In a recent systematic review published in the journal Nutrients, Researchers from the United Kingdom (UK) reviewed current evidence on increasing consumption of plant-based diets (vegan and vegetarian) among children in high-income settings, explored their associations with child health outcomes, and provided a roadmap for practice.
Study: Plant-based diets in children: global trends, health outcomes and a roadmap for urgent practice recommendations and research—A systematic review. Image credit: Chay_Tee / Shutterstock
Record
The global shift to a plant-based diet, driven by environmental and health concerns, is impacting children’s health. The increasing adoption of plant-based diets, including vegan and vegetarian diets, is occurring in high-income countries. Limited data on children’s health outcomes reveal potential risks, such as stunted growth and nutrient deficiencies, with modern plant-based alternatives being over-processed. Concerns remain about the impact of additives on the microbiome and preliminary associations with cardiovascular disease and cancer risk. Heterogeneous plant-based dietary guidelines for children reflect gaps in nutritional advice. Urgent research is needed to ensure the safety of these diets for children, aligning dietary recommendations worldwide. Therefore, the researchers in this review aimed to analyze trends in plant-based diets among children, assess the health outcomes of vegetarian and vegan diets, assess current heterogeneity in dietary advice, and propose research questions for establishing safe guidelines for the implementation of these diets. to the children.
Secular trends in plant-based diets in children
The prevalence of plant-based diets, including veganism, has increased significantly in high-income countries. In the past decade, Germany has seen a 15-fold increase in the number of vegans and in the UK, 4.5% of the population identified as vegetarian or vegan in 2019, a 50% increase. Similar trends are seen in Western Europe, the United States of America (USA) and Australia, where up to half of the population is reducing their intake of animal products. Children are also adopting these dietary patterns, with 8% of UK children identifying as vegan and 13% as vegetarian, according to a 2021 survey. The rise in plant-based food sales worldwide further reflects this growing trend.
Associations of plant-based diets with child health outcomes (1980-2013)
Previous studies, often cross-sectional with small samples, showed that children on meat-free diets tended to have comparable or slightly lower anthropometric measures, altered bone metabolism, and varied micronutrient status. However, the evidence remains insufficient to draw firm conclusions about health outcomes. There is also a lack of studies assessing serum micronutrient status in vegan children.
Associations of plant-based diets with child health outcomes (2013–2023)
Although the anthropometric indices of vegetarian children are in line with or slightly below the reference group, vegan children often show lower weight, height and fat than omnivores, with a slightly increased risk of stunting and wasting, affecting a limited proportion. Data for vegetarian children suggest a trend towards lower bone mineral content and density. For vegan children, the lower values persisted even after adjustment for bone and body size, accompanied by altered indices of bone metabolism.
Both vegetarian and vegan children show signs of vitamin B12 deficiency without supplementation, with about 30% not taking supplements. In addition, they have lower iron stores, increased risk of vitamin D deficiency, and potentially inadequate iodine intake. Vegans may also have lower levels of certain nutrients, particularly fat-soluble vitamins. Children on vegan diets show a more favorable lipid profile compared to omnivores, whereas evidence for vegetarian diets is inconsistent and outcome specific. Available evidence is limited and fair to poor quality, but reveals consistent associations of plant-based diets with health outcomes in children.
Summary of the effects of vegetarian and vegan diets on a range of child health outcomes
Conflicting position statements from medical and nutritional institutions around the world
International guidelines for vegetarian and vegan diets for children vary, with the US and UK supporting well-planned vegan diets. On the other hand, many European countries express caution, emphasizing the risks and the need for constant medical monitoring. Discrepancies in these guidelines suggest the potential impact of plant-based diets beyond health concerns, possibly linked to environmental or animal welfare issues.
Roadmap for future research
Key research questions remain regarding the varying health effects of plant-based diets at different developmental stages, the effects of supplementing bone-supporting nutrients, the consequences of emerging highly processed plant foods, and potential long-term health effects. Practice recommendations are urgently needed to provide basic training to health professionals, introduce tailored dietary guidelines that adapt to local habits, and establish clear regulations on nutritional transparency and suitability of highly processed plant alternatives for children.
conclusion
In conclusion, children who adopt plant-based diets may have cardiometabolic benefits, but face potential risks of nutritional deficiencies that may affect growth, bone health, and developmental outcomes. The heterogeneity in dietary advice reviewed in the study calls for harmonization, urging further research and immediate implementation of practice recommendations for the safe implementation of vegan and vegetarian diets in children globally.
