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Meeting the Nutritional Needs of Children with a Vegetarian Diet
By Susan M. Parlato
Types of Vegetarian Diets and Foods Excluded
Type of Vegetarian Diet
Foods Excluded
Semi- or partial-vegetarian Red meat
Lacto-ovo-vegetarian Meat, poultry, fish, seafood
Lacto-vegetarian Meat, poultry, fish, seafood, eggs
Vegan (total vegetarian) Meat, poultry, fish, seafood, eggs, dairy products (may exclude honey)
Macrobiotic Meat, poultry, eggs, dairy, seafood, fish (fish may be included in the diets of some macrobiotic vegetarians
Vegetarianism During Childhood
Young children usually follow their parents’ eating practices
Preadolescents may choose to follow a vegetarian diet for the following reasons:animal welfareecologythe environment
Vegetarianism During Adolescence
About 4% of adolescents report following a vegetarian diet
Reasons why adolescents adopt a vegetarian lifestyle include:cultural or religious beliefsmoral or environmental concernshealth beliefsa means to restrict calories and/or fat intakemeans of exerting independence by
adopting eating behaviors that differ from those of the family
Benefits of a Well-Planned Vegetarian Diet
A vegetarian diet is nutritionally adequate and appropriate for all stages of life
Decreased risk for:coronary heart diseaseobesityhypertensiontype-2 diabetesosteoporosis
Vegetarians consume fewer overall calories, a lower proportion of calories from fat (particularly saturated fat) and cholesterol
Vegetarian have higher intakes of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals than non-vegetarians
Negative Effects of a Poorly Planned Vegetarian Diet
Stunted growthImpaired immune functionEffects on energy metabolismOsteoporosisIron-deficiency anemiaImpaired brain function Vision impairment
Possible Deficiencies in a Vegetarian and Vegan Diet
EnergyProteinEssential fatty acidsVitamins B12 and DMinerals:
CalciumIronZinc
EnergyAs a vegetarian diet becomes more
restrictive, the energy intake requirements become more difficult to attain
The vegetarian diet is a bulky one that can restrict energy intake in children
Appropriate energy intake may be a concern in adolescents who practice vegetarianism as a means of losing weight
Getting Adequate Daily Energy through Concentrated Sources of Energy
Soy productsNuts and seedsNut buttersGrain productsProtein powders
ProteinTotal protein in vegetable-based
foods is lower than in animal sources
Plant protein is less digestible than animal protein
Many vegetable proteins are deficient in one or more essential amino acids
Vegetarian and Vegan Sources of Protein
Whole grainsQuinoaTofu and other soy productsLegumes, lentils, beansNuts, seeds and nut buttersSeitan, veggie burgers and meat
substitutesEggs and dairy products are excellent
protein sources for lacto-ovo vegetarians and lacto-vegetarians respectively
Essential Fatty Acids (EFAs)
There are two EFAsLinoleic acid (LA)Alpha linolenic acid (ALA)
Humans can convert LA and ALA to more physiologically active fatty acidsLA to arachidonic acid (AA) ALA to EPA and DHA
Arachidonic acid, EPA and DHA are necessary for:Cell membrane functionProper development and functioning of the
brain and nervous system
Daily Recommended Intakes of LA and APA
LA (g) ALA (g)
Males
9-13 years 21 1.2
14-18 years 16 1.6
Females
9-13 years 10 1.0
14-18 years 11 1.1
Good Sources of EPAsTo maximize production of EPA and DHA,
include good sources of ALA such as:Flaxseed and flaxseed oilWalnuts and walnut oilCanola oilSoybeans and soybean oilTofu
• DHA can be obtained in the diet through:Foods fortified with DHA from microalgaeSupplements containing DHA from microalgae
Vitamin B12 Vitamin B12 is primarily found in animal
productsIt is necessary for red blood cell formation and
nerve functionThe body needs only small amounts and it can
be stored in large amountsDeficiency can take a long time to develop,
however once developed, it results in irreversible nerve damage
Deficiency may be associated with:impaired cognitive performance in adolescencespatial ability short-term memory
Sources of Vitamin B12 Vegetarians can obtain enough vitamin
B12 from dairy products and eggs, if they include these in their diet
Vegans can obtain vitamin B12 from:Nutritional yeast Fortified soy milk Fortified meat analoguesFortified energy barsVitamin B12 supplements (children 9-13
years, 1.8mg/day; children 14-18 years, 2.4mg.day
Vitamin DWhy is it important? Required to absorb calcium from the digestive tract Incorporates calcium into bones and teethWhy are vegetarians and vegans at risk for deficiency? The best sources–fortified milk, egg yolks and liver–are
all of animal origin The body makes vitamin D from sunlight on the skin People regularly exposed to sunlight can get enough
vitamin D without having any come from food Sun exposure can be limited by several factors including
dark skin pollution northern latitudes.
