Plant-Based Nutrition: Navigating Vegetarian and Vegan Options for Toddlers

Plant-Based Nutrition: Navigating Vegetarian and Vegan Options for Toddlers 

Humans are naturally omnivorous, and the consumption of meat and fish has played a significant role in human evolution. However, vegetarianism has deep historical roots in many cultures, especially in India, where plant-based diets (PBDs) have been practiced for thousands of years. In recent decades, PBDs have gained popularity in industrialized countries. Current data shows that 3.4% of Europeans follow a PBD, and in Italy, 9% of families have introduced some form of PBD during infancy (1).  

Data from adults indicate that following a PBD is associated with several health outcomes. Vegetarian and vegan adults, show  lower  cardiovascular disease risk,  and lower prevalence of  obesity, type 2 diabetes, and cancer (2).  Motivations for adopting PBDs include animal welfare, environmental concerns, cultural and religious beliefs, health, and ethics.  The term PBD includes several types of diet. The characteristics of those diet are summarized in table 1 (3) 

Pediatric societies differ in their recommendations regarding PBDs for children. While organizations in the U.S. and Canada support well-planned vegetarian diets for all ages, societies in Germany and Spain recommend omnivorous or at least ovo-lacto vegetarian diets during infancy and early childhood. 

Restrictive PBDs may lack essential nutrients. The more restrictive the diet, the higher the risk of deficiencies. Key nutrients of concern include: Protein and energy, Vitamin B₁₂, Iron, Zinc, Calcium, Vitamin D, DHA/EPA. (4) 

Research shows that vegetarian and vegan children can grow normally if their diets are well-planned. However, vegan children may have higher rates of stunting and wasting, while omnivorous children tend to have higher rates of overweight. 

Protein intake among children on PBDs is generally comparable to those on omnivorous diets, although plant proteins are of lower biological quality. This can be addressed by combining cereals (low in lysine and threonine) with legumes (low in methionine and cysteine) to achieve complete protein profiles. 

Energy intake is also similar between PBD and omnivorous children, with PBDs typically providing more fiber and less sugar. Fat intake in PBDs tends to be lower in saturated fats and higher in polyunsaturated fats. However, plant-based foods do not contain direct sources of DHA and EPA. These essential omega-3 fatty acids must be synthesized from ALA, which requires a balanced intake of omega-6 fatty acids to maintain an appropriate LA/ALA ratio. 

Iron intake is comparable between PBD and omnivorous children, but plant-based iron (non-heme) is less bioavailable due to phytate and oxalate content of vegetal foods. Vitamin C can enhance iron absorption. Vitamin B₁₂ is only present in foods form animal origin, so supplementation is crucial to prevent serious health issues. 

Children on PBDs that exclude dairy are at risk of inadequate calcium and vitamin D intake. Although some plant foods contain calcium, absorption may be hindered by oxalates and phytates. Therefore, it’s important to include calcium-rich foods with low oxalate content. 

A recent position paper from ESPGHAN (4) recommends regular nutritional counseling for children on PBDs. Key recommendations include increasing protein intake, supplementing with plant-based DHA (from algae), and ensuring supplementation with vitamins B₁₂ and D. 

In conclusion, when properly planned and supplemented, PBDs can be safe and healthy for children at any age. However, concerns remain about pediatricians’ readiness to support families choosing these diets. A study in Italy found that 45.2% of parents felt pediatricians lacked adequate knowledge about PBDs, and 77.4% experienced resistance. Only 37.7% of vegetarian-weaned infants received B₁₂ supplements (5). Pediatricians must be trained to support families in making informed dietary choices. 

References