Çocukluk Döneminde Vejetaryen Beslenme Güvenli mi?

Öz

Vejetaryenlik, et ve balık dahil olmak üzere tüm hayvan etlerinin diyetten dışlanması ile karakterize edilmektedir. Vegan diyet ise daha kısıtlı olup süt ürünleri ve yumurta dahil olmak üzere tüm hayvansal kaynaklı gıdalar dışlanmaktadır. Vejetaryen diyetlerin yaşamın tüm aşamalarında ve özellikle hızlı büyüme döneminde uygun olup/ olmadığı konusu sıklıkla sorgulanmaktadır. Gebelik ve emziklilik döneminde beslenme, yaşam boyu hastalık riskinin önemli bir belirleyicisi olduğu için potansiyel olarak değiştirilebilir bir risk faktörüdür. Bu nedenle, gebelikte ve emzirme döneminde annelerin yeterli ve dengeli beslenmeye teşvik edilmesi büyük önem taşımaktadır. Bebeklik, çocukluk ve ergenlik kritik dönemler olup, bu dönemlerde beslenme gereksinimlerinin karşılanması çok önemli hale gelmektedir. Vejetaryen ve vegan çocuklar n-3 yağ asitleri, B12 vitamini, D vitamini, kalsiyum, demir ve çinko gibi bazı besin ögesi eksiklikleri ile karşı karşıya olabilir. Ayrıca, bu dönemde edinilen beslenme alışkanlıkları ve beslenme düzeni, yaşamın ilerleyen dönemlerinde hastalık riskini etkileyebilmektedir. Vejetaryen beslenmenin çocuklar üzerindeki etkisini araştıran çalışmaların çoğu güncelliğini kaybetmiştir. Çocuklukta vejetaryen diyetlerinin güvenliği konusunda pek çok tartışma söz konusu olup yeterli uzunlamasına çalışma bulunmamaktadır. Bu derleme, çocuklarda vejetaryen diyetlerin etkilerine ve sağlık üzerindeki sonuçlarına odaklanmaktadır.

Anahtar Kelimeler

• Çocuk
• beslenme durumu
• vejetaryen diyet
• vegan diyet
• sağlık
• güvenlik
• Children
• nutritional status
• vegetarian diet
• vegan diet
• health
• safety

Is a Vegetarian Diet Safe to Follow During Childhood?

Öz

Vegetarianism is characterized by the exclusion of all animal flesh foods from the diet, including meat and fish. The more restricted form is a vegan diet that excludes all animal-derived food, including milk, dairy products, and eggs. During past decades questions have been raised about whether vegetarian diets are suitable during all stages of life and during the fast growth period. Nutrition during pregnancy and lactation is a potentially modifiable risk factor as it is an important determinant of lifetime disease risk. Therefore, it is of great importance to encourage mothers to have adequate and balanced nutrition during pregnancy and lactation. Infancy, childhood, and adolescence are critical periods, and nutritional requirements become crucial to be met during this time. Children on vegetarian diets might be at risk of certain nutrient deficiencies such as n-3 fatty acids, vitamin B12, iron, and zinc. Furthermore, the nutritional habits acquired during this period may influence dietary patterns and the risk of disease later in life. Most of the studies investigating the effect of vegetarian diets on children are outdated. There is a lot of controversy regarding the safety of vegetarian diets in childhood, and more longitudinal studies are needed. This review focuses on the effects of vegetarian diets in children and the health consequences of vegetarian diets.

Anahtar Kelimeler

• Children
• nutritional status
• vegetarian diet
• vegan diet
• health
• safety

Kaynakça

1. [1]. Sofi F, Dinu M, Pagliai G, Cesari F, Marcucci R, Casini A. Mediterranean versus vegetarian diet for cardiovascular disease prevention (the CARDIVEG study): study protocol for a randomized controlled trial (published correction appears in Trials. 2016;17(1):253). Trials. 2016;17(1):233. Published 2016 May 4.
2. [2]. Melina V, Craig W, Levin S. Position of the academy of nutrition and dietetics: vegetarian diets. J Acad Nutr Diet. 2016;116(12): 1970-1980. 

3. [3]. Ferrara P, Corsello G, Quattrocchi E, Dell'Aquila L, Ehrich J, Giardino I, et al. Caring for infants and children following alternative dietary patterns. J Pediatr. 2017;187: 339-340.
4. [4]. Baroni L, Goggi S, Battino M. Planning Well-Balanced Vegetarian Diets in Infants, Children, and Adolescents: The VegPlate Junior. J Acad Nutr Diet. 2019;119(7):1067-1073.
5. [5]. Lemale J, Mas E, Jung C, Bellaiche M, Tounian P, Hepatology, F. S. P. Vegan diet in children and adolescents. Recommendations from the French-speaking Pediatric Hepatology, Gastroenterology and Nutrition Group (GFHGNP). Arch Pediatr. 2019; 26(7): 442-450.
6. [6]. Cofnas N. Is vegetarianism healthy for children? Crit Rev Food Sci Nutr. 2019; 59(13): 2052-2060.
7. [7]. Mihrshahia S, D Ding J. Gale, M. Allman-Farinelli, E. Banks, and A. E. Bauman. Vegetarian diet and all-cause mortality: Evidence from a large population-based Australian cohort – the 45 and up study. Prev Med. 2017; 97:1–7.
8. [8]. Pawlak R. To vegan or not to vegan when pregnant, lactating or feeding young children. Eur J Clin Nutr. 2017; 71(11):1259-1262.

