Vegan diet in children and adolescents. Recommendations from the French-speaking Pediatric Hepatology, Gastroenterology and Nutrition Group (GFHGNP)

Attitudinal factors associated with protein sufficiency in Chilean vegan university students - A pilot study

Introduction

Introduction: vegan diets are currently an essential topic of discussion because they are recognized as a prototype of a healthy diet but are also associated with deficits in the intake of critical nutrients such as protein. Evaluating the factors that influence the deficit in their intake in vulnerable populations such as university students represents an important topic of interest, considering that this is one of the groups where veganism is most popular. Given this, the present study aimed to determine the degree of protein sufficiency and its associated factors in a sample of Chilean vegan university students. Materials and methods: an exploratory cross-sectional study was conducted on 114 vegan university students who responded to an online survey on academic, attitudinal, clinical, dietary, and sociodemographic variables. Protein intake was calculated, and based on self-reported weight, daily protein adequacy was calculated according to the recommendation of 0.9 g/kg/day. Finally, the association between protein adequacy and previously consulted variables was calculated by determining the odds ratios. Results: only 53.5 % had adequate daily protein intake, which was associated with the length of time respondents had been vegan (OR, 2.86; 95 % CI, 1.07 to 7.34; p < 0.05), use of supplements (OR, 5.24; 95 % CI, 1.17 to 25.2; p < 0.05), and the frequency with which they ate lunch at home (OR, 87.7; 95 % CI, 24.1 to 304; p = 0.000). Conclusion: there needs to be more protein adequacy in the assessed sample. Protein adequacy is associated with the length of time on the vegan diet, frequency of eating lunch away from home, and use of supplements regularly.

Comment on Jakše et al. Vegan Diets for Children: A Narrative Review of Position Papers Published by Relevant Associations. Nutrients 2023, 15, 4715

We have read the recent narrative review article by Jakše et al [...].

Exploring Vitamin B12 Supplementation in the Vegan Population: A Scoping Review of the Evidence

With a significant portion of the population adopting veganism and conflicting views among nutrition professionals regarding the necessity of vitamin B12 supplementation, this review aims to explore existing studies evaluating interventions through food supplementation. It focuses on the impact of vitamin B12 deficiency across different demographics. The present study seeks to understand how research has addressed the relationship between the rise in veganism and vitamin B12 deficiency over the past decade. A scoping review was conducted following the PRISMA flow diagram. Studies from 2010 to 2023 were identified using Boolean operators and key terms in electronic databases such as PubMed/MEDLINE, Web of Science, and EBSCO (Library, Information Science & Technology Abstracts, and Academic Search Complete). Out of 217 articles identified, 70 studies were included. The topical analysis categorized the studies into three groups: those associating vitamin B12 deficiency with diseases (n = 14), those analyzing the dietary habits of vegetarian individuals (vegan or not) without a specific focus on vitamin B12 (n = 49), and those addressing food guides and nutrition institution positions (n = 7). The authors concluded that vitamin B12 deficiency is prevalent among vegans due to limited consumption of animal products. For vegetarians, supplementation is an efficient means of treating and preventing deficiency; a daily dose of 50 to 100 micrograms is advised. There are still significant gaps in the research, nevertheless, such as the absence of randomized controlled trials evaluating various forms or dosages of vitamin B12 among vegetarians and the requirement for more information and awareness of the vitamin's significance in vegan diets.

Micronutrient deficiency and supplements in schoolchildren and teenagers

PURPOSE OF REVIEW

The essential micronutrients are corner stones in the functional and physical development. Early deficiency has life-long consequences. While awareness about iron deficiency is relatively high, it remains lower for other micronutrients. This review aims at reporting on recent data and attracting attention to the high prevalence of micronutrient deficiencies in school-age and adolescent individuals.

RECENT FINDINGS

Iron deficiency anaemia remains highly prevalent worldwide and the most frequent deficiency but can be corrected with simple tools ranging from food fortification, nutritional intervention, and to supplements. The link between micronutrient (MN) deficiency and neurobehavioral disorders is increasingly established and is worrying even in Western countries. Paediatric individuals are prone to imbalanced diets and picky eating behaviour, and their diets may then become incomplete: the highest risk for deficiency is observed for iron, zinc and vitamin D.

SUMMARY

There is not much new information, but rather confirmation of the importance of health policies. Well conducted randomized controlled trials confirm that deficiencies can be corrected efficiently including with food fortification, and result in clinical benefits. Individual complementation should be considered in children and adolescents with proven deficiency.

Pro-vegetarian dietary patterns and essential and heavy metal exposure in children of 4-5-years from the INfancia y medio Ambiente cohort (INMA)

Dietary patterns provide a comprehensive assessment of food consumption, including essential nutrients and potential exposure to environmental contaminants. While pro-vegetarian (PVG) dietary patterns have shown health benefits in adults, their effects on children are less well studied. This study aims to explore the association between children's adherence to the most common PVG dietary patterns and their exposure to metals, assessed through urine concentration. In our study, we included a population of 723 children aged 4-5-years from the INfancia y Medio Ambiente (INMA) cohort in Spain. We calculated three predefined PVG dietary patterns, namely general (gPVG), healthful (hPVG), and unhealthful (uPVG), using dietary information collected through a validated Food Frequency Questionnaire. Urinary concentrations of various essential and heavy metals (Co, Cu, Zn, Se, Mo, Pb, and Cd) were measured using mass spectrometry. Additionally, urinary arsenic speciation, including arsenobetaine (AsB), dimethylarsinic acid (DMA), monomethylarsonic acid (MMA), and inorganic arsenic (iAs), was measured. The sum of urinary MMA and iAs was used to assess iAs exposure. We estimated primary (PMI) and secondary iAs methylation (SMI) indices. To explore the association between PVG dietary patterns in quintiles and metal exposure, we utilized multiple-adjusted linear regression models and the quantile g-computation approach. Compared with the lowest quintile, participants in the highest quintile of gPVG showed a 22.7% lower urinary Co (95% confidence interval (CI): -38.7; -1.98) and a 12.6% lower Se (95%CI: -22.9; -1.00) concentrations. Second quintile of adherence to hPVG was associated with a 51.7% lower urinary iAs + MMA concentrations (95%CI: -74.3; -8.61). Second quintile of adherence to an uPVG was associated with a 13.6% lower Se levels (95%CI: -22.9; -2.95) while the third quintile to this pattern was associated with 17.5% lower Mo concentrations (95%CI: -29.5; -2.95). The fourth quintile of adherence to gPVG was associated with a 68.5% higher PMI and a 53.7% lower SMI. Our study showed that adherence to a gPVG dietary pattern in childhood may modestly reduce the intakes of some essential metals such as Co and Se. Further investigations are warranted to explore any potential health implications.

Use of dietary supplements by children and adolescents

OBJECTIVES

Narrative review evaluating the use of dietary supplements by children and adolescents.

DATA SOURCE

The terms "dietary supplements", "children" and "adolescents" were used in combination in the PubMed, MEDLINE, and SciELO databases, between 2000 and 2023, evaluating studies in humans, published in Portuguese, English, French and Spanish.

