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. 2023 Feb 18;15(2):e35148. doi: 10.7759/cureus.35148

The Impact of a Vegan Diet on Many Aspects of Health: The Overlooked Side of Veganism

Atul Bali 1,2,3, Roopa Naik 4,
Editors: Alexander Muacevic, John R Adler
PMCID: PMC10027313  PMID: 36950003

Abstract

Vegetarianism in any of its various forms, particularly veganism, has been increasing in popularity over the past few years, especially among the young population in the United States. While several studies have shown that a vegan diet (VD) decreases the risk of cardiometabolic diseases, such as cardiovascular disease, type 2 diabetes mellitus, obesity, and non-alcoholic fatty liver disease, veganism has been associated with adverse health outcomes, namely, nervous, skeletal, and immune system impairments, hematological disorders, as well as mental health problems due to the potential for micro and macronutrient deficits. The goal of this review article is to discuss the current literature on the impact and long-term consequences of veganism on vulnerable populations, including children, adolescents, pregnant and breastfeeding women, and fetal outcomes in strict vegan mothers. It also focuses on the many deficiencies of the vegan diet, especially vitamin B12, and the related increased risk of malignancies.

Keywords: children adolescents, bone mineral density, mental wellbeing, vegan diet, maternal and fetal outcome, food and nutrition

Introduction and background

Vegetarianism in various forms has gained widespread popularity in recent years. These types include vegans, who adhere to the most stringent dietary restrictions, omitting all animal-source foods and their by-products from the diet. Others include lactovegetarians (no meat, fish, or eggs but do consume dairy goods), ovo-vegetarians (no meat, fish, or dairy products but do consume eggs), lacto-ovo-vegetarians (no meat but do consume eggs and dairy products), and pescatarians (no meat except fish and shellfish) [1,2]. There has been growing interest in dietary habits given the worsening obesity epidemic and obesity-related health concerns [3,4]. Obesity is an established risk factor for diabetes mellitus, which, in turn, is an independent risk factor for coronary artery disease [5]. While studies have shown that a vegan diet (VD) may be associated with improved health outcomes [6,7], the negative health repercussions of these food preferences, on the other hand, are rarely highlighted, and veganism may be associated with negative health effects due to nutritional deficiencies.

Additionally, vegans have a greater prevalence of mental health problems, which may lead to a poorer quality of life. An optimal diet should be balanced, consisting of lean meat, nuts, fresh fruits and vegetables, and olive oil (Figure 1) [8,9]. A wholesome diet is essential in maintaining a healthy gut flora, which in turn is pivotal in avoiding inflammatory disorders [10-13]. The primary aim of this review will be to draw attention to the current literature associated with veganism, including the side effects of practicing a VD and long-term consequences for a variety of populations, including adults, adolescents, pregnant and lactating women, and the fetal outcomes of vegan mothers.‬‬‬‬‬‬

Figure 1. Image of diverse dietary elements constituting a balanced diet with proportion sizes.

Figure 1

Review

Protein

A recent systematic study examined the intake and adequacy of the VD in terms of macro and micronutrient intake in the adult European population. The study found that vegans consumed the least total protein compared to other diet groups, confirming concerns that VD may include insufficient protein, particularly in instances where legume, seed, and nut consumption is limited [14]. Vegans consume fewer essential amino acids than non-vegans [15]. Plant proteins are less digestible (50-70%) than animal proteins, and food processing methods like heating may further reduce digestibility. According to the WHO, animal proteins are considered complete proteins and have higher biological value, protein efficiency ratio, net protein utilization, and, ultimately, have a higher Protein Digestibility Corrected Amino Acid Score (PDCAAS) compared to plant proteins [16,17]. By and large, soy proteins constitute a significant protein source for most vegans [18].

