The scientific discourse on vegan diets for children and adolescents primarily involves referencing position statement papers from different scientific and professional organizations, including paediatric associations. Over the past two decades, specialized associations have issued official statements and published position papers about adopting well-designed vegan diets during crucial life stages, including pregnancy and lactation, infancy, and childhood. A subset of these associations firmly supports the notion that a well-designed vegan diet can indeed be healthy and support normal growth and development during particularly delicate life stages, emphasizing careful planning, vitamin B12 supplementation, and regular supervised medical and dietetics oversight. In contrast, specific paediatric associations caution against vegan diets for children and adolescents, citing potential harm and the lack of adequate substantiation. These criticisms in position papers frequently point to lower-quality studies and/or outdated studies. Additionally, concerns extend to comparing vegan and omnivorous diets, considering public health issues such as obesity and early stages of cardiovascular disease as well as the risk of prediabetes and type 2 diabetes. Notably, some scepticism stems from studies where children’s adherence to a well-designed vegan diet is incomplete. Scientific rigor suggests performing a comparable assessment of omnivorous and vegan diets. This narrative review highlights the need for a comprehensive, up-to-date literature review to inform balanced perspectives on vegan diets for children and adolescents. Researchers and decision-makers should aim to actively improve the design and consistent implementation of both diet types.

Vegan Diets for Children: A Narrative Review of Position Papers Published by Relevant Associations

The effect of a vegetarian diet on bone health remains controversial. This retrospective medical record review compared changes in bone mineral density (BMD) and trabecular bone score (TBS) between vegetarian and non-vegetarian middle-aged and older women who underwent two general health examinations (T1 and T2) that were approximately three years apart. Generalized estimating equations were used to compare the change in lumbar spine and bilateral hip BMD and TBS over time. At T1, the mean age of the patients was 56.6 years (standard deviation 9.7 years) and the mean interval between T1 and T2 was 2.7 years. For women aged 40–55 years, compared with non-vegetarians, vegetarians were significantly associated with a larger reduction in lumbar spine BMD (p < 0.001) and left hip femoral neck BMD (p = 0.015) over the three-year interval. On the contrary, changes in BMD were not significant at any site in women aged ≥ 56 years. Moreover, the changes in BMD and TBS over the three-year interval did not significantly differ between vegetarian and non-vegetarian women aged 65–90 years. In conclusion, for women aged 40–55 years, vegetarian diets reduced bone quantity, as measured by BMD, but not bone quality, as measured by TBS.

/pdf/changes-in-bone-mineral-density-and-trabecular-bone-score-21lne9lr.pdf

Changes in Bone Mineral Density and Trabecular Bone Score over Time between Vegetarian and Non-Vegetarian Middle-Aged and Older Women: A Three-Year Retrospective Medical Record Review

CONTEXT
Plant-based lifestyle is a global trend, lower bone mineral density and increased fracture risk in vegan people are reported.


OBJECTIVE
Primary objective: To assess trabecular and cortical bone microarchitecture in vegans and omnivores. Secondary objectives: To evaluate relationships between bone microarchitecture, nutrition parameters and physical activity.


DESIGN
Observational study.


SETTING
Medical Department II, St. Vincent Hospital (Tertiary referral center for gastrointestinal, metabolic and bone diseases, and Teaching hospital of the Medical University of Vienna).


PARTICIPANTS
43 healthy non-obese female and male subjects on a plant-based diet for at least five years; 45 healthy non-obese female and male subjects on an omnivore diet for at least five years.


MAIN OUTCOME MEASURES
Parameters of trabecular and cortical bone microarchitecture (high-resolution peripheral quantitative computed tomography), serum markers of bone turnover, nutrients intake (nutrition protocol), self-reported resistance training (physical activity questionnaires).


