Difference in Motives and Basic Health Behavior of 8799 Children and Adolescents Aged 10–19 Years Following a Vegan, Vegetarian, or Omnivorous Diet

Abstract

Background

Young generations appear to be pushing for more sustainable food production as part of the trend toward healthier dietary habits. Long-term sustainable healthy behavior from secondary school ages may contribute to the life course prevention of chronic, noncommunicable diseases.

Objectives

The present study aimed to analyze the motivations and key health behaviors of secondary school pupils following vegan, vegetarian, and omnivorous diets.

Methods

The present study was conducted cross-sectionally with a multi-level, cluster sampling strategy. Secondary school pupils (levels I and II) in Austria were requested to complete an online questionnaire independently or with parent/guardian or teacher supervision, including questions on personal characteristics, physical activity levels, nutrition habits, dietary motives, and alcohol and nicotine habits. The statistical analysis was performed with χ² and analysis of variance tests.

Results

A total of 8799 pupils (3249 boys; 5550 girls) with an mean age of 15.1 ± 2.3 y were classified into the vegan (1.6%), vegetarian (5.6%), or omnivorous diet (92.8%). Boys were found to be more likely to follow an omnivorous diet (97%; P < 0.01). Health was the leading motivation for dietary adherence across the total sample (33.6%; 2959). Sports performance was a leading dietary motivation among the vegan diet subgroup (20.1%). Pupils following a vegan diet were the most active during leisure time (86.6%; P < 0.01) and the most consistently active across the week (3.4 ± 1.2 d/wk; P < 0.01), and the prevalence of daily fruit and vegetable intake was the highest between the vegan subgroup (81.7% and 80.3%; P < 0.01) followed by the vegetarian subgroup (72.4% and 84.2%).

Conclusions

This is the first investigation to examine the differences in motives and basic health behavior between vegan, vegetarian, and omnivorous diets in school pupils. The findings indicate that following a vegan diet during childhood and adolescence is associated with more advantageous basic health behavioral choices.

Introduction

In Europe, ≥75 million (10 %) people eat vegan or vegetarian [1], with Austria having the highest prevalence of vegan dieters (5% vegans, 5% vegetarians, 37% flexitarians) [2,3]. Currently, at 91% of the global population, the most common diet around the world is the omnivorous diet, including a mix of plant and animal foods (e.g., meat or fish) regularly [4]. However, 51% of Europeans, 51% of Austrians, and 59% of Germans (compared with 4% of vegans, 6% of vegetarians, and 40% of flexitarians in Germany) have reduced their meat consumption [2,3]. In addition, the number of vegans and vegetarians in Germany has doubled during the COVID-19 pandemic [5], with young people eating a vegan (2.3%) or vegetarian (10.4%) diet twice as often as the average population [6]. The latest numbers show an 18% and 12% prevalence between the age groups of 14–29 y and 30–44 y eating vegan or vegetarian, respectively [6]. In parallel, flexitarians make up >50% of the German population, with their change in diet actively contributing to a plant-predominant transformation of food systems [7]. The massive shift of dietary choice toward more plant-predominant diets, especially by younger generations today, appears to be related to several important issues, including but not limited to health and well-being, environmental protection, animal welfare and ethics, sports performance, and the impression of the veggie diet and lifestyle as cool [[8], [9], [10]]. By 2070, ChatGPT predicts veganism to be the norm for young generations and that the world will be almost entirely vegan in 2073 based on Generation Z (age <24 y) and Millennials (age ≤38 y) as key drivers of the trend toward healthier and more sustainable foods and diets (health, resources, climate, ethics, etc.) [11]. As young generations push for more plant and plant-predominant foods [[10], [11], [12]], the trend toward healthier and more sustainable food production and dietary habits will evolve.

Analyzing >2 million Facebook posts regarding users (15–65+ y) interest in sustainability (low CO₂ footprint) themes, Eker et al. [12] (2021) identified 12% of Austrian social media users interested in sustainable and plant-predominant diets and lifestyles. The most common reasons to adopt plant-predominant diets are health, animal welfare, environmental concern, body weight loss, and sensory/taste/disgust [13], with ethical and ecological concerns (animal welfare, food scandals, climate, and environment protection), health reasons, and global or humanitarian reasons (resources, hunger) among the top motives stated by vegans or vegetarians [7,[14], [15], [16], [17], [18]]. With these major events of societal relevance, along with the background numbers as a whole, vegetarians and vegans can no longer be considered a fringe group.

However, for over 60 y, chronic, noncommunicable diseases (NCDs: cardiovascular diseases, cancer, diabetes mellitus type 2, etc.) have been the leading causes of death in Austria [19], similar to other developed nations in Western society [20]. Not only are they life-threatening, accounting for 80% of premature NCD deaths globally [[19], [20], [21]], but they also create 90% of all causes of disability [22], with most cases preventable and even reversible. Improving the current status of NCDs in countries like Austria is the major obstacle to the corresponding sustainable development of health and well-being worldwide [23]. Although healthy behavior is known to be vital for the prevention of NCDs and early death [24], only 5.8% of European (2.8% of Austrian) adults live a healthy lifestyle based on 5 personally modifiable lifestyle factors [physical activity (PA), fruit and vegetable intake, alcohol, and smoking] [25]. In addition to PA, sports, and exercise [[26], [27], [28], [29]], food choices and personal nutrition can be decisive regarding the response of the immune system, prevention of ill health, or the attenuation of moderate-to-severe disease progression and premature death [[30], [31], [32], [33]]. These unenthusiastic findings extend to children and adolescents as vulnerable populations with regard to health [34]. Large-scale international studies report most children and adolescents follow unhealthy PA and dietary behaviors [35,36], with results from the latest WHO Health Behavior of School-aged Children study revealing a 22% overweight/obesity prevalence (Austrian prevalence: 25% for boys, 17% for girls), and only 25% of boys and 15% of girls (52% and 30%, respectively in Austria) are meeting the minimum PA recommendation [37,38].

However, adults (including parents and family, teachers, doctors, athletes, and friends) are the major role models for children’s and adolescents’ development of health behavior [39]. It has also been well-established that health-related behaviors and lifestyles often emerge and solidify during childhood and adolescence, persisting into adulthood (for better or worse) [[40], [41], [42], [43]], with limited possibility of learning healthy behavior in adulthood [44]. With social circumstances playing a key role in health behavior development besides the predominant role of (parental) guardianship [39,45], schools offer an excellent environment for health behavior interventions and to become qualified with knowledge and competencies through education and training, especially considering the minimum of 9 y of compulsory education in Austria [46,47].