Vitamin B12

Low vitamin B12 intake is a significant problem in vegan diets due to the exclusion of vitamin B12-rich foods such as meat, poultry, and eggs. A lack of vitamin B12 has been linked to neurologic and hematologic problems [19]. Low vitamin B12 intake has serious clinical consequences, although deficient symptoms appear gradually over time. High folate levels may also partly and temporarily obscure some of the typical vitamin B12 hematological manifestations. To prevent vitamin B12 deficiency, vegans must get their levels checked regularly and meet their daily requirements via supplements or fortified foods.

A growing body of research indicates that inadequate B12 consumption may contribute to carcinogenesis. Vitamin B12 deficiency increases uracil misincorporation, impairing DNA synthesis and genomic instability. Global hypomethylation of DNA is a characteristic of early carcinogenesis. Thus, if not adequately replaced, VD may inadvertently lead to cancers [20]. Wu et al found that blood B12 levels were substantially lower in menopausal and postmenopausal breast cancer patients, and patients with the lowest B12 levels had an elevated risk of breast cancer [21]. Reduced B12 levels have also been linked to an increased risk of cervical and gastrointestinal tract malignancies [22-24]. As a result, B12 supplementation is imperative for vegans due to the extensive and irreversible detrimental effects of the deficiencies.

Other minerals and micronutrients

Vegans have greater iron needs than other diet patterns [25], mainly because non-heme iron from plant-based foods is less bioavailable, as absorption is hindered by whole grains, legumes, and nuts due to their phytic acid content [26]. Vegans also have a zinc deficit. While meat, dairy, and eggs contain zinc, some zinc-rich plant foods (e.g., nuts, seeds, and whole grains) have poor bioavailability owing to the presence of phytate, which inhibits absorption in the gut [16]. Inadequate zinc consumption may be associated with mental health problems (e.g., depression), dermatitis, diarrhea, and alopecia, all of which are more prevalent among vegans [27,28]. Selenium insufficiency has also been seen among vegetarians.

Vitamin D, calcium, bone mineral density, and risk of fractures

Numerous studies have shown that vegans consume insufficient calcium and vitamin D, not only owing to the absence of dairy products but also due to calcium bioavailability problems in plant-based diets [28]. Vitamin D insufficiency exacerbates calcium shortage further owing to impaired intestinal absorption. After adjusting for socioeconomic variables, lifestyle covariates, and body mass index (BMI), a recent study reported that as compared to meat-eaters, there was an increased risk of hip fractures observed in vegetarians (HR 1.25; CI 1.04-1.50), vegans (2.31; 1.66-3.22), and fish eaters (1.26; 1.02-1.54) [29]. Vegans also had a greater incidence of overall fracture (1.43; 1.20-1.70), leg fractures (2.05; 1.23-3.41), and fractures in other major sites (1.59; 1.02-2.50). The higher risk of fractures may be related to vegans' significantly lower calcium intake, reduced dietary protein intake, and lower BMI [30-32].

Mental health

The most recent systematic review [33], which included eighteen studies, compared meat abstainers versus meat eaters in terms of mental health. The research included 160,257 individuals (85,843 females and 73,232 men) from various geographic areas, including 149,559 meat eaters and 8584 meat abstainers (aged 11 to 96 years). Eleven of the 18 studies found that meat-free diets were linked with worse psychological health, four were inconclusive, and three found that meat-free diets resulted in improved results. The most thorough research found that meat-avoiders (i.e., "full vegetarians") had a 7.4%, 24.1 %, and 35.2% 1-month, 12-month, and lifetime prevalence of unipolar depressive disorders, respectively. In contrast, meat consumers had a much lower prevalence: 6.3%, 11.9%, and 19.1%. Similarly, the 1-month, 12-month, and lifetime prevalence of anxiety disorders for meat abstainers were much higher at 20.4%, 31.5%, 31.5%, and 10.7%, 17.0%, and 18.4% in the meat eaters respectively. The study highlights the high incidence of mental health problems among vegans, emphasizing the vital need of increasing awareness of these illnesses to facilitate early intervention. Women notably appeared to be adversely impacted by mental disorders such as stress [34-36].

