GENERAL PAPERS

1
VEGETARIAN DIET IN CHILDREN
Dana-Teodora Anton-Paduraru1, Carmen Oltean2, Laura Mihaela Trandafir1,
Amalia Maria Mineata3
1
3-rd Clinic of Pediatrics, Gr. T. Popa University of Medicine and Pharmacy, Iasi
2
Childrens Emergency Hospital Sf. Maria, Iasi
3
Hiperclinica Medlife, Iasi

ABSTRACT
Vegetarianism may have implications on the growth of children and adolescents. There are different types of
vegetarian diets: some may be suitable for children, other deficient in essential nutrients. If a vegetarian diet is
done properly and includes fortified foods it can promote health and reduce risk for major chronic diseases.
Restriction or exclusion of products of animal nature can lead to low intake of essential nutrients.

Keywords: vegetarianism, child

Childhood is the period when nutritional habits TABLE 1. Types of vegetarians

are acquired, when growth is intense and when de- Classic vegetarians New vegetarians
posits of essential nutrients are stored. Ovolactovegetarians Vegetarians consuming small
According to the Merriam-Webster Dictionary, amounts of meat
vegetarianism is defined by the consumption of a Lactovegetarians Vegetarians to a large extent
Ovo-vegetarians Semi-vegetarians
diet that contains vegetables, fruits, nuts, cereals
Vegans1 Pesco-vegetarians2
and sometimes eggs and dairy products (1). 3
Consumers of the RAW diet Vegetarians consuming
Vegetarianism may have severe implications on puddings
the growth of children and adolescents, therefore it Seed consumers
is necessary to assess the nutritional status of veg- Fruit consumers
etarians to insure optimum growth and a good Macrobiotic vegetarians4
health state and to prevent potential deficits. 1
consume a diet lacking in any animal product, including meat, eggs
There are different types of vegetarians (1) and all ingredients deriving from these products
2
consume food from vegetal sources and fish
Table 1. 3
uncooked vegan diet
Each of these diets has implications on the nutri- 4
consume grain as a food basis and avoid processed and refined
tion and health of children and adolescents. The products
reasons for which one adheres to a vegetarian diet
are different:
economic reasons: in some countries, vegeta- ecological reasons: the effect of meat pro-
bles are cheap; duction on the environment involves the in-
the risk of omnivorous diets and the negative efficient use of the planet resources;
publicity on the diseases emerged as a conse- religious reasons: seventh-day Adventists,
quence of the consumption of animal prod- some Hindu, Buddhists;
ucts; philosophical reasons: transcendental medi-
moral reasons: the belief that eating meat in- tation, yogis, anthroposophists, macrobiot-
volves cruelty and environmental degrada- ics;
tion; animal-rights militants; social influences (1).

Corresponding author:
Dana-Teodora Anton-Paduraru, Gr. T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, Iasi
E-mail: antondana66@yahoo.com

