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Chouraqui JP. Vegetarian diets and diets which restrict animal-source foods during childhood in high-income countries. Paediatr Int Child Health 2023; 43:57-82. [PMID: 37649436 DOI: 10.1080/20469047.2023.2245186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/21/2023] [Indexed: 09/01/2023]
Abstract
Increasing numbers of populations in the West are restricting their intake of meat and other animal products for reasons relating to health or ethics; in many countries, these restrictions are already common for cultural, religious, or socio-economic reasons. By following their parent's diet, children are exposed in parallel. This narrative review aims at assessing current data regarding vegetarian diets in children from birth to 18 years of age, which include, by increasing degree of restriction, flexitarian, lacto-ovo-vegetarian, lacto-vegetarian, pescatarian, vegan and macrobiotic diets. The 202 references include 45 studies in children. The more restrictive the diet and the younger the child, the greater the risk of nutritional deficiency. Of particular concern are vitamin B12, iron, zinc, calcium, n-3 long-chain polyunsaturated fatty acids, and protein and energy intake, especially in pregnant and nursing women, infants and young children. Providing an adequate lacto-ovo-vegetarian diet is relatively easy, whereas the maintenance of more restrictive diets may be challenging. The benefits and risks of vegetarian diets in adults are relatively well documented, but data for children are scarce. Vegan and macrobiotic diets should be discouraged in pregnant and lactating mothers as well as in young children, who, otherwise, should pay careful attention to ensuring nutritional adequacy, blood testing and appropriate supplementation. The health consequences of a chosen diet should be discussed with parents and adolescents to ensure the best possible adherence to advice and prescriptions. There is a need for well conducted studies in children but also for better knowledge of nutrition in healthcare professionals.Abbreviations: ALA: α-linolenic acid; ARA: arachidonic acid; ASF: animal source foods; BMC: bone mineral content; BMD: bone mineral density; DHA: docosahexaenoic acid; DRV: dietary reference value; EPA: eicosapentaenoic acid; FLD: flexitarian diet; LA: linoleic acid; LC-PUFA: long-chain polyunsaturated fatty acids; LOVD: lacto-ovo-vegetarian diet; LVD: lacto-vegetarian diet; MAD: macrobiotic diet; OMD: omnivorous diet; PSF: plant-source foods; SFA: saturated fatty acids; VGD: vegetarian diets; VND: vegan diet.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Paediatric Division of Nutrition and Gastro-Enterology, Department of Paediatric, Grenoble-Alpes University Hospital (CHUGA), Grenoble, France
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Pepe RB, Lottenberg AM, Fujiwara CTH, Beyruti M, Cintra DE, Machado RM, Rodrigues A, Jensen NSO, Caldas APS, Fernandes AE, Rossoni C, Mattos F, Motarelli JHF, Bressan J, Saldanha J, Beda LMM, Lavrador MSF, Del Bosco M, Cruz P, Correia PE, Maximino P, Pereira S, Faria SL, Piovacari SMF. Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022). Diabetol Metab Syndr 2023; 15:124. [PMID: 37296485 DOI: 10.1186/s13098-023-01037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/23/2023] [Indexed: 06/12/2023] Open
Abstract
Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.
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Affiliation(s)
- Renata Bressan Pepe
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Ana Maria Lottenberg
- Laboratório de Lipides (LIM10), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
- Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), Rua Mato Grosso 306 - cj 1711, Sao Paulo, SP, 01239-040, Brazil.
