Young Swedish Vegans Have Different Sources of Nutrients Than Young Omnivores CHRISTEL L

RESEARCH

Research and Professional Briefs Young Swedish Vegans Have Different Sources of Nutrients than Young Omnivores CHRISTEL L. LARSSON, PhD; GUNNAR K. JOHANSSON, DDS

cluded, however, intakes of vitamin B-12, vitamin D, and ABSTRACT calcium were above average requirements. Selenium ob- The aim of this study was to identify sources of nutrients tained from both diet and supplements provided 79% of in diets of young Swedish vegans and omnivores. Three the average requirement. For female omnivores at group months of dietary intakes were investigated by diet his- level the dietary intake from diet alone was above aver- tory interviews. Volunteers were recruited through ad- age requirements for all nutrients except selenium. vertising and visits to schools in the city of Umeå, Swe- Intake at group level of male vegans showed that the den. Thirty vegans, 15 female and 15 male, aged 17.5Ϯ1.0 years, were compared with 30 sex-, age-, and height- contribution from diet alone of vitamin B-12, riboflavin, matched omnivores. Vegans had different sources of nu- calcium, and selenium was below average requirements trients than young omnivores and relied to a great extent (3). Calcium and selenium obtained from both diet and on dietary supplements as a source of vitamin B-12, vi- supplements provided 98% and 65% of the average re- tamin D, calcium, and selenium. Dietary intake of vege- quirement, respectively. Intake of vitamin B-12 and ribo- tables, fruits, and berries exceeded 500 g/day for 21 of the flavin was above average requirements when intake from 30 vegans, whereas the same held true for only 1 of the 30 dietary supplements was included. For male omnivores, omnivores. Instead of animal products, young vegans rely the dietary intake at group level was above average re- on dietary supplements, legumes, vegetables, fruits, and quirements for all nutrients. berries as sources of nutrients. It is of interest to further analyze the dietary data J Am Diet Assoc. 2005;105:1438-1441. collected to identify sources of nutrients and choice of vegetables and fruits in diets of young Swedish vegans and omnivores. The method of analysis and sources of n the mid-1990s, an increasing number of young people nutrients are presented and discussed in this article. became vegans in Sweden (1). People eating a vegan Idiet consume food products from the plant kingdom only and exclude meat, fish, eggs, and dairy products (2). SUBJECTS AND METHODS The young vegans were eating vegan food mainly for Subjects ethical reasons rather than health considerations. Be- cause of this, there was apprehension that they excluded Volunteers, who had to be 16 to 20 years old and in good animal products from their diet without replacing them health with no chronic diseases, were recruited with nutritionally equivalent products from the plant through poster advertising and visits to schools in the kingdom. This concern was based on speculations rather Umeå area. Vegans were defined as people eating food than on scientific knowledge and, in order to obtain more of plant origin only, and they were included in the information, a study was conducted to gather data on the study if they had consumed a vegan diet for at least 6 food intake of young vegans. months and were planning to continue. Omnivores Dietary intake of 30 vegans was investigated by diet were defined as people eating food of both plant and history interview and compared with that of 30 omni- animal origin. They were considered for participation vores. Intake for the female group of vegans showed that in the study if they had consumed an omnivorous diet contributions from diet alone of vitamin B-12, vitamin D, through their entire life and were planning to continue calcium, and selenium were below average requirements to do so. No lacto-ovo-vegetarians or individuals with (3). When consumption of dietary supplements was in- dietary restrictions of special diets for weight loss, lactose intolerance, or other conditions were included among the group of omnivores. In total, 65 self-de- C. L. Larsson is a senior lecturer and G. K. Johansson scribed vegans and 272 omnivores were interviewed is a professor, Department of Food and Nutrition, Umeå regarding food habits, age, and height. Thirty vegans University, Umeå, Sweden. were eligible for inclusion according to the above-men- Address correspondence to: Christel Larsson, Depart- tioned inclusion criteria. Thereafter, 30 omnivores ment of Food and Nutrition, Umeå University, SE-901 were matched by sex, age (Ϯ6 months), and height 87 Umeå, Sweden. E-mail: [email protected] (Ϯ3.5 cm). Background data for the subjects have been Copyright © 2005 by the American Dietetic published previously (4). Each participant gave written Association. informed consent and the study was approved by the 0002-8223/05/10509-0012$30.00/0 research ethics committee of the Medical Faculty, doi: 10.1016/j.jada.2005.06.026 Umeå University, Umeå, Sweden.

