Vegetarian diets in children and adolescents

Question 1

Which micronutrients may be lower in a vegetarian diet?

Answer 1

Protein
Omega 3 fats
Vitamin B12, Vitamin D, calcium, zinc, iron

Question 2

Is a lacto-ovo-vegetarian diet sufficient in meeting the nutrition requirements of a child?

Answer 2

Yes

Question 3

How much more protein should a child who is vegetarian consume?

Answer 3

10-15% more

Question 4

How much more iron should a child who is vegetarian consume?

Answer 4

Needing 2x more due to lower bioavailability

Question 5

How much more zinc should a child who is vegetarian consume?

Answer 5

1.5 x more due to lower bioavailability

Question 6

How much more calcium should a child who is vegetarian consume?

Answer 6

More a concern for children who are vegan** as vegetarians usually eat good amounts of dairy

Question 7

What percentage of children are vegetarian? What percentage are vegan?

Answer 7

2-4% vegetarian

0.5% are vegan

Question 8

What are the recommendations for calories/growth if following a vegetarian or vegan diet?

Answer 8

Follow Canada’s food guide
If vegan–> include soy, nut, nut butter for more concentrated calories
Monitor growth carefully

Question 9

What are the recommendations regarding fat consumption for vegetarian or vegan children?

Answer 9

Fat = 30% of energy intake; tend to have higher omega 6 fatty acid intake

• Can be deficient in omega 3 (needed for DHA/EPA synthesis) - normally found in fish/seafood/eggs
• Consume linolenic acid* precursor for DHA/EPA
• Avoid trans-fats because they inhibit omega-3 synthesis

Question 10

What are sources of linolenic acid?

Answer 10

Flaxseed oil
Canola oil
Walnuts
Soy

Question 11

Are vegan diets sufficient in B12? What are sources of B12?

Answer 11

No!

• Animal products- including dairy and eggs
• Other sources- yeast, fortified soy, nut beverages, cereal

Question 12

What are the recommendations for B12 within the diet?

Answer 12

Minimum 3 servings of B12 rich foods per day or daily supplementation with 5-10 mcg
If vegan mother, then baby should have supplementation

Question 13

What are sources of vitamin D within the diet?

Answer 13

Liver, fatty ocean fish, egg yolks, infant formula, cow’s milk, fortified soy and rice milk products, sunlight

Question 14

What are recommendations for vitamin D if following a vegan or vegetarian diet?

Answer 14

Sunlight on face and hands for 3 days/week for 20-30 minutes
For all children less than 1 year - 400 IU vitamin D
- Remember formula is supplemented but need to be consuming a minimum of 500 ml/day
- For all children <2 years old in northern latitude, dark skin, or avoiding sunlight- 800 IU from October to April

• For all children older than 1 year (not meeting above conditions) then minimum 200 IU

Question 15

What are vegetarian sources of iron?

Answer 15

Iron-fortified cereals, grains, beans, peas, iron supplement

Question 16

Are vegetarian diets sufficient in zinc?

Answer 16

Generally speaking yes!

Sources include: legumes, nuts, human milk, yeast leavened bread, fermented soy

Question 17

Is there enough fibre in vegetarian or vegan diets?

Answer 17

Yes and usually excessive which can impact bioabsportion

Limit fibre to 0.5 g/kg/day to avoid dilution or impaired absorption

Question 18

What are special recommendations for pregnant or breast feeding women?

Answer 18

Folate supplementation during pregnancy 
Ensure adequate sources of Vitamin B12
Ensure adequate calcium, vitamin D and supplement 2000 IU during winter
Include linoleic acid for Omega 3
Consider iron supplementation

Question 19

What should adolescents adopting a vegan or vegetarian diet be screened for?

Answer 19

Eating disorders* highly restricted eating pattern
Stress fractures
Ammenorrhea
Review Vitamin B12, Vitamin D, Calcium and iron intake