However, the prevalence of, reasons, and possible body growth complications among vegan and vegetarian diets among today’s youth is very limited and thus remains unclear [48]. In addition, previous studies on the health behavior of school pupils 1) did not distinctly discriminate between kinds of diet but rather pooled vegan with vegetarian dieters [37,38,[49], [50], [51]], 2) had low sample sizes insufficient for the representation of bigger populations (i.e., a nation, an educational setting, etc.) [52,53], and 3) overlooked the exploration of the relationship between diet type (especially linked to PA, sports, and exercise) and public health [37,38,49,50]. Likewise, data are lacking on the prevalence of current dietary trends among children and adolescents in Austria. In order to overcome the lack of information available, also considering the weak study designs of dietary subsamples in previous research in children [54], the From Science 2 School study (www.science2.school/en) is the first to investigate current dietary trends based on distinctly differentiated diet types, particularly in the school context in connection with PA, sports, and exercise. Therefore, the present study aimed to examine the motives and basic health behaviors of secondary school pupils following vegan, vegetarian, and omnivorous diets nationwide in Austria. Based on sound evidence from adult cohorts, a difference in basic health behavior between vegan, vegetarian, and omnivorous secondary-level pupils was hypothesized.

Methods

From Science 2 School was carried out with a cluster sampling strategy, including multiple levels following a cross-sectional design. The Federal Ministry of Education, Science, and Research (Bundesministerium für Bildung, Wissenschaft und Forschung; Department 1/7—School and University Sports) supported this nationwide study in Austria. The study protocol may be accessed on the official website (including the previously published questionnaires as supplementary material) and was approved by the all ethics committees of the 9 Federal Education Authorities in Austria. Based on the requirements of the respected educational authorities and the corresponding school management entities, no further ethical vote (e.g., institutional review committee or ethics board) was required.

Study procedure and measures

The standardized survey (published as supplemental material) was made available online (28 October, 2019 to 10 July, 2020) for anonymous participation of secondary school pupils (levels I & II) nationwide across Austria through an encrypted web platform (see: https://www.science2.school/en/#Questionnaire). Before the pupils participated in the voluntary study, written information on the study procedure was provided, and informed consent was required by the pupils themselves (independently) or with parent/guardian or teacher supervision. Withdrawal from study participation was possible at any time without consequence. The pupils could access and complete the survey with a smartphone, computer, or tablet with school staff or parental supervision. The survey was based on 5 parts: individual characteristics (part 1), PA, sports, and exercise (part 2), nutrition and diet type (part 3), health (part 4), and additional information (part 5). Throughout the survey, control questions were provided to determine illegitimate responses and conflicts to aid in increasing the reliability of the data.

The online survey obtained data on sociodemographic characteristics {[school level (middle compared with high school), sex, residence (urban compared with rural) nationality, age, and anthropometrics [body height and weight, calculated BMI (in kg/m²) and BMI percentiles: BMI_PCT]}, and general diet type (omnivorous, vegetarian, and vegan)]. Furthermore, data on dietary motives (e.g., health, tradition, animal welfare, environmental protection, performance, taste/preference, no specific or other reason), lifestyle interests [e.g., smoking, alcohol, vegan/vegetarian lifestyle and/or diet (i.e., respectively clothing, philosophy, etc.), eating meat, lifestyle of sport, engagement in sports, etc., dietary behavior (fruit and vegetable consumption, fluid intake level, and most common fluids consumed), PA, sports, and exercise participation (leisure-time sports, club sports, days per week), and alcohol consumption and smoking were collected. Based on their self-report combined with their reported dietary intake, pupils were assigned to the corresponding subgroup: vegan diet (no consumption of foods, products, or ingredients from animals at all, 100% plant-originated nutrition), vegetarian diet (no consumption of red/white meats and processed meat or fish, shellfish and seafood, but eggs, dairy products, etc.), or omnivorous diet (consumption of animal and plant foods) [14,15,17].

Study participation

The nationwide sample size included all pupils (N = 771,525) of secondary schools in Austria. In line, all 2688 secondary schools in Austria were invited by e-mail to take part in the school study. School staff received the initial information concerning the study goals and study procedure with details to share the survey responsibilities with the class teachers. The pupils were instructed to complete the survey in class or at home with their parents. The basic sample included participation from 8845 pupils at data closure. Figure 1 displays the flow of the pupils’ study enrolment.

FIGURE 1.

Flow of pupils’ study enrolment following vegan, vegetarian, and omnivorous diets.

Data clearance

A total of 8845 participants completed the online survey. Because of the implausible anthropometric data (body height <110 cm, body weight <20 kg, BMI >50, or BMI <10), 46 pupils were excluded from the initial sample (Figure 1). Following the German reference values, BMI was converted into BMI_PCT, with the 90th and 97th percentile serving as cutoff points for overweight and obesity, respectively [55]. Pupils with a BMI_PCT below the 10th percentile were classified as underweight [55]. Considering the kind of diet, 7902 (89.8%) pupils reported following an omnivorous diet, whereas 804 (9.1%) and 93 (1.1%) participants reported a vegetarian and vegan diet, respectively. After checking responses to various dietary control questions, the reported food consumed did not match the reported diet type in 334 (3.8%) participants (see Figure 1 for shifted cases). Misclassification was more pronounced in girls compared to boys (4.8% compared with 2.1%). A total of 8799 secondary level I and II pupils were included in data analysis following data clearance (1.14% of the available 771,525 pupils). A power analysis was conducted to determine statistically representative and reliable results detectable with a minimum of 984 secondary-level pupils, considering data on biometric characteristics (sex, age, and diet type).

Statistical analysis

Descriptive statistics were reported in prevalence (%, n) and mean with SD. Analysis of variance and Bonferroni adjustment for post hoc analyses were used to examine differences in anthropometric characteristics across the dietary subgroups. Kruskal-Wallis and χ² tests were used to examine associations between dietary subgroups and ordinal or nominal scaled data. The statistical analyses were performed on the total sample, as well as separately by school level (middle compared with high school), sex, living environment (urban compared with rural), and nationality (Austrian compared with international). SPSS version 29.0 (SPSS Inc, IBM Corporation) was used to perform all statistical tests. The level of statistical significance was set at P < 0.01.

