Journal of Human Nutrition and Dietetics (1992), 5, 11-21

The growth and development of vegan

children

T. A. B. Sanders* and Joan Manning

Department of Nutrition and Dietetics, King's College London, Campden Hill
Road, London W8 7AH

The results of prospective study on the growth and diets, estimated from 7-day
weighed food intake records, of 20 life vegan children (aged 5.8-12.8 years) are
presented. The growth and development of the children were normal but they
tended to be lighter in weight and exceptionally lean compared with standards.
Heights were around the median of the Tanner-Whitehouse standards but
were lower than the medians recently proposed by the Department of Health.
Energy intakes were similar to those reported i n children of the same age in
the general population, but dietary fibre intakes were very high which may
have influenced the digestible energy. Sugar provided an average 15.6% of the
dietary energy and this was supplied mainly by fruit and fruit juice. Mean fat
intakes were close to the dietary reference values. Daily intakes of essential
nutrients generally met the amounts recommended, with the exceptions of
calcium and vitamin BIZ. Many children received supplementary sources of
vitamin BI2 and only two children had intakes below the lower recommended
nutrient intake. Intakes of saturated fatty acids were low and those of linoleic
acid were high. The ratio of linoleic/a-linolenic acid was high. As
docosahexaenoic acid is absent from vegan diets, it is suggested that vegans
should use oils with a lower ratio of linoleic/a-linolenic acid. Future studies
should also consider the influence of a vegan diet on retinal function. None of
the children was immunized against whooping cough and 11 had not been
immunized against polio: 16 of the children had suffered from whooping
cough. Future studies need to take into account factors other than diet when
assessing the health of vegans. The results of this study show that children can
be successfully reared on a vegan diet providing sufficient care is taken to
avoid the known pitfalls of a bulky diet and vitamin BIZdeficiency.

Key words: diet, growth, polyunsaturated fatty acids, vegans, vegetarianism,

vitamin BIZ.