• If sun exposure is limited and there are no animal products in the diet a vitamin D supplement is needed
Vegetarian and Vegan Sources of Vitamin D
Vegans:Fortified vegan milks Fortified vegan margarineDirect sunlight (if possible)Supplementation (5mg/day for males
and females age 9-18)Some vegetarians can consume these
sources of Vitamin D:Fortified dairy milkEgg yolks
CalciumCalcium is needed for: strong bones and teeth normal blood clotting normal muscle and nerve function
Adolescence is a critical period for bone development
Calcium retention is higher at this point in life than any other time
Failure to consume adequate calcium can result in increased risk for the development of osteoporosis later in life.
Recommended intake for children 9-18 years of age is 1300mg
Vegetarian and Vegan Sources of Calcium
Vegan sources of Calcium:Blackstrap molassesLeafy greens Calcium-fortified orange juiceCalcium-fortified vegan milksCommercial soy yogurt, plainTofu processed with calcium sulfateBeansVegetarians:dairy products
Iron Iron combines with protein to form hemoglobin, the
substance in the blood that carries oxygen and carbon dioxide
Adequate intake of iron is necessary to prevent anemia
Iron is found in animal and plant foods, but the iron in animal foods (heme iron) is more easily absorbed by the body then non-heme iron found in plants
Dietary fiber, phytates and tannins found in plants may inhibit absorption
For these reasons, vegetarians may be at a higher risk for developing iron deficiency
Recommended iron intake for males 12-19 years is 19.6mg/day; females 12-19 years, 13.3mg/day
Sources of Iron for Vegetarians and Vegans
Blackstrap molasses Soybeans, cooked Legumes, such as lentils, black beans, and kidney beans Leafy greens such as spinach, Swiss chard, turnip greens
and beet greens Bulgur Quinoa Dried fruits such as apricots and raisinsImportant Fact!Eat plant sources of iron at the same meal as foods high in
vitamin CVitamin C increases the availability of iron in the intestinal
tractWhen vitamin C and iron are eaten together, more iron is
absorbed into the body
ZincZinc is important for optimal growth
and sexual maturation during adolescence
The recommended intake for adolescents is 8-11 mg/day
Zinc is a mineral that is present in plant foods but better absorbed from animal sources
Like iron, zinc can be better absorbed when eaten in combination with vitamin C-rich foods.
Vegetarian and Vegan Sources of Zinc
CheeseEggsSome sources for Vegans include:Soy productsLegumesGrainsNuts and seedsWheat germEggs
Recommended Intakes of Macronutrients Based on the Institute of Medicine Daily Recommended
Intakes (DRI)Estimat
ed Energy Requirem-ents (Kcals)
Carbohyd-rate
(g)
% of Daily
Energy from
Carbohyd-rate
Fiber (g) % of Daily
Energy from Fat
Protein (g)
% of Daily
Energy from
Protein
Males
9-13 2279 130 45-65 31 25-35 34 10-30
14-18 3152 130 45-65 38 25-35 52 10-30
Females
9-13 2071 130 45-65 26 25-35 34 10-30
14-18 2368 130 45-65 26 25-35 46 10-30
How can you meet your DRI on a vegetarian or vegan diet?