| | - Clarissa Tamie Hiwatashi Fujiwara
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Mônica Beyruti
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Dennys Esper Cintra
- Centro de Estudos em Lipídios e Nutrigenômica - CELN - University of Campinas, Campinas, SP, Brazil
| | - Roberta Marcondes Machado
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Alessandra Rodrigues
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Natália Sanchez Oliveira Jensen
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | | | - Ariana Ester Fernandes
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Carina Rossoni
- Instituto de Saúde Ambiental, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Fernanda Mattos
- Programa de Obesidade e Cirurgia Bariátrica do Hospital Universitário Clementino Fraga Filho da UFRJ, Rio de Janeiro, RJ, Brazil
| | - João Henrique Fabiano Motarelli
- Núcleo de Estudos e Extensão em Comportamento Alimentar e Obesidade (NEPOCA) da Universidade de São Paulo - FMRP/USP, Ribeirão Preto, Brazil
| | - Josefina Bressan
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, MG, Brazil
| | | | - Lis Mie Masuzawa Beda
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Maria Sílvia Ferrari Lavrador
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Mariana Del Bosco
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Patrícia Cruz
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | | | - Priscila Maximino
- Instituto PENSI - Fundação José Luiz Egydio Setúbal, Instituto Pensi, Fundação José Luiz Egydio Setúbal, Hospital Infantil Sabará, São Paulo, SP, Brazil
| | - Silvia Pereira
- Núcleo de Saúde Alimentar da Sociedade Brasileira de Cirurgia Bariátrica e Metabólica, São Paulo, Brazil
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Hargreaves SM, Rosenfeld DL, Moreira AVB, Zandonadi RP. Plant-based and vegetarian diets: an overview and definition of these dietary patterns. Eur J Nutr 2023; 62:1109-1121. [PMID: 36681744 DOI: 10.1007/s00394-023-03086-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 01/06/2023] [Indexed: 01/23/2023]
Abstract
PURPOSE This paper aims to present an overview of the definitions of "plant-based and "vegetarian diets" adopted by different organizations worldwide, proposing new standard definitions and discussing the notion of vegetarianism as a restrictive dietary pattern. METHODS An extensive literature review on the different definitions of vegetarian and plant-based diets was conducted. Definitions of different international vegetarian and vegan organizations were also taken into account. Objective definitions for vegetarian and plant-based diets, as well as for their subcategories, were proposed. Other aspects related to how vegetarian diets are viewed and defined were also discussed. RESULTS We proposed that a vegetarian diet should be defined as "a dietary pattern that excludes meat, meat-derived foods, and, to different extents, other animal products". This definition would include, among others, ovolactovegetarian and vegan diets. The proposed definition for a plant-based diet was "a dietary pattern in which foods of animal origin are totally or mostly excluded". Other types of diets, such as flexitarian and pescetarian diets, could be considered plant-based. A vegetarian diet should not be considered restrictive. Instead, terms such as alternative or non-conventional could be used to define it and to distinguish it from the conventional diet adopted by most of the Western population. CONCLUSION This paper was able to elaborate objective definitions of vegetarian and plant-based diets. Standardizing nomenclatures may reduce misinterpretation and confusion in this field of study.
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Affiliation(s)
- Shila Minari Hargreaves
- Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia, DF, 70910-900, Brazil
| | - Daniel L Rosenfeld
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | | | - Renata Puppin Zandonadi
- Department of Nutrition, Faculty of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia, DF, 70910-900, Brazil.
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Chouraqui JP, Turck D, Briend A, Darmaun D, Bocquet A, Feillet F, Frelut ML, Girardet JP, Guimber D, Hankard R, Lapillonne A, Peretti N, Roze JC, Siméoni U, Dupont C. Religious dietary rules and their potential nutritional and health consequences. Int J Epidemiol 2021; 50:12-26. [PMID: 33207368 DOI: 10.1093/ije/dyaa182] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The vast majority of the world population declares affiliation to a religion, predominantly Christianity and Islam. Many religions have special dietary rules, which may be more or less strictly adhered to. METHODS Religious food rules were collected from holy books and religious websites as well as their translation into dietary practices. The literature was searched for potential associations between these rules and potential nutritional consequences. RESULTS Jewish, Islamic and Indian religions support prolonged breastfeeding. Religious avoidance of alcohol is probably beneficial to health. When strictly applied, a few rules may lead to nutritional inadequacies, mainly in populations living in unfavourable socio-economic or environmental conditions. In Jewish and Muslim observants, animal slaughtering procedures may increase the risk of iron deficiency. Jews may be at risk of excess sodium intake related to home-prepared foods. A vegan diet, as observed by some believers, often by drifting from original precepts, or by some Hindus or Buddhists, may result in vitamin B12, calcium, iron, zinc, selenium and n-3 fatty acids deficiencies. CONCLUSION When implemented in accordance with the rules, most religious food precepts are not detrimental to health, as suggested by the fact that they have more or less been followed for millennia. Nevertheless, some practices may lead to nutritional inadequacies, such as iron, calcium, vitamin D and vitamin B12 deficiencies. Patients with low socio-economic status, children and women of childbearing age are of particular risk of such deficiencies. Being aware of them should help health professionals to take an individualized approach to decide whether to supplement or not.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Pediatric Nutrition and Gastroenterology Unit, Division of Pediatrics, Woman, Mother and Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Dominique Turck
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, University of Lille; INFINITE-INSERM U1286, Lille, France
| | - André Briend
- Institut de Recherche Pour le Développement, Marseille, France
| | | | - Alain Bocquet
- French Association of Ambulatory Paediatrics, Orléans, France
| | | | | | - Jean-Philippe Girardet
- Cabinet de Pédiatrie, 81000 Albi, Pierre et Marie Curie-Paris 6, University 75005, Paris, France
| | - Dominique Guimber
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, University of Lille, Lille, France
| | | | - Alexandre Lapillonne
- Paris Descartes University, APHP Necker-Enfants Malades Hospital, Paris, France and CNRC, Baylor College of Medicine, Houston, TX, USA
| | - Noel Peretti
- Pediatric Nutrition, University Pediatric Hospital of Lyon and INSERM U1060, CarMeN laboratory, Claude Bernard Lyon-1 University, France
| | - Jean-Christophe Roze
- Neonatology and Pediatric Intensive Care Unit, Univesity Hospital of Nantes and UMR 1280 INRA, Nantes University, France
| | - Umberto Siméoni
- Division of Pediatrics and DOHaD Lab, Woman, Mother and Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Christophe Dupont
- Pediatric Gastroenterology Department, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France
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Ferrara P, Sandullo F, Di Ruscio F, Franceschini G, Peronti B, Blasi V, Bietolini S, Ruggiero A. The impact of lacto-ovo-/lacto-vegetarian and vegan diets during pregnancy on the birth anthropometric parameters of the newborn. J Matern Fetal Neonatal Med 2020; 33:3900-3906. [PMID: 30909771 DOI: 10.1080/14767058.2019.1590330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: The data in the literature on the appropriateness of vegetarian diets during pregnancy and the impact on the birth anthropometric parameters of the newborn are divergent and conflicting. The aim of the present study is to compare the birth anthropometric parameters of three groups of children distinguished according to the dietary pattern followed by their mothers during pregnancy. Moreover, the second aim is to study the cultural inference of vegetarianism.Materials and methods: Between September 2017 and May 2018, from the Pediatric Service of the Campus Bio-Medico University Hospital of Rome and vegetarian-oriented societies, detailed information have been provided to all mothers who showed interest in participating in the study. More than 100 mothers gave their consent, but in consideration of the criteria of inclusion and exclusion only 55 with the respective children (for a total of 63 kids) have been enlisted in the study. Based on the dietary pattern followed by women during pregnancy, the participants have been divided into three groups: vegan group, lacto-ovo-/lacto-vegetarian group, and omnivorous group. The data necessary for the study have been collected through a questionnaire previously created and sent electronically to 55 enrolled mothers.Results: From our statistical analysis, it has emerged that birth weight, both when expressed in grams and when expressed in growth percentiles, of the vegan mothers' children is lower than that of the omnivorous mothers' children. No significant difference has emerged from the comparison for the length, cranial circumference and BMI at birth between the three groups.Conclusion: Although from our study statistically significant differences in birth weight between the vegan group and the omnivorous one has emerged, the values of this anthropometric parameter were all included within the physiological range decided by the experts in the field. From this, it emerges that the planning of any type of diet with experts in the field is indispensable to ensure a physiological development of the fetus, but given the limited number of participants we cannot draw unequivocal and certain conclusions on this subject.
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Affiliation(s)
- Pietro Ferrara
- Institute of Pediatrics, Catholic University Medical School, Rome, Italy.,Service of Pediatrics, Campus Bio-Medico University, Rome, Italy
| | | | | | | | - Benedetta Peronti
- Unit of Food Science and Human Nutrition, Campus Bio-Medico University, Rome, Italy
| | - Valeria Blasi
- Food Sciences and Human Nutrition Unit, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | - Antonio Ruggiero
- Institute of Pediatrics, Catholic University Medical School, Rome, Italy
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