1438 Journal of the AMERICAN DIETETIC ASSOCIATION © 2005 by the American Dietetic Association Figure. Contribution to nutrient intake of different food categories eaten by 30 vegans and 30 omnivores in Umeå, Sweden. Categories are presented in order from dietary supplements on the right in the stack bar to miscellaneous on the left. The miscellaneous category includes: mixed dishes that could not be subdivided into food components, alcoholic drinks, oil, dressing, coffee, tea, salt, and spices. The animal product category includes meat, ﬁsh, seafood, dairy products, and eggs.

Dietary Assessment validity of the method, and information about energy Each respondent was asked about usual food intake and nutrient intakes of the 60 subjects, has been pub- during two separate 1- to 2-hour diet history interviews lished previously (3,4). 1 to 2 weeks apart during the period August 1997 to June 1998. The aim was to construct a typical eating pattern for the preceding 3 months. No food records or RESULTS food frequency questionnaire was used. Rather, the Sources of Nutrients subjects reported in the ﬁrst interview what type of Sixteen percent of the vegan energy intake came from food they usually ate and how often. During the second low-nutritious food (such as candy, pastry, chips, and soft interview, portion sizes of foods were described in drinks) compared with 22% of the omnivore energy intake terms of household measures, standard weights of food (Figure). items, three-dimensional food models, or portion pho- Vegans obtained 53% of protein intake from bread, tographs of known weights (5). The reported food, bev- cereals, pasta, and rice; 24% from legumes; and 14% erage, and dietary supplement intakes were entered in from vegetables and potatoes, while the corresponding the dietary analysis program Stor MATs 4.03e (Rudans ﬁgures for omnivores were 19%, 0%, and 3%, respec- Lättdata, Västerås, Sweden), which uses the Swedish tively (Figure). A large amount (62%) of protein intake Food composition database (version 2.97). Composite in the omnivorous diet came from animal products. foods (eg, casseroles) were split into ingredients (food All vitamin B-12 in the vegan diet came from dietary items). Each food item has a unique “food item code” in supplements (Figure). The greatest food source of vitamin the database and food items also have a “food category D in the vegan diet was margarine (50%), while in the code.” The program provides weight reports (in grams) omnivorous diet it was animal products (51%). The three of various food categories. Recipes and information on best food sources of iron in the vegan diet were the food nutritional content of composite foods and dietary sup- categories consisting of bread, cereals, pasta, and rice plements not listed in the food database were added. (29%); vegetables and potatoes (16%); and legumes (15%); Further information about the dietary assessment, the the best sources for omnivores were bread, cereals, pasta,

September 2005 ● Journal of the AMERICAN DIETETIC ASSOCIATION 1439 Table. Comparison of Swedish vegans’ and omnivores’ choice of bread, cereals, vegetables, potatoes, fruits, and berries to identify sources of nutrients Vegans Omnivores Vegans Omnivores Fruits and Vegans Omnivores (30؍n) (30؍berries (n (30؍n) (30؍Vegetable and (n (30؍n) (30؍n) Bread, cereals, pasta, potato intake intake and rice (rank)a (g/d) %b (g/d) %b (rank)a (g/d) %b (g/d) %b (rank)a (g/d) %b (g/d) %b