Eat a variety of foods and the right amount of foods to meet your energy and nutrient needs
Be conscious of protein-rich foods - protein can easily be met by eating a variety of plant foods, such as beans, peas, soy products, nuts, and seeds
Include whole grains and other fiber-rich foods
Eat good sources of vitamins D and B12 as well as minerals including calcium, iron and zinc to prevent deficiencies
Suggested Daily Food Guide (in servings) for Lacto-ovo-vegetarians and vegans 11 years and older requiring 2200-2800 Kcals per day
Food Groups Lacto-Ovo-Vegetarians
Vegan
Breads. grains, cereal
9-11 10-12
Legumes 2-3 3 or more
Vegetables 4-5 5 or more
Fruits 4 4 or more
Nuts, seeds 1 4-6
Milk, yogurt cheese
4 -
Soy, almond or rice milk (fortified with calcium and vitamin D)
- 4
Eggs ½-1 -
Vegetarian Diet for the AthleteVegetarian diets can meet all the needs of
competitive athletesProtein requirements may be increased for
endurance training (1.2 g/kg to 1.4 g/kg) and weight training (1.6 g/kg to 1.7g/kg)
Energy, calcium and iron needs also require educated supervision to ensure adequate intake
Female athletes, particularly those presenting with recent changes in diet, a stress fracture or amenorrhea, should be screened for eating disorders
Vegetarian diets and Eating Disorders
Eating disorders are a serious problem that affect teenage girls more often than other groups
There is some evidence that eating disorders are more common among vegetarians than meat eaters
Girls sometimes adopt a vegetarian diet as a way to manage and disguise their eating disorder
Vegetarian diets and Eating Disorders
If your child decides to become a vegetarian it does not mean that you need to be concerned about an eating disorder
The following factors are signs that an eating disorder may be present:Weight loss that continues beyond three monthsMeal skippingAvoidance of all foods that appear to be high in calories or
that have fat in them–tofu, meat substitutes, peanut butter, breads, and pastas.
Compulsive counting of fat-grams and calories.Weighing themselves frequently or reports of feeling
bloated when eating normal portionsRitualistic behavior around food–such as cutting food into
tiny pieces or eating only one food at a time.Distorted body image
The Role of Parents Teens are often attracted to vegetarianism because
they are concerned about the environment and animal welfare
It is extremely important for parents to be supportive of a child's dietary choices
Parents need to become knowledgeable about vegetarian diets and give children some guidance, since most children and teens will not make the best diet decisions if left to their own devices
Help your children make good food choices by having appropriate foods that are easy to prepare on hand
Stock the kitchen with healthful foods that make good quick snacks or that can be easily packed into a backpack
SummaryA vegetarian diet can be a healthy way to eat
for children and teensDeficiencies in major nutrients are possible
when vegetarian and vegan diets are not planned out properly
The key is to consume a variety of foods and the right amount of foods to meet your energy and nutrient needs
Getting educated about vegetarian and vegan diets from reliable sources can help ensure your child’s nutrient needs are being adequately met
Be supportive of your kids’ choices and get involved in meal planning
References Amit, M. (2010). Vegetarian diets in children and adolescents. Paediatrics
& Child Health, 15(5), 303-308. Bellows, L. (2013, April 19). Vegetarian diets. Retrieved from
http://www.ext.colostate.edu/pubs/foodnut/09324.html Brown, J. (2011). Nutrition through the life cycle. (4th ed., p. 165).
Belmont, CA: Wadswoth Cengage Learning. Davis, B., & Kris-Etherton, P. (2003). Achieving optimal essential fatty acid
status in vegetarians: current knowledge and practical implications. American Journal of Clinical Nutrition, 78(3), 640S-646S.
Di Genova, T., & Guyda, H. (2007). Infants and children consuming atypical diets: Vegetarianism and macrobiotics. Paediatrics & Child Health, 12(3), 185-188.
Dwyer, J., Dietz, W., Andrews, E., & Suskind, R. (1982). Nutritional status of vegetarian children. American Journal of Clinical Nutrition, 35(2), 204-216.
Haddad, E. (1994). Development of a vegetarian food guide. American Journal of Clinical Nutrition, 59(5), 1248S-1254S.
Jacobs, C., & Dwyer, J. (1988). Vegetarian children: appropriate and inappropriate diets. American Journal of Clinical Nutrition, 48(3), 811-818.
Sanders, T., & Reddy, S. (1994). Vegetarian diets and children. American Journal of Clinical Nutrition, 59(5), 1176S-1181S.