Results

A total of 8799 secondary-level pupils (mean age of 15.1 ± 2.3 y) form the final sample of the present study. Although a pooled prevalence of 7.2% of participants consumed plant-predominant diets (vegetarian: 5.6%; n = 493; and vegan: 1.6%; n = 142), the majority of participants (n = 8164 or 92.8%) followed an omnivorous diet. Significantly more male pupils followed an omnivorous diet (97%; n = 3151), whereas the prevalences of vegetarian and vegan diets were higher in female pupils (9.6%; n = 537; P < 0.01). Omnivorous and vegan diets were more prevalent in middle school pupils, whereas a vegetarian diet was more prevalent in high school pupils (P < 0.01). The prevalence of a vegetarian diet was higher in Austrian participants (5.9%; n = 457) compared to international participants (P < 0.01). On average, pupils had a normal BMI_PCT, whereas the BMI_PCT differed significantly between omnivorous and vegetarian pupils only (P < 0.01). Vegetarian pupils had a significantly higher prevalence of underweight compared to those with an omnivorous diet (18.7% compared with 12%; n = 680; P < 0.01), whereas no difference was found between vegetarian and vegan participants. Table 1 provides the detailed results of secondary pupils by diet type.

TABLE 1.

Anthropometrics and sociodemographic distribution of participants across dietary subgroups by school level, sex, living environment, and nationality.

	Total	Vegan	Vegetarian	Omnivorous
	N = 8799	1.6% (n = 142)	5.6% (n = 493)	92.8% (n = 8164)
School level1,2
Middle school, %	43.1 (n = 2651)	2.3 (n = 60)	3.1 (n = 82)	94.6 (n = 2509)
High school, %	69.9 (n = 6148)	1.3 (n = 82)	6.7 (n = 411)	92 (n = 5655)
Sex3,4,5
Male, %	36.9 (n = 3249)	1 (n = 34)	2 (n = 64)	97 (n = 3151)
Female, %	63.1 (n = 5550)	1.9 (n = 108)	7.7 (n = 429)	90.3 (n = 5013)
Age ± SD (years)3,5	15.1 ± 2.3	14.6 ± 2.7	15.9 ± 2.0	15.1 ± 2.3
Height (cm)4,5	166.6 ± 10.5	162.7 ± 12.1	166.5 ± 8.3	166.6 ± 10.6
Body weight (kg)4	58.5 ± 14.3	53.9 ± 14.1	57.0 ± 11.7	58.6 ± 14.4
BMI percentile (kg)3	49.7 ± 30.4	45.7 ± 31.3	44.5 ± 29.7	50.3 ± 30.3
Underweight1, %	12.4	17.6	18.7	12.0
Normal weight1, %	75.8	75.4	73.8	75.9
Overweight, %	7.1	2.1	5.1	7.3
Obese, %	4.7	4.9	2.4	4.8
Residence
Urban, %	31.7 (n = 2785)	2 (n = 57)	5.4 (n = 149)	92.6 (n = 2579)
Rural, %	68.3 (n = 6014)	1.4 (n = 85)	5.7 (n = 344)	92.9 (n = 5585)
Nationality6
Austrian, %	88 (n = 7746)	1.5 (n = 120)	5.9 (n = 457)	92.6 (n = 7169)
International, %	12 (n = 1053)	2.1 (n = 22)	3.4 (n = 36)	94.5 (n = 995)

Note. Values are prevalences (percentage), total numbers, and mean ± SD. Significant difference (P < 0.01).

Abbreviations: SD, standard deviation.

¹Significant difference (P < 0.01) for omnivorous diet.

²Significant difference (P < 0.01) for vegan diet.

³Significant difference (P < 0.01) between omnivorous and vegetarian diet.

⁴Significant difference (P < 0.01) between omnivorous and vegan diet.

⁵Significant difference (P < 0.01) between vegetarian and vegan diet.

⁶Significant difference (P < 0.01) for vegetarian diet.

Dietary motives

Both vegan and omnivorous pupils reported health most commonly as the primary motive for their kind of diet (35.4% and 34.0%, respectively). For vegetarian pupils, animal welfare was mentioned most often as their primary motive (28.7%), followed by health (27.0%). Sports performance was the second most popular motive among vegans (20.1%), whereas omnivore participants reported taste as the second most important motive for dietary choice (20.9%). Table 2 displays an overview of dietary motives across subgroups, whereas information on dietary motives and lifestyle preferences by diet type for sex, school level, living environment, and nationality are presented in Supplemental Appendix, Supplemental Tables 1 and 2 in full detail.

TABLE 2.

Dietary motives and lifestyle preferences according to diet types.

		Total	Vegan	Vegetarian	Omnivorous
		N = 8799	1.6% (n = 142)	5.6% (n = 493)	92.8% (n = 8164)
Dietary motives	Health, % Animal welfare, %	33.6 (n = 2959)	35.4 (n = 50)	27.0 (n = 133)	34.0 (n = 2776)
		9.6 (n = 844)	9.8 (n = 14)	28.7 (n = 141)	1.7 (n = 139)
	Sports performance, %	9.6 (n = 844)	20.1 (n = 29)	6.3 (n = 31)	9.6 (n = 784)
	Taste/Preference, %	20.1 (n = 1770)	6.0 (n = 9)	11.1 (n = 55)	20.9 (n = 1706)
	Tradition, %	10.2 (n = 898)	2.1 (n = 3)	4.2 (n = 21)	10.7 (n = 874)
	Environment protection, %	1.9 (n = 166)	3.0 (n = 4)	9.5 (n = 47)	1.4 (n = 114)
	No specific reason, %	11.0 (n = 966)	9.5 (n = 13)	4.4 (n = 22)	11.4 (n = 931)
	Other, %	10.2 (n = 896)	14.2 (n = 20)	8.7 (n = 43)	10.2 (n = 833)
Lifestyle preferences	Sports engagement, %	26.4 (n = 2324)	24.5 (n = 35)	23.8 (n = 117)	26.6 (n = 2172)
	Sports lifestyle, %	21.4 (n = 1883)	13.8 (n = 20)	13.6 (n = 67)	22.0 (n = 1796)
	Alcohol, %	6.1 (n = 541)	4.3 (n = 6)	4.2 (n = 21)	6.3 (n = 514)
	Smoking, %	1.4 (n = 120)	1.9 (n = 3)	0.7 (n = 3)	1.4 (n = 114)
	Eating meat, % Vegetarian diet, %	14.1 (n = 1245)	2.1 (n = 3)	0.2 (n = 1)	15.2 (n = 1241)
		6.3 (n = 555)	11.0 (n = 16)	25.0 (n = 123)	5.1 (n = 416)
	Vegetarian lifestyle, %	3.3 (n = 293)	4.8 (n = 7)	11.5 (n = 57)	2.8 (n = 229)
	Vegan diet, %	1.8 (n = 159)	15.5 (n = 22)	4.6 (n = 23)	1.4 (n = 114)
	Vegan lifestyle, %	1.9 (n = 171)	10.2 (n = 14)	3.8 (n = 19)	1.7 (n = 139)
	Other, %	17.2 (n = 1517)	11.9 (n = 17)	12.8 (n = 63)	17.6 (n = 1437)

Note. Values are prevalences (percentage) and total numbers.