DATA SYNTHESIS

The use of dietary supplements by children and adolescents has increased in recent decades. The most commonly used supplements are vitamins, minerals, trace elements, proteins, amino acids, melatonin, fatty acids, probiotics and energy drinks.

CONCLUSION

Despite having specific indications, most of the time they are not prescribed by a healthcare professional. The reasons for use are varied. In children, the main reasons are protection against infections, stimulating growth, and poor food intake, with multivitamins and minerals being the most commonly used supplements. In adolescents, they are used to improve athletic performance and attain the "ideal body", with proteins and amino acids being the most often used nutrients. As they are not regulated by health agencies and are sold without a prescription, their unsupervised use can lead to inadequate doses, with inefficiency or overdose risk. As for compounding formulations, or when available in preparations with multiple nutrients, the chance of errors increases. It is essential that pediatricians advise parents and patients about the indications, risks and benefits, prescribing them when necessary.

Plant-Based Diets in Children: Secular Trends, Health Outcomes, and a Roadmap for Urgent Practice Recommendations and Research-A Systematic Review

People are increasingly encouraged to reduce animal food consumption and shift towards plant-based diets; however, the implications for children's health are unclear. In this narrative review of research in high-income settings, we summarize evidence on the increasing consumption of plant-based diets in children and update an earlier systematic review regarding their associations with children's health outcomes. The evidence indicates that vegan, but not vegetarian, diets can restrict growth relative to omnivorous children and increase the risk of being stunted and underweight, although the percentage affected is relatively small. Bone mineral content is reduced in vegetarian and, in particular, vegan children, compared to omnivores. Both vegetarian and vegan children who do not use vitamin B12 supplements manifest with B12 deficiency; however, supplementation rectifies this problem. Both vegetarians and vegans have lower concentrations of 25(OH)D if unsupplemented, and lower body iron stores, but usually have normal iron metabolism markers. Both groups are at risk of iodine deficiency, and this might affect thyroid health. Children consuming a vegan diet have a more favorable lipid profile than omnivorous children; however, the results for a vegetarian diet are inconsistent and vary by outcome. Based on the same scientific evidence, national and international dietary recommendations are heterogeneous, with some countries supporting plant-based diets among infants, children, and adolescents, and others discouraging them. We offer a research roadmap, highlighting what is needed to provide adequate evidence to harmonize dietary recommendations for plant-based diets in children. A number of measures should urgently be introduced at international and national levels to improve the safety of their use in children.

Medical management of vegetarian and vegan children in France: Medical practices and parents' perceptions

OBJECTIVES

Despite a significant increase in the prevalence of vegetarianism and veganism in children in France, data on the care pathway of these children are scarce. This study aimed to describe the characteristics of the medical follow-up of vegan/vegetarian children, to evaluate the medical practices, and to analyze the perceptions of parents.

MATERIALS AND METHODS

This was a double cross-sectional survey. One questionnaire was sent to parents of vegetarian/vegan children, and the other to French doctors (pediatricians or general practitioners).

RESULTS

A total of 241 vegetarian families responded to the study and nearly one quarter (n = 67, 28 %) were unsatisfied with the medical follow-up of their child. Parents considered that their child's diet was responsible for refusing a medical consultation in 11 % (n = 27) of cases. In almost one third of cases (n = 70, 29 %), participants declared that the doctor was unaware of their child's diet. Vitamin B12 supplementation was commonly used (n = 195, 81 %), mainly by self-medication, and laboratory testing was performed for 30 % (n = 72) of children. Regarding the questionnaire for doctors, most of the participants (n = 318/501, 63 %) reported having vegetarian/vegan children in their cohort. A few of them (n = 70, 14 %) declared they did not systematically screen for meat and fish consumption during consultations. Doctors caring for vegetarian/vegan children had 27 % correct answers to questions regarding the nutrition guidelines. Overall, 36 % of them (n = 117) systematically referred the child to a specialist.

CONCLUSION

The medical follow-up of vegetarian/vegan children in France is very heterogeneous. Parents and doctors alike stressed the need to develop reliable sources of knowledge. A systematic screening of the diet and a referral to a specialist could help to improve the management of vegetarian/vegan children.

[Nutritional problems of vegetarian and vegan children]

Introduction

The number of people following plant-based diets to a greater or lesser degree is increasing, but the more restrictive a diet, the greater the risk of nutritional deficiencies. The childhood stage is a stage of great physical and maturational growth, therefore, nutritional deficiencies at this stage can have serious and sometimes permanent consequences. People who follow restrictive diets of any kind, such as plant-based diets, should receive support from specialized staff to ensure that their diets are varied and balanced, as is desirable in any case.

Vegan Diets for Children: A Narrative Review of Position Papers Published by Relevant Associations

The scientific discourse on vegan diets for children and adolescents primarily involves referencing position statement papers from different scientific and professional organizations, including paediatric associations. Over the past two decades, specialized associations have issued official statements and published position papers about adopting well-designed vegan diets during crucial life stages, including pregnancy and lactation, infancy, and childhood. A subset of these associations firmly supports the notion that a well-designed vegan diet can indeed be healthy and support normal growth and development during particularly delicate life stages, emphasizing careful planning, vitamin B12 supplementation, and regular supervised medical and dietetics oversight. In contrast, specific paediatric associations caution against vegan diets for children and adolescents, citing potential harm and the lack of adequate substantiation. These criticisms in position papers frequently point to lower-quality studies and/or outdated studies. Additionally, concerns extend to comparing vegan and omnivorous diets, considering public health issues such as obesity and early stages of cardiovascular disease as well as the risk of prediabetes and type 2 diabetes. Notably, some scepticism stems from studies where children's adherence to a well-designed vegan diet is incomplete. Scientific rigor suggests performing a comparable assessment of omnivorous and vegan diets. This narrative review highlights the need for a comprehensive, up-to-date literature review to inform balanced perspectives on vegan diets for children and adolescents. Researchers and decision-makers should aim to actively improve the design and consistent implementation of both diet types.

Diet-Related Attitudes, Beliefs, and Well-Being in Adolescents with a Vegetarian Lifestyle

Vegetarianism can meet healthy, ethical, or ecological values (such as equality and protection of animals or the environment). At the same time, it can represent a response to the need for self-determination in adolescence. Furthermore, some studies show vegetarians have greater depressive risk and a lower sense of body satisfaction. Considering the spread of non-meat diets in the Western world, researchers have investigated the benefits and risks to physical and psychological health. Despite this, few studies have been conducted on factors influencing adolescent's vegetarian diet-related attitudes. Through self-administered loosely structured interviews, this research investigated factors potentially associated with vegetarian choices in adolescence. It checked (a) gender differences in vegetarian choices; (b) religious, familial, ethical, or health factors implied in vegetarian choices; and (c) indicators of well-being among young vegetarians. The findings suggest that for our sample, non-vegetarians have lower scores on health-related questions than others, while for vegetarian adolescents, the benefits of vegetarianism mainly depend on their ethical stances, beliefs, and values. Conversely, it is unrelated to factors such as the desire to lose weight, dissatisfaction about one's body shape, or depressive feelings.