Semi whole-wheat bread 93 23 60 21 Potatoes 137 27 109 50 Apples 69 38 49 32 Rice 71 18 33 12 Tomatoes 90 18 29 14 Bananas 36 20 46 30 White bread 68 17 61 22 Cucumbers 40 8 13 6 Oranges 34 18 32 21 Pasta 57 14 40 14 Onions 37 7 12 5 Pears 12 6 10 7 Porridge 46 12 42 15 Carrots 29 6 15 7 Melons 6 3 – – Crisp bread 42 11 23 8 Iceberg lettuces 21 4 8 4 Grapes 5 3 3 2 Breakfast cereals 15 4 23 8 Peppers 20 4 5 3 Strawberries 3 1 – – Gruel 4 1 0 0 Mushrooms 17 3 2 1 Peaches 3 1 – – Total 396 100 282 100 Zucchinis 13 3 – – Raisins 2 1 2 1 Vegetable mixes 10 2 3 1 Mangos 2 1 – – Leeks 10 2 1 1 Plums 2 1 – – Bean sprouts 9 2 – – Figs 2 1 – – Broccolis 8 2 – – Blueberries 2 1 – – Corn 8 2 – – Apricots 1 1 1 1 Peas 7 1 – – Fruit cocktails 1 1 – – Avocados 6 1 2 1 Kiwis 1 1 3 2 Cabbages 6 1 4 2 Pineapples – – 4 3 Aubergines 5 1 – – Raspberries – – 1 1 Chinese leaves 5 1 2 1 Total 181 98 151 100 Beetroots 4 1 3 1 Pickled cucumbers 4 1 – – Asparagus 3 1 – – Cauliﬂowers – – 2 1 Lettuces – – 2 1 Spinach – – 2 1 Total 489 98 214 100

aFood items are ranked by largest intake of vegans. bIntake of a speciﬁc food item expressed as a percentage of the total amount of all food items in the present category.

and rice (26%) and animal products (25%). The largest accounting for 42% and 36% of the intake for each group, sources of calcium, zinc, and selenium for vegans were respectively. The most common fruits eaten by both veg- dietary supplements, while animal products were the ans and omnivores were apples, bananas, oranges, and largest sources in the omnivorous diet. However, the best pears, which accounted for 82% and 90% of the fruit source of calcium from food in the vegan diet was vege- consumption, respectively. tables and potatoes (15%), and 33% of the zinc intake and 14% of the selenium intake came from bread, cereals, pasta, and rice. DISCUSSION Significantly lower intake of candy and chocolate was seen among vegans compared with omnivores in the Choice of Vegetables, Fruits, and Berries present study. The same was found in Canadian and Intake of pasta, rice, and crisp bread was statistically American studies (7-9). higher (PϽ.05) among vegans than omnivores, while the Legumes and bread were the greatest sources of pro- intake of breakfast cereals was lower (Figure). For 21 of tein for vegans in the present study and accounted for the 30 vegans, the dietary intake of vegetables (except 11% and 24% of the protein intake, respectively. How- potatoes), fruits, and berries was above 500 g/day, which ever, fruits, berries, and vegetables were also a great conforms to the Swedish recommendation (6). The same source and accounted for 12% of the protein intake. These held true for only one of the 30 omnivores. Vegans ate results may be compared with findings of another study significantly more vegetables but not significantly more of lacto-ovo-vegetarians in which legumes, bread/cereals, fruits and berries than the omnivores. Vegans and omni- and fruits/vegetables accounted for 39%, 19%, and 14% of vores tended to choose similar types of vegetables, fruits, protein intake, respectively (7). and berries in their diets, but vegans included a larger Similar to the results of other studies (10,11), the main variety (Table). The most common vegetables eaten were food sources of iron were found to be bread (19%) and tomatoes, cucumber, onions, carrots, and iceberg lettuce, fruits, berries, and vegetables (14%). However, dietary