Lifestyle interests and PA, sports, and exercise participation

Engaging in PA, sports and exercise, and the lifestyle of a certain sport were most commonly considered cool across the entire sample (26.4% and 21.4%, respectively). However, 6.1% and 1.4% of pupils considered alcohol and smoking as cool, respectively. A certain lifestyle linked to the so-called “veggie boom” was mentioned by 5.2% (3.3% vegetarian and 1.9% vegan lifestyle) pupils across the total sample. Vegetarian pupils most commonly reported vegetarian food (25.0%), and 11.5% considered a vegetarian lifestyle as being cool. Among vegans (n = 142), a vegan diet and a vegan lifestyle were considered cool for 15.5% and 10.2%, respectively (Table 2). Considering sex, more male than female pupils reported eating meat as being cool (19.0% compared with 11.2%). A vegetarian diet and lifestyle, on the contrary, was mentioned more often by female than male pupils (8.3% compared with 3.0% for a vegetarian diet and 4.5% compared with 1.3% for a vegetarian lifestyle, respectively). The difference in considering eating meat as being cool was also observed between age groups, with a higher prevalence in middle school compared to high school pupils (17.0% compared with 12.9%). Alcohol consumption, on the contrary, was more often mentioned as a cool lifestyle in high school than in middle school pupils (8.0% compared with 1.7%), albeit the prevalence was small in either group. Similar patterns regarding what was considered a cool lifestyle were reported across living environments and nationalities.

For participation in PA, sports, and exercise, 82.4% of the participants engaged regularly in leisure-time sports, but only 42.5% of active participants were club sports members. The prevalence of leisure-time activity increased from omnivorous to the vegan diet (82.3% compared with 86.6%; P < 0.01), whereas there was no difference in the prevalence of leisure-time activity in boys and also not in club sport participation considering diet type (P > 0.01; Table 3). Vegan pupils were more active on a weekly basis (3.4 ± 1.2 d/wk) than vegetarians and omnivores (2.8 ± 1.9 d/wk; omnivorous: vegetarians: 2.8 ± 2.0 d/wk, respectively; P < 0.01; Figure 2). Further, the number of days for sports participation increased across dietary subgroups in girls from 2.5 ± 1.9 d/wk in omnivores over 2.8 ± 1.9 d/wk in vegetarians to 3.5 ± 2.1 d/wk in vegan pupils (P < 0.01). No difference was observed in boys (vegan: 3.3 ± 2.4 compared with vegetarian: 3.0 ± 2.3 compared with omnivorous: 3.3 ± 2.1 d/wk).

TABLE 3.

Prevalence (percentage) of physical activity, sports, and exercise engagement by dietary subgroups.

TOTAL (N = 8799)	Leisure-time sports 82.4% (n = 7253)			Club sports 42.5% (n = 3083)
	Vegan	Vegetarian	Omnivorous	Vegan	Vegetarian	Omnivorous
	86.6% (n = 123)	83.8% (n = 413)	82.3% (n = 6717)	35.8% (n = 44)	41.6% (n = 172)	42.7% (n = 2867)
School level
Middle School, %	93.3 (n = 56)	91.5 (n = 75)	90.0 (n = 2259)	35.7 (n = 20)	42.7 (n = 32)	49.5 (n = 1119)
High School, %	81.7 (n = 67)	82.2 (n = 338)	78.8 (n = 4458)	35.8 (n = 24)	41.4 (n = 140)	39.2 (n = 1748)
Sex
Male, %	82.4 (n = 28)	81.3 (n = 52)	85.9 (n = 2707)	57.1 (n = 16)	44.2 (n = 23)	52.1 (n = 1409)
Female, %	88.0 (n = 95)	84.1 (n = 361)	80.0 (n = 4010)	29.5 (n = 28)	41.3 (n = 149)	36.4 (n = 1458)
Residence
Urban, %	91.2 (n = 52)	85.2 (n = 127)	80.5 (n = 2077)	44.2 (n = 23)	45.7 (n = 58)	42.0 (n = 873)
Rural, %	83.5 (n = 71)	83.1 (n = 286)	83.1 (n = 4640)	29.6 (n = 21)	39.9 (n = 114)	43.0 (n = 1994)
Nationality
Austrian, %	86.7 (n = 104)	84.5 (n = 386)	83.2 (n = 5966)	36.5 (n = 38)	42.5 (n = 164)	43.9 (n = 2618)
International, %	86.4 (n = 19)	75.0 (n = 27)	75.5 (n = 751)	31.6 (n = 6)	29.6 (n = 8)	33.2 (n = 249)

FIGURE 2.

PA, sports, and exercise participation (days/week) by diet type (n = 7253). Note. Values are displayed as median and IQR, including means (x). PA, physical activity.

Analyzing participants separately by living environment, school level, and nationality, Austrian participants, high school pupils, and those living in an urban environment with a vegan diet reported more weekly involvement with PA, sports, and exercise compared to their omnivorous peers (P ≤ 0.01). The prevalence of PA, sports, and exercise engagement also increased in participants living in an urban environment from participants with an omnivorous to a vegan diet, whereas no differences were observed in other subgroups. There was no difference in the prevalence of club sports participation across diet types in any subgroup analysis (Table 3).

Dietary behavior

The majority of participants reported daily fruit (66.0%) and vegetable (63.9%) consumption. There was a significant increase in the prevalence of daily fruit consumption across dietary subgroups which resulted in a significantly higher prevalence of daily fruit intake for vegan pupils (81.7%; n = 116) compared to vegetarian (72.4%; n = 357) and omnivorous pupils who displayed the lowest consumption (65.4%; n = 5,339) (P < 0.01; Figure 3). Similarly, the prevalence of daily vegetable consumption was significantly higher in vegetarian (84.2%; n = 415) and vegan pupils (80.3%; n = 114) compared to their omnivorous peers with the lowest intakes (62.4%; n = 5,094; P < 0.01), whereas there was no difference in daily vegetable consumption between participants with a vegan and vegetarian diet. Table 4 provides an overview of distribution for school level, sex, residence, and nationality.

FIGURE 3.

Prevalence (percentage) of daily fruit and vegetable consumption by diet type (N = 8799).