REVISTA ROMN DE PEDIATRIE VOLUMUL LXIII, NR. 4, AN 2014 357

358 REVISTA ROMN DE PEDIATRIE VOLUMUL LXIII, NR. 4, AN 2014
A study done in the USA in 2003 shows that 2%
of the children between 2-17 years are vegetarians
and approximately 0.5% are vegans (2). Along with
the increase in the popularity of the vegetarian di-
ets, more and more parents encourage their chil-
dren to adopt them. The degree of adherence to the
vegetarian diets varies, therefore the nutrients in-
take varies from one vegetarian to another. The
American Dietetic Association and Dietitians of
Canada considers that a carefully planned vegetar-
ian diet can be healthy and suitable from the nutri-
tional point of view and can have benefits in the
prevention and treatment of certain diseases (1).
The vegetarian diet, including the vegan one,
must observe the daily nutrition recommendations
(DNR) for proteins, iron, zinc, calcium, vitamin D,
vitamin B6 and B12, vitamin A, omega-3 fatty ac-
ids and iodine. In some cases, the use of fortified
foods or supplements may be useful in covering the
recommendations for each nutrient.
The benefits of the vegetarian diet are:
low intake of saturated fats, cholesterol and
animal proteins;
high levels of carbohydrates, fibers, magne-
sium, vitamins C and E, carotenoids;
body mass index lower than that of non-veg-
etarians;
lower incidence of obesity, coronary disease,
hypertension and diabetes mellitus type 2;
improvement of the lipid profile;
vegetarian adolescents are less affected by
acne, allergies and gastro-intestinal disor-
ders;
decrease of mortality caused by cardiovascu-
lar diseases, shock, cancer (1,3).
It has also additional implications:
moderate consumption of or abstinence from
alcohol and other stimulating products (nico-
tine);
increased involvement in physical activities;
vegetal products have lower caloric density,
therefore they predispose less to obesity (1).
Another benefit has been reported in children
with an anthroposophical life style. This style in-
volves the increased consumption of organic foods,
including naturally fermented vegetal products and
products with live lactobacilli, as well as the re-
strictive use of antibiotics, antipyretics and vac-
cines. A study that assessed the intestinal flora in
children under 2 years old with this life style in
comparison to the one of children with a traditional
life style showed that the microflora characteristics
differ in two groups: this diversity of the bacteria
may contribute to the lower prevalence of the atop-
ic disease. The study done in Poland in vegetarian
children in the prepubertal period emphasized low-
er leptine-polypeptid concentrations playing an im-
portant role in bone growth and weight adjustment
(4).
The risks of the vegetarian diet are:
emergence of rickets;
risk of deficiency in vitamin A and subse-
quently in keratomalacia;
the emergence of anemia as well as the defi-
cit of proteins and zinc (1,2).
GUIDES REGARDING NUTRIENT INTAKE
FOR VEGETARIAN CHILDREN
Caloric intake
The appropriate energetic intake must ensure
growth according to the growth curves. The recom-
mendations regarding the caloric intake are similar
to the ones for the general population. Caloric
sources accepted for babies and children are soy,
vegetables, nuts, oil and nut butter and fruit juices.
The recommendations for the nutrient intake are in-
creased by up to 2 standard deviations over the
DNR average to compensate for the potential in-
take deficits. Furthermore, the recommendations
for the same nutrient may vary in different coun-
tries (5).
Protein intake
Despite the low caloric density of strict vegetar-
ian diets, especially if the weaning takes place ear-
ly, the nutrition intake is usually enough to cover
the protein needs. Plant proteins can cover the ener-
getic needs if a variety of plants is consumed. Com-
plementary proteins must not be consumed in the
same meal. Different studies (1.6) showed that due
to low digestibility of plant proteins, the necessary
proteins must be 30-35% higher than in vegan ba-
bies, 20-30% in vegans between 2 and 6 years and
15-20% in vegan children over 6 years old.
The 5 major plant protein sources are: vegeta-
bles, cereals, nuts and seeds, fruits and vegetal
products. Each of them have advantages and disad-
vantages:
vegetables and cereals provide relatively
large amounts of high quality proteins, but
they must be cooked and processed to be-
come tasty and to eliminate substances that
decrease digestibility such as amylase inhibi-
tors, lecithin and tannin;
the amount, quality and digestibility are con-
cern reasons, especially when vegan/ vege-
tarian diets are used in babies;
REVISTA ROMN DE PEDIATRIE VOLUMUL LXIII, NR. 4, AN 2014
the quality of plant proteins vary: isolated
soy proteins ensure the necessary proteins
just like the animal proteins, while the wheat
proteins are 50% les usable in comparison to
the animal proteins;
the lysine content is lower in all plants in
comparison to the animal products, and the
methionine and cysteine content is low both
in vegetables and in fruits;
the content of essential amino acids (threo-
nine) is low in cereals, and tryptophan in
fruits (1).
Lipid intake
Even if the dietetic fat intake in vegetarian chil-
dren over 2 years old (25-35% from calories) is
lower than in omnivores, the effects on growth
seem to be low. Still, when the intake supplies un-
der 15% of the calories, the intake of essential fatty
acids must be ensured. The minimum 3% of the
calories must be ensured from linoleic acid (omega
3) and 1% from linoleic acid (omega 6). The rec-
ommended ratio omega 6: omega 3 varies between
2:1-4:1. The linoleic acid is to be found in nuts,
seeds and grains. The alpha-linoleic acid is found
