Good nutritional advice A balancing act between evidence and common sense MONITOR “A purely vegan diet without consistent supplementation, for example with vitamin B12, is not recommended for children and adolescents,” Prof. Dr. Silvia Rudloff , a nutritional scientist at the Justus Liebig University Giessen (Ger- many), stated at a symposium in Munich. A balanced ovo-lacto vegetarian diet, however, is not considered to be problematic. According to Dr. Isabelle Mader, Pfaff enhofen (Germany), a step-by-step concept for infancy and todd- lerhood developed by HiPP might prove to be useful in the critical phase of weaning.

According to Dr. Hermann amongst children and 3.6% of the children in Kalhoff , a senior paediatri- adolescents (see text box ), the vegan test group were cian at Klinikum Dortmund the question of whether underweight and 3.6% (Germany), paediatricians such diets pose a health were too small according who want to give their pa- risk is becoming more to WHO standards. The tients, or rather their pa- important. According to data regarding minerals tients’ parents, good nutri- Dr. Rudloff , however, this and micronutrients that “Germans eat too much tional advice are faced with question cannot be ans- potentially infl uence a meat.” the following dilemma: wered with absolute child’s growth and de- Prof. Dr. Silvia Rudloff , Justus Due to a lack of hard scien- certainty. Based on the velopment, such as cal- Liebig University Giessen tifi c evidence and scientifi c results of the “VeChi Study”, cium, zinc and iron, are (Germany) studies, doctors can only which has not yet been still being evaluated. Dr. rely on common sense re- fully evaluated, the nu- Rudloff points out that the interpretation of the For the most valuable in life. Enlightened vegetarians results, as in other studies, is complicated by the fact According to the results of the EsKiMo II study carried out that, compared to the A vegetarian diet for babies and toddlers – between 2015 and 2017, the proportion of vegan children average population, the What’s important to know? re you a vegetarian and want to feed your Particularly during the critical phase of infancy Ababy a vegetarian diet as well? That‘s possib- and toddlerhood they need nutrient-rich foods le. However, there are a few aspects you need to in their diet. This way, you can ensure your child’s between 6 and 17 years of age had risen from 1.6% in 2006 consider. If entire food groups are missing from a healthy growth and healthy physical and mental baby’s diet, they might lack certain nutrients that development. study groups consist of a are necessary for their healthy development. to 3.3%3. Currently, 4.9% of girls and 1.7% of boys are ve- disproportionately large Which forms of vegetarianism are most common? What they do eat and and what Vegetarian diets Which nutrients are scarcely present? getarian. According to Prof. Dr. Silvia Rudloff , from Gießen they don’t eat Ovo-lacto vegetarianism Meat Vitamin B12, animal protein, iron, zinc, Fish iodine, long-chain polyunsaturated Eggs omega-3 fatty acids like DHA* number of families with a *Docosahexaenoic acid (Germany), vegetarians, compared to the average populati- Milk and dairy products Lacto vegetarianism Meat In addition to those mentioned above: Fish Vitamins D and A Eggs on, are disproportionately well educated, come from fami- special and above-average Milk and dairy products Ovo vegetarianism Meat In addition to those mentioned above:

Fish Calcium, vitamins B2, D and A Eggs lies with a high socio-economic status, do more sports and interest in nutrition. An- Milk and dairy products Veganism Meat All of the above mentioned nutrients g

Fish vitamin B12 in particular! Eggs are more likely to use nutritional supplements. This makes Milk and dairy products other fact that needs Honey it diffi cult to interpret a study on the potential health risks of a vegetarian diet. In conclusion, it is essential for a “healt- to be considered is that hy vegetarian diet” during childhood that parents and their every second one of the You can download con- children are well informed and that they are appropriately “vegan” children was still sultation materials on supervised by a paediatrician. vegetarian nutrition from breastfed. In regard to vo- hipp-fachkreise.de free of luntary food restrictions, charge. commendations in many tritional scientist deems Dr. Rudloff recommends areas of nutritional medi- the risk of vegetarian/ that vegetarians and ve- cine. With this in mind, any vegan diets during infan- gans should keep a close initiatives by food manu- cy as not being too high1. eye on the following nu- Imprint facturers to create a better In this study, 139 vegeta- trients and potential defi - Verlag Kirchheim + Co GmbH Wilhelm-Theodor-Römheld-Str. 14, scientifi c foundation by rian, 127 vegan and 164 ciencies: 55130 Mainz (Germany) means of appropriate re- omnivorous children aged • iodine and long-chain Satellite symposium “From vegeta- search are very welcome. between one and three omega-3 fatty acids in rian diet to infant formula: Off ering parents good advice on nutritional years were compared in cases where fi sh is not issues”, Organiser: HiPP, Munich, 14 Vegetarian diets: terms of growth as well consumed September 2019. No problem! Or is it? as protein and energy in- • iron, zinc and proteins Editing: Dr. med. Ludger Riem The editors of the journal do not Due to the increase in take. The results showed in cases where meat take responsibility for its content. people opting for a vegan/ no signifi cant diff erences and eggs are not con- Powered by HiPP GmbH & Co. Ver- vegetarian diet, also in these areas. However, sumed trieb KG