Orthorexia

Orthorexia nervosa (ON) is defined as a fixation on health-conscious eating behavior [37]. It involves obsessive (compulsive) food decisions, self-imposed anxiety, self-punishment, and increasingly extreme limitations. As a result of diet-related concerns, individuals develop dietary restrictions, lack of food pleasure, inflexible and rigid eating behaviors, and ritual activities surrounding food preparations. Vegetarian, and vegan, women are more prone than males to have disordered eating attitudes and practices [38].

Mortality

Although some studies indicate a reduction in mortality associated with vegetarianism and VD, the larger body of evidence indicates that the health benefits associated with vegetarianism may be due to other “lifestyle” factors associated with socioeconomic statuses, such as adequate physical activity, low alcohol, and drug consumption, or avoidance of tobacco products. Recently, Johnston et al. argued that the evidence supporting public health recommendations to reduce or eliminate meat intake was based on questionable studies and "inappropriate analysis" [39]. This argument and the growing body of contrasting and conflicting findings create a conundrum for doctors and policymakers alike.

Effects on children and adolescents

Adolescents are also known to show a strong preference for VD. A balanced diet is critical for children and adolescents to meet their bodies' rising demands during the growth spurt, rendering the implications of VD in this vulnerable age more intriguing. A recent study examined the anthropometry, dietary intakes, and nutritional status of 149 vegetarians, 115 vegans, and 137 omnivore children and adolescents using a cross-sectional design (6-18 years old, mean age: 12.7 ± 3.9 years) [40]. Vegetarians and vegans consumed more carbohydrates than omnivores (p = 0.0002). Vegetarians (p = 0.02) had the lowest protein consumption, however, vitamin B2, D3, HDL-C, and triglyceride blood concentrations did not differ between diet groups. The authors concluded that there are no specific nutrient concerns among vegetarian, vegan children and adolescents compared to omnivores. The study's cross-sectional design and lack of representativity should be considered when interpreting the findings.

In contrast to the above study, subsequent cross-sectional studies showed that vegetarian and/or vegan children had a lower bone mineral density (BMD) [41,42]. Desmond et al. observed that vegetarians and vegans were shorter than omnivores (-0.32 and -0.57 height z scores, respectively), but the difference was non-significant in vegetarians [42]. The research showed that after controlling for body size, vegan children had substantially lower vitamin D levels and BMD than omnivores. It is suggested to maximize childhood BMD to promote peak BMD and therefore reduce the risk of osteoporosis and fracture in adulthood. The authors concluded that vegans had lower BMDs even when body and bone size were taken into consideration. It does not seem to be ideal to start puberty, a period when bone-specific nutrition requirements are greater, with an already established BMD deficiency. If such deficiencies continue throughout adolescence as a result of a diet, they may raise the likelihood of poor bone outcomes later in life. Prospective longitudinal studies are required to better understand the consequences of VD on children and adolescents.

Effects on pregnancy, fetal outcomes, and lactation

Optimal fetal growth requires balanced maternal nutrition during pregnancy. Mothers on rigorous VD are at risk of vitamin insufficiency, which can lead to poor fetal outcomes. A recent study included 273 women, including 112 omnivores, 37 fish eaters, 64 lacto-ovo-vegetarians, and 60 vegans, respectively [43]. In comparison to an omnivorous diet, the vegan diet was substantially linked with an elevated risk of small-for-gestational-age infants (RR = 5.9, 95 percent CI, 1.2-21.8). All the groups had a similar incidence of preterm births. Birthweight in vegans was lower compared to lacto-ovo-vegetarians (3015 ± 420 g vs. 3285 ± 482 g, P = 0.004) and to omnivores (3328 ± 495 g, P < 0.001) but not to fish-eaters. Vegans also had a lower mean gestational weight gain compared only to omnivores (11.6 ± 4.2 kg vs. 14.3 ± 4.6 kg, P = 0.001). A review of 13 low and middle-income nations found low docosahexaenoic acid levels in breast milk in mothers on plant-based diets but greater in the fish-eating population [44].