in green leaves, phytoplankton, seaweeds, certain
seeds, nuts and vegetables as well as in flax, hazel-
nuts, soy. These may be transformed in non-saturat-
ed fatty acids (arachidonic ARA, eicosapentae-
noic EPA, docosahexaenoic DHA). The fatty
acids must supply 3-10% of the total calories. ARA
is found in meat and eggs; EPA and DHA in fish
and seafood. Vegans/vegetarians have no sources
of long-chain omega-3 fatty acids and obtain them
from the alpha-linolenic acid (7).
The pregnant women that are vegan, vegetarian
or are on a macrobiotic diet and do not eat fish or
eat small amounts of fish and animal products do
not get these fatty acids. The risks are high for ba-
bies that can be premature, as their capacity of de-
saturating the alpha linolenic acid in DHA is limit-
ed.
Fiber intake
Depending on age and gender, the recommend-
ed daily fiber intake is of:
19 g/zi for 1 to 3-year old children;
25 g/zi for 4 to 8-year old children;
38 g/zi for adolescents.
For very small children, the low energetic den-
sity of diets rich in fibers can make difficult the suf-
ficient caloric consumption and may inhibit the ab-
sorption of certain minerals. The cereal grind and
359
the squash of the vegetal products may increase
their digestibility, and the partial replacement of
whole-wheat with refined cereals poorer in fibers
may increase the energetic intake. The ovolacto-
vegetarians usually consume appropriate not ex-
cessive amounts of fibers (5).
Vitamin intake
Vitamin A: as vegetal foods contain only carot-
enoids, the necessary vitamin A must be covered by
3 portions/day of vegetal products rich in beta-car-
otene such as vegetal products and yellow or or-
ange fruit. The beta-carotene absorption is less ef-
ficient when the vegetal products are uncooked or
raw than when they are cooked, chopped or mashed
or when small amounts of fats are added upon
cooking or consuming (7).
Riboflavin: the riboflavin intake seems similar
in vegetarians and omnivorous. Occasionally, peo-
ple on very restrictive or macrobiotic diets may
face deficits of riboflavin. Sources of riboflavin:
soy, wheat germs, fortified cereals, yeast, enriched
grains (1,5).
Folic acid: usually, the consumption of an in-
creased amount of fruit and vegetables ensures a
suitable intake of folic acid. People who consume
vegetal products boiled or roasted at high tempera-
tures and rarely eat cereals fortified with folic acids
or fruit juices may face deficiencies (1,5).
Vitamin B12: no vegetal food, even fortified
contains vitamin B12. Mushrooms are often con-
sidered a source of vitamin B12, but actually they
contain a compound structured similarly to vitamin
B12 that does not act like vitamin B12 in the organ-
ism. Ovolactovegetarians receive sufficient amounts
of vitamin B12 if they consume dairy products reg-
ularly. The typical vegetarian diets are rich in folic
acid that may mask the deficit hematologic symp-
toms, leading to a tardy diagnosis. The regular in-
take of foods fortified with vitamin B12 or dairy
products must be encouraged in vegetarians and
especially in breastfeeding mothers (1,5).
Vitamin D: children must consume daily foods
such as cow milk, certain types of soy milk, rice
milk, cereals enriched with vitamin D2 or D3. The
bioavailability of vitamin D2 is lower, consequent-
ly the needs are high for certain vegetarians. If sun
exposure and the intake of fortified foods is insuf-
ficient, then supplements are recommended (8).
Mineral intake
Iron: is vital in all ages, especially in babies,
adolescents and pregnant women. The iron deficit
360 REVISTA ROMN DE PEDIATRIE VOLUMUL LXIII, NR. 4, AN 2014
is the most frequent micronutrient deficit in vege-
tarian children, as well as in non-vegetarian chil-
dren. It is more frequent especially in vegan chil-
dren, as vegetal foods contain non-heme iron, in
comparison to the animal products, which contain
heme iron. Non-hem iron is more sensitive to fac-
tors inhibiting iron absorption such as phytates, cal-
cium, plant tea, cocoa, certain spices and fibers.
Vitamin C and other organic acids from fruits and
vegetal products that increase iron absorption. In
vegetarians, the recommended intake is 1.8 times
higher than in non-vegetarians due to the low bio-
availability of iron in vegetarian diets and lower
iron deposits of vegetarians, despite the fact that
serum ferritin is usually within normal limits (4,5).
Zinc: in American diets approximately half of
the zinc comes from meat and fish. Foods such as
red meat contain high zinc and protein amounts
that increase its bioavailability. Human milk does
not contain sufficient zinc for babies over 6 months
old. The bioavailability of plants relatively rich in
zinc, such as whole-cereals, soy, grains, nuts, peas,
lentil, tends to be low as many of them contain phy-
tates and fibers that inhibit the zinc absorption. In
ovolactovegetarians, the zinc absorption is approx-
imately one third lower than in omnivorous. In veg-
ans, the daily necessary must be 50% higher. Sources
of plants rich in zinc are whole-cereal bread made
with yeast and zinc fortified cereals (4,5).
Calcium: is important for bone health; approx-
imately 45% of the bone mass is formed by the age
of 8, 45% between 8-16 years and 10% in the fol-
lowing decade. In vegans, the calcium intake tends
to be low in comparison to the lactovegetarians and
non-vegetarians. Although the plant oxalates, phy-
tates and fibers reduce the availability of calcium in
vegetal products, it is higher than in milk. Calcium
in contained by broccoli, cabbage, turnips, and kale
leaves (4,5).
Iodine: if iodised salt is consumed, the iodine
deficit is rare. Vegans whose diets are restrained to
non-iodised sea salts and contain substantial intake
