This paper reviews the patterns observed in the diversity and structure of the macrofauna benthic community under the influence of fish farming. First, we explain the effects of organic enrichment on the sediment and the consequences for the inhabiting communities. We describe the diversity trends in spatial and temporal gradients affected by fish farming and compare them with those described by the Pearson and Rosenberg model. We found that in general terms, the trends of diversity and other community parameters followed the Pearson and Rosenberg model but they can vary to some extent due to sediment local characteristics or to secondary disturbances. We also show the different mechanisms by which wild fish can affect macrofauna diversity patterns under fish farming influence. In addition, we comment the importance of the macrofauna diversity in the ecosystem functions and propose some guidelines to measure functional diversity related to relevant processes at ecosystem level. We propose more research efforts in the main topics commented in this review to improve management strategies to guarantee a good status of the diversity and ecosystem functioning of sediments influenced by fish farming.