Introduction adults, in view of their low saturated fat

The popularity of vegetarianism has in-
creased greatly over the past few years
with growing concerns about animal wel-
fare, the environment and healthy eating.
While strict vegetarian or vegan diets may
offer certain advantages to the health of
'To whom correspondence should be ad-
dressed.
and high fibre contents (Sanders, 1978),
their adequacy for children has been a
moot point (Jacob & Dwyer, 1988).
In 1978 we began a prospective study on
the growth and development of children
born to vegan mothers (Sanders et al.,
1978a, 1978b; Hughes, 1979; Sanders &
Purves, 1981). In this paper we report on
the dietary habits and development of the
children in 1987-88.
11
12 T. A. B. Sanders and J. Manning
Methods
Twenty-seven vegan families who had
been the subjects of earlier research (San-
ders & Purves, 1981;Roshanai, 1983)were
contacted by letter. Twelve families re-
plied: one family was not willing to partici-
pate, two families were no longer vegans,
nine families agreed to take part in the
study.
The families were visited at home by
J.M. and a structured interview was car-
ried out with the parents and children. The
children were weighed in minimum in-
door clothing on electronic bathroom
scales that had been calibrated and their
heights without shoes recorded with a
portable stadiometer. Chest and head cir-
cumference measurements were made and
biceps, triceps and subscapular skinfold
thickness were measured using Harpenden
callipers. Photographs of all but two of the
children were taken. The parents and
children were given clear instructions on
how to record foodintake. Each family was
provided with a Soehlne electronic dietary
balance (accurate to 1 g) and a food record
diary. Food wrappers, recipes and the
composition of packed lunches were re-
quested where applicable. The families
were asked to keep a weighed food-intake
record for each child for a minimum of five
consecutive days including a weekend.
The families returned their diaries and the
scales by post. They were reimbursed their
postage expenses and sent photographs of
their children.
Anthropometric measurements were
compared with the Tanner and White-
house standards and the centiles for height
and weight were estimated using charts
obtained from Creaseys Ltd (Castlemead,
Herts SG14 1LH). Samples of hair were
obtained from the children and analysed
for heavy metals and trace elements by
atomic absorption spectroscopy (Bio-
labs; Weymouth Street, London). Nutrient
intakes were calculated from the weighed
food intake data using the FOODTABS
computer program (T.A.B. Sanders, unpub-
lished). This program uses the McCance
and Widdowson data base (Paul & South-
gate, 1978;Paul et al., 1979; Tan et al., 1985;
Holland et al., 1988, 1989) as well as
supplementary information obtained from
manufacturers.
Results
General health
Twenty children (mean age 9.5 years,
range 5.8-12.8 years) were studied. The
general health of the children appeared
good and all the children were registered
with a general practitioner. Eight of the
nine families, however, reported that they
preferred to seek advice from an alterna-
tive practitioner (homeopath or herbalist).
Nineteen out of 20 of the children were
registered with a dentist and 18 of these
visited regularly. Two children had miss-
ing teeth, two decayed teeth and nine had
dental fillings. The mean decayed, missing
or filled (DMF) index was 1.2 (S.E. 0.38).
None of the children had been vacci-
nated against whooping cough and 16 had
suffered from whooping cough. Only nine
children had been immunized against po-
lio. Nine children received vitamin BI2
supplements regularly.
All of the children had been breast-fed
from birth, on average for 15.5 months
(range 3 months-8 years). Three children
received cows' milk or cow's milk infant
formula at 1 week, 2 years and 5 years
respectively.
One child WRS educated at home, one at
a music school and all the others attended
state schools. No behavioural problems
were reported by the parents. Most of the
children (17) took packed lunches to
school, but four also had school lunches,
usually chips and beans. Other food con-
sumed away from the home included
crisps, nuts and fruit, cakes, biscuits, jelly
and sandwiches. Fifteen of the children
did not mind eating non-vegan foods but
five were upset by the thought and two of
these claimed it made them physically ill.
The children were asked whether they
had eaten any food of animal origin and if
so what food and how often. The usual
reason for eating non-vegan food was to be
sociable. The quantities eaten were small
 Growth and development of vegan children
Table 1. Anthropometric measurement on 20 vegan children
Height
Mean 96 standard for age
Median centile for age
Weight
Mean % standard for age
Median centile for age
Mean head circumference (cm)
Median centile for age
Mean Biceps skinfold (mm)
Triceps skinfold
Mean (mm)
Median centile for age
Subscapular skinfold
Mean (mm)
Median centile for age
Age (years)
and were infrequently consumed [from
once a week to 2-3 times a year). Cake,
milk, biscuits, ice-cream, egg, chocolate
and jelly were the non-vegan foods most
commonly consumed.
Potato crisps were the favourite snack
food, followed by sweets, fruit and health
bars [i.e. muesli bars). Snack foods were
part of the daily diet of 13 of the children.
The average age of the parents was 41
years [range 33-50). The mothers had been
vegans for 16 years on average [s.d. 9.4
years). The parents in seven families drank
moderate amounts of alcohol and in two
families, the parents smoked cigarettes.
The families bought their food in bulk
from supermarkets as well as from special-
ity shops. They all purchased wholegrain
cereals and grew some of their own vege-
tables. Six families always purchased or-
ganic and pesticide-free foods. Eight of the
families claimed to avoid food additives.
Anthropometric measurements
The growth and development of the chil-
dren were normal and their heights and
weights were generally inside the normal
range for children of their age [Table 1).
However, there was a tendency for the
children to be lighter in weight compared
13
Range
100.7 89.7- 110.8
55 (3-97
95.5 77-119
35 3-88
53.9 51-55.5
94 50- >97
2.1 1.8-2.9
2.7 1.9-3.7
(3 all <3
5.2 3.6-5.9
25 (3-50
9.5 5.8-12.8
with standards, although their heights
were on average around the median. This
tendency for the children to be smaller in
stature was more marked in the boys than
amongst the girls, and this was noted when
the children were under the age of five
years. One child was mildly malnourished
at the age of 13 months-on resurveying
her at age 8 years, she had caught up and
was on the 75th percentile for weight and
height for her age. The children were all
exceptionally lean and this was reflected
in their low skinfold thickness measure-
ments. In contrast to the rest of their
bodies, their head circumferences were
high.
Dietary intakes
The diets of the children consisted mainly
of wholemeal bread, other cereals, pota-
toes, soya products and fresh fruit and
vegetables [Table 2). The weight of foods
consumed was relatively high and the
energy density was on average 1.15 kcal/g
[range 0.93-1.37; s.e. 0.029). Table 3 shows
the intakes of proximate nutrients. Fat
provided on average 31.5% of the dietary
energy. The intake of saturated fatty acids
was very low in the children, but the
intake of linoleic acid was high. Conse-
quently the average polyunsaturated/satu-
14 T.A. B. Sanders and J. Manning
Table 2. Weights of food making up the daily used to calculate nutrient intakes in that
diet of 18 vegan children study). Comparisons of energy intakes are
made in this case with the 1979 rec-
g ommended daily amounts (Department of
Bread 137
Health and Social Security, 1979). The
Breakfast cereals 33
Other cereals 63
vegan diets provided greater amounts of
Cakes end biscuits 21 most nutrients with the notable exceptions
Fats 29 of fat, calcium and vitamin BIZ.The vegan
Vegetables 88 diets provided large amounts of dietary
Potatoes 162 fibre. Total energy intakes were similar to
Other root vegetables 42 those reported in non-vegetarian children.
Leafy vegetables 34 Comparisons of the intakes with esti-
Pulses, including soya milk 239 mated energy requirements and dietary
Fresh fruit 216 guidlines are shown in Table 5. Compared
Dried fruit 13
with the recent WHO (1990) guidelines,
Nuts 25
Sugar 4
intakes of sugar and polyunsaturated fat
5
and total fat exceeded the upper limits
Jam
Confectionery 5 recommended for the population. None of
Fruit juice and soft drinks 238 the children had intakes of vitamin D that
Other 205 approached the UK recommendation-
although a dietary source may not be
Number of foods making
up diet 55 (30-84) necessary if exposure to sunlight is ade-
quate. The diets of the majority of children
provided intakes below the recommended
nutrient intakes (RNI) for calcium and
rated ratio was 1.89. The ratio of vitamin B,2.
n-6/n-3 fatty acids was also high, 44:l.
Sugar provided on average 15.6% of the Table 6 shows the contribution made by
energy intake. different food groups to the intakes of
Table 4 shows the intakes of nutri- selected nutrients. Cereals provided most
ents/1000 kcal compared with intakes of of the energy, protein, carbohydrates, fibre,
children of the same age estimated from 7- calcium and iron. Fats provided almost
day weighed food intake records in North half the vitamin E intake and margarine
London reported by Nelson et aJ. (1990) about 20% of the vitamin A intake. Nuts
eating mixed diets (the same software was and pulses provided useful amounts of