of goitrogenic foods such as broccoli, mustard,
cabbage, kales, have iodine deficit risk. They are
recommended iodine fortified foods (4,5).
RECOMMENDATIONS ON AGE GROUPS
Recommendations for babies
Until the age of 4-6 months, the vegetarian and
non-vegetarian babies diets are identical, the hu-
man milk being the best food for this period, due to
its well-known advantages. Babies that receive hu-
man milk or different milk formulas have appropri-
ate calory and nutrient sources (iron vitamin B12,
vitamin D) ensuring their normal growth. For the
vegan babies that are not naturally fed, the soy milk
is the only option, but just like rice and goat milk it
does not contain an optimum ratio between nutri-
ents and can lead to unbalances. The guides for the
nutrition diversification are similar in vegetarians
and non-vegetarians. Babies older than 6 months
run a potential risk of deficiencies due to the re-
strictive diet, being more vulnerable if they receive
a macrobiotic diet and can develop a psycho-motor
retard. By the age of 6 months the iron reserves of
the organism are exhausted and the diet must in-
clude foods rich in iron, in order to increase the ab-
sorption of iron, the consumption of foods rich in
vitamin C is recommended (citrus fruit, green leaf
products rich in vitamin C (citrus fruit, green leaf
products) (1,5).
Recommendations for children
This period is important for the development of
nutrition habits that can be the basis of a healthy
diet during adulthood. Vegetarian children, except
those who receive extremely restrictive diets (non-
macrobiotic vegan diets) experience a growth com-
parable to that of non-vegetarian children of the
same age. Vegan children may need large quantities
of proteins due to the differences in the digestibility
of proteins and in the profile of amino acids. They
also need a suitable intake of calcium, zinc, iron.
Special attention must be paid to allergy preven-
tion. Foods such as nuts, grapes, honey or corn
syrup must not be fed before the age of three, espe-
cially to children with family history of allergy, ec-
zema or asthma (1,5).
Recommendations for adolescents
Even if they have recently become vegans or
they are vegans from their early childhood, nutri-
tional unbalance has major consequences in adult-
hood. The vegetarian practices at this age can be a
marker in the identification of adolescents tending
to have eating disorders or weight obsession. It has
been noticed that 30% of the vegetarian adolescents
receive the recommended calcium intake of 1,300
mg/day (1,5).
Vegetarian mothers and natural nutrition
If the diet is correct, human milk may be suffi-
cient for the baby up to 6 months. The diet must
contain:
proteins from nuts, eggs, dried grains, lentil
and tofu;
REVISTA ROMN DE PEDIATRIE VOLUMUL LXIII, NR. 4, AN 2014
dairy products (cow milk, cheese, yoghurt)
or calcium fortified soy products;
fortified or whole cereals;
fruits and vegetables (green leaf vegetal prod-
ucts);
poly-/ monosaturated oils.
Breastfeeding vegan mothers need vitamin and
mineral supplements. If these mothers diet contains
small amounts of vitamin B12, then their milk will
contain insufficient amounts of vitamin B12. They
will need vitamin B12 supplements or will have to
consume vitamin B12 sources (fortified cereals, soy,
oat extract). The vitamin D content of human milk
varies depending on the mothers diet and her sun
exposure. The docosahexaenoic acid is necessary for
the development of the eyes and brain, and vegetar-
ians source is the alpha-linolenic acid contained by
REFERENCES
1. Kleinman R. Nutritional Aspects of Vegetarian Diets. Pediatric
Nutrition Handbook 6TH Ed. 2009; 201-224
2. Kirby M., Danner E. Nutritional Deficiencies in Children on Restricted
Diets. Pediatr Clin North Am. 2009; 56(5):1085-103
3. Sabat J., Wien M. Vegetarian Diets and Childhood Obesity
Prevention.
4. Laskowska-Klita T., Chechowska M., Ambroszkiewicz J.,
Gajewska J., Klemarczyk W. The Effect of Vegetarian Diet on
Selected Essential Nutrients in Children. Med Wieku Rozwoj. 2011;
15(3):318-25
5. Van Winckel M., Vande Velde S., De Bruyne R., Van Biervliet S.
Clinical Practice: Vegetarian Infant and Child Nutrition. Eur J Pediatr.
2011; 170(12):1489-94
361
the human milk of the vegetarian woman, if her diet
contains flax and rape seed oil (9).
CONCLUSIONS
1. The more restrictive the diet and the younger
the child is, the higher the deficiency risk.
2. Vegetarians must be assessed individually by
frequent nutrition questionnaires regarding the di-
etetic intake.
3. Vegetarian diets may cover the children and
adolescents nutritional needs if carefully planned
and monitored.
4. Even if the vegetarian diet observes the current
recommendations for all nutrients, the use of sup-
plements and fortified foods is necessary to prevent
deficiencies.
6. Mangels R., Hood Sandra. The Vegan Diet for Infants and Children.
Simply Vegan 3rd Edition, 1999; 194-195
7. Chechowska M., Laskowska-Klita T., Klemarczyk W. Lipids and
Vitamin A and E Status in Vegetarian Children. Med Wieku Rozwoj.
2003; 7(4 Pt 2):577-8
8. Ambroszkiewicz J., Klemarczyk W., Gajewska J., Chechowska
M., Struciska M., Otarzewski M., Laskowska-Klita T. Effect of
Vitamin D Supplementation on Serum 25-Hydroxyvitamin D and Bone
Turnover Markers Concentrations in Vegetarian Children. Med Wieku
Rozwoj. 2009; 13(1):34-9
9. *** Vegetarian Diets And Children. www.betterhealth.vic.gov.au
 REFERATE GENERALE
1
DIETA VEGETARIAN LA COPIL
ef Lucr. Dr. Dana-Teodora Anton-Pduraru1, Dr. Carmen Oltean2,
Asist. Univ. Dr. Laura Mihaela Trandafir1, Dr. Amalia Maria Minea3
1
Clinica III Pediatrie, Universitatea de Medicin i Farmacie Gr. T. Popa, Iai
2
Spitalul de Urgene pentru Copii Sf. Maria, Iai
3
Hiperclinica Medlife

