Textos para consulta: Veganismo na infância e adolescência

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Baroni L et al. Vegan Nutrition for Mothers and Children: Practical Tools for Healthcare Providers: Practical Tools for Healthcare Providers. Nutrients 2018 11(1):5.


As the number of subjects choosing vegan diets increases, healthcare providers must be prepared to give the best advice to vegan patients during all stages of life. A completely plant-based diet is suitable during pregnancy, lactation, infancy, and childhood, provided that it is well-planned. Balanced vegan diets meet energy requirements on a wide variety of plant foods and pay attention to some nutrients that may be critical, such as protein, fiber, omega-3 fatty acids, iron, zinc, iodine, calcium, vitamin D, and vitamin B12. This paper contains recommendations made by a panel of experts from the Scientific Society for Vegetarian Nutrition (SSNV) after examining the available literature concerning vegan diets during pregnancy, breastfeeding, infancy, and childhood. All healthcare professionals should follow an approach based on the available evidence in regard to the issue of vegan diets, as failing to do so may compromise the nutritional status of vegan patients in these delicate periods of life.

Rudloff S et al. Vegetarian diets in childhood and adolescence. Position paper of the nutrition committee, German Society for Paediatric and Adolescent Medicine (DGKJ). . Molecular and Cellular Pediatrics 2019 6:4.


In Western countries, vegetarian diets are associated with lower intakes of energy, saturated fatty acids and animal protein and higher intakes of fibre and phytochemicals, compared to omnivorous diets. Whether the corresponding health benefits in vegetarians outweigh the risks of nutrient deficiencies has not been fully clarified. It should be noted that vegetarians often have a higher socioeconomic status, follow a more health-conscious lifestyle with higher physical activity, and refrain from smoking more often than non-vegetarians. The nutritional needs of growing children and adolescents can generally be met through a balanced, vegetable-based diet; however, due to their higher nutrient requirements per kilogramme of body weight, vegetarian children have a higher risk for developing nutrient deficiencies than adults. With a vegetarian diet, the mean intakes of some nutrients, such as the omega-3 fatty acid docosahexaenoic acid (DHA), are lower than in omnivores or those eating fish. For other nutrients, such as iron and zinc, the bioavailability from vegetable foodstuffs is reduced when the intake of phytates and fibre is high; thus, the prevalence of iron deficiency can be increased despite high vitamin C intake. In addition, vitamin B12 is only found in animal-source foods. Vitamin B12 should be supplemented in people of all age groups who follow a strict vegan diet without consuming animal products. A vegetarian diet in childhood and adolescence requires good information and supervision by a paediatrician, if necessary, in cooperation with an appropriately trained dietary specialist.

Muller P. Vegan Diet in Young Children. Nestlé Nutr Inst Workshop Ser. Nestlé Nutrition Institute, Switzerland/S. Karger AG., Basel, 2020, vol 93, pp 103–110.


The prevalence of restrictive diets, mainly vegetarian and vegan, is markedly on the increase in Europe and other Western countries. In young children and adolescents, not only weight and height but also neurocognitive and psychomotor development are all strongly influenced by the source, quantity, and quality of their nutrition. In studies done mainly in adult populations, a plant-based diet showed benefits in the reduced risk of chronic diseases such as obesity, type 2 diabetes, cardiovascular diseases, and some types of cancer. However, there is no clear evidence that a vegan diet started in early childhood confers a lasting health benefit. On the other hand, a vegan diet can be potentially critical for young children with risks of inadequate supply in terms of protein quality and energy as well as long-chain fatty acids, iron, zinc, vitamin D, iodine, calcium, and particularly vitamin B12. Deficiencies in these nutrients can lead to severe and sometimes irreversible developmental disorders. If such a diet is chosen for ethical, ecological, or health reasons, a well-planned, diversified diet with additional supplementation of vitamin B12, vitamin D, iodine, and potentially other micronutrients is crucial to ensure a healthy and nutritious intake during childhood.

