European Journal of Nutrition

, Volume 56, Issue 5, pp 1797–1817 | Cite as

Vegetarian diets in children: a systematic review

  • S. Schürmann
  • M. Kersting
  • U. AlexyEmail author



While the prevalence of children on vegetarian diets is assumed to be on the rise in industrialized countries, there are hardly any representative data available. In general, vegetarian diets are presumed to be healthy; nevertheless, there are concerns as to whether the dietary specifications required during infancy, childhood, and adolescence can be met. Therefore, the objective of this systematic review was to evaluate studies on the dietary intake and the nutritional or health status of vegetarian infants, children, and adolescents.


The database MEDLINE was used for literature search. In addition, references of reviews and expert opinions were considered. Inclusion criteria were (1) sufficient dietary information to define vegetarian type diet and (2) characteristics of nutritional or health status. Case reports and studies from non-industrialized countries were excluded.


24 publications from 16 studies published from 1988 to 2013 met our criteria. Study samples covered the age range from 0 to 18 years, and median sample size was 35. Five studies did not include a control group. With regard to biomarkers, anthropometry, and dietary or nutritional intake, the outcomes were diverse. Growth and body weight were generally found within the lower reference range. The intakes of folate, vitamin C, and dietary fiber were relatively high compared to reference values and/or control groups. Low status of vitamin B12 was reported in one study and low status of vitamin D in two studies.


Due to the study heterogeneity, the small samples, the bias towards upper social classes, and the scarcity of recent studies, the existing data do not allow us to draw firm conclusions on health benefits or risks of present-day vegetarian type diets on the nutritional or health status of children and adolescents in industrialized countries.