REZUMAT
Vegetarianismul poate avea implicaii asupra creterii copiilor i adolescenilor. Exist diferite tipuri de diete
vegetariene: unele pot fi adecvate pentru copii, altele deficitare n nutrieni eseniali. Dac o diet vegetarian
este realizat adecvat i include alimente fortifiate, poate promova starea de sntate i reduce riscul de boli
cronice majore. Restricia sau excluderea produselor de natur animal poate conduce la aport sczut de nu-
trieni eseniali.

Cuvinte cheie: vegetarianism, copil

Copilria este perioada n care se formeaz obi- TABELUL 1. Tipuri de vegetarieni

ceiurile alimentare, n care creterea este accelerat Vegetarieni clasici Noii vegetarieni
i n care se acumuleaz depozitele de nutrieni Lacto-ovovegetarieni Vegetarieni care consum mici
eseniali. cantiti de carne
Conform Merriam-Wester Dictionary, vegetaria- Lactovegetarieni Vegetarieni n mare parte
Ovovegetarieni Semivegetarieni
nismul se definete prin consumul unei diete care
Vegani1 Pescovegetarieni2
conine vegetale, fructe, nuci, cereale i, uneori, ou
Consumatori ai dietei RAW3 Vegetarieni care consum
i produse lactate (1). budinci
Vegetarianismul poate avea implicaii severe Consumatori de semine
asupra creterii copiilor i adolescenilor astfel n- Consumatori de fructe
ct este necesar s se evalueze statusul nutriional Vegetarieni macrobiotici4
al vegetarienilor pentru a asigura o cretere optim 1
consum o diet fr nici un fel de produs animal, incluznd
i o stare de sntate bun i pentru a preveni poten- carnea, oule i toate ingredientele care deriv din aceste produse
2
consum hran din surse vegetale i pete
ialele deficite. 3
diet vegan fr foc
Exist diferite tipuri de vegetarieni (1), Tabelul 1. 4
consum grne ca baz alimentar i evit produsele procesate i
rafinate
Fiecare dintre aceste diete are implicaii asupra
nutriiei i sntii copiilor i adolescenilor. Moti- mediului; militani pentru drepturile anima-
vele pentru care se ader la o diet vegetarian sunt lelor;
diferite: motive ecologice: efectul produciei de carne
motive economice: n unele ri vegetalele asupra mediului implic folosirea ineficient
sunt ieftine; a resurselor planetei;
riscul dietelor omnivore i publicitatea nega- motive religioase: adventitii de ziua a 7-a,
tiv despre bolile aprute ca urmare a consu- unii hindui, buditii;
mului de produse de origine animal; motive filosofice: meditaia transcedental,
motive morale: credina c folosirea crnii n yoginii, antroposofitii, macrobioticii;
alimentaie implic cruzime i degradarea influene sociale (1).

Autor de coresponden:
ef Lucr. Dr. Dana-Teodora Anton-Pduraru, Universitatea de Medicin i Farmacie Gr. T. Popa, Str. Universitii nr. 16, Iai
E-mail: antondana66@yahoo.com

