Nutritional Adequacy, Growth Trajectories, and Metabolic Health Outcomes Associated with Plant-based Diets and Alternative Milk Consumption in Toddlers
Muazzam Sheriff Maqbul
*
Department of Medicine, Ibn Sina National College of Medical Studies, Jeddah, Kingdom of Saudi Arabia.
Ekram Abdulmatlub Aljohani
Department of Clinical Nutrition, National Guard Hospital, Jeddah, Kingdom of Saudi Arabia.
Noha Mohammed Mujally
Department of Clinical Nutrition, National Guard Hospital, Jeddah, Kingdom of Saudi Arabia.
Morouj Ahmed Alabyadh
Department of Clinical Nutrition, King Abdul Aziz Medical City, Jeddah, Kingdom of Saudi Arabia.
Shahd Saleh Alharbi
Department of Clinical Nutrition, King Abdul Aziz Medical City, Jeddah, Kingdom of Saudi Arabia.
Lina Mohammad Haytham Mawardi
Department of Medicine, Ibn Sina National College of Medical Studies, Jeddah, Kingdom of Saudi Arabia.
Ghadeer Yusuf Hashem Alsubahi
Department of Medicine, Ibn Sina National College of Medical Studies, Jeddah, Kingdom of Saudi Arabia.
Hiba Mostafa Abdulhalim Bapary
Department of Medicine, Ibn Sina National College of Medical Studies, Jeddah, Kingdom of Saudi Arabia.
Faduma Bashir Khalif
Department of Medicine, Ibn Sina National College of Medical Studies, Jeddah, Kingdom of Saudi Arabia.
Neama Gamal Mohamed Abdalla Shabib
Department of Medicine, Ibn Sina National College of Medical Studies, Jeddah, Kingdom of Saudi Arabia.
Ashjan Nasser Bamarhool
Department of Medicine, Ibn Sina National College of Medical Studies, Jeddah, Kingdom of Saudi Arabia.
Muath Saeed Ali Alamri
Department of Medicine, Ibn Sina National College of Medical Studies, Jeddah, Kingdom of Saudi Arabia.
Ahmed Yousef Daghmash
Department of Medicine, Ibn Sina National College of Medical Studies, Jeddah, Kingdom of Saudi Arabia.
Obaidullah Muhammad Shafi
Department of Medicine, Ibn Sina National College of Medical Studies, Jeddah, Kingdom of Saudi Arabia.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Background: The rising global adoption of plant-based diets (PBDs) including vegetarian (VG) and vegan (VN) patterns in the uniquely vulnerable period of toddlerhood (12–36 months) necessitates a critical assessment of their nutritional and clinical impact. This is particularly relevant given the increased replacement of traditional dairy with plant-based milk alternatives (PBMAs).
Objective: To systematically synthesize and critically evaluate evidence regarding the impact of PBDs and PBMA consumption on the triad of Growth Trajectories, Nutritional Adequacy, and Metabolic Health in toddlers (12–36 months).
Methods: (PRISMA-Informed): This systematic review synthesized robust evidence from cohort studies and clinical trials conducted primarily in high-income settings. The literature search spanned PubMed, Embase, Cochrane] from using a comprehensive strategy that included MESH terms for 'toddler,' 'vegan,' 'vegetarian,' 'plant-based diet,' 'growth,' and 'nutritional status.' Studies were selected based on pre-defined inclusion criteria, focusing on those reporting anthropometric data, biochemical biomarker status, and long-term metabolic outcome markers in toddlers on PBDs vs. omnivorous controls.
Results: The data reveal a clinical paradox while PBDs are associated with a favorable cardiometabolic profile (significantly lower total and LDL cholesterol and reduced systemic inflammation), they also pose a risk to growth (WHO European Office for the Prevention and Control of Noncommunicable Diseases, 2021). Although the average anthropometric status is within normal limits, a statistically significant subset of toddlers (VN: 3.6%; VG: 2.4% vs. Omnivores: 0%) were classified as stunted or wasted. This vulnerability stems from the lower energy density of high-fiber foods and the use of nutritionally inferior PBMAs. Biomarker analysis consistently confirms a high prevalence of subclinical deficiencies in critical nutrients (B12, DHA, iodine, iron, and zinc), while simultaneously identifying cases of B12 hypervitaminosis due to non-standardized supplementation practices.
Conclusion: The safe implementation of PBDs in toddlers is contingent upon a mandatory shift from casual adoption to rigorous, clinical management. The long-term metabolic promise is conditional upon meticulous planning, the exclusion of inadequate PBMAs, and the enforcement of precise, mandatory supplementation protocols for B12, DHA, and Vitamin D. This must be coupled with regular anthropometric and biochemical monitoring to prevent both deficiency and over-supplementation, safeguarding optimal development during this critical growth phase.
Keywords: Vegetarian, vegan, toddlers, alternative milk, growth, nutrient deficiencies, bone health, metabolic health, systematic review