Lemale J et al. Vegan diet in children and adolescents. Recommendations from the French-speaking Pediatric Hepatology, Gastroenterology and Nutrition Group (GFHGNP). Archives de Pediatrie 2019 26:442-450.


The current craze for vegan diets has an effect on the pediatric population. This type of diet, which does not provide all the micronutrient requirements, exposes children to nutritional deficiencies. These can have serious consequences, especially when this diet is introduced at an early age, a period of significant growth and neurological development. Even if deficiencies have less impact on older children and adolescents, they are not uncommon and consequently should also be prevented. Regular dietary monitoring is essential, vitamin B12 and vitamin D supplementation is always necessary, while iron, calcium, docosahexaenoic acid, and zinc should be supplemented on a case-by-case basis

Melina, Vet al. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J. Acad. Nutr. Diet. 2016, 116, 1970–1980.


It is the position of the Academy of Nutrition and Dietetics that appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes. Plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and are associated with much less environmental damage. Vegetarians and vegans are at reduced risk of certain health conditions, including ischemic heart disease, type 2 diabetes, hypertension, certain types of cancer, and obesity. Low intake of saturated fat and high intakes of vegetables, fruits, whole grains, legumes, soy products, nuts, and seeds (all rich in fiber and phytochemicals) are characteristics of vegetarian and vegan diets that produce lower total and low-density lipoprotein cholesterol levels and better serum glucose control. These factors contribute to reduction of chronic disease. Vegans need reliable sources of vitamin B-12, such as fortified foods or supplements.

Redecillas-Ferreiro S et al. Position paper on vegetarian diets in infants and children. Committee on Nutrition and Breastfeeding of the Spanish Paediatric Association.


In the last few years, there are an increased number of families following a vegetarian diet, including their children. In order to guarantee child heath, paediatricians need to know the characteristics of this diet and the main foods that are used.
There are few data on the medium and long-term health outcomes when removing all animal foods from the child’s diet, especially at younger ages. Nevertheless, new tools have recently become available to facilitate following a vegetarian diet and decreasing the risk of deficiencies.
In this document, the group of foods commonly used in vegetarian diets are reviewed, as well as recommendations for each age group. It also mentions the need to use B12 supplements at all ages, as well as other nutrients (iodine, iron, vitamin D3, poly-unsaturated fatty acid n-3), when required.
A vegetarian or a vegan diet, as in any other kind of diet, needs to be carefully designed. After reviewing current evidence, even though following a vegetarian diet at any age does not necessarily mean it is unsafe, it is advisable for infant and young children to follow an omnivorous diet or, at least, an ovo-lacto-vegetarian diet.

Karlsen MC et al. Theoretical Food and Nutrient Composition of Whole-Food Plant-Based and Vegan Diets Compared to Current Dietary Recommendations. Nutrients. 2019;11(3): 625.


Public interest in popular diets is increasing, in particular whole-food plant-based (WFPB) and vegan diets. Whether these diets, as theoretically implemented, meet current food-based and nutrient-based recommendations has not been evaluated in detail. Self-identified WFPB and vegan diet followers in the Adhering to Dietary Approaches for Personal Taste (ADAPT) Feasibility Survey reported their most frequently used sources of information on nutrition and cooking. Thirty representative days of meal plans were created for each diet. Weighted mean food group and nutrient levels were calculated using the Nutrition Data System for Research (NDSR) and data were compared to DRIs and/or USDA Dietary Guidelines/MyPlate meal plan recommendations. The calculated HEI-2015 scores were 88 out of 100 for both WFPB and vegan meal plans. Because of similar nutrient composition, only WFPB results are presented. In comparison to MyPlate, WFPB meal plans provide more total vegetables (180%), green leafy vegetables (238%), legumes (460%), whole fruit (100%), whole grains (132%), and less refined grains (?74%). Fiber level exceeds the adequate intakes (AI) across all age groups. WFPB meal plans failed to meet the Recommended Dietary Allowances (RDA)s for vitamin B12 and D without supplementation, as well as the RDA for calcium for women aged 51–70. Individuals who adhere to WFBP meal plans would have higher overall dietary quality as defined by the HEI-2015 score as compared to typical US intakes with the exceptions of calcium for older women and vitamins B12 and D without supplementation. Future research should compare actual self-reported dietary intakes to theoretical targets.