Vegetarian diets and diets which restrict animal-source foods during childhood in high-income countries

Increasing numbers of populations in the West are restricting their intake of meat and other animal products for reasons relating to health or ethics; in many countries, these restrictions are already common for cultural, religious, or socio-economic reasons. By following their parent's diet, children are exposed in parallel. This narrative review aims at assessing current data regarding vegetarian diets in children from birth to 18 years of age, which include, by increasing degree of restriction, flexitarian, lacto-ovo-vegetarian, lacto-vegetarian, pescatarian, vegan and macrobiotic diets. The 202 references include 45 studies in children. The more restrictive the diet and the younger the child, the greater the risk of nutritional deficiency. Of particular concern are vitamin B12, iron, zinc, calcium, n-3 long-chain polyunsaturated fatty acids, and protein and energy intake, especially in pregnant and nursing women, infants and young children. Providing an adequate lacto-ovo-vegetarian diet is relatively easy, whereas the maintenance of more restrictive diets may be challenging. The benefits and risks of vegetarian diets in adults are relatively well documented, but data for children are scarce. Vegan and macrobiotic diets should be discouraged in pregnant and lactating mothers as well as in young children, who, otherwise, should pay careful attention to ensuring nutritional adequacy, blood testing and appropriate supplementation. The health consequences of a chosen diet should be discussed with parents and adolescents to ensure the best possible adherence to advice and prescriptions. There is a need for well conducted studies in children but also for better knowledge of nutrition in healthcare professionals.Abbreviations: ALA: α-linolenic acid; ARA: arachidonic acid; ASF: animal source foods; BMC: bone mineral content; BMD: bone mineral density; DHA: docosahexaenoic acid; DRV: dietary reference value; EPA: eicosapentaenoic acid; FLD: flexitarian diet; LA: linoleic acid; LC-PUFA: long-chain polyunsaturated fatty acids; LOVD: lacto-ovo-vegetarian diet; LVD: lacto-vegetarian diet; MAD: macrobiotic diet; OMD: omnivorous diet; PSF: plant-source foods; SFA: saturated fatty acids; VGD: vegetarian diets; VND: vegan diet.

Nutrient Intake and Status in Children and Adolescents Consuming Plant-Based Diets Compared to Meat-Eaters: A Systematic Review

Health authorities increasingly recommend sustainable and healthy diets rich in plant foods and with moderate amounts of animal foods. However, there are concerns about whether such diets can meet all nutrient requirements, especially in children and adolescents, who have relatively high nutrient needs for growth and development. Therefore, we aimed to evaluate the nutrient intake and status of children and adolescents (2-18 y) consuming plant-based (i.e., vegetarian and vegan) diets compared to those of meat-eating children following a systematic literature review of studies published between 2000 and 2022. Mean intake and status data of nutrients were calculated across studies and benchmarked to dietary reference values and cut-off values for nutrient deficiencies. A total of 30 studies were included (15 in children 2-5 y, 24 in children 6-12 y, and 11 in adolescents 13-18 y). In all diets, there were risks of inadequate intakes of vitamin D and calcium. Children consuming meat had a risk of inadequate folate and vitamin E intake; and mean fiber, SAFA, and PUFA intakes were not in line with the recommendations. Children consuming plant-based diets risked inadequate vitamin B12, iron, and zinc intakes. In contrast to vegans, vegetarian children may not meet the recommended intakes of fiber, SAFA, and possibly PUFA, but their mean intakes were more favorable than in meat-eating children. Although the data are limited and need further validation, our findings indicate that there are risks of nutritional inadequacies in all diet groups. Therefore, increasing consumption of a variety of plant-based foods, in combination with food fortification and supplementation where needed, is recommended for children and adolescents to have sustainable and nutritionally adequate diets.

Influence of Plant-Based Diet on the Cardiovascular System: A Narrative Review

A plant-based diet (PBD) includes multiple dietary patterns such as vegetarianism, veganism, lacto-ovo-vegetarianism, etc. A well-balanced PBD has positive effects on body mass index, hyperlipidemia, and type 2 diabetes, and it is associated with decreased risk of cardiovascular diseases. Due to its high fiber content, which lowers levels of low-density lipoprotein cholesterol, high antioxidant content, which prevents capillary wall damage; the presence of polyunsaturated fatty acids, which have an anti-inflammatory effect, improvement in glucose homeostasis through improved insulin sensitivity, and impact on the gut microbiota, it has been proven to be beneficial for the heart. Despite their possible benefits, PBDs can be low in essential nutrients such as vitamin B12, zinc, vitamin D, iodine, and amino acids. This review aims to analyze the influence of PBDs on the cardiovascular system and associated disease progression.

Fermented foods and beverages: a potential in situ vitamin B12 biofortification - a literature review

Millions of dollars have been increasingly spent on plant-based diets. Considering that vitamin B12 is obtained from the consumption of animal-derived foods, new sources of vitamin B12 and methods of food fortification are being eagerly sought. Therefore, this work aims to evaluate advances in situ fermentation processes of food and beverages produced on a large scale and industrial applications for obtaining cobalamin-rich products. Bibliometric analysis was performed and revealed that several studies report a great capacity for in situ biofortification of B12 in foods, mostly on the use of propionic (PB) and lactic (LAB) bacteria. In this context, market potentials for such products, the main microorganisms, including simultaneous cultures, and their respective applications have been presented herein. Although knowledge on potential applications is still limited, field research has been increasingly conducted, thus revealing scientific and technological opportunities, both for the production and the stability of B12 found in plant-based foods.

Parental Nutritional Knowledge and Type of Diet as the Key Factors Influencing the Safety of Vegetarian Diets for Children Aged 12-36 Months

There are some concerns about the adequacy of vegetarian diets for pregnant women, infants, and young children because diets that exclude meat and other animal-based products increase the risk of nutrient deficiencies. The aim of the present study was to assess the nutritional knowledge of parents raising 12- to 36-month-old children on vegetarian diets and to evaluate the children's diets based on the recommendations formulated in the model food ration. The study involved a questionnaire survey that was completed by 326 women raising their children on various types of vegetarian diets and 198 women raising their children on an omnivorous diet. Mothers raising children on a lacto-ovo-vegetarian diet had the highest nutritional knowledge scores (15.8 points on average), whereas control group mothers and women raising children on a vegan diet had the lowest nutritional knowledge scores (average of 13.6 points). Parents who raised their children on more restrictive vegetarian diets were more aware of the risk of nutritional deficiencies and administered dietary supplements more frequently. A vegetarian diet can be safe for young children, but parents should be educated about the risk of nutritional deficiencies and the principles of healthy nutrition regardless of the administered diet, and effective communication between parents, pediatricians, and dietitians should be the cornerstone of every nutritional strategy in the management of vegetarian children.