Sonderdruck aus Kipra 6/2019, Seite 445 – 446, © Verlag Kirchheim + Co GmbH, Mainz • calcium, proteins and same time consuming ex- Needs-based

vitamin B2 in cases cessive amounts of meat, step-by-step concept where dairy products sweets and sugary soft According to Dr. Mader, a are not consumed drinks. nutritional concept spe-

• vitamin B12 in cases of cially developed by HiPP a purely vegan diet – New EU Regulation on not only meets the requi- appropriate supple- infant and follow-on rements of the new EU Re- mentation is absolute- formula gulation, but even exceeds ly necessary Based on the current scien- it when it comes to one tific data compiled by the important aspect. While Potential iron, zinc or pro- European Food Safety Au- the EFSA-based nutrient tein deficiencies cannot thority (EFSA)4, new legal content guidelines consist- be easily avoided because regulations for infant and ently refer to the content in the bioavailability of the- follow-on formulae will breast milk as a reference se nutrients in pulses and/ take effect on 22 Februa- and therefore do not dis- “In the critical first 5 or wholemeal products is ry 2020 . In the case of HA tinguish between infant stage of weaning, significantly lower than in formulae, these regulati- and follow-on formulae, follow-on formula can meat products. You can, ons will first apply in 2021. HiPP takes a different ap- contribute significantly however, significantly in- Dr. Isabelle Mader, a nutri- proach for the following to the right supply of crease the bioavailability tional scientist working in reason: In the critical first nutrients.” of plant-based iron with HiPP’s R&D Department stage of weaning, when the addition of vitamin C in Pfaffenhofen (Germa- infants are between 4 and Dr. Isabelle Mader, (e.g. from juice or fruits). ny), reports that according 6 months of age, they of- Pfaffenhofen (Germany) to this piece of European ten do not eat more than Simple and safe with legislation (EU Regulation a few spoonfuls of the as “optimiX” 2016/127), all infant and yet unfamiliar food. This In view of the current data, follow-on formulae must means that a nutrient sup- the German Society of contain the long-chain ply equivalent to that from Paediatrics and Adolescent unsaturated omega-3 fat- infant formula may pose Medicine (DGKJ) supports ty acid docosahexaenoic the risk of an inadequate the common sense recom- acid (DHA). The addition supply when compared mendation for a balanced omnivorous diet with a high intake of plant-ba- sparing fatty and sed foods and a moderate amounts of sugary foods consumption of meat, sea fish, milk and other dairy milk 2 moderate meat animal-based products . The diagram amounts of fish foods below shows the princip- eggs les of the optimised mixed vegetables, fruits diet (“optimiX”) which Dr. ample water bread, cereal flakes plant-based amounts of unsweetened tea potatoes, noodles, foods, drinks Rudloff promotes. The op- rice legumes timiX diet can be imple- References mented during the first 1. Weder S. et al. Nutrients. year of life by starting off Fig. 1: The principles of the optimised mixed diet for infants, children and 2019 Apr 12;11(4). pii: adolescents (optimiX) [2] E832. doi: 10.3390/ with a puree made of vege- nu11040832. tables, potatoes and meat, of arachidonic acid (ARA) to the nutritional bench- 2. Kersting M. et al. Dtsch recommended for the first continues to be optional. marks. The HiPP step-by- Med Wochenschr. 2018 Feb;143(4):279-286. doi: stage of weaning at 4 to Another change is that for- step concept takes this 10.1055/s-0043-119864. 6 months of age, which mulae with a reduced pro- into account, which is why Epub 2018 Feb 22. can later be added to with tein content (>1.8 g/100 follow-on formula contains 3. Patelakis E. et al. Ernährungsumschau 2019. milk cereals as well as fruity kcal) no longer need an more of certain nutrients 4. EFSA-Journal 2014; cereal purees. The results underlying safety study. such as iron, calcium, vi- 12(7):3760. of a study on the nutri- The addition of hydrolysed tamin B or niacin. It also 5. Commission Delegated 6 Regulation (EU) 2016/17 of tional habits of 6 to 11- protein, however, still re- takes the ideal ratio of iron

25 September 2015. 85273 Pfaffenhofen KG, Vertrieb AL48875-03.2020 – HiPP GmbH & Co. year-old children in Ger- quires proof of safety and to vitamin C into account https://eur-lex.europa.eu/ many (EsKiMo), which was efficacy. Furthermore, ma- and contains less vitamin K legal-content/DE/TXT/ PDF/?uri=CLEX:32016R presented by Dr. Rudloff, nufacturers must stay ab- than infant formula. 0127&from=DE (retrieved show that they do not con- reast of changes regarding in October 2019) sume enough fruits and the min./max. levels of cer- vegetables while at the tain vitamins and minerals.