Child Growth and Nutritional Adequacy
White Paper
Abstract
Background: The most common concern of children consuming plant-based diets, particularly vegetarian and vegan diets, is child growth and nutrient adequacy.
Objective & methods: Studies published in the past decade that assessed growth in children (of all ages) in developed countries were analyzed to determine the appropriateness of vegan and vegetarian diets in children. Case reports, studies that did not clearly define dietary patterns, and studies of highly restricted diets (strict raw food, macrobiotic) known to result in nutrient deficiencies were excluded. Guidelines and position statements on vegetarian and vegan diets from various reputable organizations were also reviewed.
Results: Studies suggest that vegan and vegetarian diets result in adequate growth in children. All diets, including omnivorous patterns, may be low in several nutrients, including vitamin D and calcium, and plant-based diets, including vegan and vegetarian diets, are at a higher risk for vitamin B12 deficiency (supplements are usually necessary).
Conclusion: The nutritional needs of growing children and adolescents can generally be met through a balanced, plant-based diet, but they require patient education.
Research
A systematic review by Sutter et al. analyzed the health and growth impacts of vegan diets in children. With a small percentage of outliers, they found that vegan children showed normal growth and were less often obese. The children also obtained all the nutrients examined, particularly with the use of supplements and/or fortified foods. However, proper planning by caregivers is needed to prevent deficiencies, particularly with vitamin B12, calcium, and vitamin D.
Nutrient Status and Growth in Vegan Children
A recent food modeling study looked at the nutritional adequacy of dairy-free and vegan diets (for non-pregnant non-lactating adults) by comparing them to the recommended vegetarian dietary pattern of the Dietary Guidelines for Americans. Their models used substituted soy products for dairy (typically fortified in the US) and legumes, nuts, and seeds for eggs. They show minimal changes from the current vegetarian recommendations, with both models meeting dietary reference intakes for nearly all populations. They also discuss supplementation, fortification, and bioavailability. We look forward to seeing this USDA-funded and authored research incorporated into the next Dietary Guidelines for Americans to support that balanced vegan and dairy-free diets can be nutritionally adequate with simple modifications of the current guidelines.
A vegan diet modeled using available US food substitutions for dairy and eggs. Can it meet nutrient recommendations?
Craig et al. reviewed the scientific data on plant-based diets and their role in cardiovascular disease, cancer, diabetes, obesity, and osteoporosis. They provide evidence that consuming plant-based diets is safe and effective for all life stages, from pregnancy and lactation to childhood and adulthood. They discuss the adequacy of several nutrients, including vitamin B12, calcium, vitamin D, iron, zinc, and omega-3 fats, as well as the use of fortified foods and/or supplements and appropriate food choices. Finally, guidelines are suggested for health professionals working with clients consuming plant-based diets.
Effects of plant-based diets on health and nutrition (with health professional guidelines)
Measuring micronutrient status is challenging. Nutrients can be in circulation, stored, and bound to enzymes, proteins, or other cellular components, complicating the assessment of nutritional status. Also, many nutrients are homeostatically regulated or are affected by conditions such as inflammation, compounding the difficulty in status assessment. Furthermore, biomarker cut-off values that suggest nutrient insufficiency, deficiency, and excess are not always straightforward or agreed upon by experts.
A comprehensive report from the Biomarkers of Nutrition for Development (BOND) details the current state of biomarker research evaluating nutritional status in individuals and populations for six nutrients:
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Vitamin A
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Vitamin B12
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Folate
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Iodine
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Iron
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Zinc
These reports provide information on a range of biological markers (e.g., serum, urine) with commonly used deficiency cut-off values and caveats of use. For example, clinicians must understand that cut-off values for determining B12 status in infants, children, and during pregnancy are different from those used for adults. An incorrect diagnosis can occur when biomarker values are misunderstood, or labs fail to provide cut-off values for different groups.
These papers provide the most comprehensive information on these nutrient biomarkers published to date. We summarize many publications for quick reference for several nutrients in our Nutrient Library.