SOY MILK AND VEGETARIAN DIET IN CHILDREN

PROTEIN ASPECT

• Soybean-based products are essentially equivalent in quality to animal protein. • Soybeans are deficient in methionine.

• Supplementation of soy-based formulas with methionine may improve the utilization of soy protein by infants. The need for essential amino acids decreases as growth and development progress.

• Soy protein isolates without methionine supplementation can serve as a primary source of essential amino acids and nitrogen for protein maintenance in children older than two years.

SUGER ASPECT

• Soy products contain sucrose as the basic disaccharide, which breaks down into glucose and fructose. • Since soy does not contain galactose, a product of

lactose breakdown, soy-based infant formulas can safely replace breast milk in children with galactosemia.

• Like lactose-free cow's milk, soymilk contains no lactose, which makes it an alternative for those who are lactose-intolerant.

SOY PROTEIN-BASED FORMULAS

• Numerous studies have documented normal growth and development in term neonates fed methionine-supplemented isolated soy protein-based formulas

• Soy protein-based formulas are not recommended for preterm infants. • Serum phosphorus concentrations are lower, and

alkaline phosphatase concentrations are higher in preterm infants fed soy protein-based formula than they are in preterm infants fed cow milk-based formula

VEGETARIAN

• Semi-vegetarian

• Lacto-ovovegetarian

• Lactovegetarian

• Macrobiotic

• Vegan

POSSIBLE LIMITING NUTRIENTS

• Energy

• Protein(essential aminoacid)

• Iron, zinc, calcium

• Vitamin D

• Vitamin B12 (cyanocobalamin)

• Long-chain omega-3 fatty acids

• Dietary fiber,

ENERGY

• A plant-based diet that has a high fiber content and low caloric density may provide a sense of fullness before an adequate amount of energy is ingested. This situation may be a significant problem in young children, who have small stomach capacities• A Vegetarian Food Guide Pyramid• Frequent meals and snacks containing

energy and nutrient-dense foods to meet their energy needs.

PROTEIN

• Plant protein often deficient in one or more of the essential amino acids• Grains are lower in lysine • Legumes are lower in methionine

• Digestibility: • In general, amino acids from animal sources

are most easily digested (over 90 %). Well-processed soy isolates are as digestible as egg protein. • Amino acids from legumes is 80 to 90%

digestible. Proteins from grains and other plant foods are less digestible (70 to 90 %)

OMEGA3 FATTY ACID

• Vegetarian diets generally are rich in omega-6 (n-6) fatty acids, but marginal in omega-3 (n-3) fatty acids, unless the diet includes fish, eggs, or generous amounts of algae.

• Omega-3 fatty acids, which include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), or their precursor alpha-linolenic acid (ALA), are important for cardiovascular health and eye and brain development.

• Adolescent vegetarians who do not eat oily fish should include good sources of alpha-linolenic acid in their diet, such as flaxseed, walnuts, canola oil, and soy

IRON

• The RDA for iron is • 7 mg in children 1 to 3 years• 10 mg in children 4 to 8 years• 8 mg in children 9 to 13 years• 11 mg for boys and 15 mg for girls age 14 to 18 years. • The value is increased to 27 for pregnant adolescents

IRON

• Heme(in meat) iron is more readily absorbed than is non-heme(in plant) iron (15 to 35 % versus 2 to 20 %, respectively). • Ascorbic acid, which prevents the formation of

less soluble ferric compounds, is a powerful promoter of nonheme iron absorption and can counteract the inhibitory effect of phytates. • Fruits and vegetables such as citrus fruits,

strawberries, broccoli, and tomatoes are important sources of both vitamin C and other facilitators of iron absorption (eg, citric and malic acid

FACTORS INFLUENCING THE ABSORPTION AND

BIOAVAILABILITY OF DIETARY IRON• Absorption of heme iron

• Amount of heme iron, especially in meat• Content of calcium in the meal (calcium impairs iron

absorption)• Absorption of nonheme iron

• Iron status• Amount of potentially available nonheme iron• Balance between positive and negative factors

• Positive factors• Ascorbic acid• Meat or fish (heme iron enhances absorption of nonheme iron)

• Negative factors• Phytate (in bran, oats, rye fiber)• Polyphenols (in tea, some vegetables and cereals)• Dietary calcium• Soy protein

