Anuj Maheshwari, Anubha Srivastava, Nishant Kanodia, Rajesh Kesari, Amit Gupta, Ajoy Tewari, Narsingh Verma, Rakesh Parikh, BANSHI D. SABOO, NAGENDRA K. SINGH, Aravinda Jagadeesha, Vanisha Nambiar, MANOJ S. CHAWLA, SUNIL S. GUPTA, Kavita Gupta, Prahlad Chawla, Purvi Chawla, Shubhashree M. Patil, Anita Nambiar, Subodh Jain, Mangesh Tiwaskar, Amit Saraf, Ketan Mehta, Abhisek Raha, Narayan Deogaonkar, Smita Singh, Abhinav Verma, Sanjay Singh, Vijay Viswanathan
Abstract Background: Mass religious gatherings offer unique opportunities for large-scale public health screening. Sadhus, ascetic spiritual practitioners with distinctive lifestyle patterns, represent an understudied subgroup with potentially divergent cardiometabolic risk profiles compared with non-sadhus. Materials and Methods: This cross-sectional study analyzed data from 26,577 adults screened during Maha Kumbh 2025 in Prayagraj, India. Participants were categorized as sadhus ( n = 3,538) or non-sadhus ( n = 23,039) based on self-identification. Demographic characteristics, cardiometabolic risk factors, behavioral patterns, and medication adherence were compared between groups using chi-square tests, t tests, and Mann–Whitney U tests. Results: Sadhus were significantly older (51.0 ± 14.1 vs. 48.2 ± 15.0 years, P < 0.001), more rural (76.0% vs. 61.5%, P < 0.001), and more male (69.3% vs. 66.2%, P < 0.001). Despite a marginally lower body mass index (25.0 ± 4.3 vs. 25.4 ± 4.6 kg/m 2 , P < 0.001), sadhus had a substantially higher prevalence of self-reported diabetes (34.6% vs. 24.1%, P < 0.001), self-reported hypertension (21.8% vs. 15.2%, P < 0.001), and self-reported cardiovascular disease (14.5% vs. 3.8%, P < 0.001). Alcohol consumption (49.6% vs. 15.5%, P < 0.001), tobacco use (45.0% vs. 13.6%, P < 0.001), and medication nonadherence specific to Maha Kumbh travel (36.1% vs. 15.0%, P < 0.001) were markedly elevated among sadhus. Conclusion: Contrary to expectations, sadhus represent a high-risk cardiometabolic subgroup warranting targeted, culturally sensitive screening and preventive health strategies.