Assessment of Nutritional Status in the Diagnostic Evaluation of the Child with Growth Failure

Current clinical guidelines provide information about the diagnostic workup of children with growth failure. This mini-review focuses on the nutritional assessment, which has received relatively little attention in such guidelines. The past medical history, in particular a low birth size and early feeding problems, can provide information that can increase the likelihood of nutritional deficits or several genetic causes. The current medical history should include a dietary history and can thereby reveal a poorly planned or severely restricted diet, which can be associated with nutritional deficiencies. Children on a vegan diet should receive various nutritional supplements, but insufficient compliance has been reported in one-third of cases. While proper use of nutritional supplements in children consuming a vegan diet appears to be associated with normal growth and development, insufficient intake of supplements may impede growth and bone formation. Physical examination and analysis of height and weight over time can help differentiating between endocrine causes, gastrointestinal disorders, psychosocial problems, or underlying genetic conditions that prevent adequate nutritional intake. Laboratory screening should be part of the workup in every child with short stature, and further laboratory tests can be indicated if warranted by the dietary history, especially in children on a poorly planned vegan diet.

Plant-Based Milk Alternatives in Child Nutrition

Plant-based milk alternatives can be distinguished in two main categories, differing in production processes and regulation: plant-based formulas and plant-based drinks. They are now a widely accepted class of products on the international market. The various plant-based milk alternatives differ in nutritional characteristics due to their origin and manufacturing; more importantly, whereas formulas from plant and cow origin can be used interchangeably, plant-based drinks are nutritionally different from cow's milk and can be consumed by children subsequently to the use of formula. Several scientific organizations have expressed differing opinions on the use of these products in the diets of children. In the face of unanimous conclusions regarding the use of these products during the first year of life, in subsequent ages there were conflicting opinions regarding the timing, quantities, and type of product to be used. From the viewpoint of the child's overall diet and health, it could be suggested that these foods be considered not as simple substitutes for cow's milk, but as part of a varied diet, within individual advice of use. We suggest accepting the presence of these products in a baby's diet (omnivores included), planning their use correctly in the context of a balanced diet, according to the specific product and the needs of the individual.

Autonomous motivation, goal-facilitating behaviours, and dietary goal progress in individuals transitioning to a veg*n diet: A longitudinal study

Previous studies have consistently shown that autonomous motivation - pursuing goals because one wants to, rather than has to - is associated with greater behaviour maintenance in the context of healthy eating, exercise, and diet maintenance. The present study used a 7-wave longitudinal design to examine how autonomous motivation is related to dietary goal progress in individuals (N = 222) transitioning to a veg*n (i.e., vegetarian or vegan) diet. We hypothesized that when people reported more autonomous motivation (compared to their own average) they would be more successful in reaching their dietary goals. We also explored the role of goal-facilitating behaviours in this process. We found no directional effects of relative autonomous motivation on goal progress or goal-facilitating behaviours, although the concurrent relations were significant. There were also no within-person effects of behaviours on progress. These findings shed light onto the relationship between autonomous motivation, behaviours, and goal progress both at the same time and over time, and highlight the importance of examining within-person fluctuations over time.

Does a Plant-Based Diet Stand Out for Its Favorable Composition for Heart Health? Dietary Intake Data from a Randomized Controlled Trial

A plant-based diet (PBD) can provide numerous health benefits for patients with cardiovascular risk factors. However, an inadequately planned PBD also bear the potential for deficiencies in certain macro- and micronutrients. The present study analyzed nutrient profiles of individuals who adopted a PBD as part of the CardioVeg study. Participants with cardiovascular risk factors were randomly assigned to either a whole-food PBD intervention (n = 36; eight 90 min group meetings including two 120 min cooking sessions) or a control group asked to maintain an omnivorous diet (n = 34) for eight weeks. Food intake data were collected using three-day weighed food records and analyzed with NutriGuide software, including the German Nutrient Data Base (German: Bundeslebensmittelschlüssel). Nutrient intake was compared before and after eight weeks as well as between the groups. The results for both groups were then contrasted to the current dietary recommendations published by the societies for nutrition in Germany, Austria, and Switzerland. Moreover, anthropometric/laboratory data and ambulatory blood pressure monitoring were determined at baseline and after 8 weeks. Data of a subsample (n = 18 in the PBD group and n = 19 in the control group) were used for the present analyses of the dietary intake data. A PBD yielded several benefits including (but not limited to) a lower energy density, a lower intake of cholesterol and saturated fat, an increased consumption of fiber, and a lower intake of salt. Recommended intakes of most vitamins and minerals were generally met, except for vitamin B12 in the PBD group. A low intake of several other critical nutrients (vitamin D, iodine) was observed in both groups. Compared with the control group, PBD resulted in a significant decrease in body weight, body mass index, waist circumference, HbA1c, and fasting blood glucose after 8 weeks. Overall, it can be concluded that a PBD had a more favorable nutrient composition for cardiovascular health than the omnivorous dietary pattern of the control group.

Do Vegetarian Diets Provide Adequate Nutrient Intake during Complementary Feeding? A Systematic Review

During the complementary feeding period, any nutritional deficiencies may negatively impact infant growth and neurodevelopment. A healthy diet containing all essential nutrients is strongly recommended by the WHO during infancy. Because vegetarian diets are becoming increasingly popular in many industrialized countries, some parents ask the pediatrician for a vegetarian diet, partially or entirely free of animal-source foods, for their children from an early age. This systematic review aims to evaluate the evidence on how vegetarian complementary feeding impacts infant growth, neurodevelopment, risk of wasted and/or stunted growth, overweight and obesity. The SR was registered with PROSPERO 2021 (CRD 42021273592). A comprehensive search strategy was adopted to search and find all relevant studies. For ethical reasons, there are no interventional studies assessing the impact of non-supplemented vegetarian/vegan diets on the physical and neurocognitive development of children, but there are numerous studies that have analyzed the effects of dietary deficiencies on individual nutrients. Based on current evidence, vegetarian and vegan diets during the complementary feeding period have not been shown to be safe, and the current best evidence suggests that the risk of critical micronutrient deficiencies or insufficiencies and growth retardation is high: they may result in significantly different outcomes in neuropsychological development and growth when compared with a healthy omnivorous diet such as the Mediterranean Diet. There are also no data documenting the protective effect of vegetarian or vegan diets against communicable diseases in children aged 6 months to 2-3 years.

Complementary feeding in preterm infants: a position paper by Italian neonatal, paediatric and paediatric gastroenterology joint societies

Nutrition in the first 1000 days of life is essential to ensure appropriate growth rates, prevent adverse short- and long-term outcomes, and allow physiologic neurocognitive development. Appropriate management of early nutritional needs is particularly crucial for preterm infants. Although the impact of early nutrition on health outcomes in preterm infants is well established, evidence-based recommendations on complementary feeding for preterm neonates and especially extremely low birth weight and extremely low gestational age neonates are still lacking. In the present position paper we performed a narrative review to summarize current evidence regarding complementary feeding in preterm neonates and draw recommendation shared by joint societies (SIP, SIN and SIGENP) for paediatricians, healthcare providers and families with the final aim to reduce the variability of attitude and timing among professionals.

