Annales 80.1 - Foods for the future and their potential impact on child nutrition
Since the issues on climate change and how it affects the food people eat was brought up in 2019, attitudes when it comes to diet have evolved. This includes the shift to plant-based diets which is thought to nurture the human body more than modern diets, while also being better for planetary health. With this, more individuals have implored a vegetarian or vegan diets. However, there are also numerous things to be considered, such as how it affects children’s diets, how can novel plant-based foods be safely introduced, and the special care needed to avoid deficiencies. With this, certain recommendations as to continued studies on the potential outcomes of consuming alternative plant-based drinks and meats in substantial amounts, and in policies for national advisory boards and proper guidance for parents choosing to feed their children a vegetarian or vegan diet.
Human culture is evolving rapidly, and many of these changes are affecting our attitudes to food. Foremost among these is the realisation that the threat of anthropogenic climate change—present and future—requires a radical rethinking about the contribution that food and agriculture make to greenhouse gas emissions and the need to integrate considerations of planetary health into our diet choices.
Awareness of these issues was brought centre stage by the EAT–Lancet Commission on food, planet and health that published a seminal paper on ‘Food in the Anthropocene’ in 2019.1 Arguing that modern diets are failing to nurture human health while also damaging the planet, the commission proposed radical changes in food systems and diets requiring a major shift away from animal source foods. While not without critics, especially in Africa, the EAT–Lancet recommendations have accelerated an already growing interest in plant-based diets. In many Western nations, the proportion of vegetarians and vegans is increasing and industries are innovating a diverse range of plant-based drinks and artificial meats. In the following three articles in this volume, we consider how these changes are affecting the diets of children and whether, when and to what extent novel plant-based foods can be safely introduced.
Alexy reviews recent trends in vegetarianism and veganism in children.2 Recent reviews conclude that about 10% of adults are vegetarians in high-income countries and about 1%–2% are vegans with both proportions on the rise. Estimates for children are sparse but the comprehensive EsKiMo Study from Germany also shows a rising prevalence in the past two decades. Among adults, the motives for change include both animal welfare issues and concerns about the environment; these are often shared across family members.
Dietetic professionals in many countries accept that vegetarian and even vegan diets can be adopted for young children but great care must be taken to address the possibility of deficiencies in certain critical nutrients: protein, iron, zinc, calcium, selenium, vitamin B12 and vitamin D. There is little data for very young children and it would generally be considered that the greatest care should be taken in this age group if animal foods are to be withheld. For older children, analysis of recent studies revealed comparable growth between omnivore and vegetarian and vegan children, but with a tendency towards a lower fat mass in the non-meat eaters. Blood lipid profiles seem better in vegetarians/ vegans, but bone density is lower. The long-term significance of these trends is not yet known and will require longitudinal studies. Alexy concludes that, if not already in place, national advisory bodies should develop detailed advice for parents choosing to feed their chil- dren on vegetarian and especially vegan diets, and such guidance needs to be actively disseminated.
Merritt addresses the complex issues of plant-based drinks that have flooded many markets in recent years.3 This article was commissioned to discuss the use of ‘plant-based milks’ but uses the term plant-based drinks because legislation in some countries forbids them from being called milks. He starts with a clear statement that plant-based milk substitutes should never be given in infancy apart from specialised commercial soy or rice substitutes used for medical reasons. For older children, milk (usually cows’ milk) plays a prominent part in the diet in many countries and provides an important source of high-quality protein, calcium and other nutrients. Milk is not essential but requires careful dietary adjustments to adequately compensate for its absence. There are wide differences in the composition of plant-based milk substitutes (usefully tabulated in Merritt’s paper) and, as yet, there is very little information about their impact on child nutrition, except for the knowledge that children not consuming animal milks tend to grow more slowly than those that do.
As with vegetarianism, there are many and varied drivers of these food choices including concerns about animal welfare and the greenhouse gas emissions associated with dairy production. These are discussed in some detail by Merritt and some of the widely held public misconceptions are challenged. Nonetheless, there is an ever-increasing choice of alternative milks with advances in manu- facture including precision fermentation that can help produce a milk substitute that would address the various concerns about cows’ milk and the current range of plant-based alternatives. Informative labelling and consumer education with respect to using such products in children’s diets will help ensure that children receive their optimal supply of nutrients.
Addressing the topic of alternative meat substitutes in children’s diets, Cerami describes the range of manufac- turing innovations seeking to reproduce the organoleptic qualities of meat and fish using solely plant-derived ingredients.4 There are four generic processes for making alternative animal mimetic foods: plant-based, mycoprotein-based, insect-based and synthetically cultured meats (and fish) products. The first two categories are typically based on soy, wheat or legume proteins with the addition of fats, carbohydrates and flavourings to mimic the flavour of meat. Imitating the texture of meat is a major challenge, sometimes over- come by using ‘scaffolding’ structures. Insect-derived proteins are conceptually attractive in terms of ease of production and their greenhouse gas footprint, but remain culturally alien in most high- income countries. Many companies are developing cultured meats and the first of these have received regulatory approval, but reducing the costs of production and finding substitutes for the bovine serum required for culture remain a major challenge.
It is too early to know the extent to which alternative plant-based drinks and meats will replace traditional animal-based foods and, as yet, there have been no studies of the potential outcomes for any children consuming with diets substantial amounts. It seems likely that consumption levels will increase, although at the time of writing the initial consumer enthusiasm for alternative meats has dipped to such an extent that several companies have gone into administration and others are acknowledging that the initial surge in sales has waned. Dissatisfaction with the organoleptic characteristics of such foods (texture, flavour, aroma) accounts for some of the loss of sales. An additional emerging reason is that most such foods are classed as ‘ultra-processed’ and consumers are aware of negative health messaging about such foods. An urgent research need in this respect is to identify the mechanisms by which ultra-processed foods may lead to harm and hence to define whether all such foods are harmful or whether the reported adverse effects are confined to certain specific food processing procedures.
Assuming that current trends towards a greater intake of plant-based foods continue, all three authors contributing to this volume have emphasised the need for national pediatric dietetic bodies to develop clear guidelines to set any limits to intakes (if deemed appropriate) and to help parents to devise food strategies that will avoid potential deficiencies and optimise their chil- dren’s growth, development and lifelong health.
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Funding This work was supported by Nestlé Nutrition Institute.
Competing interests The author is a member of the Global Nutrition Science Committee for the Nestlé Nutrition Institute (NNI). He has received honoraria for educational talks from Danone/Nutricia and NNI.
Patient consent for publication Not applicable.
Ethics approval Not applicable.
Provenance and peer review Commissioned; internally peer reviewed.
1 - Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT- lancet Commission on healthy diets from sustainable food systems. Lancet 2019;393:447–92.
2 - Alexy U. Diet and growth of vegetarian and Vegan children. BMJ Nutr Prev Hlth 2023;6(Suppl 2):s3–11.
3 - Merritt R. Plant based drinks in the diets of infants and young children. BMJ Nutr Prev Hlth 2023;6(Suppl 2):s12–21.
4 - Cerami C. Alternative meat in the diets of young children. BMJ Nutr Prev Hlth 2023;6(Suppl 2):s22–6.