Table 3. Daily nutrient intakes of 18 vegan children aged 5.8-12.8

years

Mean Range

Energy (MJ) 7.20 5.60-10.48

Energy (kcal) 1720 1340-2500
Per cent EAR (DOH, 1991) 95 69-136
Protein % energy 12.4 9.2-16.9
Fat O h energy 31.5 22,O-45.5
Saturated fatty acid % energy 4.8 3.1-6.9
Linoleic acid % energy 8.8 4.35-13.41
Linolenic acid % energy 0.2 0.15-0.46
Polyunsaturated/Saturated ratio 2 -89 1.26-2.50
Carbohydrate % energy 55.6 43.8-65.6
Sugar % energy 15.6 8.2-26.5
Dietary fibre (g) 36.9 23.5-52.3
 Growth and development of vegan children 15
Table 4. Nutrient density of the vegan children’s diets compared with
those of British omnivorous children excluding supplements

British
Vegan children*
children 7-12 yrs
(n=18) s.d. (n=194)

Energy O h RDA (DHSS, 1979) 83 15.7 82

Protein (g/1000 kcal) 31.0 5.12 6 30.8
Fat (g/1000 kcal) 35.0 6.4 41.1
Carbohydrate (g/lOOO kcal) 148 36.9 135
Fibre (g/1000 kcal) 21.8 4.42 9.2
Calcium (mg/1000 kcal) 270 48.3 400
Iron (mg/1000kcal) 12.6 7.1 5.7
Zinc (mg/1000 kcal) 4.3 0.85 3.9
Copper (rng/1000 kcal) 0.96 0.14 0.96
Vitamin A (r.e./1000 kcal) 546 202 370
Thiamin (rng/lOOO kcal) 0.98 0.22 0.64
Riboflavin (rng/1000 kcal) 1.00 0.49 0.82
Niacin (n.e./1000 kcal) 14.0 3.02 14.1
Vitamin B, (mg/1000 kcal) 0.79 0.19 0.66
Vitamin B,2 (&lo00 kcal) 1.3 1.18 1.64
Total folate @g/1000 kcal) 146 29.6 77
Biotin (pg/1000kcal) 10.9 2.95 7.9
Vitamin C (rng/1000kcal) 54 24.2 38.2
Vitamin D @g/1000 kcal) 1.1 0.60 0.9
Vitamin E (mg/lOOO kcal] 4.4 0.81 2.5

‘Source: Nelson et 01. (1990).