Vegetarian and Vegan Diets: Beliefs and Attitudes of General Practitioners and Pediatricians in France

Studies suggest a decreasing trend in the consumption of meat products and a growing interest in vegetarian diets. Medical support may be relevant, especially when switching to a vegan diet. Our objective was to describe the beliefs and attitudes of primary care physicians toward vegetarian diets. A cross-sectional survey was conducted among general practitioners and pediatricians thorough a questionnaire including socio-demographic characteristics, specific care to vegetarians, and the risks and benefits of vegetarian diets according to physicians. Out of the 177 participating physicians, 104 (59%) have seen at least one vegetarian patient in consultation in the last three months. Half of the physicians declared that they would dissuade their patients from switching to a vegan diet (n = 88, 51%) and 14% (n = 24) from switching to an ovo-lacto-vegetarian (OLV) diet. Most physicians (n = 141, 88%) did not feel informed enough about these diets. Physicians thought that the most frequent deficiencies for OLV and vegan diets were iron (76% and 84%, respectively) and protein (45% and 79%, respectively). These results highlight the fact that French primary care physicians feel concerned by this subject and need more information on these diets. Specific recommendations would be useful to support their practice and relationship with vegetarians.

Vitamin D and calcium intakes in general pediatric populations: A French expert consensus paper

OBJECTIVES

Nutritional vitamin D supplements are often used in general pediatrics. Here, the aim is to address vitamin D supplementation and calcium nutritional intakes in newborns, infants, children, and adolescents to prevent vitamin D deficiency and rickets in general populations.

STUDY DESIGN

We formulated clinical questions relating to the following categories: the Patient (or Population) to whom the recommendation will apply; the Intervention being considered; the Comparison (which may be "no action," placebo, or an alternative intervention); and the Outcomes affected by the intervention (PICO). These PICO elements were arranged into the questions to be addressed in the literature searches. Each PICO question then formed the basis for a statement. The population covered consisted of children aged between 0 and 18 years and premature babies hospitalized in neonatology. Two groups were assembled: a core working group and a voting panel from different scientific pediatric committees from the French Society of Pediatrics and national scientific societies.

RESULTS

We present here 35 clinical practice points (CPPs) for the use of native vitamin D therapy (ergocalciferol, vitamin D2 and cholecalciferol, vitamin D3) and calcium nutritional intakes in general pediatric populations.

CONCLUSION

This consensus document was developed to provide guidance to health care professionals on the use of nutritional vitamin D and dietary modalities to achieve the recommended calcium intakes in general pediatric populations. These CPPs will be revised periodically. Research recommendations to study key vitamin D outcome measures in children are also suggested.

Healthy Eating and Diets: Fad or Rad?

One of the top chronic diseases in the United States is pediatric obesity. As such, many pediatricians will have conversations with patients and families regarding the health effects of this disease process. This article will provide a broad overview of many of the popular diets as well as evidence for their effectiveness. Lastly, recommendations for healthy eating and nutritional counseling with patients and families will be discussed. [Pediatr Ann. 2022;51(3):e88-e92.].

A Cross-Sectional Assessment of Human Milk Oligosaccharide Composition of Vegan, Vegetarian, and Nonvegetarian Mothers

Purpose: Recently, maternal nutrient intake has been associated with human milk oligosaccharides (HMOs) composition. The goal of this study was to assess HMO composition in breast milk samples from vegan, vegetarian, and nonvegetarian lactating women. Second, we assessed impact of maternal body mass index (BMI), age, parity, and lactation stage on HMO composition. Materials and Methods: A cross-sectional analysis of HMO composition from vegan (n = 26), vegetarian (n = 22), and nonvegetarian (n = 26) lactating women was carried out. The majority of participants took dietary supplements. Results: In an unadjusted bivariate model, there was no difference in individual HMO composition, total HMO-bound fucose and HMO-bound sialic acid, or diversity and evenness scores by diet group. When adjusting for factors that significantly differed between groups (maternal BMI and lactation stage), no differences in HMO composition were observed. Secretor status was significant for 13 of the outcome variables with the strongest positive relationship with total HMO (β = 0.922) and HMO-bound fucose (β = 0.910), and the strongest negative relationship with sialyl-lacto-N-tetraose b (LSTb) (β = -0.544). Lactation stage was significant for eight analytes, with the strongest positive impact on 3'sialyllactose (3'SL) (β = 0.433), and the strongest negative impact on 6'sialyllactose (6'SL) (β = -0.519). Maternal BMI had a significant positive relationship with total HMO composition (β = 0.113) and 3'SL (β = 0.325). Conclusions: Lactating women who consume plant-based diets do not produce different breast milk as it relates to HMO composition.

Cross-Sectional Study of the Prevalence of Cobalamin Deficiency and Vitamin B12 Supplementation Habits among Vegetarian and Vegan Children in the Czech Republic

Vegetarian (VG) and vegan (VN) diets in childhood are of growing interest due to their perceived health and environmental benefits. Concerns remain due to the possible disruption of healthy growth and development of children because of the scarcity of evidence-based studies. Among the nutrients of special concern is vitamin B12. Therefore, the Czech Vegan Children Study (CAROTS) decided to examine the relationship between B12 metabolism parameters and B12 intake through diet and supplementation. We analyzed laboratory parameters within n = 79 VG, n = 69 VN, and n = 52 omnivores (OM) children (0−18 years old). There were no significant differences in levels of holotranscobalamin (aB12), folate, homocysteine (hcys), or mean corpuscular volume. However, there was a significant difference in levels of cyanocobalamin (B12) (p = 0.018), even though we identified only n = 1 VG and n = 2 VN children as B12 deficient. On the other hand, we identified n = 35 VG, n = 28 VN, and n = 9 OM children with vitamin B12 hypervitaminosis (p = 0.004). This finding was related to a high prevalence of over-supplementation in the group (mean dose for VG 178.19 ± 238.5 µg per day; VN 278.35 ± 394.63 µg per day). Additionally, we found a significant (p < 0.05) difference between B12, aB12, and hcys levels of supplemented vs. non-supplemented VG/VN children. This can show that the intake of vitamin B12 via diet in the VG group might not be sufficient. Secondly, we analyzed a relation between supplement use in pregnancy and breastfeeding and its impact on vitamin B12 levels of children aged 0−3 years. Out of n = 46 mothers, only n = 3 (e.g., 6.5%) were not supplemented at all. We have not identified any clinical manifestation of B12 deficiency and only n = 1 child with low serum cobalamin, a child who did not receive vitamin B12 supplementation and whose mother took only low doses of vitamin B12 (25/µg/day).To conclude, we did not observe any life-threatening or severe consequences of laboratory-stated vitamin B12 deficiency; thus, our group was well supplemented. On the other hand, we have identified many subjects with vitamin B12 hypervitaminosis of unknown impact on their health. Further research and new guidelines for B12 supplementation among VG and VN children are needed.

The weaning practices: A new challenge for pediatricians?

