On Doctoring MEDLINE searches, with reference librarian comments, March 2000

The question was

Question: Is a vegetarian diet healthy for children?
Result: Yes, it may be better in some respects, though certain dietary pitfalls need to be taken into account in planning a balanced vegetarian diet-- namely Vitamin B12 and Iron intake.

1     Vegetarianism/    results=490   
2     Child nutrition/ or Diet/ or Protein-energy malnutrition/    results= 17490   
3     1 and 2    results= 141   
4     from 3 keep 2-3,8,36,44,68,90,138    results= 8   

Reference Librarian comments

Good job. Usually I would "explode" the subject-headings, and frequently I like to check the "focus" box, to get fewer but more "on-target" references, but you did OK with this subject.

I tried it myself, just for fun, and used the strategy you see below...

Medline 1991 to January 2000

#
Search History
Results
1
exp *Vegetarianism/
325
2
exp Child nutrition/
7867
3
1 and 2
12
4
limit 1 to (newborn infant < birth to 1 month > or infant < 1 to 23 months > or preschool
child < 2 to 5 years > or child < 6 to 12 years > or adolescence < 13 to 18 years >)
74
5
3 or 4
75
6
limit 5 to (human and english language)
67

°°°

I selected a few, from that set of 67 references

<1>
AN 99408700
AU Hebbelinck M. Clarys P. De Malsche A.
IN Laboratories of Human Biometry and Biological Chemistry, Faculty of Physical
Education and Physical Therapy, Vrije Universiteit Brussel, Brussels,
Belgium. mhebbel@vub.ac.be
TI Growth, development, and physical fitness of Flemish vegetarian
children, adolescents, and young adults.
SO American Journal of Clinical Nutrition. 70(3
Suppl):579S-585S, 1999 Sep.
LM Pre-1993 at Dana,1993-date at MFHSL.
AB This study was designed to assess average daily dietary intakes of energy in
82 vegetarian children (group A: 6- 9-y-old girls and
6-11-y-old boys), adolescents (group B: 10- 15-y-old girls and 12-17-y-old
boys), and young adults (group C: 16-30-y-old females and 18-30-y-old males)
and included determination of height and weight; triceps, suprailiac, and
calf skinfold thicknesses; puberty ratings; and physical fitness. Dietary
energy intake was lower than recommended values in all 3 groups. Height and
weight did not differ significantly from the reference data except in group
B, which had significantly lower heights and weights and lower body mass
indexes (P<0.05). Triceps and suprailiac skinfold thicknesses were lower in
all age groups, whereas the calf skinfold thickness was only significantly
lower in the 10-15-y-old girls (P<0.05). The vegetarian
children were as physically fit as the reference group. The
vegetarian adolescent boys and girls and the young adults scored
significantly lower on the standing long jump and 30-s sit-up (P<0.05). The
vegetarian subjects of groups B and C recovered significantly faster from the
step test (P<0.05). Puberty ratings plotted on percentile graphs showed that
all vegetarian subjects, except for 1 girl, were within the normal
developmental range. We conclude that, within the limits of this study,
vegetarian subjects have lower relative body weights and skinfold thicknesses
in adolescence than do nonvegetarians. They scored lower on the strength
tests and better on the cardiorespiratory test when compared with reference
values. The growth and maturation status of the vegetarian population were
within the normal range.

<2>
AN 99408696
AU Sanders TA.
IN Nutrition, Food and Health Research Centre, King's College
London, United Kingdom. Tom.Sanders@kcl.ac.uk
TI Essential fatty acid requirements of vegetarians in pregnancy, lactation,
and infancy. [Review] [28 refs]
SO American Journal of Clinical Nutrition. 70(3
Suppl):555S-559S, 1999 Sep.
LM Pre-1993 at Dana,1993-date at MFHSL.
AB Long-chain polyunsaturated fatty acids (LCPUFAs) derived from linoleic
(18:2n-6) and alpha-linolenic (18:3n-3) acids are required for the normal
development of the retina and central nervous system, but the extent to which
they can be synthesized from the parent fatty acids is debated. Consuming
LCPUFAs markedly increases their proportions in tissue lipids compared with
their parent fatty acids. Thus, it has been argued that LCPUFAs must be
supplied in the diet. LCPUFAs are generally absent from plant foods, thus it
is important find out how essential fatty acid requirements are met by
vegetarians. A developing fetus obtains LCPUFAs via selective uptake from its
mother's plasma and LCPUFAs are present in the breast milk of vegetarians.
There is no evidence that the capacity to synthesize LCPUFAs is limited in
vegetarians. However, there are greater proportions of n-6 LCPUFAs and lower
proportions of n-3 LCPUFAs in vegetarians compared with omnivores. This
difference is probably a consequence of the selection of foods by vegetarians
with high amounts of linoleic acid. Although lower concentrations of
docosahexaenoic acid (22:6n-3; DHA) have been observed in blood and artery
phospholipids of infants of vegetarians, it is uncertain whether their brain
lipids contain lower proportions of DHA than do those of infants of
omnivores. On the basis of experiments in primates that showed altered visual
function with a high ratio of linoleic acid to alpha-linolenic acid, it would
be prudent to recommend diets with a ratio between 4:1 and 10:1 in
vegetarians and that excessive intakes of linoleic acid be avoided.
[References: 28]