426 REVISTA ROMN DE PEDIATRIE VOLUMUL LXIII, NR. 4, AN 2014

REVISTA ROMN DE PEDIATRIE VOLUMUL LXIII, NR. 4, AN 2014
Un studiu efectuat n SUA n 2003 arat c 2%
dintre copiii cu vrsta ntre 2-17 ani sunt vegetarieni
i aproximativ 0,5% sunt vegani (2). Odat cu cre-
terea popularitii dietelor vegetariene, tot mai muli
prini i ncurajeaz copiii s adere la acestea.
Gradul de aderare la dietele vegetariene variaz i,
prin urmare, i aportul de nutrieni variaz de la un
vegetarian la altul. American Dietetic Association
i Dietitians of Canada consider c o diet vege-
tarian atent planificat poate fi sntoas i adec-
vat din punct de vedere nutriional i poate avea
beneficii n prevenirea i tratamentul unor boli (1).
Dieta vegetarian, inclusiv cea vegan, trebuie
s respecte recomandrile zilnice alimentare (RZA)
pentru proteine, fier, zinc, calciu, vitamina D, vita-
mina B6 i B12, vitamina A, acizi grai omega-3 i
iod. n unele cazuri folosirea alimentelor fortifiate
sau a suplimentelor poate fi util n asigurarea reco-
mandrilor pentru fiecare nutrient n parte.
Beneficiile dietei vegetariene sunt:
aport sczut de grsimi saturate, colesterol i
proteine animale;
niveluri crescute de carbohidrai, fibre, mag-
neziu, vitamina C i E, carotenoizi;
indice de mas corporal mai mic dect al non-
vegetarienilor;
inciden mai sczut a obezitii, bolii coro-
nariene, hipertensiunii i diabetului zaharat
de tip 2;
ameliorarea profilului lipidic;
adolescenii vegetarieni sunt mai puin afec-
tai de acnee, alergii i tulburri gastro-intes-
tinale;
reducerea mortalitii prin boli cardiovascu-
lare, oc i cancer (1,3).
De asemenea, prezint i unele implicaii adiio-
nale:
consum moderat de alcool sau abstinen,
precum i al altor produse stimulante (nico-
tin);
implicare mai crescut n activiti fizice;
produsele vegetale au densitate caloric mai
mic i astfel predispun mai puin la obezitate
(1).
Un alt beneficiu a fost raportat la copiii cu un stil
de via antroposofic. Acest stil implic consumul
crescut de alimente organice, inclusiv vegetale fer-
mentate natural i alimente cu lactobacili vii, pre-
cum i folosirea restrictiv a antibioticelor, antipi-
reticelor i a vaccinurilor. Un studiu care a evaluat
flora intestinal la copii mai mici de 2 ani cu acest
stil de via comparativ cu cea a copiilor cu un stil
de via tradiional a artat c difer caracteristicile
microflorei la cele dou grupuri: aceast diversitate
427
a bacteriilor poate contribui la prevalena mai sc-
zut a bolii atopice. Studiul efectuat n Polonia la
copii vegetarieni n perioada prepubertar a evi-
deniat concentraii mai sczute de leptin poli-
peptid cu rol n creterea osoas i reglarea greutii
(4).
Riscurile dietei vegetariene sunt:
apariia rahitismului;
risc de deficien n vitamina A i, subsecvent,
de keratomalacie;
apariia anemiei, precum i a deficitului de
proteine i zinc (1,2).
GHIDURI DE APORT N NUTRIENI PENTRU
COPIII VEGETARIENI
Aportul caloric
Aportul energetic adecvat trebuie s asigure
creterea conform curbelor de cretere. Recoman-
drile cu privire la aportul caloric sunt similare cu
cele pentru populaia general. Sursele de calorii
acceptate pentru sugari i copii sunt soia, legumele,
nucile, uleiul, untul din nuci i sucurile de fructe.
Recomandrile pentru aportul de nutrieni sunt cres-
cute cu pn la 2 deviaii standard peste media RZA
pentru a compensa potenialele deficite n aport.
Mai mult, recomandrile pentru acelai nutrient pot
varia n diferite ri (5).
Aportul de proteine
n ciuda densitii calorice sczute a dietelor ve-
getariene stricte, n special dac nrcarea are loc
devreme, aportul alimentar este de obicei suficient
pentru a acoperi nevoile proteice. Proteinele din
plante pot acoperi nevoile energetice dac este con-
sumat o varietate de plante. Proteinele complemen-
tare nu trebuie consumate la aceeai mas. Diferite
studii (1,6) au artat c, datorit digestibilitii sc-
zute a proteinelor din plante, necesarul proteic tre-
buie s fie cu 30-35% mai mare la sugarii vegani,
20-30% la veganii cu vrsta ntre 2-6 ani i cu 15-
20% pentru copiii vegani cu vrsta peste 6 ani.
Cele 5 surse majore de proteine din plante sunt:
legumele, cerealele, nucile i seminele, fructele i
vegetalele. Fiecare dintre acestea prezint avantaje
i dezavantaje:
legumele i cerealele furnizeaz cantiti re-
lativ mari de proteine de calitate, dar trebuie
gtite sau procesate pentru a deveni gustoase
i pentru a elimina substanele care scad di-
gestibilitatea cum ar fi inhibitorii amilazei,
lecitina i taninul;
428
cantitatea, calitatea i digestibilitatea sunt
motive de ngrijorare n special cnd dietele
vegane/vegetariene sunt folosite la sugari;
calitatea proteinelor din plante variaz: pro-
teinele izolate din soia asigur necesarul la
fel ca i cele animale, n timp ce proteinele din
gru sunt cu 50% mai puin utilizabile com-
parativ cu cele animale;
coninutul n lizin este mai sczut n toate
plantele comparativ cu alimentele de origine
animal, iar coninutul n metionin i ciste-
in este sczut att n legume, ct i n fructe;
coninutul n aminoacizi eseniali (treonin)
este sczut n cereale, iar triptofanul n fructe
(1).
Aportul de lipide
Chiar dac aportul dietetic n grsimi la copiii
vegetarieni mai mari de 2 ani (25-35% din calorii)
este mai sczut dect la omnivori, efectele asupra
creterii par s fie mici. Totui, cnd aportul furni-
