Infants, children, and adolescents who consume well-planned vegetarian diets can generally meet all of their nutritional requirements for growth^19,20. Those who follow vegan or veganlike diets should consume a reliable source of vitamin B12 and should have a reliable source of vitamin D. Calcium, iron, and zinc intakes may also deserve special attention, although intakes are usually adequate when reasonable variety and adequate energy are consumed.

If exposure to sunlight is limited, the need for vitamin D should be assessed. Because vegan diets tend to be high in bulk, care should be taken to ensure that caloric intakes are sufficient to meet energy needs, particularly in infancy and during weaning. Both vegetarians and nonvegetarians whose infants are premature or solely breastfed beyond 4 to 6 months of age should provide supplements of vitamin D, if exposure to sunlight is inadequate, and iron from birth or at least by 4 to 6 months of age²¹.

Well-planned vegetarian diets can be adequate for pregnant and lactating women. Vegetarians and nonvegetarians alike are generally advised to take iron and folic acid supplements during pregnancy, although vegetarians frequently have greater intakes of those nutrients than do nonvegetarians. A regular source of vitamin B12 is recommended for vegans during pregnancy and lactation^21,22. A vitamin D supplement should be taken by pregnant and lactating vegans if exposure to sunlight is inadequate. Consumption of a variety of foods and adequate energy will help ensure adequate intakes of calcium, iron, and zinc.

In planning vegetarian diets of any type, one should choose a wide variety of foods and ensure that the caloric intake is adequate to meet energy needs²³. (See the Figure.) Additionally, the following recommendations are in order.

 Keep the intake of low nutrient-dense foods, such as sweets and fatty foods, to a minimum. - Choose whole or unrefined grain products, instead of refined products, you servewhenever possible, or use fortified or enriched cereal products.

 Use a variety of fruits and vegetables, including a good food source of vitamin C.

 If milk or dairy products are consumed, use low-fat or nonfat varieties.

 Limit egg intake to 3 to 4 yolks per week.

 Vegans should have a reliable source of vitamin B12, such as some fortified commercial breakfast cereals, fortified soy beverages, or a cyanocobalamin supplement. A vitamin supplement may be indicated if exposure to sunlight is limited.

 Vegetarian and nonvegetarian infants who are solely breastfed beyond 4 to 6 months of age should receive supplements of iron and vitamin D if exposure to sunlight is limited.

The Dietary Guidelines for Americans²⁴ recommend a reduction in fat intake and an increased consumption of fruits, vegetables, and whole grains. Well-planned vegetarian diets can effectively meet these guidelines and can be a health-supporting dietary alternative.

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