protein, fibre, calcium and iron. Carrots
provided 60% of the vitamin A intake.
Fruit and fruit juice provided most of the
vitamin C intake followed by potatoes and
other vegetables. Very little of the sugar
was provided by confectionery, sugars and
preserves; most was provided by fruit (both
fresh and dried) and soft drinks, mainly
fruit juice. Potatoes were the most impor-
tant source of potassium in the diet.
Table 7 shows the results of the hair
mineral analyses. The results were gener-
ally inside the reference ranges for the
laboratory. One child had a slightly ele-
vated level of lead in his hair. However, his
father had a metal workshop in the garden
and it is possible that the lead was not of
dietary origin (e.g. solder) as his sister had
normal levels of lead in her hair.
Discussion
This prospective study of the growth and
development of children reared as vegans
is unique. Other studies of vegan children
have been cross-sectional (O’Connell et al.,
1989) and have involved the inclusion of
children who have not been vegans for life.
The families studied lived independently
inside the general community, unlike
some other studies which have looked at
commune dwelling vegetarians. Neverthe-
less, the families in our study differed from
the general population in respects other
than that of diet. These have implications
for health. This was highlighted by the low
proportion of children who have been
immunized against whooping cough and
polio. All t h e children were registered
with a general practitioner and the low
uptake of immunization was for ethical
reasons as vaccines are usually raised in
animals. It is noteworthy that the majority
of the children had suffered from whoop-
ing cough which, although rarely fatal, is
associated with significant long-term mor-
bidity.
16 T. A. B. Sanders and J. Manning
Table 5. Comparison of the nutrient intakes of the vegan children with
dietary guidelines (DHSS,1991)

Number out of 18

Energy(Estimated Average Requirement 16

Protein< RNI 0
Fat>30% energy 11
Fat>35% energy 3
Saturated fat>lo% energy 0
Polyunsaturated fatty acids>lo% energy 5
Sugars>lO% energy 17
CalciumcRNI 17
Calcium<LRNI 1
IrontRNI 0
ZinctRNI 9
ZinctLRNI 0
Vitamin A<RNI 2
Vitamin AtLRNI 0
Thiamin <R NI 0
RiboflavintRNI 6
Riboflavin< LRNI 0
NiacintRNI 0
Vitamin B,<RNI 0
Vitamin B,,<RNI 9 (3)’
Vitamin B,,<LRNI 2 (1)’
FolatetRNI 0

*including supplements.
RN1:recommended nutrient intake.
LRNI: lower recommended nutrient intake.

Height is believed to be a good indicator
of nutritional status, but diet is not the only
environmental factor influencing height.
Childhood illness can also cause growth
faltering and this may have a permanent
effect on growth. The growth and develop-
ment of the children appeared to be within
the normal range but there was a tendency
for the children to be lighter in weight and
shorter in stature compared with children
on mixed diets. The tendency for the
children to be short in height compared
with standards was also noted when the
children were under the age 5 (Sanders &
Purves, 1981). In contrast to height, the
head circumference was greater than the
90th centile. The Department of Health
(1989a) found that children on mixed diets
tended to be taller and heavier compared
with the Tanner-Whitehouse standards
which were based on measurements made
on children in the 1960s. The vegan chil-
dren were around the 50th centile for
height using these standards. The Depart-
ment of Health (1991) has recently pro-
posed new standards for height and weight
which allow for the increase in average
height and weight in the general popula-
tion. If the vegan children are compared
with those, then there is certainly a ten-
dency for them to be shorter in stature.
In the present study it should be noted
that the children were exceptionally lean.
Weight and, in particular, the proportion of
body fat is a good predictor of the rate of
maturation. Adipose tissue plays an impor-
tant role in the peripheral aromatization of
androgens to form oestrogens. It would be
predicted therefore that sexual maturation
would be delayed in girls. This may be
advantageous in that an early age of men-
arche is well-known to be associated with
an increased risk of breast cancer in later
life.
The lower proportion of body fat in the
children cannot be explained by low en-
Table 6. Contributions made by different food groups to mean daily intake of nutrients in 18 vegan children aged 5.8-12.8years

Per cent total intake

Energy Protein Fat CHO Sugar Fibre Potassium Calcium Iron Vit A Vit E Vit C Folate

Bread 17.6 23.3 5.8 22.9 3.3 26.6 8.6 19.2 21.4 0 6.3 0 21.5
Other cereals 19.8 19.2 9.9 25.4 9.1 21.5 9.6 11.5 23.4 4.6 5.3 0 14.6
Nuts 7.1 7.6 16.9 1.5 0.8 3.9 4.3 4.1 4.7 0 11.0 0 1.3 9
Fats 12.3 0 37.9 0 0 0 0 0 0 19.7 49.0 0 0
Pulses 11.8 32.1 12.4 6.4 3.3 20.6 17.0 27.2 21.5 2.8 2.1 4.1 14.7 y
z
Potatoes 11.9 6.5 8.9 14.7 0.7 5.8 25.0 2.8 5.2 0 5.9 21.9 6.3 Q