Agnoli, C et al. Position paper on vegetarian diets from the working group of the Italian Society of Human Nutrition. Nutr. Metab. Cardiovasc. Dis. 2017, 27, 1037–1052.


•Vegetarian diets that include a wide variety of plant foods provide adequate nutrient intake for Italians of all ages.
•However, vitamin B12 intake may be low, so vitamin-fortified foods/B12 supplements are advised.
•Vegetarians should eat more protein than recommended for omnivores because of reduced plant protein digestibility.
•Vegetarians should eat good sources of Ca, Fe and Zn and prepare foods to enhance Ca, Fe and Zn bioavailability.
•Vegetarians should eat sufficient α-linolenic acid and limit linoleic acid intake.


Background: Interest in vegetarian diets is growing in Italy and elsewhere, as government agencies and health/nutrition organizations are emphasizing that regular consumption of plant foods may provide health benefits and help prevent certain diseases.
Methods and results: We conducted a Pubmed search, up to September, 2015, for studies on key nutrients (proteins, vitamin B12, iron, zinc, calcium, vitamin D, and n-3 fatty acids) in vegetarian diets. From 295 eligible publications the following emerged: Vegetarians should be encouraged to supplement their diets with a reliable source of vitamin B12 (vitamin-fortified foods or supplements). Since the plant protein digestibility is lower than that of animal proteins it may be appropriate for vegetarians to consume more proteins than recommended for the general population. Vegetarians should also be encouraged to habitually consume good sources of calcium, iron and zinc – particularly vegetables that are low in oxalate and phytate (e.g. Brassicaceae), nuts and seeds, and calcium-rich mineral water. Calcium, iron, and zinc bioavailability can be improved by soaking, germination, and sour-dough leavening that lower the phytate content of pulses and cereals. Vegetarians can ensure good n-3 fatty acid status by habitually consuming good sources of a-linolenic acid (walnuts, flaxseeds, chia seeds, and their oils) and limiting linoleic acid intake (corn and sunflower oils).
Conclusions: Well-planned vegetarian diets that include a wide variety of plant foods, and a reliable source of vitamin B12, provide adequate nutrient intake. Government agencies and health/nutrition organizations should provide more educational resources to help Italians consume nutritionally adequate vegetarian diets.

Richter, M et al. Vegan diet. Position of the German Nutrition Society (DGE). Ernahrungs Umschau 2016, 63, 92–102.


On the basis of current scientific literature, the German Nutrition Society (DGE) has developed a position on the vegan diet. With a pure plant-based diet, it is difficult or impossible to attain an adequate supply of some nutrients. The most critical nutrient is vitamin B12. Other potentially critical nutrients in a vegan diet include protein resp. indispensable amino acids, long-chain n-3 fatty acids, other vitamins (riboflavin, vitamin D) and minerals (calcium, iron, iodine, zinc and selenium). The DGE does not recommend a vegan diet for pregnant women, lactating women, infants, children or adolescents. Persons who nevertheless wish to follow a vegan diet should permanently take a vitamin B12 supplement, pay attention to an adequate intake of nutrients, especially critical nutrients, and possibly use fortified foods or dietary supplements. They should receive advice from a nutrition counsellor and their supply of critical nutrients should be regularly checked by a physician.

Mangels, A.R.; Messina, V. Considerations in planning vegan diets: Infants. J. Am. Diet. Assoc. 2001, 101, 670–677.


