NPR on Vegetarian Children and Iron

On November 10, NPR featured an article on vegetarian children, Raising Vegetarian Kids? Here Are Some Pointers.

As with most nutrition articles on vegetarian children, they make it seem much harder than it actually is. I will only address the scariest statements in the article. It says:

“Iron is the most common nutrient deficient in vegetarians, and especially in vegans, who don’t eat any animal products, the American Academy of Pediatrics’ Pediatric Nutrition Handbook says.”

I don’t have a copy of the Pediatric Nutrition Handbook (it’s rather expensive and I could find no searchable versions on-line), so Reed Mangels, PhD, RD (also quoted in the NPR article and an expert on nutrition for vegetarian children) forwarded me the excerpt from the 6th Edition (2009). Reed’s comments are in brackets:

“The iron nutritional status of vegetarian infants and children varies. Iron deficiency is by far the most common of the micronutrient deficiencies exhibited by vegetarian children (62). It is particularly common in children consuming vegan diets [no reference] because plant foods contain nonheme iron as opposed to heme iron in animal sources [it would be more accurate to say a mix of heme and nonheme iron in animal sources]…Recommended iron intakes for vegetarians are 1.8 times those of nonvegetarians because of the lower bioavailability of iron in a vegetarian diet (64), and although vegetarians have lower iron stores their serum ferritin concentration is usually within the normal range (65, 66). Incidence of iron deficiency anemia among vegetarians is similar to nonvegetarians (55). Although many studies have been short-term, there is evidence that adaptation to low intakes takes place over a longer term and involves increased absorption and decreased losses (67, 68).”

Reed commented further:

“Reference 62, the Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride, is an odd reference to cite for this; it does not provide evidence for iron deficiency incidence in vegetarian children.

“As you can see, they say iron deficiency (not anemia) is the most common deficiency in vegetarian children. This is likely true since iron deficiency is the most common nutritional deficiency in all children and why should vegetarian children be the exception? I don’t think there is evidence that it is particularly common in vegan children. The two studies I know of (Swedish and UK) that look at iron intakes of vegan children and teens actually found higher or similar intakes in vegans compared to non-vegetarians.

“Anemia does not appear to be more common in vegetarians and while serum ferritin levels are lower, they are within the normal range. Note that these findings are mainly, if not exclusively, in adults – there just aren’t that many studies of vegetarian children. So, when the article said that iron is the most common nutrient deficient in vegetarians, this should have been qualified to say ‘and in children in general’ or something like that.”

Back to the NPR article. Dr. Jatinder Bhatia, the chairman of the American Academy of Pediatrics’ committee on nutrition is quoted:

“If the child’s pediatrician isn’t aware that the child is a vegetarian, the doctor may not know to test for iron deficiency, Bhatia says…Iron deficiency may not become apparent until the child is older, Bhatia says, and at that point, the child may actually have irreversible cognitive defects.”

Dr. Mangels responds:

“Dr. Bhatia is correct that iron deficiency does affect brain development but this should be a concern for all parents, not just parents of vegetarians. The AAP handbook suggests either universal screening for iron deficiency at 9-12 months and then 15-18 months for communities where a significant level of iron deficiency exists or selective screening using the same time points and measures for infants believed to be at risk, including those over 6 months not consuming a diet with adequate iron content. Annual screening should also be done for children with a possibly low iron diet who are 2-5 years old. So, I can’t fault him for saying parents should tell their pediatrician about their child’s diet. I can see why parents might not bring it up if they thought they would be discouraged from raising their child on a vegetarian diet. ”

A 1985 study of vegetarian children in India indicated that iron deficiency anemia was not uncommon, at least at that time (1), but this was not the case in the one study that tested vegan children’s iron levels, none of whom had anemia (2). As someone who corresponds with many parents of vegan children, I am not aware of any prevalence of iron deficiency anemia (or any recent cases at all).

Parents of vegetarian children do need to know a few things, but it is not rocket science. A good summary is Vegan Nutrition in Pregnancy and Childhood by Reed Mangels, PhD, RD and Katie Kavanagh-Prochaska, RD.

1. Seshadri S, Shah A, Bhade S. Haematologic response of anaemic preschool children to ascorbic acid supplementation. Hum Nutr Appl Nutr. 1985 Apr;39(2):151-4. (Link)

2. Kim Y-C. The effect of vegetarian diet on the iron and zinc status of school-age children. [master’s thesis]. Amherst: University of Massachusetts; 1988. Cited in: Messina V, Mangels AR. Considerations in planning vegan diets: children. J Am Diet Assoc. 2001 Jun;101(6):661-9. (Link)

3. Sanders, T. A. B. and Manning, J. The growth and development of vegan children. Journal of Human Nutrition and Dietetics,1992 5(1): 11–21. (Link)

4. Larsson CL, Johansson GK. Dietary intake and nutritional status of young vegans and omnivores in Sweden. Am J Clin Nutr. 2002 Jul;76(1):100-6. (Link)