Other mot vegetables 0.6 0.7 0 0.9 3.1 3.2 2.4 3.7 1.3 60.6 1.8 2.1 3.3 EL
Fresh vegetables 2.2 2.4 3.8 1.3 3.4 5.5 7.7 7.4 4.4 7.7 6.2 15.7 10.2 a
m
Fresh fruit 5.4 2.1 0.5 8.9 21.8 9.6 10.9 6.1 4.3 2.7 5.3 37.2 8.6
Dried fruit 1.8 0.3 0 3.1 9.8 2.3 3.0 2.0 1.3 0.1 0 0 0.2 'c1
Sugar and preserves 1.6 0 0.1 2.7 9.1 0.2 0.5 1.2 0.9 0 0 0.3 0 3
Confectionery 1.2 0.4 1.1 1.3 3.7 0.1 0.3 0.5 0.8 0 0.1 1.0 0 -s
Soft drinks 6.0 0.9 0.3 10.0 31.8 0 7.0 3.6 7.4 0.4 0.2 16.5 1.6
17.7 (D
<
Miscellaneous 0.7 4.5 2.4 0.9 0.1 0.7 3.7 10.7 3.4 1.4 6.8 1.2
op
Mean Intake 7.20 MJ 538 64g 268 g 72g 37g 3.3 g 458mg 16.6mg 1022 re 8.8 mg 107.0 mg 25Ol.4 5
18 T. A. B. Sanders and J. Manning
Table 7. Trace minerals in hair of 18 vegan active (Herbert, 1988). Fortified foods con-
children (mg/kg) aged 5.8-12.8 years taining cyanocobalamin are, however,
used by many vegans in the U.K. Most of
Normal the families were aware of the need to use
Mean s.d. range food supplemented with vitamin B,, and
generally the diets of the children pro-
Iron 27 2.1 20-60
Calcium 16 1.0 10-40 vided insufficient amounts of the vitamin.
Zinc 183 14.1 150-240 However, all but a few had adequate
Chromium 0.78 0.028 0.6-1.5 intakes if the contribution made by supple-
Manganese 1.28 0.098 1.0-2.6 ments were included. There is clearly a
Selenium 2.08 0.066 1.5-4.0 need for vegans to be vigilant in avoiding
Nickel 0.53 0.039 0.4-1.4 dietary vitamin BI2 deficiency.
Cobalt 0.20 0.029 0.1-0.7 Iron intakes were reassuringly high. The
Lead 6.46 0.94 €15 availability of iron from plant sources is
Mercury 0.42 0.085 (2 generally low, but it would be enhanced by
Cadmium 0.15 0.017 (0.5
the high intakes of vitamin C provided by
Arsenic 0.10 0.009 (2
Aluminium 3.49 0.589 (10 the vegan diets. Reddy & Sanders (1990)
found low serum ferritin levels in vegetar-
ians compared with omnivores. However,
both vegetarian and vegan diets are able to
ergy intakes as their energy intakes were sustain normal haemoglobin concentra-
similar to children on mixed diets. This tions (Sanders et al., 1978a; Reddy & San-
tendency for leanness in vegans has been ders, 1990).
previously reported (Sanders et al., 1978b) Calcium intakes almost without excep-
and again there is little evidence to suggest tion were below the amounts rec-
that vegans have lower intakes of food ommended by most authorities (National
energy than omnivores (Roshanai & San- Research Council, 1989; Department of
ders, 1984; Sanders & Key, 1987).The diets Health, 1991). However, they were gener-
of the vegan children contained large ally above the lower recommended nutri-
amounts of dietary fibre. This may have ent intake (Department of Health, 1991).
decreased the digestibility of fat and other Besides milk products, there are few other
energy-providing nutrients (British Nutri- rich sources of calcium. Fortunately, some
tion Foundation, 1990). soya milks, such as Plamil, are fortified
Low serum vitamin BI2 concentrations with calcium. Dark green, leafy vegetables
have been reported both in vegans (San- are often recommended as a good source of
ders et al., 1978a)and vegetarians (Reddy & calcium but they are rarely eaten in suffici-
Sanders, 1990) and in children reared on ent quantity to make a significant contribu-
macrobiotic diets (Dagnelie et a]., 1989; tion to total intake. Cereals and pulses
Specker et al., 1990 Miller et al., 1991).The [particularly soya milk) were the most
latter two reported increased urinary ex- important sources of calcium in the vegan
cretion of methyl malonic acid in macro- diets. Although the availability of calcium
biotic vegetarians which is consistent with is reduced by the presence of phytates in
an inadequate intake of the vitamin. A cereals, the process of leavening bread
number of isolated cases of dietary vitamin destroys the phytate. The results of this
B,* deficiency have been reported in ve- study support the earlier conclusion drawn
gans. Deficiency mainly presents as the by Widdowson & McCance (1954) that
more insidious neurological symptoms children will grow and develop quite nor-
