Pediatric Nutrition in Practice

Vegetarian Diets 137

2

sorbed as the vitamin D 3 derivative from lanolin
(sheep’s wool) more commonly found in fortified
foods [9].

Calcium
Calcium intakes tend to be adequate in lacto-veg-
etarian children but can be lower than recom-
mended in vegan children. Good sources of cal-
cium in vegetarian diets are shown in table 2. Cal-
cium bioavailability is inhibited by phytate (found
in high-fibre cereals, legumes and seeds) and oxa-
late (found in fruit, vegetables, legumes and
grains) content of food. In addition to consuming
calcium-fortified soy products, low-oxalate green

vegetables such as cabbage, spring greens and kale

have higher calcium bioavailability (49–61%) and

should be consumed regularly by vegans [10].

Iron

The clinical incidence of iron deficiency anaemia

is no greater in vegetarian children than in omni-

vores, although iron stores tend to be lower [11].

It is recommended that iron intakes are 1.8 times

higher in vegetarians [10] as plant sources of iron

(non-haem) are less bioavailable. Phytate, soy

protein and polyphenols/tannins can inhibit iron

absorption, while several nutrients, including vi-

tamin C, retinol and carotenes, can enhance the

Ta b l e 2. Vegetarian (includes semi- and lacto-vegetarian and vegan) food sources for main nutrient concerns in chil-
dren

Nutrient Main food source Points to note

n–3 fatty
acids

Oily fish (EPA/DHA); ground flaxseed; flaxseed/

linseed oil; canola/rapeseed oil; cooked soybeans;

tofu; walnuts; walnut oil

Supplement may be required in vegans

Vitamin B 12 Dairy products; eggs; poultry; fish; fortified cereal;
fortified yeast; fortified soy milk

Supplement may be required in vegans

Vitamin D Fortified dairy products; egg yolks; oily fish;
fortified cereals; fortified soy milk;
fortified vegan margarines

Supplement is required in infants;

supplement may be required in vegan

children/adolescents

Calcium Dairy products; green vegetables (broccoli, cabbage,
collard greens, bok choy, turnip greens, kale);
fortified soy products (milk, yogurts, tofu, tempeh);
fortified cereals; dried figs; almonds; sesame tahini

Oxalate/phytate reduces bioavailability;

intestinal absorption increases when intake

is reduced; supplement may be required in

vegans

Iron Animal products (dairy, fish, poultry); cooked
soybeans, tofu, tempeh; cooked legumes
(lentils, chickpeas, adzuki, kidney); dried pumpkin/
squash seeds, cashews, sunflower seeds, tahini;
fortified cereals; baked potatoes (including skin)

Non-haem iron absorption enhanced by

vitamin C, vitamin A (retinol) and carotenes,

inhibited by phytates, tannins/polyphenols

and soy protein

Zinc Soybeans (cooked/roasted), tofu, fortified
vegetarian meats; baked beans, lentils, navy beans;
dried pumpkin/squash seeds, cashews, toasted
sunflower seeds; fortified cereals; wheat germ;
cooked peas

Phytate reduces bioavailability

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 134–138
DOI: 10.1159/000367873