<3>
AN 98334830
AU Hackett A. Nathan I. Burgess L.
IN Centre for Consumer Education and Research, Liverpool John Moores
University.
TI Is a vegetarian diet adequate for children. [Review] [29
refs]
SO Nutrition & Health. 12(3):189-95, 1998.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
AB The number of people who avoid eating meat is growing, especially among
young people. Benefits to health from a vegetarian diet have been reported in
adults but it is not clear to what extent these benefits are due to diet or
to other aspects of lifestyles. In children concern has been
expressed concerning the adequacy of vegetarian diets especially with regard
to growth. The risks/benefits seem to be related to the degree of restriction
of he diet; anaemia is probably both the main and the most serious risk but
this also applies to omnivores. Vegan diets are more likely to be associated
with malnutrition, especially if the diets are the result of
authoritarian dogma. Overall, lacto-ovo-vegetarian children
consume diets closer to recommendations than omnivores and their pre-pubertal
growth is at least as good. The simplest strategy when becoming vegetarian
may involve reliance on vegetarian convenience foods which are not
necessarily superior in nutritional composition. The
vegetarian sector of the food industry could do more to produce foods closer
to recommendations. Vegetarian diets can be, but are not necessarily,
adequate for children, providing vigilance is maintained,
particularly to ensure variety. Identical comments apply to omnivorous diets.
Three threats to the diet of children are too much reliance
on convenience foods, lack of variety and lack of exercise. [References: 29]

<4>
AN 98234507
AU Worsley A. Skrzypiec G.
IN Department of Public Health, University of Adelaide, Australia.
TI Teenage vegetarianism: prevalence, social and cognitive
contexts.
SO Appetite. 30(2):151-70, 1998 Apr.
LM Some Web & Print available, check catalog for details.
AB The aim of this study was to measure the prevalence of teenage
vegetarianism and associated food habits and beliefs. Two
thousand senior secondary school students (mean age 16 years), from 52
schools in South Australia, participated in a two part survey. The findings
show that teenage vegetarianism is primarily a female
phenomenon, ranging in prevalence, according to definition, from 8 to 37% of
women and 1 to 12% of men. Support for vegetarian practices was high
especially from mothers (63%) and classmates (46%). Generally, "teenage
vegetarians" consumed fewer red meats than non-vegetarians but ate more
chicken. They cited health, animal welfare and environmental reasons in
support of their habits. The importance of operational definitions of
vegetarianism is emphasized and the findings are discussed
in relation to likely motivational influences.

<5>
AN 98061657
AU Krajcovicova-Kudlackova M. Simoncic R. Bederova A. Grancicova E.
Magalova T.
IN Research Institute of Nutrition, Bratislava, Slovak
Republic.
TI Influence of vegetarian and mixed nutrition on selected
haematological and biochemical parameters in children.
SO Nahrung. 41(5):311-4, 1997 Oct.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
AB To evaluate the health and nutritional status of
children with two different nutritional
habits, the authors examined 26 vegetarians (lacto- and lacto-ovo; an average
period of vegetarianism 2.8 years) and 32 individuals on
mixed diet (omnivores) in the age range 11-14 years. Vegetarian
children had significantly lower erythrocyte number as well
as reduced levels of haemoglobin and iron compared to omnivores. The average
level of iron did not reach the lower limit of the physiological range and
hyposiderinemia was found in 58% of vegetarians vs 9% of omnivores. Reduced
iron levels were observed in spite of increased intake of vegetable iron
sources and vitamin C (which facilitates the conversion to ferro-form). This
reduction can be attributed to the absence of animal iron sources with high
utilizability and to lower iron utilization in the presence of phytic acid
(higher intake of grains compared to omnivores). The incidence of
hypoalbuminemia and hypoproteinemia in vegetarian children
was 38 and 12%, respectively, compared to 0% in omnivores. The protein
mixture from milk, eggs and vegetable sources is complete, but vegetarian
children had significantly reduced intake of milk and dairy
products. Favourable lipid and antioxidant parameters in vegetarian
children reflect the optimal nutrition
composition with respect to the prevention of free radical diseases. Such a
nutrition results in significantly lower levels of
cholesterol and LDL-cholesterol compared to omnivores and significantly
higher and over threshold values of essential antioxidants--vitamin C,
vitamin E/cholesterol (more effective protection against LDL oxidation),
beta-carotene, vitamin A.

<6>
AN 97446901
AU von Schenck U. Bender-Gotze C. Koletzko B.
IN Kinderpoliklinik, Klinikum Innenstadt, Ludwig-Maximilians-Universitat,
Munich, Germany.
TI Persistence of neurological damage induced by dietary vitamin B-12
deficiency in infancy [see comments]. [Review] [20 refs]
CM Comment in: Arch Dis Child 1998 Apr;78(4):398-9
SO Archives of Disease in Childhood. 77(2):137-9, 1997 Aug.
LM Pre-1993 Dana; 1993-dateMFHSL;for Web access-check catalog
AB A case is reported of a 14 month old boy with severe dietary vitamin B-12
deficiency caused by his mother's vegan diet. Clinical,
electroencephalography (EEG), and haematological findings are described.
Cranial magnetic resonance imaging (MRI) showed severe frontal and
frontoparietal cranial atrophy. Vitamin B-12 supplements led to a rapid
improvement of haematological and neurological symptoms. Serum vitamin B-12
and urinary methylmalonate excretion were normal 10 days after treatment
began. After six weeks, EEG was normal and cranial MRI after 10 weeks showed
complete disappearance of all structural abnormalities. Cognitive and
language development, however, remained seriously retarded at the age of 2
years. It is concluded that infantile vitamin B-12 deficiency induced by
maternal vegan diets may cause lasting neurodisability even though vitamin
B-12 supplementation leads to rapid resolution of cerebral atrophy and
electroencephalographic abnormality. [References: 20]