Is the trend to a more plant-based diet in the UK being adequately resourced?

Vegetarianism, veganism, reducing meat consumption. These are all societal shifts which are increasing. As our planet warms and awareness of climate challenges increases, more and more families are changing their diets. Alternative versions of the Eatwell Guide produced by the Vegan Society and the Vegetarian Society, as well as resources like One Blue Dot produced by the British Dietetic Association have helped to guide many to alternative options but there hasn’t been enough focus on the needs of children right from preconception through to adolescence. This is a huge topic and this article can only scratch the surface but will hopefully open up discussions and possible research ideas.

There are over 3 million vegetarians and vegans in the UK, about 4.5% of the population according to the Vegetarian Society. The proportion of National diet and Nutrition Survey (NDNS) respondents in 2018/19 who self-reported being vegetarian was 2.1% with 0.2% being vegan[i]. Despite these percentages varying hugely, the rise in vegetarian diets is well recognised.

How about children? The BBC Good Food Nation Survey found that 13% of children are vegetarian[1].  With so many choosing to follow a vegetarian diet, are the systems in place to support them?

Let’s start with the early years.

The Scientific Advisory Committee on Nutrition (SACN) in their report into feeding of children age 1-5 included vegetarian diets in their review and gave the following recommendations:

• “support parents or caregivers of children aged 1 to 5 years following vegetarian, vegan and plant-based diets to ensure the nutritional requirements (including for iron, iodine, calcium and vitamin B12) of their children are met
• monitor the nutritional impact of a population shift towards adopting vegetarian, vegan and plant-based diets”[2]

SACN noted in their report on infants (under 1s) that “The evidence considered suggested that the iron intake and status of vegetarians was not significantly different to non-vegetarians (SACN, 2010). However, these studies were conducted in adults and it is not known whether the findings can be extrapolated to infants.”

SACN recognises the need for further research to “Examine the potential impact of different dietary patterns (such as vegetarian or vegan diets) on infant immediate and long-term health outcomes” but only highlights protein as a potential risk for not getting enough into a vegetarian diet. This does not mean it is the only area for consideration but the research is lacking for this age group to make recommendations. Further research has been conducted since 2010 however there are still gaps.

As with all children, children following a vegetarian diet need a balanced diet in order to thrive. Careful planning of the diet is necessary in order to ensure they get the nutrients they need. If children’s food preferences are limited, this can add to the challenge. A report from the Canadian Paediatric Society also highlights the need to screen for eating disorders in adolescents on very restricted vegetarian diets, which could be further impacting food choice[3].

With most children aged 4-18 in school, school food for vegetarians cannot be overlooked. In 2019, a food industry poll by Linda McCartney of 1,000 school students (aged 8-16 years) found that 77% of meat-free youngsters said they had to eat meat because there wasn’t another option. The survey also found that 81% parents reported there are not enough healthy and tasty vegetarian options at their children’s school[4].

With researchers from Leeds University finding that just 1.6 per cent of primary children’s packed lunches met the nutritional standards set for their classmates eating in the school canteen, there is a risk that the lack of vegetarian options drives vegetarian families to having packed lunches which are likely to be nutritionally inadequate.[5]

The School Food Standards practical guide states when it comes to protein that:

“You must include:

• a portion of food from this group every day
• a portion of meat or poultry on 3 or more days each week
• oily fish once or more every 3 weeks
• for vegetarians, a portion of non-dairy protein on 3 or more days each week
• a meat or poultry product (manufactured or homemade, and meeting the legal requirements) no more than once each week in primary schools and twice each week in secondary schools (applies across the whole school day)

You can:

• ensure vegetarian meals are as varied as the rest of the menu by using pulses twice a week, soya, tofu, or mycoprotein-based meat substitute once or twice each week, and eggs and cheese once or twice each week”[6]

Although meat eaters have the option to have a protein food every day (in addition to dairy), the standards only require schools to provide a non-dairy protein 3 times a week (although they can have it every day). And, although ensuring vegetarian meals are mentioned in the standards, this is an aspiration not a requirement. Perhaps there is a need for updating these standards?