Introduction of complementary feeding, or weaning, is the period where infants are gradually introduced to solid foods, with a progressive reduction of breastfeeding or bottle-feeding. Weaning represents a crucial nutritional moment in the growth and development of infants, and it can also affect future health. Throughout the years, various weaning strategies have been proposed, ranging from classic to baby-led weaning. Recently, vegetarian-/vegan-based approaches are also being increasingly adopted by young parents. This rostrum aims to critically address the safety profiles of current weaning practices for infants and to highlight the important role of pediatricians in choosing the most advisable weaning approach for their patients.

Diet Implications and Oral Health Status of Women in Central Italy

OBJECTIVE

 The relationships between oral health habits, dietary practices, and oral health status, as well as general health status, in the population of Italian women, are complex, with many mutual and interrelating factors. The purpose of this study is to investigate oral habits, oral status, and dietary habits of a sample of women in Italy, highlighting the links between nutrition and oral health and discussing how oral health care professionals can integrate nutrition counseling that aimed at improving the oral health of their patients into their practices.

MATERIALS AND METHODS

 In the period between February 2020 and July 2020, an anonymous questionnaire made up of 20 questions was administered to a randomized sample of 120 Italian women.

RESULTS

 Most of women declare good manual skills in oral hygiene (50%) but just less than half of them brushes their teeth more than three times a day. Statistically significant correlations were found between frequency of dental checkups and dental mobility (p = 0.036), and halitosis (p = 0.006), as well as between frequency of flossing and gum bleeding. Correlation between the type of diet and oral health status showed more halitosis (∼21%), sensitivity (∼26%), and xerostomia (∼53.3%) for vegetarian and vegan women.

CONCLUSION

 More awareness need to be raised concerning oral hygiene habits, and regarding the importance of regular dental checkups. Brushing at least twice or three times a day needs to be encouraged and the valid support of dental aids has to be in the everyday domestic oral hygiene protocol, as scientific evidence demonstrates. Future clinical studies need to be performed on a more consistent number of vegetarian and vegan patients, to obtain more statistically significant results and support future research that will compare omnivorous, vegetarian, and vegan diets and their influence on oral health status.

Perspective: Striking a Balance between Planetary and Human Health: Is There a Path Forward?

The global adoption of predominantly plant-based sustainable healthy diets will help reduce the risk of obesity- and malnutrition-related non-communicable diseases while protecting the future health of our planet. This review examines the benefits and limitations of different types of plant-based diets in terms of health and nutrition, affordability and accessibility, cultural (ethical and religious) acceptability, and the environment (i.e., the four pillars underlying sustainable healthy diets). Results suggest that, without professional supervision, traditional plant-based diets (vegan, vegetarian and pescatarian diets) can increase the risk of nutritional deficiencies among infants, children/adolescents, adult females, pregnant/lactating women and the elderly. In contrast, flexitarian diets and territorial diversified diets (TDDs, e.g., Mediterranean and New Nordic diets) that include large quantities of plant-sourced foods, low levels of red meat and moderate amounts of poultry, fish, eggs and dairy can meet the energy and nutrition needs of different populations without the need for dietary education or supplementation. Compared to vegan, vegetarian and pescatarian diets, more diverse flexitarian diets and TDDs are associated with reduced volumes of food waste and may be more acceptable and easier to maintain for people who previously followed western diets. Although flexitarian diets and TDDs have a greater impact on the environment than vegan, vegetarian and pescatarian diets, the negative effects are considerably reduced compared to western diets, especially if diets include locally-sourced seasonal foods. Further studies are required to define more precisely optimal sustainable healthy diets for different populations and to ensure that diets are affordable and accessible to people in all countries.

Review: Quality of animal-source foods

This article critically reviews the current state of knowledge on the quality of animal-source foods according to animal production and food processing conditions, including consumer expectations-behaviours and the effects of consumption of animal-source foods on human health. Quality has been defined through seven core attributes: safety, commercial, sensory, nutritional, technological, convenience, and image. Image covers ethical, cultural and environmental dimensions associated with the origin of the food and the way it is produced and processed. This framework enabled to highlight the priorities given to the different quality attributes. It also helped to identify potential antagonisms and synergies among quality attributes, between production and processing stages, and among stakeholders. Primacy is essentially given to commercial quality attributes, especially for standard commodity animal-source foods. This primacy has strongly influenced genetic selection and farming practices in all livestock commodity chains and enabled substantial quantitative gains, although at the expense of other quality traits. Focal issues are the destructuration of chicken muscle that compromises sensory, nutritional and image quality attributes, and the fate of males in the egg and dairy sectors, which have heavily specialised their animals. Quality can be gained but can also be lost throughout the farm-to-fork continuum. Our review highlights critical factors and periods throughout animal production and food processing routes, such as on-farm practices, notably animal feeding, preslaughter and slaughter phases, food processing techniques, and food formulation. It also reveals on-farm and processing factors that create antagonisms among quality attributes, such as the castration of male pigs, the substitution of marine-source feed by plant-based feed in fish, and the use of sodium nitrite in meat processing. These antagonisms require scientific data to identify trade-offs among quality attributes and/or solutions to help overcome these tensions. However, there are also food products that value synergies between quality attributes and between production and processing phases, particularly Geographical Indications, such as for cheese and dry-cured ham. Human epidemiological studies have found associations between consumption of animal-source foods and increased or decreased risk for chronic non-communicable diseases. These associations have informed public health recommendations. However, they have not yet considered animal production and food processing conditions. A concerted and collaborative effort is needed from scientists working in animal science, food process engineering, consumer science, human nutrition and epidemiology in order to address this research gap. Avenues for research and main options for policy action are discussed.

Knowledge on the Complementary Feeding of Infants Older than Six Months among Mothers Following Vegetarian and Traditional Diets

Solid foods should be introduced not later than the age of six months, regardless of whether the family adheres to a traditional, vegetarian, or vegan diet. The aim of this study was to compare the knowledge on the complementary feeding of infants older than six months among mothers who adhere to traditional and vegetarian diets and to identify problems that require the assistance of a dietician. A total of 251 mothers of children aged 10–12 months participated in the study. Only 10% of vegetarian mothers declared that they had placed their children on a vegetarian diet, whereas 36 mothers adhered to a lacto-ovo-vegetarian diet during complementary feeding in the first year of life. Mothers adhering to a traditional diet were characterized by lower levels of knowledge (4.1 ± 2.3 points) than vegetarian mothers (5.3 ± 2.1 points). Mothers following a traditional diet were more likely to indicate a higher than recommended number of daily meals (OR = 1.76; Cl: 1.31–1.97, p < 0.001). Significant differences were noted in the respondents’ adherence to the BLW method, which was more readily implemented by vegan (p < 0.05) and lacto-vegetarian (p < 0.05) mothers and was least popular among mothers following a traditional diet (OR = 0.81; CI: 0.66–1.23, p < 0.04). Vegetarian mothers unnecessarily delayed the introduction of gluten and potentially allergizing foods to the children’s diets, sometimes even past the age of 12 months.

Inflammatory, oxidative and DNA damage status in vegetarians: is the future of human diet green?