zeaz sub 15% din calorii, trebuie asigurat aportul
n acizi grai eseniali. Minimum 3% din calorii
trebuie asigurate din acid linoleic (omega 3) i 1%
din acid linolenic (omega 6). Raportul recomandat
ntre omega 6: omega 3 variaz ntre 2:1 4:1. Aci-
dul linoleic se gsete n nuci, semine i grne.
Acidul alfa-linolenic se gsete n frunze verzi,
fitoplancton, alge, unele semine, nuci i legume,
ct i n in, alune, soia. Acetia pot fi transformai n
acizi grai nesaturai (arahidonic ARA, eicosa-
pentanoic EPA, docosahexanoic DHA). Acizii
grai polinesaturai trebuie s furnizeze 3-10% din
totalul caloriilor. ARA se gsete n carne, ou;
EPA i DHA n pete i fructe de mare. Veganii/ve-
getarienii nu au surse de aceti acizi grai omega-3
cu lan lung i trebuie s transforme acidul alfa-li-
nolenic n acetia (7).
Gravidele vegane, vegetariene sau cu diet ma-
crobiotic i care nu consum pete sau consum
cantiti mici de pete i produse animaliere nu pri-
mesc aceti acizi grai. Riscurile sunt crescute pen-
tru sugari care pot fi prematuri deoarece capacitatea
lor de a desatura acidul alfa linolenic n DHA este li-
mitat. Aceste persoane necesit suplimente cu DHA
fie din ulei de pete, fie din microalge cultivate.
Aportul de fibre
n funcie de vrst i sex, aportul zilnic de fibre
recomandat este de:
19 g/zi pentru copii 1-3 ani;
25 g/zi pentru copii 4-8 ani;
38 g/zi pentru adolesceni.
REVISTA ROMN DE PEDIATRIE VOLUMUL LXIII, NR. 4, AN 2014
Pentru copiii foarte mici densitatea energetic
sczut a dietelor bogate n fibre poate face dificil
consumul caloric suficient i poate inhiba absorbia
unor minerale. Mcinarea cerealelor i zdrobirea
vegetalelor poate crete digestibilitatea lor, iar nlo-
cuirea parial a cerealelor integrale cu cereale ra-
finate mai srace n fibre poate crete aportul ener-
getic. Lacto-ovovegetarienii consum de obicei can-
titi adecvate, dar nu excesive de fibre (5).
Aportul de vitamine
Vitamina A: deoarece alimentele de origine ve-
getal conin numai carotenoizi, nevoile de vitamina
A trebuie acoperite prin 3 porii/zi de produse vege-
tale bogate n betacaroten cum ar fi vegetale i
fructe galbene sau portocalii. Absorbia betacarote-
nului este mai puin eficient cnd vegetalele sunt
nepreparate sau raw dect atunci cnd sunt gtite,
tocate sau sub form de piure sau cnd sunt adugate
mici cantiti de grsimi la preparare sau consum
(7).
Riboflavina: aportul de riboflavin pare s fie
similar la vegetarieni i omnivori. Ocazional, poate
fi deficient la cei cu diete foarte restrictive sau ma-
crobiotice. Surse de riboflavin sunt: soia, germenii
de gru, cerealele fortifiate, drojdia, boabele mbo-
gite (1,5).
Acidul folic: de obicei, consumul unor cantiti
crescute de fructe i legume asigur un aport adec-
vat de acid folic. Cei care consum vegetale fierte
sau prjite la temperatur nalt i care mnnc rar
cereale fortifiate cu acid folic sau sucuri de fructe
pot avea deficiene (1,5).
Vitamina B12: nici un aliment de natur vege-
tal, chiar i fortifiat nu conine vitamina B12. Ciu-
percile sunt considerate adesea o surs de vitamina
B12, dar n realitate conin un compus cu structur
similar vitaminei B12 care nu acioneaz ca vita-
mina B12 n organism. Lacto-ovo-vegetarienii pri-
mesc cantiti suficiente de vitamina B12 dac pro-
dusele lactate sunt consumate regulat. Dietele ve-
getariene tipice sunt bogate n acid folic care poate
masca simptomele hematologice de deficit, condu-
cnd la un diagnostic tardiv. Aportul regulat de ali-
mente fortifiate cu vitamina B12 sau de produse
lactate trebuie ncurajat la vegetarieni i n special
la mamele care alpteaz (1,5).
Vitamina D: copiii trebuie s consume alimente
ca laptele de vac, unele tipuri de lapte de soia, lap-
tele de orez, cerealele mbogite cu vitamina D2
sau D3. Biodisponibilitatea vitaminei D2 este mai
mic i, prin urmare, nevoile sunt crescute pentru
unii vegetarieni. Dac expunerea la soare i aportul
REVISTA ROMN DE PEDIATRIE VOLUMUL LXIII, NR. 4, AN 2014
de alimente fortifiate sunt insuficiente, atunci se re-
comand suplimente (8).
Aportul de minerale
Fierul: este vital la toate vrstele, n special la
sugari, adolesceni i gravide. Deficitul de fier este
cel mai frecvent deficit de micronutrieni la copiii
vegetarieni, la fel ca i la non-vegetarieni. Este mai
frecvent n special la copiii vegani, deoarece ali-
mentele de natural vegetal conin fier non-hem
comparativ cu cele de natur animal, care conin
fier-hem. Fierul non-hem este mai sensibil la facto-
rii care inhib absorbia fierului cum ar fi fitai, cal-
ciu, ceai din plante, cacao, unele condimente i fibre.
Vitamina C i ali acizi organici din fructe i vege-
tale cresc absorbia fierului. La vegetarieni, aportul
recomandat este de 1,8 mai mare dect la non-vege-
tarieni datorit biodisponibilitii sczute a fierului
din dietele vegetariene i depozitelor mai sczute
de fier ale vegetarienilor, cu toate c feritina seric
este n limite normale de obicei (4,5).
Zincul: n dietele americane aproximativ ju-
mtate din zinc provine din carne i pete. Alimente
precum carnea roie conin cantiti crescute de
zinc i proteine care cresc biodisponibilitatea aces-
tuia. Laptele uman nu conine suficient zinc pentru
sugarii mai mari de 6 luni. Biodisponibilitatea plan-
telor relativ bogate n zinc cum ar fi cerealele inte-
grale, soia, boabele, nucile, mazrea, lintea tinde s
