Impact of Plant-Based Drinks on Cardiometabolic Outcomes: A Systematic Review and Network Meta-analysis

The global demand for plant-based milk alternatives is rising, but their health effects compared with cow milk remain uncertain. Therefore, we conducted a systematic review and network meta-analysis (NMA) to compare different plant-based drinks with each other and with cow's milk on cardiometabolic outcomes. A systematic search was conducted in 3 electronic databases (MEDLINE, Cochrane CENTRAL, and Web of Science) and 2 trial registries. Randomized controlled trials (RCTs) with a minimum duration of 3 wk comparing different plant-based drinks (e.g., soy, rice, and oat) with another or with cow milk were included. We rated risk of bias using RoB 2.0 tool. Anthropometric outcomes, blood lipids, fasting glucose, and blood pressure were pooled using mean differences (MDs). NMAs were performed using a random-effects model. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Fourteen RCTs involving 543 participants were included, comparing soy-, rice-, oat drinks, and cow milk. Overall, few differences were observed comparing plant-based drinks with another or with cow milk on cardiometabolic outcomes. Replacing 500 mL/d of cow's milk with soy drink may reduce low-density lipoprotein (LDL) cholesterol [MD: -0.47 mmol/L (-0.85; -0.10); low certainty], but showed no effect for high-density lipoprotein (HDL) cholesterol [MD: 0.01 mmol/L (-0.03; 0.05); moderate certainty]. Oat drink may slightly reduce total cholesterol compared with cow milk and rice drink [MD: -0.12 mmol/L (-0.24; -0.01); MD: -0.23 mmol/L (-0.40; -0.05)], but the evidence is very uncertain. Replacing 500 mL/d of cow milk with soy drink may reduce systolic and diastolic blood pressure [MD: -8.23 mmHg (-10.90; -5.55); MD: -7.82 mmHg (-13.61; -2.02); low certainty]. Our findings suggest that evidence for cardiometabolic differences between plant-based drinks and cow milk is limited. However, soy drink may lower blood pressure and LDL cholesterol compared with cow milk. The certainty of evidence was mainly low, highlighting the need for high-quality RCTs. This study was registered at PROSPERO as CRD42025638028.