Vegetarianism and adolescent health
By Angela Kong and Jamie Stang
A vegetarian eating style is defined broadly and consists of a range
of eating patterns. The various patterns are distinguished by the foods
excluded from the diet. The most basic types of vegetarian diets include
semi- or partial -vegetarian.
Only a minority of adolescents report consuming a vegetarian diet,
however vegetarianism among this age group has gained popularity over
the years. Adolescents who adopt a vegetarian eating pattern have
similar characteristics to adults who select this eating style.
Many
choose a vegetarian diet for religious, health, social, weight-control,
animal welfare, and environmental reasons. What may distinguish
adolescents from the adult population is their increasing sense of
autonomy.
Selecting a diet different from parents and the rest of the family is
a common way for adolescents to exert independence.
Well-planned vegetarian diets are compatible with adequate growth and
meet most nutritional requirements for adolescents. However, it is well
documented that zinc, iron, and calcium intakes are low among adolescent
girls consuming omnivorous and vegetarian diets alike.
In a plant-based diet, there is concern that a high intake of fiber
and phytates can interfere with zinc and iron absorption. With adequate
planning and inclusion of a variety of food sources, most vegetarian
diets (with the exception of vegan or macrobiotic diets) can be
substantial on their own, without the need of vitamin supplementation.
Guidelines for adolescent nutrition
services
The consumption of a well-planned vegetarian diet may provide more
nutrients from fruit, vegetable, complex carbohydrate, and fiber
sources, and less fat and cholesterol than omnivorous diets.
A school-based study found that adolescents consuming a vegetarian
diet had higher intakes of fruit and vegetables and lower consumption of
sweets and salty snacks compared to non-vegetarian youth.
Research that compared Seventh Day Adventist vegetarians with Mormon
omnivores suggests that vegetarian eating patterns may contribute to
lower blood pressure and other health benefits, such as lower body
weight.
Several studies of preadolescent girls show some vegetarian females
experience a delay in the pubertal growth spurt and menarche compared to
their non-vegetarian peers.
However, by late-adolescence, all of the vegetarian females were as
tall or taller than their non-vegetarian counterparts.
In fact, the delay in menarche may prove beneficial for long-term
health, such as reducing the risk of breast cancer. As with most diets
that exclude certain groups of foods, there is a concern of excessive
restriction.
In particular, vegetarian diets low in vitamins B12 and D, iron,
zinc, and calcium should be of particular concern for the growing
adolescent.
Health professionals should pay special attention to adolescents who
choose to adopt a vegetarian diet as a means to control weight by
restricting energy and/or fat. A school-based study reported that
vegetarian youth were almost twice as likely to report frequent dieting,
four times as likely to report intentional vomiting, and eight times as
likely to report laxative use.
Although it is not appropriate to conclude that vegetarian youth are
more prone to eating disorders, it is important to be aware of signals
that suggest the presence of an eating disorder. A few signs to look for
are excessive weight loss, eliminating all fat from the diet, eating
only a few foods, and skipping meals.
Screening and
assessment
The importance of a well-balanced vegetarian diet cannot be
emphasised enough for the growing adolescent. To determine if an
adolescent is consuming a nutritionally adequate diet, food groups and
foods that are present in the diet and those that are restricted need to
be determined.
Diet assessment tools such as food frequencies, 24-hour diet recalls,
or food records can be utilised to help assess dietary intake. Questions
about supplement use may also provide important information about
nutrient intake.
Appropriate energy intake may be of concern for adolescent
vegetarians, especially those who adopt a vegetarian diet for weight
control reasons should ensure adequate energy intake. Determine
acceptable nutrient-dense foods that will fit into the type of
vegetarian diet chosen by the teen. Emphasise a variety of foods to
encourage intake of all necessary nutrients.
Monitor weight status and linear growth. Adequate growth and
development and maintenance of a stable, healthy body weight signifies
that energy needs are being met.
One misperception of vegetarian diets is that they are universally
low in protein. Protein is found in a wide variety of plant foods,
particularly in whole grains, nuts and legumes. However, no single plant
food provides a complete protein source since they are limited sources
of one or more essential amino acids.
Contrary to popular belief, incomplete proteins (such as grains) do
not have to be consumed in the same meal to meet protein needs.
Requirements for essential amino acids will be met if energy intake
is adequate and a variety of plant foods are consumed over the course of
the day. Legumes (dried beans), seeds, whole grains, nuts, and whole
wheat pasta are particularly good sources of amino acids for vegans.
Dairy products and eggs are excellent sources of complete proteins for
lacto and lacto-ovo vegetarians.
