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Vegetarian Diets in Children and Adolescents  

A Vegetarian Diet Can Help Reduce the Risks of:

  • Cardiovascular disease
  • Hypertension
  • Diabetes
  • Obesity
  • Cancer
  • Osteoporosis
  • Renal disease
  • Dementia

 Classification of Vegetarians

Classification

Foods Included 

Foods Avoided

Lacto-ovo
Grains, legumes, nuts, seeds, fruits, vegetables, dairy products, eggs Meat, fish, poultry
Lacto Grains, legumes, nuts, seeds, fruit, vegetables, dairy products  Meat, poultry, fish, eggs
Vegan  Grains, legumes, nuts, seeds, fruit, vegetables  Meat, poultry, fish, eggs, dairy products
Macrobiotic  Grains, legumes, vegetables, wide use of sea vegetables, soy products, and Asian condiments, (nuts, seeds, fruit to a lesser extent), possibly fish Meat, poultry, sometimes fish, dairy products, eggs, vegetables of nightshade family, tropical fruits, processed sweeteners
Fruititarian  Fruit, nuts, seeds Meat poultry, fish, dairy products, eggs, grains, legumes, most vegetables (except tomatoes, eggplant, avocado, zucchini)

Nutritional Considerations for Vegetarians

Energy

  • Diets high in bulk and fiber may interfere with adequate energy intake in young children, especially vegan children once weaned
  • The fiber content can be reduced by giving some refined grains, fruit juices, peeled fruits and vegetables
  • Provide energy dense snacks scheduled throughout the day.
High energy foods:
  • Fats (avocado, nuts, nut butters, seeds, seed butters, olives, oils), dried fruits, whole fat dairy products

Protein

  • Plant proteins can meet protein requirements when a variety of plant foods are consumed and energy needs are met
  • Complementary proteins don’t need to be consumed at the same meal
  • Protein recommendations for vegans: Vegan children may require 20-30% more protein due to the amino acid composition and digestibility of plant proteins.
Protein containing foods:
Infants
  • Breast milk or formula
  • Well cooked or pureed legumes
  • Mashed or blended tofu
  • Cottage cheese / Yogurt
  • Cooked egg yolks
Children
  • Legumes
  • Grains
  • Soy products
  • Meat analogs
  • Dairy products
  • Eggs
  • Nuts/nut butters
  • Seeds/seed butters

Iron

Iron found in plant food is nonheme iron which is sensitive to both inhibitors and enhancers of iron absorption. Because of the lower bioavailability of iron from a vegetarian diet, the recommended iron intakes for vegetarians are 1.8 times those of nonvegetarians.
Iron Sources:
  • Whole or enriched grain and grain products
  • Iron fortified cereals
  • Legumes
  • Green leafy vegetables
  • Consume foods rich in Vitamin C
Enhancers: Vitamin C and other organic acids found in fruits and vegetables both enhance absorption and reduce the inhibitory effects of phytates

Inhibitors: Phytates, calcium, polyphenolics in tea, coffee, herb teas, and cocoa, fiber (slightly)
Phytates:
  • Organic compound that stores phosphorus in seeds and grains
  • Zinc, iron, copper and calcium form insoluble chelates with phytate and these compounds can’t be absorbed in the digestive tract greatly reducing absorption of these minerals
  • No long term adaptation to a high phytate diet

Calcium

  • Calcium intake of lacto-ovo-vegetarians is similar to or greater than nonvegetarians
  • Calcium intake of vegans tends to be lower than both groups
  • EPIC-Oxford Study: bone fracture risk was similar in L-O-vegetarians with meat eaters, while vegans had a 30% greater risk of fractures possibly due to their lower calcium intakes
  • Both higher protein and higher sodium intakes result in greater urinary calcium losses
  • Diets high in fruits and vegetables reduce urinary calcium losses
  • Limiting high oxalate vegetables maximizes calcium absorption (spinach, chard, wheat germ, dried beans, sweet potatoes, tea and cocoa)
High calcium foods:
  • Calcium fortified soy milk, juices and food products
  • Calcium precipitated tofu
  • Dark green leafy vegetables including collard greens, kale, mustard greens, turnip greens, broccoli, bok choy
  • Modest amounts of calcium are found in almonds, almond butter, blackstrap molasses, figs, and tahini