TABLE 4.

Prevalence (%) of daily fruit and vegetable consumption by dietary subgroups.

Total (N = 8799)	Daily fruit intake 66% (n = 5807)			Daily vegetable intake 63.9% (n = 5623)
	Vegan	Vegetarian	Omnivorous	Vegan	Vegetarian	Omnivorous
	81.7 (n = 116)	72.4 (n = 357)	65.4 (n = 5336)	80.3 (n = 114)	84.2 (n = 415)	62.4 (n = 5095)
School level
Middle School, %	80.0 (n = 48)	80.5 (n = 66)	74.7 (n = 1874)	68.3 (n = 41)	79.3 (n = 65)	60.7 (n = 1522)
High School, %	82.9 (n = 68)	70.8 (n = 291)	61.2 (n = 3462)	89.0 (n = 73)	85.2 (n = 350)	63.2 (n = 3573)
Sex
Male, %	76.5 (n = 26)	67.2 (n = 43)	60.2 (n = 1896)	64.7 (n = 22)	85.9 (n = 55)	55.1 (n = 1737)
Female, %	83.3 (n = 90)	73.2 (n = 314)	68.6 (n = 3440)	85.2 (n = 92)	83.9 (n = 360)	67.0 (n = 3358)
Residence
Urban, %	82.5 (n = 47)	70.5 (n = 105)	63.8 (n = 1645)	71.9 (n = 41)	82.6 (n = 123)	62.8 (n = 1620)
Rural, %	81.2 (n = 69)	73.3 (n = 252)	66.1 (n = 3691)	85.9 (n = 73)	84.9 (n = 292)	62.2 (n = 3475)
Nationality
Austrian, %	80.8 (97)	72.9 (n = 333)	65.3 (n = 4681)	80.8 (n = 97)	84.2 (n = 385)	61.9 (n = 4437)
International, %	86.4 (n = 19)	66.7 (n = 24)	65.8 (n = 655)	77.3 (n = 17)	83.3 (n = 30)	66.1 (n = 658)

The most common level of fluid intake was 2 L/d and similar for omnivores (33.1%; n = 2702), vegetarians (35.7%; n = 176), and vegans (29.6%; n = 42). The prevalence of a daily fluid intake >2 L/d was significantly higher in vegan pupils (26.8%; n = 38) compared to their vegetarian and omnivorous peers 17.4%; n = 86 and 23.0%; n = 1879, respectively; P ≤ 0.01).

As shown in Figure 4, water was the most common drink consumed by the total sample (72.9%; n = 6413), followed by syrup (9.1%; n = 803), fruit juices (7.5%; n = 661) and soft-drinks (4.7%; n = 415). A significantly higher prevalence of vegetarian pupils (84.6% compared with 75.4% in vegans and 72.1% in omnivores; P < 0.01) reported water as their most common drink, whereas syrup (9.6%) and fruit juice (7.8%) were more often reported as most common drink in omnivorous pupils. Vegan pupils reported tea (9.2%) as their most common drink more often than their peers.

FIGURE 4.

Prevalence (percentage) of most commonly consumed fluid by diet type (N = 8799).

Alcohol consumption and smoking

Across the entire sample, 46.9% (n = 4123) reported alcohol consumption and 9.3% (n = 815) smoked. Alcohol consumption was significantly higher in vegetarian pupils (55.0%; n = 271; P < 0.01) compared to omnivorous and vegan pupils (46.5%; n = 3798 and 38.0%; n = 54, respectively; P < 0.01) (Figure 5), whereas there were no significant differences in the smoking prevalence between dietary subgroups (vegans: 8.5%; n = 12 compared with vegetarians: 9.7%; n = 48 compared with omnivores: 9.2%; n = 755; P > 0.01) as well as in subgroup analyses across dietary subgroups (P > 0.01). Subgroup analyses for alcohol intake showed no significant differences across dietary subgroups, except for significant differences for pupils living in an urban environment (50.3% in vegetarians compared with 33.5% in omnivores compared with 28.1% in vegans; P < 0.01) and Austrian participants (55.8% in vegetarians compared with 48.7% in omnivores compared with 40.0% in vegans; P < 0.01) by diet type .

FIGURE 5.

Prevalence (percentage) of alcohol consumption by diet type (N = 8799).

Discussion

The present investigation of the From Science 2 School Study aimed to assess the dietary motivations and associations of basic health behaviors among Austrian secondary school pupils following vegan, vegetarian, and omnivorous diets based on a big sample size. The major findings are as follows: 1) 3 out of 4 pupils have a healthy BMI, with most pupils following an omnivorous diet, predominantly males; 2) health as single motive ranks top for dietary choice across the total sample; 3) sport engagement pooled with its lifestyle was the leading reason contributing to lifestyle preference; 4) pupils following a vegan diet were the most active during leisure time and the most consistently active across the week; 5) the prevalence of daily fruit and vegetable intake was highest between the vegan followed by the vegetarian subgroup; 6) water was the most consumed fluid across the total sample, with water and tea being the leading fluids by vegetarian and vegan pupils; 7) the vegetarian subgroup was more likely to consume alcohol than their peers, with more vegans reporting alcohol avoidance. The study findings confirm the hypothesis that there is a difference in the basic health behavior among vegan, vegetarian, and omnivorous secondary school pupils in Austria.

