A study of nearly 9,000 children found those who eat a vegetarian diet had similar measures of growth and nutrition compared to children who eat meat. The study, published in Pediatrics and led by researchers at St. Michael’s Hospital of Unity Health Toronto, also found that children with a vegetarian diet had higher odds of underweight weight status, emphasizing the need for special care when planning the diets of vegetarian kids.
The findings come as a shift to consuming a plant-based diet grows in Canada. In 2019, updates to Canada’s Food Guide urged Canadians to embrace plant-based proteins, such as beans and tofu, instead of meat.
“Over the last 20 years we have seen growing popularity of plant-based diets and a changing food environment with more access to plant-based alternatives, however we have not seen research into the nutritional outcomes of children following vegetarian diets in Canada,” said Dr. Jonathon Maguire, lead author of the study and a pediatrician at St. Michael’s Hospital of Unity Health Toronto.
“This study demonstrates that Canadian children following vegetarian diets had similar growth and biochemical measures of nutrition compared to children consuming non-vegetarian diets. Vegetarian diet was associated with higher odds of underweight weight status, underscoring the need for careful dietary planning for children with underweight when considering vegetarian diets.”
Researchers evaluated 8,907 children age six months to eight years. The children were all participants of the TARGet Kids! cohort study and data was collected between 2008 and 2019. Participants were categorized by vegetarian status – defined as a dietary pattern that excludes meat – or non-vegetarian status.
Researchers found children who had a vegetarian diet had similar mean body mass index (BMI), height, iron, vitamin D, and cholesterol levels compared to those who consumed meat. The findings showed evidence that children with a vegetarian diet had almost two-fold higher odds of having underweight, which is defined as below the third percentile for BMI. There was no evidence of an association with overweight or obesity.
Underweight is an indicator of undernutrition, and may be a sign that the quality of the child’s diet is not meeting the child’s nutritional needs to support normal growth. For children who eat a vegetarian diet, the researchers emphasized access to healthcare providers who can provide growth monitoring, education and guidance to support their growth and nutrition.
International guidelines about vegetarian diet in infancy and childhood have differing recommendations, and past studies that have evaluated the relationship between vegetarian diet and childhood growth and nutritional status have had conflicting findings.
“Plant-based dietary patterns are recognized as a healthy eating pattern due to increased intake of fruits, vegetables, fiber, whole grains, and reduced saturated fat; however, few studies have evaluated the impact of vegetarian diets on childhood growth and nutritional status. Vegetarian diets appear to be appropriate for most children,” said Dr. Maguire, who is also a scientist at MAP Centre for Urban Health Solutions at St. Michael’s Hospital.
A limitation of the study is that researchers did not assess the quality of the vegetarian diets. The researchers note that vegetarian diets come in many forms and the quality of the individual diet may be quite important to growth and nutritional outcomes. The authors say further research is needed to examine the quality of vegetarian diets in childhood, as well as growth and nutrition outcomes among children following a vegan diet, which excludes meat and animal derived products such as dairy, egg, and honey.
The study was funded by the Canadian Institutes of Health Research (CIHR), St. Michael’s Hospital Foundation and SickKids Foundation.