fie sczut deoarece multe conin fitai i fibre care
inhib absorbia zincului. La lacto-ovovegetarieni,
absorbia zincului este cu aproximativ o treime mai
mic dect la omnivori. La vegani necesarul zilnic
trebuie s fie cu 50% mai mare. Surse de plante bo-
gate n zinc sunt pinea din cereale integrale pre-
parat cu drojdie i cerealele fortifiate n zinc (4,5).
Calciul: este important pentru sntatea oase-
lor; aproximativ 45% din masa osoas se formeaz
pn la vrsta de 8 ani, 45% ntre 8-16 ani i 10%
n urmtoarea decad. La vegani, aportul de calciu
tinde s fie sczut comparativ cu lactovegetarienii
i non-vegetarienii. Cu toate c oxalaii, fitaii i
fibrele din plante scad disponibilitatea calciului din
produse vegetale, aceasta este mai mare dect cea
din lapte. Calciul este coninut n brocoli, varz,
gulii, frunze de napi. Pentru copiii care consum
soia se recomand produse fortifiate cu calciu (4,5).
Iodul: odat cu introducerea srii iodate defi-
citul de iod este rar. Veganii ai cror diete sunt res-
trnse la sruri de mare care nu sunt iodate i care
au un aport substanial de alimente guogene ca
broccoli, mutar, varz, napi prezint risc de deficit
n iod. Pentru acetia se recomand alimente forti-
fiate n iod (4,5).
429
RECOMANDRI PE GRUPE DE VRST
Recomandri pentru sugari
Pn la vrsta de 4-6 luni dietele sugarilor vege-
tarieni i non-vegetarieni sunt identice, laptele uman
fiind cel mai bun aliment pentru aceast perioad
datorit avantajelor binecunoscute. Sugarii care
primesc lapte uman sau diferite formule de lapte au
surse adecvate de calorii i nutrieni (fier, vitamina
B12, vitamina D) care le asigur o cretere normal.
Pentru sugarii vegani care nu primesc alimentaie
natural, laptele de soia este singura opiune, dar
acesta, la fel ca i laptele de orez i de capr, nu
conine un raport optim ntre nutrieni i poate con-
duce la dezechilibre. Ghidurile pentru diversificarea
alimentaiei sunt similare la vegetarieni i non-ve-
getarieni. Sugarii mai mari de 6 luni prezint risc
potenial de deficiene datorit dietei restrictive,
fiind mai vulnerabili dac primesc o diet macro-
biotic i pot prezenta retard psiho-motor. La vrsta
de 6 luni se epuizeaz rezervele de fier ale organis-
mului i este necesar includerea n diet a alimen-
telor bogate n fier. Pentru creterea absorbiei fie-
rului se recomand consumul de alimente bogate n
vitamina C (citrice, vegetale cu frunze verzi) (1,5).
Recomandri pentru copii
Aceast perioad este important pentru dezvol-
tarea obiceiurilor alimentare care pot fi baza unei
diete sntoase n perioada de adult. Copiii vegeta-
rieni, cu excepia celor care primesc diete extrem
de restrictive (diete vegane non-macrobiotice) pre-
zint o cretere comparabil cu a copiilor de aceeai
vrst non-vegetarieni. Copiii vegani pot necesita
cantiti mai mari de proteine datorit diferenelor
n digestibilitatea proteinelor i n profilul aminoa-
cizilor. De asemenea, necesit aport adecvat de cal-
ciu, zinc, fier. O atenie deosebit trebuie acordat
prevenirii alergiilor. Alimente ca nuci, struguri,
miere sau sirop de porumb nu trebuie introduse
naintea vrstei de 3 ani, n special la copiii cu is-
toric familial de alergie, eczem sau astm (1,5).
Recomandri pentru adolesceni
Chiar dac au devenit recent vegani sau erau ve-
gani nc din mica copilrie, dezechilibrul nutriio-
nal are consecine majore pentru perioada de adult.
Practicile vegetariene la aceast vrst pot fi un
marker n identificarea celor cu tendine la tulburri
alimentare sau obsesie privind greutatea. S-a ob-
servat c numai 30% dintre adolescenii vegetarieni
primesc aportul recomandat de calciu 1.300 mg/zi
(1,5).
430 REVISTA ROMN DE PEDIATRIE VOLUMUL LXIII, NR. 4, AN 2014
MAMELE VEGETARIENE I ALIMENTAIA
NATURAL
Dac dieta este corect, laptele uman poate fi su-
ficient pentru sugarul cu vrsta pn la 6 luni. Dieta
trebuie s conin:
proteine din nuci, ou, boabe uscate, linte i
tofu;
produse lactate (lapte de vac, brnz, iaurt)
sau produse din soia fortifiate cu calciu;
cereale fortifiate sau integrale;
fructe i legume (vegetale cu frunze verzi);
uleiuri poli- / mononesaturate.
Mamele vegane care alpteaz necesit supli-
mente de vitamine i minerale. Dac dieta acestor
mame conine cantiti mici de vitamina B12, atunci
i laptele acestora va conine cantiti insuficiente
de vitamina B12. Ele vor necesita suplimente cu
vitamina B12 sau consumul unor surse de vitamina
B12 (cereale fortifiate, soia, extract de ovz). Con-
inutul n vitamina D al laptelui uman variaz n
funcie de dieta mamei i de expunerea sa solar.
Acidul docosahexanoic este necesar pentru dezvol-
tarea ochilor i creierului, vegetarienii avnd ca
surs acidul alfa-linolenic coninut de laptele uman
al femeii vegetariene dac dieta sa conine ulei de
semine de in i rapi (9).
CONCLUZII
1. Cu ct dieta este mai restrictiv i vrsta co-
pilului mai mic, cu att riscul pentru deficiene este
mai mare.
2. La vegetarieni este necesar evaluarea indivi-
dual prin chestionare alimentare frecvente a apor-
tului dietetic.
3. Dietele vegetariene pot acoperi nevoile nutri-
ionale ale copiilor i adolescenilor dac sunt atent
planificate i monitorizate.
4. Chiar dac dieta vegetarian respect recoman-
drile curente pentru toi nutrienii, folosirea supli-
mentelor i a alimentelor fortifiate este necesar
pentru a preveni deficienele.