- Lacto-ovo-vegetarianism, which encompasses dairy products, eggs, and honey. Subcategories are lacto-vegetarianism that prohibits eggs, and ovo-vegetarianism that prohibits dairy products;
- Veganism, that prohibits dairy products, meat, eggs, and honey. All vegetables, seaweed, mushroom and bacteria (probiotics) are allowed.
- Raw food diet, which consists of vegetables, legumes and pulses, fruits, cereals, seeds, milk and eggs, all of which are mainly consumed raw;
- Fruit diet, which consists mainly of fresh and dried fruits, but allows also seeds and some vegetables;
- Macrobiotic diet, which is based on cereals, vegetables, legumes and pulses, seaweed, and soy products; fish may also be consumed .
2. Materials and Methods
- The prevalence of alternative weaning;
- The correlation between parental food regimens and the type of weaning;
- The food regimen chosen by children at the time of autonomous food selection;
- Breastfeeding duration according to the type of weaning;
- The role of family pediatricians in the management of weaning;
- The use of food supplements.
3.2. Narrative Review
- Consume large amounts and a wide variety of plant foods, better whole or minimally processed foods;
- Limit the amount of fiber;
- Choose vegetable fats cautiously, favoring sources of omega-3 fatty acids and monounsaturated oils, and limiting trans-saturated fats and tropical oils (e.g., coconut and palm) to preserve omega-3 metabolic pathway; during infancy and early childhood fats intake should not be restricted;
- Consume adequate amounts of calcium from calcium-rich foods (dairy products for lacto-ovo-vegetarians and lacto-vegetarians; calcium-rich plants, soy drinks, and tofu for ovo-vegetarians and vegans);
- Supplement vitamin D (1000–1200 IU/day if breastfed, or 600-800 IU/day if formula fed with vitamin D-enriched formula);
- Consume adequate amounts of vitamin B12 (from fortified rice- or soy-based infant formula -if not breastfed-, algae, some fungi, tempeh) or supplement the lactating mother and the infant.
Conflicts of Interest
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|Demographic Features||TOTAL 360|
|Maternal Diet Regimen|
|Paternal Diet Regimen|
|Weaning Time (Months)|
|Breastfeeding Duration (Months, Mean)|
|Child Diet after Weaning|
|Weaning||Mother Diet||Father Diet|
|Omnivore (t = 327)|
|Alternative (t = 33)|
|Authors||Article Type||Year||Age of the Population||Main Conclusions|
|Lemoine et al. ||Case report||2020||13 months||Warning against nutritional deficiencies due to vegetarian/vegan diets in infants and children.|
|Lemale et al. ||Recommendations GFHGNP||2019||Infancy, childhood and adolescence||Vegan diets are not suited to children; strict guidance of competent health professionals is needed to prescribe nutritional supplements essential to their dietary balance.|
|Lemale et al. ||Brief report||2018||0–1 year||Replacing infant formula with nondairy drinks may lead to severe adverse effects, especially if early in life.|
|Baroni et al. ||Recommendations SSNV||2018||Pregnancy, lactation, infancy and childhood||Vegetarian/vegan diets are suitable during pregnancy, lactation, infancy, and childhood, but special attention to critical elements (e.g., protein, vitamin D and B12, fiber, omega-3 fatty acids, iron, zinc, iodine, calcium) is needed.|
|Fewtrell et al. ||Position paper ESPGHAN||2017||n.a.||Vegan diets are generally contraindicated during weaning due to the high risk of severe deficiencies.|
|Ferrara et al. ||Editorial||2017||0–2 years||Vegetarian or vegan diets need appropriate pediatric supervision to guarantee adequate supply of nutrients.|
|Agnoli et al. ||Position paper SINU||2017||Pregnancy, lactation, pre-scholar age, children, adolescents, adults, and the elderly||Well-planned vegetarian diets may provide adequate nutrient intake. Special attention should be made during pregnancy, breastfeeding and infancy, since nutritional deficiencies have been widely reported.|
|Mangels et al. ||Recommendations||2012||Infancy and early childhood||Carefully planned vegetarian and vegan diets are adequate for infants and toddlers.|
|Van Winckel et al. ||Review||2011||Infants, toddlers/preschool children, adolescents||Lacto-ovo-vegetarian diets may be appropriate for the growing child, whilst a vegan diet requires supplementation with vitamin B12. Special care is needed for the intakes of calcium, zinc and high-quality protein. The risk for deficiencies is inversely related to the age of the child and the variety of the foods.|
|Vegetarian Diet||Vegan Diet|
|BF (Lactating Woman)||FF||CF||BF (Lactating Woman)||FF||CF|
|Vitamin B12: is likely to be lacking. Vitamin B12 fortified foods (cereals, alternative milk, meat analogs, and nutritional yeast) or vitamin B12 supplementation (50 μg/day) are recommended. If the mother refuses either, the baby should be supplemented with vitamin B12.|
Vitamin D: vitamin D supplementation of 1000–1200 IU/day is recommended in all breastfed infants. Currently, the only commercial infant vitamin D drop is derived from sheep’s wool (lanolin), thus suitable for vegetarians but not for vegans.
Proteins: Varied consumption of vegetables and cereals.
Calcium: 500–1000 mg/day depending on other sources.
Iron: Iron-rich plants with vitamin C-rich fruit.
Specific preparation methods (grinding, soaking, germination).
Supplementation of 2–3 mg/kg of iron depending on serum ferritin.
Zinc: Plants rich in zinc (Brassicaceae);
Specific preparation methods (grinding, soaking, germination).
If deficiency: 1 mg/kg/day of zinc gluconate.
Iodine: 6.5 g/day of iodized salt.
DHA and ALA:
Vegetarian lactating women should consume DHA fortified foods and ALA rich foods (flaxseeds, chia seeds, walnuts, etc.).
100–200 mg of micro-algae/day source of DHA suitable also for vegans.
|Cow’s milk-based formula provides good amounts of Vitamin B12, proteins, calcium, iron, zinc, iodine, and DHA (if DHA enriched).|
Vitamin D: 1000–1200 IU/day (or 600–800 IU/day if formula is vitamin D enriched).
DHA: if formula not DHA enriched, 100 mg of micro-algae/day
|In formula-fed infants, there are no specific concerns. Conversely, breastfed infants may lack iron and zinc, therefore iron- and zinc-fortified infant cereal or firm tofu should be advised. |
Iodine: No addition of iodized salt up to 12 months of life.
|Vitamin B12: same considerations as for vegetarian diet.|
Vitamin D: if the family declines to supplement the baby with lanolin-derived vitamin D3, the mother should receive a high-dose vitamin D2 (derived from fungi) supplementation of 2000 IU/day or 60,000 IU/month for three months to ensure good concentrations of vitamin D in breast milk.
DHA and ALA: same considerations as for vegetarian diet.
|Soy protein-based formulas (even though they are supplemented with lanolin-derived vitamin D3).|
Commercial soy drinks or other plant-based beverages, homemade formulas from grains or nuts, vegetable juice, and unmodified cow’s milk should be avoided.
Vitamin D: 1000–1200 IU/day (or 600–800 IU/day if formula is vitamin D enriched)
DHA: if formula not DHA-enriched, 100 mg of micro-algae/day
|Same considerations as for vegetarian diet.|
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