Growth, body composition, and cardiovascular and nutritional risk of 5- to 10-y-old children consuming vegetarian, vegan, or omnivore diets

Abstract

Background Plant-based diets (PBDs) are increasingly recommended for human and planetary health. However, comprehensive evidence on the health effects of PBDs in children remains incomplete, particularly in vegans. Objectives To quantify differences in body composition, cardiovascular risk, and micronutrient status of vegetarian and vegan children relative to omnivores and to estimate prevalence of abnormal micronutrient and cholesterol status in each group. Methods In a cross-sectional study, Polish children aged 5–10 y (63 vegetarian, 52 vegan, 72 matched omnivores) were assessed using anthropometry, deuterium dilution, DXA, and carotid ultrasound. Fasting blood samples, dietary intake, and accelerometry data were collected. Results All results are reported relative to omnivores. Vegetarians had lower gluteofemoral adiposity but similar total fat and lean mass. Vegans had lower fat indices in all regions but similar lean mass. Both groups had lower bone mineral content (BMC). The difference for vegetarians attenuated after accounting for body size but remained in vegans (total body minus the head: –3.7%; 95% CI: –7.0, –0.4; lumbar spine: –5.6%; 95% CI: –10.6, –0.5). Vegetarians had lower total cholesterol, HDL, and serum B-12 and 25-hydroxyvitamin D [25(OH)D] without supplementation but higher glucose, VLDL, and triglycerides. Vegans were shorter and had lower total LDL (–24 mg/dL; 95% CI: –35.2, –12.9) and HDL (–12.2 mg/dL; 95% CI: –17.3, –7.1), high-sensitivity C-reactive protein, iron status, and serum B-12 (–217.6 pmol/L; 95% CI: –305.7, –129.5) and 25(OH)D without supplementation but higher homocysteine and mean corpuscular volume. Vitamin B-12 deficiency, iron-deficiency anemia, low ferritin, and low HDL were more prevalent in vegans, who also had the lowest prevalence of high LDL. Supplementation resolved low B-12 and 25(OH)D concentrations. Conclusions Vegan diets were associated with a healthier cardiovascular risk profile but also with increased risk of nutritional deficiencies and lower BMC and height. Vegetarians showed less pronounced nutritional deficiencies but, unexpectedly, a less favorable cardiometabolic risk profile. Further research may help maximize the benefits of PBDs in children.

Nutrient Intake and Status of German Children and Adolescents Consuming Vegetarian, Vegan or Omnivore Diets: Results of the VeChi Youth Study

“…In contrast to a recent study [ 14 ], there was no elevated risk for iron deficiency in the vegetarian or vegan subgroup. Obviously, the higher iron intake observed in the vegan participants of the VeChi Youth Study could compensate for the lower bioavailability of non-haem iron in plant-based diets (average iron bioavailability is 5–12% in a vegetarian diet, 14–18% in a mixed diet) [ 56 , 57 ].…”

“…However, the prevalence of low concentrations was high, as in representative studies in Germany [ 47 ], partly because in Germany, unlike for example in the USA [ 6 ], supplementation is not recommended for children even with low vitamin D intakes. The aforementioned Polish study confirmed the relevance of vitamin D supplementation in children consuming plant-based diets [ 14 ]. However, vitamin D is strongly associated with calcium absorption and metabolism.…”

“…Studies indicate that vegetarian, including vegan, adults have a lower bone mineral density [ 49 ] and a higher risk for fractures [ 50 ]. Two cross-sectional studies confirmed a lower bone mineral density among vegetarian and/or vegan children [ 12 , 14 ]. However, in addition to calcium and vitamin D, several other dietary and non-dietary factors affect bone health and the relationship of vegetarian and vegan food patterns and bone health is complex and not yet fully understood.…”

“…Obviously, the use of vitamin B12 supplements was sufficient to ensure an adequate vitamin B12 status for the majority (>90%) of the vegan children and adolescents in our sample, even with a mean duration of a vegan diet of four years. It should be noted that the prevalence of supplementation of vitamin B12 was considerably higher than among vegetarian and vegan participants of a recently published study with Polish 5–10 year old children (vegetarian: 35%, vegan 44%) [ 14 ]. However, in our sample there was a tendency toward an insufficient vitamin B12 supply among the vegetarian subgroup.…”

“…To our knowledge, after the publication of the aforementioned review, only a few more studies on vegetarian and vegan diets during growth have been conducted. Three of them were published by a Polish working group examining in a cross-sectional design the vitamin status, inflammation and bone health in vegetarian and/or vegan children [ 12 , 13 , 14 ]. Another two cross-sectional studies from Scandinavia compared the dietary intake and nutrient status of Swedish vegans and omnivores aged 6–20 years ( n = 30) [ 15 , 16 ], and of Finnish children ( n = 40, median age 3.5 years) on a vegan, vegetarian (including fish-eaters) or omnivore diet [ 17 ].…”