Vegetarian diet Dietary intake Health Infants Children Adolescents 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Leitzmann CKM (2010) Vegetarische Ernährung. 74 Tabellen. Begriffe und Definitionen., 2nd edn. Ulmer, StuttgartGoogle Scholar
  2. 2.
    Claus Leitzmann MK (2013) Vegetarische Ernährung. [Vegetarian nutrition.], 3rd edn. Ulmer, StuttgartGoogle Scholar
  3. 3.
    Daniel CR, Cross AJ, Koebnick C et al (2011) Trends in meat consumption in the USA. Public Health Nutr 14(04):575–583. doi: 10.1017/S1368980010002077 CrossRefGoogle Scholar
  4. 4.
    Mensink GBM, Kleiser C, Richter A (2007) Lebensmittelverzehr bei Kindern und Jugendlichen in Deutschland. Bundesgesundheitsbl. 50(5–6): 609–623. doi: 10.1007/s00103-007-0222-x CrossRefGoogle Scholar
  5. 5.
    Appleby PN, Key TJ (2015) The long-term health of vegetarians and vegans. Proc Nutr Soc. doi: 10.1017/S0029665115004334 Google Scholar
  6. 6.
    Pawlak R, Lester SE, Babatunde T (2014) The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature. Eur J Clin Nutr 68(5):541–548. doi: 10.1038/ejcn.2014.46 CrossRefGoogle Scholar
  7. 7.
    Tucker KL (2014) Vegetarian diets and bone status. Am J Clin Nutr 100 Suppl 1: 329S–335. doi: 10.3945/ajcn.113.071621 Google Scholar
  8. 8.
    Rosell MS, Lloyd-Wright Z, Appleby PN et al (2005) Long-chain n-3 polyunsaturated fatty acids in plasma in British meat-eating, vegetarian, and vegan men. Am J Clin Nutr 82(2):327–334Google Scholar
  9. 9.
    Sabaté J, Ratzin-Turner R (eds) (2001) Vegetarian nutrition. Modern nutrition. CRC Press, Boca RatonGoogle Scholar
  10. 10.
    Kleinman RE (2009) Pediatric nutrition handbook, 6th ed. American Academy of Pediatrics, Elk Grove Village, ILGoogle Scholar
  11. 11.
    Domellöf M, Braegger C, Campoy C et al (2014) Iron requirements of infants and toddlers. J Pediatr Gastroenterol Nutr 58(1):119–129. doi: 10.1097/MPG.0000000000000206 CrossRefGoogle Scholar
  12. 12.
    Braegger C, Campoy C, Colomb V et al (2013) Vitamin D in the healthy European paediatric population. J Pediatr Gastroenterol Nutr 56(6):692–701. doi: 10.1097/MPG.0b013e31828f3c05 CrossRefGoogle Scholar
  13. 13.
    Guez S, Chiarelli G, Menni F et al (2012) Severe vitamin B12 deficiency in an exclusively breastfed 5-month-old Italian infant born to a mother receiving multivitamin supplementation during pregnancy. BMC Pediatr 12:85. doi: 10.1186/1471-2431-12-85 CrossRefGoogle Scholar
  14. 14.
    Zimmermann MB (2008) Iodine requirements and the risks and benefits of correcting iodine deficiency in populations. J Trace Elem Med Biol 22(2):81–92. doi: 10.1016/j.jtemb.2008.03.001 CrossRefGoogle Scholar
  15. 15.
    Koletzko B, Lien E, Agostoni C et al (2008) The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. J Perinat Med 36(1):5–14. doi: 10.1515/JPM.2008.001 CrossRefGoogle Scholar
  16. 16.
    Kleinman RE (2013) Pediatric Nutrition, 7th ed. American Academy of Pediatrics, Elk Grove VillageGoogle Scholar
  17. 17.
    Position of the American Dietetic Association (2009) Vegetarian diets. J Am Diet Assoc 109(7): 1266–1282. doi: 10.1016/j.jada.2009.05.027
  18. 18.
    DGE Deutsche Gesellschaft für Ernährung Vegane Ernährung: Nährstoffversorgung und Gesundheitsrisiken im Säuglings- und Kindesalter. DGE info 2011(4/2011): S 48–53Google Scholar
  19. 19.
    Piccoli GB, Clari R, Vigotti FN et al (2015) Vegan-vegetarian diets in pregnancy: danger or panacea? A systematic narrative review. BJOG 122(5):623–633. doi: 10.1111/1471-0528.13280 CrossRefGoogle Scholar
  20. 20.
    Kushi M (1987, ©1986) The book of macrobiotics. The universal way of health, happiness, and peace, Completely rev. and enl. ed. Japan Publications, TokyoGoogle Scholar
  21. 21.
    Kushi LH, Cunningham JE, Hebert JR et al (2001) The macrobiotic diet in cancer. J Nutr 131(11 Suppl):3056S–3064Google Scholar
  22. 22.
    Dagnelie PC, Vergote FJ, van Staveren WA et al (1990) High prevalence of rickets in infants on macrobiotic diets. Am J Clin Nutr 51(2):202–208Google Scholar
  23. 23.
    Dagnelie PC, van Staveren WA, Vergote FJ et al (1989) Increased risk of vitamin B-12 and iron deficiency in infants on macrobiotic diets. Am J Clin Nutr 50(4):818–824Google Scholar
  24. 24.
    Sanders TA (1988) Growth and development of British vegan children. Am J Clin Nutr 48(3 Suppl):822–825Google Scholar
  25. 25.