Protein – whilst there are many sources of protein which are suitable for vegetarians, many are lower in protein per 100g than meat. A review of studies between 2018 and 2023 found protein intakes were lower in vegetarian children[7]. In addition to the amount of protein per 100g, where children are the sole vegetarian in the family there could be a tendency to remove the meat and serve the child the rest of the meal which could be lacking. Ensuring a variety of different protein rich foods is as important for vegetarian children as it is for those eating meat.

Iron – Desmond et al found that both vegetarians and vegans have lower concentrations of 25(OH)D if unsupplemented, and lower body iron stores, but usually have normal iron metabolism markers[8]. Since iron from plant sources is not absorbed as well as iron from non-vegetarian sources, vegetarians need to be mindful of intake to ensure adequacy. Advising the iron rich foods are served with vitamin C rich foods can be a simple way to help with iron absorption as well as giving education regarding sources – including fortified breakfast cereals, nuts, seeds, pulses and green leafy vegetables.

Iodine, calcium and vitamin B12 – these nutrients were all highlighted in the SACN report but are more of an issue in vegan diets than vegetarian diets as milk and milk products are a source of iodine, calcium and vitamin B12. Advising three portions of dairy a day helps to meet the recommendations. If plant milks are preferred or necessary, an unsweetened option which is fortified with calcium, B12 and iodine is important. Nutritional yeast and fortified breakfast cereals are a helpful addition to boost vitamin B12 intake, although nutritional yeast is quite salty so not ideal for the under 5s. Although vegan diets being more at risk of inadequacy, Desmond et alix also found that bone mineral content is reduced in vegetarian children, compared to omnivores and vitamin B12 levels without supplementation indicated deficiency, so care to ensure intake in vegetarians is still important.[9)

EPA and DHA omega 3 Fatty Acid – this is not highlighted in the SACN report however is an essential nutrient for vegetarians to be aware of and plant sources should be included in both the home and school settings. Plant sources of ALA, which is converted into EPA and DHA, include flaxseeds, chia seeds and walnuts.

References:

1. Stewart, C et al (2021) Trends in UK meat consumption: analysis of data from years 1–11 (2008–09 to 2018–19) of the National Diet and Nutrition Survey rolling programme. The Lancet – Planetary Health Volume 5, Issue 10 e699-e708October 2021 https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00228-X/fulltext

2. BBC (2021) BBC Good Food Nation: Survey looks at children's eating habits. 23 September 2021.

   https://www.bbc.co.uk/newsround/58653757#:~:text=They%20also%20found%20that%2013,vegetarian%20would%20like%20to%20be.&text=The%20survey%20also%20asked%20children,over%20the%20next%20ten%20years. Accessed 12th September 2024

3. Office for Health Improvement and Disparities (2024) Feeding young children aged 1 to 5 years - summary report. 8th May 2024. https://www.gov.uk/government/publications/sacn-report-feeding-young-children-aged-1-to-5-years/feeding-young-children-aged-1-to-5-years-summary-report

4. Amit M. (2010). Vegetarian diets in children and adolescents. Paediatrics & child health, 15(5), 303–314. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912628/

5. Meat Free Mondays (2019) Give us more meat free meals, say British schoolchildren. 15th May 2019 https://meatfreemondays.com/give-us-more-meat-free-meals-say-british-schoolchildren/ Accessed 12th September 2024

6. University of Leeds (2016) Too few school packed lunches meet nutritional standards. 6th September 2016.

   https://www.leeds.ac.uk/news-health/news/article/3907/too-few-school-packed-lunches-meet-nutritional-standards Accessed 24th September 2024

    

7. Department for Education (2024) School food standards practical guide. 19th September 2024. https://www.gov.uk/government/publications/school-food-standards-resources-for-schools/school-food-standards-practical-guide

8. Alexy U. (2023) Diet and growth of vegetarian and vegan children BMJ Nutrition, Prevention & Health 2023;6:doi: 10.1136/bmjnph-2023-000697 https://nutrition.bmj.com/content/6/Suppl_2/s3

9. Desmond, M. A., Fewtrell, M. S., & Wells, J. C. K. (2024). Plant-Based Diets in Children: Secular Trends, Health Outcomes, and a Roadmap for Urgent Practice Recommendations and Research-A Systematic Review. Nutrients, 16(5), 723. https://doi.org/10.3390/nu16050723 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10934552/