abstract from Uptodate

1. SOY MILK AND VEGETARIAN
DIET IN CHILDREN

2. PROTEIN ASPECT
• Soybean-based products are essentially
equivalent in quality to animal protein.
• Soybeans are deficient in methionine.
• Supplementation of soy-based formulas with
methionine may improve the utilization of soy
protein by infants. The need for essential amino
acids decreases as growth and development
progress.
• Soy protein isolates without methionine
supplementation can serve as a primary source of
essential amino acids and nitrogen for protein
maintenance in children older than two years.

3. SUGER ASPECT
• Soy products contain sucrose as the basic
disaccharide, which breaks down into glucose and
fructose.
• Since soy does not contain galactose, a product of
lactose breakdown, soy-based infant formulas can safely
replace breast milk in children with galactosemia.
• Like lactose-free cow's milk, soymilk contains no lactose,
which makes it an alternative for those who are lactose-intolerant.

4. SOY PROTEIN-BASED
FORMULAS
• Numerous studies have documented normal growth
and development in term neonates fed methionine-supplemented
isolated soy protein-based formulas
• Soy protein-based formulas are not recommended for
preterm infants.
• Serum phosphorus concentrations are lower, and
alkaline phosphatase concentrations are higher in
preterm infants fed soy protein-based formula than they
are in preterm infants fed cow milk-based formula

5. VEGETARIAN
• Semi-vegetarian
• Lacto-ovovegetarian
• Lactovegetarian
• Macrobiotic
• Vegan

6. POSSIBLE LIMITING
NUTRIENTS
• Energy
• Protein(essential aminoacid)
• Iron, zinc, calcium
• Vitamin D
• Vitamin B12 (cyanocobalamin)
• Long-chain omega-3 fatty acids
• Dietary fiber,

7. ENERGY
• A plant-based diet that has a high fiber
content and low caloric density may provide a
sense of fullness before an adequate amount
of energy is ingested. This situation may be a
significant problem in young children, who
have small stomach capacities
• A Vegetarian Food Guide Pyramid
• Frequent meals and snacks containing energy
and nutrient-dense foods to meet their energy
needs.

8. PROTEIN
• Plant protein often deficient in one or more
of the essential amino acids
• Grains are lower in lysine
• Legumes are lower in methionine
• Digestibility:
• In general, amino acids from animal sources
are most easily digested (over 90 %). Well-processed
soy isolates are as digestible as egg
protein.
• Amino acids from legumes is 80 to 90%
digestible. Proteins from grains and other plant
foods are less digestible (70 to 90 %)

9. OMEGA3 FATTY ACID
• Vegetarian diets generally are rich in omega-6 (n-6)
fatty acids, but marginal in omega-3 (n-3) fatty acids,
unless the diet includes fish, eggs, or generous amounts
of algae.
• Omega-3 fatty acids, which include eicosapentaenoic
acid (EPA) and docosahexaenoic acid (DHA), or their
precursor alpha-linolenic acid (ALA), are important for
cardiovascular health and eye and brain
development.
• Adolescent vegetarians who do not eat oily fish should
include good sources of alpha-linolenic acid in their
diet, such as flaxseed, walnuts, canola oil, and soy

10. IRON
• The RDA for iron is
• 7 mg in children 1 to 3 years
• 10 mg in children 4 to 8 years
• 8 mg in children 9 to 13 years
• 11 mg for boys and 15 mg for girls age 14 to 18 years.
• The value is increased to 27 for pregnant adolescents

11. IRON
• Heme(in meat) iron is more readily absorbed
than is non-heme(in plant) iron (15 to 35 %
versus 2 to 20 %, respectively).
• Ascorbic acid, which prevents the formation of
less soluble ferric compounds, is a powerful
promoter of nonheme iron absorption and can
counteract the inhibitory effect of phytates.
• Fruits and vegetables such as citrus fruits,
strawberries, broccoli, and tomatoes are important
sources of both vitamin C and other facilitators of
iron absorption (eg, citric and malic acid

12. FACTORS INFLUENCING THE
ABSORPTION AND
BIOAVAILABILITY OF
• Absorption of heme iron DIETARY IRON
• Amount of heme iron, especially in meat
• Content of calcium in the meal (calcium impairs iron
absorption)
• Absorption of nonheme iron
• Iron status
• Amount of potentially available nonheme iron
• Balance between positive and negative factors
• Positive factors
• Ascorbic acid
• Meat or fish (heme iron enhances absorption of nonheme iron)
• Negative factors
• Phytate (in bran, oats, rye fiber)
• Polyphenols (in tea, some vegetables and cereals)
• Dietary calcium
• Soy protein