which can lead to peripheral neuropathy mally on a diet consisting of plenty of
and optic nerve damage rather than as bread and vegetables with minimal
megaloblastic anaemia because of their amounts of milk and meat.
high intakes of folate. Small amounts of The value of hair analyses for the assess-
vitamin B,,-like material is present in ment of mineral status has been ques-
some plant foods, but is not biologically tioned (Fairweather-Tate, 1988). However,
 Growth and development of vegan children
it was reassuring that the concentrations of
essential and toxic minerals were inside
the laboratory normal range.
It is of interest to compare the dietary
intakes of the children with recent dietary
guidelines. A decrease in ‘free’ or ‘extrin-
sic’ sugars to less than 10% of the energy
intake (WHO,1990; Department of Health,
1991) have been advocated in order to
avoid dental caries and obesity but also
because sugar is regarded as a source of
‘empty calories’. From a practical stand-
point, it is difficult to define, in the cur-
rency of food, what is meant by the term
‘intrinsic’ sugar as defined by the Depart-
ment of Health (1989b), especially as the
‘extrinsic’ sugar in fruit becomes, intrinsic
sugar when it is chewed in the mouth!
Similarly, the term ‘free sugar‘ is ambig-
uously defined by the WHO (1990) as
‘including monosaccarides, disaccharides
and other short-chain sugars produced by
refining carbohydrates’. This begs several
questions. Is the sugar in unsweetened
apple juice free sugar? Is the sugar in
bananas, dates and raisins free?
The total sugar intakes of the vegan
children were high. However, only a small
fraction was derived from ‘added sugars’,
i.e. confectionary, jam and table sugar.
Indeed vegans tend to avoid white sugar as
animal charcoal is sometimes used to
bleach it. Despite their high sugar intakes,
the children generally had good teeth and
the level of dental caries was low. More-
over, there certainly was no evidence to
suggest that their high sugar intake was
causing obesity. In fact the opposite was
true, the children were very lean. The
desirability of decreasing the intake of
sugar in these children is questionable as
the foods that provided the sugar also
supplied several other useful nutrients.
Indeed, it would be more appropriate to
advise them against consuming sugary
snacks (including fruit) too frequently be-
tween meals as frequency of consumption
is more strongly related to risk of dental
caries than the total quantity of sugar in
the diet (Curzon,. 1988).
The Department of Health and Social
Security (1984), WHO (1990) and Depart-
ment of Health (1991) have recommended
19
reductions in total fat and saturated fatty
acid intake. The rationale for imposing
these limits is the association of obesity
with high fat intakes and the relationship
between high intakes of saturated fatty
acids and coronary heart disease in adults.
Total fat intakes were lower in the vegan
children than in children on mixed diets
and those of saturated fatty acid were
particularly low. On the other hand, the
intake of polyunsaturated fatty acids was
relatively high. Moreover, the ratio of
linoleic/linolenic acid was high and this is
likely to inhibit conversion of a-linolenic
acid (18:3n -3) to docosahexaenoic acid
(22:6n-93). This may be important as
docosahexaenoic acid is absent from vegan
diets (Roshanai & Sanders, 1984). Previous
studies (Sanders et al., 1978b; Sanders &
Younger, 1981; Roshanai, 1983) have re-
ported reduced levels of docosahexaenoic
acid in plasma, erthrocyte and platelet
phospholipids of vegans compared with
controls. Similar differences have also
been noted i n the Hindu vegetarians
(Reddy & Sanders, 1987). Docosahexaenoic
acid (22:6n-3) is believed to play a n
important role in the retina and in the
central nervous system. It has been argued
that docosahexaenoic acid might be condi-
tionally essential for the premature infant.
Primates fed on diets containing a high
ratio of linoleic/linolenic acid show im-
paired visual function (Neuringer et al.,