The health benefit of a vegetarian diet is still under debate as it may result in a higher intake of some beneficial micronutrients, while others may be reduced, thus influencing various metabolic pathways and health-related biomarkers. This scoping review discusses inflammatory, oxidative and DNA damage status in vegetarians and vegans compared to omnivores. Most of the reviewed studies indicated favorable effects of a vegetarian diet on oxidative status compared to omnivores but did not clearly associate particular dietary habits to genome damage. The evidence on the effect of vegetarian diet on the inflammatory and immunological biomarkers is poor, which could at least partly be explained by methodological constraints such as small sample size, short duration of vegetarianism and inconsistent definitions of the omnivorous diet. The only inflammatory biomarker that seems to be associated with the vegetarian diet was inflammatory mediator C-reactive protein, which in several studies showed lower values in vegetarians as compared to omnivores. There were very few studies on immunological markers and the results on the difference between vegetarians and omnivores were inconclusive. Although several biomarkers involved in oxidative stress and inflammation showed a beneficial association with the vegetarian diet, further research in well-defined and sufficiently sized cohorts is needed to provide more evidence.

The Safety of a Vegan Diet During Pregnancy

There is an increasing number of people who go vegetarian. Some young parents also switch to this diet. The safety of vegetarian diets, especially vegan diets, is very important, especially during pregnancy. Unfortunately, reference publications do not provide coherent data on the safety of vegetarian diets during pregnancy. On the one hand, the vegan diet has advantages because it reduces the risk of heart disease and gestational diabetes. On the other hand, vegetarians/vegans should be aware of potential deficiencies of some nutrients (iron, zinc, vitamin B12, vitamin D, omega-3 fatty acids, calcium, iodine) and the clinical consequences for the fetus. For example, iron deficiency may affect cognitive abilities, behavior, intelligence and increase the risk of preterm birth and low birth weight of infants. Plant food contains non-haem iron with variable absorption. Therefore, the vegan diet should include nutrients increasing the bioavailability of iron, e.g. ascorbic acid, carotene and retinol. Due to the fact that animal food is the main source of vitamin B12, vegans are at a very high risk of vitamin B12 deficiency, which will affect the infant’s weight at birth. Low level of vitamin D, which is prevalent in animal food, is the most common deficiency among vegans and lacto-ovo vegetarians. This vitamin prevents gestational diabetes, reduces insulin resistance and guarantees normal function of the musculoskeletal system. Zinc deficiency during pregnancy may lead to preterm birth, neural tube defects or even miscarriage. In view of the clinical consequences of potential deficiencies of nutrients, the vegetarian/vegan diet should be well balanced.

Raising Children on a Vegan Diet: Parents' Opinion on Problems in Everyday Life

A growing number of Italian families are adopting a vegan diet (VD) for their offspring from infancy for various reasons, with health benefits and ethics being the most common reasons. Barriers to effective communication with primary care pediatricians (PCPs) are perceived by many parents and, depending on the actors involved and the environment, a VD may affect social interactions in everyday life. A national cross-sectional survey was conducted between July and September 2020. Parents of children following a VD completed an online questionnaire. Data from 176 Italian parents were collected. About 72% (71.8%) of the children included in this study had been on a VD since weaning. Parents did not inform their primary care pediatricians (PCP) about the VD in 36.2% of the cases. In 70.8% of the cases, PCPs were perceived as skeptical or against a VD. About 70% (71.2%) of the parents relied on medical dietitians, and 28.2% on nutritionists/dietitians for dietary counseling. Parents administered an individual B12 supplement in 87.2% of the cases. To the best of our knowledge, this survey is the first which explores the relationship between vegan parents and their PCPs, the parental management of their children's diet and problems regarding the implementation of a VD in everyday life.

Vegetarian Diet: An Overview through the Perspective of Quality of Life Domains

Vegetarianism has gained more visibility in recent years. Despite the well-described effects of a vegetarian diet on health, its influence on the quality of life of the individuals who follow it still needs to be properly investigated. Quality of life relates to a subjective perception of well-being and functionality, and encompasses four main life domains: physical, psychological, social, and environmental. The adoption of a vegetarian diet, despite being a dietary pattern, could potentially influence and be influenced by all of these domains, either positively or negatively. This review aims to present an overview of the background, conceptualization, features, and potential effects of vegetarianism in all quality of life domains. The choice of adopting a vegetarian diet could have positive outcomes, such as better physical health, positive feelings related to the adoption of a morally correct attitude, an increased sense of belonging (to a vegetarian community), and lower environmental impact. Other factors, however, could have a negative impact on the quality of life of those choosing to abstain from meats or other animal products, especially when they go beyond one's control. These include the environment, the social/cultural group in which a person is inserted, gender-based differences, economic aspects, and a limited access to a wide variety of plant-based foods. It is important to understand all the effects of adopting a vegetarian diet-beyond its nutritional aspects. Not only do studies in this area provide more consistent data, but they may also contribute to mitigating all factors that might prevent individuals from adopting a vegetarian diet, or that may have a negative impact on the quality of life of those who already follow it.

Healthy Food on the Twitter Social Network: Vegan, Homemade, and Organic Food

Online social networks have become an everyday aspect of many people’s lives. Users spend more and more time on these platforms and, through their interactions on social media platforms, they create active and passive digital footprints. These data have a strong potential in many research areas; indeed, understanding people’s communication on social media is essential for understanding their attitudes, experiences, behaviors and values. Researchers have found that the use of social networking sites impacts eating behavior; thus, analyzing social network data is important for understanding the meaning behind expressions used in the context of healthy food. This study performed a communication analysis of data from the social network Twitter, which included 666,178 messages posted by 168,134 individual users. These data comprised all tweets that used the #healthyfood hashtag between 2019 and 2020 on Twitter. The results revealed that users most commonly associate healthy food with a healthy lifestyle, diet, and fitness. Foods associated with this hashtag were vegan, homemade, and organic. Given that people change their behavior according to other people’s behavior on social networks, these data could be used to identify current and future associations with current and future perceptions of healthy food characteristics.

What are the new guidelines and position papers in pediatric nutrition: A 2015-2020 overview

BACKGROUND

Nutrition related publications in pediatric population cover wide range of topics and therefore it is usually difficult for clinicians to get an overview of recent nutrition related guidelines or recommendations.

METHODS

The Special Interest Group (SIG) of Pediatrics of European Society for Clinical Nutrition and Metabolism (ESPEN) performed a literature search to capture publications in the last five years aiming to provide the latest information concerning nutritional issues in children in general and in specific diseases and to discuss progression in the field of pediatric nutrition evidence-based practice.

RESULTS

Eight major topics were identified as the most frequently reported including allergy, critical illness, neonatal nutrition, parenteral and enteral nutrition, micronutrients, probiotics and malnutrition. Furthermore, it was noted that many reports were disease focused or included micronutrients and were, therefore, represented as tables.

CONCLUSION

Overall, it has been shown that most reports on nutrition topics in pediatrics were systematic reviews or guidelines/position papers of relevant societies, but many of them basing the conclusion on a limited number of high-quality randomized controlled trials or large observational cohort studies.

