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Vegetarian Diet, Growth, and Nutrition in Early Childhood: A Longitudinal Cohort Study

Laura J. Elliott, RD, MSc,a,b Charles D.G. Keown-Stoneman, PhD,c,d Catherine S. Birken, MD, MSc, FRCPC,e,f,g,h,i David J.A. Jenkins, MD, PhD, DSc, FRSC, FRCP, FRCPC,a,j,k,l,m Cornelia M. Borkhoff, MSc, PhD,e,f,h,n Jonathon L. Maguire, MD, MSc, FRCPC,a,b,g,h,i,l on behalf of the TARGet KIDS! COLLABORATION


Objectives: The primary objective of this study was to examine the relationships between vegetarian diet and growth, micronutrient stores, and serum lipids among healthy children. Secondary objectives included exploring whether cow's milk consumption or age modified these relationships.

Methods: A longitudinal cohort study of children aged 6 months to 8 years who participated in the TARGet Kids! cohort study. Linear mixed-effect modeling was used to evaluate the relationships between vegetarian diet and BMI z-score (zBMI), height-for-age z-score, serum ferritin, 25-hydroxyvitamin D, and serum lipids. Generalized estimating equation modeling was used to explore weight status categories. Possible effect modification by age and cow's milk consumption was examined.

Results: A total of 8907 children, including 248 vegetarian at baseline, participated. Mean age at baseline was 2.2 years (SD 1.5). There was no evidence of an association between vegetarian diet and zBMI, height-for-age z-score, serum ferritin, 25-hydroxyvitamin D, or serum lipids. Children with vegetarian diet had higher odds of underweight (zBMI <-2) (odds ratio 1.87, 95% confidence interval 1.19 to 2.96; P = .007) but no association with overweight or obesity was found. Cow's milk consumption was associated with higher nonhigh-density lipoprotein cholesterol (P = .03), total cholesterol (P = .04), and low-density lipoprotein cholesterol (P = .02) among children with vegetarian diet. However, children with and without vegetarian diet who consumed the recommended 2 cups of cow's milk per day had similar serum lipids.

Conclusions: Evidence of clinically meaningful differences in growth or biochemical measures of nutrition for children with vegetarian diet was not found. However, vegetarian diet was associated with higher odds of underweight.

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