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Topical Area: Community and Public Health Nutrition

Community and Public Health Nutrition (Poster Session)

(P24-046-23) Substitution of Sweetened Soymilk for Unsweetened Cow’s Milk and Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Feeding Trials

Monday, July 24, 2023
12:45 PM – 1:45 PM ET
Location: Poster Board 457
Disclosure(s):
Madeline Erlich, RD, PhD(c): Canadian Institutes of health Research (CIHR): Grant/Research Support (Ongoing)
Soy Nutrition Institute: Grant/Research Support (Ongoing)
Diana Ghidanac, RD: No relevant financial relationship(s) with ineligible companies to disclose.
Laura Chiavaroli, MSc, PhD: No relevant financial relationship(s) with ineligible companies to disclose.


Objectives: Although fortified soymilk is recognized by the Dietary Guidelines for Americans and Health Canada as a non-dairy equivalent to cow’s milk, it is at odds with dietary recommendations to reduce ultra-processed foods and added sugars (as soymilk is often made to be a similar sweetness containing 5-7g added sucrose [10-15% daily value] versus 12g lactose in cow’s milk per 250 mL serving). To assess whether sweetened soymilk in substitution for unsweetened cow’s milk impairs intermediate cardiometabolic outcomes, we conducted a systematic review and meta-analysis of randomized controlled feeding trials.

Methods: MEDLINE, Embase, and The Cochrane Central Register of Controlled Trials were searched. We included randomized controlled feeding trials of ≥3 weeks. Two independent reviewers extracted data and assessed risk of bias. Outcomes included established markers of blood lipids, glycemic control, blood pressure, inflammation, adiposity, and liver damage. Data were pooled and expressed as a mean difference (MD) with 95% confidence intervals (95% CI). GRADE assessed certainty of evidence.

Results: Eligibility criteria were met by 10 trials in 277 adults with a range of health statuses. The median dose of soymilk was 602 mL/day (24.5 g protein; 19 g/day or 7 g/250 mL added sugars) and cow’s milk was 538 mL/day (24.5 g protein; 26 g/day or 12 g/250 mL lactose). The substitution of sweetened soymilk for unsweetened cow’s milk reduced LDL-C (MD, -0.22 mmol/L [95% CI, -0.34 to -0.09 mmol/L]) and systolic (-7.51 mmHg [-10.26 to -4.76 mmHg]) and diastolic (-4.08 mmHg [-6.59 to -1.58 mmHg]) blood pressure. There was no effect on HDL-C, non-HDL-C, TG, HbA1c, FPG, 2hPG, fasting insulin, body weight, BMI, body fat %, waist circumference, AST, ALT, or CRP. The certainty of evidence was generally moderate across outcomes.

Conclusions: Sweetened soymilk in substitution for unsweetened cow’s milk does not have an adverse effect on a broad range of intermediate cardiometabolic outcomes. The available evidence provides a good indication that sweetened soymilk providing up to 7 g/250 mL of added sugars (15% DV) may even have advantages for LDL-C and blood pressure reduction. ClinicalTrials.gov identifier, NCT05637866.

Funding Sources: Soy Nutrition Institute (SNI) Global