9. [9]. Gorczyca, D. Nutritional Status of Vegetarian Children. Mariotti F (Ed) In Vegetarian and Plant-Based Diets in Health and Disease Prevention, Academic Press. 2017. p. 529-547.
10. [10]. Foster M, Samman S. Vegetarian diets 40. across the lifecycle: Impact on zinc
intake and status. Adv Food Nutr Res. 2015; 74:93-131.
11. [11]. Schürmann S, Kersting M, Alexy U. Vegetarian diets in children: a systematic review. Eur J Nutr. 2017;56(5):1797-1817.
12. [12]. Müller P. Vegan Diet in Young Children. In Global Landscape of Nutrition Challenges in Infants and Children, Karger Publishers. Basel, 2020.p.103-110.
13. [13]. Scaglioni S, De Cosmi V, Mazzocchi A, Bettocchi S, Agostoni, C. Vegetarian infants and complementary feeding. Mariotti F (Ed). In Vegetarian and Plant-Based Diets in Health and Disease Academic Press. Prevention 2017. p. 513-527.
14. [14]. Hovinen T, Korkalo, L, Freese R, Skaffari E, Isohanni P, Niemi M. et al. Vegan diet in young children remodels metabolism and challenges the statuses of essential nutrients. EMBO Mol Med, 2021;13(2), e13492.
15. [15]. Sutter, D. O., & Bender, N. Nutrient status and growth in vegan children. Nut Res 2021; 9:13-25
16. [16]. Thane CW, Bates CJ. Dietary intakes and nutrient status of vegetarian preschool children from a British national survey. J Hum Nutr Diet. 2000; 13(3):149-162.
17. [17]. Alexy U, Fischer M, Weder S, Längler A, Michalsen A, Sputtek A, & Keller M. Nutrient intake and status of german children and adolescents consuming vegetarian, vegan or omnivore diets: Results of the vechi youth study. Nutrients. 2021;13(5): 1707.
18. [18]. Peddie M, Scott T, Ranasinghe C, Fleming E, Webster K, Brown R, ... & Haszard J. A Sample of Female Adolescent Self-Identified Vegetarians in New Zealand Consume Less Protein and Saturated Fat, but More Fiber than Their Omnivorous Peers. Nutrients. 2022;14(3): 711.
19. [19]. Ambroszkiewicz J, Klemarczyk W, Gajewska J, Chełchowska M, Franek E, Laskowska-Klita T. The influence of vegan diet on bone mineral density and biochemical bone turnover markers. Pediatr Endocrinol Diabetes Metab. 2010; 16(3): 201-4.
20. [20]. Osei-Boadi K, Lartey A, Marquis GS, Colecraft EK. Dietary intakes and iron status of vegetarian and non-vegetarian children in selected communities in Accra and Cape Coast, Ghana. Afr J Food Agric Nutr Dev.2012;12(1): 5822-5842.
21. [21]. European Food Safety Authority. Scientific opinion on dietary reference values for cobalamin. https://www.efsa.europa.eu/en/efsajournal/pub/4150 2015;13(7):4150 (last accessed 07 October 2022).
22. [22]. Pawlak R, Bell K. Iron status of vegetarian children: a review of literature. Ann Nutr Metab. 2017; 70(2): 88-99
23. [23]. Byrne HM. Iron and Zinc Nutrition in Vegan and Lacto-Ovo Vegetarian Children. 2017.Doctoral dissertation, D'Youville College, ProQuest, 10282090, 11-24.
24. [24]. Jain N, Jain VM. Prevalence of anemia in school children. Med Pract Rev. 2012; 3(1): 1-4.
25. [25]. Ambroszkiewicz J, Klemarczyk W, Mazur J, Gajewska J, Rowicka G, Strucińska et al. Serum hepcidin and soluble transferrin receptor in the assessment of iron metabolism in children on a vegetarian diet. Biol Trace Elem Res. 2017;180(2): 182-190.
26. [26]. Rudloff S, Bührer C, Jochum F, Kauth T, Kersting M, Körner A, et al.Vegetarian diets in childhood and adolescence. Mol Cell Pediatr. 2019; 6(1): 1-7.
27. [27]. Leung SS, Lee RH, Sung RY, et al. Growth and nutrition of Chinese vegetarian children in Hong Kong. J Paediatr Child Health. 2001;37(3):247–53.
28. [28]. Iguacel I, Miguel-Berges ML, Gómez-Bruton A, Moreno L. A, Julián C. Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis. Nutr Rev. 2019; 77(1): 1-18.
29. [29]. Krebs NF, Westcott JE, Culbertson DL, Sian L, Miller LV, Hambidge KM. Comparison of complementary feeding strategies to meet zinc requirements of older breastfed infants. Am J Clin Nutr. 2012; 96(1): 30–35.
