Human Health

Restricting animal source foods puts the young at risk

Paediatric guidance and parental responsibility are crucial in the case of strict vegetarian diets. Animal foods provide key nutrients, such as vitamin B12, iron, EPA/DHA, and choline, the absence of which could seriously compromise the health and well-being of young children. Moreover, a low supply of these nutrients during pregnancy and lactation can lead to negative outcomes for infants. Deficiencies in essential nutrients can lead to serious health problems, including failure to thrive, anaemia, neuropathies, and cognitive impairment. Clinical case reports of children on strict vegetarian diets have shown severe health consequences, emphasizing the need for proper nutritional planning and monitoring. Professional associations worldwide caution against vegan and vegetarian diets for pregnant women, infants, children, and adolescents.

Animal-sourced foods and malnutrition in the young


The global situation of infant and child malnutrition is concerning. More than half of children under the age of five suffer from micronutrient deficiencies necessary for healthy development, and nearly a quarter of children are stunted. Stunting is influenced by various factors, including poverty-driven issues, poor intake of protein and micronutrients, and maternal nutritional status. 

The early childhood period, especially the first 1000 days, is crucial for development, and animal source foods play a significant role during this time. Undernutrition during early age can lead to irreversible damage, particularly concerning neural health. On the long term, this can have an adverse impact on education, lifelong achievement, economic productivity, and community outcomes. 

Micronutrient deficiencies and growth issues are still prevalent in various countries. For example, India faces significant micronutrient deficiencies, stunting, and wasting rates. In the West, strict vegetarian diets may also create a risk for suboptimal physical or cognitive development, while paralleling reduced bone mineral content, vitamin B-12 deficiency, and iron-deficiency anaemia. 

Maternal avoidance of animal source foods: why is it risky?


Maternal nutrition is critical for infant health, especially during pregnancy and lactation when nutrient requirements increase. Consumption of animal-sourced foods correlates with better health markers in offspring, while low intake may result in inadequate stores of key nutrients, also in breast milk. 

Iron, DHA, choline, iodine, and vitamin B12, predominantly found in animal-sourced foods, are vital for fetal growth and neurocognitive development. Deficiencies in these nutrients can lead to altered growth trajectories, lower birth weights, and impaired brain development, with vegan and vegetarian diets posing particular risks if not carefully supplemented. 

Pregnant and lactating women, especially those on plant-based diets, should prioritize supplementation and a dietary diversity of micronutrient-rich foods to meet critical nutritional needs.These challenges are exacerbated in low-income regions where vegetarian diets are prevalent, and dietary recommendations often fail to account for cultural and economic contexts. 

Iron deficiency, common even in high-income countries, can affect myelination and cognitive function in infants, while insufficient DHA impacts neural and visual development. Similarly, iodine deficiency during pregnancy can disrupt thyroid function and neurological outcomes. Vitamin B12, often deficient in vegan diets, is crucial for neural health, and its shortage can irreversibly impair infant development. 

What is know from the medical literature?


Neonates and infants born to vegan, vegetarian, or macrobiotic mothers may experience reduced birth weight and various nutrient deficiencies, which can result in serious or irreversible pathological symptoms. The latter may include failure to thrive, hyperparathyroidism, macrocytic anaemia, neuropathies, psychosis, lethargy, spinal cord degeneration, cerebral atrophy, and optic neuropathies. 

Of particular concern is vitamin B12 deficiency, which can be life-threatening and may lead to impaired cognitive functions later in life. Additionally, strict vegetarian children may face vitamin D deficiencies, potentially leading to conditions like rickets. 

Numerous clinical case reports have documented that avoiding animal source foods can lead to harm in infants, children, and adolescents. Such reports are considered lower on the hierarchy of evidence, but they nonetheless raise serious concerns given their severity. Larger and more controlled studies looking into restrictive diets for vulnerable populations are limited due to ethical reasons.

Parental responsibility vs. paediatric guidance


Ensuring a nutritionally suitable diet for children on vegan or vegetarian diets is primarily the responsibility of parents, but paediatricians should also be involved in monitoring and managing such diets. Vegan children require specific nutritional supplements to avoid deficiencies, and expert advice is recommended when transitioning to or raising children on plant-based diets. However, even with careful planning and supplementation, strict vegetarian diets can still pose short- and long-term risks and official nutrient guidelines may not fully account for the risks. 

Paediatricians and gynaecologists often consider strict vegetarian diets inadequate for pregnant and lactating women, and when parents reject this guidance, alternative support in the form of tailored dietary advice is necessary. Potential risks for children on vegan diets include vitamin A and B12 insufficiency and low serum levels of DHA. 

There are also social and ethical challenges surrounding the guidance of vegan parents, as some may be resistant to interventions due to philosophical beliefs or distrust of medical advice. In severe cases, when a child's health is jeopardized, some argue that legal intervention may be required, with the potential to treat such cases as child abuse.

Professional associations and authorities


Pediatricians and professional associations and authorities worldwide have issued warnings and caution against vegan diets, especially for vulnerable population groups such as pregnant and lactating women, infants, children, and adolescents. Notable exceptions are the position papers of the US Academy of Nutrition and Dietetics. They are to be interpreted with caution given the ideological and activist background of their authors. 

Warnings are based on the difficulty of attaining adequate nutrient supply through vegan diets, which may lead to severe nutrient deficiencies and irreversible health consequences.