Vegan diet and nutritional status in infants, children and adolescents: A position paper based on a systematic search by the ESPGHAN Nutrition Committee
ESPGHAN · 2025 · Europe
Source and licence
- Authors
- Elvira Verduci, Jutta Kӧglmeier, Nadja Haiden et al.
- Title
- Vegan diet and nutritional status in infants, children and adolescents: A position paper based on a systematic search by the ESPGHAN Nutrition Committee
- Journal
- Journal of Pediatric Gastroenterology and Nutrition, 2025
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC12580465
Licence statement of the original publication
This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Growth
- The approach to monitoring growth and development in vegan children should be similar to the general paediatric population.
Nutritional adequacy
- Children on a vegan diet should have regular nutritional counselling from a qualified paediatric dietitian. In settings where dietary support is not available, a public health approach should be adopted to provide clear advice based on evidence‐based research and clinical observation.
- Vegan diets in infants, children and adolescents should provide the same age‐appropriate average requirements for energy intake as for the general paediatric population.
- Vegan children may need to consume more protein than recommended for the general population in view of the lower digestibility of plant protein compared to animal protein.
- The protein intake should be assessed on an individual basis for each child. The quality as well as the quantity of protein should be taken into account to optimise essential amino acid intake.
- Foods rich in ALA should be consumed regularly to support adequate omega‐3 fatty acid ingestion. An algal‐based, age‐appropriate DHA supplement with titrated content might be considered in children aged <2 years.
- Nutritional advice should emphasise the intake of iron‐rich foods and nutrients such as vitamin C, which enhances iron absorption in view of the lower bioavailability of plant‐derived iron sources. Families should also be aware that nutrients such as phytates, polyphenols, calcium and oxalic acid inhibit iron absorption.
- Iron supplements should be considered in breastfed infants from 6 months and in older children if inadequate nutritional intake.
- To guarantee adequate calcium intake when introducing complementary feeding, breastfeeding and/or infant formula should be continued for 12 months or longer until the infant is on a nutritionally complete diet. Nutritional counselling should target calcium‐rich foods, e.g. calcium‐supplemented foods/fluids, and calcium supplements, where needed.
- Vegan children should aim to include vitamin B12 fortified foods in their diets, and a daily age‐appropriate vitamin B12 supplement is recommended (see Table S2).
- Consider an age‐appropriate vitamin D supplement (see Table S3) since a vegan diet is considered a risk factor for deficiency from birth to 18 years. 43 , 44
- In the same way as in the general population, Vitamin D supplements are even more important when there is a lack of skin (arms and face) exposure to sun, in more Northern countries, and/or an indoor lifestyle.
- If dietary calcium intake is insufficient, children benefit from a vitamin D and calcium supplement.
Laboratory biomarkers
- Vitamin B12 metabolic parameters, such as plasma vitamin B12, plasma MMA and/or plasma homocysteine, should be monitored in all vegan children and adolescents during periods of rapid growth and/or suspicion of inadequate supplementation/intake.
- Other biochemical parameters, such as vitamin D and iron status, should be assessed if there is clinical suspicion of deficiency and/or insufficient intake.
Abstract
Vegan and other plant‐based diets are becoming increasingly popular in the paediatric age group. There is limited evidence in the current medical literature to determine whether a vegan diet is adequate for children, since the currently available society position papers are based on narrative reviews and expert opinion. Updated evidence‐based recommendations are needed to guide clinical practice. This position paper presents findings from a literature review performed using a systematic search strategy, following the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines. We analyzed the current evidence on the effect of vegan diet compared to omnivorous diet on body growth, nutritional adequacy and laboratory biomarkers in infants, children and adolescents. Observational studies, cohort studies and clinical trials published over the last 15 years in MEDLINE/PubMed, EMBASE and Cochrane Library were retrieved. Our position paper aims to update the evidence for or against the adequacy of a vegan diet in infants, children and adolescents and to provide evidence‐based recommendations. A total of 10 articles were accepted and included in the final review, providing information on approximately 1500 children following a vegan diet. Several articles assessed more than one outcome: seven addressed body growth, five evaluated nutritional adequacy and five examined laboratory biomarkers. To complement the primary data, three systematic reviews and meta‐analyses were also included. Current evidence is inconclusive to determine whether a strictly vegan diet supports normal childhood growth, although no significant differences in height or body mass index z‐scores were observed compared to omnivorous peers. We recommend that dietary intake, growth and nutritional status should be regularly monitored in vegan children. Focusing on dietary intakes (e.g., protein, omega‐3, calcium and iron) and ensuring supplementation with specific micronutrients, including vitamin B12, is essential during paediatric age when following a strict vegan diet. Clinical research, well‐designed prospective studies and high‐quality trials are required to address current research gaps.
Contents of the original publication
The section headings of the original.
- INTRODUCTION
- METHODS
- Data sources and search strategies
- Inclusion and exclusion criteria
- Identification of relevant studies
- Data extraction and interpretation
- RESULTS
- Outcome A: Body growth and anthropometric parameters
- Outcome B: Dietary intake and nutritional inadequacies
- Outcome C: Nutritional biomarkers and health‐related parameters
- CONCLUSIONS
- Growth
- Nutritional intake
- Laboratory biomarkers
- RECOMMENDATIONS FOR ROUTINE CLINICAL PRACTICE
- Growth
- Nutritional adequacy
- Laboratory biomarkers
- PERSPECTIVES FOR FUTURE RESEARCH
- Growth
- Nutritional intake
- Laboratory biomarkers
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