13. ZINC
• Recommendations for zinc are
• 3 mg/day for children aged 1 to 3 years,
• 5 mg/day for children aged 4 to 8 years,
• 8 mg/day for children aged 9 to 13 years.
• For adolescent females and males aged 14 to 18 years,
the recommendations are 9 mg/day and 11 mg/day
respectively

14. WHERE CAN GET ZINC
• Animal sources include oysters, shellfish, liver, meat,
poultry, and dairy products
• Milk and milk products are the primary source of zinc for
children on vegetarian diets who also consume animal
products. Good plant sources include whole grains,
legumes, wheat germ, and nuts.

15. CHILDREN NEED ZINC
• The zinc in vegetarian diets has a lower bioavailability
because of the high content of phytate and dietary
fiber
• Adult vegetarians do not typically develop zinc
deficiency because they have a compensatory
increase in fractional absorption. Children may be at
greater risk of a suboptimal zinc status because of high
requirements for growth

16. CALCIUM
• The optimal daily dietary allowance of calcium for
children and adolescents is
• controversial but probably approximates
• 700 mg for children 1 to 3 years of age,
• 1000 mg for children 4 to 8 years of age,
• 1300 mg for those 9 to 18 years

17. VITAMIN D
• Normal levels of vitamin D metabolites are
necessary for adequate intestinal calcium,
phosphate absorption, and bone formation.
Vitamin D availability is a function of sunlight
exposure and dietary intake
• Maintenance of normal serum vitamin D
concentrations requires exposure to the sun on
hands, arms, and face for 10 to 15 minutes per day
for fair-skinned individuals; individuals with dark skin
pigmentation require 6 to 10 times as much
exposure as a light-skinned individual.
• In addition to sun exposure, a dietary intake of 600
IU generally is recommended.

18. VITAMIN D
• The principal dietary source of vitamin D for omnivores,
lacto-ovovegetarians, and lactovegetarians is milk
fortified with vitamin D (100 IU per 8 oz).
• Vegetarians who do not consume milk are at risk for
vitamin D deficiency and rickets in children and
osteomalacia in adults

19. WHERE CAN FIND
VITAMIN D
• Fatty fishes (sardines, salmon, tuna, mackerel) and cod
liver oils are some of the better food sources of vitamin
D. Beef liver, cheese, and egg yolks provide small
amounts of vitamin D

20. VITAMIN B12
• RDA for cobalamin is
• 0.9 mcg for children 1 to 3 years of age,
• 1.2 mcg for those 4 to 8 years,
• 1.8 mcg for 9 to 13 years,
• 2.4 mcg for 14 to 18 years,
• 2.6 mcg for pregnant adolescents

21. WHERE CAN GET
VITAMIN B12
• Much of the vitamin B12 present in spirulina, sea
vegetables, tempeh, and miso is inactive and can
compete with active forms for absorption
• Lycium fruit

22. FIBER
• A childhood diet too high in fiber can
compromise dietary energy intake and, as
noted above, reduce the bioavailability of
minerals such as iron, calcium, and zinc.
• Studies of weaning diets with increased
fiber found no negative effect on the
absorption of energy, zinc, and calcium or
iron bioavailability and suggested
5 g/day is beneficial

23. HOW MUCH FIBER
SHOULD TAKE?
• The recommended fiber intake
• For children aged 1 to 3 years, about
19 g/day.
• For children aged 4 to 8 years, about 25g/day.
• For children aged 9 to 13 years, ranges from 26
to 31 g/day.
• This amount of dietary fiber should not have an
adverse effect on mineral bioavailability,
provided the dietary mineral intake is
adequate.

24. INTAKE OF FIBER DECREASE
MINERAL BIOAVAILABILITY
• Intake of fiber that exceeds the
recommendation may decrease mineral
bioavailability?
• Unlikely in vegetarian children who consume a
balanced diet from a variety of foods
• Likely in children who follow strict macrobiotic or
vegan diets with low intake of calcium, iron, and
zinc.
• Studies of children younger than 10 years of
age who consumed a macrobiotic diet based
mainly on whole-grain cereals and vegetables
revealed deficiencies of energy, protein,
vitamins, and minerals, resulting in retarded
growth and slower psychomotor development

25. REFERENCE
• Uptodate: Vegetarian diets for children
• Jatinder, et al. Use of Soy Protein-Based Formulas in
Infant Feeding. Pediatrics 2008;121;1062