Fat
Fat is essential for growth and development. At least 20 percent of
total energy consumed should come from fatty acids. Inadequate intakes
of fat may result in essential fatty acid deficiencies or inadequate
energy intake, leading to delayed or stunted physical growth.
Diets of vegetarian adolescents should be assessed for adequacy of
total fat and essential fatty acid intakes, with special attention
focused on intakes of the essential fatty acids.
Linoleic acid is metabolised to arachidonic acid, which is an
important component of cell membranes. A primary source of linoleic
acids is vegetable oil.
Alpha linolenic acid is metabolised to eicosapentaenoic acid (EPA)
and docosahexaenoic acid (DHA). DHA is vital for visual and neurological
functions. Alpha linolenic acids can be found in eggs, flax seed, canola
oil, walnuts, and soy products.
Generally, diets low in fat are also low in alpha linolenic acids. To
avoid restricting too much fat from the diet, diet should provide around
25-30 percent total calories from fat.
Importance of Calcium
Adolescence is a critical period for bone development. Calcium
retention is higher at this point in life than any other time and
failure to consume adequate calcium can result in increased risk for the
development of osteoporosis later in life. The Dietary Reference Intake
(DRI) for calcium intake among adolescents in the 14-18 year age range
is 1300 mg.
Data from the National Health and Nutrition Examination Survey data
from 1988-91 (NHANES III) show that calcium intakes among adolescents in
this age range fall far below recommendations, especially among females.
The most common sources of calcium are dairy products, but for vegans
this source is not acceptable.
Consumption of dark green leafy vegetables, tofu, and
calcium-fortified foods and beverages can provide calcium for vegans.
Not all milk substitutes or juices are fortified with calcium, however.
Why Vitamins?
Vitamin D
To properly utilise calcium, an adequate intake of vitamin D is
necessary.
The primary sources of vitamin D in most diets are dairy products.
While sunlight exposure can improve vitamin D status, a dietary source
is generally needed, especially in northern climates. For vegans,
consuming foods supplemented with vitamin D such as milk substitutes or
cereals is a critical way to obtain this vitamin.
Vitamin B12
Vitamin B12 is found naturally in animal sources only. The importance
of vitamin B12 relates to its role in spinal cord, brain, optic nerve,
and peripheral nerve function.
Vitamin B12 deficiency can result in serious and sometimes
irreversible neurological abnormalities. Vegetarians who do not consume
animal-derived foods need a reliable dietary source of vitamin B12.
The active form of vitamin B12 in humans is cyanocobalamin.
Cyanocobalamin can be found in fortified breakfast cereal, fortified soy
beverages, some multivitamins, and some several brands of nutritional
yeast. It is important to note that inactive analogs of vitamin B12 may
be present in some foods such as spirulina, seaweed, tempeh, and
fermented foods.
Iron
The iron status of vegetarians is always of concern since the
predominant source of iron in plantbased foods is in the non-heme form,
which is less bio available than the heme form found in animal sources
such as meats.
Adolescent females are particularly likely to consume low levels of
dietary iron. Research suggests that lacto-ovo vegetarians have iron
status similar to that of omnivores.
Other studies indicate that even though vegetarians may have lower
iron stores, iron deficiency anemia is no more prevalent than among
omnivores. In fact, vegetarians often consume more dietary iron and more
ascorbic acid (vitamin C), which improves the bio availability of non-heme
sources.
Good sources of iron available to vegetarians include fortified and
enriched cereals and grain products, legumes, dried fruit, pasta, and
green leafy vegetables.
Zinc
Zinc is important for optimal growth and sexual maturation during
adolescence. The recommended intake for adolescents is 8-11 mg/day.
NHANES III data show that zinc intake among adolescents generally meets
recommended intake.
However, research suggests that a greater proportion of vegetarians
had lower serum zinc levels than omnivores, even though there was little
difference in intake. Some zinc sources for vegetarians include
fortified cereals, legumes, nuts, eggs, soy foods, and dairy products.
Consultation of a doctor or a dietician is critical for vegetarian
teens who are found to be at risk for nutritional deficiencies. Many
health professionals find it useful to involve the adolescent in
determining behavior changes that are needed to improve dietary intake.
Key messages
* Include a variety of foods in the diet - don’t be afraid to try new
foods.
* Try to avoid skipping meals.
* Encourage snacks of nutrient-dense foods that provide calcium,
iron, and other vitamins and minerals.
* Avoid restricting fat to levels below 20 percent of calories or
consuming many high fat “vegetarian” snacks, such as snack chips,
cookies, and cakes. |