Maternal B12 status influences their offspring’s B12 levels and is an independent risk factor for neural tube defects (NTD) [45]. Studies have shown an association between low B12, low birth weight, and pre-term delivery [46]. A Chinese study associated increased maternal pickled vegetable consumption with NTD due to excessive nitrate, nitrite, and N-nitroso compound content [47]. They found that eating pickled vegetables more frequently (>6 meals/week) increased the risk of NTD. The investigators also found that maternal consumption of meat, eggs, or milk (>1 meal/week) reduced the risk of NTD. Vegan mothers may have poor prenatal nutritional status, resulting in low maternal fat reserves for breastfeeding. The postpartum nutritional profile of vegetarian mothers declines without sufficient energy intake, thus maternal nutritional reserves are lost to promote infant normal development. 

Providers should evaluate a woman's nutrition and energy consumption frequently. Women on restrictive diets may need to take supplements or eat fortified foods to meet the required needs throughout pregnancy and breastfeeding. Plant-based diets during pregnancy and breastfeeding need a heightened awareness of the importance of consuming all necessary nutrients and vitamin supplements, as recommended by international guidelines [48].

Conclusions

While veganism has been shown to decrease the risk of cardiovascular and metabolic syndrome, it also carries the potential for micro- and macronutrient deficits. It should be noted that vegans often have better socioeconomic levels, live a healthier lifestyle with more physical exercise, and tend to smoke less compared to non-vegetarians, making it difficult to isolate the effects of veganism in observational research. Existing research is often skewed by selection bias, which is when the study sample is chosen based on prior eating patterns and such studies are often recruited in environments with a high level of health awareness. Our review focuses on the impact of veganism on vulnerable populations, including children, adolescents, pregnant and breastfeeding women, and fetal outcomes in strict vegan mothers. Vegans should be closely monitored and treated for nutritional deficiencies, in order to mitigate any long-term negative health outcomes. Given the growing interest in diets without animal protein intake in the general population, it is crucial, now more than ever, to have a clear understanding of both the risks and benefits of such diets among clinicians, policymakers, and the public.

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Footnotes

The authors have declared that no competing interests exist.

