Meta-analysis finds vegetarian and vegan diets can support healthy growth in children

Vegetarian and vegan dietary patterns are increasingly adopted by families for ethical, environmental, and health-related reasons, prompting questions about their suitability for children and adolescents. A large systematic review and meta-analysis published in Critical Reviews in Food Science and Nutrition evaluated whether plant-based diets support healthy growth and nutritional adequacy in pediatric populations.^1,2

The analysis included data from 59 observational studies conducted across 18 countries, encompassing more than 48,000 children and adolescents younger than 18 years. Dietary patterns examined included lacto-ovo-vegetarian diets, which exclude meat, poultry, and fish but allow eggs and dairy, and vegan diets, which exclude all animal-derived foods. These groups were compared with omnivorous diets across a broad range of nutritional, anthropometric, biochemical, and health outcomes.

Vegetarian and vegan diets show distinct nutrient intake patterns

Overall, vegetarian children consumed higher amounts of fiber, iron, folate, vitamin C, and magnesium than omnivorous children. However, they also had lower intakes of total energy, protein, fat, vitamin B12, and zinc. Evidence for vegan diets was more limited but followed similar trends, with higher intake of carbohydrates and fiber and lower intake of several nutrients typically obtained from animal-based foods.

Although mean energy and protein intakes generally fell within recommended ranges, the authors noted that plant-based diets rely on careful food selection to ensure adequate nutrient density, particularly during periods of rapid growth.

Vitamin B12, calcium, iron, iodine, and zinc remain key nutrients of concern

Several nutrients emerged as consistent concerns for children following vegetarian and vegan diets. “Notably, vitamin B12 didn't reach adequate levels without supplementation or fortified foods, and calcium, iodine and zinc intakes were often at the lower end of recommended ranges, making them important nutrients to consider for children on plant-based diets,” explained study co-author Jeannette Beasley, PhD, associate professor in the Departments of Nutrition and Food Studies and Medicine at New York University. “Vegan children, in particular, had especially low calcium intake.”

Iron intake was often higher in vegetarian and vegan diets, but biochemical measures such as ferritin were lower, reflecting the reduced bioavailability of non-heme iron. These findings underscore the importance of monitoring laboratory markers in addition to dietary intake.

Growth and body composition differ modestly in plant-based diets

Anthropometric outcomes showed that vegetarian children tended to be slightly shorter and lighter than omnivorous children, with lower body mass index (BMI), fat mass, and bone mineral content. Vegan children also demonstrated shorter stature and lower BMI scores. Importantly, most measurements remained within pediatric reference ranges.

“Our analysis of current evidence suggests that well-planned and appropriately supplemented vegetarian and vegan diets can meet nutritional requirements and support healthy growth in children,” said lead author Monica Dinu, PhD, from the University of Florence.

These findings suggest leaner growth patterns rather than overt growth impairment, although individual variability was substantial.

Bone health outcomes remain understudied in vegan children

Data on bone health were limited, particularly among vegan children. Lower calcium intake and reduced vitamin D levels observed in some plant-based groups raise concerns during critical periods of skeletal development. While reduced bone mineral content was noted among vegetarian children, data were insufficient to draw firm conclusions regarding long-term fracture risk.

Clinicians should remain attentive to bone-related nutrients and consider supplementation or fortified foods when indicated.

Favorable cardiovascular risk profiles observed with plant-based diets

Despite nutritional challenges, vegetarian and vegan children demonstrated more favorable cardiovascular profiles. Both groups had lower total and low-density lipoprotein (LDL) cholesterol levels compared with omnivorous children. These differences are consistent with higher fiber intake and lower consumption of saturated fat and dietary cholesterol.

While high-density lipoprotein (HDL) cholesterol was also lower, the clinical significance of this finding in the context of overall lower LDL levels remains uncertain.

Study highlights need for careful planning and clinical monitoring

The authors emphasized that families should not be discouraged from choosing vegetarian or vegan diets for ethical, environmental, or health reasons. Instead, they recommended informed planning and collaboration with healthcare professionals, including pediatricians and dietitians, to ensure nutritional adequacy.

“We hope these findings offer clearer guidance on both the benefits and potential risks of plant-based diets, helping the growing number of parents choosing these diets for health, ethical, or environmental reasons,” Dinu added.

Experts call for evidence-based guidance for families choosing plant-based diets

The researchers cautioned that most included studies were cross-sectional, limiting causal interpretation. Variability in dietary assessment methods, age ranges, and supplement use also contributed to heterogeneity. Nonetheless, the size and scope of the analysis provide a comprehensive overview of current evidence.

“In conclusion,” said co-author Wolfgang Marx, PhD, from Deakin University, “while well-planned vegetarian and vegan diets are nutritionally adequate and beneficial for adults, there is far less clarity about their suitability for children, leading to inconsistent or even conflicting advice for parents.

“Our findings suggest that a balanced approach is essential, with families paying close attention to certain nutrients – particularly vitamin B12, calcium, iodine, iron, and zinc–to ensure their children get everything they need to thrive.”

For clinicians, the findings reinforce the importance of individualized dietary assessment, routine monitoring of key nutrients, and proactive counseling. When carefully planned and supported, vegetarian and vegan diets can support healthy growth while aligning with family values and broader public health goals.

References

1. Taylor & Francis Group. Largest study of its kind highlights benefits – and risks – of plant-based diets in children. Eurekalert. December 12, 2025. Accessed December 12, 2025. https://www.eurekalert.org/news-releases/1109143
2. Lotti S, Panizza G, Martini D, et al. Lacto-ovo-vegetarian and vegan diets in children and adolescents: a systematic review and meta-analysis of nutritional and health outcomes. Critical Reviews in Food Science and Nutrition. Published online December 11, 2025:1-21. doi:https://doi.org/10.1080/10408398.2025.2572983