In the present study, the relative distribution of vegan/vegetarian secondary pupils (7.2% pooled compared with ∼93% omnivores) is in accordance with the respective prevalences of especially vegan (2–7%) and vegetarian (5–10%) children/adolescents (5.1% pooled at age 12–17 y) in Germany [49]. In line with the previous reporting of diet type adherence among adults [16] and children/adolescents in Germany [49,52,56], the present study consistently revealed that boys (males in general) are more likely to follow an omnivorous diet. This omnivorous predominance (∼9 in 10 overall) result may be due to several reasons, including 1) parental dietary habits, which is in line with findings from the VeChi Youth Study [56], 2) the socio-cultural appropriation of meat-centered diets, especially among the male archetype of masculinity (power, vigor) [38,[57], [58], [59], [60], [61]], which is apparent considering 15% of the omnivorous sample ranked eating meat as cool, and 3) 1 in 2 vegans and 2 in 5 vegetarians face hostility from dissimilar family and friends [17]. In addition, the boys of the present study were mostly of high school ages (15.1 y on average) and living in rural environments in Austria. Thus, the boys of the present study, being primarily of high school ages, have nearly formed their complete autonomy for nutritional decision-making based on the surrounding cultural and political factors [62,63] rather than scientific evidence of healthy and long-term sustainable nutrition [29,30]. Coherently, pupils in the omnivorous subgroup most frequently ranked taste (1 in 5) and tradition (1 in 10) as their leading motives for their diet type adherence, which might be a display of a lack of their own critical and self-reflective nutritional experience. In addition, the EsKiMo II study (nutrition module of KiGGS – German Health Interview and Examination Survey for Children and Adolescents) showed that the composition of the quantity and choice of foods consumed by German children and adolescents is far from the nutritional recommendations for an optimized omnivorous diet suggested by the Research Institute of Child Nutrition [64]. However, although Austria is considered the leading country in the world for supporting animal welfare [65], meat and dairy-focused advertisements have a strong foundation nationwide in Austria, with rural communities subject to direct contact with animal agriculture as a means of financial dependence [62,63]. The present results revealed that animal welfare was the leading motive among the vegetarian pupils (28.7%); however, the vegan pupils were far more interested in health (9.8% for animal welfare compared with 35.4% for health preference), which may be due to social media, informative documentaries, as well as peer support [[8], [9], [10],48,50,56,65,66]. In addition, tax subsidies in countries like Austria play a major role in supporting the current dietary habits and structural framework of animal agriculture [62,63], and 82% of European Union agricultural subsidies (38% direct and 44% for feed) support emission-intensive animal products (84% of greenhouse gas emissions, providing only 35% of calories and 65% of proteins) rather than sustainable plant products [67].

Although ethics, animal welfare, environmental protection, and sustainability are important dietary motives in vegan/vegetarian adults [16], this study surprisingly revealed these reasons of rather secondary importance for the specific dietary choice (animal welfare: ∼10% in total but the leading motive among vegetarians and #4 among vegans; environmental protection with only ∼2% overall, and ∼10% of vegetarians showing the greatest interest across dietary subgroups). Overall, health was the single most important dietary motive in this study (1 out of 3 children/adolescents). However, based on sound evidence, diets emphasizing plant foods are not only healthier and most beneficial regarding planetary health [14,16,35,68,69] but are especially relevant for environmental health and sustainability [[70], [71], [72], [73]], even environmental impact among vegan/vegetarian children/adolescents (1–18 y) was markedly better than for omnivorous peers [74,75]. In addition, 8.3% of parents in the United Kingdom are raising their children on a vegan diet, mentioning health benefits (61%) and ethical reasons (35%) as main motives [76]. With this, ∼35% of vegan pupils stated health as the most important motive to adopt their diet; however, interestingly, 34% of omnivorous pupils stated so, too. As a cornerstone of scientific conclusion, the Academy of Nutrition and Dietetics, the world’s largest nutritional organization, not only consistently upholds in its current position statement the adequacy of well-planned and implemented vegan and vegetarian diets supplemented with vitamin B12 (e.g., fortified foods, food supplements) is healthy and health-promoting, nutritionally adequate for all people across the lifecycle from pregnancy and breastfeeding to old age, including childhood and adolescence, and for athletics, but explicitly emphasizes the tremendous health benefits of these diets with regard to the prevention and treatment of chronic and NCDs [14,15]. This is in line with the nutritional recommendations of the EAT-Lancet Commission for planetary health [69], and since 2024, the German Nutrition Society [77] and the Austrian Nutrition Society [78] have agreed. The Austrian Federal Ministry of Social Affairs, Health, Care, and Consumer Protection consequently updated the guideline for school cafeterias and determined that by 2024, the minimum criteria for school snacks and meals must include vegan bread and pastries (snacks) and ≥1 vegan meal [79].

Regardless of the direction of scientific evidence on the unique and highly needed health benefits of plant-predominant diets [32,54,80], also considering the diversity of randomized controlled trials showing NCD reversal following the vegan diet [31,[80], [81], [82]], there is still debate on health adequacy [77]. However, the Italian Society of Human Nutrition [83] and the Canadian Paediatric Society [84] agree with the Academy of Nutrition and Dietetics (2016) position on vegan/vegetarian diets in childhood and adolescence [14], the German Nutrition Society (2024) does not take a clear position regarding a recommendation either in favor of or against a vegan diet for these potentially vulnerable groups [77]. However, sufficient evidence shows that children and adolescents (6–18 y) thrive well on well and versatilely planned, vitamin B12-supplemented vegan and vegetarian diets with cautious consideration of critical nutrients, as is evident for all kinds of diets [16,54,68,85]. The Austrian Nutrition Society (2024) states that the risk of an undersupply or deficiency of specific nutrients during sensitive phases of life, such as childhood and adolescence, increases only with inadequate planning of a vegan diet [78]. However, vegetarian kind diets were already mentioned in 2010 as a sensible approach for obesity prevention in children, optimal health, and environmental benefits [86], which corresponds with the respective lower BMI and body weight between vegetarian and vegan subgroups in the present study.

Among the pupils following the vegan diet, the predominant dietary motivation for health (1 in 3) was followed up by the interest in performing better in sports (1 in 5). This result is in line with previous findings as well as previous literature speculating on the advantages of the vegan diet for sports performance [[87], [88], [89], [90]]. However, sports engagement pooled with lifestyle was the leading reason for considering lifestyle preference across all dietary subgroups. Findings for sports performance differences based on diet type, especially concerning the vegan diet across various areas of health and skill-related fitness, have identified minor inconsistencies [[87], [88], [89], [90]]. However, it should be noted that no significant differences in sports performance have been concluded based on general types of diet (omnivorous, vegetarian, and vegan) [[87], [88], [89], [90]]. In addition, documentaries like The Game Changers [91], alongside anecdotal evidence of professional athletes thriving on vegan nutrition across various disciplines like Diana Taurasi (basketball), Novak Djokovic (tennis), Dotsie Bausch (cycling), or Patrick Baboumian (strength) have accentuated the likelihood of uncovering a vegan performance advantage with future rigorous scientific study [[87], [88], [89], [90]]. In addition to parents, professional (especially medal-winning) athletes are powerful role models [92,93], which appears to have an impact on the daily health behavior of children and adolescents.

