Impacto de las bebidas vegetales en los resultados cardiometabólicos: una revisión sistemática y un metanálisis en...

The global demand for plant-based milk alternatives is rising, but their health effects compared to cow's 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 three electronic databases (MEDLINE, Cochrane CENTRAL, Web of Science) and two trial registries. Randomized controlled trials (RCTs) with a minimum duration of three weeks comparing different plant-based drinks (e.g., soy, rice, oat) with another or with cow's 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 GRADE approach.

Fourteen RCTs involving 543 participants were included, comparing soy-, rice-, oat drinks, and cow´s milk. Overall, few differences were observed comparing plant-based drinks with another or with cow's milk on cardiometabolic outcomes. Replacing 500 ml/d of cow´s milk with soy drink may reduce LDL-cholesterol (MD: -0.47 mmol/L [-0.85; -0.10]; low certainty), but showed no effect for HDL-cholesterol (MD: 0.01 mmol/L [-0.03; 0.05]; moderate certainty). Oat drink may slightly reduce total cholesterol compared to cow's 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's 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's milk is limited. However, soy drink may lower blood pressure and LDL-cholesterol compared with cow's milk. The certainty of evidence was mainly low, highlighting the need for high-quality RCTs.

CRD42025638028.