Vitamin B12 levels in children and adolescents on plant-based diets: a systematic review and meta-analysis

Water-Soluble Vitamins: Hypo- and Hypervitaminosis in Pediatric Population

BACKGROUND/OBJECTIVES

Water-soluble vitamins, comprising the B-complex vitamins and vitamin C, are essential for normal growth, cellular metabolism, and immune function in pediatric populations. Due to limited storage in the body, these vitamins require consistent intake to prevent deficiencies. Pediatric populations, particularly infants and young children, face a heightened risk of both deficiency and, in rare cases, toxicity due to varying dietary intake and increased developmental needs. This review explores the clinical importance of water-soluble vitamins, focusing on hypo- and hypervitaminosis in children.

METHODS

A narrative review of the recent literature on the sources, recommended intakes, deficiency symptoms, and potential toxicities associated with each water-soluble vitamin was conducted.

RESULTS

Deficiencies in water-soluble vitamins can lead to diverse clinical outcomes, such as neurological, hematological, and immune-related symptoms, depending on the specific vitamin involved. Pediatric populations with increased nutritional needs, such as those experiencing rapid growth or with malabsorption conditions, are particularly vulnerable to vitamin insufficiencies. Conversely, although uncommon, excessive intake of certain water-soluble vitamins may cause mild toxicity, primarily gastrointestinal or neurological.

CONCLUSIONS

Monitoring water-soluble vitamin levels and providing tailored nutritional support are critical to prevent the adverse effects of hypo- and hypervitaminosis in children. Further research is needed to refine pediatric nutritional guidelines and address the specific needs of young patients, supporting optimal health outcomes.

Plant-based dietary patterns, nutrient intake, growth, and body composition in childhood: Results from a prospective population-based study

BACKGROUND & AIMS

Transitioning to more plant-based diets promotes environmental sustainability and has health benefits for adults. However, associations with nutrient intake adequacy and growth in children remain unknown. This study aimed to examine associations of plant-based diets with nutrient intake levels among children, and with longitudinal growth and body composition up to adolescence.

METHOD

We included 3340 children in the Generation R Study, a population-based cohort. Food and nutrient intake were assessed at the age of 8 years, and anthropometrics and body composition (using dual-energy X-ray absorptiometry) were measured at the ages of 10 and 13 years. Plant-based diets were quantified using three plant-based diet indices (PDIs): overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI). Modified Poisson regression and linear mixed models were used to estimate the associations of PDIs with nutrient intake levels, and with sex- and age-standardized measures of anthropometrics and body composition.

RESULTS

Higher scores on each of the three PDIs were associated with lower intake of vitamin B2, B12, and calcium, while higher hPDI score was associated with higher intake levels of fiber, vitamin C, magnesium, and copper. Higher hPDI score was also associated with higher fat-free mass index (FFMI) z-score (0.05 per 10-hPDI score increment, 95 % CI: 0.01, 0.10), and with lower body fat percentage z-score (-0.05, 95 % CI: -0.09, -0.01), while higher uPDI score was associated with lower height, weight, and FFMI z-score (FFMI: -0.08, 95 % CI: -0.12, -0.03) up to age of 13 years.

CONCLUSIONS

In this cohort study, higher adherence to healthful plant-based diets, rather than unhealthful ones, was associated with better nutrient intakes, and subsequent healthy body composition throughout childhood to adolescence. Our findings suggest that consuming healthful plant-based foods may contribute to children's diets' nutrient quality and subsequent body composition. Still, attention should be given to ensuring balanced and adequate nutrient intake for optimal plant-based eating.

Impact of Plant-Based School Meals on Gut Bifidobacterium spp. Abundance and Health Outcomes in Schoolchildren from Bahia, Brazil

Plant-based diets have been linked to various health benefits, including an improved gut microbiota composition, potentially influencing non-communicable diseases. This study investigates the impact of a school meal intervention on the gut microbiota, specifically the abundance of Bifidobacterium spp. (BIF), in Brazilian schoolchildren. A quasi-experimental intervention was conducted in 2019 across four municipalities in the semi-arid region of Bahia, Brazil. The Sustainable School Program aimed to replace animal-based and ultra-processed foods with plant-based options. Clinical, dietary, anthropometric, and laboratory data were collected at the beginning and end of the school year. Fecal samples were analyzed for BIF abundance using RT-PCR. The intervention improved anthropometric and laboratory outcomes, including increased serum hemoglobin levels and reduced LDL-cholesterol. Despite these benefits, no significant change in BIF abundance was observed. However, a negative correlation between BIF abundance and waist-to-height ratio was found. While the intervention positively affected several health parameters, it did not significantly alter BIF abundance. Nevertheless, the abundance of BIF may explain some of these positive outcomes. The findings highlight the potential of plant-based diets to improve overall health, but suggest that further research is needed to understand the role of the gut microbiota in these outcomes. Future studies should explore the influence of factors such as physical activity on the gut microbiota and health.

Nutrition classification schemes for plant-based meat analogues: Drivers to assess nutritional quality and identity profile

Changes in dietary patterns promoted by the emergence of alternative food systems are becoming increasingly common. The decrease in the consumption of animal-derived products promoted exponential growth in plant-based product demand and, consequently, the availability of several meat analogues for this consumer market. Plant-based meat analogues (PBMAs) were developed to mimic the physical and sensory characteristics of meats and their derivatives. Therefore, the composition of these products has been studied in some countries as an attempt to evaluate their nutritional quality in comparison with that of traditional meat products. The main aim of this study was to employ different Nutrition Classification Schemes (NCSs) to assess the nutritional quality of plant-based meat and to discuss the application of one or more NCSs in defining the identity and quality profile of these foods. Five NCSs were used: three nutrient-based (Nutri-Score; Nutrient Profiling Model (NPM) from Brazil; NPM from PAHO); one food-based (NOVA classification); and one hybrid (Plant-Based Nutrient Profile Model). The nutritional composition and ingredients were collected from labels of 349 PBMAs; 117 were classified as burgers, and 182 products employed soy as the main protein ingredient. The use of different NCSs is strategic for PBMAs' nutritional quality evaluation, and the Nutri-Score was able to show the effectiveness of differentiating products as having poor nutritional quality. In this way, the employment of NPM from Brazil is recommended as a driver for PBMAs choices, especially due to the excellent agreement between the Nutri-Score and NPM from Brazil for burgers.

Dietary intake, nutritional adequacy and food sources of vitamins involved in the methionine-methylation cycle from Spanish children aged one to <10 years: results from the EsNuPI study

Background

Methionine-methylation cycle and the derived critical functions during infancy are key regulated by folates, vitamins B12, and B6. At present in Spain, there is an absence of studies that assess the intakes and dietary sources of total folates and B12 by children consuming all types of milks and those regularly consuming adapted milk formulas. Thus, our aim was to evaluate folates intakes alongside with vitamins B6 and B12 while describing their major dietary contributors in Spanish children aged one to <10 years.

Methods

A total of 1,448 children aged between 1 and 10 years (49.7% girls and 50.3% boys) from the EsNuPI, a prospective cross-sectional study, were allocated into two cohorts: one Spanish Reference Cohort (SRS) of the general population (n = 707), and another including children consuming adapted milks called Adapted Milk Consumers Cohort (AMS) (n = 741) completed two 24 h dietary recalls used to estimate their nutrient intakes and to compare them to the European Food Safety Authority (EFSA) Population Reference Intakes.

Results

The median intake of vitamin B6 was 1.35 (1.06-1.70) mg/day in the SRS and 1.45 (1.17-1.79) mg/day in the AMS, being significantly higher in the AMS for all age-groups. Prevalence of adequacy for vitamin B6 in the SRS and AMS was 97.7 and 98.7%, respectively. Total folates intakes in the AMS were significantly higher (p ≤ 0.001) in all age groups than in the SRS, independently of age. In addition, the prevalence of adequacy for folates intakes in all groups was more than 60%. Vitamin B12 intake increased with age independently of the type of milk consumed. The prevalence of adequacy for vitamin B12 was highly compliant by all population groups. The major contributors to vitamin B6 were milk and dairy products being significantly higher in AMS than SRS (p ≤ 0.001). The highest contributors to folates intakes were milk and dairy products, cereals, vegetables, and fruits in both groups whereas for vitamin B12 in the SRS sample were milk and dairy products followed by meat and meats products and for adapted milks, were milk and dairy products, followed by eggs, then meat and meats products.

Conclusion

A satisfactory prevalence of adequacy for vitamins B6, and B12 amongst the Spanish children population was observed, which was not the case for folates, regardless of the dietary group evaluated. Nevertheless, a possible strategy to increase folate intake among the youngest children is to increase the consumption of milk and dairy products within a healthier dietary pattern, as these may contribute significantly to the vitamin needs of the infant population.