In line with the previous finding, the vegan children and adolescents (especially vegan girls) in the present study were found to be the most active overall (>3 d/wk compared with <3 d/wk for nonvegan pupils). Considering the relevance of the current global health crisis [19], especially concerning poor levels of PA among youth and adults [24,36], this is a major finding. Although this result may be partly due to the greater dietary motivation among the vegan pupils toward sports performance, the results on lifestyle interests in parallel revealed that all dietary groups were predominantly interested in sports (half of the total sample). Therefore, an underlying difference in nutrition [94] and the consequential metabolism between the vegan pupils and the other diet types was likely the primary factor contributing to greater and more consistent PA levels [95,96]. Considering the food options of the vegan diet are solely based on plant foods (legumes, whole grains, fruits, and vegetables), the underlying macronutrient distribution of the typical vegan diet comes predominantly from carbohydrates, especially complex carbohydrates such as oligosaccharides, polysaccharides, starches, and fiber [[90],97,98]. Therefore, the major composition of the vegan diet provides more efficient and consistent energy levels throughout the day [90,97,98], reflected by the greater level and frequency of PA among these pupils across the week. However, in the present study, the average activity reported across all dietary subgroups failed to achieve the daily PA recommendation of 60 min of moderate-to-vigorous intensity [26], which is in line with both the Austrian Health Behavior of School-aged Children as well as the KiGGS Welle 2 studies, with findings previously showing insufficient PA levels for Austrian and German children/adolescents [38,99,100], with only 22.4% of girls and 29.4% of German boys are active for ≥60 min/d [101] and only 19% of children/adolescents in Europe and Canada meet the WHO recommendations for daily PA [102].

Correspondingly, the subsequential major finding of the present study is that the pupils following the vegan diet most frequently consumed fruits and vegetables daily. This finding is especially relevant considering the connection of poor dietary habits with premature mortality, where it has been previously identified that diets low in fruits and vegetables were the cause of 20% compared with 42% of all deaths on a global compared with European level, respectively [103]. However, it was previously found that the majority of Austrian girls and boys fail to eat fruit (≤59% of girls, ≤71% of boys) and vegetables (≤57% of girls, ≤71% of boys) as recommended at least once a day [38]. In comparison, only 14% of German children/adolescents match the recommended daily intake for fruit/vegetables in the KiGGS Welle 2 study [99,101]. Likewise, a major challenge for governments and parents for over 40 y has been to increase their children’s fruit and vegetable consumption [104]. The present results, however, show a higher likelihood of more plant-predominant, vegan/vegetarian diets in school pupils. Also, results from the VeChi Youth Study on children/adolescents aged 6–18 y showed clear differences in food group intakes between dietary subgroups, with vegan children and adolescents having generally healthier food intake patterns than their peers [56]. The VeChi Youth Study did not indicate specific nutritional risks among vegan and vegetarian children/adolescents compared to omnivores, thus confirming that vegan/vegetarian diets can meet the recommended nutrient requirements in childhood and adolescence [52,53,56,75]. The study also revealed the financial burden of food costs is not necessarily a barrier to adopting a more plant-predominant kind of diet, even for very low budgets, with no significant difference between omnivores and vegans but vegetarians at the lowest cost (2.83 compared with 2.98 compared with 2.52 €/1000 kcal, respectively [105].

Regarding nonalcoholic fluid consumption habits, vegetarians and vegans displayed the highest frequencies of water and tea consumption. It has been previously reported that due to inadequate water intake, children may be at risk for hyperosmotic cell stress, which is integral to the function of the immune, cardiovascular, endocrine, neural, muscle, gastrointestinal, and skeletal systems [106]. Previous data suggests that at age 9–13 y, boys need 2.1 L/d, whereas girls need 1.9 L/d, and adolescents and adults (14 y and older) need 2.0 L/d [107]. In parallel, the present investigation revealed that the pupils following the vegan diet were significantly more likely to achieve an adequate intake of daily fluids (>2.0 L). However, the quality of the fluid consumed is also related to the overall hydration status, with still water being the best option for promoting health [106,107], which all diet types were consistently found to consume as the primary fluid. In addition, tea (especially green tea) is considered to be the second-best option for promoting health, considering the antioxidant status of tea as well as the low range of toxicity [108]. In addition, soft-drinks and energy drinks may be the least healthy nonalcoholic fluids that are regularly consumed due to the high prevalence of simple sugars as well as added ingredients such as excess caffeine, an addictive psycho-active chemical [109,110].

Population and cohort studies have shown increased health awareness among vegan/vegetarian adults and a healthier lifestyle compared to omnivores due to the avoidance of health-threatening/harmful practices and time for rest and relaxation, with vegans, in particular, drinking alcohol less frequently, being nonsmokers more often, and being significantly more physically active [16]. Concerning the consumption of especially harmful substances, the present investigation revealed that significantly more vegan secondary pupils (2 in 3) never drink alcohol compared to their nonvegan peers (Figure 5), whereas the pupils following the vegetarian diet were the most likely to partake in the consumption of alcohol, which is contrary to previous findings [30]. However, from the age of 16 y, beer and wine consumption is legal in Austria [111], and whereas younger school pupils may not necessarily adhere to laws concerning the legal drinking age of alcohol, having legal access may promote its consumption [112]. In connection, the pupils following the vegetarian diet were significantly older (15.9 ± 2 y) than their peers. On the contrary, the prevalence of a smoking habit was similar across the dietary subgroups (∼10%), which seems to indicate that smoking is not associated with diet type in secondary school pupils. Likewise, the age difference between groups is negligible, considering that almost all pupils were under the age of 18 y, the legal smoking age in Austria [113]. Nowadays, however, the image of a vegan or vegetarian diet is associated with terms such as “trendy” and “lifestyle.” The conscious renunciation of meat is considered “hip,” and veganism, in particular, has established itself as a status symbol for a sustainable diet and lifestyle and is particularly relevant in the peer groups of younger generations, which is manifested by an ever wider acceptance and growing presence in the social mainstream [[10], [11], [12],14,114]. Although in the United Kingdom, 44% of young people ≤24 y describe the vegan/vegetarian lifestyle as cooler than smoking [10], it cannot be confirmed at the present time for Austrian youth, who rated smoking similarly cool as the vegan diet/lifestyle.

However, except for smoking habits, Austrian vegetarians, and especially vegan, pupils’ basic health behavior revealed by the present study nicely matches vegan/vegetarian adults’ better state of health and health-related behavior as compared to omnivores [16]. In particular, due to the interwoven nature of lifestyle factors, the healthier the diet type is considered [24,93,103], the more favorable it associates with other modifiable behaviors such as PA, sports and exercise, or alcohol [115]. Following the prevention first strategy of the European Union [116,117], the interconnected lifestyle areas linked to holistic and sustainable health behavior are most momentous to the individual, including smoking and alcohol consumption, PA levels, and nutrition [115,118]. The present findings support the dual healthy eating and active living (HEAL) approach to sustainable and lifelong health as the minimum recommendation to start health-related behavior changes to gather additional and cumulative health effects [40,95,96].

