Planning Well-Balanced Vegetarian Diets in Infants, Children, and Adolescents: The VegPlate Junior

Vegetarian diets, defined as being devoid of flesh foods (such as meat, poultry, wild game, seafood, and their products), are followed by a growing number of people worldwide because of ethical, health, and environmental reasons.1 Vegetarian diets include a variety of plant-based foods such as grains, legumes, nuts and seeds, fruits, and vegetables, and may or may not include dairy products and eggs. Vegan diets exclude all animal foods. Although for over 30 years we have known that well-planned vegetarian diets, including vegan, are nutritionally adequate and promote regular growth from the early years of human development on,2, 3, 4 some researchers still discourage parents from raising vegetarian children.5, 6 This may be at least partially accounted for by the fact that children following very restrictive vegetarian patterns, which limit food choices and calorie intake, have been described.7 These dietary patterns do not meet the criteria to be defined as well planned,8 and therefore no conclusions about the growth of children following them should be made. In Italy, 7.1% of the population follows a vegetarian diet (6.2% a lacto-ovo-vegetarian and 0.9% a vegan diet), a percentage that has nearly doubled in the last 5 years.9 The exact number of vegetarian children is not known, but likely vegetarian parents would raise children following the same dietary pattern. Various Vegetarian Food Guides have been proposed for adult vegetarians since 1997,8 but so far none specifically for vegetarians aged 6 months to 17 years. Therefore, we designed the VegPlate Junior (VPJ), a Vegetarian Food Guide specific for dietary planning in infancy, childhood, and adolescence, and conceived to meet the Italian, as well as US, Dietary Reference Intakes (DRIs).10, 11 Diets obtained with the VPJ method meet all the criteria defining a vegetarian diet as “well-planned”8 and are therefore suitable for promoting thriving and regular growth. These criteria are: • Including a wide variety of plant foods, such as grains, legumes and their derivatives, nuts and seeds, vegetables, and fruit. Dairy products and eggs are considered optional. • Carefully choosing vegetable fats, consuming good sources of n-3 fatty acids, such as flaxseeds, chia seeds, and walnuts. • Including reliable sources of calcium and paying attention to the status of both vitamin B-12 and vitamin D. The aim of the VPJ is to help health care professionals in advising vegetarian parents, because parental education plays a central role in achieving optimal dietary patterns in vegetarian children.12