SUBJECT OF RESEARCH
Vegetarian diet, growth, and nutrition in early childhood: A longitudinal cohort study
ARTICLE PUBLICATION DATE
The funding agencies had no role in the design and conduct of the study. Dr. Maguire received an unrestricted research grant for a completed investigator-initiated study from Dairy Farmers of Canada (2011-2021) and D drops provided non-financial support (vitamin D supplements) for an investigator initiated study on vitamin D and respiratory tract infections (2011-2015). Dr. Birken received a research grant from the Centre for Addiction and Mental Health Foundation (CAMH 2017-2020). Dr. Jenkins has received research grants from Saskatchewan & Alberta Pulse Growers Associations, the Agricultural Bioproducts Innovation Program through the Pulse Research Network, the Advanced Foods and Material Network, Loblaw Companies Ltd., Unilever Canada and Netherlands, Barilla, the Almond Board of California, Agriculture and Agri-food Canada, Pulse Canada, Kellogg’s Company, Canada, Quaker Oats, Canada, Procter & Gamble Technical Centre Ltd., Bayer Consumer Care, Springfield, NJ, Pepsi/Quaker, International Nut & Dried Fruit (INC), Soy Foods Association of North America, the Coca-Cola Company (investigator initiated, unrestricted grant), Solae, Haine Celestial, the Sanitarium Company, Orafti, the International Tree Nut Council Nutrition Research and Education Foundation, the Peanut Institute, Soy Nutrition Institute (SNI), the Canola and Flax Councils of Canada, the Calorie Control Council, the Canadian Institutes of Health Research (CIHR), the Canada Foundation for Innovation (CFI)and the Ontario Research Fund (ORF). He has received in-kind supplies for trials as a research support from the Almond board of California, Walnut Council of California, American Peanut Council, Barilla, Unilever, Unico, Primo, Loblaw Companies, Quaker (Pepsico), Pristine Gourmet, Bunge Limited, Kellogg Canada, WhiteWave Foods. He has been on the speaker’s panel, served on the scientific advisory board and/or received travel support and/or honoraria from the Almond Board of California, Canadian Agriculture Policy Institute, Loblaw Companies Ltd, the Griffin Hospital (for the development of the NuVal scoring system), the Coca-Cola Company, EPICURE, Danone, Diet Quality Photo Navigation (DQPN), Better Therapeutics (FareWell), Verywell, True Health Initiative (THI), Heali AI Corp, Institute of Food Technologists (IFT), Soy Nutrition Institute (SNI), Herbalife Nutrition Institute (HNI), Saskatchewan & Alberta Pulse Growers Associations, Sanitarium Company, Orafti, the American Peanut Council, the International Tree Nut Council Nutrition Research and Education Foundation, the Peanut Institute, Herbalife International, Pacific Health Laboratories, Nutritional Fundamentals for Health (NFH), Barilla, Metagenics, Bayer Consumer Care, Unilever Canada and Netherlands, Solae, Kellogg, Quaker Oats, Procter & Gamble, Abbott Laboratories, Dean Foods, the California Strawberry Commission, Haine Celestial, PepsiCo, the Alpro Foundation, Pioneer Hi-Bred International, DuPont Nutrition and Health, Spherix Consulting and WhiteWave Foods, the Advanced Foods and Material Network, the Canola and Flax Councils of Canada, Agri-Culture and Agri-Food Canada, the Canadian Agri-Food Policy Institute, Pulse Canada, the Soy Foods Association of North America, the Nutrition Foundation of Italy (NFI), Nutra-Source Diagnostics, the McDougall Program, the Toronto Knowledge Translation Group (St. Michael’s Hospital), the Canadian College of Naturopathic Medicine, The Hospital for Sick Children, the Canadian Nutrition Society (CNS), the American Society of Nutrition (ASN), Arizona State University, Paolo Sorbini Foundation and the Institute of Nutrition, Metabolism and Diabetes. He received an honorarium from the United States Department of Agriculture to present the 2013 W.O. Atwater Memorial Lecture. He received the 2013 Award for Excellence in Research from the International Nut and Dried Fruit Council. He received funding and travel support from the Canadian Society of Endocrinology and Metabolism to produce mini cases for the Canadian Diabetes Association (CDA). He is a member of the International Carbohydrate Quality Consortium (ICQC). His wife, Alexandra L Jenkins, is a director and partner of INQUIS Clinical Research for the Food Industry, his 2 daughters, Wendy Jenkins and Amy Jenkins, have published a vegetarian book that promotes the use of the foods described here, The Portfolio Diet for Cardiovascular Risk Reduction (Academic Press/Elsevier 2020 ISBN:978-0-12-810510- 8) and his sister, Caroline Brydson, received funding through a grant from the St. Michael’s Hospital Foundation to develop a cookbook for one of his studies. The other authors have no conflicts of interest to disclose