Children are considered the future of nations and, thus, are considered a nation’s greatest wealth [119,120]. Currently, children and adolescents amount for 1 in 5 of the Austrian population (1,7 million; 19.3%) [121]. Schools are most promising considering public health measures and interventions, especially due to the fact that by Austrian state mandate, health promotion, and education constitute an overarching teaching principle and are thus relevant with immediate implementation to all compulsory school subjects [[122], [123], [124], [125], [126]]. At the same time, however, health policies considering health literacy and health promotion without including schools are doomed to fail, which has been the case over the past decades [119,120,127,128]. The Austrian school curriculum (primary to secondary level II) serves as the most powerful (child) public health tool since it holds huge but largely neglected or even untapped potential to shape the better public health of future generations [40,96]. Given that the compulsory school subject of physical education is currently in the lead for school health promotion by the Austrian curriculum [40], the Austrian Federal Ministry of Science, Education, and Research, together with the authors, is already considering making physical education the starting point for school health promotion with the dual HEAL approach as the minimum [41]. Further considerations must be made in this regard to meet the future challenges of health promotion and prevention of chronic NCDs, especially to cope with the increase of vegans/vegetarians for public catering of educational settings (buffets, canteens, refectories, and vending machines) with plant-predominant options (vegan and vegetarian meals/menus) in following the role models of Portugal (mandatory by law, government resolution: 3 March, 2017) or New York City schools (legislative bill to offer default plant-predominant meals) [129,130]. The field of tension of vegan/vegetarian meals/menus in schools is also subject to Austrian legislation and the judiciary; however, the curricula-driven overarching mandate for school health promotion is to create a health-promoting environment for all [96,122,125,131]. Likewise, in the educational context, catering (buffet, canteen, and refectory), individual preferences and dislikes must be reflected in the food offerings due to the social and psychological significance of the food [132]. Therefore, now after its update in 2024, the Austrian nutritional recommendations also include both a vegetarian version of the food plate [133,134] and the nutrition pyramid [135,136], but generally emphasizing plant foods as basic and important food groups (3 of 4 portions: 50% fruits and vegetables, 25% whole grain and potatoes) and less animal-sourced foods.

The following limitations should be considered with the findings of the present investigation. The study, From Science 2 School, was based on a cross-sectional design including a questionnaire (self-reports). Hence, misreporting may have taken place due to ideal social expectations [137]. To mitigate the effect of misreporting, control questions were included across the different survey sections in order to identify and exclude false reports. A major strength of the present investigation was the large sample collected, considering 8799 Austrian secondary school pupils (1.1% of the total population). However, the present investigation included unbalanced groups for age (omnivorous and vegan subgroups were younger) and sex (more girls across all dietary subgroups but more marked in the vegetarian and vegan subgroups). Likewise, compared to the omnivorous subgroup (n = 8164), vegetarian (n = 493) and vegan (n = 142) subgroups were considerably smaller samples; however, the power analysis available in the study protocol (https://www.science2.school/en/#Publications) revealed that a total sample of 1968 participants would allow for statistically representative and reliable results between diet type comparisons with other variables (e.g., sex, age, motivations, etc.). However, from the last author’s (KCW: principal investigator) accumulated experience with >2 decades in conducting studies on the specific aspects of vegan and vegetarian diets in different populations (performance, leisure-time, and school and university sports), even nowadays, it is still difficult to gather a sufficient sample size for vegetarian, and especially vegan, participants. Additionally, this result was partly due to another strength of the present study, following the strict criteria for diet type to refine the dietary samples through shifting flexitarian or semi-vegetarians (n = 262; 11 from vegan; 251 from vegetarian)–socio-culturally shaped to eat meat but with the desire to follow vegetarian or vegan nutrition. Thus, the present research adds a marked contribution to the limited body of evidence on dietary subsamples in children [54]. Voluntary questionnaire participation was related to health topics, which may have promoted the participation dynamic of boys and girls with greater health interest as compared to those less interested in health. To manage this effect, questionnaires were primarily shared with teachers and whole classrooms for participation. In addition, PA components did not consider the intensity level of the activity nor the total weekly duration, which is important to further assess the relationship between PA and health. Although the present results of the study may be most applicable to the Austrian population, other countries with similar cultures may benefit from the findings, such as Germany and Switzerland. Lastly, to the best of the authors’ knowledge, the present investigation is the first study to analyze basic health behavior considering refined diet type (omnivorous, vegetarian, and vegan) differences among secondary school pupils based on a large sample collected, which may contribute to improving the state of health and well-being in nations like Austria.

In conclusion, the study, From Science 2 School, was created to elaborate on health and behavioral factors among pupils of the Austrian secondary school level for the first time, with a particular focus on vegan, vegetarian, and omnivorous diets. To conclude, this investigation revealed that health ranks as the number 1 motive for dietary choice, and sports engagement plus lifestyle is the top reason for lifestyle preference. It was further revealed that, although the omnivorous diet remains the dominant diet choice, pupils following a vegan diet were the most active during leisure time and the most consistently active across the week; the healthier the diet of children/adolescents, the more physically active. The study findings support the notion that plant-predominant diets are associated with healthier activity levels, which could be a key aspect when addressing the rising global obesity epidemic. The present findings offer deeper insight into the relationship between diet type and basic health behavior, which may contribute to improving the basic connection of HEAL and the related areas of lifestyle medicine (quality sleep, stress management, avoidance of substances, and better relationships) in secondary school settings in Austria based on curricular state mandate of (school) health promotion. This study may be especially relevant for school communities (superintendents, principals, teachers, additional school staff, parents, and pupils) for improving the quality and quantity of vegan food options (whole foods and meals/snacks provided daily) in the school setting, which may also contribute to improving leisure-time PA levels and the BMI of children and adolescents.

Author contributions

The authors’ responsibilities were as follows – KCW, DRT, CD: completed the conceptualization; DRT, KCW: drafted the manuscript; CD: provided statistical methodology along with KCW; CD: appraised the data and performed the formal analysis; GW: provided technical assistance; KCW provided supervision; GR, WK, MS: provided critical review; and all authors: read and approved the final manuscript.

Funding

This Austria nationwide school study From Science 2 School was funded by the TWF (Tiroler Wissenschaftsförderung; reference number: UNI-0404/2413). The TWF was not involved in study design, conduction, data collection, data analysis, presentation, or publication of the findings.

Data availability statement

The data are not publicly available due to data protection and security laws.

Conflict of interest

The authors report no conflicts of interest.

Appendix A. Supplementary data

The following is the Supplementary data to this article: