Is iron and zinc nutrition a concern for vegetarian infants and young children in industrialized countries?

Lifestyle Strategies to Boost Total Body Iron

Patients who switch to a whole food plant-based eating pattern (WFPBD) generally have an uneventful transition, but may present with dizziness and lightheadedness. Research demonstrates that anemia is no more common when transitioning to a WFPBD than in the normal population, but Iron deficiency is possible in the context of a transition to a whole food plant-based diet resulting in either microcytic or normocytic anemia. All six pillars of lifestyle medicine; diet, activity, sleep, stress, social engagement, and risky substances, can affect absorption of Iron and are discussed. This paper discusses how the use of lifestyle modifications can potentiate iron supplementation, or replace the need for it altogether, to reverse anemia.

Vegetarian Diets During Complementary Feeding: An Overview of Nutritional and Health Features

Nowadays, vegetarian diets are present in a solid way in Western countries' lifestyles. Some families opt for this dietetic pattern for their infants too, during the period of introduction of complementary foods. Many releases have been issued about this subject, with different and often contradictory advice and conclusions. The aim of this work is to provide a comprehensive overview through the analysis of recently published opinions of the implementation of a vegetarian or vegan diet over the course of complementary feeding. The literature agrees about some key points to consider, that is the necessity for the diet to be well-planned, in order to meet energy, macro- and micronutrients requirements, as well as the need to follow the child longitudinally. Also, there is a substantial agreement on the need for fortified foods and/or supplements to be included in the diet. Following these suggestions, most (but not all) of the papers agree that normal growth and development may be achieved. Final considerations, however, are not straightforward to make and more research with better definition of the features of the diet adopted and of supplementation used and long-term follow-up studies are highly warranted.

Plant-Based Diets in Pediatric Subjects: Heart-Healthy Option or Dangerous Choice?

BACKGROUND/OBJECTIVES

Plant-based diets (PBDs) are dietary patterns characterized by a certain degree of animal-derived food exclusion. PBDs can be divided into different dietary patterns, from vegetarian to vegan, depending on the degree and the extent of animal-derived food avoidance. PBDs are becoming epidemically popular among the general population, including adult subjects as well as children and adolescents, who often follow the dietary pattern chosen by their families.

METHODS

Our narrative review aims to analyze the most frequently adopted plant-based dietary patterns in children and adolescents and to evaluate their feasibility, advantages, and risks in terms of health promotion and disease prevention in the developmental age. The MEDLINE-PubMed database was searched to collect and select publications from 1980 to 2024.

RESULTS

Subjects following these dietary patterns, especially vegan diets, must be under strict nutritional control and receive adequate micronutrients and vitamin supplementation.

CONCLUSIONS

Nutrition-skilled professionals should be adequately updated and informed about the feasibility and the risks of these different patterns' adoption at different ages, as they should guide and accompany children and adolescents and their families in their nutritional choices without prejudices, granting adequate macronutrient and micronutrient intake, adequate growth and neurodevelopment.

Analysis of adherence to a healthy lifestyle among vegetarian and non-vegetarian Peruvian university students: A cross-sectional survey

BACKGROUND

Evidence shows that a healthy lifestyle can promote physical and mental well-being in the general population. However, there are few studies that assess the adherence to a healthy lifestyle in vegetarian and non-vegetarian university students. The purpose of this study was to evaluate the differences in adherence to a healthy lifestyle between vegetarian and non-vegetarian university students in Peru.

METHODS

A cross-sectional study was carried out considering data from 6,846 students selected by non-probabilistic convenience sampling. The Diet and Healthy Lifestyle Scale (DEVS), the Peruvian validation of the Vegetarian Lifestyle Index (VLI), was used. In addition, sociodemographic and anthropometric data such as weight and height were collected. Body mass index (BMI) was also calculated.

RESULTS

Semi-vegetarian and vegetarian students had a high healthy lifestyle score compared to non-vegetarians. In addition, vegetarian diets showed a significantly higher proportion among students with a lower BMI (normal and underweight). Students with excess body weight (overweight and obesity) were less likely to report healthy lifestyle. In the overall population analyzed, it was observed that the levels of health and lifestyle behaviors, such as daily exercise and sunlight exposure, were mostly moderate and low. Additionally, sweets intake was high, while healthy food consumption such as fruits, vegetables, legumes, and whole grains was low.

CONCLUSION

The current findings show that although vegetarians had better adherence to a healthy lifestyle, interventions in the university setting are needed to improve healthy lifestyle in university students.

Medical management of vegetarian and vegan children in France: Medical practices and parents' perceptions

OBJECTIVES

Despite a significant increase in the prevalence of vegetarianism and veganism in children in France, data on the care pathway of these children are scarce. This study aimed to describe the characteristics of the medical follow-up of vegan/vegetarian children, to evaluate the medical practices, and to analyze the perceptions of parents.

MATERIALS AND METHODS

This was a double cross-sectional survey. One questionnaire was sent to parents of vegetarian/vegan children, and the other to French doctors (pediatricians or general practitioners).

RESULTS

A total of 241 vegetarian families responded to the study and nearly one quarter (n = 67, 28 %) were unsatisfied with the medical follow-up of their child. Parents considered that their child's diet was responsible for refusing a medical consultation in 11 % (n = 27) of cases. In almost one third of cases (n = 70, 29 %), participants declared that the doctor was unaware of their child's diet. Vitamin B12 supplementation was commonly used (n = 195, 81 %), mainly by self-medication, and laboratory testing was performed for 30 % (n = 72) of children. Regarding the questionnaire for doctors, most of the participants (n = 318/501, 63 %) reported having vegetarian/vegan children in their cohort. A few of them (n = 70, 14 %) declared they did not systematically screen for meat and fish consumption during consultations. Doctors caring for vegetarian/vegan children had 27 % correct answers to questions regarding the nutrition guidelines. Overall, 36 % of them (n = 117) systematically referred the child to a specialist.

CONCLUSION

The medical follow-up of vegetarian/vegan children in France is very heterogeneous. Parents and doctors alike stressed the need to develop reliable sources of knowledge. A systematic screening of the diet and a referral to a specialist could help to improve the management of vegetarian/vegan children.

Vegetarian diets and diets which restrict animal-source foods during childhood in high-income countries

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.

Zinc bioaccessibility in finger millet porridge blended with zinc-dense mushroom

Introduction

Zinc deficiency is a common health problem among people who rely heavily on cereal-based foods. Consequently, most people from low-income families, particularly young children in Sub-Saharan Africa, who rely mainly on cereal-based meals, have suffered from Zinc deficiency-related health issues. It is therefore recommended that children who show signs of zinc deficiency like poor growth and cognitive impairment be fed zinc-rich meals; however, in severe cases, they should be given zinc supplements to reduce risks of morbidity and mortality. In that regard, since edible mushrooms are nutritionally rich and contains essential minerals as well as health-promoting compounds, they are a promising tool for improving the nutritional and health quality of commonly carbohydrate-rich foods.

Objective

The objective of this study was to examine the Zinc bioaccessibility and sensory properties of HMT finger millet porridge blended with Zinc-dense mushroom.

Methods

Oyster mushroom (Pleurotus ostreatus) was grown on rice straw enriched with zinc sulfate at various concentrations. After reaching full maturity, the mushrooms were harvested, dried, and milled into a fine powder. Zinc-rich mushroom powder was mixed with millet flour in various proportions and used to prepare porridge. The zinc bioaccessibility in millet-mushroom flour blends was determined using a simulation method of gastro intestinal digestion. In addition, panelists comprising of mothers and caregivers of children aged between 6 and 23 months were asked to evaluate the sensory attributes of millet-mushroom porridge.

Results

Adding Zinc to growth substrates had a significant (p˂0.05) effect on mushroom yield. Control substrates without Zinc yielded 120 g of mushroom per kilogram substrate. However, when 100 mg Zinc was added to the substrate, the yield increased by 65.6%. The study further noted that substrates with Zinc beyond 100 mg had a negative effect on mushroom yield. Consequently, substrates with the highest Zinc level (600 mg) produced the lowest mushroom yields. Increasing substrates Zinc content, on the other hand, had positive effect on mushroom Zinc levels. Substrates without Zinc produced mushrooms containing 8.9 mg Zinc, which increased by 30.9% when 600 mg Zinc was added. Furthermore, HMT finger millet porridge without mushrooms had a phytates: Zinc molar index of 60.3, which decreased to 34 when 20% (w/w) mushroom proportions were added. Despite having the highest bioaccessible Zinc with the least effect on texture and appearance, a 20% mushroom proportion in HMT finger millet porridge considerably compromised the taste, aroma and general consumer acceptability.

Conclusion

Amending HMT finger millet flour with mushroom powder improved Zinc bioaccessibility of the porridge. However, when added beyond a certain limit, mushroom reduced organoleptic qualities of the porridge, which affected overall consumer acceptance. The study recommends, therefore, that mushroom powder be added to finger millet flour in the appropriate proportions to enhance nutritional and health benefits of porridge while minimizing possible negative impacts on sensory properties.

Parental Nutritional Knowledge and Type of Diet as the Key Factors Influencing the Safety of Vegetarian Diets for Children Aged 12-36 Months

There are some concerns about the adequacy of vegetarian diets for pregnant women, infants, and young children because diets that exclude meat and other animal-based products increase the risk of nutrient deficiencies. The aim of the present study was to assess the nutritional knowledge of parents raising 12- to 36-month-old children on vegetarian diets and to evaluate the children's diets based on the recommendations formulated in the model food ration. The study involved a questionnaire survey that was completed by 326 women raising their children on various types of vegetarian diets and 198 women raising their children on an omnivorous diet. Mothers raising children on a lacto-ovo-vegetarian diet had the highest nutritional knowledge scores (15.8 points on average), whereas control group mothers and women raising children on a vegan diet had the lowest nutritional knowledge scores (average of 13.6 points). Parents who raised their children on more restrictive vegetarian diets were more aware of the risk of nutritional deficiencies and administered dietary supplements more frequently. A vegetarian diet can be safe for young children, but parents should be educated about the risk of nutritional deficiencies and the principles of healthy nutrition regardless of the administered diet, and effective communication between parents, pediatricians, and dietitians should be the cornerstone of every nutritional strategy in the management of vegetarian children.

Food group intake of children and adolescents (6-18 years) on a vegetarian, vegan or omnivore diet: results of the VeChi Youth Study

Plant-based, i.e. vegetarian (without meat and fish) or vegan (exclusively plant-based foods) diets are in trend also among children and adolescents, but data on food intake in this group are lacking. Here, we compare the consumption of food groups of vegetarian (n 145), vegan (n 110) and omnivore (n 135) children and adolescents (6-18 years) in Germany using data of the VeChi Youth Study. Each food item reported in 3 d weighed dietary records was assigned to one of eighteen food groups and individual mean intake per day (g/MJ) was calculated. Group differences were assessed using covariance analyses adjusted for age, sex and other covariates. For food groups with a high number of non-consumers, non-parametric Kruskal-Wallis tests were run. Pairwise comparison of vegetarian and vegan groups indicated significantly higher intakes of legumes, nuts, milk alternatives (all P = 0·0003) and meat alternatives (P = 0·0065) among vegan subjects. Intake of these food groups of omnivore participants was low (Q3:0·0 g/MJ for legumes, milk alternatives and meat alternatives, 0·5 g/MJ for nuts). Dairy intake of vegetarians (11·6 g/MJ) was significantly lower than of omnivore subjects (24·7 g/MJ) (P = 0·0003). Intake of fats/oils and sweet foods was lowest in vegan compared with vegetarian and omnivore participants (P< 0·05). Whole grain intake was higher in vegan participants (14·5 g/MJ) than of vegetarian (9·1 g/MJ) and omnivore (6·5 g/MJ) participants (P = 0·0003). Longitudinal studies are necessary to evaluate the long-term health consequences of vegetarian, vegan and omnivore food patterns, especially in childhood and adolescence.

Metallomics analysis for early assessment and individualized intervention of neurodevelopmental disorders

The children today are in the midst of the epidemic of neurodevelopmental disorders. In this metallomics study for the scalp hair samples of total 2550 children with autistic disorders (2108 males and 442 females aged 0-15 year), it was demonstrated that near one half of the infantile individuals aged 0-3 year are suffering from zinc deficiency and toxic metal burdens. Zinc level correlated closely to the index of zinc/iron ratio more than zinc/copper ratio. Furthermore, there were significant relationships between zinc deficiency and toxic metal burdens such as lead and aluminum which were inversely associated with not only zinc level but also zinc/iron ratio with higher regression coefficients of r = -0.486 and -0.551 (p < 0.00001), respectively. High-significant inverse association was detected between zinc and molybdenum concentration (r = -0.509) and also between zinc/iron ratio and molybdenum (r = -0.548). These findings suggest that infantile zinc deficiency relates to the high burdens of not only toxic but also some essential metals such as molybdenum, iron and manganese and that these various mineral imbalances play principal roles to the etiology of neurodevelopmental disorders. We expect that the early assessment and intervention of the mineral imbalances (or dis-homeostasis) in individual child open an avenue for evidence-based individualized treatment of neurodevelopmental disorders and also of the comorbid immune disorders, in near future.

Vegan nutrition: a preliminary guide for health professionals

Since the beginning of the 21st century, interest in vegan diets has been rapidly increasing in most countries. Misconceptions about vegan diets are widespread among the general population and health professionals. Vegan diets can be health-promoting and may offer certain important advantages compared to typical Western (and other mainstream) eating patterns. However, adequate dietary sources/supplements of nutrients of focus specific to vegan diets should be identified and communicated. Without supplements/fortified foods, severe vitamin B12 deficiency may occur. Other potential nutrients of focus are calcium, vitamin D, iodine, omega-3 fatty acids, iron, zinc, selenium, vitamin A, and protein. Ensuring adequate nutrient status is particularly important during pregnancy, lactation, infancy, and childhood. Health professionals are often expected to be able to provide advice on the topic of vegan nutrition, but a precise and practical vegan nutrition guide for health professionals is lacking. Consequently, it is important and urgent to provide such a set of dietary recommendations. It is the aim of this article to provide vegan nutrition guidelines, based on current evidence, which can easily be communicated to vegan patients/clients, with the goal of ensuring adequate nutrient status in vegans.

Vegetarian Diet, Growth, and Nutrition in Early Childhood: A Longitudinal Cohort Study

OBJECTIVES

The primary objective of this study was to examine the relationships between vegetarian diet and growth, micronutrient stores, and serum lipids among healthy children. Secondary objectives included exploring whether cow's milk consumption or age modified these relationships.

METHODS

A longitudinal cohort study of children aged 6 months to 8 years who participated in the TARGet Kids! cohort study. Linear mixed-effect modeling was used to evaluate the relationships between vegetarian diet and BMI z-score (zBMI), height-for-age z-score, serum ferritin, 25-hydroxyvitamin D, and serum lipids. Generalized estimating equation modeling was used to explore weight status categories. Possible effect modification by age and cow's milk consumption was examined.

RESULTS

A total of 8907 children, including 248 vegetarian at baseline, participated. Mean age at baseline was 2.2 years (SD 1.5). There was no evidence of an association between vegetarian diet and zBMI, height-for-age z-score, serum ferritin, 25-hydroxyvitamin D, or serum lipids. Children with vegetarian diet had higher odds of underweight (zBMI <-2) (odds ratio 1.87, 95% confidence interval 1.19 to 2.96; P = .007) but no association with overweight or obesity was found. Cow's milk consumption was associated with higher nonhigh-density lipoprotein cholesterol (P = .03), total cholesterol (P = .04), and low-density lipoprotein cholesterol (P = .02) among children with vegetarian diet. However, children with and without vegetarian diet who consumed the recommended 2 cups of cow's milk per day had similar serum lipids.

CONCLUSIONS

Evidence of clinically meaningful differences in growth or biochemical measures of nutrition for children with vegetarian diet was not found. However, vegetarian diet was associated with higher odds of underweight.

Intake of micronutrients and fatty acids of vegetarian, vegan, and omnivorous children (1-3 years) in Germany (VeChi Diet Study)

Purpose

There is an ongoing debate whether vegetarian (VG) and especially vegan (VN) diets are nutritionally adequate in early childhood. Hence, the Vegetarian and Vegan Children Study (VeChi Diet Study) aimed to assess the food and nutrient intake of VG and VN infants.

Methods

The study examined the diets of 1–3-year-old VG, VN, and omnivorous (OM) children (n = 430). Dietary intake was assessed via a 3-day weighed dietary record and compared between groups using ANCOVA. Lifestyle data were collected using a questionnaire. Here, the results of micronutrient and fatty acid intakes are presented.

Results

Most nutrient intakes (with and without supplements) differed significantly between VN children and the two other groups, with a more favourable overall micronutrient intake in VN, followed by VG children, [e.g., the highest intake of vitamin E (8.3 mg/d vs. VG 7.4 mg/d and OM 5.1 mg/d), vitamin B₁ (569 µg/d vs. VG 513 µg/d and OM 481 µg/d), folate (143 µg/d vs. VG 116 µg/d and OM 108 µg/d), magnesium (241 mg/d vs. VG 188 mg/d and OM 164 mg/d), and iron (8.9 mg/d vs. VG 7.3 mg/d and OM 6.0 mg/d)] as well as fat quality [highest intake of polyunsaturated fatty acids (8.7 E% vs. VG 6.9 E% and OM 4.5 E%) and lowest intake of saturated fatty acids (9.1 E% vs. VG 11.9 E% and OM 14.0 E%)]. In contrast, OM children had the highest intake of vitamin B₂ (639 µg/d vs. VG 461 µg/d and VN 429 µg/d), calcium (445 mg/d vs. VG 399 mg/d and VN 320 mg/d), iodine (47 µg/d vs. VG 33 µg/d and VN 31 µg/d), and DHA (35.4 mg/d vs. VG 16.6 mg/d and VN 18.4 mg/d). Without supplementation, OM children had the highest average vitamin B₁₂ intake (1.5 µg/d vs. VG 0.6 µg/d and VN 0.2 µg/d), whereas VN children had the highest average vitamin B₁₂ intake with supplementation (73.8 µg/d vs. VG 1.3 µg/d and OM 1.7 µg/d). Without supplementation, none of the groups’ median intakes met the harmonised Average Requirement (h-AR) for vitamin D and iodine. Moreover, VG and VN children did not achieve h-ARs for vitamin B₂, vitamin B₁₂, and iron—if a low absorption of iron is anticipated; VN children also did not do so for calcium.

Conclusion

In early childhood, VN and VG diets can provide most micronutrients in desirable amounts and a preferable fat quality compared to an OM diet. Special focus should be paid to (potentially) critical nutrients, particularly vitamin D, iodine, and DHA for all children regardless of diet, as well as vitamin B₂, vitamin B₁₂, calcium, and iron for VG and VN children.

Trail registration

This study was registered with the German Clinical Trials Register (DRKS00010982) on (September 2, 2016).

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-021-02753-3.

The Safe and Effective Use of Plant-Based Diets with Guidelines for Health Professionals

Plant-based diets, defined here as including both vegan and lacto-ovo-vegetarian diets, are growing in popularity throughout the Western world for various reasons, including concerns for human health and the health of the planet. Plant-based diets are more environmentally sustainable than meat-based diets and have a reduced environmental impact, including producing lower levels of greenhouse gas emissions. Dietary guidelines are normally formulated to enhance the health of society, reduce the risk of chronic diseases, and prevent nutritional deficiencies. We reviewed the scientific data on plant-based diets to summarize their preventative and therapeutic role in cardiovascular disease, cancer, diabetes, obesity, and osteoporosis. Consuming plant-based diets is safe and effective for all stages of the life cycle, from pregnancy and lactation, to childhood, to old age. Plant-based diets, which are high in fiber and polyphenolics, are also associated with a diverse gut microbiota, producing metabolites that have anti-inflammatory functions that may help manage disease processes. Concerns about the adequate intake of a number of nutrients, including vitamin B12, calcium, vitamin D, iron, zinc, and omega-3 fats, are discussed. The use of fortified foods and/or supplements as well as appropriate food choices are outlined for each nutrient. Finally, guidelines are suggested for health professionals working with clients consuming plant-based diets.

Anemia in Sports: A Narrative Review

Recent years have brought about new understandings regarding the pathogenesis of anemia in sports. From hemodilution and redistribution considered to contribute to the so-called “sports anemia” to iron deficiency caused by increased demands, dietary restrictions, decreased absorption, increased losses, hemolysis, and sequestration, to genetic determinants of different types of anemia (some related to sport), the anemia in athletes deserves a careful and multifactorial approach. Dietary factors that reduce iron absorption (e.g., phytate, polyphenols) and that augment iron’s bioavailability (e.g., ascorbic acid) should be considered. Celiac disease, more prevalent in female athletes, may underlie an unexplained iron deficiency anemia. Iron loss during exercise occurs in several ways: sweating, hematuria, gastrointestinal bleeding, inflammation, and intravascular and extravascular hemolysis. From a practical point of view, assessing iron status, especially in the athletes at risk for iron deficiency (females, adolescents, in sports with dietary restrictions, etc.), may improve the iron balance and possibly the performance. Hemoglobin and serum ferritin are measures that are easily employable for the evaluation of patients’ iron status. Cutoff values should probably be further assessed with respect to the sex, age, and type of sport. A healthy gut microbiome influences the iron status. Athletes at risk of iron deficiency should perform non-weight-bearing, low-intensity sports to avoid inducing hemolysis.

Knowledge of Vegetarian and Nonvegetarian Peruvian Dietitians about Vegetarianism at Different Stages of Life

Background:

The vegetarian diet continues to gain recognition and popularity among people; however, few studies have considered the level of knowledge of professional dietitians about this dietary pattern.

Objective:

This study aimed to compare the level of knowledge of vegetarian and nonvegetarian Peruvian dietitians regarding vegetarianism at different life stages.

Methods:

A cross-sectional study was carried out. An online questionnaire based on the recommendations of the current dietary guidelines was administered to more than 400 registered dietitians. Of which, a total of 179 decided to participate in the study: 72 vegetarians and 107 nonvegetarians. The data were analyzed using the chi-square test, considering a significance level of 5%.

Results:

Women represented the largest proportion of the sample. The participants demonstrated a complete and exhaustive knowledge of the definition of vegetarian diets. Regarding the risks and benefits associated with vegetarianism, the largest proportion of those who got the correct answers were vegetarians. The percentage of correct answers selected for both groups regarding the critical nutrients were less than 50%. Only 17.6% identified the correct answer regarding the risk of eating disorders of vegetarianism.

Conclusions:

Dietitians did not demonstrate complete and comprehensive knowledge of the critical nutrients of vegetarianism and lack information on the risks of eating disorders from the vegetarian diet.

Nutrient status and growth in vegan children

Vegan diets have risen in popularity over the past 9 years. However, few studies have examined nutrient status and the effect of a vegan diet on the growth of children. This study analysed the existing literature on the health impact and growth impact of selected nutrients in vegan children. We assessed the intake of calories and protein, as well as the nutrients iron, calcium, vitamin D, cobalamin and folate. With a small percentage of outliers, vegan children showed normal growth and were less often obese. We found limited evidence that children on a vegan diet can obtain all the examined nutrients. Furthermore, as proper planning and supplementation by caregivers is needed, it is currently unknown how often vegan children follow well-planned diets. Deficiencies in cobalamin, calcium, and vitamin D seem to be the biggest risks associated with a poorly planned vegan diet. For a more definitive assessment, data on the intake and nutrient status of omega-3 fatty acids, zinc, iodine, and selenium in vegan children are needed. Future research should account for demographic shifts in those following a vegan diet, and should discriminate between vegan sub-populations that are open or closed towards scientific approaches, towards health in general, and toward supplementation. Studies should assess the modes and dosages of supplementation and the use of fortified foods or drinks, as well as adherence to the diet itself. Plant ferritin as a source of iron and endogenous cobalamin synthesis warrants further scientific inquiry. In summary, the current literature suggests that a well-planned vegan diet using supplementation is likely to provide the recommended amounts of critical nutrients to provide for normal progression of height and weight in children, and can be beneficial in some aspects. However, data on 5 critical nutrients are still missing, hampering a more definitive conclusion.

Silk Fibroin As an Immobilization Matrix for Sensing Applications

The development of flexible, biocompatible, and environment-friendly sensors has attracted a significant amount of scientific interest for the past few decades. Among all the natural materials, silk fibroin (SF), due to its tunable biodegradability, biocompatibility, ease of processing, presence of functional groups, and controllable dimensions, has opened up opportunities for immobilizing multitudinous biomolecules and conformability to the skin, among other attractive opportunities. The silk fibroins also offer good physical properties, such as superior toughness and tensile strength. The sensors made of SF as an immobilization matrix have demonstrated excellent analytical performance, sensing even at low concentrations. The significant advantage of silk fibroins is the presence of functional groups along with a controllable conformation transition that enables immobilization of receptor molecules using silk fibroins as an immobilization matrix enables us to entrap the receptor molecules without using any chemical reagents. This review encompasses a detailed discussion on sensors, the advantages of using silk fibroins as an immobilization matrix for various receptors, their applications, and the future research scope in this state-of-the-art technology based upon the explorable applications for silk fibroin-based sensors.

Vegetarianism and veganism compared with mental health and cognitive outcomes: a systematic review and meta-analysis

CONTEXT

Vegetarian and vegan diets are increasing in popularity. Although they provide beneficial health effects, they may also lead to nutritional deficiencies. Cognitive impairment and mental health disorders have a high economic burden.

OBJECTIVE

A meta-analysis was conducted to examine the relationship between vegan or vegetarian diets and cognitive and mental health.

DATA SOURCES

PubMed, Scopus, ScienceDirect, and Proquest databases were examined from inception to July 2018.

STUDY SELECTION

Original observational or interventional human studies of vegan/vegetarian diets were selected independently by 2 authors.

DATA EXTRACTION

Raw means and standard deviations were used as continuous outcomes, while numbers of events were used as categorical outcomes.

RESULTS

Of 1249 publications identified, 13 were included, with 17 809 individuals in total. No significant association was found between diet and the continuous depression score, stress, well-being, or cognitive impairment. Vegans/vegetarians were at increased risk for depression (odds ratio = 2.142; 95%CI, 1.105-4.148) and had lower anxiety scores (mean difference = -0.847; 95%CI, -1.677 to -0.018). Heterogeneity was large, and thus subgroup analyses showed numerous differences.

CONCLUSIONS

Vegan or vegetarian diets were related to a higher risk of depression and lower anxiety scores, but no differences for other outcomes were found. Subgroup analyses of anxiety showed a higher risk of anxiety, mainly in participants under 26 years of age and in studies with a higher quality. More studies with better overall quality are needed to make clear positive or negative associations.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42018097204.

Fighting Iron-Deficiency Anemia: Innovations in Food Fortificants and Biofortification Strategies

Iron deficiency remains one of the main nutritional disorders worldwide and low iron intake and/or bioavailability are currently the major causes of anemia. To fight this public health problem, the scientific challenge is to find an iron form with sufficient bioavailability to increase its levels in humans through food fortification. In turn, biofortification appears as a comparatively advantageous and bearable strategy for the delivery of vitamins and other micronutrients for people without access to a healthy and diverse diet. This approach relies on plant breeding, transgenic techniques, or agronomic practices to obtain a final food product with a higher iron content. It is also known that certain food constituents are able to favor or inhibit iron absorption. The management of these compounds can thus successfully improve the absorption of dietary iron and, ultimately, contribute to fight this disorder present all over the world. This review describes the main causes/manifestations of iron-deficiency anemia, forms of disease prevention and treatment, and the importance of a balanced and preventive diet. A special focus was given to innovative food fortification and biofortification procedures used to improve the iron content in staple food crops.

Evaluation of vitamin D bioaccessibility and mineral solubility from test meals containing meat and/or cereals and/or pulses using in vitro digestion

In this study, we evaluated vitamin D and mineral (iron, zinc, magnesium) transfer to the bolus aqueous phase during the digestion of meals with/without pulses. We performed in vitro digestions using test meals made either of i) beef and/or semolina and/or chickpeas, or of ii) potatoes supplemented or not with fibers, phytates, tannins and saponins. Chickpea presence led to a decrease in vitamin D bioaccessibility (-56%, p ≤ 0.05) and mineral solubility (-28% for iron, p ≤ 0.05) compared with meals with beef and/or semolina only. This effect was largely compensated for vitamin D by the fact that this vitamin was more stable during digestion of meals based on plant foods only than of meals with beef. Tannins were the most deleterious compounds for iron solubility, while phytates and tannins decreased vitamin D bioaccessibility. Agronomical or technical solutions to selectively decrease the amount in pulses of compounds that affect micronutrient bioavailability should be further explored.

Children and adults should avoid consuming animal products to reduce risk for chronic disease: YES

The consumption of animal products exposes humans to saturated fat, cholesterol, lactose, estrogens, and pathogenic microorganisms, while displacing fiber, complex carbohydrates, antioxidants, and other components needed for health. In the process, consumption of animal products increases the risk for cardiovascular disease, cancer, diabetes, obesity, and other disorders. This dietary pattern also promotes the growth of unhealthful gut bacteria, fostering, among other things, the production of trimethylamine N-oxide, a proinflammatory compound associated with cardiovascular and neurological diseases. When omnivorous individuals change to a plant-based diet, diet quality as measured by the Alternate Healthy Eating Index improves, and the risk of these health problems diminishes. Planning for nutrient adequacy is important with any diet. However, a diet based on vegetables, fruits, whole grains, and legumes, supplemented with vitamin B-12, is nutritionally superior to diets including animal products and is healthful for children and adults.

Veganism and paediatric food allergy: two increasingly prevalent dietary issues that are challenging when co-occurring

Vegan diets - defined as the exclusion of all foods of animal origin from the diet- are becoming popular. In recent years, the prevalence of food allergy has also increased, and disproportionately affects children. When vegan diets and food allergy co-occur, this combination can be challenging and pose risks of nutritional deficiencies, particularly during childhood. In this paper, we aim to summarise the major concerns regarding vegan diets and food allergy, review the literature on this topic, and provide some suggestions for healthcare providers, particularly dietitians and nutritionists, who work with food allergic, vegan patients and their family. When working with this patient population, a regular and complete medical nutrition history, including screening for any possible nutritional deficiencies, is warranted. Likewise, the routine tracking of serum markers (especially iodine, iron, zinc, calcium, Vitamins B12, D, B2, and A, selected n-3 fatty acids and protein, which are more abundant in animal vs. plant foods) and symptoms of co-morbid diseases, including asthma, is important, as comorbid diseases may increase energy and nutrient requirements. For infants and children, anthropometry ought to be tracked longitudinally at regular intervals to identify any deviations from the child's previous growth pattern, and to accommodate any increased requirements for growth and development. Correct diagnoses, education and allergy management must be disseminated to the family in a clear and appropriate manner. Children with allergy may have increased nutritional needs due to comorbidity. This is complicated by coincident food allergy and vegan diet as both impose diet restrictions (limiting sources of important nutrients, need for dietary variety and/or increased consumption due to reduced bioavaliability).

Evaluation of Nutritional and Antinutritional Properties of African Yam Bean (Sphenostylis stenocarpa (Hochst ex. A. Rich.) Harms.) Seeds

African yam bean (Sphenostylis stenocarpa (Hochst ex. A. Rich.) Harms) is an annual legume with the capacity to produce bean seeds in a pod and produce tubers with varying seed patterns and colors. It is suggested to have the potential to significantly boost food security in sub-Saharan Africa due to its considerable nutritional qualities but still yet underutilized. Many farmers show limited interest in its production owing to limited knowledge of its nutritional profile, income generation capacity for small-holder farmers’, processing, and other related utilization concerns. This study evaluated the proximate and antinutrient composition of processed and unprocessed seeds of African yam bean (Sphenostylis stenocarpa (Hochst ex. A. Rich.) Harms.). Seeds were harvested from the experimental research field consisting of 50 accessions at the International Institute of Tropical Agriculture (IITA), Ibadan, Nigeria. They were divided into two portions; the first was processed by oven drying at 60°C for 24 hours and the second was left raw. There were significant differences (P<0.05) in the levels of proximate and antinutrient in the forms in which the samples were analyzed. TSs104 had the highest protein content of 25.08%, while the lowest was TSs68 (20.50%). However, in the unprocessed seed, protein content ranged between 24.93% (TSs38) and 19.13% (TSs11). Both processed and unprocessed seeds had high carbohydrate contents. In processed seeds, TSs9 (62.93%) had the highest percentage and TSs1 (29.64%) recorded the lowest. In unprocessed seed, the percentage ranged between 67.36% (TSs4) and 54.23% (TSs38). The observed variation may suggest possible suitability of seed for various end-use products and targeted breeding programs for crop improvements. In sub-Saharan Africa, this lesser-known legume could be adapted as a promising food crop in combating protein-energy malnutrition.

Lack of nutritional knowledge among Norwegian medical students concerning vegetarian diets

Aim

Vegetarian diets are increasingly popular, particularly among young women. However, exclusion of animal products from the diet increases the risk of micronutrient deficiencies, which is particularly unfortunate during pregnancy and childhood. A person needs a substantial amount of nutritional knowledge to achieve a nutritionally complete vegetarian diet. We have tested nutritional knowledge among well-educated young vegetarians and omnivores.

Subjects and methods

In October 2018, medical students at the University of Bergen, Norway (N = 880), were invited to take an anonymous survey to test their nutritional knowledge concerning micronutrients in vegetarian diets.

Results

The responses from the students (n = 394, 45%) were categorized according to diet: former or current vegetarians (24%) versus always omnivores (76%). Forty-five percent of the vegetarians and 28% of the omnivores did not consider it necessary to take supplements while following a vegetarian diet. Sixty-one percent of vegetarians and 38% of omnivores considered it possible to have a well-balanced vegan diet. Plant foods were wrongly considered to be a dietary source of vitamin B12 by 33% and of iodine by 20% of the students.

Conclusion

Nutritional knowledge concerning vegetarian diets was not optimal among Norwegian medical students, even if they had ever followed a vegetarian diet. As vegetarian diets are popular among the younger generation and pose a risk of micronutrient deficiencies, this is a public health concern. Nutrition education should be improved in the population. A more extensive integration of nutritional training in the medical curriculum must be implemented so doctors can give adequate nutritional guidance.

Qualitative in vitro study on the degradation of mineral complexes in vegetables

Mechanisms of degradation and absorption of mineral complexes by the human digestive system are complex and still under investigation. The elaborate matrix of vegetables, and the presence of phytates and other inhibitors make study of these mechanisms difficult. In this qualitative study, extracts from freeze-dried savoy cabbage, broccoli, kale and spinach were subjected to digestion in vitro at pH 2.0 and pH 7.5 and analysed using SEC-ICP-MS. The results suggest that low molecular weight species (peak 6), related to the iron and zinc fractions, which appeared after acidic digestion in all vegetables, except in kale, were considerably reduced after digestion at pH 7.5. Low molecular weight species (peak 9), related to the phosphorus fraction, were present in all vegetables, except in kale, after alkaline digestion. While cabbage, broccoli and spinach showed similar degradation patterns, kale showed a different degradation behaviour.

Relationships between Nut Size, Kernel Quality, Nutritional Composition and Levels of Outcrossing in Three Macadamia Cultivars

Tree nuts play an important role in healthy diets, but their economic value and nutritional quality may be affected by their size and paternity. We assessed relationships between nut size and kernel recovery, the incidence of whole kernels, fatty acid composition and mineral nutrient concentrations in three macadamia cultivars, "Daddow", "816" and "A4". We determined to what extent differences in nut size and quality were the result of different levels of cross- or self-paternity. Small nuts of all cultivars had lower kernel recovery than large nuts, and small nuts provided lower incidence of whole kernels in "Daddow" and "A4". Small kernels had a lower relative abundance of the saturated fatty acid, palmitic acid, in all cultivars and higher relative abundance of the unsaturated fatty acid, oleic acid, in "Daddow" and "A4". Small kernels had higher concentrations of many essential nutrients such as nitrogen and calcium, although potassium concentrations were lower in small kernels. Most nuts arose from cross-pollination. Therefore, nut size and kernel quality were not related to different levels of cross- and self-paternity. Identified cross-paternity was 88%, 78% and 90%, and identified self-paternity was 3%, 2% and 0%, for "Daddow", "816" and "A4", respectively. Small macadamia kernels are at least as nutritious as large macadamia kernels. High levels of cross-paternity confirmed that many macadamia cultivars are predominantly outcrossing. Macadamia growers may need to closely inter-plant cultivars and manage beehives to maximise cross-pollination.

Prevention of Zinc Precipitation with Calcium Phosphate by Casein Hydrolysate Improves Zinc Absorption in Mouse Small Intestine ex Vivo via a Nanoparticle-Mediated Mechanism

Casein phosphopeptides are known to enhance zinc absorption, but the underlying mechanism remains unclear. Here, a gastrointestinal casein hydrolysate (CH) was found to keep zinc in solution despite heavy precipitation of calcium and phosphate, the omnipresent mineral nutrients that could co-precipitate zinc out of solution instantly and almost completely under physiologically relevant conditions. Dynamic light scattering, transmission electron microscopy, and energy-dispersive X-ray analysis displayed the CH-mediated formation of zinc/calcium phosphate (Zn/CaP) nanocomplexes aggregated from rather small nanoclusters. The ex vivo mouse ileal loop experiments revealed enhanced intestinal zinc absorption by CH's prevention of zinc co-precipitation with CaP, and the treatments with specific inhibitors unveiled the involvement of macropinocytic internalization, lysosomal degradation, and transcytosis in the intestinal uptake of zinc from Zn/CaP nanocomplexes. A low calcium-to-phosphorus ratio adversely affected CH's efficiency to enhance zinc solubility and absorption. Overall, our study provides a new paradigm for casein phosphopeptides to improve zinc bioavailability.

[Position paper on vegetarian diets in infants and children. Committee on Nutrition and Breastfeeding of the Spanish Paediatric Association]

In the last few years, there are an increased number of families following a vegetarian diet, including their children. In order to guarantee child heath, paediatricians need to know the characteristics of this diet and the main foods that are used. There are few data on the medium and long-term health outcomes when removing all animal foods from the child's diet, especially at younger ages. Nevertheless, new tools have recently become available to facilitate following a vegetarian diet and decreasing the risk of deficiencies. In this document, the group of foods commonly used in vegetarian diets are reviewed, as well as recommendations for each age group. It also mentions the need to use B₁₂ supplements at all ages, as well as other nutrients (iodine, iron, vitaminD₃, poly-unsaturated fatty acid n-3), when required. A vegetarian or a vegan diet, as in any other kind of diet, needs to be carefully designed. After reviewing current evidence, even though following a vegetarian diet at any age does not necessarily mean it is unsafe, it is advisable for infant and young children to follow an omnivorous diet or, at least, an ovo-lacto-vegetarian diet.

Salivary Cystatin SN Binds to Phytic Acid In Vitro and Is a Predictor of Nonheme Iron Bioavailability with Phytic Acid Supplementation in a Proof of Concept Pilot Study

BACKGROUND

Acute phytic acid intake has been found to decrease iron bioavailability; however, repeated phytic acid consumption leads to iron absorption adaptation. Salivary proline-rich proteins (PRPs) have been shown to inhibit iron chelation to tannins and may mediate similar iron absorption adaptation with phytic acid intake.

OBJECTIVES

The objectives of this study were to determine whether salivary proteins bind to phytic acid in vitro, and to explore a proof of concept in a pilot study that examined the impact of 4-wk, daily phytic acid supplementation on individuals' iron status, bioavailability, and salivary PRP concentrations.

METHODS

High-performance liquid chromatography (HPLC) and matrix-assisted laser desorption/ionization-time of flight were used to characterize in vitro salivary protein-phytic acid interactions. Nonanemic women (n = 7) consumed 350 mg phytic acid supplements 3 times daily for 4 wk, and meal challenges were employed to determine iron bioavailability, iron status, and salivary protein concentrations before and after supplementation periods. Enzyme-linked immunosorbent assay (ELISA) analysis of purified protein fractions and participant saliva identified proteins bound to phytic acid.

RESULTS

In vitro salivary protein-phytic acid interaction identified cystatin SN, a non-proline rich salivary protein, as the specific bound protein to phytic acid. Iron bioavailability (P = 0.32), hemoglobin (P = 0.72), and serum ferritin (P = 0.08) concentrations were not reduced from week 0 to week 4 after phytic acid supplementation. Basic PRPs and cystatin SN concentrations were positively correlated with iron bioavailability at week 4.

CONCLUSIONS

Overall, results suggest that phytic acid binds to the non-PRP cystatin SN and that salivary protein production may improve iron bioavailability with phytic acid consumption.

Knowledge of Health Professionals Regarding Vegetarian Diets from Pregnancy to Adolescence: An Observational Study

The number of people adopting vegetarian diets is constantly increasing, and many among them are young parents who decide to share their diet with their children. The aim of this study was to investigate health professionals' knowledge regarding the adoption of vegetarian diets from pregnancy to adolescence. A cross-sectional survey was conducted. The administered questionnaire, which was based on the recommendations of the most up-to-date guidelines, included two macro areas: The first investigated the sociodemographic and professional profile of the interviewees and the second addressed the knowledge of the participants regarding vegetarian diets. A total of 418 health professionals in Italy were interviewed, of whom 65.8% were nursing staff. Among the participants, 79.9% had not attended a nutrition course in the previous five years. A correct definition of a vegetarian/vegan diet was provided by 34.1% of the participants. The answers regarding knowledge of nutrients were correct in 20% of cases, whereas correct answers to questions assessing knowledge of the risk and benefits of a vegetarian diet and the adoption of a vegetarian diet throughout the life cycle were given by 45% and 39.4% of the participants, respectively. A significant correlation between the items of the second macro area that investigated the knowledge and dietary habits of the participants was found for seven items. The results of the study indicate that health professionals do not have complete and exhaustive knowledge about vegetarian diets and lack information on health outcomes and the adoption of a vegetarian diet throughout the different life cycles and nutrients. Improving pre- and in-service learning opportunities in vegetarian nutrition for health professionals is strongly advisable.

Zinc intake and status in Austria in the light of different reference values

Zinc has been identified as a critical micronutrient also in high-income countries. There is still some uncertainty about the evaluation of zinc sufficiency due to divergent daily intake reference values. We wanted to exemplify this issue using data from the Austrian Study on Nutritional Status 2012. Plasma zinc concentrations were measured in a nationally representative sample of 872 persons aged 6-80 years (55.5 % female). Dietary zinc intake was estimated from two 24h dietary recalls. Additionally, parameters of the antioxidative status (plasma malondialdehyde (MDA), total antioxidative capacity) and activities of alkaline phosphatase (AP), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px)) were determined. Zinc status was marginal in schoolchildren (40 % of boys and 22 % of girls) and in elderly (28 % of men and 33 % of women). Dietary zinc intake was also unsatisfactory in these groups with 38 % of boys and 32 % of girls and 64.5 % of older men below the nationally recommended intake levels. However, the adequacy of zinc intake varied with different reference values. Adults were more likely to meet the D-A-CH reference values and those from the European Food Safety Authority than the recommendations of the International Zinc Nutrition Consultative Group (IZiNCG) and the Institute of Medicine, whereas children met the IZiNCG values best. Zinc status correlated weakly with AP activity (r = -0.298, p < 0.001) and some antioxidant status markers (CAT, MDA, GSH-PX, SOD), especially in the elderly (MDA: r = -0.527, p < 0.001, and SOD: r = -0.466, p = 0.002). Our results suggest a suboptimal zinc supply in Austria particularly among schoolchildren and older adults.

Developing a Food Exchange System for Meal Planning in Vegan Children and Adolescents

Vegan diets in children need to be adequately planned so they can safely meet children’s requirements for growth and development. Adequate and realistic meal planning guidelines should not be difficult to achieve, thanks to the increasing number and availability of natural and fortified vegan foods, which can help children to meet all their nutrients requirements. In order to ensure an adequate supply of key nutrients, families and health professionals need accurate, reliable, and easy-to-use meal planning tools. The aim of this article is to provide a practical approach system to meal planning, based on the same food exchange methodology that has been already published in adults. Daily portions of each food exchange group have been calculated so the resulting menu provides at least 90% of the Dietary Reference Intakes (DRIs) of protein, iron, zinc, calcium, and n-3 fatty acids for each age group, sex, and physical activity level. These diets do not provide enough vitamin B-12 and vitamin D. Although fortified plant drinks, breakfast cereals or plant protein-rich products could provide variable amounts of these two vitamins, B12 supplementation is always recommended and vitamin D supplementation should be considered whenever sun exposure is limited. This tool can be used to plan healthful and balanced vegan diets for children and adolescents.

A brief history of meat in the human diet and current health implications

Anthropological investigations have confirmed many times over, through multiple fields of research the critical role of consumption of animal source foods (ASF) including meat in the evolution of our species. As early as four million years ago, our early bipedal hominin ancestors were scavenging ASFs as evidenced by cut marks on animal bone remains, stable isotope composition of these hominin remains and numerous other lines of evidence from physiological and paleo-anthropological domains. This ASF intake marked a transition from a largely forest dwelling frugivorous lifestyle to a more open rangeland existence and resulted in numerous adaptations, including a rapidly increasing brain size and altered gut structure. Details of the various fields of anthropological evidence are discussed, followed by a summary of the health implications of meat consumption in the modern world, including issues around saturated fat and omega-3 fatty acid intake and discussion of the critical nutrients ASFs supply, with particular emphasis on brain function.

The opportunity cost of animal based diets exceeds all food losses

With a third of all food production lost via leaky supply chains or spoilage, food loss is a key contributor to global food insecurity. Demand for resource-intensive animal-based food further limits food availability. In this paper, we show that plant-based replacements for each of the major animal categories in the United States (beef, pork, dairy, poultry, and eggs) can produce twofold to 20-fold more nutritionally similar food per unit cropland. Replacing all animal-based items with plant-based replacement diets can add enough food to feed 350 million additional people, more than the expected benefits of eliminating all supply chain food loss.

Food loss is widely recognized as undermining food security and environmental sustainability. However, consumption of resource-intensive food items instead of more efficient, equally nutritious alternatives can also be considered as an effective food loss. Here we define and quantify these opportunity food losses as the food loss associated with consuming resource-intensive animal-based items instead of plant-based alternatives which are nutritionally comparable, e.g., in terms of protein content. We consider replacements that minimize cropland use for each of the main US animal-based food categories. We find that although the characteristic conventional retail-to-consumer food losses are ≈30% for plant and animal products, the opportunity food losses of beef, pork, dairy, poultry, and eggs are 96%, 90%, 75%, 50%, and 40%, respectively. This arises because plant-based replacement diets can produce 20-fold and twofold more nutritionally similar food per cropland than beef and eggs, the most and least resource-intensive animal categories, respectively. Although conventional and opportunity food losses are both targets for improvement, the high opportunity food losses highlight the large potential savings beyond conventionally defined food losses. Concurrently replacing all animal-based items in the US diet with plant-based alternatives will add enough food to feed, in full, 350 million additional people, well above the expected benefits of eliminating all supply chain food waste. These results highlight the importance of dietary shifts to improving food availability and security.

Arizona Registered Dietitians Show Gaps in Knowledge of Bean Health Benefits

Registered Dietitians (RDs) promote nutrition practices and policies and can influence food consumption patterns to include nutrient dense foods such as beans. Although many evidence-based health benefits of bean consumption (e.g., cholesterol reduction, glycemic control) have been demonstrated, there is limited research on the knowledge, attitudes, and perceptions of RDs regarding the inclusion of beans in a healthy diet. To fill this existing research gap, this cross-sectional survey explored the perceptions, knowledge, and attitudes of 296 RDs in Arizona, USA, toward beans. The RDs largely held positive attitudes toward the healthfulness of beans and were aware of many health benefits. Some gaps in awareness were evident, including effect on cancer risk, intestinal health benefits, folate content, and application with celiac disease patients. RDs with greater personal bean consumption had significantly higher bean health benefit knowledge. Twenty-nine percent of the RDs did not know the meaning of 'legume', and over two-thirds could not define the term 'pulse'. It is essential that RDs have up-to-date, evidence-based information regarding bean benefits to provide appropriate education to patients, clients, and the public.

Serum Hepcidin and Soluble Transferrin Receptor in the Assessment of Iron Metabolism in Children on a Vegetarian Diet

The aim of this study was to assess the effect of vegetarian diet on iron metabolism parameters paying special attention to serum hepcidin and soluble transferrin receptor (sTfR) concentrations in 43 prepubertal children (age range 4.5-9.0 years) on vegetarian and in 46 children on omnivorous diets. There were no significant differences according to age, weight, height, and body mass index (BMI) between vegetarian and omnivorous children. Vegetarians had similar intake of iron and vitamin B12 and a significantly higher intake of vitamin C (p < 0.05) compared with non-vegetarians. Hematologic parameters and serum iron concentrations were within the reference range in both groups of children. Serum transferrin levels were similar in all subjects; however, ferritin concentrations were significantly (p < 0.01) lower in vegetarians than in omnivores. In children on a vegetarian diet, median hepcidin levels were lower (p < 0.05) but sTfR concentrations significantly higher (p < 0.001) compared with omnivorous children. In the multivariate regression model, we observed associations between hepcidin level and ferritin concentration (β = 0.241, p = 0.05) in the whole group of children as well as between hepcidin concentration and CRP level (β = 0.419, p = 0.047) in vegetarians. We did not find significant associations with concentration of sTfR and selected biochemical, anthropometric, and dietary parameters in any of the studied groups of children. As hematologic parameters and iron concentrations in vegetarians and omnivores were comparable and ferritin level was lower in vegetarians, we suggest that inclusion of novel markers, in particular sTfR (not cofounded by inflammation) and hepcidin, can better detect subclinical iron deficiency in children following vegetarian diets.

Importance of Dietary Sources of Iron in Infants and Toddlers: Lessons from the FITS Study

Iron deficiency (ID) affects 13.5% of 1-2 years old children in the US and may have a negative impact on neurodevelopment and behavior. Iron-fortified infant cereal is the primary non-heme iron source among infants aged 6-11.9 months. The objective of this study was to compare iron intakes of infant cereal users with non-users. Data from the Feeding Infants and Toddlers Study 2008 were used for this analysis. Based on a 24-h recall, children between the ages of 4-17.9 months were classified as 'cereal users' if they consumed any amount or type of infant cereal and 'non-users' if they did not. Infant cereal was the top source of dietary iron among infants aged 6-11.9 months. The majority of infants (74.6%) aged 6-8.9 months consumed infant cereal, but this declined to 51.5% between 9-11.9 months and 14.8% among 12-17.9 months old toddlers. Infant cereal users consumed significantly more iron than non-users across all age groups. Infants and toddlers who consume infant cereal have higher iron intakes compared to non-users. Given the high prevalence of ID, the appropriate use of infant cereals in a balanced diet should be encouraged to reduce the incidence of ID and ID anemia.

Position of the Academy of Nutrition and Dietetics: Vegetarian Diets

It is the position of the Academy of Nutrition and Dietetics that appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes. Plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and are associated with much less environmental damage. Vegetarians and vegans are at reduced risk of certain health conditions, including ischemic heart disease, type 2 diabetes, hypertension, certain types of cancer, and obesity. Low intake of saturated fat and high intakes of vegetables, fruits, whole grains, legumes, soy products, nuts, and seeds (all rich in fiber and phytochemicals) are characteristics of vegetarian and vegan diets that produce lower total and low-density lipoprotein cholesterol levels and better serum glucose control. These factors contribute to reduction of chronic disease. Vegans need reliable sources of vitamin B-12, such as fortified foods or supplements.

Impact of ingredients on the elemental content of baby foods

The levels of the minerals: Ca, K, Mg, Na, P, and the trace elements: Cd, Cu, Fe, Mn, Ni, Pb, Se, Zn were determined in foods for 4-6, 7+ and 10+ months old babies in a brand available on the UK market. The mineral contents in the vegetarian meals for all the age groups were similar, in contrast, when compared to the non-vegetarian options, the Ca, Na and P levels were higher in the former. Both the trace elements and minerals levels in the 4-6months vegetarian meal were the lowest of all the products analysed. The Cu, Se and Zn levels in all the meals were comparable to those in mature human breast milk. Calculations of the following molar ratios: Zn:Cu, Fe:Zn, and Fe:Mn, pairs of elements that have been shown to interaction antagonistically, were higher in the vegetarian meals.

Iron Status of Vegetarian Children: A Review of Literature

Background: Iron is considered a nutrient of concern for vegetarians. In children, inadequate iron status may lead to anemia and poor growth. Summary: Thirteen original manuscripts met the inclusion criteria. Various biochemical markers of iron status, such as hemoglobin (Hb) and serum ferritin, were used. Seven of the 13 studies reported the prevalence of iron deficiency separately for vegetarians and non-vegetarians. Five out of 7 showed a higher prevalence of iron deficiency among the vegetarian participants, while the other 2 showed a higher prevalence of iron deficiency among non-vegetarians. A wide range of iron deficiency prevalence, from 4.3% of vegetarian participants in one study to 73% having ferritin <10 µg/L in another study, was found. Hb data showed almost as wide variations from 0% of children having Hb values lower than 11 g/dL to 47.5% having Hb values below 3rd percentile. Key Messages: The prevalence of iron deficiency among vegetarian children varies considerably from one study to another. The wide variation in the prevalence of inadequate iron status was consistent for studies from industrial and developing countries. The physiological significance of low iron status among vegetarians reported in some studies is unknown.

Vegetarian diets in children: a systematic review

PURPOSE

While the prevalence of children on vegetarian diets is assumed to be on the rise in industrialized countries, there are hardly any representative data available. In general, vegetarian diets are presumed to be healthy; nevertheless, there are concerns as to whether the dietary specifications required during infancy, childhood, and adolescence can be met. Therefore, the objective of this systematic review was to evaluate studies on the dietary intake and the nutritional or health status of vegetarian infants, children, and adolescents.

METHODS

The database MEDLINE was used for literature search. In addition, references of reviews and expert opinions were considered. Inclusion criteria were (1) sufficient dietary information to define vegetarian type diet and (2) characteristics of nutritional or health status. Case reports and studies from non-industrialized countries were excluded.

RESULTS

24 publications from 16 studies published from 1988 to 2013 met our criteria. Study samples covered the age range from 0 to 18 years, and median sample size was 35. Five studies did not include a control group. With regard to biomarkers, anthropometry, and dietary or nutritional intake, the outcomes were diverse. Growth and body weight were generally found within the lower reference range. The intakes of folate, vitamin C, and dietary fiber were relatively high compared to reference values and/or control groups. Low status of vitamin B₁₂ was reported in one study and low status of vitamin D in two studies.

CONCLUSIONS

Due to the study heterogeneity, the small samples, the bias towards upper social classes, and the scarcity of recent studies, the existing data do not allow us to draw firm conclusions on health benefits or risks of present-day vegetarian type diets on the nutritional or health status of children and adolescents in industrialized countries.

Animal Proteins as Important Contributors to a Healthy Human Diet

Adequate protein intake is critical for health and development. Generally, protein of animal origin is of higher quality for humans owing to its amino acid pattern and good digestibility. When administered in mixtures it can enhance the quality of plant proteins, but its availability is often low in low-income communities, especially in young children, the elderly, and pregnant and lactating women, who have increased requirements and in whom high-quality protein also stimulates (bone) growth and maintenance. Although high protein intake was associated with increased type 2 diabetes mellitus risk, milk and seafood are good sources of branched chain amino acids and taurine, which act beneficially on glucose metabolism and blood pressure. However, high consumption of protein-rich animal food is also associated with adverse health effects and higher risk for noncommunicable diseases, partly related to other components of these foods, like saturated fatty acids and potential carcinogens in processed meat but also the atherogenic methionine metabolite homocysteine. In moderation, however, animal proteins are especially important for health maintenance in vulnerable persons.

The Impact of Tannin Consumption on Iron Bioavailability and Status: A Narrative Review

Iron deficiency remains a global health issue, and antinutritional factors, such as tannins, are often cited as contributors to the high prevalence of deficiency. Despite this, tannin-rich diets may have potential beneficial cardiovascular and cancer-fighting properties because of the antioxidant activity of tannins. Furthermore, epidemiologic studies and long-term trials involving participants who consumed diets rich in antinutritional factors, particularly tannins, conflict with single-meal bioavailability studies. The purpose of this narrative review is to determine the effect of tannins on iron bioavailability and status and establish whether adaptation to tannins reduces the antinutritional effects of tannins over time. We also aimed to compare tannins used in iron studies. Common themes related to iron bioavailability and iron status with tannin consumption were collected and collated for summary and synthesis based on models and subjects used. Overall, there was dissonance between iron bioavailability and status in studies. Single-meal studies with hydrolyzable and oligomeric catechin and epicatechin tannins (tea and tannic acid) generally support reductions in bioavailability related to tannin consumption but not consumption of condensed tannin, which are more commonly found in food. Long-term animal model, epidemiologic, and multimeal studies generally do not support changes in iron status related to tannin intake. Studies suggest that long-term tannin consumption may impact iron status in a different manner than single-meal studies or bioavailability iron models predict. Furthermore, iron bioavailability studies that use condensed tannins, which are more commonly consumed, may better predict mealtime iron bioavailability. More research is needed to develop representative antinutritional iron studies and investigate mechanisms underlying the adaptation to tannins and other antinutritional factors that occur over time.

Assessment of iron bioavailability from different bread making processes using an in vitro intestinal cell model

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Fe availability in three commercial bread baking process was compared.

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The sourdough bread baking process fully degraded phytic acid, a main Fe chelator.

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More Fe was released by simulated digestion from sourdough bread.

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The highest Fe uptake was achieved with sourdough bread in a simulated mixed-meal.

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The sourdough bread process could be more beneficial for iron nutrition.

Myo-inositol hexakisphosphate (IP6), is the main iron chelator in cereals and bread. The aim of this study was to investigate the effect of three commercial baking processes (sourdough, conventional yeast and Chorleywood Bread Making Process (CBP)) on the IP6 content of wholemeal bread, its impact on iron uptake in Caco-2 cells and the predicted bioavailability of iron from these breads with added iron, simulating a mixed-meal. The sourdough process fully degraded IP6 whilst the CBP and conventional processes reduced it by 75% compared with wholemeal flour. The iron released in solution after a simulated digestion was 8-fold higher in sourdough bread than with others but no difference in cellular iron uptake was observed. Additionally, when iron was added to the different breads digestions only sourdough bread elicited a significant ferritin response in Caco-2 cells (4.8-fold compared to the other breads) suggesting that sourdough bread could contribute towards improved iron nutrition.

[Guidelines for complementary feeding in healthy infants]

A proper nutrition during the first two years of life is critical to reach the full potential of every human being; now, this period is recognized as a critical window for promoting optimal growth, development, and good health. Therefore, adequate feeding at this stage of life has an impact on health, nutritional status, growth and development of children; not only in the short term, but in the medium and long term. This paper provides recommendations on complementary feeding (CF) presented as questions or statements that are important for those who take care for children during this stage of life. For example: When to start complementary feedings: 4 or 6 months of age?; Exposure to potentially allergenic foods; Introduction of sweetened beverages; Use of artificial sweeteners and light products; Food introduction sequence; Food consistency changes according to neurological maturation; Number of days to test acceptance and tolerance to new foods; Amounts for each meal; Inadequate complementary feeding practices; Myths and realities of complementary feeding; Developmental milestones; Practice of "Baby Led Weaning" and practice of vegetarianism.

Zinc and infant nutrition

Zinc is essential for a wide variety of cellular processes in all cells. It is a critical dietary nutrient, particularly in the early stages of life. In the early neonatal period, adequate sources of zinc can be obtained from breast milk. In rare circumstances, the mammary gland produces zinc deficient milk that is potentially lethal for exclusively breast-fed infants. This can be overcome by zinc supplementation to the infant. Alterations to key zinc transporters provide insights into the mechanisms of cellular zinc homeostasis. The bioavailability of zinc in food depends on the presence of constituents that may complex zinc. In many countries, zinc deficiency is a major health issue due to poor nourishment. Young children are particularly affected. Zinc deficiency can impair immune function and contributes to the global burden of infectious diseases including diarrhoea, pneumonia and malaria. Furthermore, zinc deficiency may extend its influence across generations by inducing epigenetic effects that alter the expression of genes. This review discusses the significance of adequate zinc nutrition in infants, factors that influence zinc nutrition, the consequences of zinc deficiency, including its contribution to the global burden of disease, and addresses some of the knowledge gaps in zinc biology.