    Sievers E, Dörner K, Hamm E, Janisch C, Schaub J (1991) Vergleichende Untersuchungen zur Eisenversorgunglakto-ovo-vegetabil ernährter Säuglinge. Ärztezeitschr. f. Naturheilverf. (2/91): 106–108Google Scholar
  26. 26.
    Nathan I, Hackett AF, Kirby S (1996) The dietary intake of a group of vegetarian children aged 7–11 years compared with matched omnivores. Br J Nutr 75(4):533–544CrossRefGoogle Scholar
  27. 27.
    Nathan I, Hackett AF, Kirby S (1997) A longitudinal study of the growth of matched pairs of vegetarian and omnivorous children, aged 7–11 years, in the north-west of England. Eur J Clin Nutr 51(1):20–25CrossRefGoogle Scholar
  28. 28.
    Krajcovicová-Kudlácková M, Simoncic R, Béderová A et al. (1997) Influence of vegetarian and mixed nutrition on selected haematological and biochemical parameters in children. Die Nahrung 41(5): 311–314CrossRefGoogle Scholar
  29. 29.
    Krajcovicová-Kudlácková M, Simoncic R, Béderová A et al (1997) Plasma fatty acid profile and alternative nutrition. Ann Nutr Metab 41(6):365–370CrossRefGoogle Scholar
  30. 30.
    Hebbelinck M, Clarys P, Malsche A de (1999) Growth, development, and physical fitness of Flemish vegetarian children, adolescents, and young adults. Am J Clin Nutr 70(3 Suppl):579S–585Google Scholar
  31. 31.
    Ambroszkiewicz J, Laskowska-Klita T, Klemarczyk W (2003) Low levels of osteocalcin and leptin in serum of vegetarian prepubertal children. Med Wieku Rozwoj 7(4 Pt 2):587–591Google Scholar
  32. 32.
    Taylor A, Redworth EW, Morgan JB (2004) Influence of diet on iron, copper, and zinc status in children under 24 months of age. Biol Trace Elem Res 97(3):197–214. doi: 10.1385/BTER:97:3:197 CrossRefGoogle Scholar
  33. 33.
    Ambroszkiewicz J, Klemarczyk W, Chełchowska M et al. (2006) Serum homocysteine, folate, vitamin B12 and total antioxidant status in vegetarian children. Adv Med Sci 51:265–268Google Scholar
  34. 34.
    Ambroszkiewicz J, Klemarczyk W, Gajewska J et al. (2007) Serum concentration of biochemical bone turnover markers in vegetarian children. Adv Med Sci 52: 279–282Google Scholar
  35. 35.
    Ambroszkiewicz J, Klemarczyk W, Gajewska J et al (2011) Serum concentration of adipocytokines in prepubertal vegetarian and omnivorous children. Med Wieku Rozwoj 15(3):326–334Google Scholar
  36. 36.
    Laskowska-Klita T, Chełchowska M, Ambroszkiewicz J et al (2011) The effect of vegetarian diet on selected essential nutrients in children. Med Wieku Rozwoj 15(3):318–325Google Scholar
  37. 37.
    Gorczyca D, Paściak M, Szponar B et al (2011) An impact of the diet on serum fatty acid and lipid profiles in polish vegetarian children and children with allergy. Eur J Clin Nutr 65(2):191–195. doi: 10.1038/ejcn.2010.231 CrossRefGoogle Scholar
  38. 38.
    Gorczyca D, Prescha A, Szeremeta K et al (2013) Iron status and dietary iron intake of vegetarian children from Poland. Ann Nutr Metab 62(4):291–297. doi: 10.1159/000348437 CrossRefGoogle Scholar
  39. 39.
    O’Connell JM, Dibley MJ, Sierra J et al (1989) Growth of vegetarian children: the farm study. Pediatrics 84(3):475–481Google Scholar
  40. 40.
    Kissinger DG, Sanchez A (1987) The association of dietary factors with the age of menarche. Nutr Res 7(5):471–479. doi: 10.1016/S0271-5317(87)80003-9 CrossRefGoogle Scholar
  41. 41.
    Lombard KA, Olson AL, Nelson SE et al (1989) Carnitine status of lactoovovegetarians and strict vegetarian adults and children. Am J Clin Nutr 50(2):301–306Google Scholar
  42. 42.
    Sabaté J, Lindsted KD, Harris RD et al. (1990) Anthropometric parameters of schoolchildren with different life-styles. Am J Dis Child 144(10): 1159–1163Google Scholar
  43. 43.
    Sabate J, Lindsted KD, Harris RD et al (1991) Attained height of lacto-ovo vegetarian children and adolescents. Eur J Clin Nutr 45(1):51–58Google Scholar
  44. 44.
    Sabate J, Llorca MC, Sanchez A (1992) Lower height of lacto-ovovegetarian girls at preadolescence: an indicator of physical maturation delay? J Am Diet Assoc 92(10):1263–1264Google Scholar
  45. 45.
    Persky VW, Chatterton RT, van Horn LV et al (1992) Hormone levels in vegetarian and nonvegetarian teenage girls: potential implications for breast cancer risk. Cancer Res 52(3):578–583Google Scholar
  46. 46.
    Matthews VL, Wien M, Sabate J (2011) The risk of child and adolescent overweight is related to types of food consumed. Nutr J 10:71. doi: 10.1186/1475-2891-10-71 CrossRefGoogle Scholar