Vitamin D

  • Consider sun exposure including time of day, season, latitude, skin pigmentation, sunscreen use and age
  • Low 25-hydroxy vitamin D levels and reduced bone mass have been low in vegan and macrobiotic groups
 Vitamin D fortified foods:
  • Cow’s milk
  • Some yogurt
  • Some brands of soy and rice milk
  • Some cold cereals
 Supplements:
  • Vit D-2 ergocalciferol is plant based
  • Vit D-3 cholecalciferol is animal based

Vitamin B12

  • Lacto-ovo-vegetarians consume adequate Vitamin B12 which is found in dairy foods and eggs
  • Vegans must consume B12 from fortified foods and supplements including fortified breakfast cereals, rice and soy beverages, meat analogs, or Red Star Vegetarian Support Formula nutritional yeast
  • Unfortified nutritional yeast, sea vegetables, tempeh, and algae are unreliable sources of Vitamin B12

 Zinc

  • Zinc intake of lacto-ovo-vegetarians and vegans is similar to nonvegetarians
  • Phytate reduces zinc absorption and therefore vegetarians may need to consume greater zinc
  • Overt zinc deficiency is not evident in western vegetarians
Zinc Sources:
  • Dairy products
  • Soy products
  • Legumes
  • Whole Grains
  • Fortified grains and cereals
  • Cheese
  • Nuts
Enhance zinc absorption by using yeast leavened bread, fermented soy products, discarding soaking water for beans

Vegetarian Diets by Age Group

Infants
  • Encourage breastfeeding—the quantity and quality of breast milk of vegetarian women is equal to non-vegetarian woman
  • Supplement with Vitamin D
  • Infants of vegan mothers with an inadequate source of Vitamin B12 should receive B12 supplementation
Children
  • Growth of lacto-ovo-vegetarians similar to non-vegetarian peers;
  • Poor growth associated only with very restrictive diets
  • Frequent meals and snacks to meet energy needs
  • Support use of some refined foods to meet energy needs
Adolescents
  • No difference in age of menarche between lacto-ovo-vegetarians and non-vegetarians
  • Vegetarian teens consume more fiber, iron, folate, vitamin A, and vitamin C, fruits, vegetables, fewer sweets, fast foods and salty snacks
  • Assure that absence of meat fish and poultry is not replaced with “junk food”
  • May be used to mask eating disorder, however

 Daily Food Guides for Vegetarian Children and Adolescents

1-4 years 5-6 years  7-12 years  13-19 years
Grains  4 servings* 6 servings 7 servings 10 servings
Vegetables 1 - 1 1/2 servings 2 servings 3 servings 4 - 5 servings
Fruit 1 1/2 - 3 servings 2 - 4 servings 3 servings 4 servings
Legumes 1/2 - 1 serving 1 - 2 servings 2 - 3 servings 2 - 3 servings
Nuts/Seeds 1/2 - 1 serving 1 serving  1 serving 1 serving
Milk 3 cups 3 cups 3 cups 3 cups
Fat 3 - 4 tsp  4 tsp 5 tsp 4-5 tsps
1 SERVING:
Grains = 1/2 cup cooked grain, cereal, or pasta; 1 slice bread; or 1 ounce ready-to-eat cereal.
Vegetables = 1/2 cup cooked or 1 cup raw; try to include one serving daily of dark green, leafy vegetables.
Fruit = 1 piece fresh fruit, 1/2 cup cooked or canned fruit, 1/4 cup fruit juice, or 1/4 cup dried fruit.
Legumes = 1/2 cup cooked beans, tofu, tempeh, or textured vegetable protein; 3 ounces meat analogue.
Nuts/Seeds = 2 tablespoons of nuts, nut butters, or seeds

* Suggested minimum number of servings. Some children and adolescents may need additional servings from one or more food groups to meet energy needs.
† Nuts can be replaced by 1 serving of full-fat soy product.
‡ This group included cow’s milk, breast milk, infant or toddler formula, and soymilk fortified with calcium, vitamin B-12, and vitamin D.
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Vegetarian Diets in Children and Adolescents