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

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