Risks and benefits of vegan and vegetarian diets in children

In parallel with increased public awareness of the health and environmental benefits of consuming a plant-based diet, the numbers of people who identify as vegan has increased sharply. The question of whether vegetarian and vegan diets are appropriate for children is a longstanding and unresolved controversy. The more restrictive the diet and the younger the child, the greater the risk of nutritional deficiency. Nutrients of potential concern are protein quantity and quality, iron, zinc, selenium, calcium, riboflavin, vitamins A, D, B12 and essential fatty acids. Although intakes and status of some nutrients (e.g. vitamin D and iron) are low in many children, vegan children are particularly susceptible due to inadequate supply and/or excess dietary fibre as well as other components that limit bioavailability. Although position papers from North America state that well-planned vegetarian and vegan diets, supplemented appropriately, are suitable for all life stages, European statements include strong recommendations to parents that vegan diets should not be adopted by children without medical and dietetic supervision. Case histories of malnutrition and serious harm persist, including irreversible neurological damage due to vitamin B12 deficiency among un-supplemented children. The evidence available to evaluate the nutritional appropriateness of vegetarian diets for children is inadequate and dated. Although nutritionally adequate vegetarian diets are more easily achieved, successful provision of a complete vegan diet for a young child requires substantial commitment, expert guidance, planning, resources and supplementation.

The Difficult Alliance between Vegan Parents and Pediatrician: A Case Report

The number of children on a vegetarian or vegan diet is gradually increasing. If not balanced and adequately supplemented, these dietary regimes can seriously impact the growth of children. Often the pediatrician is not perceived as a figure to rely on in the event of parents’ willingness to follow an alternative diet for their child. The feeling of distrust of parents towards the pediatrician can be dangerous for the health of the child. We present a 22-month-old boy with failure to thrive probably induced by an unbalanced vegetarian diet. The acquisition of the anamnestic data concerning the child’s diet was difficult because initially omitted by the parents. The poor compliance and the difficult follow-up highlights the difficulty in establishing a therapeutic alliance between parents who follow alternative regimens and the pediatrician.

Nutritional Quality of Vegetarian and Non-Vegetarian Dishes at School: Are Nutrient Profiling Systems Sufficiently Informative?

In France, school canteens must offer a vegetarian meal at least once per week. The objective was to evaluate the nutritional quality of school main dishes. A database of main dishes served in primary schools was first split into non-vegetarian (n = 669) and vegetarian (n = 315) categories. The latter has been divided into three sub-categories: vegetarian dishes containing cheese, vegetarian dishes containing eggs and/or dairy products but no cheese and vegetarian dishes without any eggs, cheese or other dairy products (vegan). Categories and sub-categories were compared based on nutrient adequacy ratios for "protective" nutrients (proteins, fibres, vitamins, minerals, essential fatty acids), the contents of nutrients to be limited (saturated fatty acids (SFA), sodium, free sugars) and on two nutrient profiling systems (SAIN,LIM and Nutri-Score). The vegetarian category and the non-vegetarian category displayed "adequate" levels (≥5% adequacy for 100 kcal) on average for almost all "protective" nutrients. The three sub-categories of vegetarian dishes displayed good SAIN,LIM and Nutri-Score profiles on average, although key nutrients were lacking (vitamin B12, vitamin D and DHA) or were present in insufficient amounts (vitamin B2 and calcium) in the vegan sub-category. The sub-category containing eggs and/or dairy products other than cheese was a good compromise, as it provided protective nutrients associated with eggs and fresh dairy products, while the sub-category containing cheese provided higher levels of SFA. Nutrient profile algorithms are insufficiently informative to assess the nutritional quality of school dishes.

Vegetarian and Vegan Weaning of the Infant: How Common and How Evidence-Based? A Population-Based Survey and Narrative Review

Background: Vegetarian and vegan weaning have increasing popularity among parents and families. However, if not correctly managed, they may lead to wrong feeding regimens, causing severe nutritional deficiencies requiring specific nutritional support or even the need for hospitalization. Aim: To assess the prevalence of vegetarian and vegan weaning among Italian families and to provide an up-to-date narrative review of supporting evidence. Materials and methods: We investigated 360 Italian families using a 40-item questionnaire. The narrative review was conducted searching scientific databases for articles reporting on vegetarian and vegan weaning. Results: 8.6% of mothers follow an alternative feeding regimen and 9.2% of infants were weaned according to a vegetarian or vegan diet. The breastfeeding duration was longer in vegetarian/vegan infants (15.8 vs. 9.7 months; p < 0.0001). Almost half of parents (45.2%) claim that their pediatrician was unable to provide sufficient information and adequate indications regarding unconventional weaning and 77.4% of parents reported the pediatrician’s resistance towards alternative weaning methods. Nine studies were suitable for the review process. The vast majority of authors agree on the fact that vegetarian and vegan weaning may cause severe nutritional deficiencies, whose detrimental effects are particularly significant in the early stages of life. Discussion and conclusion: Our results show that alternative weaning methods are followed by a significant number of families; in half of the cases, the family pediatrician was not perceived as an appropriate guide in this delicate process. To date, consistent findings to support both the safety and feasibility of alternative weaning methods are still lacking. Since the risk of nutritional deficiencies in the early stages of life is high, pediatricians have a pivotal role in guiding parents and advising them on the most appropriate and complete diet regimen during childhood. Efforts should be made to enhance nutritional understanding among pediatricians as an unsupervised vegetarian or vegan diet can cause severe nutritional deficiencies with possible detrimental long-term effects.

Case report of nutritional rickets in an infant following a vegan diet

We report the case of a 13-month-old infant who was referred to the pediatric emergency department because of psychomotor regression with four bone fractures due to nutritional rickets. The reason was prolonged breastfeeding from a vegetarian mother followed by a vegan diet for the infant after weaning. Rickets is one of the many nutritional deficiencies that could affect infants fed vegan or vegetarian diets. These diets are a public health concern requiring adapted information that suggests alternative formulas made from rice or soy proteins and adapted supplementation after weaning.

Nutritional Status and the Influence of the Vegan Diet on the Gut Microbiota and Human Health

The human gut microbiota is considered a well-known complex ecosystem composed of distinct microbial populations, playing a significant role in most aspects of human health and wellness. Several factors such as infant transitions, dietary habits, age, consumption of probiotics and prebiotics, use of antibiotics, intestinal comorbidities, and even metabolic diseases may continously alter microbiota diversity and function. The study of vegan diet-microbiota interactions is a rapidly evolving field, since plenty of research has been focused on the potential effects of plant-based dietary patterns on the human gut microbiota. It has been reported that well-planned vegan diets and their associated components affect both the bacterial composition and metabolic pathways of gut microbiota. Certain benefits associated with medical disorders but also limitations (including nutritional deficiencies) have been documented. Although the vegan diet may be inadequate in calorific value, it is rich in dietary fiber, polyphenols, and antioxidant vitamins. The aim of the present study was to provide an update of the existing knowledge on nutritional status of vegan diets and the influence of their food components on the human gut microbiota and health.