Does a Vegetarian Eating Pattern Affect a Child’s Nutrition Status and Growth?
A 2022 paper, Vegetarian Diet, Growth, and Nutrition in Early Childhood: a Longitudinal Cohort Study (1), has gained traction on social media. Vegetarian eating patterns are popular with children (and adults) for a variety of reasons and have recently received additional attention for their impact on the sustainability of our food system (2-4).
The PEN® Team took a closer look at the study to assess if the current PEN recommendations related to children and vegetarian eating are up to date with this latest evidence.
This Canadian-focused study examined 8,907 healthy children aged six months to eight years who were part of a longitudinal cohort study (TARGet Kids!
) between 2008 and 2019 (1). The study looked at the relationship of a vegetarian diet on child growth, micronutrient stores and serum lipids.
The children’s mean age at baseline was 2.2 years and they were followed for an average of 2.8 years. Compared to children without a vegetarian diet (n=8659), children with a vegetarian diet (n=248) had longer breastfeeding duration and were more likely to have Asian ethnicity (parent-reported as West Asian, South Asian, East Asian and Southeast Asian); otherwise baseline characteristics were similar.
Linear mixed-effect modeling was used to evaluate the relationships between a vegetarian diet and BMI z-score (zBMI), height-for-age z-score, serum ferritin, 25-hydroxyvitamin D (25(OH)D) and serum lipids. Generalized estimating equation modeling was also used to explore weight status categories and biochemical outcomes using cut-points. The study also assessed if cow’s milk intake or a child’s age affected the relationships.
When reviewing the data, the authors found (1):
- No evidence of a relationship between vegetarian eating and child growth (mean zBMI, height-for-age z-score), serum ferritin, 25(OH)D or serum lipids. This finding challenged the authors' hypothesis that children following vegetarian diets would have lower serum ferritin and 25(OH)D, based on previous studies that found an association. The authors pointed out that in previously conducted studies, which had smaller sample sizes, children were followed until they were 18 years of age; the current study may have been too short to detect insufficiency. There are also considerations of cultural differences in vegetarian dietary patterns compared with nonvegetarian diets between European countries and Canada.
- Children following a vegetarian diet were more likely to be underweight (zBMI <-2) compared to normal weight (odds ratio 1.87, 95%CI 1.19 to 2.96, P=0.007).
- Children with a vegetarian diet and little to no cow’s milk intake had modestly lower serum lipids (non-HDL cholesterol, total cholesterol and LDL cholesterol) than a non-vegetarian diet, but lipid levels in children who drank 500 mL (2 cups) of milk a day were similar among vegetarians and non-vegetarians. This study identified a stronger relationship between cow’s milk intake and serum lipids than previous research.
One of the study’s major reported limitations was that the researchers did not assess the quality of the vegetarian diets (1). The survey only provided a check box for parent-reported responses if their children followed a ‘vegetarian diet’ or ‘vegan diet’ without further descriptors. There were too few children with a vegan diet type (n=25) to analyze this group separately. Other acknowledged limitations included the small proportion of young children included in the study (<20% of the sample was under one year of age) and the relatively short follow-up period (average < 3 years).
The authors concluded that while children who followed a vegetarian diet had similar growth and biochemical nutrition measures as children who consumed non-vegetarian diets, they had a higher odds of underweight weight status, suggesting the need for careful dietary planning of vegetarian diets (1).
This study’s findings (1) align with the current evidence within the PEN System. Well planned vegetarian and/or vegan diets containing a complement of vegetables, fruit, whole grains, legumes, nuts and seeds provide the required nutrients for all lifecycle stages, from infancy to older adulthood (5,6).
Dietitians working with children and families who are considering or following vegetarian diets must carefully plan for nutrition assessment and related counselling considerations, such as:
- vitamin B12, iron and zinc when animal protein intake is absent (2,5)
- calcium, vitamin D and omega-3 fatty acids (DHA and EPA) when milk and eggs are eliminated in the diet, in addition to meat protein (2,6)
- the growth monitoring of children following vegetarian diets, as children do tend to be leaner (5).
See Additional Content:
*Note: both of these fact sheets are currently being updated
- Elliott LJ, Keown-Stoneman CDG, Birken CS, Jenkins DJA, Borkhoff CM, Maquire JL. Vegetarian diet, growth, and nutrition in early childhood: a longitudinal cohort study. Pediatrics. 2022 May;e2021052598. doi: 10.1542/peds.2021-052598. Online ahead of print. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/35499383/
- Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: vegetarian diets. J Acad Nutr Diet. 2016 Dec;116(12):1970-80. doi: 10.1016/j.jand.2016.09.025. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/27886704
- Stahler C, Mangels R. 8–18-year-olds: how many are vegetarian and vegan? The Vegetarian Resource Group. 2014;4. Available from: https://www.vrg.org/journal/vj2014issue4/2014_issue4_poll_results.php
- Dietitians of Canada. Sustainable Diets and the Environment Background. In: Practice-based Evidence in Nutrition® [PEN]. [cited 2022 May 17]. Available from: https://www.pennutrition.com/KnowledgePathway.aspx?kpid=24840&trid=27502&trcatid=38. Access only by subscription. Click Sign Up on PEN login page.
- Dietitians of Canada. Do vegetarian and/or vegan diets support normal growth and development in infants, children and adolescents? In: Practice-based Evidence in Nutrition® [PEN]. [cited 2022 May 17]. Available from: https://www.pennutrition.com/KnowledgePathway.aspx?kpid=2709&pqcatid=145&pqid=28432. Access only by subscription. Click Sign Up on PEN login page.
- Dietitians of Canada. Do vegetarian and vegan diets support bone health? In: Practice-based Evidence in Nutrition® [PEN]. [cited 2022 May 17]. Available from: https://www.pennutrition.com/KnowledgePathway.aspx?kpid=2709&pqcatid=145&pqid=3848. Access only by subscription. Click Sign Up on PEN login page.