbohydrate (CHO) ingestion compared with placebo (PLA) on endurance exercise performance in adults. Relevant databases were searched to January 2011. Included studies were PLA-controlled, randomized, crossover designs in which CHO ingestion not exceeding 8% and between 30 and 80 g/h during exercise of ≥1 h was evaluated via time trial (TT) or exercise time to exhaustion (TTE). The between-trial standardized mean differences [effect size (ES)] and pooled estimates of the effect of CHO ingestion were calculated. Of the 41,175 studies from the initial search, 50 were included. The ES for submaximal exercise followed by TT was significant (ES = 0.53; 95% CI = 0.37-0.69; P < 0.001) as was the ES for TT (ES = 0.30; 95% CI = 0.07-0.53; P = 0.011). The weighted mean improvement in exercise performance favored CHO ingestion (7.5 and 2.0%, respectively). TTE (ES = 0.47; 95% CI = 0.32-0.62; P < 0.001) and submaximal exercise followed by TTE (ES = 0.44; 95% CI = 0.08-0.80; P = 0.017) also showed significant effects, with weighted mean improvements of 15.1 and 54.2%, respectively, with CHO ingestion. Similar trends were evident for subanalyses of studies using only male or trained participants, for exercise of 1-3 h duration, and where CHO and PLA beverages were matched for electrolyte content. The data support that ingestion of CHO between 30 and 80 g/h enhances endurance exercise performance in adults.