  47. 47.
    Harris RD, Phillips RL, Williams PM et al (1981) The child-adolescent blood pressure study: I. Distribution of blood pressure levels in Seventh-Day-Adventist (SDA) and non-SDA children. Am J Public Health 71(12):1342–1349CrossRefGoogle Scholar
  48. 48.
    The Official Site of the Seventh-day Adventist world church. Accessed 18 Sept 2016
  49. 49.
    Messina V, Mangels AR (2001) Considerations in planning vegan diets: children. J Am Diet Assoc 101(6):661–669CrossRefGoogle Scholar
  50. 50.
    Kleiser C, Schaffrath Rosario A, Mensink GBM et al (2009) Potential determinants of obesity among children and adolescents in Germany. Results from the cross-sectional KiGGS study. BMC Public Health 9(1):46. doi: 10.1186/1471-2458-9-46 CrossRefGoogle Scholar
  51. 51.
    Brondel L, Romer M, van Wymelbeke V et al (2009) Variety enhances food intake in humans. Role of sensory-specific satiety. Physiol Behav 97(1):44–51. doi: 10.1016/j.physbeh.2009.01.019 CrossRefGoogle Scholar
  52. 52.
    Sabaté J, Wien M (2010) Vegetarian diets and childhood obesity prevention. Am J Clin Nutr 91(5):1525S–1529. doi: 10.3945/ajcn.2010.28701F CrossRefGoogle Scholar
  53. 53.
    Orlich MJ, Jaceldo-Siegl K, Sabaté J et al (2014) Patterns of food consumption among vegetarians and non-vegetarians. Br J Nutr 112(10):1644–1653. doi: 10.1017/S000711451400261X CrossRefGoogle Scholar
  54. 54.
    Schwingshackl L, Hoffmann G, Kalle-Uhlmann T et al (2015) Fruit and vegetable consumption and changes in anthropometric variables in adult populations: a systematic review and meta-analysis of prospective cohort studies. PloS ONE 10(10):e0140846. doi: 10.1371/journal.pone.0140846 CrossRefGoogle Scholar
  55. 55.
    Te Morenga L, Mallard S, Mann J (2013) Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ 346: e7492. doi: 10.1136/bmj.e7492 CrossRefGoogle Scholar
  56. 56.
    Elorinne A, Alfthan G, Erlund I et al (2016) Food and nutrient intake and nutritional status of finnish vegans and non-vegetarians. PLoS ONE 11(2):e0148235. doi: 10.1371/journal.pone.0148235 CrossRefGoogle Scholar
  57. 57.
    Savva SC, Kafatos A (2014) Is red meat required for the prevention of iron deficiency among children and adolescents? Curr Pediatr Rev 10(3):177–183Google Scholar
  58. 58.
    Gibson RS, Heath AM, Szymlek-Gay EA (2014) Is iron and zinc nutrition a concern for vegetarian infants and young children in industrialized countries? Am J Clin Nutr 100 Suppl 1: 459S–468. doi: 10.3945/ajcn.113.071241 CrossRefGoogle Scholar
  59. 59.
    Johner SA, Thamm M, Nöthlings U et al (2013) Iodine status in preschool children and evaluation of major dietary iodine sources. A German experience. Eur J Nutr 52(7):1711–1719. doi: 10.1007/s00394-012-0474-6 CrossRefGoogle Scholar
  60. 60.
    Montenegro-Bethancourt G, Johner SA, Stehle P et al (2015) Dietary ratio of animal. Plant protein is associated with 24-h urinary iodine excretion in healthy school children. Br J Nutr 114(01):24–33. doi: 10.1017/S0007114515001567 CrossRefGoogle Scholar
  61. 61.
    Kühne T, Bubl R, Baumgartner R (1991) Maternal vegan diet causing a serious infantile neurological disorder due to vitamin B12 deficiency. Eur J Pediatr 150(3):205–208CrossRefGoogle Scholar
  62. 62.
    Sklar R (1986) Nutritional vitamin B12 deficiency in a breast-fed infant of a vegan-diet mother. Clin Pediatr (Phila) 25(4):219–221CrossRefGoogle Scholar
  63. 63.
    Bruckmann S, Händel N, Niemann H et al. (2015) Alternative Ernährungsformen und Kinderschutz. Kinder- und Jugendmedizin 15(1): 34–37Google Scholar
  64. 64.
    van Dusseldorp M, Arts IC, Bergsma JS et al (1996) Catch-up growth in children fed a macrobiotic diet in early childhood. J Nutr 126(12):2977–2983Google Scholar
  65. 65.
    Sichert-Hellert W, Kersting M, Alexy U et al (2000) Ten-year trends in vitamin and mineral intake from fortified food in German children and adolescents. Eur J Clin Nutr 54(1):81–86CrossRefGoogle Scholar
  66. 66.
    Sichert-Hellert W, Wenz G, Kersting M (2006) Vitamin intakes from supplements and fortified food in German children and adolescents: results from the DONALD study. J Nutr 136(5):1329–1333Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Research Institute of Child NutritionPediatric University Clinic BochumBochumGermany
  2. 2.IEL-Nutritional Epidemiology, DONALD StudyUniversity of BonnDortmundGermany

Personalised recommendations