References

  • 1.Dietary change scenarios and implications for environmental, nutrition, human health and economic dimensions of food sustainability. Chen C, Chaudhary A, Mathys A. Nutrients. 2019;11:856. doi: 10.3390/nu11040856. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Vegan diets and hypothyroidism. Tonstad S, Nathan E, Oda K, Fraser G. Nutrients. 2013;5:4642–4652. doi: 10.3390/nu5114642. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Effects of bariatric surgery on atrial fibrillation recurrence rate post ablation. Singh A, Jakhar I, Singh D, Suman S, Gustavo V, Cheng A-L, O’Keefe J. https://www.jacc.org/doi/abs/10.1016/S0735-1097%2822%2901150-0 J Am Coll Cardiol. 2022;8:159. [Google Scholar]
  • 4.Singh A, Zahra F. Treasure Island (FL): StatPearls [Internet]; 2022. Chronic Venous Insufficiency. [PubMed] [Google Scholar]
  • 5.Importance of ischemia among asymptomatic patients with diabetes mellitus undergoing positron emission tomography (pet) myocardial perfusion imaging. Patel K, Singh A, Peri -Okonny Poghni, et al. J Am Coll Cardiol. 2020;24:1799. [Google Scholar]
  • 6.Methylmalonic acid levels and their relation with cobalamin supplementation in Spanish vegetarians. Gallego-Narbón A, Zapatera B, Álvarez I, Vaquero MP. Plant Foods Hum Nutr. 2018;73:166–171. doi: 10.1007/s11130-018-0677-y. [DOI] [PubMed] [Google Scholar]
  • 7.Dietary intakes and lifestyle factors of a vegan population in Germany: results from the German Vegan Study. Waldmann A, Koschizke JW, Leitzmann C, Hahn A. Eur J Clin Nutr. 2003;57:947–955. doi: 10.1038/sj.ejcn.1601629. [DOI] [PubMed] [Google Scholar]
  • 8.Nuts: natural pleiotropic nutraceuticals. Ros E, Singh A, O'Keefe JH. Nutrients. 2021;13:3269. doi: 10.3390/nu13093269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.The paleolithic diet. Singh A, Singh D. Cureus. 2023;25:2023. doi: 10.7759/cureus.34214. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Risk factors for development of severe gastrointestinal dysmotility in patients with systemic sclerosis [Internet] Jakhar I, Singh M, Singh A, Sahil S, Singh D. https://journals.aai.org/jimmunol/article-split/208/1_Supplement/158.16/236810/Risk-factors-for-development-of-severe J Immunol. 2022;208:158. [Google Scholar]
  • 11.Risk factors for development of prostate cancer in patient with inflammatory bowel disease (IBD) Jakhar I, Singh M, Sahil S, Singh A, Singh D. https://www.gastrojournal.org/article/S0016-5085(21)03862-2/fulltext#:~:text=In%20this%20longitudinal%20national%20database,is%20advised%20for%20IBD%20patients. Gastroenterology. 2022;162:0–2. [Google Scholar]
  • 12.Infective endocarditis as a complication of Crohn’s disease on immunotherapy. Singh A, Ejaz A, Gunta PS, Jakulla RS, Singh D. Cureus. 2022;14:0. doi: 10.7759/cureus.32847. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.2589 Disseminated Salmonella species-induced septic shock: a case report. Singh A, Zafar Y, Makovec A. Am J Gastroenterol. 2019;114:1424. [Google Scholar]
  • 14.Dietary protein and amino acids in vegetarian diets—a review. Mariotti F, Gardner CD. Nutrients. 2019;11:2661. doi: 10.3390/nu11112661. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Plasma concentrations and intakes of amino acids in male meat-eaters, fish-eaters, vegetarians and vegans: a cross-sectional analysis in the EPIC-Oxford cohort. Schmidt JA, Rinaldi S, Scalbert A, et al. Eur J Clin Nutr. 2016;70:306–312. doi: 10.1038/ejcn.2015.144. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.The protein digestibility-corrected amino acid score. Schaafsma G. J Nutr. 2000;130:1865–1867. doi: 10.1093/jn/130.7.1865S. [DOI] [PubMed] [Google Scholar]
  • 17.Protein - which is best? Hoffman JR, Falvo MJ. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905294/ J Sports Sci Med. 2004;3:118–130. [PMC free article] [PubMed] [Google Scholar]
