Plant-based diet nutrient planning aids children’s growth and cardiometabolic health

A major new meta-analysis finds that vegetarian and vegan diets can support children’s healthy growth when carefully planned with appropriate supplementation. Nutrition Insight discusses trends, misconceptions, and the politicization of these diets with the study’s lead researcher.

Touted to be the most comprehensive study to date, the publication in Critical Reviews in Food Science and Nutrition examined 48,000 children and adolescents following various diets. It includes information across 18 countries from 59 studies.

The researchers, from Italy, the US, and Australia, warn that vegan and vegetarian diets also carry a risk of deficiencies of certain nutrients if they are not consumed through fortified foods or supplements. 

However, they stress that these diets may still bring significant health benefits, such as improved cardiovascular risk profiles compared with omnivorous diets, for example, lower total LDL cholesterol.

Compared to omnivores, vegetarian children consumed higher levels of fiber, iron, folate, vitamin C, and magnesium. But energy, protein, fat, vitamin B12, and zinc were lower. Although data on vegan diets were limited, researchers noted similar patterns, with especially low calcium intake.

Children’s diet trends

Monica Dinu, assistant professor, Experimental and Clinical Medicine at the University of Florence, Italy, tells us that more children are being raised on vegetarian and vegan diets, especially in high-income countries

“US survey data suggest that a small but growing proportion of children and adolescents identify as vegetarian or vegan. At the same time, our review shows that the scientific literature is still catching up with this trend.” 

“Most available studies are cross-sectional, sample sizes for vegan children are relatively small, and there are limited data on long-term outcomes, particularly for bone health and neurocognitive development,” she explains. 

Dinu highlights another trend regarding the contexts of plant-based diets, such as in high-income countries, among health-motivated parents, environmental and ethical concerns, and accessibility to fortified foods and supplements. 

“In low- and middle-income countries, vegetarian or vegan diets may be driven more by culture or economic constraints, and access to fortified foods and supplements is often limited, which can increase the risk of deficiencies.”

Plant-based eating patterns in children are increasing, especially in high-income countries.“Our findings support a balanced message: plant-based diets in childhood are neither a magic bullet nor a danger in themselves. With proper planning, education, and support, they can support healthy growth and may offer some cardiometabolic advantages, but they require particular attention to a set of key nutrients,” she states.

Unraveling diet misconceptions

Plant-based or vegan diets, especially for children, are contested. Dinu says a common misunderstanding is that these eating habits are believed to be inherently dangerous for children.

“Based on the available evidence, the reality is more nuanced: when these diets are carefully planned and supported by fortified foods and supplements where needed, they can be nutrient-rich and compatible with normal growth and good health.” 

“The opposite misconception is that a ‘natural’ vegan diet automatically covers all needs without any supplementation. That is not the case. Vitamin B12 does not occur in unfortified plant foods, and our analysis shows clearly lower B12 intakes, especially in vegan children, unless fortified foods or supplements are used,” she points out.

Furthermore, people misunderstand that vegetarian or vegan children will always remain small or undernourished.

“On average, we did see a leaner profile with slightly lower body mass index and, in some cases, height differences of 1–3 cm compared with omnivores, but values generally remained within pediatric reference ranges, indicating leaner growth rather than growth failure,” explains Dinu.

“Finally, it is often assumed that nutrient adequacy is only a problem for plant-based diets. In reality, typical omnivorous diets in children also tend to be low in fruits, vegetables, whole grains, and legumes and may provide excess saturated fat and salt.”

She adds, the real issue is the diet’s overall quality, not simply the presence or absence of animal products.

Study authors emphasize that B12 must come from fortified foods or supplements in vegan diets.Commenting on the study, professor Martin Warren, chief scientific officer at Quadram Institute Bioscience, praises the timeliness of the review. However, he notes that with all observational research, causality cannot be established.

“The abstract suggests that important confounding factors, such as socioeconomic status, parental education, or typical supplementation practices, may not have been consistently accounted for. Nevertheless, the results are striking.” 

The politicization of plant-based foods

Plant-based diets are beneficial for children’s health, however, they are not in the mainstream. Dinu explains this may be because it is easily politicized. “Plant-based diets in childhood sit at the intersection of health, ethics, environment, and parental choice.”

“At the same time, the evidence based on children is still more limited than on adults and consists mainly of cross-sectional studies. This makes health authorities understandably cautious and may explain why the topic receives less clear public guidance than it deserves.”

“Different professional societies also send mixed messages: some highlight benefits such as lower rates of overweight and better lipid profiles, while others emphasize the risk of deficiencies and recommend close medical supervision for strict vegan diets in young children,” she notes. 

According to Dinu, dietary guidelines should definitely encourage all children to eat more plant-based foods, regardless of their dietary choices. Vegetables, fruits, whole grains, legumes, nuts, and seeds are associated with long-term cardiometabolic health. They are also high in fiber, micronutrients, and phytochemicals.

“Whether families choose a fully vegetarian or vegan pattern or a plant-forward omnivorous diet, a stronger emphasis on plant foods would be a positive step,” Dinu adds.

Nutrient planning regardless of diet choice

Dinu’s team found that vegetarian and especially vegan children often had lower levels of certain nutrients, such as vitamin B12 (especially in vegans), iron, calcium, vitamin D, iodine, and zinc.

Carefully planned plant-based diets may offer cardiometabolic benefits for children.“However, this does not mean that children must consume animal-based foods to meet their needs. These nutrients can be provided through a combination of carefully chosen plant foods (such as legumes, nuts and seeds, tofu, whole grains, and iodized salt), fortified products (like fortified plant milks and breakfast cereals), and targeted supplementation where appropriate.”

“Some families may prefer a more flexible approach and include moderate amounts of animal foods such as dairy, eggs, or fish. This can make it easier to achieve adequacy for some nutrients while also reminding us that the real concern lies in the excessive consumption of certain animal products rather than their moderate inclusion,” notes Dinu. 

She underscores that the key message is not to get kids to eat more meat because plant-based diets are risky, but that regardless of their chosen diet, they should consume foods that reliably cover key nutrients after thoughtful planning.

Access to health professionals

Not all children and families have equal access to dietitians and pediatric health professionals. In this case, Dinu stresses the importance for families to recognize that the higher the diet restrictions, the greater the risk of nutritional gaps, especially for vegan children.

“Ensuring adequate energy intake, including reliable sources of protein, and paying close attention to key nutrients such as vitamin B12, iron, calcium, vitamin D, iodine, zinc, and omega-3 fats is essential, but doing so without professional guidance can be challenging.” 

“For this reason, monitoring growth carefully and seeking medical evaluation whenever concerns arise is crucial. Overall, thoughtful planning and awareness of potential risks are indispensable, and families should be encouraged to consult qualified professionals whenever possible,” she concludes.