As plant-based diets gain popularity among families, researchers uncover the delicate balance of benefits and risks for children, emphasizing the critical role of expert-guided nutrition.
Study: Plant-Based Diets in Pediatric Subjects: Heart-Healthy Option or Dangerous Choice? Image Credit: everst / Shutterstock
A recent study published in the journal Healthcare examined the common plant-based diets (PBDs) in adolescents and children and their benefits and risks in health promotion and disease prevention.
Diets without animal-derived items have become popular among adults. Around 6% of adults in the United States follow a meat-free diet, and 2% and 3% of children aged 8–17 follow vegan and vegetarian (non-vegan) diets, respectively. Children and adolescents often adopt these dietary patterns due to family decisions rather than personal choices. Dietary patterns thought to be heart-healthy for adults may not be appropriate for children. In the present study, researchers analyzed the most common PBDs in adolescents and children and evaluated their benefits, risks, and viability in disease prevention and health promotion during development.
Plant-based dietary patterns
Several types of PBDs are available, each characterized by the extent to which animal items are excluded. For instance, the vegan diet is among the most restrictive, excluding all animal-derived foods. The ovo-vegetarian and lacto-vegetarian diets allow the intake of eggs and dairy products, respectively, whereas the lacto-ovo vegetarian diet permits both. The pescetarian diet permits fish intake.
Further, more stringent variants, such as the raw food diet, the fruitarian diet, and the macrobiotic diet, also exist. People may prefer vegetarian diets for different reasons, including religious, cultural, economic, health, environmental, and ethical reasons. Vegetarian and vegan diets have significantly lower emissions of greenhouse gases and water/land use than meat-based diets. However, these diets often require careful planning to meet nutritional needs, especially for children. PBDs tend to be healthier, with lower environmental impact than animal foods.
Complementary feeding and plant-based diets
Nutritional intake during the first 1,000 days from conception plays a substantial role in long-term health, neurodevelopment, body weight growth, and the predisposition to non-communicable diseases. Complementary feeding (CF) introduces liquid/solid foods when breast milk or infant formula is insufficient to meet nutritional requirements.
CF represents a crucial period during development when epigenetic interventions may have relevant effects later in life. A study reported longer breastfeeding durations in infants on vegan/vegetarian diets than those following omnivorous diets. Longer breastfeeding may increase the risk of specific nutrient deficiencies among infants with PBDs. Potential deficiencies include vitamin B12, calcium, iron, zinc, and omega-3 fatty acids.
A recent study reported that vegetarian meals supplemented with appropriate nutrients may support proper infant growth and development. Vegan diets are not recommended in the first two years of life; however, in the case of irreversible parental choice, careful monitoring of infants, along with regular dietary and medical supervision, is crucial. Neglecting professional guidance may lead to severe health outcomes, including irreversible cognitive impairments.
One study specified a timeline to introduce solid foods for vegan/vegetarian infants. Accordingly, iron-fortified cereals should be introduced first between four and six months; once cereals are tolerated, fruits and vegetables may be started in any order. Protein, such as tofu, legume puree, and soy yogurt, could be started in the seventh or eighth month. Soy-based formulas may also be essential substitutes for infants when breastfeeding is not an option.
The 2020-25 American Dietary Guidelines recommend eggs, soy-based products, dairy products, seeds, nuts, oils, fruits, and vegetables for infants aged 12–24 months who do not consume seafood, meat, or poultry. According to the American Academy of Pediatrics, a well-planned vegetarian diet is a healthy substitute for all developmental phases.
Further, a 2019 report by the Belgian Royal Academy of Medicine concluded that vegan diets were not suitable and advised pregnant/lactating individuals, children, and adolescents not to follow them. Another study similarly suggested that vegan diets should not be recommended until two years of age due to micro- and macro-nutrient deficiencies and consequent delays in growth and neurodevelopment.
Plant-based diets for adolescents and children
The health benefits of vegan diets in adults are not confirmed in adolescents and children. Moreover, there is no basis to claim that an omnivorous diet is superior to pediatric nutrition. A systematic review on PBDs for children underscored the lack of adequate studies for this age group and reported that definitive conclusions about PBD effects were not possible. The review also noted that studies on children often focus on vegetarian diets rather than vegan diets.
Although the study found no harmful effects, it identified risks of nutrient deficiencies. By contrast, another study observed positive effects of PBDs on fiber intake and lipid profiles. Further, a longitudinal cohort study involving nearly 9,000 children aged 6–8 found no significant differences in nutritional and growth status between vegetarians and non-vegetarians, albeit vegetarians were more likely to be underweight.
A Finnish study of 40 children observed micronutrient differences based on their diets. Vegan children had higher fiber, iron, zinc, and folate intake but lower saturated fatty acids and protein intake; they showed a more heart-healthy lipid profile than omnivorous children. Further, vitamin B12 deficiency is common in people on PBDs. Untreated B12 deficiency in infants can result in lasting neurological impairment, even if addressed later.
Zinc and calcium are also deficient in vegan diets. Some vegetables provide absorbable calcium, but the quantity required to reach sufficient calcium levels renders a PBD impractical unless supplements or fortified foods are included.
Concluding remarks
In sum, plant-based dietary patterns are increasingly popular worldwide, and people following them should be under nutritional control and receive adequate vitamin and micronutrient supplementation. Healthcare professionals must provide clear, evidence-based guidance to families choosing PBDs for children. Starting PBDs without proper planning is a significant health risk, and their effects on health should be avoided. Additional, more consistent longitudinal data are needed to examine the health effects of PBDs during development.