1440 September 2005 Volume 105 Number 9 supplements were also a major contributor to iron intake University and the Swedish Foundation for Healthcare (22%), as well as to selenium, zinc, calcium, vitamin D, Science and Allergy Research supported the present and vitamin B-12 intake (12). study. Both male and female vegans showed a statistically significant, higher intake of vegetables compared with References omnivores. This result is similar to the findings of a study 1. Larsson C, Johansson G. Prevalence of vegetarians in on 14- to 19-year-old Canadian adolescents in which 78 Swedish secondary schools. Scand J Nutr. 1997;41: lacto-ovo-vegetarians had a higher intake of vegetables 117-120. than 29 omnivores (7). In the present study, there was no 2. ADA Reports. Position paper of the American Dietetic significant difference in fruit and berry consumption Association and Dietitians of Canada: Vegetarian di- among vegans compared with omnivores. This was also ets. J. Am Diet Assoc. 2003;103:748-765. shown by Donovan and Gibson, but does not verify results 3. Larsson C, Johansson G. Dietary intake and nutri- of an American study of vegetarians aged 12 to 20 years tional status of young vegans and omnivores in Swe- (7-9), which showed that vegetarians were twice as likely den. Am J Clin Nutr. 2002:76:100-106. to consume fruits (excluding juice). In this study, the 4. Larsson C, Westerterp K, Johansson G. Validity of vegans tended to consume the same types of vegetables reported energy expenditure and energy and protein and fruits as the omnivores; however, the vegans con- intakes of Swedish vegan and omnivore adolescents. sumed a larger number of different fruits and vegetables Am J Clin Nutr. 2002;75:268-274. than the omnivores. 5. Håglin L, Hagman U, Nilsson M. Evaluation of the meal model “Matmallen” a means of estimating con- CONCLUSIONS sumed amounts of food. Scand J Nutr. 1995;39:79-83. The young Swedish vegans in the present study did not 6. Becker W, Hagman U. In Swedish: Mer frukt och exclude meat and animal products without replacing grönt bra för hälsan (More fruits and vegetables is them with nutritious alternatives. Rather, they had dif- good for the health). Vår Föda. 1999;6:24-28. ferent sources of nutrients than the young omnivores, 7. Donovan UM, Gibson RS. Dietary intakes of adolescent such as dietary supplements, vegetables, legumes, nuts, females consuming vegetarian, semi-vegetarian, and and seeds. For vegans, as well as omnivores, there may be omnivorous diets. J Adolesc Health. 1996;18:292-300. very different food patterns. However, if the diet is well 8. Neumark-Sztainer D, Story M, Resnich M, Blum R. planned, both a vegan diet supplemented with vitamin Adolescent vegetarians. Arch Pediatr Adolesc Med. B-12 and an omnivorous diet can offer an adequate nu- 1997;151:833-838. tritional intake. 9. Perry CL, McGuire MT, Neumark-Sztainer D, Story Meeting energy needs and limiting the intake of nutri- M. Adolescent vegetarians. How well do their dietary ent-poor foods are important considerations in the plan- patterns meet the Healthy People 2010 objectives? ning of a vegan diet. Also, a dietary supplement of vita- Arch Pediatr Adolesc Med. 2002;156:431-437. min B-12 is recommended and one needs to ensure that 10. Waldmann A, Koschizke JW, Leitzmann C, Hahn A. intake of iron, calcium, zinc, and selenium is sufficient. Dietary intakes and lifestyle factors of a vegan pop- When planning menus for young vegetarians it is also ulation in Germany: Results from the German Vegan important to consider that adolescents often consume a Study. Eur J Clin Nutr. 2003;57:947-955. lot of food as snacks and meals away from home. Portable 11. White R, Frank E. Health effects and prevalence of snacks (eg, dried and fresh fruits, nuts and almonds, vegetarianism. West J Med. 1994;160:465-471. hummus on pita bread, and juice) can make it easier for 12. Larsson C. Young vegetarians and omnivores—Dietary vegetarian adolescents to have access to nutritious food habits and other health-related aspects. Doctoral the- sources. sis, Department of Food and Nutrition, Umeå Univer- sity, Sweden, 2001. Available at: http://www.diva- The authors would like to thank all the adolescents who portal.org/umu/theses/abstract.xsql?dbidϭ5. Accessed participated. The Faculty of Social Sciences at Umeå July 27, 2005.

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