1984) and this change is accompanied by a
reduction i n docosahexaenoic acid
(22:6n - 3) in blood lipids. However, re-
versing the biochemical abnormality did
not correct the impaired visual function
(Connor et al., 1991). Uauy et al (1990)
reported abnormal electro-retinograms in
pre-term infants fed diets devoid of a-
linolenic acid or its derivatives. The chil-
dren in this study were all breast-fed.
Lower levels of docosahexaenoic acid were
found in the milk of vegan mothers com-
pared with omnivore controls (Sanders et
a]., 1978b) and the erythrocyte lipids of the
infants also contained a lower proportion
of 22 :6n -3 than infants breast-fed by
omnivorous mothers or those bottle fed on
cow’s milk formula (Sanders & Naismith,
1979).
20 T. A. B. Sanders and J. Manning
It has been alleged that low levels of
docosahexaenoic acid in brain may affect
learning ability. Although we undertook
no formal assessment of intelligence and
cognitive skills, the children did not ap-
pear to have any learning problems and
were doing well at school. Some were
exceptionally bright and had received mu-
sic scholarships. However, it might be
appropriate to recommend vegans to use
soyabean or rapeseed oils instead of sun-
flower, safflower or corn oils for cooking as
these oils have lower ratios of a-linolenic/
linoleic acid.
In future, we hope to confirm whether
sexual maturity occurs later in children
reared on vegan diets and to carry out tests
relating to visual function.
Acknowledgments
The authors wish to thank the parents and
children, Mrs Kathleen Jannaway and John
Strettle, for their co-operation in the study,
the Vegetarian Society for a grant and Dr
John Howard and Dr Stephen Davies for
the hair analyses.
References
British Nutrition Foundation (1990) Complex
Carbohydrates in Foods. The Report of the
British Nutrition Foundation’s Task Force.
London: Chapman and Hall.
Connor, W.E., Neuringer, M. & Reisbick, S.
(1991) Essentially of 3 fatty acids: evidence
from the primate model and implications for
human nutrition. In: Health Effects of 3 Poly-
unsaturated Fatty Acids in Seafoods (A. P.
Simopoulos, R. R. Kifer, R. E. Martin & S. M.
Barow, eds). Basel: Karger.
Curzon, M.E.J. (1988) Dietary carbohydrate and
dental caries. In: A Balanced Diet? (J. Dobbing,
ed.). London: Springer-Verlag.
Dagnelie, P.C., van Staveren, W.A., Vergote,
F.J.V.R.A., Dingjan, P.G.,van den Berg, H. &
Hautvast, J.G.A.J. (1989) Increased risk of
vitamin B,* and iron deficiency in infants on
macrobiotic diets. Am. J. Clin. Nutr. 50,
818-824.
Department of Health (1989a) The Diets of British
Schoolchildren. Report on Health and Social
Subjects No. 36. London: HMSO.
Department of Health (1989b) Dietary Sugars
and Human Disease. Report on Health and
Social Subjects No. 37. London: HMSO.
Department of Health (1991) Dietary Reference
Values for Food Energy and Nutrients for the
United Kingdom. Report on Health and Social
Subjects No. 41. London: HMSO.
Department of Health and Social Security (1979)
Recommended Daily Amounts. Report on
Health and Social Subjects No. 15. London:
HMSO.
Department of Health and Social Security (1984)
Diet and Cardiovascular Disease. Report on
Health and Social Subjects No. 28. London:
HMSO.
Fairweather-Tait, S.J. (1988) Zinc in human
nutrition. Nutr. Res. Rev. 1, 23-37.
Herbert, V. (1988) Vitamin B,*: plant sources,
requirements, and assay. Am. J. Clin. Nutr. 48,
852-858.
Holland, B., Unwin, I.D. & Buss, D.H. (eds) (1988)
Cereals and Cereal Products. Third Supple-
ment to McCance and Widdowson’s The Com-
position of Foods’. Letchworth: Royal Society
of Cbemistry/MAFF.
Holland, B., Unwin, I.D. & Buss, D.H. (eds) (1989)
Milk Products and Eggs. Fourth Supplement to
‘McCance and Widdowson’s The Composition
of Foods’. Letchworth: Royal Society of
Chemistry/MAFF.
Hughes, J. (1979) The Influence of Maternal Diet
on Breast Milk Composition, with Particular
Regard to the Water Soluble Vitamins. PhD
Thesis, University of London.
Jacobs, C. & Dwyer, J.T. (1988) Vegetarian chil-
dren: appropriate and inappropriate diets. Am.
