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What does the evidence say about vegan diets in children?

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2792 (Published 15 November 2021) Cite this as: BMJ 2021;375:n2792

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Re: What does the evidence say about vegan diets in children?

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Thank you for highlighting the growing interest in raising children on a vegan diet for reasons mainly related to animal justice and concerns for planetary health. The study discussed is just one of several within the medical literature. It’s worth noting that despite the findings of a shorter height and lower bone density in these vegan children from Poland, the measurements are well within the expected reference range for age. We know that cow’s milk consumption does provide an initial growth advantage in children given its primary purpose of supporting the rapid growth of baby calves, but this is not necessary a desirable outcome for human children. There are no data to suggest that final height achieved is negatively affected in vegan children or that it is of any clinical relevance. In addition, our conventional normal range for height can only be related to those following an omnivorous diet. Regarding bone health, only a third of the vegan children in the study were supplementing appropriately with vitamin D (not specifically a vegan issue) and a third were not supplementing with vitamin B12 (essential on a vegan diet). Median calcium intake was only 376mg per day whereas in the UK, for this age group, 550mg of calcium is recommended. This merely highlights the need for vegan diets, as with any chosen diet pattern, to be planned appropriately.

The study showed vegan children had lower fat mass, blood cholesterol and fasting glucose levels. Vegan children had higher intakes of some beneficial nutrients including fibre, vitamin C, folate, carotenoids, unsaturated fats, magnesium, all a reflection of the consumption of healthy plant foods. In contrast, those following an omnivorous diet were consuming higher than recommended amounts of saturated fat, free sugar and insufficient fibre. Given that atherosclerosis starts in childhood, these findings are potentially the advantage of a vegan diet, especially since we know that meat-free and vegans diets are associated with a lower risk of ischaemic heart disease in adults (1–3). In addition, a healthier body weight is essential for combating the rising rate of type 2 diabetes in children and we know that a vegan diet significantly reduces the risk of type 2 diabetes (4,5).

In contrast to this one study, we have several others reporting health outcomes in modern day vegans. This includes the German VeChi youth study in which the health of a larger number of vegan children aged 6–18 yrs (n=115) was assessed (6). Vegans were appropriately supplementing with B12 and Vitamin D with much better calcium intakes and the study concluded that ‘a vegan diet can meet the nutrient requirements in childhood and adolescence’. In addition, a previous report from the same cohort reported normal growth in vegan children (7). A recent review of vegan diets in children brings together data from 437 publications with most studies confirming that vegan children have normal growth rates, well within the normal range and a number of benefits that relate to a lower intake of saturated fat, the increased consumption of fibre and phytonutrients and a lower body weight and body fat (8).

As health professionals we need to support parents raising their families on a vegan diet, especially since most are motivated by a desire to live a kinder more compassionate life on this planet. At present, data suggests that parents are often reluctant to admit to their doctors that that are raising vegan children for fear of being adversely judged (9). Understanding patients’ dietary patterns and preferences is important and relevant to all specialities and with all aspects of medical care we should approach this in an open and non-judgmental manner, respecting the views of our patients and their family members. This requires a basic level of knowledge around vegan diets and the ability to sign post patients/clients to reputable resources. I highly recommend the book ‘Feeding Your Vegan Child’ written by NHS dietitian Sandra Hood, who herself has been vegan for over 30 years and raised a vegan family.

References

1. Tong, T. Y. N. et al. Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: Results from the prospective EPIC-Oxford study. BMJ (2019). doi:10.1136/bmj.l4897
2. Dinu, M., Abbate, R., Gensini, G. F., Casini, A. & Sofi, F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Crit. Rev. Food Sci. Nutr. (2017). doi:10.1080/10408398.2016.1138447
3. Jabri, A. et al. Meta-analysis of effect of vegetarian diet on ischemic heart disease and all-cause mortality. Am. J. Prev. Cardiol. 7, (2021).
4. Papier, K. et al. Vegetarian diets and risk of hospitalisation or death with diabetes in British adults: results from the EPIC-Oxford study. Nutr. Diabetes (2019). doi:10.1038/s41387-019-0074-0
5. Tonstad, S. et al. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr. Metab. Cardiovasc. Dis. 23, (2013).
6. Alexy, U. et al. Nutrient intake and status of german children and adolescents consuming vegetarian, vegan or omnivore diets: Results of the vechi youth study. Nutrients 13, (2021).
7. Weder, S., Hoffmann, M., Becker, K., Alexy, U. & Keller, M. Energy, macronutrient intake, and anthropometrics of vegetarian, vegan, and omnivorous children (1-3 years) in Germany (VeChi diet study). Nutrients (2019). doi:10.3390/nu11040832
8. Sutter, D. O. & Bender, N. Nutrient status and growth in vegan children. Nutrition Research 91, (2021).
9. Bivi, D. et al. Raising children on a vegan diet: Parents’ opinion on problems in everyday life. Nutrients 13, (2021).

Competing interests: Founder of Plant-Based Health Professionals UK and Co-founder of Plant Based Health Online, both Community Interest Companies

22 November 2021
Shireen Kassam
Doctor
King's College Hospital and Winchester University
Hampshire