RESULTS
In the vegan group, trabecular and cortical structure was altered, compared to omnivores.Vegans not reporting resistance training had diminished bone microarchitecture, compared to omnivores not reporting resistance training. In vegans and omnivores reporting resistance training, bone structure was similar.In both vegan subgroups (resistance training and not resistance training), a small number of correlations between nutrients intake and bone microarchitecture were without conclusive pattern were observed.


CONCLUSIONS
Bone microarchitecture in vegans differed from matched omnivores but could not be explained solely by nutrients uptake. These differences were attenuated between the subgroups reporting resistance training. In addition to a well-planned diet, progressive resistance training on a regular basis should be part of the vegan lifestyle.

Self-reported resistance training is associated with better HR-pQCT derived bone microarchitecture in vegan people.

Fracture Risk in Vegetarians and Vegans: the Role of Diet and Metabolic Factors

Osteoporosis is a systemic skeletal disease with weak and fragile bones. Dietary patterns have been described as an affecting constituent on bone metabolism. There is no consensus on the advantages or harms of vegetarian diets on bone health. This study aimed to design a Lacto-vegetarian dietary score (LVDS) to evaluate the similarity of an individual's dietary pattern to the Lacto-vegetarian dietary pattern (LVDP) and assess its association with postmenopausal osteoporosis (PMO). We hypothesized that individuals with greater LVDS will have a lower risk for PMO. In this hospital-based case-control study 220 cases (definitively diagnosed with osteoporosis) and 220 age-matched controls were registered. Usual dietary intakes were evaluated by a validated 147-item semi-quantitative food frequency questionnaire. To design LVDS, the energy-adjusted intakes of twelve food groups were categorized into quintiles, and positive or reverse points were assigned. To determine the association between the LVDS and PMO binary logistic regression was used. Those in the top tertile of the LVDS had a lower chance of PMO compared to those in the bottom tertile (OR: 0.11; 95% CI 0.06-0.22). An inverse relation was obtained between vegetables, fruits, legumes, nuts, dairy, soy protein, and eggs consumption and PMO. Higher consumption of vegetable and animal oils significantly increased the risk of PMO. A dietary pattern similar to LVDP and concentrated on greater consumption of legumes, nuts, dairy, fruits, vegetables and soy protein can be suggested as a protective way against PMO. Further, longitudinal studies are required to confirm these findings. 

Higher lacto-vegetarian dietary score is associated with reduced risk of postmenopausal osteoporosis: A case-control study in a sample of Iranian postmenopausal women.

The increased consumption of plant-based diets has encouraged studies of bone mineral density (BMD). The present systematic review and meta-analysis compared the effects of plant-based and omnivorous diets on BMD. We searched the Cochrane Library, PubMed, EMBASE, and the Web of Science to July 1, 2020. We used the mean differences (MDs) with 95% CIs to compare group outcomes. We compared the lumbar spine, femoral neck, and whole-body BMDs of those on plant-based and omnivorous diets. We performed subgroup analyses by various clinical characteristics. Two reviewers independently assessed trial quality and extracted data. All statistical analyses were performed using Review Manager version 5.2. A total of 17 cross-sectional studies including 13,888 patients were identified. The pooled results indicated that those on plant-based diets (compared to omnivores) exhibited lower BMDs at the lumbar spine (MD − 0.04; 95% CI − 0.06 to − 0.02; P < 0.0001) and femoral neck (MD − 0.04; 95% CI − 0.05 to − 0.02; P < 0.00001), and a reduced whole-body BMD (MD − 0.03; 95% CI − 0.06 to − 0.01; P = 0.0009). Both vegetarians and vegans exhibited lower lumbar spine, femoral neck, and whole-body BMDs than omnivores. Plant-based diets were associated with lower BMDs than those of an omnivore population. Plant-based diets may compromise overall bone health; prospective research is required.

Comparison of human bone mineral densities in subjects on plant-based and omnivorous diets: a systematic review and meta-analysis

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Comparison of human bone mineral densities in subjects on plant-based and omnivorous diets: a systematic review and meta-analysis