  • 18.The associations of diet with serum insulin-like growth factor I and its main binding proteins in 292 women meat-eaters, vegetarians, and vegans. Allen NE, Appleby PN, Davey GK, Kaaks R, Rinaldi S, Key TJ. https://pubmed.ncbi.nlm.nih.gov/12433724/ Cancer Epidemiol Biomarkers Prev. 2002;11:1441–1448. [PubMed] [Google Scholar]
  • 19.Vitamin B12 status upon short-term intervention with a vegan diet—a randomized controlled trial in healthy participants. Lederer AK, Hannibal L, Hettich M, et al. Nutrients. 2019;11:2815. doi: 10.3390/nu11112815. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Is there a carcinogenic risk attached to vitamin B(12) deficient diets and what should we do about it? Reviewing the facts. Loedin AK, Speijer D. Mol Nutr Food Res. 2021;65:0. doi: 10.1002/mnfr.202000945. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.A prospective study on folate, B12, and pyridoxal 5'-phosphate (B6) and breast cancer. Wu K, Helzlsouer KJ, Comstock GW, Hoffman SC, Nadeau MR, Selhub J. https://pubmed.ncbi.nlm.nih.gov/10090298/ Cancer Epidemiol Biomarkers Prev. 1999;8:209–217. [PubMed] [Google Scholar]
  • 22.Serum one-carbon metabolites and risk of cervical cancer. Pathak S, Bajpai D, Banerjee A, Bhatla N, Jain SK, Jayaram HN, Singh N. Nutr Cancer. 2014;66:818–824. doi: 10.1080/01635581.2014.916318. [DOI] [PubMed] [Google Scholar]
  • 23.Cancer risk after pernicious anemia in the US elderly population. Murphy G, Dawsey SM, Engels EA, et al. Clin Gastroenterol Hepatol. 2015;13:2282–2289. doi: 10.1016/j.cgh.2015.05.040. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Low vitamin B(12) increases risk of gastric cancer: a prospective study of one-carbon metabolism nutrients and risk of upper gastrointestinal tract cancer. Miranti EH, Stolzenberg-Solomon R, Weinstein SJ, et al. Int J Cancer. 2017;141:1120–1129. doi: 10.1002/ijc.30809. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Vitamin B12 deficiency is prevalent among Czech vegans who do not use vitamin B12 supplements. Selinger E, Kühn T, Procházková M, Anděl M, Gojda J. Nutrients. 2019;11:3019. doi: 10.3390/nu11123019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Dietary intake of vitamin B12 is better for restoring a low B12 status than a daily high-dose vitamin pill: an experimental study in rats. Greibe E, Nymark O, Fedosov SN, Heegaard CW, Nexo E. Nutrients. 2018;10:1096. doi: 10.3390/nu10081096. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Position paper on vegetarian diets from the working group of the Italian Society of Human Nutrition. Agnoli C, Baroni L, Bertini I, et al. Nutr Metab Cardiovasc Dis. 2017;27:1037–1052. doi: 10.1016/j.numecd.2017.10.020. [DOI] [PubMed] [Google Scholar]
  • 28.Multiple impacts of zinc on immune function. Haase H, Rink L. Metallomics. 2014;6:1175–1180. doi: 10.1039/c3mt00353a. [DOI] [PubMed] [Google Scholar]
  • 29.EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH, Key TJ. Public Health Nutr. 2003;6:259–269. doi: 10.1079/PHN2002430. [DOI] [PubMed] [Google Scholar]
  • 30.Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study. Tong TY, Appleby PN, Armstrong ME, et al. BMC Med. 2020;18:353. doi: 10.1186/s12916-020-01815-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Anthropometric and physiologic characteristics in white and British Indian vegetarians and nonvegetarians in the UK Biobank. Tong TY, Key TJ, Sobiecki JG, Bradbury KE. Am J Clin Nutr. 2018;107:909–920. doi: 10.1093/ajcn/nqy042. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Diet and body mass index in 38000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans. Spencer EA, Appleby PN, Davey GK, Key TJ. Int J Obes Relat Metab Disord. 2003;27:728–734. doi: 10.1038/sj.ijo.0802300. [DOI] [PubMed] [Google Scholar]
  • 33.Meat and mental health: a systematic review of meat abstention and depression, anxiety, and related phenomena. Dobersek U, Wy G, Adkins J, Altmeyer S, Krout K, Lavie CJ, Archer E. Crit Rev Food Sci Nutr. 2021;61:622–635. doi: 10.1080/10408398.2020.1741505. [DOI] [PubMed] [Google Scholar]
