Science & Research

Balancing Limited Diets


Whether families choose a plant-based diet due to lifestyle or food intolerances, or other medical conditions, it is important for healthcare professionals to be familiar with potential nutrient deficits in these diets.  It is important to include dietary sources of omega-3 fats, vitamin D, calcium, iron, zinc, and vitamin B12, among other nutrients, in such diets.   

Suggested Readings:

Baroni L, Goggi S, Battino M. Planning well-balanced vegetarian diets in infants, children, and adolescents: The VegPlate Junior. J Acad Nutr Diet. 2019;119(7):1067-73. Well-balanced vegetarian diets planned with the VegPlate Junior, which include a wide variety of plant foods and reliable sources of vitamin B-12 and vitamin D, are an adequate option for infants, children, and adolescents. Vegetarian diets, because of their favorable content of fiber and essential nutrients, have been shown to be protective against childhood and adolescent obesity. 
Melina V, Craig W, Levin S. Position of the academy of nutrition and dietetics: vegetarian diets J Acad Nutr Diet. 2016;116(12):1970-80. This paper states that appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention of disease. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes. Plant-based diets are more sustainable than animal protein-based diets as they use fewer natural resources and have less detrimental effects on environment. Vegetarians and vegans are at reduced risk for conditions such as heart disease, type 2 diabetes, hypertension, some cancers, and obesity. Low intake of saturated fat and high intakes of vegetables, fruits, whole grains, legumes, soy products, nuts, and seeds are diet characteristics that have favorable effects on glucose control and cholesterol. Vegans need reliable sources of vitamin B-12, such as fortified foods or supplement. 
Baldassarre ME, Panza R, Farella I, et al. Vegetarian and Vegan Weaning of the Infant: How Common and How Evidence-Based? A Population-Based Survey and Narrative Review. Int J Environ Res Public Health. 2020;17(13):4835. This study aimed to assess the prevalence of vegetarian and vegan weaning among Italian families and to provide an up-to-date narrative review of supporting evidence. Authors investigated 360 Italian families using a 40-item questionnaire. The narrative review was conducted searching scientific databases for articles reporting on vegetarian and vegan weaning. Results: 8.6% of mothers follow an alternative feeding regimen and 9.2% of infants were weaned according to a vegetarian or vegan diet. The breastfeeding duration was longer in vegetarian/vegan infants (15.8 vs. 9.7 months; p < 0.0001). Almost half of parents (45.2%) claim that their pediatrician was unable to provide sufficient information and adequate indications regarding unconventional weaning and 77.4% of parents reported the pediatrician’s resistance towards alternative weaning methods. Nine studies were suitable for the review process. These results show that alternative weaning methods are followed by a significant number of families. Since the risk of nutritional deficiencies in the early stages of life is high, pediatricians have a pivotal role in guiding parents and advising them on the most appropriate and complete diet regimen during childhood. Efforts should be made to enhance nutritional understanding among pediatricians as an unsupervised vegetarian or vegan diet can cause severe nutritional deficiencies with possible detrimental long-term effect. 
Messina V, Mangels AR: Considerations in planning vegan diets: children. J Am Diet Assoc. 2001;101: 661–669. This article reviews research on the growth and nutrient intake of vegan children and provides guidance for counseling parents of vegan children. Childhood vegan diets meet or exceed recommendations for most nutrients, and vegan children have increased fiber intake with lower intakes of total fat, saturated fat, and cholesterol than omnivore children. Special attention should be given to dietary practices that enhance absorption of zinc and iron from plant foods. Adequate omega-3 fats sources should be emphasized to enhance DHA synthesis. Dietetics professionals who counsel vegan families should help parents identify good sources of vitamin B-12, riboflavin, zinc, calcium and vitamin D. Therefore, with appropriate food choices, vegan diets can be adequate for children at all ages. 
Bodnar LM, Jimenez EY, Baker SS. Plant-Based Beverages in the Diets of Infants and Young Children. JAMA Pediatr. 2021;175(6):555–556. doi:10.1001/jamapediatrics.2020.5840.This article highlights the need for nutritious options, such as Else Toddler, to provide a nutritionally appropriate plant-based alternative to cow's milk for children 12-24 months old.