30. [30]. Gorczyca D, Prescha A, Szeremeta K. Impact of vegetarian diet on serum immunoglobulin levels in children. Clin Pediatr. 2013; 52(3): 241–246.
31. [31]. Gibson RS, Heath ALM, Szymlek-Gay EA. Is iron and zinc nutrition a concern for vegetarian infants and young children in industrialized countries? Am J Clin Nutr. 2014; 100(1): 459-468.
32. [32]. Baroni L, Goggi S, Battaglino R, Berveglieri M, Fasan I, Filippin D, et al. Vegan Nutrition for Mothers and Children: Practical Tools for Healthcare Providers. Nutrients. 2018;11(1):5.
33. [33]. Redecillas-Ferreiro, S., Moráis-López, A., & Moreno-Villares, J. M. Position paper on vegetarian diets in infants and children. Committee on Nutrition and Breastfeeding of the Spanish Paediatric Association. An Pediatr (Engl Ed). 2020; 92(5): 306-e1.
34. [34]. Sabaté J, Wien M. Vegetarian diets and childhood obesity prevention. Am J Clin Nutr. 2010; 91(suppl):1525S–1529S.
35. [35]. Segovia-Siapco G, Jung S, Sabaté J. Vegetarian Diets and Pediatric Obesity. Pediatr Obes. 2017; 287–303.
36. [36]. Choi KS, Shin KO, Jung TH, Chung KHA. study on the differences in the dietary habits, nutrient intake and health status of vegetarian (lacto-ovo vegetarian) and non-vegetarian Korean elementary school children. J food science nutr. 2011;40(3): 416-425.
37. [37]. Segovia-Siapco G, Burkholder-Cooley N, Haddad Tabrizi S, Sabaté J. Beyond Meat: A Comparison of the Dietary Intakes of Vegetarian and Non-vegetarian Adolescents. Front Nutr 2019; 6, 86.
38. [38]. Weder, S., Hoffmann, M., Becker, K., Alexy, U., & Keller, M. (Energy, Macronutrient Intake, and Anthropometrics of Vegetarian, Vegan, and Omnivorous Children (1–3 Years) in Germany (VeChi Diet Study). Nutrients, 2019: 11(4), 832.
39. [39]. Farella, I, Panza, R & Baldassarre, ME. The difficult alliance between vegan parents and pediatrician: a case report. Int J Environ Res Public Health 2020;17, 6380–6384.
40. [40]. Kiely, M. Risks and benefits of vegan and vegetarian diets in children. Proc Nutr Soc, 2021; 80(2), 159-164.
41. [41]. Lemale, J, Salaun, J-F, Assathiany, R et al. Replacing breastmilk or infant formula with a non-dairy drink in infants exposes them to severe nutritional complications. Acta Paediatr 2018;107, 1828–1829.
42. [42]. Movassagh EZ, Baxter-Jones ADG, Kontulainen S, Whiting S, Szafron M, Vatanparast H. Vegetarian-style dietary pattern during adolescence has long-term positive impact on bone from adolescence to young adulthood: a longitudinal study. Nutr J. 2018;17(1):36.
43. [43]. Ambroszkiewicz J, Chełchowska M, Szamotulska K, Rowicka G, Klemarczyk W, Strucińska, M, et al. Bone status and adipokine levels in children on vegetarian and omnivorous diets. Clin Nutr. 2019;38(2): 730-737.
44. [44]. Santivañez-Romani A, Carbajal-Vega V, Pereyra-Elías R. Association between a vegetarian diet and emotional symptoms: a cross-sectional study among adolescents in four developing countries. Int J Adolesc Med Health. 2018; 33(2):1-9
45. [45]. Ocklenburg S, & Borawski J. Vegetarian diet and depression scores: a meta-analysis. J Affect Disord. Journal of Affective Disorders. 2021; 294: 813-815.
46. [46]. Sublette ME, Ellis SP, Geant AL, Mann JJ. Meta-analysis: effects of eicosapentaenoic acid in clinical trials in depression. J Clin Psychiatry. 2011;72(12):1577.
47. [47]. Li F, Liu X, Zhang D. Fish consumption and risk of depression: A meta-analysis. J Epidemiol Community Health. 2016;70 (3):299–304.
48. [48]. Baş M, Karabudak E, Kiziltan G. Vegetarianism and eating disorders: association between eating attitudes and other psychological factors among Turkish adolescents. Appetite. 2005;44(3):309–15.
49. [49]. Vail B, Prentice P, Dunger B, Hughes IA, Acerini CL, Ong KK. Age at weaning and infant growth: primary analysis and systematic review. J Pediatr. 2015; 167(2): 317-324.