  • 34.Treadmill exercise stress test-induced takotsubo cardiomyopathy: a case report and review of literature. Singh A, Singh D. Cureus. 2023;15:0. doi: 10.7759/cureus.33426. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.An overlooked cause of myocardial infarction with normal coronaries presenting as stress cardiomyopathy in females. Singh A, Patel K, Patel F, Saxon JT, Grodzinsky A. Cureus. 2023;15:0. doi: 10.7759/cureus.33251. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Assessment of the impact of the Hospital Anxiety and Depression Scale on the initiation of treatment in newly diagnosed cancer patients in a safety-net hospital. Singh D, Singh A, Grover P, et al. J Clin Oncol. 2017;35:250. [Google Scholar]
  • 37.Orthorexic eating behaviour as a coping strategy in patients with anorexia nervosa. Barthels F, Meyer F, Pietrowsky R. https://www.researchgate.net/publication/292398060_Orthorexic_Eating_Behaviour_A_new_Type_of_disordered_Eating. Ernährungs Umschau. 2017;22:269–276. doi: 10.1007/s40519-016-0329-x. [DOI] [PubMed] [Google Scholar]
  • 38.Orthorexia nervosa in a sample of Italian university population. Dell'Osso L, Abelli M, Carpita B, et al. Riv Psichiatr. 2016;51:190–196. doi: 10.1708/2476.25888. [DOI] [PubMed] [Google Scholar]
  • 39.Unprocessed red meat and processed meat consumption: dietary guideline recommendations from the Nutritional Recommendations (NutriRECS) Consortium. Johnston BC, Zeraatkar D, Han MA, et al. Ann Intern Med. 2019;171:756–764. doi: 10.7326/M19-1621. [DOI] [PubMed] [Google Scholar]
  • 40.Nutrient intake and status of German children and adolescents consuming vegetarian, vegan or omnivore diets: results of the Vechi youth study. Alexy U, Fischer M, Weder S, Längler A, Michalsen A, Sputtek A, Keller M. Nutrients. 2021;13:1707. doi: 10.3390/nu13051707. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Bone status and adipokine levels in children on vegetarian and omnivorous diets. Ambroszkiewicz J, Chełchowska M, Szamotulska K, Rowicka G, Klemarczyk W, Strucińska M, Gajewska J. Clin Nutr. 2019;38:730–737. doi: 10.1016/j.clnu.2018.03.010. [DOI] [PubMed] [Google Scholar]
  • 42.Growth, body composition, and cardiovascular and nutritional risk of 5- to 10-y-old children consuming vegetarian, vegan, or omnivore diets. Desmond MA, Sobiecki JG, Jaworski M, et al. Am J Clin Nutr. 2021;113:1565–1577. doi: 10.1093/ajcn/nqaa445. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.The impact of a vegan diet on pregnancy outcomes. Avnon T, Paz Dubinsky E, Lavie I, Ben-Mayor Bashi T, Anbar R, Yogev Y. J Perinatol. 2021;41:1129–1133. doi: 10.1038/s41372-020-00804-x. [DOI] [PubMed] [Google Scholar]
  • 44.Food sources and intake of n-6 and n-3 fatty acids in low-income countries with emphasis on infants, young children (6-24 months), and pregnant and lactating women. Michaelsen KF, Dewey KG, Perez-Exposito AB, Nurhasan M, Lauritzen L, Roos N. Matern Child Nutr. 2011;7 Suppl 2:124–140. doi: 10.1111/j.1740-8709.2011.00302.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Should vitamin B(12) status be considered in assessing risk of neural tube defects? Molloy AM. Ann N Y Acad Sci. 2018;1414:109–125. doi: 10.1111/nyas.13574. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Effects of folate and vitamin B12 deficiencies during pregnancy on fetal, infant, and child development. Molloy AM, Kirke PN, Brody LC, Scott JM, Mills JL. Food Nutr Bull. 2008;29:0–5. doi: 10.1177/15648265080292S114. [DOI] [PubMed] [Google Scholar]
  • 47.Maternal periconceptional consumption of pickled vegetables and risk of neural tube defects in offspring. Li ZW, Zhang L, Ye RW, et al. Chin Med J (Engl) 2011;124:1629–1633. [PubMed] [Google Scholar]
  • 48.The effects of vegetarian and vegan diet during pregnancy on the health of mothers and offspring. Sebastiani G, Herranz Barbero A, Borrás-Novell C, et al. Nutrients. 2019;11:557. doi: 10.3390/nu11030557. [DOI] [PMC free article] [PubMed] [Google Scholar]

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