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Abstract

Vegetarianism has historically been associated with cardiometabolic benefits and reduced diabetes risk. Despite having the highest prevalence of vegetarians globally, the prevalence of type 2 diabetes in South Asians is amongst the highest globally. This review explores the relationship between vegetarianism and cardiometabolic measures in South Asian populations to clarify this paradoxical relationship. Five databases were searched to identify observational studies published between January 2000 and May 2025 that compared vegetarian diets with non-vegetarian diets and reported cardiometabolic measures. A total of 973 articles were identified, 590 articles were assessed, and 7 studies (n = 184,345) were ultimately included. Overall, each study utilized different dietary intake assessments and reported variable cardiometabolic measures. The three highest-quality studies found that vegetarian adherence was associated with a lower BMI, waist circumference, diastolic blood pressure, lipid levels, and fasting blood glucose compared with non-vegetarian diets. Conclusive findings were limited by the small number of studies, variability in dietary assessment methods, and heterogeneity in the reporting of cardiometabolic measures. These results underscore the importance of conducting more methodologically robust studies to assess cardiometabolic measures and demonstrate the need for culturally consistent dietary assessment tools to reduce inter-study variability and improve dietary reporting in South Asians.