Appropriately planned vegan diets can satisfy nutrient needs of infants. The American Dietetic Association and The American Academy of Pediatrics state that vegan diets can promote normal infant growth. It is important for parents to provide appropriate foods for vegan infants, using guidelines like those in this article. Key considerations when working with vegan families include composition of breast milk from vegan women, appropriate breast milk substitutes, supplements, type and amount of dietary fat, and solid food introduction. Growth of vegan infants appears adequate with post-weaning growth related to dietary adequacy. Breast milk composition is similar to that of non-vegetarians except for fat composition. For the first 4 to 6 months, breast milk should be the sole food with soy-based infant formula as an alternative. Commercial soymilk should not be the primary beverage until after age 1 year. Breastfed vegan infants may need supplements of vitamin B-12 if maternal diet is inadequate; older infants may need zinc supplements and reliable sources of iron and vitamins D and B-12. Timing of solid food introduction is similar to that recommended for non-vegetarians. Tofu, dried beans, and meat analogs are introduced as protein sources around 7-8 months. Vegan diets can be planned to be nutritionally adequate and support growth for infants.

Donaldson M.S. Metabolic Vitamin B12 Status on a Mostly Raw Vegan Diet with Follow-Up Using Tablets, Nutritional Yeast, or Probiotic Supplements. Annals of Nutrition and Metabolism 2000,44: 5-6.


Background: Pure vegetarian diets might cause cobalamin deficiency due to lack of dietary intake. It was hypothesized that a population following a vegan diet consuming mostly raw fruits and vegetables, carrot juice, and dehydrated barley grass juice would be able to avoid vitamin B12 deficiency naturally. Methods: Subjects were recruited at a health ministers’ reunion based on adherence to the Hallelujah diet for at least 2 years. Serum cobalamin and urinary methylmalonic acid (MMA) assays were performed. Follow-up with sublingual tablets, nutritional yeast, or probiotic supplements was carried out on subjects with abnormal MMA results. Results: 49 subjects were tested. Most subjects (10th to 90th percentile) had followed this diet 23–49 months. 6 subjects had serum B12 concentrations <147 pmol/l (200 pg/ml). 37 subjects (76%) had serum B12 concentrations <221 pmol/l (300 pg/ml). 23 subjects (47%) had abnormal urinary MMA concentrations above or equal to 4.0 µg/mg creatinine. Sublingual cyanocobalamin and nutritional yeast, but not probiotic supplements, significantly reduced group mean MMA concentrations (tablet p < 0.01; yeast p < 0.05, probiotic > 0.20). Conclusions: The urinary MMA assay is effective for identifying early metabolic cobalamin deficiency. People following the Hallelujah diet and other raw-food vegetarian diets should regularly monitor their urinary MMA levels, consume a sublingual cobalamin supplement, or consume cobalamin in their food.

Baroni, L.; Goggi, S.; Battino, M. Planning Well-Balanced Vegetarian Diets in Infants, Children, and Adolescents: The VegPlate Junior. J. Acad. Nutr. Diet. 2018.


Well-balanced vegetarian diets planned with the VPJ, which include a wide variety of plant foods and reliable sources of vitamin B-12 and vitamin D, are an adequate option for infants,  children, and adolescents. Vegetarian diets, because of their favorable content of fiber and essential nutrients, have been shown to be protective against childhood and adolescence obesity, as well as obesity-related diseases that may occur later in life. Exposing children to a great variety of plant foods may promote healthful eating habits later in life. In Italy, one of three children is either overweight or obese, and Europe and the United States show similar percentages. In this scenario, the VPJ can serve as a foundation for planning omnivorous diets rich in plant foods and protective against childhood obesity, simply by introducing some servings per week of nonvegetarian foods.

Amoroso, S et al. Acute small bowel obstruction in a child with a strict raw vegan diet. Archives of Disease in Childhood 2019, 104 (8): 815.


Phytobezoars are concretions of indigestible fruit and vegetable fibres in the gastrointestinal tract. They account for 0.4%–4% of small bowel obstructions,1 2 related to predisposing factors such as excessive consumption of fibres, poor dentition, mental retardation and motility disorders. This is the first report of an infant small bowel obstruction associated with a raw vegan diet without other predisposing factors. Given the increasing popularity of vegan diet, paediatricians should be aware of this risk.

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