2018 Vegan diets: review of nutritional benefits and risks Expert report of the Food Commission for Nutrition Impressum Citation Federal Commission for Nutrition (FCN). Vegan diets: review of nutritional benefits and risks. Expert report of the FCN. Bern: Federal Food Safety and Veterinary Office, 2018. © AND correspondence The Federal Commission for Nutrition Scientific secretariat Federal Food Safety and Veterinary Office FSVO Schwarzenburgstrasse 155 3003 Bern [email protected] www.eek.admin.ch 2 Contents Contributors ........................................................................................................................................... 5 Approval ................................................................................................................................................. 5 Preface .................................................................................................................................................... 6 1 Introduction ............................................................................................................................................ 8 2 Objectives of this review....................................................................................................................... 8 3 Methods .................................................................................................................................................. 9 4 Historical / anthropological / philosophical aspects .......................................................................... 9 5 Definitions and statistics .................................................................................................................... 11 6 Vegan diets from the nutrient perspective ........................................................................................ 14 Positive nutrient aspects of a vegan diet .......................................................................................... 17 6.2 Micronutrient deficiency risks of a vegan diet.................................................................................. 19 6.3 Further risks of vegan diets................................................................................................................ 27 7 Life cycle aspects of vegan diets ....................................................................................................... 28 7.1 Pregnancy and breastfeeding ............................................................................................................ 28 7.2 Infants / children .................................................................................................................................. 30 7.3 Ageing................................................................................................................................................... 33 8 Vegan diets and non-communicable diseases ................................................................................. 34 8.1 Overweight / obesity............................................................................................................................ 34 8.1.1 Prevention ............................................................................................................................................. 34 8.1.2 Weight loss in overweight / obese subjects ........................................................................................... 35 8.2 Type 2 diabetes .................................................................................................................................... 36 8.2.1 Prevention ............................................................................................................................................. 36 8.2.2 Therapy.................................................................................................................................................. 36 8.3 Cardiovascular diseases .................................................................................................................... 38 8.3.1 Hypertension.......................................................................................................................................... 38 8.3.2 Dyslipidemia .......................................................................................................................................... 40 8.3.3 Cardiovascular diseases ....................................................................................................................... 41 8.4 Cancer................................................................................................................................................... 46 8.4.1 Cancer incidence ................................................................................................................................... 46 8.4.2 Cancer mortality..................................................................................................................................... 49 8.5 All-cause mortality............................................................................................................................... 51 8.6 Vegan diets and other diseases ......................................................................................................... 53 8.6.1 Bone frailty ............................................................................................................................................. 53 3 8.6.2 Irritable bowel syndrome........................................................................................................................ 54 8.6.3 Fertility disorders ................................................................................................................................... 55 8.7 Mental diseases and eating disorders ............................................................................................... 57 8.7.1 Mental diseases ..................................................................................................................................... 57 8.7.2 Eating disorders ..................................................................................................................................... 59 9 Ethical considerations from the pediatricians .................................................................................. 60 10 Conclusions ......................................................................................................................................... 61 10.1 Nutrient perspective ............................................................................................................................ 61 10.2 Life cycle aspects ................................................................................................................................ 62 10.2.1 Pregnancy and breastfeeding ................................................................................................................ 62 10.2.2 Infants and children ............................................................................................................................... 62 10.2.3 Ageing ................................................................................................................................................... 62 10.3 NCDs ..................................................................................................................................................... 62 10.3.1 Cardiovascular diseases ....................................................................................................................... 62 10.3.2 Cancer ................................................................................................................................................... 63 10.3.3 Total mortality ........................................................................................................................................ 64 10.3.4 Other NCDs ........................................................................................................................................... 64 11 Final recommendations of the work group ....................................................................................... 65 11.1 Dietary guidelines ................................................................................................................................ 65 11.2 Final recommandations and perspectives ........................................................................................ 67 12 Acknowledgements ............................................................................................................................. 67 13 Conflicts of interest ............................................................................................................................. 67 14 References ........................................................................................................................................... 68 15 Appendices .......................................................................................................................................... 79 Appendix I ............................................................................................................................................ 79 Appendix II ........................................................................................................................................... 80 Appendix III 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