ZINC

• Recommendations for zinc are • 3 mg/day for children aged 1 to 3 years, • 5 mg/day for children aged 4 to 8 years, • 8 mg/day for children aged 9 to 13 years.• For adolescent females and males aged 14 to 18

years, the recommendations are 9 mg/day and 11 mg/day respectively

WHERE CAN GET ZINC

• Animal sources include oysters, shellfish, liver, meat, poultry, and dairy products

• Milk and milk products are the primary source of zinc for children on vegetarian diets who also consume animal products. Good plant sources include whole grains, legumes, wheat germ, and nuts.

CHILDREN NEED ZINC

• The zinc in vegetarian diets has a lower bioavailability because of the high content of phytate and dietary fiber

• Adult vegetarians do not typically develop zinc deficiency because they have a compensatory increase in fractional absorption. Children may be at greater risk of a suboptimal zinc status because of high requirements for growth

CALCIUM

• The optimal daily dietary allowance of calcium for children and adolescents is

• controversial but probably approximates • 700 mg for children 1 to 3 years of age,• 1000 mg for children 4 to 8 years of age,• 1300 mg for those 9 to 18 years

VITAMIN D

• Normal levels of vitamin D metabolites are necessary for adequate intestinal calcium, phosphate absorption, and bone formation. Vitamin D availability is a function of sunlight exposure and dietary intake • Maintenance of normal serum vitamin D

concentrations requires exposure to the sun on hands, arms, and face for 10 to 15 minutes per day for fair-skinned individuals; individuals with dark skin pigmentation require 6 to 10 times as much exposure as a light-skinned individual.

• In addition to sun exposure, a dietary intake of 600 IU generally is recommended.

VITAMIN D

• The principal dietary source of vitamin D for omnivores, lacto-ovovegetarians, and lactovegetarians is milk fortified with vitamin D (100 IU per 8 oz).

• Vegetarians who do not consume milk are at risk for vitamin D deficiency and rickets in children and osteomalacia in adults

WHERE CAN FIND VITAMIN D

• Fatty fishes (sardines, salmon, tuna, mackerel) and cod liver oils are some of the better food sources of vitamin D. Beef liver, cheese, and egg yolks provide small amounts of vitamin D

VITAMIN B12

• RDA for cobalamin is • 0.9 mcg for children 1 to 3 years of age,• 1.2 mcg for those 4 to 8 years,• 1.8 mcg for 9 to 13 years,• 2.4 mcg for 14 to 18 years, • 2.6 mcg for pregnant adolescents

WHERE CAN GET VITAMIN B12

• Much of the vitamin B12 present in spirulina, sea vegetables, tempeh, and miso is inactive and can compete with active forms for absorption

• Lycium fruit

FIBER

• A childhood diet too high in fiber can compromise dietary energy intake and, as noted above, reduce the bioavailability of minerals such as iron, calcium, and zinc.• Studies of weaning diets with increased

fiber found no negative effect on the absorption of energy, zinc, and calcium or iron bioavailability and suggested 5 g/day is beneficial

HOW MUCH FIBER SHOULD TAKE?

• The recommended fiber intake• For children aged 1 to 3 years, about

19 g/day. • For children aged 4 to 8 years, about

25g/day. • For children aged 9 to 13 years, ranges from

26 to 31 g/day. • This amount of dietary fiber should not have

an adverse effect on mineral bioavailability, provided the dietary mineral intake is adequate.

INTAKE OF FIBER DECREASE MINERAL

BIOAVAILABILITY• Intake of fiber that exceeds the

recommendation may decrease mineral bioavailability?• Unlikely in vegetarian children who consume a

balanced diet from a variety of foods• Likely in children who follow strict macrobiotic or

vegan diets with low intake of calcium, iron, and zinc.

• Studies of children younger than 10 years of age who consumed a macrobiotic diet based mainly on whole-grain cereals and vegetables revealed deficiencies of energy, protein, vitamins, and minerals, resulting in retarded growth and slower psychomotor development

REFERENCE

• Uptodate: Vegetarian diets for children

• Jatinder, et al. Use of Soy Protein-Based Formulas in Infant Feeding. Pediatrics 2008;121;1062