J. Clin. Nutr. 43 (Suppl. 3), 811-818.
Miller, D.R., Specker, B.L., Ho, M.L. & Norman,
E.J.(1991) Vitamin BI2status in a macrobiotic
community. Am. J. Clin. Nutr. 53, 524-529.
National Research Council (1989) Aec-
ommended Dietary Allowances, 10th edition.
Washington: National Academy of Sciences.
Nelson, M., Naismith, D.J., Burley, V., Gatenby,
S. & Geddes, N. (1990) Nutrient intakes, vita-
min-mineral supplementation, and intelli-
gence in British schoolchildren. Br. J. Nutr. 64,
13-22.
Neuringer, M., Connor, W.E., Van Petten, C. &
Barstad, L. (1984) Dietary omega-3 fatty acid
deficiency and visual loss in infant Rhesus
monkeys. J. Clin. Invest. 73, 272-276.
O’Connell, J.M., Dibley, M.J., Sierra, J., Wallace,
B., Marks, J.S. & Yip, R. (1989) Growth of
vegetarian children: The Farm Study. Pedia-
trics 84, 475-481.
Paul, A.A. & Southgate, D.A.T. (1978) McCance
and Widdowson’s The Composition of Foods’.
London: HMSO.
 Growth and development of vegan children
Paul, A.A., Southgate, D.A.T. & Russell, J. (eds)
(2979) First Supplement to McCance and Wid-
dowson’s The Composition of Foods’.
MAFF/MRC. London: HMSO.
Reddy, S. & Sanders, T.A.B. (1987) Plasma
phospholipid fatty acid composition in men of
Asian and European descent. Proc. Nutr. SOC.
46, 117A.
Reddy, S. & Sanders, T.A.B. (1990) Haematologi-
cal studies on pre-menopausal Indian and
Caucasian vegetarians compared with Cauca-
sian omnivores. Br. J. Nutr. 64, 331-338.
Roshanai, F. (1983) The Influence of Dietary 0 3
Polyunsaturated Fatty Acids on Vascular Lip-
ids and Platelet Function. PhD Thesis, Univer-
sity of London.
Roshanai, F. & Sanders, T.A.B. (1984) Assess-
ment of fatty acid intakes in vegans and
omnivores. Human Nutr.: Appl. Nutr. 38A,
345-354.
Sanders, T.A.B. (1978) Vegan diet-a remedy for
diseases of affluence. In: Getting the Most out
of Food. Burgess Hill: Van den Berghs &
Jurgens Limited.
Sanders, T.A.B. & Key, T.J.A. (1987) Blood pres-
sure, plasma renin activity and aldosterone
concentrations in vegans and omnivore con-
trols, Human Nutr.: Appl. Nutr. 41A, 101-108.
Sanders, T.A.B. & Naismith, D.J. (1979) A con-
parison of the influence of breast-feeding and
bottle-feeding on the fatty acid composition of
erythrocytes. Br. J. Nutr. 41, 619-623.
Sanders, T.A.B. & Purves, R (1981) An anthropo-
metric and dietary assessment of the nutri-
tional status of vegan pre-school children. J.
Hum. Nutr. 35, 349-357.
Sanders, T.A.B. & Younger, K.M. (1981) The
effect of dietary supplements of 0 3 polyunsa-
MS acccepted October 1991
21
turated fatty acids on the fatty acid compo-
sition of platelets and plasma choline phos-
phoglycerides. Br. J. Nutr. 45, 613.
Sanders, T.A.B., Ellis, F.R. & Dickerson, J.W.T.
(1978a). Haematological studies on vegans. Br.
J. Nutr. 40, 9-15.
Sanders, T.A.B., Ellis, F.R. & Dickerson, J.W.T.
(1978b) Studies of vegans: the fatty acid com-
position of plasma choline phosphoglycerides,
erythrocytes, adipose tissue, and breast-milk
and some indicators of susceptibility to ischa-
emic heart disease in vegans and omnivore
controls. Am. J. Clin. Nutr. 31,805-813.
Specker, B.L., Black, A., Allen, L. & Morrow, F.
(1990) Vitamin BIZ: low milk concentrations
are related to low serum concentrations in
vegetarian women and to methylmalonic aci-
duria in their infants. Am. J. Clin. Nutr. 52,
1073-1076.
Tan, S.P., Wenlock, R.W. & Buss, D.H. (1985)
Immigrant Foods. Second Supplement to
McCance and Widdowson’s The Composition
of Foods’. London: HMSO.
Uauy, R.D., Birch, D.G.,Birch, E.E., Tyson, J.E. &
Hoffman, D.R. (1990) Effect of dietary omega-3
fatty acids on retinal function of very low
birth weight neonates. Pediatr. Res. 28,
485-492.
Widdowson, E.M. & McCance, R.A. (1954) Stud-
ies on the Nutritive Value of Bread and the
Effect of Variations in the Extraction Rate of
Flour on the Growth of Undernourished Chil-
dren. Medical Research Council Special Re-
port Series No. 287. London: HMSO.
World Health Organization (1990) Diet, Nutri-
tion, and the Prevention of Chronic Diseases.
Technical Report Series No. 797. Geneva:
World Health Organization.